05x04 - Degrees of Death

[bunniefuu]

NARRATOR A man is found dead literally hanging in the air.

He is suspended by his pants off the ground

on a picket fence.

This is a real puzzler.

NARRATOR Police believe his death to be the result

of a tragic accident.

But Dr. G suspects something more sinister.

I think there's some foul play involved.

NARRATOR Then a construction worker collapses on the job.

By the time EMS gets there, he pretty much

doesn't have a heart rate.

NARRATOR Just minutes later, he's gone,

leaving both co-workers and loved

ones desperate for answers.

And I don't know how he d*ed.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

these are the everyday cases of "Dr. G, Medical Examiner."

JAN GARAVAGLIA We're building a new morgue.

You know, in all my years as a medical examiner,

this is one of the biggest projects I've ever taken on.

We looked at--

here's the options we looked at.

JAN GARAVAGLIA We've been working with these architects

for a long time.

They've never built a morgue or medical examiner's office.

So there was a lot of learning for them to understand

what we do and our workflow.

Say we do six, seven hours in the morgue, and then everything

goes into the cooler.

JAN GARAVAGLIA But the most challenging aspect

of the new morgue is that we're going green.

And we're not painting it green.

It's going to be environmentally friendly.

Our new morgue is going to be one

of the first green morgues in the country, and possibly

the world.

The really cool thing about being environmentally friendly

is natural lighting, a lot more space,

special parking for hybrid vehicles, an outdoor patio.

When you're planning a building that's

supposed to last more than years,

you got to plan for the future.

But that's the future.

Right now, I have cases to worry about.

And this next one is one of the strangest I've seen in a while.

Hm.

NARRATOR In the quiet residential suburb

of Oakland, Florida, everyone knows Lou Beckman

for all the wrong reasons.

He's basically the neighborhood drunk.

He would get intoxicated and trespass.

He would just walk through the neighborhood at will,

and just kind of a nuisance.

NARRATOR So it isn't surprising when, early in the morning,

a woman walking her dog notices that Lou is

in her neighbor's yard again.

From a distance, he simply seems to be

climbing over the picket fence.

But as she draws closer, one thing becomes clear.

Lou isn't moving.

He is suspended by his pants off the ground

on a picket fence.

His head is down, his legs are down.

It's almost as if somebody took a hook

and put his pants over it, these baggy pants

over the picket of the fence.

NARRATOR The woman immediately calls .

An operator instructs her to check for a pulse,

and it doesn't take long to figure out that Lou

Beckman doesn't have one.

Paramedics responded to the scene and notified police.

Then they called the homicide detectives.

NARRATOR A third call goes to the District

Medical Examiner's Office.

Now Lou's body and the reports from the investigation

are in Dr. G's hands.

It's a really odd case on a lot of different levels.

Obviously, he's in a bizarre position.

How did he get there?

Why did he get there?

NARRATOR Although police aren't sure how he d*ed,

they do have a theory about how Lou

ended up hooked on the fence.

It was a very hot night, so he was obviously--

he had been intoxicated earlier in the evening.

And we think he leaned against the fence,

and he was so intoxicated that he passed out,

lost consciousness at some point.

NARRATOR But after carefully examining

photographs from the scene, Dr. G isn't so sure.

I don't like the way the shirt is.

It's over his head, over on the back of his neck,

like a full nelson.

It's kind of restricting his arms.

I'm sorry, that's a kid prank.

And his shoes are neatly underneath him.

If he's trying to extricate himself,

his shoes would not be so neatly underneath him.

This looks suspicious to me.
[ … ]

My instinct is that he was placed on the fence.

I think there's some foul play involved.

NARRATOR Could Lou been the victim of a fatal as*ault,

or was it simply the result of an accident as police suspect?

Dr. G knows there's only one way to find out.

Lou's body is hard to miss in the morgue.

He's fully clothed and still awkwardly positioned.

JAN GARAVAGLIA He's got his arms still in the T-shirt,

and it's still on his back.

