Dr. G: Medical Examiner - Season 5, Episode 16 - Deadly Silence - Full Episode | Forensic Files

[HEAVY MUSIC] [SUSPENSEFUL MUSIC] NARRATOR: A family vacation turns tragic when a beloved grandfather suddenly collapses.
Maybe he was feeling bad but didn't want to tell anybody because he didn't want to ruin their vacation.
NARRATOR: And things get complicated when his family objects to an autopsy. Honestly, at this point, I don't know what to think.
I got the family not wanting an autopsy on one side. But on the other hand, I've got 20 years of experience
saying this isn't adding up. NARRATOR: And then a seemingly healthy woman dies without warning.
[SIREN WAILING] It is truly a mystery that this 39-year-old perfectly healthy woman
just drops dead for no reason. NARRATOR: Now it's up to Dr. G to put the pieces of a very
unusual puzzle together. We got to dig a little deeper here. What's going on? [THEME MUSIC]
NARRATOR: Altered lives, baffling medical mysteries, shocking revelations-- these are the everyday cases of Dr. G, medical examiner.
[SOFT MUSIC] As chief medical examiner of the District Nine morgue in Florida, Dr. Jan Garavaglia's hours
are anything but 9 to 5. DR. G: It's a long holiday weekend, and I was actually expecting the worst today.
But it's still to come, I think. So only two today, but we're expecting more the rest of the weekend.
NARRATOR: One of the bodies in the morgue today is a retired schoolteacher from Arizona named Philip Greene.
DR. G: This is a 78-year-old man that's on vacation here. He's visiting his daughter who lives here.
NARRATOR: But little did Philip know this trip would be his last. [GENTLE MUSIC]
It's early afternoon on a Friday. And Philip, along with his wife, Nora, is enjoying the day with his daughter,
Mattie, and her two children. DR. G: They've been out doing a lot of errands, sightseeing.
They've supposedly been having a good time. [SUSPENSEFUL MUSIC] NARRATOR: But as they make their way
through a park in downtown Orlando, Philip takes a bad step and falls to the curb.
WOMAN 1: Oh my gosh. NARRATOR: Fortunately, the 78-year-old appears uninjured. WOMAN 1: Did you hurt your leg?
NARRATOR: But right away, he does complain of some abdominal pain. So Mattie and Nora insist he go home and at least try
to get some rest. DR. G: He went home to his daughter's house, didn't do much that evening.
NARRATOR: But as the hours pass, Philip begins to feel increasingly ill. He didn't seem well.
He seemed sick. He has abdominal pain. NARRATOR: Although Nora's concerned, Philip insists it's just a stomach bug
and that all he needs is a good night's sleep. But just as he's about to lie down,
the 78-year-old collapses to the floor unconscious. WOMAN 1: Oh my god. WOMAN 2: Phil?
They call 911. [SIREN WAILING] PARAMEDIC: Sir, can you hear me? DR. G: EMS immediately took him to the emergency room.
But they really couldn't revive him, and they pronounced him dead. [HEAVY MUSIC]
NARRATOR: The next morning, Phil's body arrives at the District Nine morgue. Now it's up to Dr. G to find out exactly why he died.
Except there's a problem. DR. G: The family clearly didn't want an autopsy. They didn't fill an autopsy was necessary.
And they cite religious objection. NARRATOR: In fact, the Greenes are devout Jehovah Witnesses
and do not believe in autopsies. And while there's no official church mandate against the procedure, Nora simply wants
her husband to rest in peace. [SUSPENSEFUL MUSIC] In an effort to honor her wishes,
Dr. G will now attempt to determine Phil's cause of death without performing an autopsy.
Not everybody that comes through my morgue has to be autopsied. If you have a known medical history, if you die in a way
that we would suspect with that history, we could sign that out, and it's not a problem.
We often do that for people who are visiting from out of town with very serious medical problems.
NARRATOR: With this in mind, Dr. G begins a careful review of Phil's medical records
and right away finds something that could explain his death. He's had a heart attack about five years ago.
When you look at the EMS sheet, they really suspected with his history that it was the heart attack.
NARRATOR: Each year in the US, an estimated 450,000 heart attack survivors suffer a repeat episode.
And what Phil thought was just a stomach ache may have very well been a symptom of another attack.
DR. G: Abdominal pain can go along with a heart attack. I have autopsied more than one person
who came in here with abdominal pain and ended up having a heart attack. NARRATOR: Based on this history, it
appears she may very well be able to honor the family's wishes and avoid a full autopsy.
And I thought, oh, good, I can sign this case out. NARRATOR: But just as she's about to close the book
