Dr. G: Medical Examiner - Season 4, Episode 1 - Deadly Doses - Full Episode | Forensic Files

[SOMBER MUSIC] NARRATOR: A devoted sister dies young after suffering bizarre symptoms.
She developed severe itching. NARRATOR: And Doctor G's odds of solving the case prove astronomically slim.
It's probably one in a million. NARRATOR: Then a mother's death shatters her family.
I miss everything about her. NARRATOR: But in autopsy, Dr. G uncovers answers her family
may not want to hear. She's got some chronic pain. And she also has depression. I have to worry whether it's a suicide.
NARRATOR: Altered lives, baffling medical mysteries, shocking revelations. These are the everyday cases of Dr. G, medical examiner.
You want to pick the pillow you're going to bring? My older son Alex is going to college.
That's OK? All right. Did you see the dorm rooms when you were there? Yeah. Do they have more closet space or drawer space?
What else? I think the hardest is when Eric and I are together, my younger son, and we're going to sit around and miss Alex.
It's going to be touch. All right, say bye to your sugar gliders. Alex has had these since second grade.
ALEX: Since seventh grade. JAN GARAVAGLIA: He's given me nothing but happiness. He's a great kid.
Thank you. (SOBBING) I'm going to miss you. You too. I think [INAUDIBLE]. All right.
Now I gotta go somewhere where I never cry. So in this case, we have a 36-year-old black female
that's kind of an interesting story on how she got to us. NARRATOR: According to the investigator's report,
it all began the previous morning in the home of Leah Conrad. Leah lived with her younger brother Shane.
Saving every penny from her job at a local toy store, she was putting him through night school.
Typically, Leah's at work by the time Shane gets up. But on this morning, he's surprised to find her
on the couch. Leah? NARRATOR: She's barely awake and incoherent. JAN GARAVAGLIA: She's getting slurred speech.
Her lips kind of turned blue. The brother even thought maybe she was having some seizure activity.
Huh? NARRATOR: Then Shane notices an empty box and a half-empty bottle of over-the-counter drugs.
JAN GARAVAGLIA: He gets her into the car. They beeline it to the emergency room.
[TIRES SCREECHING] But by the time they arrive, Leah seems to be doing a lot better.
She was walking, talking. Normal level of consciousness. NARRATOR: She tells the ER doctors
she woke up that morning feeling flushed, nauseous, and itchy all over. Figuring it was an allergic reaction,
she took some diphenhydramine, an over-the-counter antihistamine. But the itch persisted, so she took more and more.
You know that old adage. If one doesn't do it, let's try 10 more. Well, that's not good with medicine.
NARRATOR: Concerned and a bit puzzled, the ER doctors insist on running a few tests.
No, they obviously took her seriously with the diphenhydramine. You never know exactly how much she took.
They're kind of working her up on, maybe it's an overdose, trying to figure out what's wrong with her.
NARRATOR: As they wait in the ER for the results, Leah appears to be rapidly improving.
She looked like she was doing great. NARRATOR: Until suddenly, she falls unconscious.
The next thing they know, she starts to seize. She goes into cardiac arrest. Can I get some help here please?
NARRATOR: The ER staff scrambles to revive her. I need a defrib! NARRATOR: But tragically, they can't.
JAN GARAVAGLIA: And she dies. And they have no clue what's wrong with her. NARRATOR: Leah's brother can't believe she's gone.
And he desperately needs someone to explain what happened to his big sister. That someone is Dr. G. But like the hospital staff,
she faces a perplexing set of circumstances. There's a lot of considerations in this case.
Certainly, the one thing I'm worried about is, could she have died from the diphenhydramine overdose?
NARRATOR: In addition to its antihistamine properties, diphenhydramine is a strong sedative that can cause
drowsiness even in small doses. With the large amount Leah said she took, the drug could have depressed her vital functions
to a dangerous level, low enough to stop her breathing. Just a frank overdose where you actually cause
respiratory depression and die. So we'll have to see how that plays a role in her death.
NARRATOR: But then Dr. G finds something even more disturbing and Leah's medical history.
Oh, boy. She had systemic lupus erythematosus, commonly known as lupus. Systemic lupus is one of the autoimmune diseases.
That means basically your body is making antibodies against yourself. So somehow, your body almost-- just as
if you were going to react to a foreign substance in your body, your body starts reacting to your own body.
NARRATOR: The illness can affect almost any organ at any time. Each lupus patient has their own flavor of disease.
100 patients with lupus have 100 different disease manifestations. NARRATOR: Many symptoms are benign
and occur during active periods known as flare-ups. It is a common unknown entity of that disease that you have
flare-ups and then kind of remissions and then flare-ups again. Sometimes, people flare up during the normal course
of their menstrual cycle, just with the hormonal fluctuation. NARRATOR: But patients can also develop
serious complications, like hypertension and heart disease. Certainly, there is a myriad of things
