Dr. G: Medical Examiner - Season 5, Episode 6 - Cruel Intentions - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A three-year-old toddler was found dead in his bed. It's just tragic.
Life-- you're just beginning. NARRATOR: Now, it's up to Dr. G to find out exactly what
cut this child's life so short. This is important. This is why I do my cases. This is why I went into forensics.
NARRATOR: And then a young man collapses in front of his grandparents. They had to call 911.
Paramedics arrive. He's already lost his blood pressure and pulse, and he died. NARRATOR: Could this 31-year-old sudden death
become one of Dr. G's most surprising autopsies yet? Oh, gosh. You don't always know what that autopsy is going to show,
and that's what makes this job so exciting. [MUSIC PLAYING] NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations-- these are the everyday cases of Dr. G, medical examiner. [MUSIC PLAYING]
JAN GARAVAGLIA: Well, I think we have our cause of death. Anyway, so not a bad day today--
just tragedy. NARRATOR: Dealing with death every day can take a heavy emotional toll.
Oh, always a good time in the morgue. NARRATOR: But over the years, Dr. Jan Garavaglia--
chief medical examiner for the district 9 morgue in Orlando, Florida-- has learned to distance herself from the tragedy she sees.
First of all, it makes you realize how precious life is. The people that will be autopsied tomorrow--
most of them are not thinking they're going to be autopsied tomorrow. They're kissing their kids and their loved ones,
and doing all sorts of things out there. It might be one of us, so you might as well enjoy the day
and appreciate what you have. NARRATOR: But as a mother of two, Dr. G understands that few losses are more heart wrenching
than the death of a child. JAN GARAVAGLIA: It's just tragic. Life-- you're just beginning.
Yeah, it's a beautiful child-- absolutely nothing wrong with her. We're not geared to see our children die.
They're geared to see us die. [INAUDIBLE FRANTIC CHATTER] NARRATOR: It's 6:00 AM on a cold, November
morning when Jack Garrity-- a resident of a low-income Orlando housing complex--
wakes up to the sound of frantic pounding at his door. WOMAN: Help, please help me.
NARRATOR: He opens it to find his neighbor, Ruby Walsh, holding her youngest son, 3-year-old Robbie.
And he's not breathing. They immediately call 911. But sadly, it's too late. He's clearly already dead.
NARRATOR: Robbie is pronounced dead at the scene, still in his mother's arms. Unfortunately, today, we've got a three-year-old
child to autopsy. We don't really know what's been going on. When I first get this case, all I have
is what my investigative sheet says. NARRATOR: According to his mother, Robbie was a vivacious child who loved animals
but whose prominent birthmark made him shy around strangers. She also reveals that her son experienced
one strange symptom in the days leading up to his death. The mother said that a couple days ago
that he'd been complaining of some abdominal pain. NARRATOR: Ruby gives her son acetaminophen to ease the pain,
and it appears to do the trick. JAN GARAVAGLIA: The next day, he seemed to be in good spirits.
And according to her, he seemed fine. NARRATOR: But later that evening, when Max Walsh--
Robbie's stepfather-- checks in on the sleeping child, he sees that Robbie has vomited.
Still, the toddler doesn't seem to be in any distress. He was on a bunk bed, and the stepfather found
some vomit still on his sheets. NARRATOR: But when Robbie's mother goes to wake him
the next morning, she finds the toddler lying face down on his bunk bed, unresponsive and cold
to the touch. And when she turns him over, she discovers more vomit. It's then that she gathers her son in her arms
and rushes to the neighbor's house for help. The mother-- she doesn't give us any history of any trauma.
She doesn't give us any history of really anything, except this kind of vague stomach pain
a couple days prior to death. This is a relatively poor family. Maybe he didn't have good health care
and something medically is going wrong. So it's looking like maybe natural disease,
but we certainly always have to keep our eyes open. NARRATOR: Dr. G knows that Robbie's death could have also
been the result of an accident that his mom simply wasn't aware of. Accidents-- they're still the most common cause
for kids of this age group. Certainly motor vehicle-- number one. Drownings-- things like that.
NARRATOR: But there is still another sad and sinister possibility. Unfortunately, in that age group,
we still see inflicted injuries. We still see abuse, and that's always got to be in our mind.
