Dr. G: Medical Examiner - Season 4, Episode 5 - In The Dead Of The Night - Full Episode | Forensic Files

[OMINOUS MUSIC] [DRAMATIC MUSIC] NARRATOR: A man wakes in the middle of the night gasping for air.
Paramedics rushed to save, him but it's all in vain. He's dead by the time he gets there.
NARRATOR: And a series of seemingly unrelated clues reveal little about his fate.
He had a toe infection, diabetes, diarrhea. NARRATOR: Has Dr. G finally found a case she can't crack?
And I pretty much ruled out everything that it could be. NARRATOR: Then a young man in his 20s
winds up dead in a motel room after a wild night out with friends. There's a question of possible drug use.
NARRATOR: His parents are desperate for answers. But will the truth be more than they can handle?
I just didn't know what to think. I didn't understand it. NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations. These are the everyday cases of "Dr. G, Medical Examiner."
I'm one of those early bird specials. You know, I'm always here a little bit earlier, because I like to get everything situated,
so I know when the doctors come down in the morning, it runs smoothly. I usually unlock the cooler, and I wheel the bodies out,
and then I go and start my day's work. Dr. G is a good person, and she's always been kind to me,
and very patient with me, especially when I first started out, and I really didn't know
much about how to do this job. That'll be a first. You've got to laugh and joke around because at times, it
can get heavy. That's a big part of what gets you through your day here. You never know what's going to come in,
and you never know what you're going to deal with for that day. You know, I see people in the morgue for a million
different reasons. It's of all shapes and sizes, including all people. But it's unusual that I'd have to autopsy an older gentleman.
We're more apt not to do an autopsy on an elderly person because they're often expected to die.
Well, you know, we just don't live forever. So it was odd when I came in in the morning
to see an older gentleman that it looks like I'm going to have to autopsy. [OMINOUS MUSIC]
NARRATOR: Dr. G opens the file on Jerry Richards and quickly discovers why the elderly man
is here for an autopsy. But the doctor's refusing to sign a death certificate because he says he
really is not sure why he died. [SOMBER MUSIC] NARRATOR: A third-generation steel mill worker, Jerry
was a tough man with a soft spot for his wife Elaine and daughter Melissa. Upon retiring, he convinced them both to trade
Pittsburgh for Sunny Orlando. There, they'd found a more relaxing life together.
That is, until last night. [THUD] [OMINOUS MUSIC] 4:30 AM, Jerry wakes up with an unpleasant feeling.
He's short of breath. His wheezing worries Elaine, and before long, she gets Melissa out of bed.
He's not doing well. They call the doctor, and the doctor says get him to the emergency room.
They leave him sitting on the bed. They leave to go get dressed. NARRATOR: Moments later, they return,
but are shocked to discover that Jerry is no longer conscious. He's collapsed on the bed, and his eyes kind of rolled back.
NARRATOR: He's not breathing, and they can't find a pulse. Elaine ones for the phone--
She immediately calls 911. NARRATOR: --while Melissa fights to bring them back. The daughter attempts to start CPR.
EMS arrives. He's dead by the time he gets there. [PIANO MUSIC] NARRATOR: At 71 years old, Jerry was no young man.
Still, his sudden death stuns both Elaine and Melissa. They're now hoping Dr. G's findings will give
them some sense of closure. Based on Jerry's age and the circumstances, Dr. G strongly suspects he died for a tragic yet simple reason.
You know, elderly people who died suddenly, and unexpectedly, and they're walking talking one minute,
and they collapse the next, it sounds like a cardiac death. NARRATOR: Yet clearly, his doctor was unconvinced.
And the more she reads about Jerry, the more she understands why. He's got a pretty complicated history.
NARRATOR: First and foremost, Jerry had diabetes. When you have diabetes, you have a lot
of problems that can develop. One of the problems is you're more prone to get atherosclerotic plaque.
NARRATOR: Plaque buildup in the coronary vessels can lead to a heart attack, America's
number one cause of death. A heart attack would fit with the circumstances of Jerry's
death, but Dr. G spies an important detail in this report that suggests another threat to his life.
He had a toe infection. The doctor just treated him for that. NARRATOR: This infection could also be
a complication of his diabetes. Toe infection's a common problem. You have some nerve damage from the diabetes,
and you don't feel things as well, so you're more apt to injure tissue peripherally,
and you're a setup for an infection. NARRATOR: From Jerry's toe, bacteria could have launched a deadly attack on the rest of the body.
Certainly, we've seen it before where you get an infection, and it's not fully treated,
and then it gets into your bloodstream. NARRATOR: While medical records do indicate that Jerry took
