Dr. G: Medical Examiner - Season 5, Episode 12 - Crossing The Line - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A man takes a nap and never wakes up. DR. JAN GARAVAGLIA: We have three really
deadly things going on here. This sounds like a bad combination. NARRATOR: But when the clues don't add up,
Dr. G finds herself in uncharted waters. DR. JAN GARAVAGLIA: Sometimes when things don't fit,
you gotta go with your sixth sense. NARRATOR: And then a woman is stricken with an intense but mysterious pain.
DR. JAN GARAVAGLIA: Her son said she complained just out of the blue, this stabbing eye pain.
And then it went away. NARRATOR: But when she dies the very next day, her son fears that he may have ignored a lethal warning.
The son is absolutely flabbergasted that she's dead. It just really came as a shock to him.
[MUSIC PLAYING] NARRATOR: Altered lives. Baffling medical mysteries. Shocking revelations.
These are the everyday cases of Dr. G, Medical Examiner. [MUSIC PLAYING] NARRATOR: As chief medical examiner of the District Nine
Morgue in Orlando, Florida, one of Dr. Jan Garavaglia's primary responsibilities is to keep
track of public health trends. Homicides, motor vehicle fatalities, and natural disease, such as obesity.
DR. JAN GARAVAGLIA: Do you know that there is a 100 million obese or overweight people in the United States?
And some days I think they're all coming into my morgue. NARRATOR: It's a condition Dr. G understands
both clinically and personally. You know, I was a fat child, a really fat child.
Oh, yes. I was, you know, I was the type you made fun of on the bus. SANDY: What?
Oh my god, yes. [MUSIC PLAYING] DR. JAN GARAVAGLIA: You should see pictures of me.
I was a really fat child. I lost, like, 30 pounds, I believe, between eighth grade
and ninth grade. And then I gained a lot of weight after my first child was born.
I had to lose 42 pounds. SANDY: Wow. - Yeah. And then-- Yeah. And then I gained a lot of weight
after Eric was born, too. I'm not good with kids, I guess NARRATOR: Today, Dr. G's first case also
involves a patient who has struggled with their weight, a 43-year-old man named Jeremy Weinberg.
[MUSIC PLAYING] NARRATOR: The body of Jeremy Weinberg, a beloved teacher at a nearby Orlando high school,
is wheeled from the refrigeration unit into the exam room. DR. JAN GARAVAGLIA: According to his family,
according to his principal where he teaches, this guy is a wonderful guy. He's one of those big kind of bear--
the loving kind of guy. NARRATOR: Jeremy's unexpected death has left his family and friends in a state
of shock and disbelief. It all started the previous evening while Jeremy was eating dinner with his parents.
At first, nothing seems out of the ordinary. Then, shortly after the meal Jeremy asks if he can borrow
a bedroom for a quick nap. But when his parents check on him later that evening,
they can see right away something is very wrong. DR. JAN GARAVAGLIA: His lips were blue.
He didn't look good. They tried to see if they could arouse him. They couldn't. Now, he's a very big fellow.
And they actually try to do CPR with their knee, because he's got such a big chest.
NARRATOR: Jeremy's parents immediately call 9-1-1, and paramedics rushed him to the nearest hospital.
They work on him for about 30 to 40 minutes, but they couldn't revive him. Jeremy's sudden death has left his mother and father
completely bewildered. They have no idea what could have killed their only son in the prime of his life.
DR. JAN GARAVAGLIA: I mean, to the family he's just still, I mean. To the mom and dad, he's still a baby.
He's only 43, so they're not expecting him to die. And of course, they're devastated with his death.
[MUSIC PLAYING] NARRATOR: Seeing someone pass away mysteriously at such a young age is unusual, even for Dr. G.
But one glance at Jeremy's body is all it takes to start lining up suspects. He is morbidly obese, takes very bad care of himself.
He's 400 pounds. NARRATOR: Jeremy's morbid obesity alone puts him at risk of dying prematurely from a laundry
list of different ailments. DR. JAN GARAVAGLIA: You know, this is a fellow that is prime for a lot of natural disease.
Why is that? Well, people who are that heavy have accelerated atherosclerosis-- plaque.
They have increased incidence of high blood pressure. We have an increased problem with blood clots
in the leg, which break off and can cause pulmonary emboli. So obesity can come at your body in many ways.
NARRATOR: In fact, Jeremy had already developed several conditions related to his obesity.