NARRATOR: Dr. G's investigators are her eyes and ears on the scene, and they play a crucial role in helping
to identify signs of abuse. JAN GARAVAGLIA: When they looked at him, they felt that he looked well cared for.
He did have some vomitus on his face, but they didn't see any evidence of abuse or trauma.
And they felt there it was probably an apparent, natural disease. NARRATOR: And at this point, natural disease
is high on Dr. G's list. I don't like that vomiting, not feeling well a couple days.
But that's why we're doing the autopsy. We'll see what it is. Cute, cute kid though.
Yeah, he has soft hair. Yeah, soft hair and long eyelashes. Initially when you see him, he's a cute kid.
Your heart goes out to him. Your heart goes out to the family. Beautiful little baby.
NARRATOR: But Dr. G knows that in order to do her job she must leave her emotions at the door.
You want to give me the tape measure? I sure will. I have to be cool and collected
when I do these cases-- 44.8. --because child cases are some of the hardest cases we have.
Pretty, dark brown eyes. Two lowers-- acute. Externally, he looks pretty good. He's got four uppers.
Eyes OK. NARRATOR: But Robbie has one distinctive feature that makes him stand out.
He's got a big birthmark on his face. It kind of goes across the lateral, or side, part
of his eye and onto his cheek. NARRATOR: A birthmark is a discoloration of the skin that
is either present at birth or appears a short time after delivery. 30% to 50% of babies have some type of birthmark.
Some are permanent, while others fade with time. Pigmented birthmarks, such as the one Robbie has,
are caused by an abnormal development of pigment cells. And everything else looks good, except he
does have fixed lividity. NARRATOR: Lividity-- or livor mortis-- is a natural process that occurs after death.
It is characterized by a purplish-red discoloration of the skin. Once the body dies, gravity causes blood to settle.
Initially, the pattern of lividity can be shifted if the position of the body is changed.
Yeah, put him back. I can't get him that way. NARRATOR: But 8 to 12 hours after death, the blood
begins to clot, and the lividity becomes fixed, or permanent. The fact that Robbie has fixed lividity
can mean only one thing. He's clearly been on that bed face down the way he was found for several hours.
We have a-- what happened to all our others? - Do you want the other one? - It doesn't matter.
OK. It doesn't matter, doesn't matter, doesn't matter. All righty. NARRATOR: At first, the external exam reveals
nothing out of the ordinary. OK, he looks perfectly normal. NARRATOR: But then, Dr. G takes a closer look at Robbie's torso
and gets her first surprise. Belly's a little distended. What was interesting on his belly
is that there's a little bruise there. Look at that. Just above the level of the belly button,
and a little to the right. Faint. Maybe-- It doesn't look too bad. NARRATOR: Dr. G can tell from its purplish-blue color
that this is a fresh bruise. It probably is nothing, but it could be something. NARRATOR: But she's curious as to why
neither Robbie's mother, nor his stepfather, mentioned any recent trauma. There's always a possibility of some accidental injury
that they don't know about, or some unfortunate inflicted injury. I don't know what it is, but I will keep my guard up.
NARRATOR: Taking no chances, Dr. G makes a meticulous record of the bruise. I photograph it.
I make sure there's a ruler, and documented it, and move on. And hopefully, it doesn't mean anything.
Oh, I'm just going to try something. NARRATOR: But the surprises in this case are far from over.
Oh, shoot. Because you never know what the autopsy is going to show, particularly with children.
[MUSIC PLAYING] 11-centimeter scar. Did you need the block? Um, yeah, let's see how the block does.
NARRATOR: As she nears the end of three-year-old Robbie Walsh's external exam, Dr. G is still
unable to draw any conclusions about the strange contusion-- or bruise-- on the toddler's abdomen.
JAN GARAVAGLIA: I'm a little worried. I don't know if it's an innocent bruise of play,
or if it's a deadly bruise of abuse. NARRATOR: To find out, she must look inside Robbie's body.
What looks normal on the outside may be anything but normal on the inside. NARRATOR: Dr. G has one important tool that will help
her detect possible abuse-- the X-ray machine. One of the signs of abuse is they get broken bones.
And so we do full-body X-rays looking at the head, the neck, but particularly look at the long bones.
And we look for evidence of acute fractures that have just happened. And we look for evidence of old fractures,
because that can give us a history. NARRATOR: She pours over Robbie's X-rays, looking for any signs of trauma.
