Dr. G: Medical Examiner - Season 5, Episode 14 - Lethal Intake - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A young man dies unexpectedly after eating a fish sandwich.
What went on between the fish sandwich and the next morning? NARRATOR: And as Dr. G puts the pieces together,
all signs point to a bizarre case of food poisoning. To die from it would be very unusual.
But we see the unusual here. NARRATOR: And then a woman is killed in a tragic car accident.
That oncoming car was a drunk driver. NARRATOR: But Dr. G knows there may be more to this accident
than meets the eye. I can't just put down car accident, cause of death, here. How did this happen?
NARRATOR: Altered lives, baffling medical mysteries, shocking revelations. These are the everyday cases of Dr. G, medical examiner.
It's been a grueling week for chief medical examiner, Dr. Jan Garavaglia. She's seen more than her fair share of trauma and tragedy.
There's a little baby, got run over by a golf cart. NARRATOR: But now, Dr. G is off duty and on her way
to a relaxing dinner with her husband at one of her favorite restaurants. But during the course of the meal,
something goes seriously wrong. I was eating fish at a very nice restaurant. And I started to actually have some swelling in my face,
and I was getting a little bit of a problem with breathing. I said, I think something's happening to me.
I was afraid I was going to die because it just came on so suddenly. NARRATOR: That evening, Dr. G suffers from a frightening bout
of food poisoning. She is one of many. Each year in the United States, there are a staggering 76 million reported
cases of food poisoning. And of those, approximately 5,000 result in death. I was one of those 76 million cases that year that suffered
some type of ill effect from food, but I certainly didn't die from it. NARRATOR: Unfortunately, Dr. G's next case may not be so lucky.
It's 3:00 PM on a warm afternoon in May, but 29-year-old Hector Nolasco is spending it inside suffering from extreme nausea
and vomiting. He's been sick for three days now, and Hector's symptoms are showing no signs of letting up.
He was continually vomiting, to the point where the sister was a little worried and spent the night with him.
The following morning, Hector's sister Layla is in the kitchen making breakfast when she hears a strange noise.
She runs upstairs and he had collapsed while vomiting into the trash can. She immediately calls 911.
NARRATOR: Within minutes, the paramedic team arrives on the scene. JAN GARAVAGLIA: They take him to the hospital.
They try to resuscitate him, but it's too late. NARRATOR: Hector Nolasco is pronounced
dead in the ER, just three weeks shy of his 30th birthday. Now, it's up to Dr. G to figure out
exactly how and why he died. OK, I got to get my act here. These two are working and I got to catch up with 'em.
NARRATOR: Dr. G's first step is to review Hector's somewhat slim case file. He's a 29-year-old fellow.
He's an architect, no known medical history, and according to his sister Layla, Hector was in perfect health.
JAN GARAVAGLIA: She said he didn't use illicit drugs, didn't smoke. Seemed to live a very healthy lifestyle.
NARRATOR: But then, Layla reveals a surprising detail that sheds new light on the investigation.
Hector believed he knew what made him so sick. What happened is that he had a fish sandwich
about four days prior to death. After that, he started having vomiting and abdominal pain,
he's pretty sure that the fish sandwich gave him some type of food poisoning. NARRATOR: In fact, Hector's abdominal pain
becomes so severe, that within 48 hours of eating the fish, he schedules an emergency appointment with his doctor.
He had told the doctor he had fish poisoning and the doctor was treating him. NARRATOR: But just two days later, Hector is dead.
Initially, Dr. G is skeptical of Hector self-diagnosis. Just because he went into the doctor
and said I have food poisoning, and the doctor believes him, doesn't mean I'm going to believe him.
NARRATOR: Truth is, deaths from fish-related poisonings are rare in the United States, especially in healthy adults.
But Dr. G does have cause for alarm. Two months earlier, a health alert from the FDA,
the Food and Drug Administration, came across her desk. It warned of a ciguatera outbreak
among people who had eaten toxic fish caught in the northern Gulf of Mexico. Well, we're in Florida.
You know, we're part of the Gulf of Mexico. So it did pique my interest. Maybe he could have one of those rare cases
of ciguatera poisoning. NARRATOR: But despite her 21 years of work in the morgue,
Dr. G has had little experience with this rare type of food poisoning. Luckily, she has the perfect teacher on hand.
