Dr. G: Medical Examiner - Season 5, Episode 19 - Bruised And Battered - Full Episode | Forensic Files

NARRATOR: When a perfectly healthy 8-year-old boy goes to sleep one night and never wakes up--
I can't imagine anything worse than this. NARRATOR: --his grieving family turns to Dr. G for answers.
RICK BARBER: You look at a perfectly healthy boy that goes to sleep and just passes,
you know something's happened. Something wrong. NARRATOR: Then a man is found dead on his floor, naked
and covered in bruises. This could be foul play. NARRATOR: Now police are counting on Dr. G
to find proof of murder. They don't plan on doing anything else until I tell them it's a homicide.
NARRATOR: Altered lives baffling, medical mysteries, shocking revelations-- these are the everyday cases of Dr. G, medical examiner.
All too often, Chief Medical Examiner Dr. Jan Garavaglia sees families reeling from the unexpected loss of a child.
It's the tragedies of all tragedies. The little 8-year-old boy with a mom, a dad, a sister.
NARRATOR: And even after 20 years, cases like these still tug at her emotions. This is a horrible situation for the parents.
I can't imagine putting my child to bed, and then you wake up, and he's dead. I mean, I can't imagine anything worse than this.
NARRATOR: In the spring of 2008, Garion Barber is a happy go lucky 8-year-old with big blue eyes
and a contagious smile. Real big-hearted kid-- wanted to make sure everybody was happy.
DAWN BARBER: MOM: Hey, Garion. You having fun? Yeah. would Go out of his way to talk to people and introduce himself.
DAWN BARBER: Garion used to come up out of the blue and would just give me a big old bear hug and, I love you mommy.
NARRATOR: And he was also a loving brother to his older sister Adara. We liked to swim together.
We went horseback riding one time. He used to beg me to fly with his light sabers with him.
He had a couple of them so he could sword fight. RICK BARBER: Those two were best friends.
They did everything together. They had separate rooms for a short period of time
and asked to move back in the same room together. This house was full of giggles and laughs
and carrying on all the time. NARRATOR: But no one in the close knit family could have ever imagined that their lives
were about to change forever. [CHATTER] NARRATOR: On March 28, 2008, Rick Barber is out of town
for the weekend. But his family isn't missing a beat. His wife Dawn has a full agenda planned,
including ice cream sundaes and a long anticipated movie. DAWN BARBER: We were all laughing
and having a good time. The kids watched their movie and ate their ice cream, and then it was time for them to get a bed.
And Garion asked me if they could sleep with me that night. I told him yeah. And so they went off and went to bed.
NARRATOR: A few hours later, Dawn climbs into bed next to her kids. And they all sleep peacefully through the night.
I didn't wake up until about 9 o'clock. And when I woke up, Garion was still laying down, which was odd because Garion
wakes up really easy. Garion. DR. JAN GARAVAGLIA: She nudges him. He doesn't get up.
And she realizes he's not breathing. Oh my gosh. DR. JAN GARAVAGLIA: She immediately calls 911.
NARRATOR: Within minutes, paramedics arrive. And while they rush Garion to the nearest hospital,
dawn call her husband Rick. RICK BARBER: The phone rang, and there was just screaming on the other phone.
She said, Garion's not breathing. They're taking him to the hospital. I just hit my knees, you know, and started praying.
They took us straight back into a family room at the ER. It wasn't long after that when the doctor
came in and told us then that they couldn't do anything for him. They called back, and they said, we lost him.
NARRATOR: In an instant, the family's world is turned upside down. I think the hardest thing to realize
is when you look at everything you have and you say, I'll never have a new picture of Garion.
You know? Time for him stopped. He's a piece of the family that will be missed. You will never replace.
You know, nobody would ever be able to fill that hole. DR. JAN GARAVAGLIA: Well, this is a sad case.
I could get wrapped up in the emotion of us. But what people need are answers. According to his family, he's a happy kid.
He doesn't really have a lot of problems. NARRATOR: But despite a relatively clean slate,
Dr. G spots at least one red flag in his medical history. From birth, Garion had sometimes experienced
involuntary eye movements, which were later diagnosed as partial seizures. He just has this strange kind of disturbing eye movement.
That didn't seem to be a huge problem. He takes Carbamazepine for it, anti-seizure medication.
And he's been doing that for years. NARRATOR: But his doctor had warned the Barbers
that as Garion grew older, there was a chance his seizures could intensify and progress into epilepsy.
Given this history, Dr. Gene must keep in mind SUDEP, or Sudden Unexplained Death in Epilepsy,
as a possible cause of death. He appears to have died suddenly and during his sleep.