And we don't see any fractures, and that's a good thing. NARRATOR: But this doesn't mean that Dr. G can cross
abuse off her list of suspects. You still have to autopsy this child, because he can have a lot of soft tissue injuries,
he could have head injuries, with no fractures. NARRATOR: First, Dr. G focuses her attention
on the one part of Robbie's body most likely to show signs of abuse-- his head. Children-- oftentimes, they'll be flung, or hit.
And they'll get head trauma-- closed head injuries, sometimes with a skull fracture,
sometimes not. NARRATOR: Could Robbie have died from a severe head trauma after being attacked by his mother,
Ruby, or his stepfather, Max? I'm hoping it's not that, but it's certainly in my differential.
NARRATOR: The cranial exam will also help rule out another possible suspect. The other thing we have to worry about with children
are meningitis. NARRATOR: Meningitis is an infection of the meninges, the membranes that protect
the brain and spinal cord. And it can be fatal, especially in young children. [MUSIC PLAYING]
Dr. G begins by cutting a slit across the top of Robbie's head, freeing the scalp.
And we reflect the scalp, looking for any kind of contusion, or bruising, on the inside of the scalp.
And with this cute little boy, we don't see anything. NARRATOR: Next, morgue technician
Sandy Ludwig uses an oscillating saw to cut through the skull cap. All righty. And I pull that off, and we don't
see any evidence of blood, or trauma to the brain, or even evidence of meningitis.
Two of the big things we'll see with kids of this age have already been dispelled by the autopsy.
He's fine. NARRATOR: This case is becoming more puzzling by the moment. But Robbie's family background does give Dr. G another lead.
This is a poor family. I'm not so sure how much medical attention he'd gotten. Sometimes, we'll pick up congenital heart
abnormalities that were not picked up at birth. Sometimes, we'll pick up lung infections that maybe
the family didn't pick up on. So we're just going to see what we find. OK, let me open this.
You can get your tox, and I'll go-- WOMAN: All righty. There should be some adhesions in this little guy's belly.
Let's see, do I have a-- WOMAN: Here it is. Oh. NARRATOR: Dr. G performs a Y incision
and opens up the abdominal cavity. And that's where I see my first clue of what's going on.
Oh, shoot. NARRATOR: In fact, what Dr. G finds inside Robbie's abdomen is nothing short of shocking.
Oh, my god, look at that. I find 250 cc's of blood in his belly. Wow, lots of blood.
NARRATOR: For a child of Robbie's age, 250 cc's is a significant amount of blood.
This is about 20% to 25% of the total amount of blood in his body. It's making the autopsy rather difficult.
NARRATOR: And if that weren't enough, Dr. G soon spots another serious problem. Oh, my god, all of--
Things are not looking good. I see changes in the abdomen that suggest a peritonitis--
or inflammation-- of the lining of the abdominal cavity. Something's happened to his abdomen.
NARRATOR: Suddenly, a suspicious picture is beginning to emerge. Somebody knows what happened to this child.
[MUSIC PLAYING] NARRATOR: Dr. G ladles out the blood found inside three-year-old Robbie's abdominal cavity--
There you go. Let me see if we can figure out what's going on. NARRATOR: --and makes a startling discovery.
He's got a lot of adhesions. He has gotten such a blow to the abdomen that he's bruised the entire abdominal wall.
NARRATOR: And it doesn't take much to draw a line from this internal damage to the bruise
found during the external exam. Basically, this blow went straight through him. NARRATOR: The question is, was this an accident or abuse?
Really screwed up his omentum bowel. What's really worrisome is that he's got a big bruise, even
on his omentum. NARRATOR: The omentum is the protective layer of fatty tissue that hangs down in front of the bowels.
JAN GARAVAGLIA: Ah, what else we got going on here? NARRATOR: And the more Dr. G looks,
the more damage she sees. And he's got tears in the mesentery. Oh, my god, no. The mesentery is a connective tissue
that holds the bowels in place. They kind of anchor the bowels to the back of your abdominal cavity.
NARRATOR: But its most important function is to supply blood to the bowels. Robbie's torn mesentery explains why
such a large amount of blood was found in his abdomen. And it also spells disaster for the bowels.
