Dr. G: Medical Examiner - Season 5, Episode 5 - Fearing The Worst - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A woman dies only days after undergoing radical dental surgery.
So we've got a 42-year-old female today, who has recently had her teeth pulled out.
NARRATOR: Was her death related to the surgery, or could it have been the result of a tragic accident
caused by her own sister? The sister was very upset. She felt that she was under her care,
and she slipped away from her. NARRATOR: And then when a depressed elderly woman
was found dead in her home, her family fears the worst. When I talked to the family, they're
clearly quite worried that she might have committed suicide. When the family brings something like that up,
I have to worry about it. NARRATOR: Altered lives, baffling medical mysteries, shocking revelations--
these are the everyday cases of Dr. G, medical examiner. [ELECTRONIC MUSIC] Hey, Sandi.
Sandi: Hey. Their dog, it's like a little old lady dog. I hate to tell you that-- do you have to do
the tail on your dog like that? That's like a little old lady dog. She is a little lady.
No, that's like for a little old lady. You're no little old lady. Does the dog's tail have to be like that?
Yes, she's a poodle. (LAUGHING): Oh, god. Sorry, but it is. I didn't notice it. You got it on this fancy pillow, and it's got
its little poo-foo-- That's not a fancy pillow. --tail. That's just your regular, old, flat--
no, what's it called? - Paisley. Sandi: Paisley. All I can say is don't-- if you start acting like a little old lady,
you'll become one. Sandi (LAUGHING): She's a poodle. NARRATOR: It's early morning at the district 9
morgue in Orlando, and Dr. G and her staff are ready to begin the day's caseload.
Today, their first autopsy will involve no old lady, but rather a surprisingly young woman named Vivian Kaplin, who passed
away decades before her time. This case involves a woman that dies somewhat unexpectedly.
She has an interesting history, and I'm not quite sure how this plays into what happened.
[OMINOUS MUSIC] NARRATOR: As a first step, Dr. G reads through the investigator's report which details
the circumstances preceding the woman's death, and in this case, they're a bit unusual.
So we have a 42-year-old female, who wasn't feeling very well yesterday, recently
had her teeth pulled out. NARRATOR: According to the decedent's sister, several days
ago, Vivian Kaplin traveled five hours by bus to an out-of-state clinic to have her teeth extracted.
She's having a lot of problems with her teeth, a lot of problems with her gums, and they say she
needs to have her teeth pulled. NARRATOR: A few days later, Vivian is released from the clinic.
She makes the long trip back to her home in Florida and is greeted at the bus terminal by her sister.
Things seemed to have been going well. She came in last night. Things were fine.
Her sister was talking to her, and then about 6 o'clock in the morning, she awakens her sister
and says that she feels like she's got a low blood sugar. Now she knows this because she's a diabetic.
She's had diabetes for about three years, and she's type 1 diabetic in that she needs insulin.
So her sister immediately responded to that by getting her something to drink to raise her blood sugar,
and then after that, she checked her blood sugar, and it was actually very high, not low at all.
NARRATOR: According to the blood meter, Vivian's glucose level registers 500 milligrams per deciliter,
more than five times what it should be. She immediately asks her sister Teresa to administer a dose of insulin in the hope
that it will bring her glucose levels back down, but that's when something goes terribly wrong.
About an hour after the injection, Vivian loses consciousness and stops breathing.
She is rushed to the hospital, but to Teresa's disbelief, Vivian doesn't survive the trip.
They tried to revive her, but it's too late. She's already pronounced by the time she gets to the hospital.
NARRATOR: For Vivian's sister, Teresa, the sudden loss of her only sibling is devastating.
The only thing more painful than her grief are her feelings of guilt. Teresa is overwhelmed with the thought
that she might have caused Vivian's death by injecting her with too much insulin.
She was worried, because she's the one that gave her the insulin injection, and then a couple hours later, she died.
So I think she's a little upset. You know, maybe she did something wrong. NARRATOR: If Teresa accidentally injected an overdose
of insulin, it would have caused Vivian's glucose level to plummet-- a condition known as hypoglycemia, or insulin shock,
which can cause seizure, coma, and even death. But on first blush, Dr. G thinks it's
unlikely that Teresa gave her sister an incorrect dose of insulin. You know, she was used to giving that insulin.
