Dr. G: Medical Examiner - Season 6, Episode 6 - Disturbing Behavior - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A woman survives a brutal attack, only to die five years later.
It's sad because she survived the mugging. But now, she's dead on that couch. NARRATOR: And now, Dr. G wonders if her death is somehow
related to that assault. Maybe she had severe brain trauma, who knows? NARRATOR: Then, a man tumbles 15 feet to the ground.
They heard whoa, and this guy falls off the ladder. NARRATOR: But Dr. G believes there may be more to this case
than meets the eye. Did he just slip and fall? Or did he have some kind of physical illness
that affected him? [MUSIC PLAYING] NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations. These are the everyday cases of Dr. G, medical examiner. [MUSIC PLAYING]
I guess we start it at 9:00. WOMAN: Dr. G? Yeah NARRATOR: When you were in charge of one of the busiest
morgues in Orlando, Florida, some days it feels like the bodies just keep on coming.
They're dying like flies with that. This has been an abnormal, Abby day. Abby day.
NARRATOR: So it's no wonder that Chief Medical Examiner Dr. Jan Garivaglia has learned to multitask.
Let me finish hers, and then I'll come back. I'll be there in a second, Brian. Believe it or not, I'm juggling multiple cases at one time.
Can we get this going? I think I left my ruler, my big ruler over here. I wish I could concentrate on one case,
and then not do anything else till it's done. But they don't pay me for that. I got to do multiple things at once.
This doesn't make any sense at all. NARRATOR: But sometimes, Dr. G encounters an autopsy
so challenging that it demands every bit of her attention and focus. It's a breezy march evening in downtown Orlando, Florida.
Tim Anders and his wife are just sitting down to dinner when they're interrupted
by Tim's sister Cynthia. The 45-year-old has been living with the couple for the past five years.
But today, something about her seems strange. The brother asked her if she wants to come to dinner.
She didn't. She just kind of walked away. NARRATOR: But when Tim checks on her later that evening,
he can tell right away that something is terribly wrong. She's got vomit on her shirt.
And she was unresponsive Tim immediately calls 911, but by the time EMS arrive on the scene, it's too late.
She was already dead. NARRATOR: Now, the distraught couple is desperate to know what happened.
The brother is upset because his sister died, and he just wants answers. NARRATOR: When Dr. G. Arrives at the District 9 morgue
the following morning, Cynthia Anders is first up on her roster. But before she even sees the body--
Where's those medical records? NARRATOR: --she knows that this will be no ordinary case.
911 was called. She was pronounced at the scene. None of us like to do middle aged women,
because oftentimes at the end of the autopsy, you don't know why they died. For some reason, they tend to be more subtle.
Just means it's going to be more work to try to figure it out. NARRATOR: And at first glance, the possibilities seem endless.
Certainly, natural disease could've played a role. Maybe pulmonary emboli. Maybe heart disease.
At this point, it can be anything. The circumstances surrounding this death are kind of interesting.
NARRATOR: By all accounts, Cynthia Anders had been a fun loving woman with a zest for life.
She was a waitress. She was married, and she had a normal life. NARRATOR: But one fateful day five years
ago, something happened that changed her life forever. According to the brother's story,
she was mugged and beaten about the head with the butt of a gun. This mugging supposedly had left her anxious, with depression,
and not wanting to talk. She's not coping well with life. NARRATOR: And it wasn't long before Cynthia's family
and friends began to notice some alarming changes in her behavior. It appeared she suffered some brain damage from the attack,
and seemed haunted by the traumatic experience. She starts acting very odd, kind of withdrawn.
Her social behavior kind of goes downhill. She didn't care about the way she looked,
or how she took care of herself. NARRATOR: Eventually, Cynthia hit rock bottom when
she separated from her husband. At that point, she had no choice but to move in with her brother, Tim.
Their lives kind of spiraled out of control. Now 5 years later, she's dead on that couch.
What is really going on? NARRATOR: Dr. G. now wonders if the circumstances surrounding Cynthia's attack could
have led to a drug addiction. It wouldn't be unusual for people to suffer some major injuries, and then
get addicted to pain medicine. Maybe she died for an accidental drug overdose. NARRATOR: But there is another, more disturbing possibility.