What's happened is, where those tears are, the bowels are starting to die because it's
not getting the blood it needs. NARRATOR: Starved of blood, the bowels begin to break down, with disastrous consequences.
The bowels are full of bacteria, and those bacteria leech out. They leach out into the bloodstream.
They leach out in your abdominal cavity, and you get this overwhelming infection.
I need the bowel. Just save it for me, and I'll look at it. There you go. NARRATOR: At this point, one thing is crystal clear.
The cascade of events was ultimately caused by blunt trauma to the abdomen-- a death sentence in a child as young as Robbie.
This is his cause of death, and there is no question. He's dying from this injury.
Tragic, tragic. Could it have been caused by a fall? It would have been caused by a fall
that you would have noticed. This is not a subtle injury. This is an inflicted injury.
Somebody knows what happened to this child. This is a homicide until proven otherwise.
The first thing you do is you contact the police and say, this is a homicide. This is important.
This is why I do my cases. Listen why I went into forensics. This is a case of a little, innocent kid that
comes in as probably a natural. And this turns out to be a kid that's beaten. NARRATOR: Armed with Dr. G's findings,
the police open a full-scale investigation. And what they found was really quite interesting.
NARRATOR: According to neighbors, Max Walsh-- who had married Ruby five months earlier--
has a history of violence. And, of course, it was he who went in to check on Robbie
on that fateful night. Investigators confront Robbie's mother, Ruby Walsh, with Dr. G's findings and their growing suspicions
about her new husband. Under pressure, the distraught mother eventually breaks down.
Through a veil of tears, Ruby begins to paint a disturbing family portrait. What they found is that this was
a child that had been chronically abused, picked on by his stepfather. And what was really sad is that the stepfather didn't
really pick on the other kids. But he kind of picked on this little kid, because he didn't like that birthmark,
and he was a little darker pigment than the rest of the kids. And what's really deplorable is that mother let that go on,
too. NARRATOR: Max Walsh is quickly emerging as the prime suspect in the death of his stepson.
And when the police pull him in for questioning, Max even confesses to what he calls "innocent teasing
of the toddler." He admitted that he would often flick his birthmark. He even admits to choking him, and holding him,
and tried to say that the kid liked it. NARRATOR: But when it comes to the night in question,
Max flatly denies intentionally harming Robbie. The stepfather says, well, yeah, I might have accidentally
hit him on the railing. NARRATOR: Max claims that he may have bumped Robbie against the ladder of his bunk bed
when he tried to put the toddler back to sleep. But to Dr. G, the evidence proves otherwise.
JAN GARAVAGLIA: This is no accident. He has been picking on this child for a long time,
and he gave that child a big blow to the belly. Whether he slammed him on the top of that ladder,
or whether he slammed him with his fist, I don't know. But it's not trivial. That was an intended inflicted injury.
NARRATOR: Despite Max's persistent denials, authorities now feel they have enough forensic evidence
to bring charges against him. Relying on Dr. G's findings, investigators can finally
reconstruct what they believe happened to little Robbi Walsh on the last night of his short life.
The day Max Walsh married Ruby and moved in with her three children, three-year-old Robbie's life
changed forever. JAN GARAVAGLIA: This is a kid that was singled out. He was being picked on.
He was called names because his skin was a little darker than the rest of the family.
It wasn't just physical abuse. There is a lot of emotional abuse with this poor kid.
NARRATOR: On the night of Robbie's death, Max checks up on his stepson, asleep in his bunk bed.
That night, for whatever reason, he was more angry with this child. And this child suffers a severe blow
to the abdomen, whether it be with the ladder, or with his fists. NARRATOR: This blow leaves a trail of devastation
in its wake, bruising Robbie's skin, his entire abdominal wall, his omentum, and then tearing his mesentary.
JAN GARAVAGLIA: He is leaking out blood from those tears. He vomits. The stepfather then puts him in the bed.
He knows he vomited, and he just lets him lie there. NARRATOR: But it isn't long before the damage to Robbie's
organs begins to compromise the blood supply to a section of his bowels. The bowel is slowly losing its integrity
to hold back the bacteria. The bacteria leak into his abdominal cavity and leak into his bloodstream, eventually,
and he dies from this injury while he's in bed with vomit on him. As a mother, it's deplorable.
As a human being, it's deplorable. This is an innocent kid that's being picked on because of a birthmark?