She knew about the insulin. She'd done it before. NARRATOR: She wonders instead if there might
be another explanation for Vivian's unexpected death, one stemming from her recent dental surgery.
Well, I worry the teeth, in and of itself, isn't too big a procedure being pulled,
but you've certainly have opened up your sockets. And you're more apt to get an infection.
Well, what would that matter? Normally, we could, you know, fight that off, and we wouldn't have any problem.
Well, that's bad for people with diabetes, because they don't have as good a defense
against getting an infection. NARRATOR: Dr. G's concern-- perhaps Vivian developed an infection
[DRILLING] from the dental work, which simply overwhelmed her impaired immune system.
So that could be a major problem, and that could be something I have to worry about.
NARRATOR: Was Vivian's death the result of a tragic accident or from complications of illness and disease?
There's only one way for Dr. G to find out. [ELECTRONIC MUSIC] Sandi: I got everything on there.
All right, I'll be there in a second. Oh, not just the IDs. OK, which are the ones?
Dr. Hanson likes the blues, so what is the consensus so far here? Do you like the blues?
Sandi: Yes. So you'll keep wearing the blues. So these are for people like Dr. Hanson and I. Unfortunately,
she, I think, likes these. So let me try these. I think when those things get wet, you get a little--
The blues get, yeah, real slippery. What? The only problem is they are a little bit hard to get
on with the other glove. DR. G (VOICEOVER): When I first see her, I'm actually kind of taken back, because she looks much older
than her stated age of 42. And when I do an exam, I'm usually quite generous and always state that they look their stated age of 40
if you even maybe don't too good. But, you know, with her, I really had to say she didn't look her stated age of 42.
She looked older partly maybe because she didn't have any teeth. She was thin. She didn't look like she had taken
very good care of herself. She had wrinkles. She was thin. She had no teeth. She just looked old.
NARRATOR: Dr. G inspects the body carefully, looking for any unusual marks or trauma.
No bruises. I don't see the injection site. She does have some mild pitting edema, a little bit of edema
to her lower extremities. NARRATOR: Then she turns to examine Vivian's mouth, the site of her recent surgery and where Dr. G suspects
she might find a clue to her death. Well, I'm looking-- you know, one of the things I want
to concentrate on is her mouth. She just had all her teeth pulled. And when I look in, sure enough, she
just had all her teeth pulled. She had all those extraction pits, and they were starting to heal.
But, you know, it looked painful to me, and it looked, you know, inflamed a little bit.
NARRATOR: But Dr. G finds no obvious signs of infection, such as pus or ulcerations.
Externally, at least, a deadly infection now seems less likely. For Vivian's sister, this kind of news could be devastating.
If Vivian didn't die from an infection, perhaps something did, in fact, go wrong with the insulin
injection. The sister was very upset. And I think she felt that she was under her care,
and she slipped away from her. [MUSIC PLAYING] NARRATOR: Dr. G opens the body of 42-year-old Vivian
Kaplin with a Y-incision. DR. G: Did anybody see that video of the mistreatment of the cows before they were killed?
I couldn't. I glimpsed it, and I couldn't look. I had to turn away. I turned the channel.
NARRATOR: Once the body is open, Dr. G's first priority is to draw samples for toxicology.
Urine and eye fluid are collected, which will give an indication of Vivian's glucose level
at the time of her death, and whether or not her sister administered too much insulin.
I need to know what her glucose was. I need to know if she was dehydrated. I need to put all these things together still.
And so the toxicology and the chemistries on her eye fluid are all going to play a major role.
I hope to have me put this all together. NARRATOR: Then Dr. G prepares to draw blood from Vivian's heart.
If she developed a fatal infection as a result of the dental surgery, bacteria will surely be present in the samples.
It's very important that I get blood right away for blood culture to see if there
is any bacteria growing. I very gently open up the heart sac, I go for the major blood vessels to try to remove some blood
and then put it in a blood culture tube, to send to the lab, to see if it grows any bacteria.
I'm very careful. I try to do this very sterilely. A lot of people think that post mortem blood culture, because
of the bacteria kind of getting out of your gut, going into your body, aren't worth anything.
But occasionally if you get the person fresh enough, and you use good technique, you can
get either a single organism, meaning the one growing in their blood, or you can get a negative meaning
nothing was there-- a non-contaminated specimen, which is helpful, indicating they didn't have an overwhelming sepsis.