that you can die from with lupus. NARRATOR: Dr. G also notes that, between the occasional visits
to her specialist, Leah was taking prescription drugs for her lupus. Ironically, that treatment may have posed
another threat to her life. And she's, lo and behold, on some very potent medicine.
That can have some side effects. NARRATOR: In particular, one of her drugs prednisone, an immunosuppressant,
has been known to cause stomach ulcers. An undiagnosed ulcer may have eroded the lining in her stomach, erupting in
a fatal gastrointestinal bleed. That's a possibility, something maybe they didn't recognize right
away in the emergency room. It's something I certainly want to look for. NARRATOR: But Dr. G doesn't know how
any of these possible causes of death could fit with Leah's bizarre set of symptoms.
It seems pretty sketchy. We've got the overdose. We've got the drug she's on. NARRATOR: And then there's the itching.
You always worry when you have this really weird symptomatology that maybe you're
not going to get an answer. All right, let's see. All right. NARRATOR: The first task at hand is for Dr. G
to see how severe Leah's lupus was. She begins by checking for the most classic visible signs.
The butterfly rash and the malar rash right on the cheeks. We look for a kind of a discoid rash, patches of red
with a scaly kind of surface on it. NARRATOR: But surprisingly, Leah has none of these skin conditions.
She actually looked pretty good, except for, you know, the resuscitation. NARRATOR: Dr. G then looks closer,
searching through other external marks of lupus-- swollen joints, ulcers in the nose and mouth, even hair loss.
She finds none. She has a nice, thick head of hair. NARRATOR: The negative findings suggest
Leah's lupus was very mild, or at least under complete control. I don't even have any indication she has lupus,
except for the fact we have it in our history, and it appears she's on meds that are consistent with lupus.
With modern medicine, most people live for a very long time with lupus. Maybe her lupus has nothing to do with her death.
NARRATOR: But if complications from lupus didn't kill this 36-year-old woman in the prime of her life,
what did? I have to chart, you know. Yeah, go ahead. But after you do that, I'll do the ribs.
OK. NARRATOR: In the final stroke of the Y incision, Dr. G cuts into Leah Conrad's abdomen
on a hunt for her cause of death. One possibility is that Leah's lupus medication
caused severe ulcers, killing her with a gastrointestinal bleed. If so, the GI tract would be filled with hemorrhage.
Carefully, she reflects the skin and subcutaneous fat. And with one look, it's clear.
Leah had no fatal blood loss whatsoever. So I'm pretty much ruling out a gastrointestinal hemorrhage.
NARRATOR: No signs of lupus and no signs the medication for it caused her demise.
Dr. G must now consider the other drug in Leah's history, the diphenhydramine she
took to ease her itchy skin. It might be an overdose. [INAUDIBLE] first. NARRATOR: With the help of her morgue technician,
Dr. G removes Leah's major organs and isolates the stomach. Because I wonder, you know, maybe she's
got a lot of pills in the stomach and it's going to be a slam dunk. NARRATOR: But when she cuts open the organ, all she finds
is the natural lining of mucus. Nothing really to write home about. NARRATOR: Unfortunately, whatever
Leah ingested before her death has already been absorbed. And Dr. G will only be able to find out exactly how
much different diphenhydramine was in her system through toxicology tests. For now, it's time to shift gears.
JAN GARAVAGLIA: OK, let's see. If you have-- you know, I'm going to take a lot of tissue, Arden.
NARRATOR: Perhaps a natural disease could explain Leah's symptoms, if not her death.
But with every organ she examines, Leah appears as healthy internally as she did externally.
JAN GARAVAGLIA: All the organs look pretty good. Her liver doesn't show signs of liver failure.
Her gallbladder looks fine. I don't see anything that'll give me a hint so far. Yeah, that's it.
NARRATOR: In the meantime, Leah's brother is waiting for answers as to how his seemingly
healthy 36-year-old sister could die so suddenly. But Dr. G is no closer to identifying her cause of death.
She now has only one internal organ left to dissect, the heart. And it doesn't look promising.
She's never complained of heart disease. She doesn't drink. She doesn't smoke. She leads a clean, healthy life.
So I'm not thinking that it's probably her heart. NARRATOR: First, she examines its exterior.
I look at the epicardial surface, the surface of the heart. That looks normal. NARRATOR: Yet there's something slightly odd.
It's somewhat rounded and dilated. NARRATOR: She cuts in for a better look. I start with the left main coronary artery and just
dissect it out every few millimeters and do a cross-section of that coronary artery.
NARRATOR: And there, in these cross-sections, Dr. G discovers that Leah's heart is riddled with disease.
She has 80% narrowing of her left main coronary artery. She has 95% narrowing of her left anterior descending
coronary artery, the coronary artery that supplies the front of the heart. NARRATOR: In fact, her vessels have been completely overrun
by arteries atherosclerotic plaque, layers of cholesterol, and other waxy materials that obscure blood flow
and often trigger a heart attack. [AMBULENCE SIREN] The condition afflicts more than 4.6
