Dr. G: Medical Examiner - Season 5, Episode 4 - Degrees Of Death - Full Episode | Forensic Files

NARRATOR: A man is found dead literally hanging in the air. He is suspended by his pants off the ground
on a picket fence. This is a real puzzler. NARRATOR: Police believe his death to be the result
of a tragic accident. But Dr. G suspects something more sinister. I think there's some foul play involved.
NARRATOR: Then a construction worker collapses on the job. By the time EMS gets there, he pretty much
doesn't have a heart rate. NARRATOR: Just minutes later, he's gone, leaving both co-workers and loved
ones desperate for answers. And I don't know how he died. NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations-- these are the everyday cases of "Dr. G, Medical Examiner."
JAN GARAVAGLIA: We're building a new morgue. You know, in all my years as a medical examiner,
this is one of the biggest projects I've ever taken on. We looked at-- here's the options we looked at.
JAN GARAVAGLIA: We've been working with these architects for a long time. They've never built a morgue or medical examiner's office.
So there was a lot of learning for them to understand what we do and our workflow.
Say we do six, seven hours in the morgue, and then everything goes into the cooler.
JAN GARAVAGLIA: But the most challenging aspect of the new morgue is that we're going green.
And we're not painting it green. It's going to be environmentally friendly. Our new morgue is going to be one
of the first green morgues in the country, and possibly the world. The really cool thing about being environmentally friendly
is natural lighting, a lot more space, special parking for hybrid vehicles, an outdoor patio.
When you're planning a building that's supposed to last more than 25 years, you got to plan for the future.
But that's the future. Right now, I have cases to worry about. And this next one is one of the strangest I've seen in a while.
Hm. NARRATOR: In the quiet residential suburb of Oakland, Florida, everyone knows Lou Beckman
for all the wrong reasons. He's basically the neighborhood drunk. He would get intoxicated and trespass.
He would just walk through the neighborhood at will, and just kind of a nuisance.
NARRATOR: So it isn't surprising when, early in the morning, a woman walking her dog notices that Lou is
in her neighbor's yard again. From a distance, he simply seems to be climbing over the picket fence.
But as she draws closer, one thing becomes clear. Lou isn't moving. He is suspended by his pants off the ground
on a picket fence. His head is down, his legs are down. It's almost as if somebody took a hook
and put his pants over it, these baggy pants over the picket of the fence. NARRATOR: The woman immediately calls 911.
An operator instructs her to check for a pulse, and it doesn't take long to figure out that Lou
Beckman doesn't have one. Paramedics responded to the scene and notified police.
Then they called the homicide detectives. NARRATOR: A third call goes to the District
9 Medical Examiner's Office. Now Lou's body and the reports from the investigation
are in Dr. G's hands. It's a really odd case on a lot of different levels. Obviously, he's in a bizarre position.
How did he get there? Why did he get there? NARRATOR: Although police aren't sure how he died,
they do have a theory about how Lou ended up hooked on the fence. It was a very hot night, so he was obviously--
he had been intoxicated earlier in the evening. And we think he leaned against the fence,
and he was so intoxicated that he passed out, lost consciousness at some point. NARRATOR: But after carefully examining
photographs from the scene, Dr. G isn't so sure. I don't like the way the shirt is.
It's over his head, over on the back of his neck, like a full nelson. It's kind of restricting his arms.
I'm sorry, that's a kid prank. And his shoes are neatly underneath him. If he's trying to extricate himself,
his shoes would not be so neatly underneath him. This looks suspicious to me. My instinct is that he was placed on the fence.
I think there's some foul play involved. NARRATOR: Could Lou been the victim of a fatal assault,
or was it simply the result of an accident as police suspect? Dr. G knows there's only one way to find out.
Lou's body is hard to miss in the morgue. He's fully clothed and still awkwardly positioned.
JAN GARAVAGLIA: He's got his arms still in the T-shirt, and it's still on his back.