And that would fit SUDEP, but I really have to see from his medical records how severe these seizures are.
NARRATOR: But SUDEP leaves behind no physical evidence. So the only way she'll know for sure if it killed him
is to rule out everything else. All right. NARRATOR: Along the way, Dr. G will be on the lookout
for another potential culprit-- a congenital heart defect, a common and potentially fatal
abnormality in children Garion's age. I'm worried about heart defect. In fact, I would think a heart defect even more than SUDEP.
In this age group, most of the major heart defects would have been picked up by his pediatrician.
But a few of them will still slip through that may not cause symptoms until later.
NARRATOR: But Dr. G must also consider one other tragic, although unlikely, scenario.
I'd have to rule out drugs. We always wonder. Could he have gotten into somebody
else's medication or his own medication and taken too much? RICK BARBER: You never want to think about in an autopsy,
but at the same time, you know, it will give us clues as to what happened to him.
DR. JAN GARAVAGLIA: This is just a sweet looking kid. You ready? He is cute as a button.
He looks like he could be sleeping. He looks well cared for. He is the appropriate height and weight for an 8-year-old boy.
NARRATOR: First, she documents the obvious resuscitation efforts made by emergency personnel.
These are all from CPR. Look at this. We see needle puncture marks on the back of the hand.
We see an endotracheal tube. He was intubated. We see EKG pads. We see resuscitation pads.
NARRATOR: But as Dr. G scans the body, something immediately catches her attention.
He's got frothy fluid coming out of his mouth consistent with pulmonary edema-- fluid buildup in the air spaces in his lungs.
What happens is when you have this fluid going into your air sacs, and you're still trying to breathe,
it whips it up almost like egg white. And it forms a frothy fluid that actually comes up the column of the windpipe
and then comes out the mouth. That's a very non-specific finding. We will let the body and the tox speak to us to tell
us why it has pulmonary edema. Did you get this? ASSISTANT: Yes, both sides. Oh.
At this point, this external exam doesn't rule anything in or out. I've really got to put the pieces of the puzzle together.
I mean, that's what I'm here for, and that's what I'm hoping to eventually do. NARRATOR: And no one is more eager for answers
than Garion's family. You look at a perfectly healthy boy that goes to sleep and just passes--
you know, you know something's happened. Something's wrong. NARRATOR: Dr. G is prepping for the internal exam
on 8-year-old Garion barber, whose sudden death has left his family in a state of crisis.
RICK BARBER: Everybody spent sleepless nights wondering what in the world had happened.
DAWN BARBER: He'd start worrying about what it may be like if you don't-- if you don't find out.
Give me a scalpel with a sterile blade. I'm not sure the autopsy will necessarily
give us the answer for sure. There you go. But it will rule many things out. All righty.
The first thing I do is take my normal toxicology. So we've got the blood. Did you get the bile.
I'll take blood, and I'll take bile. And those I'll check for drugs. And I'll certainly check for any electrolyte abnormality,
any evidence of diabetes, because a kid going into diabetic ketoacidosis is another possibility.
Although we don't have any symptoms, maybe the family didn't pick up on them. And then I'll start looking at the organs one by one.
NARRATOR: Peering into the chest cavity, you can see right away that the lungs are swollen with fluid.
FATHER: The lungs are heavy. They're consistent with pulmonary edema. Oftentimes, it's associated with a failure of his heart.
It could be related to sudden unexpected death of epilepsy, the SUDEP. it's very non-specific.
I'll be there in a minute, [INAUDIBLE].. NARRATOR: Next, Dr. G heads straight to an organ high
on her list of suspects-- the heart. Here, she'll be on the lookout for an undetected congenital
defect, a killer that claims thousands of young lives each year in the US. When I get to the heart, the first thing I want to look at
is the general shape. And it looks normal. So that heart's about normal size. It's a normal shape, and the consistency of the muscle
appears normal. Everything looks good. I carefully make sure all the parts are going to the right place.
Then I'll look at the coronary arteries. I look at the valves. I look at the lining of the heart.
I look at the thickness of the wall. And there appears to be no congenital heart abnormalities.
But there's still a possibility that I'm not finding something subtle. And so I need to look at the heart under the microscope.
NARRATOR: Next, Dr. G turns her attention to the abdominal cavity. And there, something immediately catches her eye.
Oh, look at that. Now the kidneys are interesting. He only has one. Yeah, looks like a kidney.
He just wasn't born with his right kidney. It's a relatively common finding in the morgue.
