02x12 - Kiss of Death?

[bunniefuu]

[music playing]

NARRATOR A healthy woman rapidly

succumbs to a virulent illness.

She gets antibiotics and ends up in the hospital.

A week after that, dies.

NARRATOR Her body is covered with dozens

of raw, oozing sores.

DR. G Well, I looked at the body, and I'm kind of, like,

taken aback.

She's got these vesicles all over her.

Oh, gosh.

NARRATOR Can Dr. G identify the deadly disease

and find its source?

I have never seen a case like this,

and I know I will never see another case like this.

NARRATOR And then a woman helps her husband

recover from what appears to be a routine epileptic seizure.

I said, are you sure you don't want me to call --?

No, no.

No, no.

I'll be all right if you just let me sleep.

NARRATOR But this time, he never wakes up.

DR. G She felt horrible.

I knew that she was going to be dealing with some guilt right

from the start.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of Dr. G, medical examiner.

It's just after AM at the District morgue in Orlando,

Florida, and preparations for the day's work

are in full swing.

OK.

We need--

NARRATOR When chief medical examiner

Jan Garavaglia arrives, she and her staff

size up the day's cases.

We've got three to x-ray.

NARRATOR Dr. G's first autopsy will

be the case of a -year-old woman who d*ed

a bizarre and unexpected death.

Claire Jackson was transferred to the District morgue

last night after she d*ed in the hospital

due to a sudden illness, which appears to have

caused massive liver failure.

We have this woman, and we've gotten her from the hospital.

And the doctors don't know why she d*ed.

She's in fulminant liver failure.

It's massive death of your liver, and they don't know why.

NARRATOR According to Dr. G's investigator's report,

the woman's ordeal began approximately one week earlier.

Claire Jackson is feeling sick.

She visits her doctor complaining

of a fever, diarrhea, nausea, and pain in her mouth.

Her physician suspects she may have a minor infection.

He prescribes an antibiotic and a painkiller

and sends her home to rest, but the treatment is ineffective.

A week after she gets the antibiotic,

she just gets sicker and sicker.

She goes to the hospital and they

thought she was septic, or, you know, bacteria in her blood.

NARRATOR Suspecting that Claire has developed

an aggressive bacterial infection called septicemia,

doctors rushed to treat her with powerful antibiotics.

But Claire's condition quickly spirals out of control.

Within only hours, her vital organs, including her liver,

begin to fail, and she is put on life support.

Barely alive, she begins to develop a strange rash,

and by the next day, Claire is dead.

The hospital is baffled by the woman's swift decline.

Their suspicion?

She d*ed from septicaemia, a massive and often catastrophic

bacterial infection in the bloodstream,

which caused her liver to fail.

So that's what I've got, and they don't know.

They don't have anything diagnosed,

really, in the hospital.

NARRATOR For Dr. G, the death of Claire Jackson

is a mystery with no easy answers

and no clear hypothesis.

She begins immediately with the external examination.

On the exam table, Dr. G gets her first look

at Claire Jackson's body, but it's

not at all what she expected.

Well, I walk over to the body and I'm kind of, like,

taken back.

She's got these vesicles all over her, like-- like blisters

on her skin.

And I'm like, nobody told me about this.

I was shocked.

I mean, when I'm looking at the chart,

when I'm reviewing medical records,

they don't mention that.

They mentioned some kind of crusted thing on her forehead,

but she's got like of them on her face,

on the backs of her arms, on her back.

NARRATOR In her years as a medical examiner,

Dr. G has rarely seen a body with such

an unusual affliction.

DR. G She looked really sick.

I mean, when I looked at her, she looked really sick.
[ … ]

Her gums were all red.

She had lesions on the gums.

Her teeth were actually even falling out of the gums.

Oh, gosh.

She looked very, very bad.

NARRATOR Dr. G has no explanation

for Claire's condition or what would cause it.

But to her, it certainly does not

look like a bacterial infection as the hospital thought.