So it kind of restricts his arms. He has a pair of oversized pants on, which are unbuckled and unzipped.
You know, nothing of significance in his pockets. There are some socks, which are relatively
clean, except for a little bit of dirt on the toes. OK, I guess you can undress him.
NARRATOR: With the help of morgue technician Tom Hemphill, Dr. G removes the clothing and begins
searching for any injuries that might have been sustained in either an accident or an assault.
We don't know much about him. NARRATOR: Initially, Lou's general appearance confirms
only what she already knows. JAN GARAVAGLIA: He's not in the best of shape. He's a chronic alcoholic, and he's 49 years old.
You know, that starts to get to you after a while, and you don't always look that great.
Living on the street, drinking heavily, smoking heavily, and that's what he looks like.
NARRATOR: But then on the inside of his right calf, she spots her first clue. I see these abrasions, some of which
are dried, but with some crusted blood. NARRATOR: Soon, she locates more abrasions on his feet,
his ankles, and his arms. Together, the injuries provide a gruesome glimpse into Lou's final moments.
It shows that he's moving, trying to extricate himself against this picket fence.
So he clearly got put up there or got stuck up there while he's alive. He was alive and he didn't want to be there.
NARRATOR: She then discovers that his hands are also smeared with blood. The question now is, could Lou have been literally
fighting for his life? He's very petite man. He only weighs 110 pounds. It wouldn't take much to pick him
up and place him on that fence. NARRATOR: There, Lou would have been an easy target.
Just a few strong blows to the head or torso could have been enough to cause fatal internal bleeding.
We're going to have to go inside and see what's cooking there. I really need to know what happened to him.
It's awfully thin, too. We're trying to find history on medical records from previous hospitals.
NARRATOR: As Dr. G prepares to open Lou Beckman's body, she's on the hunt for any evidence of foul play.
Police believe his death was the result of a freak accident, but Dr. G doesn't agree.
The police are clearly thinking he just got caught on the fence. I just have a hard time buying that theory.
All right, we're ready, right? NARRATOR: She begins by making the standard Y incision down his torso, looking for any signs of trauma.
When I initially open him up, I'm looking for fractures. I'm looking for injuries.
Nope, no. No rib fractures, no collection of blood, no evidence of trauma in his chest, abdomen.
It doesn't look like anybody beat him up. NARRATOR: But she can't rule out trauma as a cause of death
until she performs a cranial exam. For now, she continues her search for clues inside his abdominal cavity.
One by one, she removes and examines each of Lou's abdominal organs. And it's not long before she finds
an abnormality in his liver. A little fatty liver there. His liver looked bad. You cut it and you can feel that there's probably some increased
fibrosis in there. NARRATOR: The fibrosis, or scarring, is clearly the result of alcohol abuse.
Left untreated, it would have ultimately led to liver failure and possibly his death.
But Dr. G can see that Lou's liver disease is only in its early stages. Nothing acute going on there.
NARRATOR: Still searching for a clear cause of death, she now moves on to the chest cavity,
and immediately, she sees trouble. His lungs show evidence of chronic smoking. A lot of anthracotic pigment--
black, smoky tar that gets in your lungs. He's got emphysema. NARRATOR: Emphysema would have caused
Lou to have trouble breathing. In time, it might have even killed him. But from the color and texture of the lungs,
Dr. G can tell that this, too, was not his ultimate cause of death. He's clearly not end stage emphysema.
NARRATOR: But Lou's smoking could have led to another life threatening problem. We know he smokes, and we know that's a risk factor
for coronary artery disease. Possibly had a heart attack because he gets hooked on the fence.
NARRATOR: To find out if Lou's heart is the culprit, Dr. G cuts open his pericardial sac and extracts it.
One by one, she inspects every vessel in the heart. And what she finds astounds her.
Despite his history of smoking and drinking, Lou's heart is surprisingly free of disease.