You see it in about between 1 in 1,000 or 1 in 2,000 people. NARRATOR: Truth is, most people can lead normal, healthy lives
with just one kidney. But Dr. G knows that if the single kidney was damaged or infected, the result may have been fatal.
[INAUDIBLE]. But the lone kidney appeared healthy. NARRATOR: Next, she checks the stomach contents for evidence
of an accidental overdose. When I look in the stomach, I'm looking for pill fragments.
And I don't see any that doesn't mean that he doesn't have an overdose or he'd gotten into somebody's medicine
only the tox will tell us that. NARRATOR: For now, Dr. G switches gears and heads
to a part of the body that just might give her the answers she's been looking for--
the neck. An often neglected part of the autopsy people don't think about is the neck.
But the neck can give us a lot of information, and it could be some possibilities
of death for this child. Could he have choked on something? Is there evidence of maybe an allergic reaction?
NARRATOR: Layer by layer, Dr. G dissects the tissue. FATHER: He didn't have evidence that looked like he
had an allergic reaction. There's no evidence of a strangulation. So all of that appeared completely normal.
Ultimately, his neck doesn't give us the answer. OK. NARRATOR: One by one, Dr. G examines the remaining
organs in Garion's body. But after an exhaustive search, she comes up empty. At this point, really, what do we have?
We have pulmonary edema, a normal appearing heart, and a congenitally absent kidney but not much else.
OK. Well, basically, so far, we don't have an answer. But I still have the brain to go.
NARRATOR: Using an oscillating saw, morgue technician Brian Mahulsky carefully opens the skull.
FATHER: I immediately see that there is edema to his brain. Like, it just hasn't gotten enough oxygen.
It could be related to the SUDEP, but we don't know the cause at this point. Let's cut that brain, and then we'll be done.
NARRATOR: But as Dr. G removes the brain itself, she spots something that is nothing short of shocking.
Oh my god, look at that. He's got some very prominent cerebellar tonsils. And that's at the bottom of your brain
right next to your brain stem. They actually extended down into the spinal canal
where the spinal cord should be. NARRATOR: It's clear that Garion's cerebellum tonsils have extended out of his skull
and down his spinal canal. Dr. G now suspects that he may have had a Chiari 1 malformation, a rare congenital abnormality that affects
about 1 in 1,000 people. Yeah, was that OK? NARRATOR: To be sure, she enlists the expertise
of neuropathologist Dr. Gary Pearl, who specializes in rare brain disorders. I really would like Dr. Pearl to look at this brain
to see if he concurs with me. NARRATOR: When Dr. Perl arrives at the morgue, they get straight to the task at hand--
a careful examination of the cerebellar tonsils. That helps. Let's see. We got a brain knife?
In this case, we saw downward herniation of the cerebellar tonsils. There was also some fibrosis and adhesions of the tonsils
to the brain stem. This tells us that it's a chronic condition that's Chiari 1 malformation by definition.
NARRATOR: This means that Garion had been living with an undiagnosed brain malformations
possibly for years. But while Chiari 1 could present some uncomfortable symptoms,
it's rarely life threatening. And if the condition did kill him, it would have left no physical trace in his body.
Just like SUDEP, you have to rule everything else out, and you see if this fits.
NARRATOR: Bottom line-- after a complete cranial exam, Dr. G is still not certain as to what killed Garion so suddenly.
So far, I don't clearly know why he died. I've got my work cut out for me. I need a boatload of records, both from his pediatrician
and from his neurologist. I need to look under the microscope, and I need to get the toxicology results.
No answers can be complete until all those pieces are together. So I have to call the family, and I'm basically telling them,
I don't know. I'm not sure what it is yet. RICK BARBER: The not knowing, really not even having a clue,
was extremely frustrating. You know, it was a long process trying to find out exactly what happened.
NARRATOR: It's been four long weeks since the autopsy of eight-year-old Garion Barber.
But Dr. G still has no definitive answers, and she's hoping that the lab work might
hold the key to his death. DR. JAN GARAVAGLIA: Is it SUDEP? Is it Chiari 1? Is it something wrong with his heart
that I couldn't see with my eye? Is it something in toxicology? NARRATOR: Today, however, could be the turning point,
as the long-awaited lab reports and microscopic slides finally arrive at the morgue.
DR. JAN GARAVAGLIA: When I look at the toxicology, he just has his anti-seizure medication.
And that was at a relatively low level. So he certainly didn't overdose on anything.
So when I looked at the heart under the microscope, there was no abnormalities that could be seen.
With all of these negatives, I'm pretty much left with is it a sudden, unexplained death of epilepsy,