However, she does learn from Claire's medical records

that the victim had her own theory

about her strange illness, a very unusual theory.

According to Claire, two weeks earlier she

was having a drink at a local bar

when she kissed a man she had recently met,

and then he bit her.

Claire believed that whatever made her sick,

she caught from the bite.

Ugh, you know?

Is it some kind of as*ault?

What did she die of?

NARRATOR Death from a human bite

would be highly improbable, but at this point

Dr. G needs to pursue any lead she can find.

First, she carefully inspects Claire's mouth

for any signs of a bite mark.

Inside of her mouth looked horrible.

The mucosa was sloughing off.

She had these all sort of lesions.

Bad teeth.

NARRATOR And yet, Dr. G finds no scarring

to corroborate Claire's claim.

And I'm looking, because I have a history of a bite,

and I didn't find it.

NARRATOR With another theory apparently off the table,

the mystery only deepens.

But there was another potential culprit Dr. G can pursue.

Claire has a history of cervical cancer,

which required a hysterectomy and genital surgery.

DR. G She's got a large abdominal scar going down

basically from her belly button down to her bone-- pubic bone.

And then we also have that she's got a history

that the cancer had recurred and was on the outside

of her genitalia.

They had to do vulvectomy, remove

some of the external genitalia.

NARRATOR But until she examines the body internally,

Dr. G has no clear answers as to whether the cancer

was Claire's k*ller.

A supposed bite, unusual lesions on the skin, cancer.

At the close of the external exam,

the woman's case remains baffling.

DR. G None of it was making sense.

What exactly is going on, I wasn't sure.

NARRATOR However, Dr. G believes

she might have a viable, albeit tentative,

diagnosis as to the cause of her strange disorder.

Well, you know, I am looking--

I'm looking at her, and I'm thinking

could it-- it might be chicken pox.

It might have been chicken pox that k*lled her.

NARRATOR Chicken pox, known clinically as the virus

varicella zoster, is typically thought

of as a benign childhood rite of passage

which causes a rash of itchy welts

and a fever lasting about a week.

But for reasons unclear the disease

can be exceptionally virulent and even deadly

for certain individuals.

Especially vulnerable, according to Dr. Mark Wallace,

are newborn babies and adults.

The older you are when you acquire

chickenpox by and large, the more severe it is.

Sometimes when neonates acquire it, babies that are born

to mothers with chickenpox, that can be quite severe,

but that's sort of an exception.

NARRATOR Because chicken pox is easily spread by direct contact

or through the air from a sneeze or cough,

Dr. G knows that Claire could have

been infected just about anywhere and never known it.

One way she can test if Claire was infected with chickenpox

is to take samples of the pustules themselves,

and that's where she turns next.

I had to do some special procedures, because I wanted

to know what the infection was.

NARRATOR Coming up, Dr. G inspects

slides from Claire's sores and discovers that her death seems

to defy medical possibility when "Dr. G, Medical Examiner"

continues.

[music playing]

At the District morgue in Orlando, Florida,

chief medical examiner Dr. Jan Garavaglia

is working on her first autopsy of the day,

the case of Claire Jackson.

Her next step is to collect a sample

from one of the many sores that covered

the woman's body to examine later under the microscope.

DR. G I took one of her vesicles and I opened it.

I broke it open and scraped it so I could see the cells

that were inside that vesicle.
[ … ]

NARRATOR The woman d*ed yesterday in the hospital

after a rapid onset of a bizarre illness

that she believed was caused by a human bite during a kiss.

However, Dr. G found no evidence of a bite mark

in the external exam, and she suspects

instead that Claire's death may have been due to chickenpox.

She had an infection that was-- that was k*lling her.

It was pretty obvious by looking at her.

NARRATOR But there's also the lingering

possibility that Claire d*ed from a relapse

of cervical cancer.

Chicken pox or cancer?