NARRATOR: Thanks to Dr. G's testimony at his trial, Max Walsh was convicted of serious bodily injury
to a child and is currently serving a 20-year sentence. Ruby Walsh was charged with failure to protect
the welfare of a child. Her two remaining children were placed in foster care. You would think that these would be emotionally hard
cases for me, but they're not. Those are the kind of cases that we exist for, where it comes in
as a natural, and we can speak for that little kid and say, hell, no. It's no natural.
Somebody did this to him. There is no time for any kind of emotion when you have a child abuse case to do.
NARRATOR: Many of Dr. G's cases are heartbreaking, but very few take her so completely by
surprise as her next autopsy. I thought it was going to be a run-of-the-mill drudgery type of case that I just have to get through.
But what's happening to this guy is actually very rare. [MUSIC PLAYING] NARRATOR: As a medical examiner, Dr. G knows firsthand
the benefits of exercise. That's why she's recently been trying to amp up her own workout.
Go to the gym three times a week, but you just kind of get in a rut. The most important thing is you have to tell the person
what you're looking for, what you want to achieve. 10 pounds. It's not really that hard.
It's not. I can find you a simple routine. You need a starting point. I know, but you won't push me.
You're too nice a guy. [LAUGHS] See, Brian, it's not a good idea for you to do this for me, because I'll
take my aggression out on you. It'll be just bad. NARRATOR: But talk of working out and losing weight
must move quickly to the backburner as a troubling new case arrives at the district 9 morgue.
The previous afternoon, paramedics responded to an emergency call from a couple in their 80s living just outside Orlando.
But when they arrive, they find that the elderly couple is fine. It's their grandson, 31-year-old Stefano Medina, who is not.
He's slumped on the floor and has no pulse. Leah Victor frantically explain that their grandson
hadn't been feeling well but insisted on helping with the yard work. Before long, he became too weak to continue,
and that's when the nightmare began. He arrested in front of his grandparents, collapses.
They had to call 911. Paramedics arrive. He's already lost his blood pressure and pulse.
NARRATOR: The paramedics work furiously to revive him, and they succeed, to some degree.
They were able to get his blood pressure back and his pulse rate back, but he still
doesn't have any mental status. It looks like he's in a coma. NARRATOR: They then rushed him to the hospital,
where he's immediately admitted to the ICU. He had to get multiple IVs. They did a lot of tests on him, and it looked
like he was going downhill. NARRATOR: Doctors run a battery of tests, hoping to find something that might save him,
but they quickly run out of time. He codes again in the ICU about 10 hours after he gets there.
NARRATOR: And shortly before midnight, Stefano Medina dies. The sudden loss devastates Leah and Victor.
A troubled child from a broken home, Stefano ran away often in his youth, but he'd always found
refuge with his grandparents. Now, they've lost him forever, and their only hope of finding
out why lies with one person-- Dr. G. Dr. G begins the autopsy by scanning through Stefano's
medical history. For someone 31, he's got a pretty extensive history. Been in the hospital for gunshot would.
We also find out that he's been in the hospital before for some recurrent pancreatitis, which is
inflammation of your pancreas. NARRATOR: About 80,000 Americans are diagnosed with acute pancreatitis each year, most of whom
are treated successfully with little more than fluid IVs and dietary restrictions.
JAN GARAVAGLIA: He's had a couple times. It sounded like they were always mild. They resolved spontaneously on their own
with very little treatment. So it certainly hinders your quality of life, but you don't usually die from it.
NARRATOR: Dr. G doesn't think a simple case of pancreatitis could have landed Stefano in the morgue.
But then, she sees something in the report that may explain what did. This is a man that started some bad habits early.
He started drinking at an early age, and drinking quite heavily at an early age.
He starts smoking at an early age. And he starts doing illicit drugs at a fairly early
age, specifically cocaine. NARRATOR: In fact, looking at his charts from the hospital,
Dr. G sees that Stefano's urine tested positive for cocaine, leading doctors to believe that the drug caused
his sudden arrest and, ultimately, his death. My number one suspect is I'm going
to go with what the doctors felt in the hospital. Cocaine can cause bleeding in the brain.
Cocaine can cause heart attacks. It can cause an arrhythmia, or the heart to quiver from the stimulant effect.