million Americans every year and kills one patient every hour. Most are older than 65.
But Dr. G believes there's a good reason why Leah had such severe atherosclerosis
at almost half that age. People with lupus have an earlier onset of corneal artery disease.
So it looks like maybe she's got just a run of the mill heart attack. NARRATOR: At last, it seems Dr. G has
found Leah's cause of death. But then she detects something very strange. Oh, boy.
NARRATOR: Something else that could have killed Leah. This is separate from the atherosclerosis.
NARRATOR: It's on the lining of the arch of the aorta, where the body's biggest blood vessels diverge.
She's got a thrombus attached to the aorta, tightly attached to the wall, 3/4 of an inch in length
and about a half an inch in width. It comes out maybe about a fourth of an inch.
NARRATOR: Thrombi, or blood clots, most often form in the body's smaller blood vessels
for reasons ranging from trauma to genetics. But Leah's thrombus grew in her aorta, a large central vessel.
This is highly unusual. And it could have been deadly if pieces of it traveled to her brain and cut off the flow of blood.
She's had two episodes where people say she had some mental status changes and maybe seizing.
MAN: Can I get some help here? I mean, it is a possibility she's throwing these little clots that break off and go to the brain.
NARRATOR: A minute ago, Dr. G had no possible cause of death. Now, she has one too many.
It is always worrisome when I do an autopsy and I don't find anything. It's also worrisome that I'm not putting
it together when I have several things that could kill her. Sometimes, actually, I wish I could save something
I found on one person and, you know, give it to somebody that I can't figure out.
Because you know, if somebody already has three reasons to die, they don't really need all three.
This guy needs one. But unfortunately, I can't do this. And I have to kind of figure out what really went on.
NARRATOR: Unfortunately, none of the theories would explain Leah's strangest symptom.
We've got her pure pruritis or diffused itching. NARRATOR: Still, Dr. G must explore every option.
Determined to unlock this mystery, she extracts Leah's brain for inspection. The search will be difficult.
The problem is, it's going to be a needle in a haystack for me to find one of those little thrombi that
flicked off. NARRATOR: Ultimately, Dr. G finishes the internal exam with a wealth of evidence and nothing that ties it together.
I don't have the smoking gun yet that tells me why she died. NARRATOR: To untangle this perplexing death,
Dr. G must now rely on the two forensic tools left in her arsenal-- toxicology and the microscope.
JAN GARAVAGLIA: I'm still worried about the diphenhydramine overdose. So I'll be interested to see what her level is.
NARRATOR: Somewhere in Leah's blood and tissue is the key to closure for her grieving
brother, if Dr. G can find it. And I was going to say-- I was going to say-- you remember that--
There's no peanuts! No! My lunch staple! All right, I'm going to run across the street.
Yeah. NARRATOR: A quick bite and it's time to buckle down with Leah's tissue slides and toxicology report.
Immediately, she checks the report to see if Leah had overdosed on the diphenhydramine
she took too ease her itch. The numbers tell a disturbing tale. Her diphenhydramine level was very high,
past even the level that we see where you would take it for a hypnotic to go to sleep.
NARRATOR: But surprisingly, the dosage is still far from deadly. You don't really start getting lethal
until you start seeing seven or eight milligrams per liter. Hers was closer to maybe a one or two milligrams per liter.
She clearly doesn't have enough that would kill her. NARRATOR: But the high levels do explain the state
her brother found her in-- lethargic and slurring her speech. And she really didn't have anything else
of significance in her blood. So I think we've ruled out an overdose on this case.
NARRATOR: This leaves her with one more shot at deciphering Leah's sudden death.
I really, at this point, can't wait until I look at this under the microscope. What is going on with this woman that
would really explain and unify all of her symptoms and my findings? NARRATOR: Dr. G slides the first tissue sample under the lens.
Now, the thing that I was most fascinated with was, why is there a thrombus on her aorta?
And so that's where I'm going to. NARRATOR: At 400 times magnification, she can discern the cell structure of the vessel wall.
Slowly, she turns the dial. And what comes into focus takes her completely aback.
She's got inflammation-- like white cells and breakdown products of the white cells--
all through the aorta. NARRATOR: The invasion has visibly damaged the vessel's delicate tissue.
And the body is reacting to that and putting a clot over it. NARRATOR: This is a sign of vasculitis, a condition
in which white blood cells attack and inflame blood vessels all over the body. The affliction is a rare complication of lupus.
Externally, Dr. G had found no symptoms of lupus. But clearly, Leah's immune system had gone haywire,
and her medication was not enough to stop it. What's happened is, this immune complex--
the antigen and that antibody which have formed together-- go into the vessel wall.
And that causes your body to react to it and causes the white cells to get there.