antibiotics for his toe infection, Dr. G wonders if it may have been too little, too late.
There is a chance it could be somewhere else, and it wasn't totally treated, but we'd have to see.
[DRAMATIC MUSIC] NARRATOR: But then she discovers a third possibly fatal complication in Jerry's recent health history.
The antibiotic gave him diarrhea. NARRATOR: One serious complication of diarrhea
is rapid dehydration, the loss of water and electrolytes in the body. This can be especially disastrous to the elderly, who
are sometimes more frail and less able to cope with the changes. Dehydration causes death usually
by generalized weakness. You know, you're losing a lot of fluids, and your sodium can build up, and then
that, really, you can end up with a cerebral edema and seizures. NARRATOR: Dr. G notes that Jerry was given a prescription
to combat the diarrhea. But so far, he'd only taken a few doses. And it is possible that the medication
had yet to take effect. And there's another danger from diarrhea. I mean, it's possible that he had
a megacolon or toxic megacolon. NARRATOR: A megacolon develops when severe diarrhea causes
harmful bacteria to inflame the bowel to a point where it expands unnaturally to more than six
centimeters in diameter. And then the dilated bowel kind of perforates, and then you get the leakage of everything
that should be in your bowel, which is stool and bacteria, into the abdominal cavity, which
isn't a good thing. NARRATOR: Bottom line, Jerry's complex history obscures the truth about his death, which makes
Dr. G's mission crystal clear. So I think it's worth doing the autopsy to kind of figure
this out. [OMINOUS MUSIC] Dr. G begins by exploring the possibility of dehydration.
Externally, with dehydration, we'll often see the eyes sunken in their sockets. You've all seen people who are dehydrated.
They look kind of gaunt. Their skin turgor is kind of loose and tense. You've just lost a lot of fluid.
NARRATOR: After a thorough exam, however, she finds none of the telltale signs. He certainly didn't look dehydrated at all.
NARRATOR: But to completely rule out dehydration, she'll have to search for signs internally.
For now, she continues the external exam and quickly uncovers a puzzling clue. He's got a few little excoriation, like little scabs.
I think he probably was scratching himself. Hard to say what that was from. NARRATOR: And far more concerning,
she detects a reddish congested look to Jerry's face and chest. We see that a lot, actually, in heart attacks.
NARRATOR: Jerry was an aging diabetic, which put him at a higher risk for coronary problems.
It's looking more and more as if a simple heart attack may have ultimately been the culprit here.
[THUD] The rest of the external exam yields nothing more. Aside from the congestion, his body
seems in good shape, including his toe. Well, I certainly checked his feet, because, you know,
I'm wondering, you know, if this is what started the whole chain reaction of what's going on.
And his toe actually looks pretty good. NARRATOR: But the fact that the toe is healed on the outside
does not necessarily mean that the bacteria has been eradicated. That bacteria then could get into his blood,
and start multiplying, and then your body reacts to that by your heart beating fast.
You breathe fast. Your blood vessels dilate. You can't maintain your blood pressure,
and you go into shock, and then you die if not treated very aggressively, very quickly.
NARRATOR: But could something as basic as a cut on the toe have led to this man's untimely death?
Only the internal examination can see for sure. [OMINOUS MUSIC] Dr. G's scalpel is so sharp, it can slice through human skin
like a knife through butter. A scalpel is probably the most dangerous thing we have to deal with.
Cutting yourself is our biggest injury. NARRATOR: Now, she uses her scalpel to cut a Y incision across the chest
of 71-year-old Jerry Richards. Dr. G's first task is to see whether or not the diarrhea brought on by his antibiotic medication triggered
life-threatening symptoms of dehydration. So I'm going to cut that. NARRATOR: And it doesn't take long
to determine that Jerry's internal organs are neither dull nor dry. His tissues were glistening.
In fact, there appears to be maybe a little extra edema fluid, which certainly doesn't go along with dehydration.
NARRATOR: She then checks for a second possible cause of death, sepsis, or a rampant infection that
may have spread from Jerry's toe into his bloodstream and organs. A lot of times, people who die of sepsis, you
get a vague appearance at autopsy they look really sick, and they start to decompose a little faster on the inside
than we normally see. Can I quantitate that? No. That's just, like, 20 years of experience
you just get this, like, sixth sense that they're just not right. NARRATOR: In this case, her expert ion instincts
tell her there's no raging infection here. Certainly, he didn't look septic when we looked at his organs.
Everything looked OK as far as just grossly in the abdomen. NARRATOR: Through the abdominal cavity,