Coronaries looked good, normal size. Has no chronic heart disease. NARRATOR: With no evidence of trauma
or a deadly disease in Lou's body, Dr. G still has no idea what caused his sudden death.
But there's one more place to look-- his head. That's going to be the last thing we look
at for this cause of death. We need some good clear cut evidence. NARRATOR: Dr. G cuts the scalp across the top of Lou's head,
then peels it back, exposing the bone. First, she carefully checks for any evidence of blunt trauma.
If there's a nice blow to the head, that'll at least prove one theory to the other.
I'm looking for blood, you know, a bruise on the inner aspect of the skull. I don't see any.
Skull is intact-- indicates no skull fractures. Then I take the skullcap off and look at the brain itself.
Let's see what's going on here. NARRATOR: Immediately, she detects an abnormality.
The brain's a little atrophic, a little shrunken-- not uncommon with alcoholics.
NARRATOR: She methodically dissects the organ, but doesn't find any abnormal bleeding or bruising anywhere.
JAN GARAVAGLIA: The cerebral hemispheres look OK. At this point, it certainly doesn't look like he's
been a victim of blunt trauma. NARRATOR: But then she cuts deep into the middle portion
of his brain stem, known as the pons. And there, she sees something unusual. When I cut the pons, something very odd is there.
I see a central area, a little over a centimeter in size, almost a half an inch, of discoloration.
Kind of some loss of tissue in the center of the pons. And it looks like what I've learned as Central
Pontine Myelinolysis. NARRATOR: Central Pontine Myelinolysis, or CPM, is a condition often seen in alcoholics
who have been treated for a common side effect of alcoholism-- low sodium levels.
But the treatment can backfire. If you correct that sodium too fast in an alcoholic who
chronically has low sodium, that's when they go into Central Pontine Myelinolysis.
NARRATOR: The rapid rise in sodium levels can destroy a layer of nerve cells in the brainstem called the myelin sheath.
This interrupts signals between the brain and the rest of the body, triggering a range of severe symptoms.
JAN GARAVAGLIA: They certainly get problems with their speech. They can have disorientation, paralysis, and die from this.
It's got a fairly high mortality rate. NARRATOR: But as Dr. G examines the pons more closely,
she's surprised. It's obvious that CPM was not Lou Beckman's killer. This clearly didn't just happen.
It happened a while ago, because this is somewhat old that I'm seeing. Some people have gotten over it totally.
But a lot of people have chronic disabilities from it, even if they get over it.
Now, did he get over it totally? Hard to say because he was always stumbling around.
NARRATOR: By the end of her autopsy, Dr. G has discovered that Lou was living with the effects of liver disease, emphysema, and Central
Pontine Myelinolysis. But she still can't identify what killed him. I'm not so sure I've made any headway in this case.
NARRATOR: To solve the mystery of Lou's bizarre and sudden death, she'll have to rely on the few weapons
still left in her arsenal. I'm certainly going to look for some recent hospitalization
or medical records. I want to gather as much evidence as I can, look at the micros of all the organs.
Maybe the tox will tell me something, because I still don't have a clear cut explanation.
NARRATOR: Weeks after the autopsy of 49-year-old Lou Beckman, a lingering question still
puzzles Dr. G. How did he end up dead, suspended on a picket fence? We still have the police theory that it's accidental
and we still have my theory that I'm worried it's not accidental. NARRATOR: Now her only hope of solving the case lies
with the remaining information available to her, including toxicology, microscopics,
his medical records, and a careful review of the scene. His medical records are actually
very interesting to me. NARRATOR: Here, she discovers that about a year before he died, Lou was treated for low sodium levels.
This confirms her earlier suspicion that Lou had Central Pontine Myelinolysis, a nerve disease
that can occur when doctors attempt to correct a person's sodium levels. And while it didn't kill him, she
believes that the disease left Lou with nerve damage that affected his motor control.
Because he was always stumbling around, I suspect that it was from recovering from this Pontine Myelinolysis.