on Philip Greene, a notation in the investigator's report catches her attention.
He never was quite right that evening. He has confusion and then mental status changes
where he's totally out of it. So it could be something just in his brain. [PHILIP GROANS]
NARRATOR: According to his wife, Philip's abdominal pain and confusion began immediately after his fall.
DR. G: That makes me worry. Maybe he has some type of blow to the abdomen that's causing problems.
[TENSE MUSIC] NARRATOR: Now with multiple suspects at hand, Dr. G is facing a tough dilemma.
DR. G: Honestly, at this point, I don't know what to think. I got the family not wanting an autopsy on one side.
I've got a history of heart disease. I got the hospital saying it's probably a heart attack.
But on the other hand, I've got 20 years of experience saying this isn't adding up.
The more I read, at least I want to look at him and see what's going on. [OMINOUS MUSIC]
He looks good. BRIAN MACHULSKI: Yeah. He really looks good. DR. G (VOICEOVER): For 78 years old, he looks great.
He looks younger than the stated age of 78, which is a wish of mine when I get to be 78.
[SUSPENSEFUL MUSIC] NARRATOR: Dr. G begins the external exam, searching for signs of head trauma.
But she doesn't see any overt cuts or palpable bumps that would suggest a serious injury.
All righty. Doesn't look so bad. NARRATOR: Next, she moves on to Phil's body. DR. G (VOICEOVER): And I notice that he does have some trauma.
He's got a big bruise on his arm, little scrape on his elbow, and a bruise and a scrape on his knee.
NARRATOR: But Dr. G quickly determines that the wounds are superficial and not in any way
life-threatening. DR. G (VOICEOVER): I mean, if he looks completely normal, there's nothing that looks odd, you know,
I'll think about signing him out. NARRATOR: But as Dr. G and her assistant, Brian Machulski,
remove what's left of Philip's clothing, she gets her first good look at his lower abdomen.
And right away, she's convinced that she won't be able to sign this case out after all.
I take his clothes off, his boxer shorts. And I'm not so sure the hospital noticed this.
This is no plain heart attack. [OMINOUS MUSIC] [SOFT MUSIC] NARRATOR: Dr. G has just made a shocking discovery
in the external exam of Philip Greene, a 78-year-old retired schoolteacher who died unexpectedly while visiting his family in Florida.
For religious reasons, his wife, Nora, is hoping to avoid an autopsy. And Dr. G has been doing her utmost to honor that request.
DR. G (VOICEOVER): We really tried to work with people who have true religious objections
to an autopsy. I have to have really good reasons to put the family through that.
NARRATOR: But this latest finding may throw the entire plan into question. Oh, gosh.
OK. DR. G (VOICEOVER): He's got a huge inguinal hernia. [HEAVY MUSIC] NARRATOR: An inguinal hernia occurs when a part of the bowel
protrudes through a weak point in the lower abdominal wall. Usually, it's absolutely a benign.
I mean, it's usually not a problem. NARRATOR: But in Phil's case, Dr. G can see that the skin surrounding
Phil's groin and lower abdomen has become discolored. DR. G: It's red on the left side,
and there's redness on his abdomen coming up from his scrotal sac. I mean, something's going on here.
[TENSE MUSIC] NARRATOR: At this point, only one thing is clear. Dr. G must proceed with the full autopsy.
I do not feel comfortable signing this case out, not at all. So I have to talk to the family.
And so I call them up, and we talk about it. NORA: Yes, this is Nora. DR. G: We talk about the pros and cons of never knowing
why their loved one died. We talk about the problems with things that you can find out for other family members,
you know, inherited things. So we just talk about the whole gamut of the information
you can get from an autopsy. And don't they really want to know why he died? She's said that Dad passed away--
NARRATOR: It's not an easy call for either Mattie or Nora to make. But ultimately, they decide to put their trust in Dr. G.
They fully understood and actually wanted the autopsy by the time I got done talking to 'em.
DR. G: So we've got him ready to go. If I can get the answer to the head and it's a clear-cut answer, I may not have
to do the rest of the autopsy. [TENSE MUSIC] So I start at the head. You ready? BRIAN MACHULSKI: Yep.
DR. G (VOICEOVER): I'm going to be looking for trauma from when he fell. I'm going to be looking for natural disease,
a stroke or maybe a bleed inside of his brain. NARRATOR: First, she cuts the scalp from ear to ear,
then peels back the skin. And there, she makes an unexpected discovery. Lo and behold, he does have a bruise
to the back of his scalp. NARRATOR: Dr. G now wonders if this might indicate fatal head trauma.
DR. G: Although they didn't think he hit his head. You know, sometimes you can't tell.