It's a question that can only be answered by completing

the internal examination.

DR. G OK, we ready?

You took a picture?

You did.

NARRATOR Claire's body is opened

with a Y-incision from the shoulder blades

to the pubic bone.

Immediately, the extent of her illness is apparent.

Well, when you open her up, she just looks sick.

Sick on the inside, just like she looked sick on the outside.

NARRATOR Dr. G draws toxicology samples

and then begins her search of Claire's body

cavity for any signs of recurring cancer.

As medical records indicated, Dr. G

find several of Claire's reproductive organs

previously removed as a result of the disease.

Internally, she has no uterus, tubes,

or ovaries, which goes along with her history

of cervical cancer.

NARRATOR But she finds absolutely

no evidence of a relapse.

DR. G There was no cancer.

NARRATOR Dr. G is now confident that the woman's rapid death

was not due to a cancer relapse.

Could it have been from chicken pox?

OK.

So the right is --

NARRATOR She isn't sure, but then she sees Claire's liver.

DR. G Her liver was-- had kind of a pitted surface.

It was somewhat soft and round.

Her liver does not look good.

NARRATOR It's obvious that Claire succumbed

to liver failure, just as the hospital

indicated in its records.

Dr. G now needs to find a link between Claire's liver

and chickenpox, but infections like chickenpox

can only be positively identified

through lab analysis.

Oh, right.

NARRATOR Dr. G must take tissue samples of Claire's liver

and send those to the lab, along with the skin scrapings

from the vesicles, to have microscopic slides prepared.

DR. G So we've got to put it all together.

We've got the vesicles.

We have the vesicles on her skin,

the vesicles in her mouth, the mucosa sloughing off.

We've got pretty much dead-looking liver.

And what does it all mean?

NARRATOR She must wait several weeks to find out.

[music playing]

I just have--

I have the one from today for the death certificate.

First thing I got back was I got the slides stained

of the vesicle that I scraped.

Yeah.

[inaudible]

And it's-- it's-- you see these kind of--

these cells almost kind of look like they fuse.

It's big cells, and then they have

a-- like a little glob of kind of pink purple stuff,

and that shouldn't be there.

Your cells shouldn't have these pink purple globs, and

the cell's kind of enlarged.

And they look like several of them together.

NARRATOR Claire's liver samples and blood

cultures are abnormal as well, and they

all point to the same disease.

But it's not chicken pox.

It's something Dr. G never expected.

It had the characteristic findings for herpes.

NARRATOR But the type of herpes Dr. G finds in Claire's body

is herpes simplex type , or oral herpes,

one of the most common viral infections in the world.

Unlike genital herpes, herpes simplex type

is not considered a sexually transmitted disease

because it is usually contracted through casual contact

in childhood.

Typically, the virus causes only localized cold sores

on the face, lips, and gums.

The idea that such a common virus, which usually remains

localized on the mouth, could have spread through Claire's

entire body and caused her death seems

almost impossible to believe.

DR. G Herpes, systemic herpes infection?

That's-- you know, I'm thinking, that's got to be ridiculous.

I've never heard of, you know--

I mean, she's a healthy woman.
[ … ]

I don't-- I don't know why she would

get systemic herpes infection.

NARRATOR It's impossible, and yet there it is on the slide.

For Dr. G, the unbelievable finding begs one question.

Why?

Why does she have herpes all through her body?

I mean, I'm like, I don't know.

NARRATOR Coming up next, the hunt

for answers to Claire Jackson's stunning death

leads Dr. G to a shocking conclusion.

I really couldn't get a handle on why she

would be get systemic herpes.

NARRATOR And later when an epileptic man dies

after a seizure, his wife is stunned

by what k*lled him and blames herself for his death.

If I'm such a smart nurse, why didn't I notice your symptoms?

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

In the case of Claire Jackson, Dr. G

has two findings that seem to contradict medical science,

the death of a woman and absolute proof

that a massive herpes simplex infection k*lled her.