NARRATOR: But CPM wasn't the only reason Lou was stumbling around. She checks his toxicology report.
And sure enough, his blood is saturated with alcohol. Although it's not at a fatal level,
it is more than three times the legal limit. I believe it's a 0.28. That's high.
That's really intoxicated. That would pass some of us out. NARRATOR: Finally, she turns to the microscopic slides.
And in Lou's lung tissue, she discovers the last critical piece of the puzzle, one that escaped
her naked eye in autopsy. JAN GARAVAGLIA: He's developing pneumonia. And I see some aspirated material, meaning maybe
some food that he vomited got into his lungs, set off an infection-- not uncommon with alcoholics who pass out.
Is that pneumonia enough to kill him? Mm, no. Probably in and of itself, not enough to kill him,
but we've already got two bad things going on in his lungs-- his emphysema, which he's probably living with.
Now he's got some pneumonia on top of that. NARRATOR: Pneumonia, emphysema, intoxication, and CPM--
none of these conditions alone killed him. But when Dr. G considers them altogether and also factors
in the position of his body on the fence, she can finally replay the unusual chain of events that
led to Lou Beckman's death. As the sun sets, Lou begins his nightly ritual-- going for a walk and getting drunk.
Before long, he's passed out on a patch of grass, and that's when the trouble begins.
He vomits and inhales it back into his lungs. That explains why he's got the early pneumonia.
NARRATOR: What happens next is still unclear. Police believe Lou eventually woke up
and staggered over to a fence. We believe that because it was a hot night, he pulled the T-shirt up to try to get some air, to try
to cool off a little bit. They felt very strongly it was an accident that he got suspended.
Maybe he fell forward, and the picket fence caught his pants. I feel strongly that somebody put him there.
They were messing with him. I don't know if there's kids. I don't know who it is.
I think they picked him up while he was passed out. NARRATOR: Either way, Lou finds himself in a jam,
hooked on a fence and completely trapped. In a panic, he desperately tries to free himself,
scraping his arms and legs until he's bleeding. But it's no use. He's, you know, clearly intoxicated.
He's most likely debilitated from his Central Pontine Myelinolysis. He's got emphysema.
He's already having a hard time breathing, and he's got pneumonia. So all of those probably played a role in why
he can't extricate himself. NARRATOR: Eventually, gravity starts pulling his blood downward.
When you're upside down and the blood is going into your brain, and your legs are suspended,
you're having pooling blood in your legs, and you're having pooling blood in your head.
And you don't get blood returning back to your heart. NARRATOR: The condition is called positional asphyxia,
and it can starve the heart and brain of oxygen rich blood until they stop functioning entirely.
You can actually die from being suspended upside down. It's clearly a known phenomenon with this kind of suspension.
He either goes into an arrhythmia, or he passes out from the lack of fresh blood
being pumped to his head. NARRATOR: Had someone simply helped Lou off the fence,
he would have most likely survived. But by the time a passerby happens upon him,
it's too late. Hi, this is Dr. Garavaglia at the medical examiner's office. NARRATOR: Dr. G makes contact with Lou's estranged family
to inform them of his death. She explains the findings of her autopsy, though there's one aspect still unresolved.
Yeah, the problem is, I don't know how he got on that fence. Is this a homicide, or is this an accident?
I have my theory. The police have their theory. And I'm not sure we'll ever know the answer.
For me, I feel very strongly that I think somebody is messing with this poor guy.
I think they picked him up and put him on that fence and put the shirt over his head.
And that's a kid prank. Come on, man. JAN GARAVAGLIA: I don't think they meant to kill him.
I think they thought he'd wake up and he'd be struggling. And he'd get himself out of there.
But that would still be a homicide. And I think that's what happened. That's why I refuse to make this an accident.
NARRATOR: Dr. G tells Lou's family that she will leave the manner of death undetermined.