Things happen so fast. [SAW WHIRRING] NARRATOR: Doctor G's morgue technician, Brian Machulski,
cuts through the skull or calvarium so she can access the brain itself. [SUSPENSEFUL MUSIC]
OK. Let's see what we got here. DR. G (VOICEOVER): And as soon as I open up that calvarium,
I peek in, and there's no blood. Nothing. He could have gotten that bruise on the curb,
but it didn't cause any internal brain trauma. And when I cut the brain, there's no evidence of stroke
and no evidence of bleeding. [SUSPENSEFUL MUSIC] NARRATOR: No closer to solving the case,
Dr. G is now left with no choice. We've got to finish the autopsy now. I sure hope it doesn't end up to be a heart attack.
[TENSE MUSIC] I start the Y incision, of course, on the chest. They did say he'd hit his side.
And so I'm looking for rib fractures, punctured lungs, anything along that line.
NARRATOR: But her scalpel cuts into Philip's abdomen-- Oh, boy. NARRATOR: --an awful stench takes Dr. G by surprise.
It does smell bad. DR. G (VOICEOVER): Something terrible has happened. He's got bowel contents which have spilled
into his abdominal cavity. There's clearly something wrong. DR. G: Look at that.
NARRATOR: Right away, she can see that the bowel contents, loaded with bacteria, have caused an infection
in the abdominal cavity, creating pools of pus, inflammation, and dying fatty tissue.
It's a mess in here. I don't know if his hernia is the cause of it yet. But I suspect it is.
NARRATOR: It's possible that Phil developed what's called a strangulated inguinal hernia.
This occurs when the bowel protrudes into the scrotal sac and becomes twisted or swollen.
DR. G: The bile gets trapped into the scrotum sac, and its blood supply gets cut off.
NARRATOR: Starved of oxygen-rich blood, the bowel wall begins to weaken and die, allowing
the bacteria to leak out. And then that gets into your bloodstream and you can die of sepsis.
OK. NARRATOR: But the only way to know for sure if Phil suffered from this type of hernia
is to dissect his scrotal sac. And while it doesn't take long to confirm Dr. G's suspicion--
There it is. NARRATOR: --there's an unexpected twist. The hernia itself, though clearly present,
does not appear to have been fatal. The bowel wall itself looks great. There's no perforation.
It's not dilated. There's no obstruction. It looks good all the way around. Nothing to do with that hernia.
[SUSPENSEFUL MUSIC] NARRATOR: But if Phil's hernia didn't cause the massive outflow of his bowel contents, what did?
The reason for it was not in that scrotal sac. I have to look elsewhere in the bowel.
NARRATOR: This means searching through pus, spillage, and more than 25 feet of bowels.
Oh, wow, that's nasty. DR. G (VOICEOVER): You know, it's one thing to deal with a decomposed body.
This is a whole different kind of smell when you have bowel contents that have gone into the abdominal cavity.
It's a nasty appearance, and it's a nasty smell. This is going to be kind of a tedious, messy dissection.
[OMINOUS MUSIC] NARRATOR: Dr. G surveys the jumble of internal organs and spilled bowl contents in Philip
Greene's abdominal cavity. A mess. NARRATOR: But there's a step she must take before she can pinpoint the source of the leak.
It was such a mess in there that I really wanted to do the chest first, give me some more room.
Go ahead. NARRATOR: With Brian's help, she cracks open the ribs and removes the heart and lungs.
Given Phil's history of heart disease, her next step is to weigh the heart and dissect it.
[SUSPENSEFUL MUSIC] Immediately, she can see the telltale mark left by the first heart attack he suffered five years ago.
DR. G (VOICEOVER): From the nice, beefy, red heart muscle, it's replaced by kind of white scar tissue.
So it clearly looks like a scar. And when I look at his heart, he does have coronary artery disease.
Hmm. DR. G (VOICEOVER): But all his heart disease looks very stable. Nothing new, nothing acute, nothing
that's just happened to him, nothing that would have killed him. Even though he'd had a history of heart disease,
even though the ER said he had a heart attack, it didn't really sound like a heart attack to me.
I'm glad it just didn't turn out to be a heart attack. NARRATOR: It's a huge relief knowing her initial instinct
was correct. But she still doesn't know what caused the infection in Phil's abdomen.
[SUSPENSEFUL MUSIC] I've got to deal with this bowel. Let's see what's going on here.
DR. G (VOICEOVER): So you just-- you start at the beginning. You start, you know, where the esophagus
goes into the stomach. NARRATOR: Then she follows the small intestine, noting how it's abnormally expanded or dilated.
DR. G (VOICEOVER): It's got liquid and air in it. That's a clear sign that he's got some type of obstruction.