or is it a sudden death associated with the Chiari 1 malformation? NARRATOR: Dr. G has finally narrowed it down
to two possibilities, and there's only one thing left in her arsenal that may help determine Garion's
ultimate cause of death-- his medical records. DR. JAN GARAVAGLIA: We start working on getting the records.
But they seem to be taking forever. They're closed on the weekend. OK, you try. Thank you.
I really need to look at what symptoms is he showing, what kind of seizures does he have.
I really need to get some medical history here to put this together. NARRATOR: Four days later, Garion
Barber's medical records finally show up at the district nine morgue. And as she reads through the file,
she's amazed to learn that throughout his entire childhood, Garion had been suffering from a host
of disturbing symptoms. DR. JAN GARAVAGLIA: : Some of the symptoms was not just the weird eye movements, but he
would sometimes see double. And sometimes complain of headaches and some even behavioral problems.
NARRATOR: For Dr. G, these new symptoms are a critical clue that lead her to a surprising conclusion.
Garion did not suffer from a seizure disorder at all. The strange eye movements along with the other symptoms
were all being caused by the malformation in his brain. I think his symptoms were all related to the Chiari 1.
NARRATOR: And as she reads on, she's surprised to discover that Garion's neurologist had actually diagnosed him
with the condition a year earlier. He did do an MRI scan, and I was shocked when I saw that.
NARRATOR: It appears as if the neurologist simply didn't associate Garrett's chronic symptoms
with his Chiari 1 malformation and instead attributed all the problems to the partial seizure disorder.
DR. JAN GARAVAGLIA: : I think the doctor felt this Chiari 1 was asymptomatic. NARRATOR: It's a tragic oversight
but not a surprising one. Chiari 1 malformation is a rare and often misunderstood
condition. A lot of people are under the impression that most Chiari 1s are asymptomatic.
As more and more is learned about it, we're realizing people do have symptomatology,
and they can die suddenly from it. I'll tell you, at the beginning of my career,
the neurologist wouldn't believe that there was anything called SUDEP either, that people died from epilepsy.
And now it's an accepted diagnosis. I think as time goes on, I think this is a disease that we're going to learn a lot more about.
It's rare. It's rare to die this way, but we know it happens. NARRATOR: But sadly for Garion, no one was able to figure
it out until it was too late. I think once we put this all together, when we look at his history, we look at his medical records,
the most likely explanation for his death is clearly the Chiari 1 malformation. NARRATOR: It's 10:00 PM on Saturday,
and Garion is fast asleep in bed beside his mother and sister. But unbeknownst to anyone, a Chiari malformation is
pushing down on his brain stem. To date, his symptoms have been generally mild. But on this night, Garion suffers a more dangerous side
effect of Chiari-- central sleep apnea. He's probably had some central sleep apnea before.
He sleeps alone. Nobody probably noticed it. NARRATOR: As he sleeps, the brain temporarily stops sending signals to the muscles
that control breathing. DR. JAN GARAVAGLIA: The brain stem is compressed, and it's telling your lungs not to breathe.
And then eventually, if you don't breathe enough, your oxygen goes down. NARRATOR: As his oxygen levels continue to drop,
a deadly chain reaction is set into motion. Garion's heart rate slows, and fluid begins to build up
in his lungs and brain. He stopped breathing long enough where he has a respiratory arrest and ultimately
also a cardiac arrest. NARRATOR: Sometime in the middle of the night, Garion's heart simply stops beating,
and the 8-year-old dies peacefully in his sleep. That same afternoon, Dr. G calls Rick and Don
barber to share her findings. Although the results of the autopsy bring some closure,
they're shocked by the Chiari 1 diagnosis and insist the neurologist never shared
this discovery with them. We were incredibly surprised to know that the doctor knew about the Chiari
and never mentioned it to us. DAWN BARBER: Had I been told what it was then and had done
the research then, I could have changed his doctor or I could have asked for somebody
to look at something else to at least try to help him with his symptoms. NARRATOR: If they had known, they
might have opted for surgery. But it is a high risk procedure and generally reserved
for the most extreme cases. The treatment would be surgery, neurosurgery on the base of your skull so that cerebellum is
not compressing the brain stem. That's not a surgery you take lightly. All right, bye bye.
NARRATOR: But despite her troubling findings, the Barbers are grateful for Dr. G's work and care.
I think very highly of Dr. G. I think I got more information from her than I ever expected and, more