An infectious disease specialist named Dr. Mark Wallace, who also happens to be her husband.
JAN GARAVAGLIA: Oh, I love worry with Mark. You know, you just bounce things off of him.
By trying to [INAUDIBLE]---- so when I got word that I had a possible food poisoning in the morgue, well, he's the first
person I turned to. And I mean literally turned, because we drive to work together.
Mark what do you know about food poisoning? Oh, by George, I just gave a lecture on fish food poisoning.
I don't know have that in my knowledge base. Yeah, we can look it up. OK. He's very helpful, besides being sweet.
Ciguatera is a serious illness, and it occurs when people eat grouper, or jacks,
or barracuda, in particular. Those reef fish can be contaminated with this toxin.
And when people ingest this, they can get very sick. NARRATOR: In fact, people suffering from ciguatera often
experience the exact same symptoms as Hector. Nausea, vomiting, and abdominal pain.
But there can also be strange neurological side effects. People can describe all sorts of weird neurologic things.
When they touch things that are cold, they think they're hot, or vice versa. They think that their teeth are loose and about to fall out.
NARRATOR: The mechanism of death with ciguatera is either cardiac or respiratory failure.
People either stop breathing due to profound weakness, or the toxin can actually depress
the function of the heart and they can have heart failure. NARRATOR: But there's one problem with the diagnosis.
Ciguatera is rarely fatal. It's thought that about one in 1,000 people who get ciguatera
die from it. JAN GARAVAGLIA: To die from it would be very unusual, but we see the unusual here.
I love it when we have weird things in the morgue. NARRATOR: Still, Dr. G knows that there's a lot more
at stake here than cracking the mystery behind a sudden, unexplained death. Bottom line, if Hector died from Ciguatera poisoning,
a whole lot of people could be at risk. If it is food poisoning and he got it from that restaurant,
that restaurant needs to know and the health department needs to know. Now, Dr. G's first priority is to identify
the exact type of fish Hector ate, and test it. Oh yeah, it's absolutely. NARRATOR: To that end, she wastes
no time enlisting the help of the county health department. We went ahead and asked them, could you
check and figure out what kind of fish it was for us? NARRATOR: In the meantime, Dr. G and her team prep
Hector for the external exam, to see what clues can be gathered directly from his body.
I can't wait to do the autopsy and see what I find. So when I look at him, He certainly
looks like he was healthy. NARRATOR: Dr. G's first step is to examine Hector's face and mouth.
Oh, bad, huh. NARRATOR: Immediately, she notices a contusion on his upper forehand.
Look at that. Did you take a facial that time? His face has a bruise-- Yeah, let's get it.
Right there? --which I'm assuming is when he fell onto the trash can, which he was vomiting in.
That's not a pleasant way to die. - [INAUDIBLE]. - No. Let me see his mouth first.
Hold on. And his oral cavity has some bite marks to the lips. Oftentimes, I'll see that from resuscitation,
pressing the lips onto the teeth. Boy, whoever did CPR on him really did it aggressively.
All right. NARRATOR: But it isn't long before Dr. G discovers something highly unusual.
Oh, gosh. NARRATOR: Something that could change the entire course of the investigation.
I can't sit there and worry about what the ramifications are. I have to focus on getting the answer.
That's my job and that's why I do it. [MUSIC PLAYING] NARRATOR: Dr. G is carefully examining the body
of 29-year-old Hector Nolasco, whose family believes that he was a victim of fish-related food poisoning.
And with a recent alert from the FDA about a ciguatera outbreak, Dr. G could have a potential health scare on her hands.
We have a lot of people just standing by to get some things in motion. Health department, his family.
They want to know why he died. NARRATOR: But in the morgue, assumptions can be dangerous.
One mistake you make in forensics is you come up with a hypothesis, and then you kind of blind yourself
to any other possibilities. You have to keep your options open. Maybe he has something else wrong with him.
Maybe he's got an infection in his belly, maybe he's got something wrong with his bowels.
There's maybes, maybes, maybes, and I can't be blindsided by, he thinks he's got food poisoning.
You get the sides of the neck, to? NARRATOR: Sure enough, just as Dr. G's wrapping up the external exam, she spots something
completely unexpected. Oh, what was that? His hands have classic clubbing of the distal aspects
of the fingers. And the nail is kind of curved upward, then you get a bulbous appearance.