Her herpes took off and went all over her body.

She has acute fulminant liver necrosis from the herpes.

NARRATOR But now Dr. G might finally

have a logical explanation.

After consulting with her staff and other infectious disease

experts, Dr. G theorizes that herpes might have become

lethal in Claire because her immune system was

somehow significantly weakened.

To me, to--

one reason for her to have systemic herpes

would-- maybe she's immunosuppressed.

In the cases that I could find, the only people

who really get it systemically are

immunosuppressed people, people whose immune system

can't control this virus.

And I thought, well, what could have acutely caused

her becoming immunosuppressed?

Well, AIDS is one of them.

So immediately, I order an HIV to see if maybe she's immune--

has an immune problem.

NARRATOR Dr. G asks the lab to recheck

samples of Claire's blood for HIV,

the virus that causes AIDS.

This could be the explanation she needs in the case.

HIV and AIDS could have inhibited Claire's ability

to fight off the infection, rendering

even the most benign viruses like herpes simplex

a potential k*ller.

But when Dr. G receives the results from the lab,

once again, she's taken aback.

DR. G It was negative.

She wasn't-- she didn't have AIDS.

She didn't have the virus that would cause immunosuppression.

I cannot explain that.

I had experts that I contacted.

I cannot explain why, with her, it went all over her body.

I thought surely she had to be immunosuppressed.

I thought surely she must have AIDS, uh, something

that would cause immunosuppression.

And I don't have an answer on why it happened to her.

NARRATOR Despite her lack of answers as to why,

she does make one shocking inference into how Claire

might have contracted herpes.

After reviewing the entire case, Dr. G

believes that Claire was right after all about the bite,

despite no evidence of scarring at autopsy.

We clearly has a history that something happened,

so it's hard to believe that that didn't play a role.

I just can't totally connect the dots

and totally blame him for this whole thing,

because it still doesn't make sense

why she got it systemically.

But it sure sounds about from the timeline

that she got that herpes from that bar and from that kiss

from Prince Charming.

NARRATOR With her long awaited findings in hand,

Dr. G can finally speculate about what

happened to Claire Jackson during her last two weeks

alive.

Two weeks before her death, Claire Jackson

stops into a local bar, looking for a drink and some company.

She finds both.

But unbeknownst to Claire, her impromptu suitor is likely

a carrier of herpes simplex .

And tonight, the virus is active in his mouth.

DR. G She kisses someone.

Probably this someone has a cold sore.

And during this kiss, we think that she was bitten either

on the lip or the tongue.

Herpes simplex type is usually acquired from contact

with saliva, so it's certainly possible

that you might be exposed to more virus at one time

through a bite then--

then through just exposure to a sore or infected saliva.

NARRATOR For unknown reasons, Claire's body

is unable to fight the usually benign virus

and it quickly spreads.

DR. G I don't think anybody has a good answer
[ … ]

on why a healthy person could then get systemic herpes.

It just happens.

NARRATOR By the time she visits her doctor approximately five

days later, she is nauseous, suffers from a fever,

and has diarrhea.

She also complains of pain in her mouth.

Suspecting a bacterial infection,

the doctor prescribes antibiotics,

but the treatment is ineffective in quelling herpes.

And then from there she gets sicker and sicker and sicker.

NARRATOR Her decline is swift.

About two days after visiting her doctor,

Claire was rushed to the hospital, critically ill.

Her body teams with a systemic herpes infection.

Overrun with the rampant virus within only hours,

her liver fails to function.

By then, Claire's body has erupted with hundreds

of herpes blisters.

And shortly thereafter, Claire dies.

The herpes went into her body and went into her liver

and actually k*lled her liver.

And she d*ed from fulminant hepatic necrosis.

NARRATOR Amazingly, there have been only people

in the world not suffering from immunosuppression who are known

to have d*ed from systemic herpes infections,

And Claire was one of those unlucky few.