He's only 43, but he has severe osteoarthritis wear and tear on his knees. He is already on chronic pain meds for that.
[MUSIC PLAYING] DR. JAN GARAVAGLIA: He also-- and this is very disturbing-- he has a history of high blood pressure,
and he stops taking his high blood pressure medicine. And he's got sleep apnea. Sleep apnea is basically where you stop breathing
while you're sleeping. And about 30% of really obese people will have sleep apnea.
NARRATOR: The disclosures are troubling. Sleep apnea, high blood pressure, and morbid obesity
are all risk factors for one fatal condition, heart disease. We have three really deadly things going on here.
Any three of which could be possibly lethal. I mean, this sounds like a bad combination.
400 pounds, not taking medication. It's just a sure ticket to be coming in here at a young age.
NARRATOR: But as Dr. G continues through Jeremy's medical records, she discovers yet another health concern.
DR. JAN GARAVAGLIA: He also interesting enough has a family history of atrial fibrillation.
That's where the top part of the heart quivers and doesn't beat well, although the bottom part
of the heart continues to beat. Now, that actually has an increased mortality in and of itself if he has it.
So, you know, for a 43-year-old man, I'd characterize his overall health as pretty bad.
NARRATOR: But there's only one way for Dr. G to know if Jeremy Weinberg's heart led to his early death.
[MUSIC PLAYING] DR. JAN GARAVAGLIA: So I do the external examination. The first thing you look at is just his sheer size.
It's just a huge mountain of a man. And looking at him, he doesn't look well. I can't imagine walking around at 400 pounds,
and that it would be comfortable. NARRATOR: From the start, Dr. G notes that Jeremy's body shows
signs of oxygen deprivation, particularly his nails, which are blue in color. DR. JAN GARAVAGLIA: His nail beds were very cyanotic.
Believe it or not, not everybody who dies has cyanotic nail beds. But his were very cyanotic, as if he wasn't getting
enough oxygen. But keep in mind, there's about a half hour period, 45 minutes of being resuscitated.
NARRATOR: Next, Dr. G turns to examine Jeremy's legs. Obesity can cause blood to pool in the lower body,
leading to the formation of life-threatening clots. DR. JAN GARAVAGLIA: Because of its sheer size,
we have an increased problem with thrombosis, blood clots in the leg, which break off
and can cause pulmonary emboli. So that is a possibility. Could you lift the leg up for me when I measure?
Thanks. OK. That all right? NARRATOR: Sometimes, Dr. G can detect signs of a clot
by identifying swelling in the calves, but Jeremy's size makes the analysis troublesome.
OK, he's kind of heavy. DR. JAN GARAVAGLIA: It's just difficult sometimes to do physicals on people who are that big,
because it sometimes masks some of the physical findings. So a subtle change we wouldn't be able to pick up.
OK. NARRATOR: By the end of the external exam, Dr. G still has no concrete findings.
But one thing is clear: Jeremy's obesity has taken a costly toll on his body. Perhaps more than either he or his family realized.
This is a fellow that is primed for a lot of natural disease. There is a number of complications
that could have got him. [MUSIC PLAYING] DR. JAN GARAVAGLIA: OK. So I'll tell you what we'll do, is I'll open him--
SANDY: All right-- NARRATOR: Dr. G is ready to open the body of 43-year-old Jeremy
Weinberg, who died without warning at his parent's home less than 24 hours ago. They knew he didn't take care of themselves,
but they certainly didn't expect him to die. And of course they're devastated with his death.
[MUSIC PLAYING] DR. JAN GARAVAGLIA: So in this fellow, to start the internal, I have to do the Y incision.
It actually is a little more involved. We have to-- he's so big, we really have to get a little stool.
Sandy gave me a little stool, and then she's going to take it over in a minute. He's got in some areas over six inches of fat between his skin
and his muscle. It really is more dangerous for us, because it really is greasy and fatty.
It's difficult on our backs to get-- because they sit so much higher on those tables.
And then just trying to get in there and get the organs out and everything is very greasy.
And it's just more dangerous. [MUSIC PLAYING] NARRATOR: Once the body is opened,
Dr. G gets her first look at Jeremy's internal organs. DR. JAN GARAVAGLIA: You know, everything's
in the right place, but it's all surrounded by a tremendous amount of abdominal,
or what we call visceral, fat. NARRATOR: In fact, the fat is so extensive, it's actually pressing into Jeremy's chest cavity.
DR. JAN GARAVAGLIA: All that fat in the abdomen it's just pushed up against his diaphragm.