NARRATOR: However, no sooner does Dr. G begin drawing blood samples from the heart than she makes
an unexpected finding, one that may change the course of the entire autopsy. Oh, brother.
She's got adhesions. NARRATOR: In other words, there's scar tissue connecting Vivian's heart and the pericardial sac,
the protective sheath surrounding the organ. Pericardial sac was unusual in that there were
fibrous adhesions between the lining of the sac and the top of her heart, and those are, like, little scar
tissues between the two. That was important, because that indicates that she had
a pericarditis, or an inflammation of that heart sac, which is interesting because that's
a common manifestation of Lupus. NARRATOR: Lupus is a chronic inflammatory disease
that causes the body to attack its own tissues. This, in turn, can trigger serious and sometimes
life-threatening complications. Lupus has tremendous amount of manifestations. It can kill you many different ways.
It could be the heart. It could be the lungs. It could be the brain. It could be the kidneys.
All of those things can be affected by Lupus. [OMINOUS MUSIC] NARRATOR: Up to this point, Dr. G
has had no indication besides this finding that Vivian was ever diagnosed with Lupus.
But could it be the ultimate cause of her death? DR. G (VOICEOVER): Now I'm really
interested in that heart, because believe it or not, one of the most common ways that Lupus can kill you acutely,
particularly if you've had it for a long time, is by a heart attack, because it accelerates atherosclerosis,
or the plaque in the coronary arteries. And even women, who are relatively young like this woman, could have a severe atherosclerosis
and have a heart attack. [MUSIC PLAYING] NARRATOR: Dr. G's next step is to examine
the heart more closely. DR. G (VOICEOVER): Her heart was a normal-to-small size.
And I look at the coronary arteries, which atherosclerosis can be accelerated in both Lupus and diabetes.
NARRATOR: But she finds no obvious damage to Vivian's heart from either disease.
Her coronary arteries were completely normal. Her heart muscle was a little soft,
and I'm not sure what that indicated. It may be an infection, or it may be a myocarditis.
People with Lupus tend to have inflammation of the heart tissue, but the heart doesn't appear
to be why she died, unless I find something microscopically. NARRATOR: Next Dr. G turns to examine
Vivian's abdominal organs, looking for any signs of disease or infection there. But once again, she comes up empty handed.
DR. G (VOICEOVER): Well, internally, I don't see much going on. She's got some kidney changes.
She's got a fatty liver. DR. G: But overall, nothing too bad-- certainly nothing that I
can see acutely killed her. So I don't really see a cause of her death. I mean, I was hoping that it would be more clear cut,
but I do know there are many things, that could have caused her death, that I may not see.
The infection, I need to look under the microscope. The myocarditis associated with Lupus,
I need to look under the microscope. I need to check her levels of glucose in her eye fluid.
So many things are still possible that I still need to do the investigation, and I
haven't done the head yet. [MUSIC PLAYING] [SAW GRINDING] NARRATOR: Dr. G's morgue assistant, Sandi Ludwig,
opens Vivian Kaplin's skull. DR. G (VOICEOVER): You know, there's still possibilities that we could have had
the Lupus effect on the brain. And we've certainly have had people come through here
with Lupus with bleeds in their brain, and that's why they die. She could even have an infection.
DR. G: So I think that would be what I'd be most worried about. [OMINOUS MUSIC] DR. G (VOICEOVER): And I take the calvarium off.
Her brain's a little bit edematous, a little bit swollen. I cut the brain, and what I find is she
does have a bleed in her brain. [OMINOUS MUSIC] DR. G (VOICEOVER): But it's not the kind of hemorrhage
that would kill you. It's just a small, little hemorrhage maybe 8 millimeters by 3 millimeters
in the white matter. It's certainly an acute event. But how does this cause her death?
I'm not convinced it did, and I need to know how these pieces all fit together. DR. G: And I can't put it all together yet.
It's not making sense. [MUSIC PLAYING] [CART ROLLS] NARRATOR: The autopsy of 42-year-old Vivian Kaplin
is over, but Dr. G still has no answers. DR. G (VOICEOVER): I have some interesting history.
I have a few subtle findings. DR. G: I have the small bleed in the brain that probably didn't kill her.