NARRATOR: The physical finding of clubbed fingers is nonspecific. It can indicate anything from heart and lung disease,
to some forms of cancer. But the deformity, along with Hector's symptoms, raises a possibility that Dr. G had not previously considered.
I'm wondering if this guy has Crohn's disease. NARRATOR: Crohn's is a debilitating autoimmune disease
in which the body's immune system literally attacks the gastrointestinal tract. He does have clubbing and that is
associated with Crohn's disease, which is associated with abdominal pain. So that'll be interesting to look for.
All right, let me take your picture. NARRATOR: Although Hector had no history of chronic illness,
and the disease is rarely fatal, Crohn's is a definite possibility. But considering the recent FDA alert,
ciguatera is still high on Dr. G's list of suspects. JAN GARAVAGLIA: So at this point,
we're just kind of putting the building blocks together of what I'm finding. NARRATOR: Dr. G begins the internal exam
by performing the standard y incision, fully revealing the internal organs. Let's see what we have here.
NARRATOR: And immediately, she spots something amiss. JAN GARAVAGLIA: Wow, look at that.
I see that he's got about 400 CC's of a amber color fluid collected in his abdominal cavity.
NARRATOR: 400 CC's Is a significant amount of fluid, almost two cups worth. So that's our first hint that something's wrong.
NARRATOR: Dr. G goes on to discover more of this fluid in Hector's pleural space,
the body cavity that contains the lungs. But in order to determine what caused the strange buildup
of fluids in the first place, she'll need to take a closer look at Hector's heart and lungs.
JAN GARAVAGLIA: Heart looks good. It's nice to see a normal heart, and he had one.
NARRATOR: And the lungs, though heavy with fluid, do not look especially disease or infected.
There's many things that can cause fluid. So it's a nonspecific finding, but he's certainly ill.
NARRATOR: And given Hector's symptoms of stomach pain and nausea, she wastes no time zeroing
in on the abdominal cavity. Immediately, you can see there's something wrong in the abdomen.
He's got reddening of the mesenterial of the tissues that hold the bowel. It's inflamed.
And there's little patchy areas of little necrosis, little pieces, areas of fat just appear to be dying.
NARRATOR: This discovery only furthers Dr. G's theory that Hector indeed suffered from Crohn's disease
because Crohn's causes inflammation in the bowel wall, which can lead to perforations, or tears,
ultimately damaging the mesentery. JAN GARAVAGLIA: Oh, what else we got going on here.
NARRATOR: But to find out for sure, she must examine all 25 feet of Hector's bowels.
I need to still look at those bowels. And you got something for me to put them in?
NARRATOR: The bowel examination is a standard step in most autopsies, but it's not a popular one.
JAN GARAVAGLIA: Well, it's never fun to have to open the entire bowel. It's not something my techs like to do.
In fact, I know they dislike it so much that I usually open it myself, because I
know what I'm looking for. NARRATOR: Yet despite an exhaustive inspection, the initial findings are disappointing.
There's really nothing here. His bowels look completely normal on the inside. Nothing out of the ordinary.
Everything looks good. NARRATOR: At this point, Dr. G still doesn't know what caused the inflammation to the mesentery.
But she can now be certain of one thing. He had absolutely no evidence of Crohn's.
NARRATOR: But if Hector didn't suffer from Crohn's, what caused his clubbed fingers?
Most likely, the clubbing of his fingers is probably just inherited. If I looked at the father, probably his father has it to.
NARRATOR: Then, just as Dr. G is ruling out the Crohn's theory, the autopsy is interrupted by her Chief Medical Investigator,
Steve Hansen. I do get word that the health department contacted the restaurant and the type of fish
that they use for the sandwich was tilapia. NARRATOR: Tilapia is a freshwater fish,
and is not associated with ciguatera. JAN GARAVAGLIA: It had nothing to do with the type of fish
that you get ciguatera poisoning with. I still think ciguatera poisoning was an interesting red herring, and I'm almost
disappointed it wasn't. NARRATOR: But if neither food poisoning nor Crohn's disease
killed Hector, what did? Dr. G suspects the answer may lie in one of the organs underneath the inflamed mesentery.
This is an area where your stomach is, where your lower portion of your liver is, and beneath
that is where your pancreas is. One-by-one she carefully examines each organ, and it isn't long before Dr. G uncovers a shocking new clue.