If her life is really out of control, it may be a suicide. NARRATOR: And if this is the case,
it could be devastating for her family. If we find that it's a suicide, they may feel terribly guilty, because she
did it right in front of them. NARRATOR: But it's also possible that Cynthia's death
was completely unrelated to her depression. Maybe she had severe brain trauma from the mugging
five years earlier. And this is what caused her symptoms. NARRATOR: And despite the time that's passed since Cynthia's m
if Dr. G. can make the connection that the complications from brain trauma caused her death,
this becomes a homicide investigation. If we can link her cause of death, and connect it to the incident of when she was mugged,
then this would be a homicide. Why can't they find that hospital record? Hold on.
Let's get some info, and I'll be right back. NARRATOR: 21 years of experience tell
Dr. G. that this case will be anything but a walk in the park. You're on tomorrow?
Yes. These kind of deaths, these are very difficult because you do have to connect the dots.
Thanks. I think we've got our work cut out for us. [MUSIC PLAYING] So this woman looks like she's got a lot of chronic problems.
This should be funny. Oh my god, this woman's a mess, isn't she? I'm shocked. I'm really shocked at the way she looked.
She looks terrible. She looks much older her stated age of 45. She's very thin and gaunt.
She has clearly lost a lot of muscle mass. Don't take any blood out of here. Let me see her hands.
She's got inner osseous muscle wasting. When you start losing muscle, you kind of
see these little shallow dips in the backs of your hands, because your muscles are atrophying between the bones.
She's got that. She's got vomit on her shirt. That's not unusual for a terminal kind of event.
That part doesn't bother me so much. Don't take that out until-- Her eyes are sunken within her eye sockets.
Her hair is a mess, and her fingernails are long with what looks like feces underneath of them.
She clearly is not taking care of herself. She's very difficult to autopsy. All righty, let's try her this way.
I guess there's a possibility that she could have fallen, and just hit her head.
I palpate her scalp, but I don't really feel anything except some matted, unkempt hair.
NARRATOR: Given Cynthia's emaciated state, Dr. G will be on the lookout for any signs of drug use.
She almost looks like she may be a methamphetamine user, or a chronic cocaine user.
But I certainly don't see needle tracks, or any clear evidence of drug use. But of course, the toxicology results
would play a major role. NARRATOR: But when Dr. G removed Cynthia's shorts, she makes another shocking discovery.
Oh, my. There's something wrong here. Oh my. Let's see what we find under that. When I take off her shorts, she's
got to an adult style diaper on, held together with duct tape. Why is she not taking care of herself?
Why is she looking like this? Something is really wrong with this woman. What's going on here?
She looks terrible on the outside, and I'm wondering what does she look like on the inside?
[MUSIC PLAYING] Oh, gosh she's a mess. This one is bad. NARRATOR: From the external exam,
Dr. G can tell that something is terribly wrong with 45-year-old Cynthia Anders.
She's been having some definite problems. I think her life is falling apart. The brother is telling me she's depressed, withdrawn,
anxious, not acting right. Well, you know, this is a 45-year-old woman whose fingernails are lined with feces underneath?
Oh my. And she's got an adult diaper on. This is more than just not acting right.
This is much worse. NARRATOR: She now believes that Cynthia's erratic behavior and sudden death could very well be connected to an assault five
years earlier. Is it just a psychological event of the mugging, which has caused depression?
Or is it really some type of a brain injury from that trauma she suffered? I'll definitely save this brain.
If we have enough evidence to say that that lugging is what ultimately caused her death,
then this would be a homicide. I've got doctors I'm calling. NARRATOR: Looking for anything that
could shed light on Cynthia's case, Dr. G's investigators do their best to track down more
information about the attack. Bye now. Nobody could find any kind of report. There was none that existed.
OK. NARRATOR: But it's also possible that Cynthia's death had nothing whatsoever to do with her mugging.
All right. Then, I'll be back. It's really unclear what this is going to be. I don't know what that body is going to tell me.
[MUSIC PLAYING] OK, we're ready, right? As soon as I do my y incision, I make sure
all the abdominal organs are intact, and they're fine. NARRATOR: Her first order of business
is to collect samples of Cynthia's blood and urine to send to the lab. I do toxicology because that might be our answer.
Maybe this is an overdose. We'll have to see what the tox shows. Depending what kind of drugs she has in her system,
it may take anywhere from two weeks to 12 weeks for me to get that toxicology result back.