NARRATOR: Inch by inch, she works her way along his bowel. Until finally, she hits pay dirt.
Well, look at that. DR. G (VOICEOVER): I've got a 1-inch defect in the bowel. It's open.
See that? That hole? DR. G (VOICEOVER): And the bowel contents are going into the abdominal cavity.
That's not good. Uh-uh-uh. What caused that hole? Well, one thing I'm worried about
is cancer may be eroding through. But when I open it up, there's like necrosis or dead tissue
around the hole, but nothing that looks cancerous. It truly was completely normal bowel except for the hole.
[SUSPENSEFUL MUSIC] So my assistant and I were kind of taking this bowel out a little bit of time.
NARRATOR: And then in a collection of pus, she comes across something strange, something surprisingly solid.
I'm like, what is this hard thing? What is this hard thing loose in his belly? NARRATOR: Dr. G then grabs hold of the object
and pulls it out of the abdominal cavity. DR. G (VOICEOVER): It was this round, hard stone.
[TENSE MUSIC] NARRATOR: The exact same size as the defect in the bowel. DR. G (VOICEOVER): It took a second,
and then I realized this little stone-looking thing is ultimately what killed him.
NARRATOR: Now with the last piece of the puzzle literally in her hand, Dr. G can finally replay
the bizarre chain of events that led to Philip's unexpected death. [HEAVY MUSIC]
[GENTLE MUSIC] It's a gorgeous afternoon in Orlando. And Philip Greene is enjoying his long-awaited family
vacation. [CHILD GIGGLES] Or at least he's trying to. DR. G: He's got this scrotal hernia
that nobody knows he had. It must have been uncomfortable, but ultimately didn't have anything to do with his cause of death.
NARRATOR: But something else did-- a stone-like object in his intestines called an enterolith.
DR. G: An enterolith is like a rock that forms inside your small intestine. NARRATOR: They may develop for a number of reasons,
ranging from a natural buildup of minerals in the body to problems with the digestive system itself.
DR. G: They're kind of like gall stones, with concretions that form in layers, kind of like a pearl,
I guess, inside of an oyster. Believe it or not, the most common reason for these things
are in the Middle East. It's people who eat persimmons. The undigested persimmon has this vegetable material
that kind of sticks together, coagulates, and kind of forms this hard stone. Any veterinarian you talk to knows
all about enteroliths because it's a huge problem with horses. If they eat enough alfalfa, the pH of alfalfa
is such that it kind of causes these stones to form inside their bowel and they end up obstructing.
NARRATOR: But in humans, they're extremely uncommon. And most enteroliths are very small.
So Dr. G is surprised to find that Phil's is nearly an inch wide. They're not usually get that big,
and they just pass through your entire bowel without any problem. NARRATOR: And Dr. G now believes it's
been forming inside his bowel for quite some time. DR. G: This man's enterolith took a while to develop--
days, weeks, maybe even months. NARRATOR: She suspects that the earliest symptom
was just a little constipation. First, his problem was the obstruction. Nothing was getting through.
NARRATOR: But as the enterolith grows larger, a more dangerous problem develops.
DR. G: That enterolith is pressing on the inside wall of the small intestine, kind of working
its way through that wall. NARRATOR: Gradually, it wears away the thin lining of tissue.
This was a time bomb waiting to happen. [TENSE MUSIC] NARRATOR: At this point, however, Phil most likely
could have defused the bomb. DR. G: He could have had that bowel obstruction easily corrected.
NARRATOR: But Phil doesn't seek medical help. DR. G: Maybe he was starting to have these abdominal complaints
and really didn't want to tell anybody because he didn't want to ruin their vacation.
NARRATOR: And now on this beautiful day, a minor misstep sends the enterolith on a fatal trajectory.
DR. G: When he falls and there's increased pressure, it kind of pops it out through that weakened tissue.
And then clearly once that happened, the bowel contents leaked out. As that bowel contents leaks into his belly,
the bacteria start to multiply. [TENSE MUSIC] NARRATOR: But the final blow comes when the bacteria
infiltrates his bloodstream. DR. G: Your body starts reacting to the bacteria. Your vessels start to kind of lose their integrity
and kind of get dilated. Your heart starts beating faster. And eventually, you can't maintain your blood pressure.
You go into shock, and you can't provide blood and oxygen to your vital organs, including
your heart and your brain. Dad? [PHIL GROANS] NARRATOR: By the time the 78-year-old
collapses on the floor-- I think he's had an attack. He's fallen. NARRATOR: --it's simply too late to save him.