So it kind of restricts his arms.

He has a pair of oversized pants on, which

are unbuckled and unzipped.

You know, nothing of significance in his pockets.

There are some socks, which are relatively

clean, except for a little bit of dirt on the toes.

OK, I guess you can undress him.

NARRATOR With the help of morgue technician Tom Hemphill,

Dr. G removes the clothing and begins

searching for any injuries that might

have been sustained in either an accident or an as*ault.

We don't know much about him.

NARRATOR Initially, Lou's general appearance confirms

only what she already knows.

JAN GARAVAGLIA He's not in the best of shape.

He's a chronic alcoholic, and he's years old.

You know, that starts to get to you after a while,

and you don't always look that great.

Living on the street, drinking heavily, smoking heavily,

and that's what he looks like.

NARRATOR But then on the inside of his right calf,

she spots her first clue.

I see these abrasions, some of which

are dried, but with some crusted blood.

NARRATOR Soon, she locates more abrasions on his feet,

his ankles, and his arms.

Together, the injuries provide a gruesome glimpse

into Lou's final moments.

It shows that he's moving, trying to extricate himself

against this picket fence.

So he clearly got put up there or got stuck

up there while he's alive.

He was alive and he didn't want to be there.

NARRATOR She then discovers that his hands

are also smeared with blood.

The question now is, could Lou have been literally

fighting for his life?

He's very petite man.

He only weighs pounds.

It wouldn't take much to pick him

up and place him on that fence.

NARRATOR There, Lou would have been an easy target.

Just a few strong blows to the head or torso

could have been enough to cause fatal internal bleeding.

We're going to have to go inside

and see what's cooking there.

I really need to know what happened to him.

It's awfully thin, too.

We're trying to find history on medical records

from previous hospitals.

NARRATOR As Dr. G prepares to open Lou Beckman's body,

she's on the hunt for any evidence of foul play.

Police believe his death was the result of a freak accident,

but Dr. G doesn't agree.

The police are clearly thinking he

just got caught on the fence.

I just have a hard time buying that theory.

All right, we're ready, right?

NARRATOR She begins by making the standard Y

incision down his torso, looking for any signs of trauma.

When I initially open him up, I'm looking for fractures.

I'm looking for injuries.

Nope, no.

No rib fractures, no collection of blood,

no evidence of trauma in his chest, abdomen.

It doesn't look like anybody b*at him up.

NARRATOR But she can't rule out trauma as a cause of death

until she performs a cranial exam.

For now, she continues her search for clues

inside his abdominal cavity.

One by one, she removes and examines

each of Lou's abdominal organs.

And it's not long before she finds

an abnormality in his liver.

A little fatty liver there.

His liver looked bad.

You cut it and you can feel that there's probably some increased

fibrosis in there.

NARRATOR The fibrosis, or scarring,

is clearly the result of alcohol abuse.

Left untreated, it would have ultimately led to liver

failure and possibly his death.

But Dr. G can see that Lou's liver disease

is only in its early stages.

Nothing acute going on there.

NARRATOR Still searching for a clear cause of death,

she now moves on to the chest cavity,

and immediately, she sees trouble.

His lungs show evidence of chronic smoking.

A lot of anthracotic pigment--

black, smoky tar that gets in your lungs.
[ … ]

He's got emphysema.

NARRATOR Emphysema would have caused

Lou to have trouble breathing.

In time, it might have even k*lled him.

But from the color and texture of the lungs,

Dr. G can tell that this, too, was not

his ultimate cause of death.

He's clearly not end stage emphysema.

NARRATOR But Lou's smoking could have led to another life

threatening problem.

We know he smokes, and we know that's a risk factor

for coronary artery disease.

Possibly had a heart att*ck because he

gets hooked on the fence.

NARRATOR To find out if Lou's heart is the culprit,

Dr. G cuts open his pericardial sac and extracts it.

One by one, she inspects every vessel in the heart.

And what she finds astounds her.