NARRATOR: The next step is to examine Cynthia's heart. Her heart is a normal size and weight.
The blood vessels that supply blood to the heart look good. The heart muscle looks good.
Everything looked fine. Heart looks good. NARRATOR: Dr. G then turns her attention to Cynthia's lungs.
Because she's clearly sitting a lot, not doing a lot of movement. I would worry that maybe she does have pulmonary emboli.
NARRATOR: People like Cynthia, who are physically inactive, are at greater risk of developing
blood clots in the legs. These clots can break loose, travels through the bloodstream, and lodge themselves in the lungs,
cutting off all blood supply to the lungs, and in turn, the heart. That would cause you to die suddenly.
Let's see what's in her lungs. But when I cut the lungs out, the main pulmonary arteries
are without blood clots. Well I'm looking. I don't see any. And I cut the lungs themselves, and there's
no pulmonary emboli. She doesn't have any. But it isn't long before Dr. G spots something
else, something curious. Oh, wow. There's something going on in that lung. Her lungs don't look right.
Her lungs are heavy, and kind of dense. The bronchi have some kind of creamy, white material in them,
that look kind of like pus. I'm very worried she might have pneumonia. NARRATOR: Pneumonia is an infection of the lungs,
usually caused by bacteria. Look at this. This is nasty. I really need to look under the microscope
to see how extensive this disease is in her lungs. NARRATOR: Dr. G collect tissue samples from Cynthia's lungs
and prepares to send them to the lab for processing. I'll take a little biopsy of tissue
from each lobe of both lungs. I usually have all my cassettes laying next to my cutting board, with the case
number on the cassette. So I'll take little snippets of lung, and put each snippet in a different cassette.
They come back to me, usually within a week or two weeks, and then I can read those slides under the microscope.
NARRATOR: If the micros confirm the presence of pneumonia, she could have her cause of death.
All right, then I'll be back. NARRATOR: For now, all Dr. G can do is wait until the slides come back from the lab.
So, I guess another one we're not going to know until we look at the micros, are going to look at the tox.
NARRATOR: But Cynthia's gaunt appearance gives Dr. G an idea as to where to look next.
Because she is so thin, could she have something wrong with her GI tract? I need to still look at those bowels.
Any time you do an autopsy, you're looking at their digestive tract. Their esophagus, their stomach, they're
large and small intestine. Let's see what's going on in this little belly. That doesn't look bad.
NARRATOR: But right away, she can cross the organ off her list of suspects. Her bowels look perfectly normal.
NARRATOR: Unfortunately, the rest of the internal exam provides little in the way of answers.
No gallstones. Should doesn't look bad. Her liver. She has a spleen. Her spleen, her kidneys, all look pretty good.
It's already done. I did it. NARRATOR: But there's something about this case that still troubles Dr. G.
What surprises me is her bizarre behavior. Her not taking care of herself. My question is, what's causing her to be like this?
I still need to look at her head, because that's where I think the answers are going to be.
[MUSIC PLAYING] NARRATOR: Dr. G's morgue technician, Tom Hemphill, carefully saw through Cynthia's cranium.
We're going to look to see if there's evidence and maybe an old skull fracture, evidence of a blood,
maybe contusions or bruising on the brain. And she could still have natural disease in her head.
Who knows? So, I reflect the scalp. Now five years later, I certainly wouldn't expect a bruise.
But I could see possibly evidence of an old skull fracture. Well, it's underwhelming.
But everything looked fine. Scalp looks completely normal. NARRATOR: Dr. G gingerly removes the skull cap,
and exposes the brain. Ah! And I'm shocked. I don't see anything that looks like old trauma.
She doesn't have any evidence of old blood. I see no old skull fractures. She doesn't have any of them.
NARRATOR: One thing is now clear, there is no evidence of any brain damage as a result of her mugging.
Oh my god. Look at that. But I do see something very odd. What's shocking is the frontal lobes were all shrunken down.
NARRATOR: In fact, the entire front part of Cynthia's brain has atrophied, or wasted away.
Something's wrong here. It was such an odd appearing brain, that I really wanted Dr. Pearl, my neuropathologist to see it.
Let's see. We got a brain knife? Brain pathology is difficult, and it takes a lot of special knowledge.