I have never seen a case like this,

and I know I will never see another case like this.

It's just-- I'm never going to see it.

Systemic herpes infection in a normal woman is really rare.

It is frightening.

You know, I guess life is just full of uncertainties,

and sometimes bad things happen that you just can't explain.

NARRATOR Coming up next, did epilepsy k*ll this man?

There was a small subset of people

who have these major seizures that

can die suddenly from them.

So what we've got here is a man who has a known

history of seizure disorder.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

Krishell is here looking--

looking pretty today.

And because Krishell decided to show up,

we have a pay statement for her.

Oh, thank you.

There you go.

She was looking rough yesterday,

but she looks good today.

Oh.

And she's doing this on camera, Krishell.

Oh, yeah.

That's right.

Dr. G was saying such nice things about us yesterday.

She was vicious.

I was not.

She put her head in the fan like she was one of those dogs,

sticking it out the window for air.

Yeah.

So that's nice.

Call me a dog.

NARRATOR Dr. G's next case involves the death

of a -year-old man named Dale Ennis,

who has suffered from epileptic seizures since childhood.

OK.

NARRATOR As her morgue assistant Krishell [inaudible]

prepares the body for examination,

Dr. G familiarizes herself with the case history.

So what we've got here is a man who is a known

history of seizure disorder.

The seizure disorder started when he was a little kid

after an episode of what they think

was meningitis encephalitis.

He would sleep for a long time afterwards [inaudible]..

NARRATOR According to Dr. G's investigator's report,

yesterday afternoon Dale was discovered by his wife,

collapsed in the backyard.

PAULA I went outside, and he was down on the ground.

And I could see that he'd had a seizure.

I shook him, and I said, are you all right?

And he goes, yeah, yeah.

I had a seizure.

Just let me lay here and sleep for a few minutes

and I'll get up.

And I said, are you sure you don't want me to call --?

No, no. No, No.

I'll be all right.

Just let me sleep.

He's been quite firm with her not

to call EMS, not to transport him to the hospital.

He sleeps for about minutes in his post ictal state,

you know, after the seizure, and then he's fine.

NARRATOR Paula, a nurse, places a pillow

under Dale's head and an umbrella over him

to shield the sun.

Then she waits for her husband to wake as usual.

OK.

NARRATOR But minutes pass and Dale is still unconscious.

Well, you see, something horrible happens this time.

He doesn't wake up.
[ … ]

NARRATOR Sensing something is wrong, Paula calls --.

PAULA The ambulance pulled in.

They came over, and she checked him.

And she goes, he doesn't have a pulse.

And I said, what do you mean he doesn't have a pulse?

I just checked him.

He had a pulse. - No pulse.

PAULA And she said, well, he doesn't have one now.

Initially they feel a pulse, and then

he had some jerking movements.

And then he-- they lose the pulse and they start CPR.

NARRATOR Dale is rushed to the hospital

in full cardiac arrest.

But only four minutes after his arrival, he is pronounced dead.

Um, it was just--

you just go into a state of shock.

You feel like somebody rips open your chest

and pulls out your heart and your lungs.

And your brain shuts down.

NARRATOR According to medical records,

Dale had no major health problems, only mild high blood

pressure and epilepsy.

And at this point, it's his brain disorder

that concerns Dr. G the most.

Epilepsy is a malady where, for unknown reasons,

nerves in the brain signal abnormally

and trigger recurrent seizures.

DR. GARY PEARL Epilepsy is a state where a person has

enhanced electrical activity.

This electrical activity may then

spread through other areas of the brain

and cause the manifestations of the seizure.

NARRATOR But while epilepsy is generally

considered a manageable disorder,

for some it can and does k*ll.

The deadly but mysterious phenomenon

is known as SUDEP, or Sudden Unexpected Death in Epilepsy.

DR. GARY PEARL SUDEP is a diagnosis of exclusion.