than that, a willingness to sit and talk and to give of her time. Dr. G has definitely give us, you know,
the closure that you have to have to take the next step in life. They have a wonderful attitude.
They know they still have to raise their daughter, and they're not going to let this ruin their family.
They can't let the bitterness and the sadness of losing a child ruin the second child's life.
RICK BARBER: If you can take, you know, one thing away from everything we've had to go
through, understand that-- that everything you do builds a memory. And you know, every moment can be important,
and every moment can be something that you can hold onto forever. The thing I miss about Garion is his smile and his laughter
and the things he used to say and do. If there's one more thing I can say to Garion,
it's I love you and I'll see you soon. And just tell him that I love him. You know, I love you, little man, and I'll see you soon.
DR. JAN GARAVAGLIA: What the story teaches us is appreciate your loved ones. You never know.
Life changes on a dime. I mean, this is a happy family with two beautiful kids, and one dies suddenly.
We never know what life has in store for us. NARRATOR: Unexpected deaths are nothing new to Dr. G,
but in a potential homicide like that of 45-year-old Hank Mosley, she finds herself facing a whole different set
of challenges. DR. JAN GARAVAGLIA: Law enforcement is leaning on me a lot because they want
to know, well, how much further do we have to investigate this case. When you die suddenly, everything stops.
And it's a snapshot into the way you lived. That actually is one of the best parts of my job
is just seeing how people live and what they do And even what they have on when they die.
And then I'll investigate those final moments. NARRATOR: And in Dr. G's next case,
those final moments may in fact hold the key to solving the mystery behind a man's sudden death.
DR. JAN GARAVAGLIA: Oh, today, the police are going to come by to see the results of this autopsy.
The police are very concerned because they're not sure whether foul play was involved or not.
NARRATOR: It's late afternoon on a Sunday in the middle of March. Orlando resident Maggie Shepard is catching up on some reading
when she gets a sense that something's happening upstairs. [CRASHING] Something not at all right.
She hears some goings on in the apartment above her. She is so worried that she calls the police.
[SIRENS] NARRATOR: When police arrived, Maggie informs them that a man named Hank Mosley
lives on the second floor. She describes to the police that he's kind of a recluse,
and he's a chronic alcoholic. She calls him the old man. NARRATOR: Next, police head upstairs to Hank's apartment.
And right away, they can tell that something's wrong. The door is not locked. Hello?
DR. JAN GARAVAGLIA: Slightly ajar. They walk in. And initially, they think that the place is ransacked.
NARRATOR: Cautiously, they make their way through the apartment. And it isn't long before the officers
make a horrific discovery. DR. JAN GARAVAGLIA: He's dead on the floor. He's naked, and he's covered with bruises.
This could be foul play. NARRATOR: Police immediately secure the area and wait for Dr. G's investigator to arrive.
My investigator looks around. There's beer bottles around. There's trash around.
But they can't even tell if it's ransacked or not. They don't plan on doing anything else until I
tell them it's a homicide. He's just a poor soul found dead. NARRATOR: As a first step, Dr. G reads
through the investigator's report. And on first blush, all signs seem to support
the possibility of foul play. DR. JAN GARAVAGLIA: Well, certainly, when you see a bruise, the first thing you'll think about
is trauma or foul play. And in this case, it's a real possibility. You're easy pickings for somebody when you're drunk.
Did he die because he's brought unsavory people over to drink with him and they bopped him on the head?
NARRATOR: But from experience, Dr. G knows there's a laundry list of other ways that alcohol could have contributed to his death.
DR. JAN GARAVAGLIA: It could be accidental. Maybe he's an alcoholic that fell. We always have to worry about trauma with alcoholics.
NARRATOR: Or did years of chronic abuse simply take a fatal toll on Hank's body?
Alcohol can kill you in many ways-- heart disease, liver disease, pancreatic disease, GI disease.
You know, there's a lot of problems. DR. JAN GARAVAGLIA: However, there's another theory
high on Dr. G's list. Hm. I'm not suspecting the acute alcohol poisoning so much because he's definitely not a naive drinker,
but I worry. Did he die from alcohol withdraw? NARRATOR: Alcohol withdrawal syndrome
occurs when chronic alcoholics abruptly stopped drinking either because they are trying to quit
or they simply run out of alcohol. Your body gets so physically addicted to alcohol
that you will have symptoms if you don't continue that alcohol at a certain level, particularly seizure and delirium tremors,
that you can actually die from the withdrawal of alcohol. So I will look to see if any alcohol is in his body.