I enjoy working with Dr. G. We review cases together every two weeks. Her cases are always very interesting.
Yeah, that's right. In this case, the striking finding was severe atrophy of the frontal lobes of the brain.
That's not normal. I love those cases that you think gets going one way, and then the autopsy changes the whole direction.
I mean, how cool is that? [MUSIC PLAYING] NARRATOR: Dr. G and Dr. Pearl have just
made an unexpected discovery during the cranial exam of 45-year-old Cynthia Anders.
She's got something wrong with her brain. Her frontal lobes are all shrunken down.
I've never seen it that bad. NARRATOR: In order to determine what is causing this wasting
of the front part of her brain, Dr. Pearl collects tissue samples to examine under the microscope.
He has special stains that I don't have access to. I wish I could look at those slides right that second.
But it has to be processes, that has to be returned a couple of weeks later. NARRATOR: In the meantime, Cynthia's toxicology
report comes back from the lab. And she doesn't have a thing in her system, not a thing.
The fact that her toxicology was negative, it ruled out a suicide, or an accidental drug overdose.
When I looked at the eye fluid, the electrolytes, it did show that she was dehydrated.
Not dehydrated enough to kill her. But kind of went along with her general appearance
of not taking care of herself. NARRATOR: Two weeks later, the micros from Cynthia's lungs
are delivered to the District 9 morgue. When I get the slides, and I put those long slides under the microscope,
I have my suspicions. I believe she's got pneumonia. NARRATOR: And all it takes is a quick look under the lens
to prove her right. There it was. She had extensive bronchi pneumonia, and that's ultimately why she died.
NARRATOR: Dr. G is now certain of the cause of death. But this crucial finding raises more questions than answers.
We have the reason for her death, but why would a 45-year-old woman have pneumonia?
And what's causing her behavioral problems? NARRATOR: Dr. G believes that the missing
link may lie in the stain samples prepared by Dr. Pearl I just need all the pieces of the puzzle
together on this one. NARRATOR: Finally Dr. Pearl reviews his much anticipated findings with Dr. G.
When he showed me his slides, that he had prepared of the brain and the special stains,
it confirmed our suspicions. I had my answer. Oh, yeah. I see it. All of that makes sense now.
NARRATOR: It's 7:00 PM, and Tim Anders has just sat down to dinner with his wife, leaving his sister Cynthia
to relax on the couch. Little does he know, she's slowly dying and has been for years.
I suspect she probably did start her symptoms at least five years earlier. NARRATOR: But in a cruel coincidence,
just as Cynthia begins to exhibit strange behaviors, she gets mugged. Everybody is attributing her behavioral changes
to this mugging, when this had nothing to do with her mugging. She has said neurologic degenerative disease
called frontal lobe dementia. NARRATOR: Dementia is a loss of mental function severe enough
to interfere with daily life. So behavior and personality, reasoning, language functions,
any of those can be affected. NARRATOR: There are many different types of dementia,
each with a different root cause. Not all dementia is the same. We all think of Alzheimer dementia,
where it starts out initially as memory loss, or being unable to recognize people.
But frontal lobe dementia has to do with the way you act, the way you take care of yourself.
Sometimes your language. So they may not have problems with reasoning or memory,
but they'll have problems with social interactions. Her bizarre behavior, her not taking care of herself,
her feces under the nails, her diaper, for all of that is classic for a frontal lobe dementia.
I know people think 45, that's too young to have dementia. But frontal lobe dementia is much younger onset than some
of the other dementias. It's not uncommon to start with those behavioral problems
at a very early age. NARRATOR: And while the condition is often known to influence behavior, it can affect
basic motor functions as well. In Cynthia's case, her gag reflex no longer works properly, and bacteria from her saliva
is inhaled into her lungs. That bacteria is coming from her oral cavity, and making a home in the lung, where it's not supposed to be.
NARRATOR: The bacteria begin to multiply, and that causes a deadly pulmonary infection.
She doesn't even know she's sick because her brain has shrunken down that much. She had no ability to even realized something was wrong.
She was getting sicker and sicker, and she slowly succumbs, and slips into a coma, and dies.
You know, if her pneumonia was caught earlier, sure, they'd have saved her this time.
But there was no stopping the progression of her dementia. And ultimately, that's what did kill her.