You have an individual who has a history of seizures who

is found dead, most often at home, and no cause of death

is found.

So all we have is a history of seizures and no findings

to explain the death.

So it looked like it was going to be pretty straightforward.

I wouldn't find anything, and he was going to be a sudden death

associated with seizure.

NARRATOR But if SUDEP is Dale's k*ller,

it would leave his widow Paula with a tremendous burden.

According to investigator Bill Stratton, who spoke with Paula

at the hospital, she feels partially responsible

for her husband's death.

When I first met with her, she seemed very upset by his death.

But she also was concerned that she

hadn't called -- earlier.

It was clear from what my investigators got from the wife

is that she felt horrible because she

followed his directions and didn't call EMS.

NARRATOR Could Paula have saved her husband's life

by acting sooner?

Only an autopsy can tell.

DR. G So basically at autopsy, the first thing I look at him

is how he came in.

He's got-- he's got some little minor trauma to him

that we could see right away.

He's got a little abrasion on his nose, some little abrasions

on his forehand.

And if you feel, you could see that he's got a small abrasion

on the back of his scalp.

He's got a little [inaudible] a little abrasion up there.

NARRATOR On his scalp Dr. G also

finds evidence of the seriousness of Dale's epilepsy.

There was a large scar near his right temple

from brain surgery years earlier.

He's got this craniotomy scar.

His seizures were so bad at one point years ago

that he actually went into a major hospital

to get part of his brain taken out.

NARRATOR Most people with epilepsy

can control their symptoms with medication.

But for some, like Dale Ennis, dr*gs alone are ineffective.

Brain surgery, the removal of the irregular and localized

parts of the brain responsible for seizures,

is sometimes an effective albeit risky alternative.

After Dale's surgery he was free of seizures for many years

until just several months before his death.

PAULA He loved it.

He was thrilled.

He could go back to work.

He could drive again.

He was able to just live like a normal person.

NARRATOR For Dr. G, the autopsy so far

is straightforward, exactly what is

anticipated in a case of SUDEP.

But the internal exam will not be so routine.

Coming up next, Dr. G opens Dale Ennis's body

and discovers that despite what his medical records state,

epilepsy was not his only medical problem.

I said, I have no idea what you're talking about.

He's never made any complaints about this.

NARRATOR The unexpected findings
[ … ]

and their consequences when "Dr. G, Medical Examiner" continues."], index ,…}

[music playing]

Dr. G is now ready to open Dale Ennis's body.

An epileptic since childhood, Dale

d*ed without warning yesterday afternoon after a seizure.

Dr. G believes that Dale might have succumbed

to a fatal but little known phenomenon associated

with the disease, Sudden Unexpected Death in Epilepsy,

or SUDEP.

And his widow, Paula, wonders if calling -- sooner

would have saved his life.

PAULA I was just basically in a wait mode.

I couldn't lay still.

I couldn't think.

I just wandered the house and cried.

NARRATOR Once Dale's chest cavity is opened,

Dr. G gets her first look at his internal organs.

And then the chief medical examiner comes

face to face with a bombshell.

Look at the heart.

He's got a-- he's got a big heart.

Right off when we weigh his heart,

we see there's something wrong.

He's got an enlarged heart.

Normal heart should-- for him shouldn't be over .

His is grams.

So his heart was enlarged, grams.

And then I look at the coronary arteries,

and he has very significant narrowing

to the coronary arteries that they didn't know about.

His left anterior descending is at least % narrowed.

His first diagonal is at least % narrowed.

Dilated there's not much left where

the blood is supposed to be.

NARRATOR Dale's heart has severe atherosclerosis,

or clogged arteries, and it is also enlarged from the effects

of chronic high blood pressure.

That heart could have k*lled him easily from an arrhythmia.

NARRATOR The finding of heart disease

seems to contradict Dr. G's original hypothesis.

However, some physicians theorize

that the heart might actually be a contributing

factor in SUDEP deaths.