she can also check the condition of Jerry's bowels. One thing I am very curious about
was when I look in his abdomen to see if there's any toxic megacolon or any perforation
of the abdomen. Now, we don't have any history of abdominal pain, but, you know, it could have come on very quickly.
NARRATOR: Yet his intestines, too, are perfectly normal. And he doesn't have any perforation.
His bowel really doesn't look that inflamed. NARRATOR: At this point, Dr. G is fairly certain of how
Jerry did not die. It looks like he's toe infection's completely cleared, and he doesn't have any signs of an infection anywhere else.
And I don't really don't think the diarrhea killed him. NARRATOR: Of the possible killers
she's flagged in Jerry's medical history, she suddenly left with only one. Fortunately, it's her prime suspect, the heart.
The way he died just a cardiac death. NARRATOR: And Dr. G knows that as a diabetic,
Jerry's heart was at grave risk. You can get, you know, accelerated atherosclerosis,
and you get plaque buildup in your coronary arteries. NARRATOR: If Jerry had developed atherosclerosis,
it could have reduced the flow of blood to the point where it set off a deadly heart attack.
[HEART BEATING] Now assisted by her morgue technician Ashley Shaughnessy, Dr. G removes Jerry's internal organs
and goes straight for the heart. He has some pretty severe coronary artery disease.
His left anterior descending coronary artery, that's the coronary artery that supplies
the front of the heart, was about 90% narrowed by atherosclerotic plaque, which was calcified.
That right coronary artery, which supplies the posterior part of the heart, was about 100%
occluded. NARRATOR: Blockage this bed could have easily ended Jerry's life, but there's another piece of evidence
within the network of blood vessels that may suggest otherwise. You can have 100% occluded and it not be the cause of death.
Well, how is that? Your heart has a way to compensate for that slow buildup of atherosclerosis
by forming collaterals, meaning another coronary artery will form new vessels to supply that part of the heart.
NARRATOR: Jerry's body had done just that, formed collaterals to help the blood bypass the blockage
and prevent a full-on heart attack. It certainly puts your heart in a weakened condition
by having that 100% occlusion. But with the collaterals, it gives it kind of a Band-Aid
on it, that it can survive. NARRATOR: Still, without a clear cause of death, Dr. G cannot
rule out the heart just yet. Nothing acute looking. He certainly could have died of a cardiac arrhythmia,
but I have to finish the rest of the autopsy. OK, let's see. [EASY LISTENING MUSIC]
NARRATOR: With no suspects left, this means starting from scratch, checking every internal organ
for signs of any acute illness. She begins with the lungs. As I'm taking the lungs out, I'll certainly
look for a pulmonary embolus. NARRATOR: A pulmonary embolus is a large blood clot that
forms in an outlying vessel and travels to the pulmonary artery, where it blocks the blood supply to the lungs
and strikes the victim down. It's often seen in bedridden patients. He may be staying in bed, not moving as much
because of the sickness. But as soon as I took the lungs out, he didn't have any major pulmonary emboli.
NARRATOR: Next, she inspects the organs from Jerry's abdominal cavity. It's hard to see because the ligaments are holding it in.
NARRATOR: But here, too, she finds nothing acute. His kidney show some nephrosclerosis.
They were granular. And that goes along with maybe even some diabetes, also. NARRATOR: Then, she checks to see if there's something
going on in the brain. Ah, yeah I worry about maybe a stroke or a hemorrhagic bleed.
OK. NARRATOR: After careful examination, however, all of the remaining organs appear healthy.
[SAWING] Nothing in his brain that would suggest why he died. NARRATOR: It's clear now that the autopsy of Jerry Richards
has hit a brick wall. And I've pretty much ruled out everything obvious that it could be.
NARRATOR: But Dr. G isn't ready to throw in the towel just yet. Well, at this point, I'm going to really have
to think about everything I've found and reassess the whole autopsy. NARRATOR: She takes a moment to review
all her notes so far alongside the original investigator's report. At least the unfortunate chain reaction in Jerry's health
is very clear. Well, he's got diabetes, which then set him up for the toe infection, which then had to be treated
with an antibiotic, which gives him diarrhea, which then has to be treated. NARRATOR: The first thing she notices is how briefly he'd
been on his new prescription to combat diarrhea, an antibiotic called metronidazole.
They give him this medication. He only took a few of them. NARRATOR: Then, she also recalls something she saw in Jerry's
chest during the external exam. Thinking back, he's got these scratch marks on him.
NARRATOR: The two details suddenly click, and Dr. G knows exactly what to do next.
I need to look at the neck. [THUD] [OMINOUS MUSIC] NARRATOR: Dr. G continues the internal exam