He's got this tiny little chest cavity. I don't know how he can breathe that way.
NARRATOR: Dr. G also discovers that he has several broken ribs. I noticed the broken ribs, both right and left side.
These ribs have very little hemorrhage, and it's associated with trying to do CPR on him.
NARRATOR: Next, Dr. G cuts through the ribs to get a better look at his heart. And it isn't long before she notices something troubling.
Whoa. Something here. We've got a big heart. I can see right off that his heart is enlarged.
It's at least 600 grams. The right side is dilated. The left side's a little dilated.
And it's thickened. NARRATOR: This finding is exactly what Dr. G feared. Though only 43 years old, Jeremy had already developed
severe cardiovascular disease. DR. JAN GARAVAGLIA: It's probably a combination of the high blood pressure, which
he didn't want to treat for some reason, and just the sheer obesity. The muscle was normal and could be
a setup for a sudden cardiac arrhythmia. At this point, I wouldn't have any problem saying
that his heart killed him. But if you're going to pin your cause of death on arrhythmia,
you still have to rule everything else out. NARRATOR: To rule out any other complications in Jeremy's
death, Dr. G turns next to examine the inside of the atria, the top two chambers of his heart.
According to his medical records, Jeremy had a family history of atrial fibrillation, a heart
rhythm disorder in which the atria momentarily flutter instead of beat. This can cause deadly blood clots to form in the chambers.
People who have atrial fibrillation are at increased risk for having strokes and thombotic events,
because the blood just kind of sits there and forms a clot, which then can break loose.
Where's my fancy knife? Eh, it's all right. We'll do this. NARRATOR: Dr. G cuts open the atria,
but she sees nothing abnormal. DR. JAN GARAVAGLIA: He doesn't have that, and I suspect that he probably didn't have
atrial fibrillation, even though he's got a family history of it. NARRATOR: As a next step, Dr. G cuts Jeremy's lungs out
of the cramped chest cavity. OK. NARRATOR: She's searching for any blood clots in the pulmonary artery, the large vessel
that carries blood out of the heart and into the lungs. Now, obesity could have, you know--
they're more prone to pulmonary emboli. But he doesn't have any. NARRATOR: And yet, Jeremy's lungs are not at all normal.
His lungs are remarkable for being very edematous. NARRATOR: The organs are heavy with edema,
or fluid, which is often an indication that a person died slowly. However, this contradicts her theory that Jeremy may have
died from a sudden arrhythmia. Now, this puts up a little flag in my brain, that he just didn't maybe die suddenly.
NARRATOR: Next, she draws toxicology samples from Jeremy's body. Oh, nice full bladder.
NARRATOR: And here she discovers another clue that Jeremy's death was not sudden.
DR. JAN GARAVAGLIA: His bladder is very distended, which can be due to him being in a coma for a period of time.
You know, we're thinking about the heart and thinking a sudden death, but with his bladder being
distended and his lungs full of fluid, I kind of suspect maybe more of a slower death.
And now I'm worried maybe he's got something going on in his brain, like a bleed, brought on by his high blood
pressure that caused his death. So we've got to go to the head. [MUSIC PLAYING] NARRATOR: Morgue technician Tommy Hemphill
opens Jeremy's skull with a bone saw, and Dr. G immediately begins searching for any abnormalities, such as bleeding in the brain.
But the findings are not what she was expecting. DR. JAN GARAVAGLIA: There's no evidence of anything
abnormal in that brain. Right off the bat, I can tell. And I slice the brain, there's no evidence of hemorrhage
anywhere in that brain. No evidence of any kind of stroke in that brain, which that brain looked normal.
I don't know if surprised is the right word, and I'm actually a little disappointed that I don't find
the bleed in his brain, because I thought that would tie things up nice and neatly.
So I'm a little disappointed that he doesn't have that bleed in the brain. NARRATOR: At this point, only one thing is certain:
Jeremy had a severely enlarged heart that could have been a ticking time bomb. DR. JAN GARAVAGLIA: You know, I'm done with the autopsy
and I could assign this out right then and there: his heart. But something tells me differently.
I don't like the fact that he's got so much pulmonary edema and that distended bladder.
It just doesn't really fit that sudden cardiac arrhythmia. And, you know, sometimes when things don't fit,
you've gotta go with your sixth sense. I don't think there's any harm in appending this.
NARRATOR: Dr. G pends Jeremy's case until toxicology and microscopic results are complete.