Right. All right, bye bye. NARRATOR: They simply appreciate her commitment to the truth.
I think he was already a lost soul. They understand that partly how he lived his life
is how he ended up here. And they know that if somebody ever comes forward, we can change the manner of death.
You know, that's real life. Sometimes we don't always have all the answers. NARRATOR: And Dr. G's next case is no different.
But this time, the answers she's looking for may prove more elusive than anyone expects.
This is a catastrophe. Summer. Summer. Sandy's favorite time when it's hot. It's hot.
It's the worst time of the year in Florida. NARRATOR: But despite another blistering hot day,
Orlando shows no signs of slowing down. Life goes on as usual, but not for Joseph
Cleary, Dr. G's next case. It's a bright sunny morning when Joseph Cleary arrives at a condominium construction
site in Winter Park, Florida. He's a day laborer. Hadn't been on this construction site before.
NARRATOR: It's Joseph's first day on a new job, and he gets straight to work. When he started work that day, he was feeling pretty well.
NARRATOR: But as the afternoon wears on, he begins to feel unusually ill. He complains of all of a sudden not feeling well.
But he says he's dizzy. NARRATOR: His co-worker notices that he looks alarmingly pale
and tries to convince him to take a short break. Joseph insists that he's fine and keeps on working.
But just a few minutes later, he drops to the ground. He just collapses and goes unconscious on them.
NARRATOR: His co-workers try to rouse him, but Joseph is out cold. By the time EMS gets there, he pretty much
doesn't have a heart rate. NARRATOR: On the way to the hospital, emergency workers attempt to revive him.
But to everyone's shock, it's too late. Boy, you know, he dies pretty suddenly. He's dead on arrival to the hospital.
NARRATOR: No one can believe that Joseph, who seemed perfectly fine this morning, is dead by 2:00 PM.
And everyone that cares for him is counting on Dr. G for answers. Well, you know, his co-workers are disturbed.
His family is disturbed. We have a 42-year-old Caucasian man. He died pretty suddenly at the construction site.
We don't know what happened to him. This is a real puzzler. NARRATOR: It's particularly puzzling
because no one has been able to locate Joseph's medical records. Searching for clues about Joseph's medical history,
Dr. G's investigator, Carol Crosby, tracks down Joseph's girlfriend, Maureen. She was clearly in shock still over the death,
but she said she didn't understand why he died now. You know, he was just getting his life together.
Ooh, that made my ears perk up. NARRATOR: Maureen explains that Joseph had recently kicked his habit of intravenous cocaine abuse.
But for Dr. G, this raises a red flag. So many of the sudden deaths I see in the morgue
are from drug overdoses. It's making me think maybe he didn't get over his drug addiction.
There's a possibility he overdosed. NARRATOR: And there's only one way to find out.
All right, let's see what else we have. So I'm going to really have to autopsy him and get these answers.
NARRATOR: Dr. G begins her external examination by rolling up the sleeves of Joseph's heavy work shirt.
She then searches for the telltale signs of IV drug use-- track marks. I don't notice any needle puncture marks.
I don't see any scars. NARRATOR: But the absence of track marks does not rule out the possibility
that Joseph was injecting himself with drugs before he died. A lot of times, intravenous cocaine users
may not get a lot of scars on the skin. The thing that causes the marks with IV drug
is usually the talc and some of the material they use to cut the drugs. That's usually what causes most of the scarring.
NARRATOR: Continuing her external examination of Joseph's body, Dr. G turns her attention to his head.
But she doesn't see anything unusual, until she checks his eyes. He's a little jaundiced in the sclera.
The white of his eyes had turned slightly yellow. NARRATOR: Yellowing of the eyes is a common symptom
of liver malfunction. It can be caused by hepatitis C, a common malady among IV drug users like Joseph.
But Dr. G won't know for sure if drugs played a role in Joseph's death until she
completes the autopsy. I really need to look at all the organs, see if I find anything else.
I'm not going to be able to tell until I get in. NARRATOR: As a next step, she carefully