DR. G We don't really know the true mechanism

of why these seizures k*ll.

And one theory is that it affects your heart,

and it's possibly the electrical component

of the heart with the seizure kind of short circuits also.

So if you already have a bad heart on top of that,

that certainly could play into it.

Appendix present.

NARRATOR Her tentative conclusion?

Dale Ennis d*ed from two causes of death.

You can't really separate.

It'll be sudden death associated with seizure or epilepsy

with hypertensive and atherosclerotic

cardiovascular disease.

NARRATOR It is a finding that comes

as a shock to Paula, who had no knowledge that her husband had

heart disease.

I'm like, you're kidding me.

I said, he has never had any complaints.

NARRATOR But before closing the case,

there's one more organ that Dr. G must examine, the brain.

Will there be any hidden surprises there?

OK.

I'm coming.

NARRATOR Coming up next, the unpredictable case

of Dale Ennis takes yet another left turn.

DR. G Well, I reflect the scalp and something

kind of popped out right away.

I'm like, what?

I was beyond surprised.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

[interposing voices]

NARRATOR At the outset, the death of -year-old Dale Ennis

seemed straightforward, a case of sudden death

during an epileptic seizure.

But during the internal exam, Dr. G

has discovered that Dale suffered

from advanced heart disease.

And she now believes that both his heart and the epilepsy

contributed to his death.

DR. G I mean, at this point I'm feeling fairly confident.

But we still have to look at the head, and there's always--

you know.

You never know until you finish the head.

Ew.

I reflect the scalp and something

kind of popped out right away.

I knew going in that he'd already

had a craniotomy to get part of his brain taken out

where the seizure focus was.

And, you know, they have to take out a little bony window,

and then they cut out the brain and then

put the bony window back and the bone heals very nicely.

It's remodeled.

I mean, your bone will reabsorb.

And then the little area that they cut, it grows back
[ … ]

and there's union.

But in his case, something was amiss.

It never grew back together.

There's a huge non-union, particularly

in the area of temporal lobe--

temporal bone kind of going on the inferior lower

aspect, pretty big area.

[inaudible] his part.

It's about almost an inch and a half, I'd say.

NARRATOR In other words, Dale's surgery years ago

left him with an actual opening in the temporal region

of his skull, an extremely unusual and potentially

dangerous condition.

DR. G You could have easily put a--

a quarter in that space.

It was actually very pliable.

You could just press on that temporal bone,

and it would move back and forth.

NARRATOR Moreover, Dr. G discovers that the abrasion

on the back of Dale's head, which was first

noted in the external exam, is much deeper

than she originally thought.

Now I didn't know what significance that had,

so I just noted it and then proceeded

in having my technician remove the calvarium, the skull cap.

And then I go and remove the brain.

[inaudible]

Oh.

Lo and behold, we see a surprise.

NARRATOR There was abnormal bleeding in Dale's brain,

very close to the non-fused portion of his skull.

He's got--

Well, you know, it should be nice and white.

You notice it's awfully bloody?

NARRATOR For Dr. G, the diagnosis

is immediately apparent.

He's got a subdural hematoma, and that's not what

we usually see with a seizure.

He does have a subdural.

NARRATOR A subdural hematoma is a bleed

that occurs in the tiny blood vessels

between the brain and the dura, the protective sheath that

covers the brain.

Such bleeding can be life threatening

as the pooling blood compresses the brain within the skull.

And it's almost always caused by trauma, not seizures.

In an instant, the real cause of Dale Ennis's death is clear.

He did not die from epilepsy or advanced heart disease.

He d*ed from a head injury.

He actually d*ed from the subdural.

PAULA She said that the vessels in his brain

were just very friable.

You know how old cloth falls apart in your hands?

His vessels were just falling apart in her hands.

I was beyond surprised.

I had to pick my jaw up and put it back on my face

where it fell off.

And then I called his family to let them know,

and they were surprised.