In the meantime, she makes a difficult call to his family. I talk to the family.
They understood that I wanted to wait. I needed to look at the tissues under the microscope.
And I wanted to look at the toxicology, because I still have that uneasy feeling in my mind
that something else is going on. [MUSIC PLAYING] NARRATOR: Several weeks after the autopsy
of 43-year-old Jeremy Weinberg, Dr. G still doesn't know what killed him. But today she's hoping that microscopic slides of his heart
and toxicology results will provide some clarity both for her and Jeremy's grieving parents.
DR. JAN GARAVAGLIA: It's always a trying time for the families, waiting for the answers.
We always get a lot of anxious phone calls. Is it done yet? Is it done yet? But we have to wait for the lab to finish their tests.
NARRATOR: Dr. G begins by examining the slides of Jeremy's heart. Sometimes you do get surprised looking under the microscope
at something you don't suspect. But in this case, there was really no surprises.
We still have the effects of obesity and high blood pressure. And that could be a setup for a cardiac arrhythmia,
which certainly could be the cause of death. But I still have that same problem--
the pulmonary edema, the distended bladder. NARRATOR: To make sense of Jeremy's sudden death,
Dr. G needs an explanation that can reconcile these conflicting findings. [MUSIC PLAYING]
But then she gets her first look at the toxicology report, and staring her right in the face
is a problem she never anticipated. DR. JAN GARAVAGLIA: At this point, this is out of the blue.
NARRATOR: First, Jeremy had high levels of oxycodone in his blood. The medication he was prescribed for his arthritic knee.
DR. JAN GARAVAGLIA: He had levels way above therapeutic. He was clearly taking too much.
NARRATOR: The level of oxycodone alone isn't high enough to kill Jeremy, but it's what Dr. G
discovers next that reveals the truth behind his untimely death. DR. JAN GARAVAGLIA: Toxicology results
didn't let me down on this. I think they added a very important piece of this puzzle
of what's going on. [MUSIC PLAYING] NARRATOR: It's a Sunday afternoon in Orlando,
and 43-year-old Jeremy Weinberg is on his way to his parent's house for dinner. But his knee is acting up, so he takes
the edge off what some of his prescribed pain medication, oxycodone. Unfortunately, this isn't the only drug Jeremy
has been using for pain relief. DR. JAN GARAVAGLIA: Tox finding just came out of the blue for me, in that he had both oxycodone
and methadone on board. NARRATOR: Methadone is a narcotics often used to treat heroin addiction, but it's also a potent pain
medicine, and one that Jeremy had been taking without medical supervision. DR. JAN GARAVAGLIA: He does not have a prescription
for the methadone. The methadone he was getting somewhere else, which is still a mystery.
NARRATOR: But what Jeremy doesn't realize, is that methadone lingers in the body
much longer than most drugs. DR. JAN GARAVAGLIA: It's got such a long half life,
that it stays in your system for a long time and can cause an accumulative effect.
And then you take more on top of that, and the levels just keep building. NARRATOR: Unbeknownst to Jeremy or his parents,
the tragic misuse of two powerful pain medications is about to come to a head. DR. JAN GARAVAGLIA: Now, this is a bad combination.
The way these drugs-- both of which are narcotics, very potent narcotics-- will affect you, Is that their central nervous system
depressants. And they can decrease your respiration. NARRATOR: By the time dinner is over,
Jeremy is beginning to feel the full effect of the oxycodone-methadone cocktail.
He's overwhelmed with drowsiness and lays down for a nap. But it isn't long before Jeremy's
body, already ravaged by morbid obesity, is pushed over the edge. Now, this is a morbidly obese man that already has problems
with a small chest cavity not being able to expand his lungs, sleep apnea causing him to obstruct his airway
to not get enough oxygen. And now we're throwing on top of that, let's throw in a little central nervous system depressant
so I don't breathe well enough. So what is all that combination do? That combination is going to decrease your oxygenation.
Well, let's say he's already got a big heart that's sensitive to decreased oxygenation,
and that's just a setup for death. NARRATOR: While he's sleeping, Jeremy's lungs
start to fill with fluid. And it isn't long before he slips into a coma. Eventually, his heart gives out, and in the guest bedroom
of his parent's home, he dies. In medicine, sometimes it's not just one thing. It's piled up.
Many things piled up on top of each other. And that's probably why this man died, with the coup
de gras being the drugs. Without the drugs, at that moment he probably wouldn't have died.