[SIREN WAILING] [SOFT MUSIC] With the full report now complete, Dr. G once again reaches out to Phil's wife and daughter.
DR. G (VOICEOVER): I think the family was shocked. It's such an odd thing. Like, didn't he have complaints?
I know something is going on with him prior to him falling. And they're like, no, he's really private.
He's really stoic. I mean, this is the definition of stoic. NARRATOR: But while both Nora and Mattie wished
Phil had shared his discomfort with them, they ultimately find solace in knowing
the autopsy wasn't in vain. DR. G (VOICEOVER): They were actually very thankful that I did an autopsy.
They were thankful to really know why he died. Oftentimes, people are so afraid to do
an autopsy on their loved one. But there are, you know, many things you can find out that might help you
come to grips with the death. [TENSE MUSIC] NARRATOR: Dr. G is the first to admit
that the majority of autopsies she performs on older patients like Philip are relatively routine.
But when a seemingly healthy young woman dies suddenly, it will take all of her skill and experience
to track down a hidden killer. DR. G (VOICEOVER): I love cases that I really don't know
what it's going to be going in. She's healthy, active 39-year-old woman. This death could be just about anything.
[HEAVY MUSIC] [LIGHT MUSIC] Well, it's a rare treat for me to get out of work. And today, we're in Charleston, South Carolina,
and it is beautiful here. We've been invited to come up to this company, Berchtold,
to look at their surgical lights. We've been told that these lights are very energy efficient.
MAN: Good morning. Good morning. DR. G (VOICEOVER): It's important for me because, you know, good lighting really makes
or breaks an autopsy room. So it doesn't limit the vertical range of the lights.
DR. G (VOICEOVER): I'm looking for lighting from my new green morgue. These lights look good.
But there's really only one way to find out for sure. Nice to meet you. Would you?
[LIGHT UPBEAT MUSIC] When's the last time you've been to the dentist? Oh, no. [LAUGHTER]
I'm teasing. I get to hold the heart. Yeah, you get to hold the heart. But look how nice--
it does have-- WOMAN: Ooh. [LAUGHTER] DR. G: I don't usually put 'em back, but we'll put that back.
[LAUGHTER] NARRATOR: Outfitting the new morgue properly is a top priority for the entire District Nine team.
[SOFT MUSIC] But back in Florida, bodies are waiting. And one particularly troubling case has
gotten the attention of Dr. G. [DRAMATIC MUSIC] [GENTLE GUITAR MUSIC] It's a busy Saturday morning, and 39-year-old Judith Kerckner
is at her flower shop meeting with two new clients, a bride-to-be and her mother, about arrangements
for an upcoming wedding. But just a few minutes into the consultation, Judith is suddenly overcome by some unusual and frightening
symptoms. She, all of a sudden, started getting short of breath and having difficulty breathing.
And she just collapsed right in front of 'em. [DRAMATIC MUSIC] WOMAN 1: My god. WOMAN 2: Are you OK?
NARRATOR: One of the clients immediately calls 911. Emergency crew got there. WOMAN 2: She just collapsed.
PARAMEDIC: Let's get her on the stretcher. DR. G: They tried to resuscitate her en route to the hospital.
[TENSE MUSIC] [SIREN WAILING] But she didn't make it. [SOMBER MUSIC] NARRATOR: When Judith's only sister,
Christine, gets the news, she's overwhelmed with grief. DR. G: As you can imagine, her sister was floored.
I mean, she's at work, and she starts getting short of breath and dies. [SUSPENSEFUL MUSIC]
NARRATOR: And as Dr. G reads through the investigator's report, she, too, is bewildered by Judith's death.
It is truly a mystery that this 39-year-old perfectly healthy woman just drops dead for no reason.
NARRATOR: But the abrupt nature of the death itself might provide a critical clue.
I suspect something sudden in her brain, something sudden in her lungs like a clot,
or something sudden in her heart. NARRATOR: Still, all theories aside, Dr. G knows that the truth behind Judith's untimely death
may not come so easily. You know, you had sudden infant death syndrome. I have sudden middle-aged woman death syndrome
because their cause of death are a lot more subtle and take a lot more work for some reason.
[TENSE MUSIC] NARRATOR: But it's this very challenge that motivates Dr. G to find the answer.
DR. G (VOICEOVER): I love cases that are mysterious, that I really don't know what it's going to be going in.
[SUSPENSEFUL MUSIC] DR. G: Let's see. Quite attractive. DR. G (VOICEOVER): When I first look at her,
I notice something I hardly ever see in my morgue-- a dress. I don't get too many people who die in a dress.
Do you want me to go ahead and undress her? Yeah. Yeah, go ahead and undress her.