Despite his history of smoking and drinking,

Lou's heart is surprisingly free of disease.

Coronaries looked good, normal size.

Has no chronic heart disease.

NARRATOR With no evidence of trauma

or a deadly disease in Lou's body,

Dr. G still has no idea what caused his sudden death.

But there's one more place to look--

his head.

That's going to be the last thing we look

at for this cause of death.

We need some good clear cut evidence.

NARRATOR Dr. G cuts the scalp across the top of Lou's head,

then peels it back, exposing the bone.

First, she carefully checks for any evidence of blunt trauma.

If there's a nice blow to the head,

that'll at least prove one theory to the other.

I'm looking for blood, you know, a bruise on the inner aspect

of the skull.

I don't see any.

Skull is intact-- indicates no skull fractures.

Then I take the skullcap off and look at the brain itself.

Let's see what's going on here.

NARRATOR Immediately, she detects an abnormality.

The brain's a little atrophic, a little shrunken--

not uncommon with alcoholics.

NARRATOR She methodically dissects the organ,

but doesn't find any abnormal bleeding or bruising anywhere.

JAN GARAVAGLIA The cerebral hemispheres look OK.

At this point, it certainly doesn't look like he's

been a victim of blunt trauma.

NARRATOR But then she cuts deep into the middle portion

of his brain stem, known as the pons.

And there, she sees something unusual.

When I cut the pons, something very odd is there.

I see a central area, a little over a centimeter

in size, almost a half an inch, of discoloration.

Kind of some loss of tissue in the center of the pons.

And it looks like what I've learned as Central

Pontine Myelinolysis.

NARRATOR Central Pontine Myelinolysis, or CPM,

is a condition often seen in alcoholics

who have been treated for a common side

effect of alcoholism--

low sodium levels.

But the treatment can backfire.

If you correct that sodium too fast in an alcoholic who

chronically has low sodium, that's

when they go into Central Pontine Myelinolysis.

NARRATOR The rapid rise in sodium levels

can destroy a layer of nerve cells

in the brainstem called the myelin sheath.

This interrupts signals between the brain

and the rest of the body, triggering

a range of severe symptoms.

JAN GARAVAGLIA They certainly get problems with their speech.

They can have disorientation, paralysis, and die from this.

It's got a fairly high mortality rate.

NARRATOR But as Dr. G examines the pons more closely,

she's surprised.

It's obvious that CPM was not Lou Beckman's k*ller.

This clearly didn't just happen.

It happened a while ago, because this is

somewhat old that I'm seeing.

Some people have gotten over it totally.

But a lot of people have chronic disabilities from it,

even if they get over it.

Now, did he get over it totally?

Hard to say because he was always stumbling around.

NARRATOR By the end of her autopsy,

Dr. G has discovered that Lou was living

with the effects of liver disease, emphysema, and Central

Pontine Myelinolysis.

But she still can't identify what k*lled him.

I'm not so sure I've made any headway in this case.

NARRATOR To solve the mystery of Lou's bizarre and sudden

death, she'll have to rely on the few weapons

still left in her arsenal.

I'm certainly going to look for some recent hospitalization

or medical records.

I want to gather as much evidence as I can,

look at the micros of all the organs.
[ … ]

Maybe the tox will tell me something,

because I still don't have a clear cut explanation.

NARRATOR Weeks after the autopsy of -year-old Lou

Beckman, a lingering question still

puzzles Dr. G. How did he end up dead,

suspended on a picket fence?

We still have the police theory that it's accidental

and we still have my theory that I'm

worried it's not accidental.

NARRATOR Now her only hope of solving the case lies

with the remaining information available to her,

including toxicology, microscopics,

his medical records, and a careful review of the scene.

His medical records are actually

very interesting to me.

NARRATOR Here, she discovers that about

a year before he d*ed, Lou was treated for low sodium levels.

This confirms her earlier suspicion

that Lou had Central Pontine Myelinolysis, a nerve disease

that can occur when doctors attempt to correct

a person's sodium levels.