NARRATOR: With the cause of Jeremy's death finally revealed, Dr. G once again calls his mother
and father to explain the complex chain of events that took their son's life. His parents were totally surprised that he had
that kind of narcotics in him. Right. OK. They knew he didn't take care of himself.
They really were surprised, though, that he was taking narcotics. You know, I find cases like this really, really frustrating.
He leaves in his wake people who are devastated by his death. The kids in his classroom are devastated
that their teacher dies. All his co-workers loved him. They're devastated that he died.
His family is devastated. His mom and dad. These are frustrating cases that come through here that didn't
have to come through here. NARRATOR: Sadly, many of Dr. G's cases have one lesson in common--
unhealthy choices often lead to premature deaths. DR. JAN GARAVAGLIA: I think a lot of people
don't appreciate what bad habits can do to your body. And I don't think they see sometimes
the connection between the habit and the disease. That's something I see every day in the morgue.
NARRATOR: And on first glance, her next case appears to be no exception. [MUSIC PLAYING]
NARRATOR: Today, Dr. G and some of her staff are checking on the construction of their future workplace.
[DRILLING NOISES] (SHOUTS) Welcome to your new home. (SHOUTS) Thank you very much!
This is the office. My desk is right here, I think. MAN: Yep, right there. It's really going to look really pretty.
It's unbelievable to see this go up like this. MAN: That's the outside wall. This is the length of a cooler right here.
This is also where the skeletons will be, so anything that's decomposed or skeleton--
This is where you bring the stinky ones. DR. JAN GARAVAGLIA: You got it. (CHUCKLES)
You like doing this part better than decomp? (CHUCKLES) DR. JAN GARAVAGLIA: This has been a lot of fun, Sandy.
It is much better than doing a decomp. [LAUGHTER] [MUSIC PLAYING] NARRATOR: But Dr. G's work can't wait for the new morgue
to be complete. Back at the old building, she has a full caseload. And the next one on her list looks
to be anything but clear-cut. Well, today we have a 53-year-old African-American female who really has
very little medical history. [MUSIC PLAYING] NARRATOR: Fresh out of college, Justin Bailey
lives in his own apartment in Orlando, Florida. But he still leans on his mother, Cora,
for support and guidance. So early one morning when a new job offer comes his way,
he wastes no time calling his mom for advice. The son tries to call her, she doesn't answer.
He can't get a hold of her. NARRATOR: Justin continues calling throughout the day,
but all he gets is his mother's voicemail. Growing more concerned by the moment,
he leaves work and drives directly to her house. He comes over and knocks on the door.
She doesn't answer. He walks in and finds her sitting on the couch. [MUSIC PLAYING]
He sees that she's unresponsive. NARRATOR: Frantic, Justin calls 911, but it's too late.
[MUSIC PLAYING] DR. JAN GARAVAGLIA: She's clearly dead. This is a sudden, unexpected death.
The son had no idea what could have killed her. It just really came as a shock to him.
Because she's only 53, and you shouldn't normally die at 53. NARRATOR: But the initial shock soon gives way to guilt,
as Justin wonders if he could have saved his mother had he only acted sooner. The one person who can answer that question now is Dr. G.
Cora's medical report begins with the mention of a common health concern. DR. JAN GARAVAGLIA: She's clearly
being treated for high blood pressure, which doesn't seem to be too bad, actually.
NARRATOR: But while the high blood pressure appears to have been under control, that was just the beginning
of Cora's problems. DR. JAN GARAVAGLIA: She smokes. Number one bad thing you can do to decrease your longevity.
She's obese. That's the number two thing that you can do to yourself that's going to decrease your longevity.
And she drinks. She drinks a lot of beer and a lot of liquor. NARRATOR: All these factors can contribute to heart
disease, stroke, even diabetes. But Dr. G is equally concerned about a strange symptom
that emerged the day before Cora died. Her son said she complained just out of the blue of this stabbing eye pain,
and then it went away. NARRATOR: At the time, Justin and his mother simply brushed it off as a harmless event,
but now Dr. G wonders if this stabbing pain could have been a harbinger of something far more serious.
DR. JAN GARAVAGLIA: You know, I wonder is that perhaps kind of, you know, pre-stroke kind of symptomatology?
NARRATOR: Only the autopsy can see for sure. This case could really be anything.
[MUSIC PLAYING] NARRATOR: Dr. G begins the external exam with Cora's face, and here she gets her first real clue.