NARRATOR: She also knows that his heavy drinking could have significantly increased
his risk of cardiac arrest. When people both drink and use cocaine, something really interesting happens.
There is a chemical that's formed in your body that's called cocaethylene that only forms inside your body
when you've taken in alcohol and you've taken in cocaine. And what's interesting about cocaethylene
is it actually probably even more of an irritant to your heart than either cocaine or ethanol alone.
There's even more of a chance of having a sudden cardiac arrest and an arrhythmia when you use those drugs together.
So there there's still other things it could be, but sounds like cocaine caused his sudden arrest.
NARRATOR: For Dr. G, drug-related deaths are, unfortunately, a dime a dozen. They've got to be extremely routine and really
not that interesting. [MUSIC PLAYING] NARRATOR: When Dr. G approaches Stefano's body on the gurney,
she immediately notes the paraphernalia left by his intensive care in the hospital.
The external examination is everything you expect from somebody that's been in the hospital
even for 10 hours. He's got an endotracheal tube. He's got intravenous lines where they're
giving him a lot of fluid. NARRATOR: But the key is whether, amidst these artifacts, she can find what put him in the hospital
in the first place. Dr. G begins her examination by looking for clues of Stefano's cocaine use.
You know, with a history of illicit drug use, I'm always wondering, does he sniff cocaine,
does he smoke cocaine, or does he inject cocaine? All of which can cause different things to your body.
If you sniff a lot of cocaine, we'll look for a nasal-septal defect-- the tissue between your two nostrils.
That's from sniffing cocaine. Certainly, from skin-popping cocaine-- where you inject cocaine right under the skin--
you get these shallow ulcers. They're often round. You usually see them on your anterior thighs.
I look for those. He doesn't really have any on his anterior thighs. Certainly, from injecting cocaine,
you can find needle puncture marks that are healing. So we look for needle puncture marks,
and healing needle puncture marks, indicating that he's used cocaine. NARRATOR: But the only sign she finds of Stefano's cocaine use
is his general appearance. For somebody 31 years old, he really doesn't look that good.
He's kind of thin and scrawny, which goes along with his cocaine habit, because cocaine is a stimulant,
and cocaine can be an appetite suppressant. NARRATOR: To Dr. G, he looks like a habitual user.
But that doesn't mean cocaine is what ultimately killed him. She'll first need to find hard evidence of the drug's
effect inside Stefano's body, and she knows just where to start. OK, go for it. The cocaine will cause your blood pressure to spike.
It can cause bleeding inside the brain. It would really kind of makes sense with all his symptoms--
then him coding, arresting, and then being comatose in the hospital. So I think I'm going to go to where the money is.
[MUSIC PLAYING] NARRATOR: Dr. G prepares to examine the cranium of 31-year-old Stefano Medina.
I'm hoping, when I do the head, this is going to give me the answers. Because it really would make sense with all his symptoms--
then him coding, arresting, and then being in the hospital. He uses cocaine, and then has that elevated blood pressure,
and he has a bleed inside his brain. That would kind of off off-fit this. [MUSIC PLAYING]
NARRATOR: Dr. G's morgue technician, Brian Machulski, guides the oscillating saw through the skull.
For him, this has been a difficult tool to master. BRIAN MACHULSKI: It's similar to sawing through a piece of wood.
The only problem-- as you're doing it, you're realizing that it was once alive, and it was a human being.
See, I have very heavy hands, and I'm notorious for breaking everything. So when I first learned how to do it,
sometimes I have a tendency to go right through the skull real fast, real heavy, and it goes into the brain.
You got to slow it down. You got to ease up on your pressure. It's definitely something that you're not used to.
Probably one of the most awkward experiences of my life. NARRATOR: If Stefano's blood pressure had skyrocketed
to the point where it burst a vessel, she would expect to see a collection of blood,
known as an intracerebral hemorrhage that is congealed into a clot. So we remove the calvarium, but when I cut that brain,
he's got no hemorrhage. There's nothing there. Well, I'm thinking, well, the cocaine didn't
cause the bleed in his brain. But there are other ways you can die from cocaine,
and I'm still expecting to find some. Cocaine can cause heart attacks, an arrhythmia.