And while it didn't k*ll him, she

believes that the disease left Lou with nerve damage

that affected his motor control.

Because he was always stumbling around,

I suspect that it was from recovering

from this Pontine Myelinolysis.

NARRATOR But CPM wasn't the only reason

Lou was stumbling around.

She checks his toxicology report.

And sure enough, his blood is saturated with alcohol.

Although it's not at a fatal level,

it is more than three times the legal limit.

I believe it's a ..

That's high.

That's really intoxicated.

That would pass some of us out.

NARRATOR Finally, she turns to the microscopic slides.

And in Lou's lung tissue, she discovers

the last critical piece of the puzzle, one that escaped

her naked eye in autopsy.

JAN GARAVAGLIA He's developing pneumonia.

And I see some aspirated material, meaning maybe

some food that he vomited got into his lungs,

set off an infection--

not uncommon with alcoholics who pass out.

Is that pneumonia enough to k*ll him?

Mm, no.

Probably in and of itself, not enough to k*ll him,

but we've already got two bad things going on in his lungs--

his emphysema, which he's probably living with.

Now he's got some pneumonia on top of that.

NARRATOR Pneumonia, emphysema, intoxication, and CPM--

none of these conditions alone k*lled him.

But when Dr. G considers them altogether and also factors

in the position of his body on the fence,

she can finally replay the unusual chain of events that

led to Lou Beckman's death.

As the sun sets, Lou begins his nightly ritual--

going for a walk and getting drunk.

Before long, he's passed out on a patch of grass,

and that's when the trouble begins.

He vomits and inhales it back into his lungs.

That explains why he's got the early pneumonia.

NARRATOR What happens next is still unclear.

Police believe Lou eventually woke up

and staggered over to a fence.

We believe that because it was a hot night,

he pulled the T-shirt up to try to get some air, to try

to cool off a little bit.

They felt very strongly it was an accident

that he got suspended.

Maybe he fell forward, and the picket fence caught his pants.

I feel strongly that somebody put him there.

They were messing with him.

I don't know if there's kids.

I don't know who it is.

I think they picked him up while he was passed out.

NARRATOR Either way, Lou finds himself in a jam,

hooked on a fence and completely trapped.

In a panic, he desperately tries to free himself,

scraping his arms and legs until he's bleeding.

But it's no use.

He's, you know, clearly intoxicated.

He's most likely debilitated from his Central

Pontine Myelinolysis.

He's got emphysema.

He's already having a hard time breathing,

and he's got pneumonia.

So all of those probably played a role in why

he can't extricate himself.

NARRATOR Eventually, gravity starts

pulling his blood downward.

When you're upside down and the blood is going

into your brain, and your legs are suspended,

you're having pooling blood in your legs,

and you're having pooling blood in your head.

And you don't get blood returning back to your heart.

NARRATOR The condition is called positional asphyxia,

and it can starve the heart and brain of oxygen rich blood
[ … ]

until they stop functioning entirely.

You can actually die from being suspended upside down.

It's clearly a known phenomenon with this kind of suspension.

He either goes into an arrhythmia,

or he passes out from the lack of fresh blood

being pumped to his head.

NARRATOR Had someone simply helped Lou off the fence,

he would have most likely survived.

But by the time a passerby happens upon him,

it's too late.

Hi, this is Dr. Garavaglia at the medical examiner's office.

NARRATOR Dr. G makes contact with Lou's estranged family

to inform them of his death.

She explains the findings of her autopsy,

though there's one aspect still unresolved.

Yeah, the problem is, I don't know how he got on that fence.

Is this a homicide, or is this an accident?

I have my theory.

The police have their theory.

And I'm not sure we'll ever know the answer.

For me, I feel very strongly that I think somebody

is messing with this poor guy.

I think they picked him up and put him on that fence

and put the shirt over his head.

And that's a kid prank.

Come on, man.

JAN GARAVAGLIA I don't think they meant to k*ll him.

I think they thought he'd wake up and he'd be struggling.