She's got frothy fluid coming out of her mouth, and she's got frothy fluid coming out of her nose.
That's worrisome. NARRATOR: This is typically an indication of pulmonary edema, an accumulation of fluid in the lungs that can flood
the respiratory passageways. Dr. G sees it often in cases of drug overdose or heart failure,
but given Cora's symptoms, there's another possibility that seems to make more sense.
DR. JAN GARAVAGLIA: We see that when something happens in your brain, like a stroke--
mind, she'd had some type of pain behind the eye just, you know, a day earlier that she clearly was complaining about.
NARRATOR: But as Dr. G shifts focus to Cora's torso and lower body, a frightening new possibility
arises, trauma. She's got a few bruises on her, about four bruises on her leg. A couple on her arm.
Even one on her abdomen. That's not normal. So it'll be interesting to do this autopsy.
These are the kind I like. [MUSIC PLAYING] NARRATOR: 53-year-old Cora Bailey was found dead by her son, Justin, yesterday afternoon.
She had suffered a mysterious pain only a day before her death, and now he feels he may be to blame.
You know, the son is wracked with guilt because he didn't check on his mom sooner.
NARRATOR: The pain may have been an early warning sign of a stroke, but the external exam
has brought another disturbing possibility to the forefront. DR. JAN GARAVAGLIA: We do see multiple bruises on her body.
I'm worried that she may have fell and hit her head. We see those bruises a lot in our alcoholics
that come through here. Sometimes it's because their liver isn't making enough clotting factor.
They tend to bleed a little more readily. They tend to fall more easily when they're intoxicated.
She's probably stumbling around when she's intoxicated, and certainly falling and hitting her head
is another possibility. Oftentimes the alcoholics already have somewhat of a shrunken brain,
and there's a little more room in there for the subdural to develop. NARRATOR: And possible cranial trauma
points her in one direction. I think we'll go to the head first. [MUSIC PLAYING]
All right, now. NARRATOR: Dr. G begins by palpating Cora's skull for any abnormalities.
DR. JAN GARAVAGLIA: I'll feel that head for evidence of a contusion before I open it, but I
don't feel anything on her. But she has a nice head of hair, and I may be missing it.
So I will go ahead and reflect the scalp off of the calvarium-- off the bone, off the skull,
and look for bruising. Good, good, good. And I really don't see anything. NARRATOR: Then, Dr. G's morgue tech, Sandy Ludwig,
uses an oscillating saw to open Cora's skull. We start to cut the calvarium off,
and my tech is having a hard time getting through the skull. [SAW BUZZING] NARRATOR: Finally, the skull cap is removed.
But before she can examine the brain for trauma, something about Cora's skull itself catches her attention.
DR. JAN GARAVAGLIA: Normally, you know, the skull is very smooth on the inside, but on this the inside was very thick and lumpy, bumpy.
Very irregular bone. NARRATOR: Dr. G immediately recognizes this as a telltale sign of a bone disorder
called Paget's disease. DR. JAN GARAVAGLIA: Paget's disease is an abnormality in the bone.
It is caused by an imbalance of the renewing of our bones. Our bones are living things.
They are constantly cells dying and cells replacing them. What happens is the cells start to die in an accelerated rate,
but the replacement bone tends to get over exuberant and try to build up new bone very quickly.
And then that starts taking over. And you get a lot of irregular bony buildup. NARRATOR: The disease can develop
in any bone in the body, and usually causes aches similar to arthritis. A lot of times we get a Paget's in the spine, which
can be painful. And in this case, the exuberant bone growth was occurring in her skull.
Now, this is a bad place for Paget's. In the skull it causes a lot of problems, because we have a lot of nerves coming up.
And if you've got exuberant bone growth, they can impinge on some of these nerves.
That bone that was pressing against the cerebral hemisphere, you could kind of see that indentation.
NARRATOR: This leads Dr. G to her first conclusion. DR. JAN GARAVAGLIA: So Paget's disease
could probably explain why she was having some eye pain, possibly. NARRATOR: But while it might account for Cora's pain,
Paget's is rarely life threatening. And from looking at the surface of Cora's brain,
Dr. G believes the condition caused no fatal damage. DR. JAN GARAVAGLIA: So at this point,
it doesn't really explain her death. NARRATOR: In fact, there doesn't seem to be any damage at all, which leads
Dr. G to her next conclusion. We've ruled out trauma to her head. NARRATOR: She then dissects the brain, looking
for evidence of a stroke. There's really nothing here. Her brain itself looked OK.