Oh, look at that. Not what I expected, but that could clearly explain everything.
[MUSIC PLAYING] JAN GARAVAGLIA: All right, back to the case at hand. Dr. G has just discovered a serious problem embedded
deep within the abdominal cavity of 29-year-old Hector Nolasco. Oh my god, look at that.
The pancreas doesn't look good. So I take the pancreas out, and it's clearly inflamed.
I've never seen it that bad. That pancreas was bad looking. That was an inflamed, dead pancreas.
NARRATOR: There's no question Dr. G has found her culprit. It's clearly an acute pancreatitis.
You know, most people, when they get pancreatitis, it's usually mild and they get over it.
It's painful, it's uncomfortable, but they get over it. NARRATOR: But in Hector's case, the damage to his pancreas
was so extensive that death was inevitable. Still, there's a fundamental question left unanswered.
I wanted to know why. Why did he get the pancreatitis? NARRATOR: One of the main causes of acute pancreatitis
is gallstones. Gallstones are hard, pebble-like particles that form in the gallbladder.
However, if they're flushed out of the gallbladder and obstruct the pancreatic duct,
they can potentially block the pancreas' release of digestive enzymes, with fatal results.
You block that pancreatic duct, and then you have a build up of pressure. And those enzymes start breaking down that tissue.
That's why your pancreas gets inflamed, because it's getting basically digested inside of you.
NARRATOR: But there's one problem. During Hector's autopsy, Dr. G failed to find a single gallstone.
He had absolutely no evidence of gallstones. NARRATOR: The second most common cause of pancreatitis
is alcohol. But once again, Hector Nolasco appears to be an unlikely candidate. I have no history that he drank at all.
As far as I know, he gets the fish, he gets sick, he goes home. What went on between the fish sandwich and the next morning
when he really started vomiting. NARRATOR: Now Dr. G wonders if Hector may be one of a small percentage of people
in which the cause of acute pancreatitis is simply unknown. At a standstill, she reaches out again to the person who knew
Hector best, his sister Layla. I talked to the sister, you know, she's devastated.
This is a guy that they all looked up to in the family. He had a bright future ahead of him.
NARRATOR: But then , Layla reveals a surprising detail about her brother. For Dr. G, it's the missing link.
And now, she can finally piece together the last moments of Hector Nolasco's all too-brief life.
Four days prior to his sudden death, Hector orders a fish sandwich while out to lunch with a friend.
But their day of fun doesn't end there. After eating that fish, he actually went out with his friend and they went to multiple bars.
NARRATOR: According to his sister, Hector was not a habitual drinker. But that evening, he makes an exception.
JAN GARAVAGLIA: You don't know how much he drank, but he was possibly binging that night.
He goes home, sleeps it off, and in the morning he is not feeling well. He's vomiting, he has abdominal pain.
He thinks that it's just the food poisoning. NARRATOR: But Hector does not have food poisoning.
Instead, he's developed acute pancreatitis. Although it's unusual for just one binge
to cause pancreatitis, it's not unheard of. Nobody really knows why some people with alcohol use get pancreatitis
and some people don't. This guy drank a lot less than most people, most college students, probably that night.
And yet, he got pancreatitis. NARRATOR: Unfortunately, it isn't long before Hector's pancreas becomes severely inflamed,
triggering tremendous abdominal pain. JAN GARAVAGLIA: The cells of his pancreas are actually breaking down and dying.
That's making him very nauseated. Now, the biggest part of the pancreas is the formation of digestive juices
that then help digest food. NARRATOR: These acidic juices proceed to leak out of the pancreas, and literally
begin digesting the fat in Hector's abdominal cavity. Now, if it's digesting food in your bowel,
think what it could do to the fat in your abdomen. And that's exactly what was happening.
It was starting to actually digest and break down the fat. That's all those little white spots
and inflammation and reddening that I see going on in the abdominal cavity. NARRATOR: Misdiagnosed as food poisoning, Hector's
pancreatitis goes undetected. Eventually, his pancreas dies, setting into motion
a deadly chain of events. You have dead tissue inside your abdomen, you don't do well.
It's actually causing organ failure. His heart's not working as well, his kidneys probably
aren't working, as well. His vessels are starting to leak. NARRATOR: Fluid rapidly begins to collect
in his abdominal and pleural cavities. And he collapses. NARRATOR: Incredibly, the man who came in
as a possible victim of a rare fish toxin is leaving as the casualty of something far different.