NARRATOR The question is, how did this trauma occur?

Dr. G removes the brain to get a closer look.

And what she discovers will add yet

another unbelievable revelation to an already complicated case.

When we took the brain out, what

was interesting is he'd had a previous subdural hematoma.

Look at that.

And this previous subdural hematoma

looked a couple weeks old, definitely less than a month.

And that was in the area where there

was non-union of the bone.

NARRATOR And at the dissecting table,

Doctor G discovers another abnormality.

DR. G Lo and behold, the brain had trauma, too,

some contusions or bruising.

We've got contusions on the tip of the temporal lobe,

some inferior frontal.

He fell on the right-- also he had a little bit of trauma

which appeared to be a contusion in the area

of the pons or the brain stem, which is a bad area.

NARRATOR A history of epilepsy, advanced heart disease,

two subdural hematomas and evidence

of critical brain trauma, a skull that never fully

healed from brain surgery.

The autopsy of Dale Ennis has been anything

but straightforward, and has uncovered

complex forensic evidence.

But Dr. G believes she now knows exactly how Dale Ennis d*ed.

The intricate findings point to an unusual chain of events,

and it's a conclusion that Dale's widow, Paula,

will find difficult to fathom.

Based on findings at autopsy, Dr. G

knows that several weeks before his death, Dale

must have suffered some minor trauma to the right side

of his head, the side that had been weakened by brain

surgery years earlier.

DR. G How he got it, I don't know if we'll ever know,

but it caused a subdural.

And because of this weakness of the bone,

it somehow caused the little blood

vessels that go between the dura and the surface
[ … ]

of the brain to tear.

NARRATOR Dale is apparently unaware

that he sustained a minor subdural hematoma,

and in the following weeks the delicate torn blood vessels

in his brain begin to heal.

Subdural hematoma aren't always K*llers.

A lot of people, particularly older people

because their brains shrink, can have small subdural from some--"], index ,…}

from minor trauma that they didn't know they had.

NARRATOR Then yesterday, Dale suffers an epileptic seizure

and collapses in his backyard.

He strikes the back of his head on the ground with force,

resulting in a contusion to the back of his skull and critical

trauma to the brain stem.

The jarring fall also jostles the weak portion of his skull,

shearing delicate blood vessels under the dura,

including those healing from his previous subdural.

Problem is with these old subdurals,

they get at a vulnerable stage when they're starting to heal

and can easily be damaged with more minor trauma.

NARRATOR Soon the bleeding begins to irritate

and compress Dale's brain.

When his wife Paula checks on him,

she believes he's recovering from a seizure as usual.

Actually, he's dying of massive head trauma.

DR. G Most likely his brain is starting to swell.

His brain is irritated from that subdural.

So there is just a lot of little findings in his brain

that it basically gets short circuited.

There's trauma there, and he dies.

[ambulance sirens wailing]

NARRATOR Based on her findings, Dr. G

draws one final conclusion.

Dale's injuries were not survivable, even if his wife

had called -- sooner.

A lot of different twists, but I'll call the wife

and tell her.

I don't think--

I think-- you know, tell her there's really

not much she could have done.

I will always try to look and see, you know,

would it have mattered?

Do-- could I get some information to tell

her that said, you know what?

You're-- you know, there's nothing you could

have done for him or-- it does.

I mean, it affects me, and I-- it's a one small way

I can help the living.

You always want to say, was there

some way that I could have figured

out to change this course?

And you come to realize at a point in time,

you couldn't have.

[music playing]

(SINGING) You are the pillow on which I rest my tired head.

My alarm is set, but you're the rising

sun that woke me up instead.

You're the peaceful sleep I never want to end.

If you're not mine to hold.

Honey, love you.

I miss you.

I'm sorry you're not here, but I can understand that you're

a lot happier up there.

So there is nothing in this world

that I would do to make you come back down here.

And I let you go.

MAN (WHISPERS) Atlas.