on Jerry Richards, dissecting the skin covering his neck. The neck is my last hope.
If she's wrong, she may never have a definitive answer for what suddenly killed this 71-year-old husband and father.
After a few cuts, she reaches the larynx. And there, her suspicion is confirmed.
Jerry's airway is almost completely blocked off-- not from choking on food or a foreign object,
but because the tissue itself is swollen with edema, or fluid. I couldn't even pass my little finger
into the opening of his larynx. NARRATOR: This narrowed, the airway clearly gave paramedics trouble as they tried to help.
They had a hard time intubating, you could tell, because I can even see injury from the intubation.
But they never were able to get the endotracheal tube into that pharynx. NARRATOR: Dr. G has no doubt as to what this means.
It's clearly looking like it was an allergic reaction. NARRATOR: An allergic response occurs
when the body's immune system overreacts to an antigen or foreign substance. It can trigger a host of symptoms, from sneezing,
to coughing, to itchy hives. [GENTLE MUSIC] At its most extreme, however, it can induce a sudden drop
in blood pressure and a rush of fluids that constrict the airway. Plus, you get contraction of the small muscles of the lungs
surrounding the bronchi, so you have a harder time getting air even deeper in. NARRATOR: And if the victim isn't treated immediately,
the lack of oxygen can trigger a deadly heart attack in the space of just a few minutes.
These anaphylactic reactions probably in the United States kill anywhere from several hundred to a thousand people
a year. Most of the people, it's going to be drugs, usually the penicillin, or a bee sting, or something they ate,
like usually shellfish or peanuts are very notorious. NARRATOR: Based on Jerry's history,
Dr. G believes that in his case, the trigger was metronidazole, the antibiotic he took to combat diarrhea.
An allergic reaction to metronidazole is very rare. But really, there are case reports
of people having anaphylactic reactions to that medication. NARRATOR: To be absolutely sure of Jerry's fate,
Dr. G request a toxicology screen, checking his blood specifically for elevated levels of tryptase and IgE,
two indicators of an allergic reaction. When I get my tox, it does confirm what I thought at autopsy in that his tryptase was very high
and his IgE was very high. NARRATOR: The shortness of breath, the mysterious scratch
marks, the congested look on Jerry's face, it all fits with the cause of death that trumps heart disease.
He had anaphylaxis. And even with a good heart, you're going to die from that. NARRATOR: Now, after what seemed like a series of dead ends,
Dr. G can finally give Jerry's wife and daughter the answers they've been waiting for.
[OMINOUS MUSIC] It's early Saturday morning. Jerry Richards wakes up with labored breathing.
Alarmed, his wife and daughter convince him the best idea is to go to the hospital,
and they leave him just briefly to get dressed. What neither of them could possibly realize
is that a string of related health problems is about to end his life in a bizarre final twist.
It's an unfortunate chain of events, to put it mildly. So he gets the diabetes, which then sets
him up for the toe infection. The toe infection is then properly treated with antibiotics, and then the antibiotics appear
to be giving him diarrhea. NARRATOR: To treat the diarrhea, his doctor prescribes metronidazole, a different antibiotic
that for most patients would have mild or no side effects. But for Jerry, it is a catastrophe.
Nobody did anything wrong. He didn't know he had an allergic reaction to that drug.
NARRATOR: Jerry's immune system, weak as it is, goes into overdrive. There was a little bit of a red flag
because he probably starts itching from the hives. NARRATOR: Unaware of the warning,
he continues taking the medication, every dose reacting like a toxin to his body.
By Saturday morning, he's in the full throes of anaphylaxis. And his blood pressure goes down,
his tissues start to swell. It swells so much that he isn't able to get air in. NARRATOR: His face turns red in the struggle to breathe.
His throat constricted, he can't even call out for help. By the time his wife and daughter return, he's out cold.
They immediately call 911. NARRATOR: But it's too late. Within minutes, he dies before EMS arrives.
For Jerry's family, this is shocking news that will take them time to come to terms with.
But for Dr. G, it's something she faces every day in the morgue. You know, the simplest thing like a little toe infection,
it's scary. Life is scary. Even though sometimes everything goes right, you still can get bad consequences.
And that's not that anything is bad, or that people did things wrong. There can just sometimes with bad luck have bad consequences.
[SOMBER MUSIC] NARRATOR: But will Dr. G's next autopsy be another case of bad luck or too much of a good time?
They were drinking heavily. There's a whole group of them out. They had a bag full of possible cocaine.