removes Joseph's work shirt. And what she finds is unlike anything she's ever seen before.
Whoa, whoa, whoa. He has an extreme case of psoriasis, the worst I've ever seen.
This rash was over much of his body. It was over his chest. It was over his back.
It was over his arms. NARRATOR: Psoriasis is a chronic recurring condition that causes skin cells to reproduce excessively.
They get this kind of raised red area. Part of it's scaly-- these piled up scaly skin cells.
NARRATOR: The cause of the disease is not fully understood. And to date, there is no effective cure.
It's very, very difficult to treat and get rid of. NARRATOR: But while Joseph's skin condition is severe,
it's unlikely that it was life threatening. Certainly a nuisance. It certainly hinders your quality of life.
But then you don't usually die from it. NARRATOR: As she wraps up her external exam,
Dr. G knows little more than when she started. Joseph's sudden fatal collapse remains a complete mystery.
JAN GARAVAGLIA: Everything's up for grabs here. Could it just be natural? You know, I don't know.
We're not going to know until we do the autopsy. Is this mine? That's yours. OK.
NARRATOR: Dr. G slides the thin sharp blade of her scalpel from shoulder to shoulder, then down the center
of Joseph Cleary's chest. After completing her external examination, she suspects that the 42-year-old man's
sudden death may have been caused by a drug overdose. We do know that he's got a history of IV drug abuse.
NARRATOR: But it's too early to say for sure. As Dr. G reflects the skin from Joseph's upper body,
she's looking for any evidence of what may have caused his fatal collapse. Once Joseph's rib cage is exposed,
she immediately notices an injury. Several of his ribs are fractured. Broke a lot of ribs back there.
Yep. NARRATOR: She inspects the fractured bones more closely. But it quickly becomes clear to Dr. G
that the breaks occurred during emergency workers' frantic efforts to revive Joseph.
He's got some rib fractures consistent with cardiopulmonary resuscitation. I often see that.
Somebody did some nice, vigorous CPR on him. It didn't have anything to do with his death.
NARRATOR: Cutting down the sides of his rib cage, Dr. G frees Joseph's chest plate,
exposing the organs beneath. There you go. Based on the circumstances of death, I'm really concerned about the lungs, the heart.
NARRATOR: And it doesn't take long to confirm that Joseph's lungs are not at all healthy.
His lungs are heavy. They are congested. NARRATOR: Removing the lungs from his body,
she cuts into them. And here, she makes another disturbing discovery. He certainly had some edema fluid.
NARRATOR: Edema, or fluid buildup in the lungs, can result from a number of causes,
including heart failure, pneumonia, and exposure to drugs. But Dr. G zeros in on one.
I'm, again, worried about drug overdose. NARRATOR: Still, edema in his lungs alone are not enough to confirm a drug overdose.
Her next stop is the heart. And as she removes the muscular organ from the chest cavity,
she discovers another anomaly. His heart is mildly enlarged for somebody his size.
So he has some effect of high blood pressure on his heart. NARRATOR: Chronic cocaine exposure
can cause changes to the heart. And these changes may ultimately have triggered a fatal heart arrhythmia.
Seeking further evidence, she begins to dissect the heart itself. I cut the coronaries.
NARRATOR: But inside the coronaries, there are no abnormalities. His coronaries are fine.
The heart muscle looks fine, just enlarged. NARRATOR: In fact, Joseph's heart is
in surprisingly good condition. And now she doubts that it played a role in his sudden death.
So far, I don't clearly know why he died. NARRATOR: Next, she focuses her attention on his liver.
And here she discovers an abnormality. And liver's normally nice and smooth. He's got the small, lumpy, bumpy liver.
He does have cirrhosis. NARRATOR: Cirrhosis is a chronic liver disease in which normal tissue is replaced
by fibrous scar tissue. The number one cause of cirrhosis in the Western world is alcohol abuse.
Another common cause is hepatitis C, a viral disease common among individuals who
inject themselves with drugs. He is an IV drug abuser. A lot of those people do have hepatitis C, and a lot of them
end up with cirrhosis. NARRATOR: But this discovery doesn't give her the answers
she's looking for either. So his liver, albeit bad, was not enough to kill him, and we certainly need another cause of death.