It's certainly not big enough to kill her, but how does that play a role? OK. DR. G (VOICEOVER): It really doesn't
[RUNNING WATER] make much sense to me, so I need to put this all together. NARRATOR: Dr. G has no choice at this stage but to append
the case until microscopic slides and toxicology results are completed. For Vivian's sister, still worried
that she may have been at fault, the wait will be agonizing. DR. G (VOICEOVER): Well, this one, I told her sister,
I'm not sure. [SPRAYING WATER] Either there's no clear-cut evidence of why she died,
and she's just going to have to give me time to put this together. I think I'm on the verge here of putting it together,
but I need a few more pieces to the puzzle. NARRATOR: And after several long days,
these final pieces begin to trickle in. [OMINOUS MUSIC] First, microscopic slides confirm the effects of Lupus
in several internal organs, including Vivian's brain and heart. Her kidneys were also damaged by type 1 diabetes.
Still, there is no sign of infection in any of her organs or blood, but then Dr. G reads through the toxicology results.
DR. G (VOICEOVER): That actually gave me a huge piece of the puzzle. And that was she was in diabetic ketoacidosis.
[OMINOUS MUSIC] NARRATOR: The results are certain. Vivian Kaplin died due to a life-threatening diabetic
complication known as ketoacidosis. [INSTRUMENTAL MUSIC] Insulin is the hormone, that is made by the pancreas, that
takes your blood sugar, your glucose, and brings it into your cells, so your body
can use that for energy. What happens is, without the insulin, the glucose levels just keep getting
higher and higher in the blood, but your cells are starving. Your cells don't have any energy.
So what happens is your body is going to have to start breaking down other components,
like protein and fat, to get energy. And the byproduct of breaking down that fat and protein
are fatty acids and eventually this production of acetone, which is a very acidic substance, which, if it gets
high enough, can start denaturing proteins-- causing body functions not to work correctly.
And you can go into a coma and die, and this is why she died. NARRATOR: And yet this finding defies logic.
DR. G (VOICEOVER): Something is causing this blood sugar to go out of whack. But why?
You know, she supposedly takes insulin just an hour or two before this happens. It really doesn't make much sense to me.
[INSTRUMENTAL MUSIC] NARRATOR: Now all Dr. G can do is take a step back, revisiting the finding she's gathered to date.
DR. G (VOICEOVER): When I worry about diabetic ketoacidosis, I also then have to think about what triggered
the diabetic ketoacidosis. NARRATOR: And it isn't long before she hits on a seemingly
inconsequential clue, one that not only explains Vivian's sudden decline but can finally put
to rest the question of her sister's role in this tragic chain of events. In the midst of a Florida heat wave,
42-year-old Vivian Kaplin travels out of state to undergo radical dental surgery.
But Vivian is a type 1 diabetic, so she must take daily insulin injections to keep her blood
glucose levels in check. According to her sister, Vivian carried her insulin kit
in her bag on the trip. [DRILLING] DR. G (VOICEOVER): She does well with her extractions,
getting all her teeth pulled in about five days. She takes the trip back. She's not having any problem.
When she gets home, she goes to bed. But lo and behold, early that next morning though, she wakes up.
She's not feeling well. She thinks her blood sugar is low. NARRATOR: But Vivian is wrong.
She isn't feeling well, because as Dr. G discovered in autopsy, she just suffered a minor stroke triggered by her Lupus.
One of the most common reasons for somebody to go into diabetic ketoacidosis would
be major stressful events to your body, like maybe a stroke, a heart attack-- all of those things are known to precipitate going
into diabetic ketoacidosis. [OMINOUS MUSIC] NARRATOR: In this case, the stress of the minor stroke
may have been the cause of a sudden and catastrophic spike in Vivian's glucose level, but Vivian misinterprets
her symptoms as low blood sugar and drinks a fruit juice, which only adds insult to injury, further
elevating her blood sugar. DR. G (VOICEOVER): Lo and behold, when she tests her blood sugar after that, it's really high,
like over 500. Then at that point, she knew she needed to get some insulin. NARRATOR: The insulin injection should
help to normalize Vivian's glucose level, but it doesn't. While it's possible that her sister administered
an incorrect dosage, Dr. G believes there may be another explanation. DR. G (VOICEOVER): The insulin that they
gave her was the same insulin she had taken on that ride up to Georgia to get her teeth pulled,
and it wasn't refrigerated. NARRATOR: Dr. G now wonders if the insulin, which could have
saved Vivian's life, might have been rendered less effective, given its exposure to excessive heat.