NARRATOR: Dr. G realizes vasculitis perfectly ties together Leah's symptoms. In the small blood vessels of her skin,
the inflammation gave her a vicious itch. And in the large vessels of her heart,
the condition actually led to her death. Her coronary arteries, when you look at them,
are completely inflamed. The blood wasn't getting through those vessels enough. And she ultimately has a heart attack.
She already had severe atherosclerosis. And this was just the coup de grace. NARRATOR: The extent to which vasculitis assaulted
Leah's body stuns Dr. G. Now, it just so happens, in lupus, it tends to occur in the smaller blood vessels.
You don't usually see it in the large blood vessels. Coronary vasculitis in a lupus patient
would be extremely rare-- certainly less than 5% of patients, and maybe even less than that.
NARRATOR: And Leah's vasculitis is not just in the coronary arteries. It's in the aorta, the biggest blood vessel in her body.
In the annals of forensic pathology, Dr. G has made an almost unheard of finding.
Very, very, very rare. It is vanishingly rare. There's really only just a handful of cases truly that
are reported that lupus affects your aorta that way. NARRATOR: But for her, it's more than
an incredibly rare discovery. You know, and this is probably one in a million for me to see in the morgue.
I'm probably never going to see that again. But it's just really-- that's just a really cool part of the job,
is to put the pieces together and say, boy, I can really explain what was going on with her.
NARRATOR: It's 7:00 AM on a Monday morning, and Leah Conrad wakes up to a fierce, unfamiliar itch.
Believing it's an allergy, she tries to fight it with diphenhydramine. 10 times more than what you should normally take.
NARRATOR: The drug impairs her motor functions. She got some lethargy, some slurred speech.
NARRATOR: Fearing an overdose, her brother rushes her to the hospital. But unbeknownst to him, or the doctors, or even Leah herself,
the real threat to her life is neither allergies nor antihistamines. I think what happened is, about three to four days prior
to her hospitalization, she was starting to get a horrible flare-up of her lupus, manifesting itself
in just diffused vasculitis. NARRATOR: In her skin, white blood cells ravaged the vessel walls, causing an unbearable itch.
And then they make an extraordinary move into Leah's aorta. She was getting more and more inflammation of her aorta.
The intima, or the lining, got irritated. The blood tries to repair that by forming a clot on it.
NARRATOR: But the vasculitis also strikes in her coronary arteries, which were already
narrowed by atherosclerosis. Now severely inflamed, the vessels can no longer carry blood to the heart.
Even as the diphenhydramine wears off, the damage reaches a catastrophic peak. And finally, Leah suffers a heart attack.
MAN: Can I get some help in here please? Do it again. Do it again. Do it again. NARRATOR: No amount of medical intervention can save her.
Ultimately, you can boil this whole thing down as complications of systemic lupus erythematosus.
Life is random. Lupus is part genetic. It's part environmental. Nobody really knows what combination
of those environment and genetics causes you to get lupus. It's quite unlucky to to have to deal with a disease like that.
And then she has, you know, added unluckiness of a rare complication from it. NARRATOR: Shane is relieved to finally have an answer.
But he's also overwhelmed by the truth behind his sister's bizarre death. He only wishes now that she had seen her doctor more often.
You know, a regular doctor might have picked up that this was a flare-up of her Lupus.
Maybe this wouldn't have happened. OK, that one's done. NARRATOR: Sadly, sometimes no amount of medical care
nor all the love in the world can save a person's life. Such is the tragic case of Deborah Grunow a beloved mother
whose fight against chronic pain may have driven her to her death. She's been expressing that she'd
like to die for a long time. I'm sure that's very difficult to live with. It's been a long week since my son Alex left for college.
I told you today about Alex calling me last night, right? WOMAN: Yeah. He is, like, so excited about school.
He's so excited about classes starting and just, you know, having fun and doing what he wants and, you know, the usual 18-year-old.
I miss him. But you know, I can't complain. Because in the morgue, I see plenty of people whose families
will miss them forever. Tom, could you hand me a chart please, and an internal? We have a 50-year-old white female
that was found unresponsive in a residence by her husband. NARRATOR: As she begins to read through the investigator's
report, Dr. G is immediately drawn to a devastating automobile accident, one that
occurred 30 years earlier and changed Deborah Grunow's life forever. She went off a cliff, and went into the windshield,
and hit the windshield with her head, and caused the initial injury. And then that just escalated over time
into degenerative disk disease. NARRATOR: Deborah was lucky to survive. But her life would soon become consumed with a string
of surgeries and treatments all in a seemingly futile attempt to ease her suffering.
But incredibly, in light of her constant battle with pain, her sense of humor and free spirit
made Deborah the heart and soul of her close-knit family. MARK GRUNOW: Very enthusiastic about life.