NARRATOR: With all the information in hand, Dr. G is finally ready to contact Cynthia's brother
Tim to share her findings. Yeah, this is Dr. Garavaglia. He was flabbergasted. He had no idea.
He really thought that she just had some kind of depression. NARRATOR: But nothing can prepare Tim
for what she tells him next. You know, in many of these people it's a genetic defect.
Oftentimes, it's inherited. So that had huge implications for the family. I'm really sorry.
NARRATOR: Sadly, there is no test that can predict whether someone will develop this condition
or not. There's nothing he can do. They just have to wait and see. NARRATOR: As for the alleged mugging,
it's unclear whether it ever happened. We never could find a police report, and I didn't really see any clear cut evidence of trauma.
Maybe the assault never occurred. Maybe because of her dementia, she fabricated that whole thing.
I don't know. I don't think we'll ever know. What did we end up doing? Six cases, right?
Four full autopsies? MAN: Yes. Oftentimes in forensics, you come across cases that
have misleading circumstances. But you ultimately have to let the body speak to you.
I love how an autopsy can give you just unexpected answers sometimes, and that's what makes this job great.
It's the surprises. [MUSIC PLAYING] NARRATOR: Despite this seemingly simple circumstances
of her next case, Dr. G knows she must dig deeper to find the answers. He fell and he hit the ground, but did he
have some kind of physical illness that affected him? Or did he just slip and fall?
[MUSIC PLAYING] When I come in to see our cases in the morning, this report states that this is a man that's 48 years old.
He's Puerto Rican, and it looks like he fell off of a ladder. Today, we have a case that seems pretty cut and dry.
NARRATOR: According to the investigators report, Leo Guzman worked as an independent contractor.
Yesterday afternoon, he and a small crew of men were outside painting a house in nearby Kissimmee, Florida.
DR. GARAVAGLIA: He's got his ladder up, ladders pretty high. About 15 feet. He's up near the top rung.
People below heard whoa. And this guy falls off the ladder. Once he hit the ground, they could see that he
clearly had a broken leg. It's kind of all cattywampus. He's unconscious. NARRATOR: Workers at the scene immediately call 911.
Paramedics arrive within minutes, and rush Leo to the ER. But he's dead on arrival by the time
they make it to the hospital. NARRATOR: Leo's body is then transferred to the District 9 morgue.
Now, it's up to Dr. G to determine the cause of death. And on first glance, this one looks pretty straightforward.
Sounds like a pretty simple case, no mystery. Ladder's pretty high, it's about 15 feet.
And that's about the height when we start seeing some very dangerous things. My number one theory is if he just falls off the ladder,
and most likely hits his head. The number one way to die from a fall from a height.
OK. That's good. That's what I needed. Thanks. NARRATOR: But Dr. G can't discount
the possibility that Leo's death was more than just a simple accident. He fell and he hit the ground.
But is there anything else that may have played a role in him falling off that ladder.
Although he's at work, believe it or not, 50% of people who fall off ladders tend to be intoxicated.
I would hope he's not on the job intoxicated, climbing the ladder, but I've seen stupider things.
[MUSIC PLAYING] NARRATOR: It's also possible that Leo's death is one of the many electrocutions
that come through the morgue. I get a lot of people, there doing things and they hit the electrical wire,
and that shocks them, and causes them to fall. That's the first thing we always ask the witnesses.
Was there anything that could have caused an electrocution? And in this case, no.
NARRATOR: Or could the Florida heat have contributed to his death? The investigators report states it was a steamy 94
degrees the day Leo died. 94 degrees here in Orlando in the summer is lovely weather.
But it's hot to work outside in that temperature. So, I always worry about heat stroke.
Heat stroke is your body's inability to get rid of produced heat, and your temperature
can go up to 106. So the first thing I'll look at is the EMS run sheet. And in this case, when I look at those records,
his temperature is 98.4. Not heat stroke. NARRATOR: Still, 21 years of experience
also tells Dr. G that an underlying medical condition could have just as easily triggered the fall.
Did he have some kind of physical illness that affected him? We did find out that he had a sister here
in the United States with him, and she felt that he was in great health. But you always worry that there may
be some natural disease, even at the age of 48, that's going untreated. So I'm worried about a stroke, or maybe a heart attack.
He doesn't have a regular job. He just freelances. He doesn't have health insurance.