It's a sad end to a young, vibrant life, that came much too soon for the loved ones he left behind.
The family couldn't believe it at first. They all bought into it that it's food poisoning.
But the facts don't lie, we have the culprit, and the culprit's pancreatitis. NARRATOR: But there is some consolation.
Hector's death may hold an important message for his sister. But when I asked his sister if there was anybody else
in the family that had pancreatitis, or died of pancreatitis, and she knew of no one.
It may not be hereditary, but some people seem to be more predisposed to it than others,
and he must have been. So maybe she is predisposed, and it gives her something to think about if she's going
to drink a lot of alcohol. It may be-- for her, it wouldn't be the best thing. NARRATOR: In the end, Dr. G knows
that had Hector's condition been identified earlier, it's possible that his fatal pancreatitis
could have been prevented. JAN GARAVAGLIA: It's a shame the doctor didn't pick up on it.
I mean, that's one of the problems with having that kind of tunnel vision. He comes in, he says he has food poisoning
and the doctor treats him for food poisoning. I don't think the doctor made a mistake.
The only thing he didn't pick up on is how bad his pain was, because his pain was really
out of proportion for food poisoning, but very common for pancreatitis. JAN GARVAGLIA: OK, you tried.
Thank you. NARRATOR: After 20 years of performing autopsies, Dr. G has seen her share of natural disease and the tragedy
it can leave in its wake. But when it comes to sudden deaths, there are few more overwhelming than the traffic
fatalities that have been arriving at her morgue almost nonstop since the day she first walked through its doors.
When you work in a morgue and you see, almost daily, somebody dying from a car accident.
That's a lot of people. [MUSIC PLAYING] NARRATOR: As Chief Medical Examiner of the district 9
morgue in Florida, Dr. Jan Garavaglia is all too familiar with the dangers of driving.
JAN GARAVAGLIA: It's typical for us on a weekend to have an automobile case. NARRATOR: And now that her youngest son's
approaching driving age, that insight is hitting very close to home. It's a year and a half till he gets his permit.
I'm already dreading it. Dreading it. So I was telling him today about how dangerous it
is for young men to get their license because the statistics of them having an accident their first year is
just extraordinarily high. And I go, I just love you too much for you to get hurt.
And he just grabs my hand and squeezes it. Aww. He goes, I won't, mom. NARRATOR: But Dr. G still has good reason to worry.
JAN GARAVAGLIA: In district 9, we see 300 car accidents a year. And that's about 18% of my workload, which is quite a lot.
NARRATOR: Sadly, her next case is another such victim. A 42-year-old woman named Betsy Trumbell.
JAN GARAVAGLIA: So we have a white female who, yesterday, didn't know she was going to be in our morgue.
Who today is in my morgue. According to the investigators report, Betsy, a nurse at a local hospital, is on her way home
after a busy shift when her routine commute takes a sudden and tragic turn. She was trying to make a left hand turn,
and in that split second, she gets hit by another vehicle. The driver of the other vehicle is a 39-year-old man
named Charlie Wilcox. He's injured, but remains conscious and manages to call 911.
When paramedics arrive, they find Betsy in her mangled car, barely clinging to life.
On the way to the hospital, they work desperately to keep her alive. But she pretty much was dead by the time they got there.
NARRATOR: It then falls to highway patrol investigator, Robert Blackwell, to deliver the devastating news
to Betsy's parents. The fatalities are very very emotional, but our job is to tell family members that their family
members have died. It's hard, a lot of times, to deal with the family's grief. NARRATOR: And their pain is only made worse when they learn
the circumstances of the crash. They did a breath test on the other driver. He had a 0.12.
That oncoming car was a drunk driver. I think, when you find out that your loved
one is killed by a drunk driver, I think your first response is anger. You immediately want to blame that drunk driver.
NARRATOR: Betsy's parents fully expect the driver to be charged and ultimately jailed for his actions,
but it's not that simple. And while it's clear Charlie was driving under the influence,
police can't just assume he's responsible for Betsy's death. State law specifically states that a driver
under the influence of alcohol has to cause or contribute to causing the crash. NARRATOR: That means if Betsy is deemed
to be the driver at fault, the drunk driver could walk away with nothing more than a DUI.