She had a great sense of humor. She was always cracking jokes. And we always found something to laugh about.
In the name of love. NARRATOR: But no one could have imagined that yesterday evening would be the last time anyone
heard Deborah's laugh again. It all begins at around 4:00 AM in the Grunow house.
Deborah is having difficulty sleeping and decides to take a shower. Her husband, briefly awakened by the noise,
drifts back to sleep in the bedroom down the hall. And he hears the shower water go off.
That's the last he remembers. NARRATOR: A few hours later, he wakes up. From outside the room, he hears a strange wheezing noise.
I just remember thinking that it was the dog snoring. Then I got up and opened the door.
NARRATOR: But it isn't the dog. Honey? She was on the floor there, just face down.
I lifted her head up to wake her up. And I could tell by the look on her face that it was-- it was big trouble.
NARRATOR: His wife of almost 25 years is barely breathing. Frantic, Mark calls 911, then immediately begins performing
CPR until paramedics arrive. They rush to the local hospital. How long has she been like this, sir?
They try to resuscitate her for a good bit of time. NARRATOR: But Deborah remains unresponsive.
EMT: I need you to step back. We're going to have to shock her again. They couldn't save her.
NARRATOR: Her daughters don't even get a chance to say goodbye. When I got to the hospital, they took us into the room.
And they told us that she was gone. They pulled the sheet down, and I looked at her
and pretty much just lost it then. But-- [LAUGHTER] MARK GRUNOW: Ew. - Don't spit. - No?
OK. MEGAN GRUNOW: I miss Everything about her-- the way she smelled, the way that she would
just make everything better. DESIREE GRUNOW: I talked to my mom everyday. That's probably one of the hardest,
that I can't just pick up the phone and call. [SNIFFS] NARRATOR: But the family's loss is
made even worse by the mysterious circumstances surrounding Deborah's death. What could have cut down their beloved mother and wife
so suddenly? Now, Dr. G is the only one who can try to provide some sense of closure.
But it won't be easy. As she studies Deborah's medical history, she does notice one clear red flag.
She has a history of high blood pressure. She doesn't necessarily take her high blood pressure medicine.
So her blood pressure is not well controlled. NARRATOR: Deborah's hypertension, or high blood pressure, had almost
killed her more than once. Her blood pressure would be so high. And there would be 100 people in the waiting room.
And they would usher her right in, because it was so dangerously high. NARRATOR: It is estimated that blood
pressure-related conditions, such as strokes and heart attacks, kill approximately 300,000 people each year
in the US. Perhaps Deborah was one of them. She may have had a stroke. But high blood pressure is also a risk factor for developing
coronary artery disease. NARRATOR: But there's another red flag-- Deborah's history of degenerative disk disease.
This disease can develop after a severe accident, resulting in damage to the disks of the neck and spine.
JAN GARAVAGLIA: They can get a lot of pain in the neck. Most people, it's mild to moderate.
And with some people, it can be quite severe. NARRATOR: This condition had plagued Deborah since her car
accident 30 years ago. DESIREE GRUNOW: She tried massages. She tried acupuncture, meditation, yoga.
NARRATOR: But nothing seemed to work. Eventually, Deborah turned to medication for relief.
But over many years, the dosage she required to feel normal continued to increase.
Dr. G knows that any time a decedent is on prescription painkillers, there is a possibility
of an accidental overdose. But that's not the only scenario the pills present. Chronic pain and depression can go hand-in-hand.
She just didn't want to hurt anymore, and she didn't want to hurt us anymore. For Dr. G and Deborah's family,
her depression presents another fatal scenario, one that her family can't bear to face--
suicide. She talked about taking her life, because she just couldn't take the pain anymore.
NARRATOR: Is it possible that this mother of two took her own life, leaving her pain and her family behind?
The first thing Dr. G notices in the external exam is three suspicious marks on Deborah's face.
A small abrasion on her chin and on her upper forehand and one in her hairline. NARRATOR: This in and of itself doesn't raise alarm bells.
But soon, she begins to uncover dozens of small injuries all over Deborah's body.
She's got a lot of multiple bruises on her body of various ages. NARRATOR: The discovery raises an entirely new possibility.
Did Deborah simply die from some fatal injury? I think it's just that left hand, isn't it?
NARRATOR: Dr. G catalogs 13 scrapes and contusions as she continues the external exam on Deborah Grunow's body.
She certainly has a lot of bruises on her. NARRATOR: Deborah, a 50-year-old mother of two,
died suddenly yesterday. Based on her history of taking large doses of medication
for neck pain, Dr. G now speculates as to how she may have gotten all those bruises.
Probably consistent with her falling, as if she had been staggering for a while.
NARRATOR: If the pain medication had begun to impair Deborah's motor functions, she may have fallen and suffered
a fatal internal injury. Maybe she fell and hit her head. And then she gets a subdural, or she gets bleeding.