DR. G (VOICEOVER): Most of my clientele are hospital gowns or pajamas. So right off the bat, I thought this is going to be unusual.
NARRATOR: Next, Dr. G turns her attention to Judith's arms and legs. Oh, look at this.
When I get to her leg, she's got pitting edema, fairly marked pitting edema. NARRATOR: Pitting edema is a common form
of swelling in the extremities. The pitting refers to the telltale indentations that briefly remain on the skin when pressure is applied.
If you press on it, it puts a little pit. NARRATOR: It may mean nothing. But it can be an indication of some serious
underlying medical problems. Well, there's many things that can cause that. One of the things we look for-- may be kidney
failure, maybe heart failure. I mean, she's kind of young for both of those things.
NARRATOR: Dr. G records the observation on the body sheet, then turns to examine Judith's head.
And as she palpates her scalp, she discovers another abnormality. Oh, her head's not good.
I feel a small contusion in her scalp. NARRATOR: There is a bruise on the back of Judith's skull.
The injury most likely occurred when Judith collapsed at work. [TENSE MUSIC] But now Dr. G must contend with another disturbing possibility.
What if the blow to her head is unrelated to her fall in the flower shop? Nobody really knows what she was
doing the previous 72 hours. Maybe the day before, the night before, she had slipped and fallen.
[SUSPENSEFUL MUSIC] I mean, what's going on? I don't know. I'm not going to know until I do the autopsy.
[HEAVY MUSIC] [SUSPENSEFUL MUSIC] NARRATOR: Doctor G's morgue technician, Tom Hemphill,
prepares the body of 39-year-old Judith Kerckner for autopsy. The florist died suddenly the previous morning
while working with clients in her flower shop. She just got up. She was complaining of shortness of breath,
and then she collapsed. We don't really have a lot to go on. DR. G (VOICEOVER): And I'm hoping the autopsy
is going to give me the answer. [TENSE MUSIC] Just something to hold her head a little bit.
I got it. NARRATOR: But before opening her body, Dr. G wants to further investigate
the bruise found on Judith's head during the external exam. Did she slip and fall earlier in the day or the night before?
Got it? DR. G (VOICEOVER): A delayed head injury, that's not unheard of in a 39-year-old woman.
NARRATOR: But the possibility of trauma isn't her only worry. DR. G (VOICEOVER): In this case, I'll
also be looking for bleeding inside the brain maybe from hypertensive disease or maybe
even a ruptured aneurysm. So there are things in the brain that could kill you quite suddenly.
[OMINOUS MUSIC] [SUSPENSEFUL MUSIC] NARRATOR: Using her scalpel, Dr. G cuts an incision across the back of Judith's head
and reflects the scalp to examine the tissue. And what she sees immediately deepens
her concerns about trauma. DR. G (VOICEOVER): I do see the scalp contusion, the bruising of the scalp.
NARRATOR: But did the bruise cause her death? To find out, Tom opens Judith's skull or calvarium
with an oscillating saw. [SAW WHIRRING] Dr. G then pries of the skullcap for a closer look
at the surface of the brain. All righty. There's no significant edema. There's no bleed in the subarachnoid space.
NARRATOR: Next, she dissects the brain, searching for any abnormalities or injuries.
DR. G (VOICEOVER): There's no bleed, tumor, or other abnormalities inside the tissue of the brain.
The contusion on her head was clearly from when she stood up with her shortness of breath and then
she had her sudden collapse onto the floor. NARRATOR: But the lack of findings starts to raise her concerns that Judith's
death might go unsolved. DR. G (VOICEOVER): I'm not going to like this case if, once I'm done with the autopsy, it's negative.
[HEAVY MUSIC] OK. NARRATOR: Dr. G opens the torso with a standard Y incision. [SUSPENSEFUL MUSIC]
Peeling back the skin, she gets her first look at the abdominal organs. DR. G (VOICEOVER): My initial examination
revealed relatively normal appearing abdominal cavity. You want to get the tox? So at this point, I go ahead and take my toxicology.
Because ultimately, tox may be the answer in this case. After I take my toxicology, I open
up the rib cage in my usual style and lift off that breastplate. And I know something unusual--
Oh, look at that. DR. G (VOICEOVER): --something I don't usually see in the morgue--
an enlarged thymus. NARRATOR: The thymus is a small gland that rests just under the breastbone.
It helps in the early development of the body's immune system, changing in size as a person grows older.
The thymus gland increases to its largest size of puberty, and then it starts to decrease in size.
And by the time you're an adult, it's very, very small. NARRATOR: But in Judith's case, something is clearly wrong.
DR. G (VOICEOVER): Her thymus was very enlarged. It was 70 grams, way bigger than we normally see.