It can actually cause heart muscle damage, and that's what my thinking is. [MUSIC PLAYING]
WOMAN: You got another new one up there when you name them. NARRATOR: Dr. G makes the Y incision from Stefano's
shoulders down to his abdomen. Then, she reflects the skin and fat to expose the ribs, a technique that also
reveals his abdominal cavity. And there, she sees something unexpected. Something else is going on here.
There's blood mixed with some fluid collection inside his abdominal cavity. But why is there some blood in his abdominal cavity?
Let's see. So I immediately look around at his liver, his spleen, for any type of trauma.
But all of those look fine. There's no evidence of trauma. NARRATOR: What she does see is more blood
in the area underneath the organs, called the retroperitoneal space. Dr. G suspects that this massive internal bleeding may have been
caused by an aortic aneurysm-- a tear in the body's largest blood vessel. Chronic cocaine users will have spikes of blood pressure,
which can cause aortic dissections, which is what I'm really thinking is going to be his mechanism
of death at this point. NARRATOR: The aorta originates at the heart and extends into the retroperitoneal space
behind the abdominal organs. JAN GARAVAGLIA: And in that space are your kidneys,
your pancreas, your aorta. NARRATOR: Unfortunately, at this point in the autopsy,
she's unable to access this area. It's a space I can't get to until all of the organs
in the abdomen are taken out. And honestly, I can't wait to get to that. It gets kind of tedious, but I would like to now go in
to figure out what is causing that blood in that retroperitoneal space. And I can't do that until I look in the heart and lungs,
so I start with his heart. NARRATOR: She pries open the rib cage and removes the heart for closer inspection.
So I'm surprised that his heart looked completely normal. I really didn't see any chronic effects of cocaine
on his heart. NARRATOR: Next, she examines the top portion of Stefano's aorta, the section that's connected to his heart.
And here, she's surprised by what she doesn't find. And there's no tearing of the aorta,
so I don't really see anything in the first part of the aorta. But I can't get to the lower part of the aorta
until I take all of the abdominal organs out. NARRATOR: She begins by removing the lungs.
I don't see any acute diseases, except that he's got a lot of edema to his lungs.
He's got a lot of fluid buildup. But I think that is a result, probably, of him just
being in the hospital, because he's clearly been on a respirator. All righty, you know what?
Just leave the bowel out like that for me. OK. NARRATOR: She finds no abnormalities in the lungs,
liver, stomach, or bowels. With the chest and abdominal cavities clear, Dr. G can finally access the retroperitoneal space
where she hopes to pinpoint what has caused Stefano's massive bleeding. JAN GARAVAGLIA: He clearly died from the loss of blood,
but I don't really see the source of that blood. And it's very difficult to dissect what's going on.
Let me get some of this out of here. NARRATOR: To get a closer look, she clears out the blood with a ladle.
When we go into that retroperitoneal space, his aorta really actually looks pretty good.
NARRATOR: The intact aorta brings Dr. G to a baffling dead end. Stefano clearly died from massive internal bleeding.
But where was the blood coming from? To hunt down the culprit, she turns back to examine the remaining organs in the retroperitoneal space--
the pancreas and the kidneys. And there, she suddenly spots a major abnormality.
Oh, gosh. He clearly had a serious problem. His body is basically digesting itself.
[MUSIC PLAYING] NARRATOR: Dr. G is on a mission to find out what killed 31-year-old Stefano Medina, beloved grandson
of Leah and Victor. She knows that he died of massive internal bleeding, but she hasn't been able to pinpoint
what caused the bleeding in the first place, until now. His pancreas does not look good.
Whoa, whoa, whoa. There is a large amount of hemorrhage surrounding the pancreas.
In fact, I can't see where the pancreas ends, because it's kind of one big clump of blood.
NARRATOR: But as she examines the organ more closely, it becomes all too clear. Stefano has suffered the worst possible complication
of pancreatitis. The biggest part of the pancreas is the formation of digestive juices
that then get emptied into your duodenum-- your small intestine-- to help digest food.
Now, pancreatitis is when you get an inflammation of your pancreas. And what's happened is he's got severe pancreatitis.
NARRATOR: Severe, acute pancreatitis causes the pancreas to leak digestive juices
into the surrounding tissues. His body is basically digesting itself. Those enzymes, which should be digesting and breaking down
your food, are actually digesting and breaking down the tissues of the pancreas itself.