NARRATOR: Every year, nearly 2 million Americans trip or fall in their homes and land in the ER.
Thousands die from their injury. [AMBULANCE SIREN] I've had somebody fall where they get bleeding
into the lungs from a punctured lung or a torn vessel from the fracture. And we get some kind of delayed deaths from the fall.
NARRATOR: Now, Dr. G turns to the most likely place to find signs of trauma-- the head.
If she can prove Deborah died from an injury and not suicide, her findings could provide tremendous relief.
Keep your fingers crossed. We've got the head. NARRATOR: First, Dr. G pulls back the scalp,
then carefully takes off the calvaria, or the roof of the skull. I'm looking for anything unusual in her brain.
NARRATOR: So far, the organ looks normal. Carefully, she extracts it for a closer look.
I slice it. And I don't see any evidence of hemorrhage, any trauma. NARRATOR: She also checks for infarcts, or dead tissue, that
may indicate that Deborah's hypertension had triggered a deadly stroke. But she finds none.
There's nothing that would suggest that her brain was the cause of her problems.
NARRATOR: Deborah's brain may be clear of trauma and illness. But in the fatal injury scenario,
several of the internal organs could still be likely suspects. Dr. G makes her usual Y incision and reflects the skin.
Poor thing. NARRATOR: Then she starts searching for injuries and internal bleeding.
I'm looking underneath for hemorrhage. I'm certainly looking at the ribs to see if there are any rib fractures.
NARRATOR: But she soon realizes it's a dead end. She's got a few little things, but nothing
that should have killed her. NARRATOR: Deborah's bruises, likely caused by repeated falls while under the influence
of her medication, were only superficial, not fatal. But the medication may have had another possibly fatal effect--
an overdose. It's a sad state of affairs. She is constantly taking too much medication,
all because of chronic pain. There would be times I would come home and find her curled
up in the fetal position on the floor, just crying like a baby, just because of the pain.
NARRATOR: Did Deborah drug herself to death in a suicide? Dr. G begins her search for evidence.
Often an overdose, whether intentional or accidental, leaves the decedent with very heavy, wet lungs.
Whatever the reason, the lungs often will fill up with fluid. NARRATOR: But Deborah's lungs are not congested.
You know, as soon as you just don't see those tremendously heavy lungs, you kind of think, eh, maybe it isn't an overdose.
NARRATOR: Still, there is one other organ that could clearly point towards an overdose and to suicide--
the stomach and its contents. The stomach, on a case like this, may be important.
Because a lot of the stuff in her stomach is pills. That usually indicates it might be a suicide.
People who want to kill themselves will take a lot of pills at once-- 20, 30 pills at once.
And some of those may still be in the stomach. NARRATOR: To examine the contents, Dr. G
first ties off both ends of the organ at the esophagus and the duodenum. Then she cuts it open and empties it out
into a container. I went up the gastric and scooped out what was left there. I took the duodenum, , what's in the duodenum scooped it out,
put that in there. I can do it through a strainer. I can sometimes just pour it over my gloved hands
and catch some of the solid pieces. Or you can just swirl it around and look at it and smell it.
NARRATOR: It's a moment in the autopsy that puts aspiring medical examiners to the test.
This would keep a lot of people out of this profession. So stomach contents is a source in the autopsy where
some people will walk away. It can have some type of melodious odor. But it is an important part of the autopsy.
So if you can't look at stomach contents, don't go into forensics. NARRATOR: She painstakingly thumbs
through several indecipherable remnants of food before finding her first clue. I see two-- a fragment of maybe two pills.
NARRATOR: Her finding confirms that Deborah had ingested medication shortly before dying.
But it's not nearly enough to have killed her on its own. If I'd have found 20, it would have been a smoking gun.
But I'm finding fragments of two. Eh, that'll help you get the tox. NARRATOR: Any evidence of an overdose
will need to come from a toxicology screening. Dr. G has her assistant, Arden Monroe,
package fluid samples from Deborah's arteries, bladder, and eye. But test results won't be in for several weeks.
Until then, there's nothing more Dr. G can do to determine whether Deborah died from an overdose.
But she can look for evidence of the other suspected culprit, high blood pressure.
She has been diagnosed with high blood pressure. And she's not taking their high blood
pressure medication regularly. NARRATOR: Dr. G knows Deborah's hypertension didn't kill her with a stroke.
But it's possible that it thickened her heart and led to a fatal arrhythmia. So it's Deborah's heart that she examines next.
OK, let's see. NARRATOR: Yet, after careful scrutiny, Dr. G is surprised by the organ's condition.
I didn't see any evidence of heart disease. She didn't have any evidence that it was failing.
Now I've pretty much ruled out that her heart is a contributing factor. It looked fine.
We've looked at the organs, the chest, the abdomen. I don't see anything really wrong.