NARRATOR: And this unexpected finding gives Dr. G her first significant clue. DR. G (VOICEOVER): The first thing
you think of when you think of an enlarged thymus, for me, is myasthenia gravis.
NARRATOR: Myasthenia gravis is a rare autoimmune disease that severely weakens muscles throughout the body.
The disease can cause sudden death. But typically, the person would experience symptoms for years.
DR. G (VOICEOVER): It'd be very rare, but it's a possibility. TOM HEMPHILL: OK. OK.
NARRATOR: Unfortunately, Dr. G cannot diagnose myasthenia gravis until blood tests return from the lab.
All right. NARRATOR: In the meantime, she turns her attention to Judith's chest cavity.
Well, then I want to look at her lungs. As you recall, the symptom was shortness of breath.
NARRATOR: On first glance, they appear healthy. But it isn't long before she finds cause for alarm.
DR. G (VOICEOVER): When I cut the lungs, there's a lot of pulmonary edema or fluid buildup in the lungs.
NARRATOR: This fluid buildup can often indicate serious heart trouble. So I really need to look at the heart.
NARRATOR: Carefully, she cuts into the pericardial sac that surrounds the heart and gets
her first glimpse at the organ. It looks like the heart's enlarged. That's not good.
DR. G (VOICEOVER): There are definitely some abnormalities. [TENSE MUSIC] NARRATOR: To get a closer look, Dr. G removes the heart
and dissects it. DR. G (VOICEOVER): When you cut the muscle, the muscles appear somewhat soft,
and there's some pallor to it. Hmm. DR. G (VOICEOVER): The heart looks like it's
playing a role in this. NARRATOR: Judith's enlarged dilated heart, combined with its pale appearance or pallor,
point Dr. G to one undeniable conclusion. She's dying of some type of congestive heart failure.
NARRATOR: Congestive heart failure is a condition in which the heart becomes so weak it
can no longer pump effectively. I know this is why she died. [SOFT MUSIC] NARRATOR: But this finding raises
more questions than answers. How could a young woman who had no history of heart failure
suddenly die from the disease? DR. G (VOICEOVER): It's not making sense to me how
a 39-year-old woman who's now dying with congestive heart failure. What is causing that heart to fail?
We got to dig a little deeper here. What's going on? [HEAVY MUSIC] [SOFT MUSIC] NARRATOR: Dr. G has just discovered
that 39-year-old Judith Kerckner died from heart failure. DR. G (VOICEOVER): We know she's in congestive heart failure.
We know there's something wrong with her heart. But inquiring minds want to know,
what is the reason for this? OK, let's see. NARRATOR: One reason may be atherosclerosis, a buildup
of fatty plaque that can block arteries, which, over time, can damage and weaken the heart muscle.
To investigate this possibility, Dr. G carefully dissects the heart's slender vessels
and is surprised by what she sees. DR. G (VOICEOVER): Her coronary arteries were actually clean.
She didn't have any atherosclerosis. NARRATOR: Furthermore, there's not a single sign
of abnormalities or defects that would have led to congestive heart failure. Right now, I'm not seeing much.
NARRATOR: So far, the findings make no sense. And Dr. G is quickly running out of options.
The only thing left is the neck. I usually save that for last. [SUSPENSEFUL MUSIC]
NARRATOR: And as Dr. G slices through the delicate neck tissue, she encounters something completely unexpected.
She has a very enlarged thyroid gland. A normal thyroid gland doesn't weigh that much.
Maybe 20 grams, it weighs. Hers weighed 70 grams, really enlarged. NARRATOR: The thyroid is a tiny butterfly-shaped gland
that sits just below the Adam's apple. But despite its small size, the thyroid has a big job--
regulating the body's metabolism. DR. G: When I saw her thyroid gland, it gave me an idea.
NARRATOR: Putting all the clues together, Dr. G now suspects that the enlarged thyroid
may have played a critical role in Judith's heart failure. DR. G: But I'm not going to be sure
until I look under the microscope and get some of my blood tests back. NARRATOR: She takes tissue samples of Judith's thyroid
and sends them to the lab for processing. Now all she can do is wait. [HEAVY MUSIC]
[SOFT MUSIC] A week later, the microscopic slides finally come back. And Dr. G anxiously puts the sample of Judith's
thyroid tissue under the lens. So when I look at the thyroid under the microscope,
all of these kind of subtle, weird things that I'm finding in autopsy are making sense.
But before I sign the death certificate, I want it confirmed with the blood test.
[SUSPENSEFUL MUSIC] NARRATOR: She quickly turns her attention to the tox report,
zeroing in on Judith's thyroid hormone levels. DR. G (VOICEOVER): Once I get the results,