However, if there's no evidence to suggest she played a role in the crash, Charlie could be looking
at up to 15 years in prison. Each car accident is investigated to try to figure out what happened the best we can.
And when we look at the human factor, the autopsy is an integral part of that car
accident investigation. NARRATOR: In this autopsy, Dr. G has two main goals. First, figure out exactly what killed Betsy.
And second, search for anything that might suggest that Betsy herself was responsible for the crash.
One scenario she'll be paying particular attention to is whether a heart attack or some other medical event
could have caused her to lose control of the car. JAN GARAVAGLIA: When you look at natural disease
playing a role in the accident, it's usually fairly small. But it's something we still look at.
And also, she's on an antidepressant, and she's on a benzodiazepine, or an anti-anxiety medication.
Now, these are medications, if high enough, could certainly impair you. So we just will have to do complete autopsy
to really figure out if toxicology or natural disease played any role in causing the accident.
Okey dokey, let's go for it. That's her hand. NARRATOR: Right off the bat, it's obvious that the crash
took a toll on Betsy's body. When you look at her, she looks like she's been in a car accident.
Oh, gosh. She certainly has a lot of abrasions on her face, a laceration on her chin.
Oh, a bruise there. Very classic look for an automobile accident. Bruised arm. She's got contusions on her body,
she's got abrasions on the knees. She's got an obvious arm fracture on the right.
Where is that fracture? It's just right at the elbow, right? TECH: Yes. NARRATOR: Betsy's broken arm is especially typical of a crash.
We often see that with drivers. They tend to have the forearm fractures more so than passengers.
The theory is that they've grasped the steering wheel and locked there with their wrists,
and that causes the fracture. NARRATOR: But as Dr. G zeros in on Betsy's torso, she spots the most gruesome injury yet.
There's something's got to be going on there. I see a very extensive abrasion across the abdomen.
NARRATOR: And suddenly, she realizes the very thing that could have saved Betsy's life may have
actually been what killed her. Oh gosh, she's a mess. [MUSIC PLAYING] NARRATOR: Dr. G has just discovered
an enormous contusion across the abdomen of 42-year-old Betsy Trumbell, who was killed in a car accident
by a drunk driver just 24 hours earlier. She's got a very vivid, very prominent abrasion
across her abdomen, with a larger abrasion near her right hip. And then an abrasion that's over 12 inches
going across slightly diagonal on her lower abdomen. NARRATOR: And right away, she can tell that this injury
was caused by her seat belt. Mainly, a seat belt is designed to keep you from being ejected, slow your deceleration,
and it's designed to keep you from impacting things on the inside of the car. They clearly play a role in decreasing
the severity of the accident and keeping people alive. But occasionally, they do cause injury.
NARRATOR: And as she inspects Betsy's seat belt injury more closely, the telltale pattern
gives her a clue. She's got such a prominent abdominal abrasion, but not a shoulder strap abrasion.
Dr. Jean now knows that Betsy was wearing her belt incorrectly. Although the lap belt was on, clearly,
the sash was not in the proper position. ROBERT BLACKWELL: We've done studies on use of seat belts
here in Orange County and Osceola County, and roughly 60% to 68% of all motorists wear their seat belt.
I wouldn't have to say 5% to 10% of those that are wearing your seat belt don't wear it properly.
They'll wear it underneath their arm, they'll throw the shoulder harness back behind them.
If you're not wearing a shoulder harness at all, you could be thrown around inside the vehicle
and cause internal injuries. This can cause very severe internal injuries to your bowel, to the mesentery that hold the bowel,
and to your spine. But we're not going to know exactly what her internal injuries are by just looking at her externally,
we've got to go internal. So when I do my y incision, right off, I find injury. Uh-oh.
That seat belt injury actually cut the muscle, cut the subcutaneous fat, and ended
up tearing also the mesentery the tissues that hold the bowel. NARRATOR: But as Dr. G digs deeper,
the news only gets worse. Oh my. There's blood in her abdomen. Most likely, she's gone across the seat belt,
and the seat belt acted like a knife, cutting that abdomen completely in half and that caused the blood,
NARRATOR: With the help of her morgue tech, Dr. G ladles the blood out of her abdominal cavity.
It can be messy, especially if it's a traumatic injury. We just basically assist her by holding the pitcher there,
and we'll kind of shift around some organs and she'll ladel out the blood. We have a pitcher that actually has measuring
increments on it that'll tell us how many CC's of fluid is in there. NARRATOR: Dr. G measures 800 CC's.