NARRATOR: No trauma. No signs of an overdose. No indications that their high blood pressure
caused a stroke or heart attack. After a full autopsy, Deborah Grunow's death has become
more of a mystery than ever. At a laboratory in Melbourne, Florida, the blood and urine of Deborah Grunow spins in a centrifuge.
It's the first of many steps in identifying what substances were in her fluids when she died.
For Dr. G, these toxicological tests are the last hope of determining what killed
this 50-year-old mother of two. I miss everything about my mom. MARK GRUNOW: It was sudden and unexpected.
And it was very painful. NARRATOR: But while the family is desperate to know what
happened, there's one answer they don't want to hear-- suicide. I was very concerned that she may have taken her life.
I really was afraid of that. NARRATOR: Will the truth bring Deborah's loved ones relief or more heartbreak?
Ultimately, I get the scientific facts. Certainly, my call will give them either peace or sometimes
anguish. It always is a tough time for the family, and I know that. NARRATOR: Dr. G Finally sits down with the report
from the toxicology lab. And the extent of Deborah's medication regimen soon becomes very clear.
JAN GARAVAGLIA: She's on three anti-anxiety medications. She's on a lot of antidepressive medications.
NARRATOR: On top of that, she had two potent painkillers in her system, one of which
is another sedative, methadone. Her methadone level was very high. And you put that with a combination of all
these medications levels. It's clearly why she died. So we have a cause of death.
And that's mixed drug intoxication. NARRATOR: For the family, this could be the answer they feared most.
Deborah might have killed herself. But Dr. G must now weigh the evidence and make the call.
How am I going to determine whether it's suicide versus accidental? Which one is more compelling?
Which one is more compelling to me? Well, one, you look at the history. And we don't have any previous suicide attempts.
NARRATOR: Dr. G also considers the hard numbers in the tox report. All of those medications were in the therapeutic range.
And her level is all just a little bit high. And we do know that she's chronically
trying to treat her pain. NARRATOR: Taking into account all of this evidence, Dr. G comes to her conclusion.
We know that she walks the line-- that razor line between what can kill her and what
puts her out of her misery. This time, she just crossed the line a little too far.
And it really-- when you look at the combination of drugs that she's on and the levels, it looks much more
like an accidental overdose. And I think the preponderance of evidence in this case
is that it was accidental. It's very difficult to really swing the other way with suicide when we know she's taken
so many drugs for so long. And it doesn't take much more to put her over. NARRATOR: After careful analysis,
Dr. G can now replay the final hours leading up to Deborah's tragic death. It's 3:00 AM, and Deborah Grunow is too uncomfortable to sleep.
Her back and neck are aching again, so bad she can barely stand it. Hoping to get some relief, she takes several methadone pills.
But when that doesn't do the trick, she opts for still more medication. She probably pops a lot of drugs,
adding more central nervous system depressant. NARRATOR: By 4:00 AM, she's likely
in a drug-induced stupor. Then, at some point, she goes into the shower. JAN GARAVAGLIA: Maybe she had vomited on herself.
Maybe she's trying to wake up. NARRATOR: But inside Deborah's body, the mixture of central nervous system depressants
is taking effect. The drugs attached to receptors in Deborah's brain, suppressing the signals that control her vital functions.
They affect sites in your brainstem that control your restoration. NARRATOR: Her breathing and pulse start grinding to a halt,
and Deborah falls into a coma. When we hear the snoring, usually, it indicates to us
that the person's in a coma. NARRATOR: By the time her husband finds her, no amount of CPR, no amount of professional help
can bring her back to consciousness. JAN GARAVAGLIA: It's too late. She eventually stops breathing and dies.
NARRATOR: The cause of death is clearly an overdose, but, according to Dr. G, not an intentional one.
On this night, she simply pushed the limits of her many prescriptions too far. I was very relieved to know that it wasn't a suicide.
And I felt very reassured after speaking with her. DESIREE GRUNOW: She really, truly cared.
And she took the time to dig and find out what happened. NARRATOR: But despite the reassuring finding,
Deborah's death continues to fill the family with lingering grief. MEGAN GRUNOW: My mom's still gone, so I can't change that.
I have regrets that I just couldn't have been there with her right at the last minute,
and just to tell her how much I loved her, and how much I cared for, and how much she meant to me.
I learned a lot from him what it was like on his end, living with that. So you know, I believe that's a big part of forensic.
You learn a lot from the family. But you also can give them a lot of comfort. And I get comfort from my family.
I made the mistake. I bought roasted peanuts instead of raw. Here, guys. You want one?
You want a peanut? Do you like the roasted? Do you like it? Oh, he took it. The worst part of Alex missing is, Eric
and I have to clean that cage. [TRANQUIL MUSIC] ANNOUNCER: Atlas.