DR. G (VOICEOVER): Insulin, if it's exposed to heat, it will lose its effectiveness.
Now I would have loved to have tested that, but it's very difficult to test for that kind of insulin
in her body after death. So at this point it's only a theory, but I think it's an appropriate theory.
So we have everything going on here. We have a stroke that's probably precipitating her blood sugar
to go up, but then we have the insulin, which probably isn't very effective because she had it exposed
to some high temperatures. NARRATOR: Because her body can no longer utilize glucose
for fuel, it begins to break down fat and protein for energy. DR. G (VOICEOVER): That causes her blood
to get very acidic, which then spirals into her going into diabetic ketoacidosis.
Her sister comes back in to check on her and realizes she has passed out. She calls 911.
They try to revive her, but it's too late. Her body had already shut down. She wasn't breathing.
She's got edema in her brain, so there is nothing they could do to save her. Hi, there.
She is right here. You're welcome. NARRATOR: With the puzzle of Vivian's sudden death solved,
Dr. G calls Vivian sister to explain her findings and to reassure her that she was not at fault.
DR. G (VOICEOVER): The sister did the best she could. DR. G: She feels bad about that insulin,
but nobody thought about that until after the fact. And hindsight is always 20/20.
OK, but just so you know, you know, how this all plays out, it's kind of complicated.
OK, just so you know we're on the same page. OK. OK. Bye, bye. She fully understands the complexity of the case.
Only because of your ability to communicate, doctor. We're so proud. My chest swells.
DR. G: Oh, you get out. [MUSIC PLAYING] DR. G (VOICEOVER): You know, I take away that sometimes
just unfortunate things happen. We can try our best to stay as healthy as we can,
but nobody knows what causes Lupus. Nobody really knows what triggers type 1 diabetes.
Then it just shows how, for those of us who don't have these devastating diseases, we should
be thankful for our health. And those that do, they need to work as hard as they can to stay as healthy as they can,
because they can. [OMINOUS MUSIC] NARRATOR: Dr. G knows that most people do what they can to try
to avoid a premature death. [MUSIC PLAYING] But in our next case, it seems that death may be exactly
what the decedent wanted. DR. G (VOICEOVER): You know, I feel bad for the family,
because maybe they could have prevented this. Maybe they should have been more attuned to what
she was going through. [OMINOUS MUSIC] [INSTRUMENTAL MUSIC] STAFF: Oh, he's the owner.
He's the owner? NARRATOR: Chief investigator Steve Hanson is responsible for leading the death investigations
at the district 9 morgue. Today, however, he's checking on a new purchase he made, for Dr. G and her staff,
to possibly replace towels in the morgue with sea sponges. Everybody that I talked to seems to think they're
a good idea. How expensive? STEVE HANSON: Well, they're supposed to last like a long, long time.
I didn't say how long they were going to last. I said how expensive. I think we bought six of them for $120.
NARRATOR: But a decision on sponges versus towels will have to wait. Dr. G's priority at the moment is her next case,
the unexplained death of a 69-year-old woman named Rose Paxton. [OMINOUS MUSIC] DR. G: OK.
NARRATOR: Reading through the investigator's report, Dr. G learned that Rose was a retired Orlando
teacher, who'd recently been struggling with depression. DR. G (VOICEOVER): She had lost her husband about
a year and a half earlier. She was really grieving over that, but she seemed to go on beyond grieving.
Her family was very worried about her. NARRATOR: Concerned, her son Jason and his family
traveled to Orlando to visit her. DR. G (VOICEOVER): They came to spend some time with her,
to try to get her out of the house and just see what was going on. Things seemed fine.
She, you know, did seem depressed, but she went out with them and had been having fun, at least
going to the attractions with them. NARRATOR: But by the time the family returns home later that evening, Rose is feeling very fatigued
and decides to turn in early. She stays in her room the rest of the night. [MUSIC PLAYING]
[BIRDS CHIRPING] DR. G (VOICEOVER): The next morning, her grandson came in to wake her up for breakfast,
and she was found unresponsive. Then he immediately went and got his dad, and she was dead.
They called 911, but there was nothing they could do. And they pronounce her in the home.