I don't see evidence of anything that would have caused her death. Everything looks good.
We've ruled out a stroke. NARRATOR: What's more, with no brain trauma and no stroke,
Dr. G can't yet make sense of an earlier finding. So after I do the cranial exam, we
can rule out the brain was not the cause of her pulmonary edema. [MUSIC PLAYING]
Suddenly, Dr. G finds herself back at square one. Hopefully the answers are going to be
found in the internal exam. [MUSIC PLAYING] DR. JAN GARAVAGLIA: Well, during my Y incision,
I don't see anything out of place. From here, I will go ahead and take off the chest plate,
and I'll turn my attention to the heart and lungs. NARRATOR: She first removes the lungs
by slicing through the vascular and bronchial connections. Yeah, there's certainly a lot of fat everywhere.
NARRATOR: Right away, she can tell something is terribly wrong. You can squeeze the lungs and get
that frothy fluid coming out. Definitely pulmonary edema. All right. NARRATOR: While there are many causes of pulmonary edema,
one suspect immediately comes to mind. DR. JAN GARAVAGLIA: We see that with congestive heart failure.
When the heart can't beat strong enough and the fluid starts backing up into the lungs.
NARRATOR: She slices open the pericardial sac and gets her first look at the heart.
It's a big heart. It's enlarged, not just by weight. It weighs a little bit heavier than we normally have.
But what's really remarkable about this heart, is that it's very dilated. So it's almost like filling up a balloon out.
A big (BREATHES IN) and we've blown it up. NARRATOR: This is a condition known as dilated cardiomyopathy, a type of heart disease
in which the organ expands, weakening its ability to pump. It's the third most common cause of heart failure
in the United States, with 500,000 new cases diagnosed each year. As soon as I see her heart in conjunction
with that pulmonary edema, I know this is why she died. She's dying of some type of congestive heart failure.
NARRATOR: But this autopsy isn't over. For Dr. G, key piece of the puzzle is still missing.
Well, you know, I could just say she's got a cardiomyopathy and leave it at that.
That's good enough for the death certificate-- she died of congestive heart failure and dilated heart,
but why? We know her mechanism of death, but we still need to put it all together with the reason why.
NARRATOR: And it's not just Dr. G who needs to know. If Cora's suffered from a fatal genetic condition,
Justin could also be at risk. DR. JAN GARAVAGLIA: Many a time that I'll do an autopsy
and something unexpectedly genetic is found out that will have ramifications to future generations.
[MUSIC PLAYING] NARRATOR: Dr. G is on the hunt for what could have caused a cardiomyopathy that
killed 53-year-old Cora Bailey. This condition can be hereditary, and if that's in fact the case here,
her son Justin may suffer from it as well. Some of these things are genetic. I see myself as their love one's last physician,
and it's part of my responsibility to explain why they died to them. Giving them a knowledge of why they died
helps them understand why their loved one died, and it may have some implications for the family
if it's congenital. So it really is our due diligence to look for the underlying cause of death.
NARRATOR: Dr. G will have to examine the heart tissue under the microscope for any abnormality that
might explain what caused Cora's cardiomyopathy. She takes tissue samples to be sent to the lab,
but it will take weeks for slides to come back. But before she finishes examining the heart,
she looks for one more possible cause of the cardiomyopathy-- coronary artery disease.
She looks at the vessels by dissecting Cora's heart. DR. JAN GARAVAGLIA: We have to look at the coronary arteries,
and I'm fully suspecting this is probably why she has this dilated heart, her coronary arteries.
And this ought to give some people who smoke and who are obese at least some hope,
her coronary arteries were clean. And there wasn't a bit of atherosclerosis in them.
NARRATOR: But there's still another very rare condition Dr. G must consider. Paget's-- a really widespread Paget's disease
could be a possibility. NARRATOR: Paget's could have caused Cora's dilated cardiomyopathy, because the heart must work
harder to send blood through the blood vessels in the abnormal bone. But this only happens in cases where the disease is severe.
To find out if the disease is widespread, she digs deeper to examine the spine, pelvis, and collarbone,
and arrives at a disappointing conclusion. It doesn't appear she's got Paget's disease,
though, bad enough to have caused her congestive heart failure. So our last hope for a definitive answer
would be the microscopics. [MUSIC PLAYING] NARRATOR: It's late on a Friday, and Dr. G finally
receives the microscopic slides of Cora Bailey's heart tissue. Let's see here. NARRATOR: Immediately, she examines the samples
for anything that might provide a clue about what caused Cora's heart failure, but finds none.