And people like that tend to not get a lot of preventative care. He's certainly, as a man, more apt not
to go get preventative care. NARRATOR: And sure enough, as she reads through Leo's medical history,
Dr. G spots a red flag. A-ha. He'd been complaining of leg pain. And when people have leg pain, and then
die suddenly, and unexpectedly well we think of a pulmonary embolism. NARRATOR: But a pulmonary embolism
isn't her only concern. Some things are not-- Even though his sister says he's in great shape,
she did hint that he may have diabetes. There are a lot of silent killers, high blood pressure, coronary artery disease, even diabetes.
So to me, they're not in great shape until the autopsy says he's in great shape.
So basically, we'll let the body speak to us. Is there anything that we'll be able to get
from that autopsy that'll help us understand what happened to this poor fellow? Well right now, I'm not quite sure.
It's hard to say. When I first see him, I notice he looks the stated age of 48, maybe even younger.
Fairly muscular. A lot of intravenous lines on him. They were trying to pump fluids in him,
in his neck, and his groin, in his arms. And they have him intubated. None of that seemed to work, because he was dead on arrival.
It looked like he was a painter. He's got shorts on with some paint. He's got high top boots, safe appearing shoes.
His shirt has already been cut off. That didn't come in with him. NARRATOR: As a first step more technician,
Brian Muholski carefully removes Leo's clothing, while Dr. G inspects his personal belongings.
In his personal effects, there is something really telling. He had cigarettes and cigarette lighters.
I'm venturing maybe those insides aren't as good as that sister says. NARRATOR: Next, Dr. G inspects Leo's body,
looking for injuries he may have sustained in the fall. He certainly shows evidence that he hit his head.
He's got an abrasion on the right side. He's got a laceration between his eyebrows.
He's got a broken leg that you don't even want to look at, you know? One part of his legs one way, and the other parts is another.
NARRATOR: Moving down the leg, she turns your attention to Leo's calves. One of the ways we look for a pulmonary embolism
is to look to see if the legs are symmetrical. Maybe there's a deep vein thrombosis that's
causing the leg to swell. NARRATOR: But in this case, Leo's broken leg makes this task close to impossible.
So I would have to wait until I get to his lungs to see if he has an any pulmonary emboli.
NARRATOR: Finally, Dr. G spots a potentially telling clue. Leo has creased ear lobes.
The medical issue has gone back and forth for years about the meaning of the creased ear lobes,
because many papers said it was associated with coronary artery disease. Well as it turns out, as you get older, a lot of people
get creased ear lobes, and it is not associated with coronary artery disease. Now in the younger male population,
there is some correlation, but it's pretty weak. NARRATOR: But before she goes digging into Leo's heart
and lungs, Dr. G has a much more likely suspect to investigate, the head. I think the other possibility on this one
is going to be the head. Head trauma is how most people die when you have a fall from a height of 15 feet or higher.
So I'm going to go to where I think the money is, the head. [MUSIC PLAYING] What I'm going to be looking for in the head are two things.
One, document the trauma, which I suspect there is. And two, check to see if there's any natural disease.
Anything that was going on in his head that caused him to fall off that ladder. NARRATOR: Dr. G begins by slicing Leo's scalp from ear
to ear. And as she peels back the skin, something takes her completely aback. Something shocking occurs when I reflect that scalp.
Oh my gosh. [MUSIC PLAYING] NARRATOR: Dr. G has just made a surprising discovery
in the cranial exam of 48-year-old Leo Guzman, who fell off a 15 foot ladder yesterday in Kissimmee.
There is no scalp contusions. And one would suspect that when falling 15 feet, hitting your head.
That doesn't mean he didn't die from head trauma, but I won't know until we get in.
NARRATOR: Using an oscillating saw, morgue technician Kelly Wood saws open the skull cap,
then Dr. G steps in to get her first look at the brain. I notice that there's no blood over the brain.
No blood, no trauma. NARRATOR: But as she carefully removes the organ, something catches her attention.
Oh my god. Look at that. What was remarkable was that he has after a atherosclerotic plaque on the vessels
at the base of his brain. We tend to see that in much older people. But it wasn't enough to really cause him any problems.
NARRATOR: However at age 48, this finding suggests that something else may be going on inside Leo's body.
Just the fact that it was there made me think he's not quite as healthy as his sister thought he was.