NARRATOR: For Rose's family, the unexpected loss is devastating. Well, at this point, the family just has a hard time
accepting that she died. They were very surprised-- very unexpected for that family.
To them, she was a picture of health. She'd just gone to the doctor about a month
or so prior to her death, and according to the son, he had given her a clean bill of health.
And so they're very worried about her depression and that maybe she committed suicide.
[OMINOUS MUSIC] NARRATOR: Rose's family is particularly concerned that she may have overdosed on one
of the many over-the-counter medications in the house. Elderly people do have a higher suicide rate
than the general population. You know, if you take all the elderly people over 60 to 85,
it's about, you know, between 14 and 15 per 100,000 population, while the general population is close to 11
per 100,000 population. So they have an increased rate of suicide. DR. G (VOICEOVER): When the family brings something
like that up, that's usually a red flag for me, because they'll usually underplay that.
And the fact that they brought it up to me, and that they were worried about it, I have to worry about it.
[MUSIC PLAYING] DR. G (VOICEOVER): Well, I had to agree with the family. She looked pretty good.
She looked like she was sleeping, and she looked like she taking care of herself.
I see no trauma on her. I see no swelling in her legs. I see someone that looks like they just went to sleep.
I mean, some people will come through my morgue, and you'd think, well, they're all dead.
They can't look that good. But some people look sick, and some people look pretty good.
She looked pretty good. NARRATOR: Dr. G notices that Rose still wears her wedding ring even though her husband
died more than a year ago. DR. G (VOICEOVER): She's still cares very much for her husband.
I see that in most widows that they're still wearing their wedding band. Let's see her mouth.
NARRATOR: As a first step, Dr. G inspects the inside of Rose's mouth. Some drugs can leave traces on the surface of the tongue.
Sometimes you take a lot of pills, they'll leave some discoloration. And I looked even for seizure activity-- bite marks
to the cheeks or the tongue. I don't see really much of anything except someone who
looks pretty good for her age, and whose of normal weight, and no evidence of trauma or natural disease externally.
So we really have a clean slate. But, you know, keep in mind, you never know what you're going to find.
[MUSIC PLAYING] NARRATOR: Dr. G prepares to open the body of 69-year-old Rose Paxton.
Her family fears she was driven to commit suicide over the recent death of her husband,
and now it's up to Dr. G to find out. You ready? In this case, I do my Y-incision,
you know, always hoping that I can tell right away why somebody died, and I don't see much of anything.
[ELECTRICAL EQUIPMENT] DR. G (VOICEOVER): Once I see the general look of what the chest and abdominal cavity look like,
I will remove blood for my toxicology. I'm worried about that this is suicide and a possible overdose.
[MUSIC PLAYING] NARRATOR: Next Dr. G begins removing each of Rose's internal organs for closer inspection,
starting with the heart. If an overdose didn't kill her, there's a good chance her heart did.
DR. G (VOICEOVER): Now this is where I think the money is. You know, somebody died suddenly and unexpectedly--
69 years old. Oh, I'm going to find heart disease. DR. G (VOICEOVER): I take out her heart.
Her heart is of normal size. It's not enlarged. I do a very careful dissection of her coronary arteries.
There was no narrowing to those coronary arteries. DR. G (VOICEOVER): The heart muscle, to me, looked fine.
The heart valves looked fine. You can die suddenly and unexpectedly with a narrowed aortic valve.
We see that sometimes. Let's see what's going on here. Anything interesting around here?
I look at the other organs. I look at her lungs. There is no evidence of disease to her lungs.
You can clearly see she didn't smoke. I look at her liver. I look at her spleen and her kidneys,
and I don't really find much of anything, in her chest and abdomen, that would have caused her death.
Internally, everything looks great. NARRATOR: Next Dr. G turns to inspect the contents of Rose's stomach.
DR. G (VOICEOVER): The stomach contents is of importance to me, because I want to see-- sometimes we'll
have residual pills, or material that they've ingested, where the levels will go up.
Like, part of it will be digested to the point where it will kill her, and there'll still be some of those pills
left in the stomach. DR. G: Oh, brother. That's not very good. There's really nothing here.
Everything looks good. In this case, she really didn't have much in her stomach.
A little autolysis-- you know, the mucosa, or the lining of the stomach, was starting to break down.
Very common finding at autopsy-- but not much stomach contents. Just a little bit of liquid in the stomach.