[OMINOUS MUSIC] Thank you, God, for the good food and that we're here together, and healthy,
and that we have each other. Amen. And let's pray that Eric doesn't get hurt in football.
What other sport has an ambulance on standby? Horse racing. That's for the horse or the jockey?
One of each. JAN GARAVAGLIA: Dinner with my family and occasionally having a glass of wine, you know,
it's one of my favorite ways of ending the day. Do I get to toast? What are we toasting?
Yes. But I also teach my children that alcohol abuse is one of the main ways that people
come into my morgue. [OMINOUS MUSIC] NARRATOR: Dr. G opens the file on 25-year-old Michael Torio.
Michael was very close to his family, living at home and even working for his mother at a restaurant.
Michael was wonderful. He was happy, full of life. You know, we used to have a lot of fun together,
you know, going to movies, going to wrestling, this and that. [ORCHESTRAL MUSIC]
NARRATOR: But there was something else Michael loved to do, party with his friends all night.
And it was no different on the night he died. He called me and said, mom, I don't
think I'll be home tonight. He says, I'm kind of chilling, was his word. And he says, well, he said, I promise
I'll be to work on time. And as always, I'd say, I love you, Mac. And he said, I love you, too.
NARRATOR: But little did she know that would be their last conversation ever. According to the investigator's report,
that night Michael and his friends first met up at a local bar. [ROCK MUSIC] MAN 1: (SINGING) Out again.
They've got a $142 bar bill. There's five of them, and the drinks are only $2 apiece.
I don't know where they're drinking, but that's pretty good, $2. [ROCK MUSIC] So you can kind of do the math.
They're drinking a lot. NARRATOR: Closing time rolls around, but they're just getting started.
They soon head over to a motel, where Michael gets a room. They all continue the party at the hotel room.
NARRATOR: Finally, at around 3:00 AM, he calls it a night. He goes to bed. Some of his buddies leave.
I guess at least one of them stays back. [OMINOUS MUSIC] NARRATOR: The next morning, the friend wakes up
and notices Michael fast asleep in the bed next to him. He's still sleeping in the same position
when he should be up getting ready for work. NARRATOR: But it isn't long before the friend realizes
that Michael's not sleeping. JAN GARAVAGLIA: He doesn't respond. His friend calls 911.
NARRATOR: The paramedics soon arrive, but they're too late. They pronounce him dead.
[OMINOUS MUSIC] NARRATOR: Meanwhile, across town, Michael's mother is furious that her son
hasn't shown up for work. [BEEPING] I blew up his cell phone calling him and calling him.
[VIBRATING] [PHONE RINGING] NARRATOR: At 3:00 PM, her phone finally rings, but it isn't her son.
It was actually his-- one of his good friend's mother that I hadn't spoken to in a while.
And she said, Marianne, how are you? And I said, fine. How are you? And she says, oh my god.
You haven't heard? And I said, heard what? NARRATOR: Her answer is at first beyond belief.
And at that moment when I turned to my office door, there stood a police officer.
And that's how I found out about Mickey. NARRATOR: The sudden loss of their son leaves Michael's parents groping for answers.
Michael was everything. He was every breath I took. I just didn't know what to think.
I just didn't understand. I didn't understand it. [WHOOSH] NARRATOR: Now, it's up to Dr. G to determine what killed him.
On first blush, she doubts it was natural. Like most young men, Michael has no medical record,
except for one odd note, grand mal seizures. And that's when a patient suddenly gets very stiff,
and then after a period of being very stiff, will start jerking and shaking. And you'll also see a frothing at the mouth.
NARRATOR: Sometimes a grand mal seizure can signal a serious condition, such as extreme low blood
sugar or kidney failure. In Michael's case, the cause of the seizures is a complete mystery.
According to his family, he had experienced four seizures in the past year, all spontaneous
and with no other symptoms. He didn't think nothing of it. He'd have the seizure, and he'd be fine afterwards, you know?
His life went on just like normal. Now, this is the sad part. He doesn't go and get medication for the seizures
because he doesn't have any insurance. He did not go to the neurologist. I even said, Mac, make the appointment
and I'll pay for it. And he said, no, I'm fine. Don't worry about it, mom. He says, you know, when I get insurance, I'll go.
[SOMBER MUSIC] NARRATOR: Michael never did find out what caused his seizures. But while seizures can be dangerous,
Dr. G knows they rarely end in death. And when they do, it usually involves a risky activity.
Like swimming, and having a seizure, and drowning, or driving when they're having a seizure,
or being on a ladder, having a seizure, and falling off. NARRATOR: On the contrary, Michael died indoors in a bed.
Still, Dr. G can't rule out the possibility that Michael's seizures or the underlying cause of them