When Dr. G receives Lea Conrad's body, she suspects the woman may have died from an antihistamine overdose. Then, Dr. G learns that Lea was being treated for lupus.

A Florida medical examiner takes viewers through puzzling cases while explaining procedures and conclusions.

Brief Summary

Dr. G investigates Leah's mysterious death from lupus complications and Deborah's accidental overdose from chronic pain medications.

Key points

Medical Mystery Unfolds. Dr. G faces a perplexing case with bizarre symptoms and a tragic outcome. 'It’s probably one in a million.'
A Devastating Loss. A devoted sister dies young, leaving her family shattered. 'I miss everything about her.'
Uncovering the Truth. Dr. G discovers a rare case of vasculitis in Leah's aorta, linking it to her death. 'This is a sign of vasculitis.'
Deborah's Tragic Death. Deborah Grunow's sudden death raises questions about her health and the circumstances surrounding it.
The Autopsy Begins. Dr. G conducts an autopsy to uncover the truth behind Deborah's mysterious death.
The Cause of Death Revealed. Toxicology results reveal Deborah's death was due to mixed drug intoxication, raising questions of intent.

Episode highlights

Episode quotes

It’s probably one in a million.

Dr. G discusses the odds of solving the case.

0:30WatchJun 10, 2021

Tension

75/ 100High tension

More from True Crime Files

Solve the Crime

Read a real case one clue at a time, then see how your call held up against the investigators.