I certainly don't see any food. I don't see any pill fragments. It is consistent with her dying during her sleep in bed,
you know, sometime after she'd eaten, because her food is clearly digested out of her stomach.
So at this point, I carefully looked at her heart. I carefully looked at her stomach contents.
I don't really find any disease anywhere. So far, her family's looking correct. She seems the picture of health.
[MUSIC PLAYING] You know, at this point, I don't have a cause of death. And it would be nice to just end this, and not keep looking,
and find something in her brain. Certainly, an inner cerebral hemorrhage or an embolic stroke, I think everybody would feel
happy with that just knowing their mom didn't commit suicide, and that it was sudden and painless.
So I'm hoping along that line. [SAW RUNNING] NARRATOR: Morgue technician, Tom Hemphill,
uses the oscillating saw to open Rose's skull. I'm going to use this. And then I need the--
DR. G (VOICEOVER): I open her calvarium. I'm OK. I'm OK. DR. G (VOICEOVER): Nothing looks abnormal on the surface.
I slice the brain very carefully, and I do find a lacunar infarct. NARRATOR: A lacunar infarct is a small stroke, typically
less than 1.5 centimeters, which occurs in the deeper parts of the brain. DR. G (VOICEOVER): It's basically a tiny little stroke.
It looked like it was in the process of healing. It still had some swelling around it.
I'm not really sure what that lacunar infarct is telling me at this point. They're sometimes considered associated with high blood
pressure, diabetes, but we don't tend to see those as a cause of death. Well, we finished the autopsy.
I thought she surely would have had a heart disease, but her heart looked pretty good.
So it's tox and microbes. We don't have a cause of death, and I am-- unfortunately,
I have to call the family and tell them we're going to have to wait for the toxicology.
And, you know, I feel bad for the family, because not finding a cause of death at autopsy,
not finding natural disease, makes them more anxious that maybe it was suicide. Maybe they could have prevented this.
Maybe they should have been more attuned to what she was going through. We'll see.
[OMINOUS MUSIC] NARRATOR: At the Wuesthoff lab in Melbourne, Florida, technicians have just completed a blood
sample and body fluid analysis on 69-year-old Rose Paxton. The results are delivered directly to Dr. G.
DR. G (VOICEOVER): Well, I think the toxicology will be very interesting. Basically, we're looking at all those drugs
that she could possibly have taken to kill her. [ELECTRONIC MUSIC] We've tested thousands of drugs, and when we test.
We certainly look at the illicit drugs, but we also screen that blood in a way that
checks for just thousands of different types of drugs that aren't illicit. And it was completely negative.
NARRATOR: It's official Rose Paxton did not commit suicide. The news will undoubtedly bring welcome relief
to Rose's family, but for Dr. G, the results only bring a deepening sense of frustration.
DR. G (VOICEOVER): What's really going to be bad, and it happens in a small percentage of cases,
we never find out why she died. And I'm hoping it's not that. NARRATOR: But at this point, all Dr. G has left to examine
are microscopic slides of Rose's internal organs. DR. G: I get really surprised at microscopic examinations.
Because if it looks normal to my eye, it usually is normal under the microscope.
So I didn't have high hopes for the microscopic examination. Certainly, the liver looked normal.
I look at her kidneys. I'm looking for evidence of high blood pressure, even long-term diabetes that wasn't diagnosed.
Her kidneys look good. I look at all these organs, and they look good except for one.
And that was her heart muscle. NARRATOR: Staring at the slide, Dr. G can now say exactly why Rose Paxton died
even though it's a cause of death she has never diagnosed before. It's Saturday May 14, and Rose Paxton
is spending a busy day, with her son and grandchildren, visiting the sites of Orlando.
Her family is worried that she's suffering from depression due to the recent loss of her husband,
and they hope the activity will brighten her spirits. But today, Rose faces a much more
dire problem, one that she and her family are completely unaware of-- a heart ravaged by small vessel disease.
Her heart muscle looked really bad. It was quite remarkable. NARRATOR: Under the microscope, Dr. G
discovers that the tiny blood vessels within her heart muscle had become significantly narrowed.
DR. DARLENE GO: The smaller materials become spastic. These small spasms that basically choke the vessels
that give oxygen to the heart. And while that happens, your heart cannot function without oxygen.