I see that her thyroid hormone was extremely high. Hmm. NARRATOR: Based on these findings
and the enlarged thyroid she saw at autopsy and under the microscope, Dr. G now knows exactly how and why the 39-year-old died so suddenly.
The mystery's solved. [HEAVY MUSIC] [SOFT MUSIC] NARRATOR: It's just before noon, and Judith
Kerckner is meeting with new clients about an upcoming wedding. --having a flower girl, flower boy?
NARRATOR: But today, she isn't feeling quite herself. DR. G: She's probably starting to feel a little jittery.
She's probably sweating a little bit. WOMAN 1: We'll see how that works together.
NARRATOR: And Dr. G finally knows why Judith feels so sick. She's got Graves' disease.
NARRATOR: Graves' is an autoimmune disease that attacks the thyroid gland and causes
it to produce excessive amounts of the thyroid hormone. DR. G: This thyroid hormone, it affects every cell in your body
on how it metabolizes energy. And so with a very high thyroid hormone, you're going to get a very high metabolic rate.
NARRATOR: The disease also explains the enlarged thymus gland found during autopsy.
DR. G (VOICEOVER): She has an enlarged thymus gland, which is what we often see with autoimmune diseases,
particularly Graves' disease. NARRATOR: Autoimmune conditions like Graves' can be difficult to decipher.
But there are certain risk factors for developing them. DR. PENNY GLICKMAN: Women have more risk, about eight
times as much risk as men do. Also, there's a genetic predisposition if someone in your family has an autoimmune disease,
and you may be more at risk for developing that as well. [SUSPENSEFUL MUSIC] DR. G: I'm sure she had symptoms days and probably
weeks prior to this crisis-- the jitteriness, the tremor, difficulty sleeping, sweatiness, the loss of weight, the palpitations.
[TENSE MUSIC] NARRATOR: In the weeks leading up to Judith's death, her body starts making antibodies that
stimulate her thyroid gland, causing it to produce more hormone. This chemical imbalance causes Judith's heart
to beat harder and faster. And on that fateful morning, the weakened organ begins to fail.
DR. G: The grave problem with that elevated thyroid hormone is that it causes your heart to beat faster that it can't
even get all the blood out each time because it's beating so fast. Her heart cannot keep pace with that beat anymore.
And it's starting to dilate because not enough blood is getting pumped out with each pump.
[TENSE MUSIC] She stands up. She's trying to take her breath. And she collapses.
[SOMBER MUSIC] Her heart goes into a terminal arrhythmia. And they can't revive her.
Ultimately, she died from congestive heart failure brought on by Graves' disease.
It's just sad because she could have prevented her death if she had taken some of these symptoms a little more
seriously and sought medical help. [MUSIC - DAN MAY, "FATE SAID NEVERMIND"] NARRATOR: But before she can close the book on the case
of Judith Kerckner, Dr. G must share the news with her sister, Christine. When you tell their next of kin
that they had a chronic disease that they knew nothing about, they're always floored.
DAN MAY: (SINGING) Where is the candlelight? DR. G (VOICEOVER): Her sister said, I didn't know there
was anything wrong with her. Unfortunately, she didn't think there was anything wrong with her either.
DAN MAY: When is it healing time? When does the peace of mind-- DR. G: It doesn't bring them closure,
but it gives them a little bit of peace at least knowing what happened.

A florist meets with clients for an upcoming wedding, but she suddenly collapses to the floor. With no apparent cause of death, Dr. G worries that this case may go unsolved.

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

Brief Summary

Dr. G investigates the mysterious deaths of Philip Greene and Judith Kerckner, uncovering hidden medical conditions that led to their untimely demises.

Key points

A Family Vacation Turns Tragic. A grandfather collapses during a family trip, leading to a medical mystery.
The Dilemma of an Autopsy. Dr. G faces a conflict as the family objects to an autopsy for religious reasons.
Shocking Discovery in the Morgue. Dr. G uncovers a significant finding that complicates the case further.
The Enterolith Revelation. A hard stone found in Philip's intestines is revealed to be the cause of his death.
The Final Moments of Philip Greene. Dr. G reconstructs the chain of events leading to Philip's unexpected death.
The Mystery of Judith's Death. Dr. G investigates the sudden death of 39-year-old Judith Kerckner, uncovering shocking truths.

Episode highlights

Episode quotes

Honestly, at this point, I don't know what to think.

Dr. G expresses her confusion over the case.

0:38WatchJun 17, 2021

Tension

75/ 100High tension

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