A lower level or no level of alcohol may indicate alcohol withdrawal syndrome. NARRATOR: But just as alcohol is looking like a good suspect,
the investigator's report provides Dr. G with another insight into Hank's medical history.
DR. JAN GARAVAGLIA: My investigator finds insulin in the refrigerator and syringes.
He is a known diabetic. Being an alcoholic, being a diabetic-- that's a bad combination in of itself.
NARRATOR: It's definitely possible that Hank died from complications related to diabetes.
But right now, it's just one potential culprit on a long list. DR. JAN GARAVAGLIA: So you know, what are we thinking of?
We're thinking of, of course, foul play. Is it accidental? It could be from the chronic effects of alcohol on his body.
It could be alcohol withdrawal. So there's a lot of things it could be. So the autopsy should be interesting.
All righty. NARRATOR: Dr. G is preparing to examine the body of 45-year-old Hank Mosley, who
was found naked and bruised yesterday in his home. And because Hank's death is a suspected homicide,
police are on hand to observe the autopsy. DR. JAN GARAVAGLIA: Well, at this point,
law enforcement is leaning on me a lot because they want to know, well, how much further do we
have to investigate this case? Do we go in there and look for more evidence, or is it just natural or accidental death?
NARRATOR: In most cases, Dr. G's first step is to remove the decedent's clothing.
But in Hank's case, that step has been eliminated. Now the body being naked, who knows what this means?
A lot of people, they don't realize how many people walk around their house naked.
Even little old ladies walk around their residence naked. Well, that's the beauty of my job.
You see a snapshot of how people live. And sometimes it's not pretty. Well, he drinks and he smokes.
Drinks and smokes? MAN: Yes, definitely. DR. JAN GARAVAGLIA: He's only 45 years old,
and the neighbor called him the old man. And I see why. He looks much older that the stated age,
and that's a testimony of what chronic alcoholism will do to you. NARRATOR: Dr. G begins the external exam
by scanning the body for clues. [CHATTER] NARRATOR: And right away, she notes a red flag.
His legs are swollen with pitting edema. DR. JAN GARAVAGLIA: The fluids build up in the tissues of the legs.
We see that with congestive heart failure when the heart can't beat, strong enough and the fluid
starts backing up. NARRATOR: But she won't know if his heart played a role in his death until she examines it.
DR. JAN GARAVAGLIA: Ah, what else we got going on here? NARRATOR: For now, she turns her attention to Hank's bruises.
There isn't a portion of his body that doesn't have a bruise. He's got contusions on his arm, particularly on the forearm.
That could be self-defense. There is bruises on his chest-- huge bruise over here and a big contusion
on the right side of his abdomen. And he's got a black eye. NARRATOR: Carefully, she documents each
and every bruise starting on his torso. There is a lot of bruises on his chest. You know, that certainly could have caused a fractured rib
that punctured his lung. He's got a bruise on the left side of his abdomen. The abdomen is a little bit distended.
That could go along with bleeding into the abdomen, a ruptured spleen. Spleens tend to be larger in alcoholics,
and a larger spleen is more prone to injury. You know, we are worried. Certainly raises the possibility he either fell or was hit.
But for the most part, just skin bruises are not going to kill you. What did it do on the inside?
We don't know until we get in there and put all the pieces together. But without a doubt, he looks like an alcoholic.
He smells like an alcoholic. He's got the history of an alcoholic. But how that plays a role in his death, we don't know yet.
I just keep going-- NARRATOR: And given Hank's black eye, Dr. G knows just where to start.
DR. JAN GARAVAGLIA: That is oftentimes where they're going to get the blow to the head for foul play.
So we're going to go ahead and look at his head. NARRATOR: Dr. G begins by slicing open the scalp from ear
to ear. Then, she carefully peels back the skin. I look on the inside of the scalp
to see if there's any bruising. And he doesn't have any. NARRATOR: With the help of her morgue tech,
she saws through the bone and removes the skullcap, getting her first look at the brain.
I don't see any blood. I don't see any fresh hemorrhage. But he's got some slight what we call xanthrochromic staining.
NARRATOR: Xanthrochromic staining is a yellow discoloration in the outer layers of the brain.
What that is is old blood that usually indicates previous trauma. So I suspect he's fallen before.
NARRATOR: But after a careful examination of the brain tissue itself, she can find
no sign of recent injuries. We've ruled out trauma to the brain as a cause of death.
But we haven't ruled out foul play to the chest and abdomen. OK, where's my scope?
NARRATOR: With scalpel in hand, Dr. G makes a Y-shaped incision from Hank's shoulders