And he'd get himself out of there.

But that would still be a homicide.

And I think that's what happened.

That's why I refuse to make this an accident.

NARRATOR Dr. G tells Lou's family

that she will leave the manner of death undetermined.

Right.

All right, bye bye.

NARRATOR They simply appreciate her commitment to the truth.

I think he was already a lost soul.

They understand that partly how he lived his life

is how he ended up here.

And they know that if somebody ever comes forward,

we can change the manner of death.

You know, that's real life.

Sometimes we don't always have all the answers.

NARRATOR And Dr. G's next case is no different.

But this time, the answers she's looking for

may prove more elusive than anyone expects.

This is a catastrophe.

Summer.

Summer.

Sandy's favorite time when it's hot.

It's hot.

It's the worst time of the year in Florida.

NARRATOR But despite another blistering hot day,

Orlando shows no signs of slowing down.

Life goes on as usual, but not for Joseph

Cleary, Dr. G's next case.

It's a bright sunny morning when Joseph Cleary

arrives at a condominium construction

site in Winter Park, Florida.

He's a day laborer.

Hadn't been on this construction site before.

NARRATOR It's Joseph's first day on a new job,

and he gets straight to work.

When he started work that day, he was feeling pretty well.

NARRATOR But as the afternoon wears on,

he begins to feel unusually ill.

He complains of all of a sudden not feeling well.

But he says he's dizzy.

NARRATOR His co-worker notices that he looks alarmingly pale

and tries to convince him to take a short break.

Joseph insists that he's fine and keeps on working.

But just a few minutes later, he drops to the ground.

He just collapses and goes unconscious on them.

NARRATOR His co-workers try to rouse him,

but Joseph is out cold.

By the time EMS gets there, he pretty much

doesn't have a heart rate.

NARRATOR On the way to the hospital,

emergency workers attempt to revive him.

But to everyone's shock, it's too late.

Boy, you know, he dies pretty suddenly.

He's dead on arrival to the hospital.

NARRATOR No one can believe that Joseph,

who seemed perfectly fine this morning, is dead by PM.

And everyone that cares for him is

counting on Dr. G for answers.

Well, you know, his co-workers are disturbed.

His family is disturbed.

We have a -year-old Caucasian man.

He d*ed pretty suddenly at the construction site.

We don't know what happened to him.

This is a real puzzler.

NARRATOR It's particularly puzzling

because no one has been able to locate

Joseph's medical records.

Searching for clues about Joseph's medical history,

Dr. G's investigator, Carol Crosby,

tracks down Joseph's girlfriend, Maureen.

She was clearly in shock still over the death,
[ … ]

but she said she didn't understand why he d*ed now.

You know, he was just getting his life together.

Ooh, that made my ears perk up.

NARRATOR Maureen explains that Joseph

had recently kicked his habit of intravenous cocaine abuse.

But for Dr. G, this raises a red flag.

So many of the sudden deaths I see in the morgue

are from drug overdoses.

It's making me think maybe he didn't

get over his drug addiction.

There's a possibility he overdosed.

NARRATOR And there's only one way to find out.

All right, let's see what else we have.

So I'm going to really have to autopsy

him and get these answers.

NARRATOR Dr. G begins her external examination

by rolling up the sleeves of Joseph's heavy work shirt.

She then searches for the telltale signs of IV drug use--

track marks.

I don't notice any needle puncture marks.

I don't see any scars.

NARRATOR But the absence of track marks

does not rule out the possibility

that Joseph was injecting himself

with dr*gs before he d*ed.

A lot of times, intravenous cocaine users

may not get a lot of scars on the skin.

The thing that causes the marks with IV drug

is usually the talc and some of the material

they use to cut the dr*gs.

That's usually what causes most of the scarring.

NARRATOR Continuing her external examination

of Joseph's body, Dr. G turns her attention to his head.

But she doesn't see anything unusual,

until she checks his eyes.

He's a little jaundiced in the sclera.