NARRATOR: The reduction in blood flow causes muscle cells to die off one by one, resulting in a buildup of dangerous scar tissue.
DR. G: They're little, tiny, basically heart attacks just a few cells at a time.
And when you start having this increase in fibrous tissue and this decrease in blood flow, you
are at risk for a sudden cardiac arrhythmia. NARRATOR: Small vessel disease typically
strikes postmenopausal women like Rose, but it is very difficult to detect with standard cardiac tests.
And doctors are still unsure of its cause. DR. DARLENE GO: The small vessels, you don't see.
Therefore, it's very difficult to diagnose that they are dysfunctional until, down the road,
you do all the workup with persistent symptoms. And most of the workup does not show anything.
There used to be a debate whether this small vessel disease really was even a risk factor for sudden death
or bad outcomes. It used to be thought, no. In fact, there was a percentage of women that would be having
chest pain, that would go to a cardiologist, would get a cardiac catheterization where
they put the dye through the coronary arteries. They'd have completely normal coronaries.
And they'd send them on their way, saying, well, it just must be anxiety-- you know, just in your head.
Then over the past few years, they're starting to see, no, you don't have to worry about it.
It is associated with sudden death. It is associated with heart disease. [MUSIC PLAYING]
NARRATOR: However, in Rose's case her symptoms were so vague, only mild fatigue,
that she didn't even realize anything was wrong. Now this woman is interesting, because we
don't have any history of any kind of chest pain. But we certainly have microscopic evidence
of the heart muscle dying off. So when you put two and two together with no other cause of death, negative toxicology,
it really points to this as her cause of death. NARRATOR: That night at home with her family,
Rose doesn't know it, but her heart is failing. She feels tired and goes to bed early,
looking forward to another day with her family, but she won't live to see morning.
Dr. G believes that, sometime during the night as Rose is sleeping, her damaged heart suddenly falls
into a deadlier arrhythmia. [HEART PUMPING] Instead of pumping, it quivers. DR. G: There is a tremendous amount of scar
tissue in that heart muscle. The electrical system kind of goes out of whack. The heart can't pump.
And the blood doesn't get to her brain, and she dies. [OMINOUS MUSIC] NARRATOR: Dr. G is certain that Rose's death
was a result of natural causes and not suicide. Her last step is to call the family
and inform them of her findings. DR. G (VOICEOVER): They were so thankful that they
didn't have to worry that she committed suicide-- that they should have picked up on things.
And they felt bad that she died of that. But, you know, when you don't have symptoms,
and you're not complaining, there was really nothing they could have done for her.
[INSTRUMENTAL MUSIC] DR. G (VOICEOVER): You know, when you see this-- and this is probably the first case
of small vessel disease, that was causing the death, that I've autopsied. There are so many ways your body can eventually cause you
to die, and there's so many ways your body can eventually betray you. But you have to remember so many of those ways
are still associated with us betraying our body and what we do to our body. [SPRAYING WATER]
And, you know, it's kind of a give-and-take. Your body will try to stay good to you
if you stay good to your body, but sometimes, no matter what we do, bad things still happen.
Destroying all the evidence. [MUSIC PLAYING]

Even with many leads, including an insulin overdose, a tooth infection and chronic lupus, the pieces don’t add up in the case of a woman's death. Will Dr. G be able to uncover the truth?

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

Brief Summary

Two women die unexpectedly; one from diabetic complications, the other from undiagnosed heart disease.

Key points

A Tragic Death. A woman dies shortly after dental surgery, leaving her sister feeling guilty.
The Autopsy Begins. Dr. G starts the autopsy of Vivian Kaplin, a seemingly young woman who passed unexpectedly.
A Shocking Discovery. Dr. G finds scar tissue on Vivian's heart, indicating a possible Lupus diagnosis.
The Cause of Death Revealed. Vivian died from diabetic ketoacidosis, a life-threatening complication of diabetes.
The Mystery of Vivian's Death. Dr. G investigates the factors leading to Vivian's unexpected death, including insulin exposure.
Unexplained Death of Rose Paxton. Dr. G examines the sudden death of a seemingly healthy 69-year-old woman.

Episode highlights

Episode quotes

The only thing more painful than her grief are her feelings of guilt.

Teresa's overwhelming guilt after her sister's death.

5:28WatchJun 15, 2021

Tension

75/ 100High tension

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