to his pelvic bone. DR. JAN GARAVAGLIA: So you know, he's got multiple contusions
on the outside. And when I do initial Y incision, he's got a really bad bruise on his chest
that goes through the muscle. I'm worried that that rib might be fractured. The bruise on the left side of the abdomen also is fairly deep
and goes into the abdominal muscle. It's really not good. NARRATOR: But Dr. G will need to look
deeper to survey the damage. She cuts through the muscle to expose the abdominal cavity.
And right away, she's taken aback. DR. JAN GARAVAGLIA: There is no free blood in the abdominal cavity.
All of the organs are intact but totally haven't ruled out the broken rib. NARRATOR: But when she turns her attention to Hank's rib cage,
she's surprised by what she doesn't find. I was looking to see if he had a rib fracture also, but he's--
I don't feel it. There is no evidence that he has a rib fracture. NARRATOR: Next, she removes Hank's chest plate for a look
at his organs in situ. DR. JAN GARAVAGLIA: There's no tears or fracturing of any of these organs.
There is no internal trauma. We've safely ruled out trauma, foul play. You don't see much trauma at all.
NARRATOR: One thing is now clear-- Hank's death was not a homicide. DR. JAN GARAVAGLIA: We really have to figure out what is
the cause of this man's death. NARRATOR: Next, Dr. G draws samples of Hank's blood, urine,
and eye fluids and sends them to the lab for analysis. DR. JAN GARAVAGLIA: His toxicology
is going to be important because that may be the clue. Is his alcohol so low that he went into alcohol
withdrawal seizures and death? NARRATOR: But the results won't arrive for at least three weeks.
What's going on? NARRATOR: In the meantime, she pushes on with the autopsy. Now I have to take each one of the organs
out and look if there is any disease affecting any of the organs. NARRATOR: And given Hank's history, Dr. G
starts with a likely culprit-- his heart. DR. JAN GARAVAGLIA: So I'm expecting the effects of alcohol, which would
be a dilated cardiomyopathy, or the effects of diabetes, which would be a narrowing
of the coronary arteries. Diabetics for greater than 10 years old more than 90% of the time will have heart disease associated with it.
Let's see what's going on here. NARRATOR: She gently removes the heart from the chest cavity
and weighs it. His heart is just about normal size, maybe a little enlarged. It's of normal shape.
The muscle looks good NARRATOR: Carefully, she dissects the organ, slicing through the tissue and into the coronary arteries.
DR. JAN GARAVAGLIA: His coronary arteries are not so bad. He's got a 40% narrowing of one of his coronary arteries
but no acute changes, nothing that really would have caused death. And I don't see anything wrong with his heart.
His heart looks normal. So nothing that really suggests a heart disease either from alcohol or diabetes.
NARRATOR: But there are still other organs that could have been fatally damaged by his lifestyle.
So she turns her attention to the abdominal organs, beginning with the GI tract.
We look at his GI tract because alcohol affects the GI tract. I'm looking for erosions.
He's got some gastritis, some superficial erosions, but I don't see any hemorrhage.
So I don't believe the GI tract had anything to do with his death. NARRATOR: She moves on--
Oh, that's not good. NARRATOR: --and immediately spots an abnormality with one of them.
His pancreas does have evidence of pancreatitis or previous inflammation. NARRATOR: But Dr. G doesn't think this finding
is related to his death DR. JAN GARAVAGLIA: It's old pancreatitis. The injury to the pancreas is from that alcohol.
It's a chronic effect. It's not anything that would affect him now. NARRATOR: But when it comes to chronic drinking, there's
one organ that takes more punishment than just about any other-- the liver. What's his liver look like?
Can't get a peak of it yet. The liver should be nice and smooth and brown. They describe it as like a football.
NARRATOR: And all it takes is a single glance at the 45-year-old's liver for Dr. G
to conclude that alcohol abuse may have very well killed Hank Mosley. It's lumpy.
It's bumpy. It's a yellowish orange. It's very rough and irregular and shrunken.
Now could that have caused his death? It could have. Got the picture. Yeah. Yeah, that's a bad thing.
NARRATOR: Dr. G has just discovered severe damage in the liver of 45-year-old Hank Mosley.
He's got the small, lumpy, bumpy liver. There's scar tissue. And basically, the liver cells have been damaged.
It's not so pretty. NARRATOR: And this damage can only mean one thing-- Hank had cirrhosis.
Cirrhosis is a chronic liver disease that occurs when healthy, thriving tissue is damaged
and replaced with scar tissue. This is what we see with chronic alcohol abuse. NARRATOR: In fact, Hank's alcohol abuse has not
only damaged the liver, but it's also greatly enlarged the spleen. DR. JAN GARAVAGLIA: And when the liver is all scarred down
like that, the spleen follow suit by getting enlarged because the blood has a hard time