NARRATOR: Dr. G moves on to examine the remaining organs-- the large intestine, the stomach, the bowels.
And she begins to notice an alarming pattern. His bowels are already starting to turn green.
His spleen is soft and friable. NARRATOR: In fact, what she sees here may be the most important
piece of evidence yet. These are all early signs of decomp, which was odd since he had just died.
When I start seeing exaggerated decomposition faster than I would normally expect,
I really worry that something else is going on with him. NARRATOR: At that moment, medical investigator Dan Dees
arrives to deliver some new information. JAN GARAVAGLIA: He brought the hospital ER record.
There was a vital piece of information on that sheet that did not get relayed to me, which changes the whole complexity of the case.
Now, I think we know why he died. NARRATOR: Dr. G just received medical records detailing the final moments of Joseph Cleary's life.
And in them, she finds a crucial piece of information. He had a markedly elevated temperature when EMS got there.
It was 108. It was 108 degrees Fahrenheit. That's hyperthermia. NARRATOR: Hyperthermia occurs when the body contains more
heat than it can release, causing the internal body temperature to climb. In its most severe form, it's called heat stroke,
and it can be fatal. That clearly is his cause of death. NARRATOR: This also might explain why Joseph's organs had
begun to decompose prematurely. Him having an elevated temperature could cause early decomposition.
NARRATOR: Dr. G now has some of the key answers she's been looking for, but one mystery still remains.
So now we have to think, why is he hyperthermic? That's clearly why he died. But why is he like that?
You know, I have a whole construction site. I have a whole city that's not undergoing heatstroke.
I need to kind of narrow down why he has this elevated body temperature. NARRATOR: And her first thought is
one that's been troubling her throughout the entire autopsy. I'm, again, worried about drug overdose.
One of the main ways we see elevated body temperatures in this morgue is cocaine use.
NARRATOR: Joseph's girlfriend is convinced that he had given up his cocaine habit.
But now Dr. G is even more suspicious that a relapse may have caused his death. The only way to find out for sure
is to send blood samples to the toxicology lab for testing. I rushed the toxicology on this case,
because I'm very, very curious if it's cocaine. NARRATOR: But even a rush job will take a few days.
In the meantime, there is another strong possibility that she must investigate. One of the causes for an elevated body temperature, that
would be a brain stem stroke. NARRATOR: During her internal exam, Dr. G discovered that Joseph had an enlarged heart, which
is evidence of high blood pressure, a condition that could have triggered a stroke.
Maybe he had a hypertensive bleed associated with the high blood pressure. So the next thing I go to is going to be his brain.
NARRATOR: Dr. G begins her examination of Joseph's cranium by sliding her blade across his scalp and reflecting it down.
Morgue technician Sandy Ludwig then uses an oscillating saw to cut through the skull.
I lift the calvarium off. Nothing's wrong with cerebral hemisphere. But I want to look at that brain stem.
He could have a bleed in his brain. You know, oftentimes we see it in the brainstem.
NARRATOR: Dr. G removes the brain, searching for a pontine hemorrhage, or bleed in the brain stem.
And I immediately put a cut in the brainstem. If it looks like a pontine hemorrhage,
you see the normal tissue and then a clot of blood within that tissue. The brain is kind of an off white to gray color.
But when you see hemorrhagic stroke, you see this nice bright red blood clot inside the brain tissue.
NARRATOR: But inspecting the tissue, she sees nothing abnormal. We had bleeding nowhere in his brain.
So we have eliminated one possibility. NARRATOR: The morgue technicians close up Joseph's body.
For now, all she can do is wait for the results of the toxicology report. So at the end of the autopsy, we
know he's got hyperthermia, a very elevated body temperature. The tox can either tell me that the cocaine is related
to his hyperthermia, or it can eliminate the cocaine as a contributing cause of death.