It's a frustrating turn in the investigation. DR. JAN GARAVAGLIA: I've ruled out the things we can rule out,
and we're left with an I don't know cardiomyopathy that's caused her heart muscle to dilate.
NARRATOR: But as Dr. G begins her draft of the autopsy report, she revisits the details
of the case one by one, and it isn't long before the findings reveal a distinct pattern.
With this last piece of the puzzle in place, Dr. G can finally confirm exactly how and why Cora Bailey died at the relatively young age of 53.
DR. JAN GARAVAGLIA: Well, this is something that just didn't occur that night. [MUSIC PLAYING]
NARRATOR: It's a balmy Sunday evening in Florida, and Cora Bailey is at home enjoying
the final hours of the weekend. Little does she know, they're also the final hours of her life.
Unbeknownst to anyone, Cora is dying from heart failure, and Dr. G now knows why.
DR. JAN GARAVAGLIA: I suspect that ultimately she died at 53 not because of her inheriting something wrong,
but what she did to her body and not taking care of herself. She's got a lot of bad habits.
She smokes. She has high blood pressure. She is obese, which in and of itself is a strain on the heart.
And she certainly has chronic alcohol abuse, which is injurious to the heart muscle itself.
NARRATOR: All of these things together take a catastrophic toll on Cora's heart.
Her heart is under a lot of pressure, and over time there is enough damage that it will start to dilate.
NARRATOR: The heart gradually experiences more and more difficulty pumping out enough blood with every beat.
And the buildup of blood stretches and weakens the walls of the muscle even further.
The heart can't maintain its shape anymore, and then that sets up a whole cascade, because if you're not
pumping enough blood, the pressure start building up, and the fluid part of the blood started going into the lungs.
NARRATOR: As the night wears on, Cora has a hard time breathing lying down flat in her bed,
so she moves to the couch. The fact that we find her sitting is probably very important, because oftentimes when
the fluid starts to build up in the lungs, people cannot lay down. It makes them feel like they're asphyxiating.
They can't catch their breath because of that fluid, so they need to sit up to sleep.
And that appears what she was doing. NARRATOR: But sitting up is of little help.
Filled with fluid, Cora's lungs can no longer deliver fresh oxygen to the rest of her body.
DR. JAN GARAVAGLIA: And eventually the heart probably goes into an arrhythmia, and then she dies
[MUSIC PLAYING] NARRATOR: Cora's son, Justin, is stunned to learn that his mother's premature death was a direct result
of her lifestyle, but he's also relieved to know that there was nothing he could have done that day
to stop the domino effect brought on by a lifetime of bad habits. It was clearly a preventable death,
but the only one who could have stopped it was Cora herself. When I talk to them and explain
that some of her choices in life, like her obesity or hypertension, her chronic alcoholism, they connect the dots then
and see that she wasn't as well on the inside as they thought she was. I think a lot of people don't appreciate what bad habits can
do to your body, and I don't think they see sometimes the connection between the habit
and the disease. That's something I see every day in the morgue. [MUSIC - ABE QUIGLEY, "SOLOMON'S MINE"]
(SINGING) I found a home here in Soloman's mine.

A teacher excuses himself for a nap after dinner, but he never wakes up. The man has a complex medical history that leads Dr. G on a hunt for an explanation to his mysterious death.

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

Brief Summary

Dr. G investigates the deaths of Jeremy Weinberg and Cora Bailey, revealing the impact of obesity and lifestyle choices on health outcomes.

Key points

A Mysterious Death. A man takes a nap and never wakes up, leaving his family in shock.
Dr. G's Sixth Sense. When clues don't add up, Dr. G trusts her instincts to find the truth.
The Deadly Combination. Jeremy's toxicology reveals a dangerous mix of medications that led to his demise.
The Shocking Truth. Jeremy's death is revealed to be caused by a combination of obesity and drug use.
Cora's Sudden Death. Cora Bailey, only 53, is found unresponsive by her son, Justin.
Dr. G's Investigation. Dr. Jan Garavaglia examines Cora's body to uncover the cause of death.

Episode highlights

Episode quotes

A man takes a nap and never wakes up.

NARRATOR introduces the story of Jeremy's sudden death.

0:18WatchJun 17, 2021

Tension

75/ 100High tension

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