getting through that liver. So the spleen is enlarged, the liver is shrunken, all from alcohol.
Yeah, I'm done with everything. We know his liver is not functioning. Is it not functioning enough to cause death?
So we won't know for sure if it's a complication of cirrhosis until we get the toxicology
and we rule out other causes. NARRATOR: Three weeks after the autopsy of 45-year-old Hank Mosley, his lab
results arrive on Dr. G's desk. DR. JAN GARAVAGLIA: When the toxicology came back,
the first thing we look at is to see if he's got alcohol withdrawal. You know, the legal level for intoxication for driving
is a 0.08, and his is a 0.3. He's got almost four times the legal limit to drive.
It's certainly not alcohol withdrawal. NARRATOR: This critical finding, along with his history
and what she found at autopsy, brings Dr. G to one inescapable conclusion. The 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. NARRATOR: It's a Sunday afternoon,
and Hank Mosley is spending it the way he spent the majority of his life-- intoxicated.
DR. JAN GARAVAGLIA: He's got all that we typically see with alcoholism, and he's
got a 0.3 acute alcohol level. For some people, a 0.3 could actually put you near death's door.
For him, it probably was an everyday occurrence. It's probably causing him to stumble, difficulty walking,
certainly slurred speech. NARRATOR: Hank's lifestyle of chronic alcohol abuse has also taken a toll on his health, especially his liver.
DR. JAN GARAVAGLIA: The alcohol started killing off his liver cells. And eventually, the liver can't do
what it's supposed to be doing. The liver has many, many functions, and one of the functions, besides detoxifying, some
of the chemicals in your body, making glucose, one of the things that it does is it makes some of the clotting
factors for your blood to clot. NARRATOR: But years of heavy drinking have compromised the liver's ability to produce
sufficient clotting factors. On top of that, his enlarged spleen has begun to inhibit
the clotting process itself. DR. JAN GARAVAGLIA: That large spleen sequesters the platelets, which add to his inability to clot.
So what happens? Easy bruiseabilitiy, easy bleeding. That's why he's covered with bruises from head to toe.
You know, it's not surprising that initially, they thought he was beat up. But oftentimes, we find it's the effect of alcoholism.
NARRATOR: But while the severe damage to Hank's liver has been building for some time, on this particular Sunday,
the organ is probably pushed over the edge by his continued excessive drinking. DR. JAN GARAVAGLIA: So ultimately, what's happening
is his liver is not functioning. Toxins are building up because his liver is not detoxifying.
And these toxins basically build up in your blood, affecting your brain. NARRATOR: And with Hank's brain exposed to toxins,
the organ malfunctions. The result is a life-threatening condition known as hepatic encephalopathy.
And in Hank's case, it's fatal. DR. JAN GARAVAGLIA: He goes into a coma and eventually dies.
And that thumping she hears, it wasn't foul play. It was him not being able to walk around that apartment
and ultimately falling to the ground. [MUSIC PLAYING] (SINGING) So long, so long.
I stand still on the ends of the earth. You know, alcohol leaves devastation to your body,
to the way you live, and your family. But I always wonder what happened. What caused this?
[MUSIC PLAYING] (SINGING) When I was worth all the songs that I sang-- You know, we see alcohol as the ultimate problem.
But I always wonder when I see a fellow like this is how did it all started. Because you know, ultimately, he was
a cute little guy at some point in his life, and somebody loved him. I know how he died, but I'm still
curious how it all started. NARRATOR: Atlas.

A neighbor hears odd sounds coming from the next apartment. When police arrive, they find a man bruised and dead. When all signs point to foul play, it’s up to Dr. G to find proof of murder.

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

Brief Summary

An 8-year-old's sudden death reveals a brain malformation; a man's alcohol abuse leads to fatal liver damage.

Key points

The Sudden Loss of Garion Barber. An 8-year-old boy goes to sleep and never wakes up, leaving his family devastated.
Dr. G's Investigation Begins. Dr. Jan Garavaglia is called to investigate the mysterious death of Garion Barber.
A Shocking Diagnosis. Garion's autopsy reveals a rare brain malformation that may have caused his death.
The Importance of Communication. Dawn Barber reflects on how knowledge could have changed her son's treatment.
A Grateful Heart. Despite their loss, the Barbers express gratitude for Dr. G's care.
The Mystery of Hank Mosley's Death. Dr. G faces a potential homicide case with many unanswered questions.

Episode highlights

Episode quotes

This is a horrible situation for the parents.

Dr. Jan Garavaglia empathizes with the grieving family.

1:34WatchJun 17, 2021

Tension

75/ 100High tension

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