The white of his eyes had turned slightly yellow.

NARRATOR Yellowing of the eyes is a common symptom

of liver malfunction.

It can be caused by hepatitis C, a common malady among IV

drug users like Joseph.

But Dr. G won't know for sure if dr*gs

played a role in Joseph's death until she

completes the autopsy.

I really need to look at all the organs,

see if I find anything else.

I'm not going to be able to tell until I get in.

NARRATOR As a next step, she carefully

removes Joseph's work shirt.

And what she finds is unlike anything

she's ever seen before.

Whoa, whoa, whoa.

He has an extreme case of psoriasis,

the worst I've ever seen.

This rash was over much of his body.

It was over his chest.

It was over his back.

It was over his arms.

NARRATOR Psoriasis is a chronic recurring

condition that causes skin cells to reproduce excessively.

They get this kind of raised red area.

Part of it's scaly-- these piled up scaly skin cells.

NARRATOR The cause of the disease

is not fully understood.

And to date, there is no effective cure.

It's very, very difficult to treat and get rid of.

NARRATOR But while Joseph's skin condition is severe,

it's unlikely that it was life threatening.

Certainly a nuisance.

It certainly hinders your quality of life.

But then you don't usually die from it.

NARRATOR As she wraps up her external exam,

Dr. G knows little more than when she started.

Joseph's sudden fatal collapse remains a complete mystery.

JAN GARAVAGLIA Everything's up for grabs here.

Could it just be natural?

You know, I don't know.

We're not going to know until we do the autopsy.

Is this mine?

That's yours.

OK.

NARRATOR Dr. G slides the thin sharp blade of her scalpel

from shoulder to shoulder, then down the center

of Joseph Cleary's chest.

After completing her external examination,

she suspects that the -year-old man's

sudden death may have been caused by a drug overdose.

We do know that he's got a history of IV drug abuse.

NARRATOR But it's too early to say for sure.

As Dr. G reflects the skin from Joseph's upper body,

she's looking for any evidence of what may

have caused his fatal collapse.

Once Joseph's rib cage is exposed,

she immediately notices an injury.

Several of his ribs are fractured.

Broke a lot of ribs back there.

Yep.

NARRATOR She inspects the fractured bones more closely.

But it quickly becomes clear to Dr. G

that the breaks occurred during emergency
[ … ]

workers' frantic efforts to revive Joseph.

He's got some rib fractures consistent with

cardiopulmonary resuscitation.

I often see that.

Somebody did some nice, vigorous CPR on him.

It didn't have anything to do with his death.

NARRATOR Cutting down the sides of his rib cage,

Dr. G frees Joseph's chest plate,

exposing the organs beneath.

There you go.

Based on the circumstances of death,

I'm really concerned about the lungs, the heart.

NARRATOR And it doesn't take long to confirm that Joseph's

lungs are not at all healthy.

His lungs are heavy.

They are congested.

NARRATOR Removing the lungs from his body,

she cuts into them.

And here, she makes another disturbing discovery.

He certainly had some edema fluid.

NARRATOR Edema, or fluid buildup in the lungs,

can result from a number of causes,

including heart failure, pneumonia,

and exposure to dr*gs.

But Dr. G zeros in on one.

I'm, again, worried about drug overdose.

NARRATOR Still, edema in his lungs

alone are not enough to confirm a drug overdose.

Her next stop is the heart.

And as she removes the muscular organ from the chest cavity,

she discovers another anomaly.

His heart is mildly enlarged for somebody his size.

So he has some effect of high blood pressure on his heart.

NARRATOR Chronic cocaine exposure

can cause changes to the heart.

And these changes may ultimately have triggered

a fatal heart arrhythmia.

Seeking further evidence, she begins

to dissect the heart itself.

I cut the coronaries.

NARRATOR But inside the coronaries,

there are no abnormalities.

His coronaries are fine.

The heart muscle looks fine, just enlarged.

NARRATOR In fact, Joseph's heart is

in surprisingly good condition.