NARRATOR: Three days later, Dr. G receives the report from the toxicology lab. She immediately scans the page for the most
vital piece of information-- whether or not cocaine was present in Joseph's blood.
JAN GARAVAGLIA: When the toxicology comes back to me, I'm actually shocked. He has no cocaine in his system.
NARRATOR: Now Dr. G is left with a puzzling question. If cocaine didn't cause Joseph's temperature to shoot up, then
what did? JAN GARAVAGLIA: He's certainly working out in the Florida sun in the summer. It's hot.
It's humid. But why him and not anybody else? NARRATOR: Thinking back to the autopsy,
Dr. G zeros in on one essential clue. There is one reason that this fellow, and this fellow
and not his other construction workers, had problems that day. NARRATOR: Based on this seemingly unrelated
observation, Dr. G can now piece together the chain of events that led to Joseph's fatal collapse.
Joseph Cleary arrives at the construction site at 7:00 AM sharp. As a day laborer, he's always taking different jobs.
Today's the first time this summer that he's working outside under the harsh Florida sun.
JAN GARAVAGLIA: During the morning, he was able to compensate for the heat. The temperature wasn't as hot.
NARRATOR: But as the day wears on, it creeps up to a humid 98 degrees. And it's such high temperatures, the human body
depends almost entirely on one mechanism for releasing heat. He has to lose his body temperature from sweating,
from evaporation. NARRATOR: It's a simple but vital mechanism. Glands in the skin produce sweat, which then exits
the body through the pores. Once in the body's exterior, the sweat evaporates, taking
excess body heat with it. If you stop sweating, then that's extremely dangerous.
NARRATOR: And on this day, something is robbing Joseph's body of its ability to sweat.
It was his psoriasis. He had one of the worst cases I've ever seen. And it's unclear why his psoriasis was so bad.
NARRATOR: But one thing is clear. The psoriasis is blocking Joseph's sweat pores.
He has lost his ability to sweat like the rest of us. NARRATOR: Heat has difficulty escaping,
and suddenly, Joseph can't cool down. His body core temperature started to go up.
His heart's trying to beat faster. NARRATOR: As Joseph's temperature rises, his blood vessels dilate in an attempt to cool him down.
This causes his blood pressure to fall, preventing oxygen rich blood from reaching his vital organs.
The extreme heat also causes the proteins in Joseph's body to break down, and cells throughout his body
stop functioning properly. He starts feeling dizzy, and he collapses relatively fast.
He goes into shock. NARRATOR: Joseph dies within minutes. This is a very unusual combination of factors.
With how bad his psoriasis was and how severe the conditions were that day, it certainly was dangerous.
NARRATOR: It gives Joseph's girlfriend, Maureen, a measure of peace to hear that his death had not
been caused by a drug relapse. But she's saddened by the fact that Joseph's death could
have been easily prevented. JAN GARAVAGLIA: He should have avoided the heat like the plague.
I don't know what possessed him to go out and work that day. I'm not sure the general public knows how
dangerous a heatwave can be. Heat can kill. MAN: Atlas.

Dr. G suspects that someone is responsible for a vagrant's unusual death. She’ll only discover the truth by finding answers to the strange events surrounding this curious case.

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

Brief Summary

Lou Beckman likely died from positional asphyxia, while Joseph Cleary succumbed to hyperthermia due to severe psoriasis.

Key points

A Mysterious Death. Lou Beckman is found dead, suspended by his pants on a picket fence, raising questions about foul play.
Dr. G's Investigation. Dr. G examines Lou's body and finds signs of struggle, leading her to suspect foul play.
Theories of Death. Dr. G and police have conflicting theories about Lou's death—was it an accident or foul play?
Sudden Death Shock. Joseph, seemingly fine in the morning, dies suddenly by 2:00 PM. "Boy, you know, he dies pretty suddenly."
The Cause Revealed. Dr. G discovers Joseph's hyperthermia was the cause of death, linked to his psoriasis.

Episode highlights

Episode quotes

I think there's some foul play involved.

Dr. G suspects foul play in Lou's death.

0:41WatchJun 15, 2021

Tension

75/ 100High tension

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