could have ultimately led to his death. However, as she reads through the investigator's report,
Dr. G is starting to suspect that by far, the biggest threat to Michael's life was not his seizures,
but alcohol. Alcohol's a central nervous system depressant. If you drink enough of it, it will
cause you to stop breathing, and then eventually cause your heart to stop. I don't see it a lot in the morgue,
but I tend to see it in younger people who guzzle alcohol. NARRATOR: But then Dr. G discovers
something even more disturbing about Michael's night out. There is a question of possible drug
use in this hotel room. They had a bag full of possible cocaine. NARRATOR: A powerful stimulant, cocaine alone
can kill in a number of ways, often as a result of cardiac arrhythmias or skyrocketing blood pressure rupturing
blood vessels in the brain. Combined with alcohol, the risks are even greater. It actually forms a chemical in your body called
cocaethylene, and you're more apt to get cardiac arrhythmias possibly when you even mix the two.
NARRATOR: Cardiac arrhythmia is abnormal electric activity in the heart. It can lead to cardiac arrest.
More and more, Michael's party is sounding like a deadly setup. But for Dr. G, investigating drugs and alcohol as
possible killers won't be easy. Their trail can be extremely elusive in autopsy.
Certainly, I don't expect to see much with the alcohol. And the drugs, I may not see anything.
But if you don't look, you're not going to find it, either. [FRANTIC MUSIC] The family just has a hard time.
It's like, well, he has no symptoms. NARRATOR: As Dr. G begins Michael's external exam,
she immediately notes a health issue unrelated to drugs. He's morbidly obese. He's over 300 pounds.
NARRATOR: Even in such a young man, such obesity can cause problems, including heart disease
and high blood pressure, conditions Dr. G will investigate in the internal exam.
But first, she opens Michael's mouth, looking for any evidence that suggests he experienced a grand mal
seizure on the night he died. A bite mark to the tongue or bite mark to the buccal mucosa.
That's the inside of your cheek. NARRATOR: Victims of seizures often bite their tongues
or cheeks while seizing, and Michael's mouth reveals definite damage. Oh, poor guy.
He's got old bite marks. I can see a lot of scarring on the inside of his mouth.
I just don't see anything new. NARRATOR: Fresh injuries which suggests that Michael had a seizure the night of his death.
But Dr. G also knows it's possible to seize without leaving bite marks, and that seizures often
come and go without a trace. Just because you don't have evidence of a bite mark
does not mean he didn't have a seizure. We certainly see a lot of people have seizures
that don't have bite marks. Finding a bite mark just helps us say, yes, he probably did
have a seizure. NARRATOR: For now, Dr. G must set aside that history and focus on one of her two prime suspects, drug use.
Looking at his skin won't tell if Michael smoked or inhaled cocaine at his party.
But if he injected the drugs, she may find its signature, a pale circular puncture wound.
I look for needle tracks. I don't see any. NARRATOR: In fact, by the end of the external exam,
she's seen nothing that supports either drug or alcohol abuse at all. So basically, we have a very overweight young man
with no evidence that he uses IV drugs and really not much else, so I'm a little bit worried.
[TENSE MUSIC] I have really no idea why he died at this point. [OMINOUS MUSIC] [SAWING]
NARRATOR: Still exploring a possible cocaine-related death, Dr. G begins Michael Torio's internal examination by opening
not his chest, but his head. I think I can get it. Maybe using cocaine, he might have
an intercerebral bleed or a ruptured aneurysm from that. NARRATOR: As a first step, she extracts the brain.
On first glance, it looks normal. But to be sure, she must dissect it. Similar to just slicing bread, very thin slices,
looking for any type of abnormalities. NARRATOR: After a careful inspection, it's clear Michael's brain has no trauma, no tumors,
no bleeding from cocaine. I don't see any abnormalities. NARRATOR: Still Dr. G can't yet rule out drugs without running
toxicology tests. She's also no closer to finding the cause of Michael's seizures
or determining whether or not he even suffered from one the night he died. The lack of clues is frustrating.
But as a mother of two, Dr. G can only imagine the agony of Michael's parents as they wait for answers.
Personally, I don't think there can be anything worse than losing a child, no matter how old they are.
He wanted to have a family. That was his biggest dream was to be a father. [DRAMATIC MUSIC]
He's on my mind constantly. I don't mean to get like this. I still wait for him to come home.
It's hard. [OMINOUS MUSIC] WOMAN: I'm going. You know, let me do-- let me do the initial and--
WOMAN: Whatever you would like. I'm just going to hose down the table so we're not sticking as much.
NARRATOR: Dr. G makes the Y incision down to Michael's navel, exposing the abdominal cavity.