JAN GARAVAGLIA: Not as much as I thought. NARRATOR: But she doesn't believe this blood loss
was enough to have killed her. OK. NARRATOR: Although the improperly worn seat belt
clearly inflicted significant damage, it doesn't appear to have caused Betsy's death.
But the exam is far from over. Let's see what's going on here. Often, very common in mobile accidents,
are tears to the liver, tears to the spleen. But miraculously enough, those are intact.
Next, NARRATOR: Dr. G turns her attention to Betsy's upper body, and right away, she spots trouble.
Oh my goodness. She's got 1,400 milliliters of blood in her pleural cavity. That's a lot of blood.
That is enough to kill her. Whatever caused that blood is really what caused her death.
So now, I have to figure out why does she have that. NARRATOR: Carefully, she inspects the chest organs,
searching for signs of injury. Like a puncture or tear that would explain the bleeding.
I look at her heart and I look at her heart sac, and that's still intact. I looked at both of the lungs both of the lungs are intact.
But then, just behind the heart and lungs, she finally spots the source of the fatal bleed.
KELLEY WOOD: Wow, look at that. She's got a transacted, or complete, tear to her aorta, the main blood vessel that pumps blood
to the rest of your body. This tear is right where the aortic arch becomes tethered to her spine.
If you decelerate quickly, your body will stop quickly, but the heart and the movable aorta
will keep moving until it rips off. NARRATOR: She now believes that because Betsy was not wearing
her shoulder strap, her upper body flew forward on impact, tearing the aorta. And with the body's largest blood vessel ripped open,
Betsy would have bled to death within minutes. This is clearly the cause of death,
and it's clearly due to the automobile accident. NARRATOR: Dr. G now knows exactly how Betsy died,
but there are still questions to be answered. First and foremost, could some type of natural disease,
like a heart attack or stroke, have caused Betsy to lose control of her car in the first place?
You know, occasionally, the medical condition of the driver plays a role in the accident.
So you always want to do the complete autopsy and make sure that something really bizarre hasn't happened.
ROBERT BLACKWELL: It's a fine line, but there's a lot of factors we need to take into consideration
just in a simple crash. Obviously, something went wrong. So what was happening at the time of the crash?
NARRATOR: To find out, Dr. G examines Betsy's organs one by one, searching for signs of natural disease.
JAN GARAVAGLIA: OK, let's see. NARRATOR: First, she dissects the heart, looking for evidence of a heart attack
or other problems that could have hindered Betsy's driving. JAN GARAVAGLIA: And I look very carefully.
I don't see any. NARRATOR: She now has only one more place to look, the head. Through my head, did she have a stroke, did she have a tumor,
did she have anything that would have caused her to not act correctly. Gently, she extracts the brain, searching for clues.
She doesn't have any skull fractures, and I don't see any contusions or bruising of the brain.
NARRATOR: She digs deeper, dissecting the organ for any abnormality or illness. But after a thorough inspection, she comes up empty handed.
I didn't find any natural disease. These negative findings suggest that Betsy was most likely in full control of her car when she crashed.
But before Dr. G can close the case, she has one last thing to check. JAN GARAVAGLIA: It could be some of the medications
she's taking. We know that she's on a benzodiazepine, which at high enough doses, can cause
you to be under the influence. We know she's on an antidepressant, and high enough levels could cause her to be sleepy.
The autopsy report truly isn't finished and will not go out until that toxicology is done.
[MUSIC PLAYING] NARRATOR: One long month after Betsy Trumbell's autopsy, toxicology results arrive from the lab.
So far, it seems that Charlie Wilcox, the drunk driver that hit her, is entirely at fault. If that evidence holds,
he could be looking at significant jail time for her death. But Dr. G must still confirm whether Betsy's medication
was a factor in the crash. Line-by-line, she begins reading through the report, and at first nothing seems amiss.
I don't find any benzodiazepine in our system. That didn't play a role. And her antidepressant was at a very low level.
NARRATOR: But as her eye move down the page, one unexpected finding stops her dead in her tracks.
I'm actually quite surprised. It's clearly the reason why she drove in front of the oncoming vehicle.