NARRATOR: And it's not just the pancreas. The enzymes were also eating away at a major blood vessel called the superior mesenteric artery.
The superior mesenteric artery runs right next to that head of the pancreas. And in his case, that artery became weaker and weaker
as it was exposed to those digestive enzymes that were leaking out. NARRATOR: The result?
The superior mesenteric artery balloons until, finally, it bursts. The source of the bleeding is clearly
when that superior mesenteric artery blew and just digested away. OK. You know, what's happening to this guy is actually very rare.
First of all, pancreatitis-- 80% is not going to cause you any trouble. But it's really rare to have a digestion of the blood vessel.
And of those that do occur, it's really rare to have the superior mesenteric be the one.
So we have a very, very rare complication of pancreatitis. NARRATOR: Now Dr. G is finally able to explain
to Stefano's grandparents what cut his life so tragically short. All righty. NARRATOR: Stefano has been working
hard for hours, cleaning up his grandparents' backyard. But he's not feeling well, for good reason.
A deadly chain reaction is unfolding deep within his body, but it's not because of cocaine, as Dr. G first suspected.
When I get his toxicology back, he wasn't high on cocaine at all. It was just a small amount of metabolite
of the cocaine that was being picked up in his urine. He probably had taken that cocaine
at least several days earlier, not when the acute event was occurring. NARRATOR: But Dr. G believes another substance is to blame.
Because of his chronic alcohol use, he started to get pancreatitis. The number one cause in Western civilization is alcohol.
The alcohol ends up affecting his pancreas intermittently in life. In this episode, he probably started
to get a much more severe case and he'd had before. NARRATOR: At some point, Stefano's inflamed pancreas
begins leaking digestive juices that consume the tissue of the organ itself, causing it to bleed.
That probably caused the initial collapse at home. NARRATOR: But at the hospital, while doctors
struggled to diagnose him, the digestive enzymes continue their rampage. JAN GARAVAGLIA: That pancreas continued
to leak digestive juices. These enzymes kind of just go into the surrounding tissues.
And unfortunately, adjacent to those enzymes being released was the superior mesenteric artery.
NARRATOR: As the enzymes eat away at this artery, the wall becomes weaker and expands
until, finally, it explodes. The blood could not be held, and the blood just rushed in to the retroperitoneal space.
And he, subsequently, died. NARRATOR: While painful to hear, the final autopsy results
helped Stefano's family to accept what they never could before-- that he was a deeply troubled soul
whose addictions ultimately got the better of him. We can talk about his cause of death, and it seems very neat.
His cause of death is due to pancreatitis, which caused a pseudoaneurysm-- or a weakening
of the wall-- of the mesentery, which then caused him to bleed internally. Did you need any more of these?
Because I have some. WOMAN: I got some. You got some? But the real cause of death--
the real cause of death on this man-- is his chronic alcoholism. NARRATOR: For Dr. G, the case reminds her
that each autopsy can be unique and unpredictable. JAN GARAVAGLIA: When I started this case,
I was not too thrilled about it. I thought it was going to be a run-of-the-mill drudgery type of case that I just have to get through.
But it turned out to be actually a fascinating case for me. And it just goes to show you, you don't always
know what that autopsy is going to show, and that's what makes this job so exciting.
[MUSIC PLAYING] [TECHNO EFFECTS] MAN: Atlas.

An otherwise healthy child had been complaining of stomach pains. Could the medicine his mother had recently given him be to blame? Or could his death be from something more sinister?

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

Brief Summary

Dr. G investigates the tragic deaths of a toddler and a young man, revealing abuse and severe health issues.

Key points

Tragic Death of a Toddler. A three-year-old boy is found dead in his bed, prompting an urgent investigation.
A Disturbing Family Portrait. Investigators uncover a history of abuse leading to the child's tragic death.
Conviction of a Stepfather. Max Walsh is convicted of serious bodily injury to a child after the autopsy reveals abuse.
A Tragic Discovery. Dr. G uncovers the rare cause of death linked to pancreatitis and cocaine use.
The Real Cause of Death. Stefano's chronic alcoholism is revealed as the underlying cause of his tragic demise.

Episode highlights

Episode quotes

Life-- you're just beginning.

0:23WatchJun 15, 2021

Tension

85/ 100High tension

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