I got to look at it. NARRATOR: Next, Dr. G begin slicing through the brain tissue itself, looking for any signs
of trauma or natural disease. When I cut his brain, he's two too little what we would call
lacunr infarcts. It's basically a tiny little stroke. This guy was not going to live to a ripe old age,
I don't think. Now they're sometimes considered associated with high blood pressure, diabetes, but nobody really
knows truly what causes those. NARRATOR: It's a suspicious discovery, but his Dr. G examines the tissue more closely,
she can see that the damage is not recent. They appeared that they've been there for a while.
So his lacunar infarcts are probably not the reason he fell off of that ladder. NARRATOR: So far, none of the findings in Leo's brain
indicate a definitive cause of death. He also doesn't have anything that would indicate why exactly he would
have fallen off that ladder. He doesn't have any trauma. NARRATOR: But she still must search
for fatal injuries and signs of natural disease inside Leo's body. So next, since his head isn't giving us the answer,
we need to do the rest of the autopsy. [MUSIC PLAYING] NARRATOR: With scalpel in hand, Dr. G cuts through the skin
and performs a standard Y shaped incision. So when I reflect his skin, and subcutaneous tissue,
I noticed right off he's got a rib fracture. NARRATOR: But as she takes a closer
look at the broken bone something catches her attention. There's no hemorrhage surrounding it.
That indicates to me that his heart isn't pumping. So in this case, most likely that's from resuscitation.
NARRATOR: Once the body is open, Dr. G draw samples of Leo's blood for toxicology tests.
I need blood to check for drugs and alcohol, because about 50% of people who fall from a height
will be intoxicated, even people who are working. NARRATOR: But the results won't arrive for several weeks.
In the meantime, Dr. G examines Leo's organs in situ for any signs of fatal trauma.
DR. GARAVAGLIA: Let's see what we've got here. So when I remove the chest plate,
there's no evidence of any kind of puncture to the lungs. The heart sac is intact.
The liver's intact, the spleen is intact. There's no free blood, and there's no evidence of trauma.
NARRATOR: Suddenly, it's looking like the case of Leo Guzman may not be as cut and dry as it once seemed.
What are we missing? At this point, we're changing our focus. I'm starting to suspect that it might be natural disease.
NARRATOR: And at the top of her list of suspects is a pulmonary embolism. So her first stop is the lungs.
When I take out his lungs, immediately you can see that his lungs, even at the age of 48,
are already starting to break down because of the chronic effects of smoking cigarettes.
But that's not what caused him to die. NARRATOR: Still on the hunt for blood clots,
Dr. G begins a careful dissection of the lungs themselves. I cut the pulmonary artery, and when I look at that,
there is no blood clot. Everything looks good. NARRATOR: With the lungs now ruled out,
she turns her attention to another likely culprit, the heart. Immediately when I see the heart I see it's enlarged.
Like I would see in high blood pressure. That's a big heart. This is a fellow that's not very big.
He's of rather small frame, but his heart weighs 550 grams. That is a big heart.
It shouldn't weigh more than 350. NARRATOR: As a next step, Dr. G slices through the muscle,
and into the coronary arteries. The left coronary artery has a 75% narrowing by atherosclerotic plaque.
But it gets worse. The left anterior descending has a 90% narrowing, and then the circumflex coronary artery
has about an 80% narrowing. NARRATOR: And as her scalpel cuts into Leo's last remaining,
artery Dr. G discovers what could be the smoking gun. Wow. This is a man that was a ticking time bomb.
[MUSIC PLAYING] Using your scalpel, Dr. G slices into the right coronary artery a 48-year-old Leo Guzman's heart,
and there she makes a key discovery. Oh my. When I get to the right coronary artery,
there's about a 75% narrowing, and just an adjacent to that there's a clot. That totally cut off the blood to that part of the heart.
It's a classic heart attack. But that clot was already very aged. You could see it's brown.
NARRATOR: This tells Dr. g that Leo's heart attack didn't happen the moment he fell.
And when she dissects the heart muscle itself, Dr. G spots another clue. There's already a hemorrhage in the back of his heart,
and his heart muscle was in the process of dying. NARRATOR: That means his heart attack
occurred, at least 24 hours before he fell off the ladder. Yeah, this isn't that old.