NARRATOR: And now, with all the facts laid bare, Dr. G can finally piece together this sequence
of events that culminated in this fatal, yet avoidable accident. It's late afternoon in Orlando, and Betsy
Trumbell is on her way home. But her driving is unsteady, and her judgment and coordination are impaired.
And based on the toxicology report, Dr. G now knows why. She has a blood alcohol level higher
than the guy that hit her. She's got a 0.16, that's twice the legal limit. Although the other guy was drunk, she's even drunker.
NARRATOR: This leads Dr. G to believe that on the day of her death, Betsy did not
go straight home after work. Most likely, she was out with friends and drinking.
She doesn't usually drink, but that night they were-- appear to be celebrating for whatever reason.
NARRATOR: Betsy consumes more alcohol than her body can process, and it isn't long before
her central nervous system begins to feel the effects. I mean, at a blood alcohol level of 0.16,
she's going to have some major problems with coordination. Some people, they can barely stand at that level.
Her perception, her judgment, is off. ROBERT BLACKWELL: She would have a loss of critical judgment,
impairment of memory, and comprehension. She's going to have a decreased sensory response.
NARRATOR: Highly intoxicated, Betsy makes a choice that's irresponsible and extremely dangerous.
She gets into the car and decides to drive drunk. A fatal mistake, very fatal mistake on her part.
NARRATOR: And then, the final coup de gras. When she gets into the car, she puts her belt on wrong.
Unprotected and very drunk, Betsy hits the road. All is fine until she gets to the fateful intersection.
In that split-second, she misjudged the car coming at her, cutting it a little too close, and gets
hit by the oncoming car. Her car stops with a sudden deceleration. Her pelvis is anchored, that belt cuts across her anterior
abdominal muscles. And then when her body slams against the dashboard or the steering wheel, the body stops,
but her heart and arch of the aorta keep moving forward. NARRATOR: At that moment, the aorta,
which is partially tethered to the spine, simply rips wide open. All the blood that's being pumped from the heart,
is going now into just your pleural cavity. And as your heart beats, the rest of your body
isn't getting any blood. Your blood pressure plummets. And by the time the paramedics got there,
there was already too much internal damage, too much bleeding, that anything could have been done.
Within several minutes, she's dead. NARRATOR: Dr. G reports her findings to the Florida Highway Patrol.
The forensic evidence clears the other driver of all charges except a DUI, and Betsy
is ruled the at-fault driver. I truly believe that the cause of the accident was because of her impairment in making this left hand turn.
NARRATOR: Then, she makes the difficult call to Betsy's parents. I called the family with the results,
and they were devastated. They knew she occasionally had a drink, but they didn't have any clue that she drank excess.
NARRATOR: It's a painful reality, and Dr. G can only hope that ultimately, the truth
will help them come to terms with their daughter's untimely death. I doubt that she died in a lot of pain.
That's always comforting to the family. [MUSIC - MIKE TESTAGROSSA] JAN GARAVAGLIA: You know, what's interesting about the family,
he still thanked me for the care I gave his daughter, the respect I gave her body,
and the way we treated her. And that was very nice. I mean, his worst time in his life,
he was still gracious enough to thank me for the care I gave his daughter.

A woman is killed in a drunk driving accident. At first, her death seems to be an open-and-shut case, but Dr. G discovers clues that the woman may have played a key role in her own death.

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

Brief Summary

Dr. G investigates food poisoning and a fatal car accident, revealing acute pancreatitis and the dangers of impaired driving.

Key points

A Young Man's Sudden Death. A young man dies unexpectedly after eating a fish sandwich, raising questions about food poisoning.
Dr. G's Frightening Experience. Dr. G suffers from food poisoning herself, highlighting the dangers of contaminated food.
The Mystery of Hector Nolasco. Dr. G investigates the sudden death of Hector Nolasco, who showed signs of severe illness.
The Shocking Diagnosis. Dr. G uncovers that Hector's death was due to acute pancreatitis, not food poisoning.
The Cause of Death. Dr. G discovers Betsy's fatal injury was caused by her improperly worn seat belt.
A Fatal Mistake. Betsy Trumbell's decision to drive drunk leads to a tragic accident.

Episode highlights

Episode quotes

I was afraid I was going to die because it just came on so suddenly.

Dr. G describes her frightening experience with food poisoning.

2:04WatchJun 17, 2021

Tension

75/ 100High tension

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