So he's got a lot of abdominal fat. NARRATOR: Her first stop, the stomach, where she hopes to uncover some trace
of her other prime suspect, alcohol. [TENSE MUSIC] If Michael overdosed on alcohol, Dr. G
may actually be able to smell it in his gastric contents. A good night of beer drinking, I'd smell it.
It gives us an idea maybe of what's going on. Not the most pleasant part of the job.
And in fact, some people hate that part of the job. It does often have a smell of vomit
and that we're all familiar with. To me, it's just part of the territory. NARRATOR: First, she extracts the organ then ties
off both ends and cuts it open. A good whiff, and she's got her answer. It really doesn't smell that much like alcohol to me.
Huh. That's interesting. NARRATOR: On the other hand, Dr. G finds something else in his stomach
that could counter the effect. I do see some greasy liquid things and some French fries.
It doesn't sound like the healthiest meal, but then again, he's 300 pounds. I'm not thinking he's eating fruits
and granola bars all day. NARRATOR: The fries at least may have slowed the absorption
of alcohol into Michael's bloodstream and prevented the binge drinking from taking his life.
But without the toxicology report, Dr. G can't be sure of exactly how heavily Michael drank before he died.
One thing she does know, if he had also snorted cocaine, any amount of alcohol could have mixed
with it to make cocaethylene. And that can cause a fatal cardiac arrhythmia. So it could be the combination of the drugs with the alcohol,
and that's what I'm guessing. NARRATOR: Though an arrhythmia leaves no physical evidence,
she must still check the condition of his heart. So I take his chest plate off. NARRATOR: Underneath it are his lungs.
And as she removes them for better access to the heart, she finds something intriguing.
His lungs are very heavy. You know, a normal weight would be maybe 350, 400 grams.
His are like over 700 grams, very congested with some edema fluid. His lungs are just full of fluid.
NARRATOR: Often, wet lungs are associated with a drug overdose, but they can also
be a result of heart failure. She must press on to find out. What she uncovers next is a startling revelation.
I open his pericardial sac, and I notice his heart is very enlarged. NARRATOR: To some extent, it's not unusual to find
a big heart in an obese person. As you get bigger, your organs get bigger. And part of that is because as you get bigger,
you have a bigger blood supply. You are having more miles of capillaries that have to be fed.
NARRATOR: To pump that volume of blood, the heart must also grow. But even for an obese man, Michael's heart
seems abnormally large. [THUDDING] When Dr. G dissects the organ, she finds that the walls of the ventricles
responsible for pumping blood out to Michael's body have become thick and stiff.
He's got a cardiomyopathy of some type, a heart muscle disease. NARRATOR: Cardiomyopathy, which has many causes from high blood
pressure, to genetics, to alcoholism, lands hundreds of people in Dr. G's morgue each year.
There's something inherently wrong with his heart. It could be partially worsened by his obesity,
but the muscle is abnormal. NARRATOR: And, yet how exactly Michael's heart disease relates to his sudden death is still unclear.
In fact, they may have no relation at all. Well, the end of the internal exam, I
have the history of the seizures. That certainly could play a component again. I've got still the drugs and alcohol,
and then I've got this heart. That heart was a setup for sudden cardiac death. [DRAMATIC MUSIC]
Toxicology is going to be key for this case, because I can't go anywhere yet until I
find what's in his system. NARRATOR: And when she does find out, nothing is what it seems.
[SOMBER MUSIC] Over four weeks after the autopsy of Michael Torio, Dr. G finally receives the 25-year-old's
toxicology report, and the findings turn the case upside down. When the toxicology comes back to me, I'm actually shocked.
He has no cocaine in his system. He has no alcohol in his system. NARRATOR: It appears Michael's alcohol intake the night
of his death was moderate enough that his body processed it completely before he died.
So he clearly had stopped the partying long enough for those things to metabolize out of his system.
NARRATOR: There's no trace of cocaethylene either, which means neither alcohol, nor cocaine,
nor their compound could have taken Michael's life. [DRAMATIC MUSIC] With drugs and alcohol out of the equation,
Dr. G must reconsider another possible threat to his diseased heart, his seizures.
Some people die from seizures called sudden unexpected death of epilepsy. NARRATOR: While the exact mechanism is unknown,
scientists believe death may occur when seizures disrupt the brain's signals to the autonomic nervous system,
the part of the nervous system that regulates the body's organs. What happens during a seizure, there's
a misfiring or desynchronization of the autonomic nervous system, which probably contributes
to cardiac arrhythmias or irregular heartbeats during a seizure. NARRATOR: Most seizure victims never experience anything close