NARRATOR: And just a few centimeters away she surprised to find another, even older attack.
He'd already suffered a previous heart attack. There's already scar tissue. He has a severely damaged heart.
NARRATOR: For Dr. G, This is the final piece of the puzzle. The fact that he fell off of that ladder,
along with what I saw in his autopsy, we know what killed him. So it doesn't really matter what is in his tox.
This trumps anything else I found. [MUSIC PLAYING] NARRATOR: To everyone around him,
Leo Guzman is in seemingly great health. But looks can be deceiving. He had high blood pressure, but he probably
didn't know he even had it. NARRATOR: And left untreated, Leo's high blood pressure
begins to damage almost every vessel in his body. And it didn't help that he smoked, also causing
injury to those vessels. He had a history of diabetes. Diabetes also caused injuries to the vessels
if it's not controlled. So he had a triple whammy of the smoking, the high blood
pressure, and the diabetes. NARRATOR: Over the years, this triple whammy wreaks havoc
on the vessels in Leo's brain. He had two small strokes to the brain, and we saw the plaques in the blood vessels of his brain
also. NARRATOR: But the most lethal destruction occurs within the vessels of Leo's heart.
He had changes in his heart from having to pump against that high blood pressure.
High blood pressure also predisposes you to coronary artery disease. And at some point in the past, he had
had a previous heart attack. NARRATOR: Then on the day before his death, he suffers yet another heart attack.
The blood starts forming a clot totally occluding any blood from getting to that blood vessel.
So that heart muscle starts to die. And that's an irritant. NARRATOR: But Leo doesn't seek medical treatment.
Why did he not go to the hospital? He must have been having either a silent heart
attack, where he's not even feeling pain, or is ignoring his symptoms. NARRATOR: The next morning, he reports to work as scheduled.
But his severely damaged heart can't handle the combined stress of physical labor in Florida heat.
He just climbs that ladder like he's in great shape, but he doesn't know that that heart muscle
is already starting to die. The stress of probably climbing that ladder was enough to cause his heart to go into an arrhythmia.
His heart starts to flutter. No blood is going to the brain. He starts feeling woozy, probably lets out the whoa,
and falls over. He's dead before he hits the ground. He never felt that fall. NARRATOR: With this, Dr. G can finally close the book
on 48-year-old Leo Guzman. And for Dr. G, this case serves as yet another lesson in the importance of preventative care.
This may or may not have been prevented. Not everybody has the same symptoms, but men tend to ignore their symptoms more.
Or he's rationalizing it as something else. Men tend to do that more than women.
He could have done a lot, particularly stop smoking. He should have known his blood pressure was elevated,
and he should have taken better control of his diabetes. I'm sure he'd lived a lot longer.
You know, I think the important message on this case is that you can look good on the outside.
You can feel good. But if you're going to ignore knowing what your blood pressure is, you're not going
to look good on the inside. You just aren't. You need some basic information about yourself.
You need to know what your cholesterol is. You need to know what your glucose is.
You need to know your blood pressure is. Those are silent killers. And what you take away from this case,
is the silent killer strike again.

Leo Guzman falls off a ladder while painting a house. At first, his death seems to be an open-and-shut case but, as the autopsy unfolds, Dr. G believes there may be more to this case.

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

Brief Summary

Cynthia died from pneumonia linked to dementia; Leo's fall was due to a heart attack from untreated health issues.

Key points

A Woman's Mysterious Death. Cynthia Anders, once vibrant, is found dead under troubling circumstances, raising questions about her past.
Unexpected Brain Findings. Dr. G discovers severe atrophy in Cynthia's frontal lobes, indicating a serious condition.
The Diagnosis of Dementia. Cynthia's bizarre behavior is linked to frontal lobe dementia, a rare condition for her age.
The Mystery of the Fall. Leo's fall from a ladder leads to an investigation that uncovers shocking health truths.
A Ticking Time Bomb. Dr. G discovers alarming health issues during Leo's autopsy, revealing he was at risk.
The Hidden Dangers of Health. Leo Guzman appeared healthy but had serious underlying conditions that led to his death.

Episode highlights

Episode quotes

What is really going on?

Dr. G contemplates the mysterious circumstances of Cynthia's death.

6:07WatchJun 22, 2021

Tension

75/ 100High tension

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