And now she doubts that it played

a role in his sudden death.

So far, I don't clearly know why he d*ed.

NARRATOR Next, she focuses her attention on his liver.

And here she discovers an abnormality.

And liver's normally nice and smooth.

He's got the small, lumpy, bumpy liver.

He does have cirrhosis.

NARRATOR Cirrhosis is a chronic liver

disease in which normal tissue is replaced

by fibrous scar tissue.

The number one cause of cirrhosis in the Western world

is alcohol abuse.

Another common cause is hepatitis C,

a viral disease common among individuals who

inject themselves with dr*gs.

He is an IV drug abuser.

A lot of those people do have hepatitis C, and a lot of them

end up with cirrhosis.

NARRATOR But this discovery doesn't give her the answers

she's looking for either.

So his liver, albeit bad, was not enough to k*ll him,

and we certainly need another cause of death.

NARRATOR Dr. G moves on to examine the remaining organs--

the large intestine, the stomach, the bowels.

And she begins to notice an alarming pattern.

His bowels are already starting to turn green.

His spleen is soft and friable.

NARRATOR In fact, what she sees here may be the most important

piece of evidence yet.

These are all early signs of decomp, which

was odd since he had just d*ed.

When I start seeing exaggerated decomposition

faster than I would normally expect,

I really worry that something else is going on with him.

NARRATOR At that moment, medical investigator Dan Dees

arrives to deliver some new information.

JAN GARAVAGLIA He brought the hospital ER record.

There was a vital piece of information

on that sheet that did not get relayed

to me, which changes the whole complexity of the case.

Now, I think we know why he d*ed.

NARRATOR Dr. G just received medical records

detailing the final moments of Joseph Cleary's life.

And in them, she finds a crucial piece of information.

He had a markedly elevated temperature when EMS got there.

It was .

It was degrees Fahrenheit.

That's hyperthermia.

NARRATOR Hyperthermia occurs when the body contains more

heat than it can release, causing the internal body

temperature to climb.

In its most severe form, it's called heat stroke,

and it can be fatal.
[ … ]

That clearly is his cause of death.

NARRATOR This also might explain why Joseph's organs had

begun to decompose prematurely.

Him having an elevated temperature

could cause early decomposition.

NARRATOR Dr. G now has some of the key answers

she's been looking for, but one mystery still remains.

So now we have to think, why is he hyperthermic?

That's clearly why he d*ed.

But why is he like that?

You know, I have a whole construction site.

I have a whole city that's not undergoing heatstroke.

I need to kind of narrow down why he has

this elevated body temperature.

NARRATOR And her first thought is

one that's been troubling her throughout the entire autopsy.

I'm, again, worried about drug overdose.

One of the main ways we see elevated body temperatures

in this morgue is cocaine use.

NARRATOR Joseph's girlfriend is convinced that he

had given up his cocaine habit.

But now Dr. G is even more suspicious that a relapse

may have caused his death.

The only way to find out for sure

is to send blood samples to the toxicology lab for testing.

I rushed the toxicology on this case,

because I'm very, very curious if it's cocaine.

NARRATOR But even a rush job will take a few days.

In the meantime, there is another strong possibility

that she must investigate.

One of the causes for an elevated body temperature, that

would be a brain stem stroke.

NARRATOR During her internal exam,

Dr. G discovered that Joseph had an enlarged heart, which

is evidence of high blood pressure, a condition that

could have triggered a stroke.

Maybe he had a hypertensive bleed associated

with the high blood pressure.

So the next thing I go to is going to be his brain.

NARRATOR Dr. G begins her examination of Joseph's cranium

by sliding her blade across his scalp and reflecting it down.

Morgue technician Sandy Ludwig then uses an oscillating

saw to cut through the skull.

I lift the calvarium off.

Nothing's wrong with cerebral hemisphere.

But I want to look at that brain stem.

He could have a bleed in his brain.

You know, oftentimes we see it in the brainstem.