to major organ failure, but a heart as diseased as Michael's could easily stop being under such stress.
And while there's no physical proof that Michael had a seizure the night he died, Dr. G suspects the odds
were stacked against him. He's been having these seizures for the past year, mostly at night.
They're increasing in frequency. Is he on medication for these seizures? No. NARRATOR: Even his general health
could have been a factor. People who are obese can have obstructive sleep apnea, where
they don't sleep well at night. And if you're not sleeping well at night, that's going to lower your seizure threshold.
So based on, you know, everything we know about him, most likely it was an interplay between the two.
He died consistent with sudden unexpected death of epilepsy in conjunction with his bad heart.
Hi, this is Doctor Jan Garavaglia dictating case for [INAUDIBLE] NARRATOR: Two unrelated conditions
converging one fateful night. Dr. G can now tell Michael's grieving parents how and why
his life ended so abruptly. [OMINOUS MUSIC] [INTERPOSING VOICES] [THUD] It's Thursday night and the fun's just begun.
Michael and his friends are hanging out at a local bar, but he has to work in the morning,
and assures his mom that he'll take it easy. The party moves to a hotel room, but Michael keeps his word.
He's been drinking, but in moderation. And by 3:00 AM, he's in bed. He goes to sleep.
He metabolizes off the alcohol that was in him. NARRATOR: It seems no different than any other night
Michael has spent partying with his friends. But in his heart, a catastrophe has been
brewing, possibly for years. It's thickened and enlarged. You know, this is something that we
found at autopsy that clearly he didn't know anything about. I wouldn't expect him to know anything about it, because he
didn't go to the doctor, and he wasn't having any symptoms yet from it. NARRATOR: At the same time, for an unknown reason,
Michael's brain has become susceptible to seizures. We have no idea what's causing them.
They start on their own. NARRATOR: And this night, the two conditions collide. At some point during the night,
he has one of his nocturnal seizures. NARRATOR: An electrical storm erupts in Michael's brain,
triggering a chain reaction in his body. His limbs flail, his jaws clench, and most dangerously, his autonomic nervous system
malfunctions, losing control of his heartbeat. Nobody knows the exact mechanism.
They do know that when people have seizures, their heart goes down really slow. NARRATOR: Michael's heart, already in trouble,
now beats erratically, quivering, until finally, it stops. [WHOOSH] MAN 2: Mike?
NARRATOR: By the next morning, there's nothing his friend or anyone can do. And they pronounce him dead.
[SOMBER MUSIC] NARRATOR: Michael's grieving parents are thankful to finally have some answers, but the revelation
is still difficult to come to terms with. I never knew he had a heart problem, never.
I'm like, what kind of a mother was I? I didn't even know my own son had an enlarged heart.
That's a very difficult thing to pick up, actually. Even a chest X-ray, you know, you
don't do chest X-rays on 25-year-old men that don't need it. I don't think you're ever relieved to find out
why your son dies, but I think it really helped her to know that it wasn't the drugs or alcohol.
I don't know how it made her feel, because he couldn't get the help for his seizures.
You know, to me, that's still very sad. [EASY LISTENING MUSIC] NARRATOR: Michael's family will never be the same,
but it's his memory that inspires them to keep going. MAN 3: (SINGING) Everyone come outside.
You just wake up, wake up every day and do what you have to do. Mickey lives in my heart.
When I need that hug or I need to see that smile, I just look in my heart, and he's there.
[TENSE MUSIC] MAN 4: Atlas.

A 71-year-old man wakes in the middle of the night, gasping for air. Paramedics rush to save him, but it’s all in vain: he’s dead by the time they arrive. What caused his death?

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

Brief Summary

Dr. G investigates the deaths of Jerry Richards and Michael Torio, revealing allergic reactions and underlying health issues as causes.

Key points

A Sudden Death. Jerry Richards wakes up gasping for air and collapses, shocking his family.
The Mystery Deepens. Dr. G uncovers a complex medical history that obscures the truth about Jerry's death.
An Unexpected Cause. Dr. G discovers Jerry's airway was blocked due to an allergic reaction.
A Shocking Loss. Michael's sudden death leaves his family grappling with disbelief and sorrow.
The Autopsy Findings. Dr. G uncovers surprising details about Michael's health during the autopsy.
The Final Revelation. Dr. G concludes that Michael's death was due to a combination of factors.

Episode highlights

Episode quotes

You never know what's going to come in.

Reflecting on the unpredictability of her job.

2:18WatchJun 10, 2021

Tension

75/ 100High tension

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