NARRATOR Dr. G removes the brain,

searching for a pontine hemorrhage,

or bleed in the brain stem.

And I immediately put a cut in the brainstem.

If it looks like a pontine hemorrhage,

you see the normal tissue and then a clot of blood

within that tissue.

The brain is kind of an off white to gray color.

But when you see hemorrhagic stroke,

you see this nice bright red blood

clot inside the brain tissue.

NARRATOR But inspecting the tissue,

she sees nothing abnormal.

We had bleeding nowhere in his brain.

So we have eliminated one possibility.

NARRATOR The morgue technicians close up Joseph's body.

For now, all she can do is wait for the results

of the toxicology report.

So at the end of the autopsy, we

know he's got hyperthermia, a very elevated body temperature.

The tox can either tell me that the cocaine is related

to his hyperthermia, or it can eliminate

the cocaine as a contributing cause of death.

NARRATOR Three days later, Dr. G receives the report

from the toxicology lab.

She immediately scans the page for the most

vital piece of information--

whether or not cocaine was present in Joseph's blood.

JAN GARAVAGLIA When the toxicology comes back to me,

I'm actually shocked.

He has no cocaine in his system.

NARRATOR Now Dr. G is left with a puzzling question.

If cocaine didn't cause Joseph's temperature to sh**t up, then

what did?

JAN GARAVAGLIA He's certainly working out in the Florida sun

in the summer. It's hot.

It's humid.

But why him and not anybody else?

NARRATOR Thinking back to the autopsy,

Dr. G zeros in on one essential clue.

There is one reason that this fellow, and this fellow

and not his other construction workers, had problems that day.

NARRATOR Based on this seemingly unrelated

observation, Dr. G can now piece together

the chain of events that led to Joseph's fatal collapse.

Joseph Cleary arrives at the construction site at

AM sharp.

As a day laborer, he's always taking different jobs.

Today's the first time this summer

that he's working outside under the harsh Florida sun.

JAN GARAVAGLIA During the morning,

he was able to compensate for the heat.
[ … ]

The temperature wasn't as hot.

NARRATOR But as the day wears on,

it creeps up to a humid degrees.

And it's such high temperatures, the human body

depends almost entirely on one mechanism for releasing heat.

He has to lose his body temperature from sweating,

from evaporation.

NARRATOR It's a simple but vital mechanism.

Glands in the skin produce sweat, which then exits

the body through the pores.

Once in the body's exterior, the sweat evaporates, taking

excess body heat with it.

If you stop sweating, then that's extremely dangerous.

NARRATOR And on this day, something is robbing Joseph's

body of its ability to sweat.

It was his psoriasis.

He had one of the worst cases I've ever seen.

And it's unclear why his psoriasis was so bad.

NARRATOR But one thing is clear.

The psoriasis is blocking Joseph's sweat pores.

He has lost his ability to sweat like the rest of us.

NARRATOR Heat has difficulty escaping,

and suddenly, Joseph can't cool down.

His body core temperature started to go up.

His heart's trying to b*at faster.

NARRATOR As Joseph's temperature rises,

his blood vessels dilate in an attempt to cool him down.

This causes his blood pressure to fall,

preventing oxygen rich blood from reaching his vital organs.

The extreme heat also causes the proteins in Joseph's body

to break down, and cells throughout his body

stop functioning properly.

He starts feeling dizzy, and he collapses relatively fast.

He goes into shock.

NARRATOR Joseph dies within minutes.

This is a very unusual combination of factors.

With how bad his psoriasis was and how

severe the conditions were that day,

it certainly was dangerous.

NARRATOR It gives Joseph's girlfriend, Maureen, a measure

of peace to hear that his death had not

been caused by a drug relapse.

But she's saddened by the fact that Joseph's death could

have been easily prevented.

JAN GARAVAGLIA He should have avoided

the heat like the plague.

I don't know what possessed him to go out and work that day.

I'm not sure the general public knows how

dangerous a heatwave can be.

Heat can k*ll.

MAN Atlas.