[dramatic music]
NARRATOR An elderly man dies after mysteriously falling
from a high-speed train.
JAN GARAVAGLIA He kind of disappeared off the train,
and nobody saw him.
At least, nobody's saying they saw it.
NARRATOR Did he simply fall or is there
a darker side to this story?
JOYCE OLSEN Right away, we were thinking
that someone did it someone.
Someone pushed him off.
NARRATOR And then, a young woman
collapses during a romantic dinner with her husband.
JAN GARAVAGLIA Basically, she's brain dead by the time
she gets to the hospital.
NARRATOR Now, her distraught husband
needs to know if a deadly habit finally took its toll.
She does like to use dr*gs, particularly cocaine.
NARRATOR Or is something else to blame?
We don't know.
I mean, there are a lot of odd things that could occur.
Altered lives, baffling medical mysteries,
shocking revelations.
These are the everyday cases of "Dr. G, Medical Examiner."
You don't have to live inside Dr. G's jurisdiction
to end up on her autopsy table.
You just need to die there.
And all too often a traveler ends their journey prematurely
with a visit to the morgue.
If you've d*ed in the jurisdiction that I cover for,
we're going to need to find out why you d*ed.
We don't care where you came from.
If you've d*ed in our jurisdiction,
we're going to do that.
NARRATOR Such is the case of Victor Gust, who passed away
while traveling through San Antonio,
Texas during Dr. G's tenure at the Bear County
Medical Examiner's Office.
As Dr. G reads through the case file,
she's surprised to learn that -year-old Victor
Gust was a resident of Wisconsin,
over , miles away.
Oh, boy.
Well, we don't get too many people
from Milwaukee, Wisconsin.
NARRATOR To those who knew him, Victor
was the life of every party.
JUDY YANTIS He was a bit of a clown,
and my mom always referred to him
as the jokester of the family.
JOYCE OLSEN Well, as far as I remember
from back in the younger days that he
had a good sense of humor.
I just remember that we had fun.
We had a lot good times.
NARRATOR Afraid to fly, Victor was traveling through Texas
by train on his way to his sister's
funeral in Phoenix, Arizona.
But when the train arrived at the Phoenix station,
Victor didn't get off.
JUDY YANTIS My sister and I went down to the train station.
We waited and waited and waited.
The train came in, people got off,
and we'd be looking, going you know, is that him?
Is that him?
We were telling ourselves that maybe he fell asleep.
NARRATOR Conductors searched through the cars for Victor,
but he's nowhere to be found.
JOYCE OLSEN We all were thinking
that maybe he got off somewhere and didn't
get back on that train.
We just had no idea what to think.
NARRATOR Two hours later, Joyce gets a call from police.
They found her uncle Victor, but he's miles away
just outside of San Antonio and lying
unconscious beside the train tracks.
They find him alive but pretty much unconscious.
He can't really talk.
They helicopter him to a hospital
that is in my jurisdiction.
NARRATOR Victor remains in critical condition in a San
Antonio hospital for two weeks.
But he never regains consciousness.
JAN GARAVAGLIA He was very ill in the hospital,
on a ventilator.
They eventually had to put a tracheostomy tube in.
His respiratory state got worse and worse,
and he eventually d*ed.
NARRATOR For Victor's family, the loss is bitter.
His death was an especially sad time, because like I say,
we had just lost my mother.
We were all just shook up by the whole thing.
JUDY YANTIS Then for this to happen, it just was--
just one thing after another was just compiled.
NARRATOR What happened to Victor Gust on that train,
traveling through San Antonio at AM?
There's no witnesses.
They don't know how he got off that train.
So it's kind of a mystery.
NARRATOR The first scenario Dr. G considers is su1c1de.
[ … ]
His sister was the only immediate family
Victor had left.
And the long trip to her funeral may have
simply been too much to handle.
JAN GARAVAGLIA He's very upset, and maybe he
feels what's the point?
He doesn't want to face that funeral,
and he commits su1c1de.
I've had more impulsive suicides that I've autopsied.
NARRATOR Another possibility is that Victor could have simply
suffered a fatal accident.
JAN GARAVAGLIA He could have accidentally just tripped
and fallen off the train.
NARRATOR Finally, Dr. G considers
the most disturbing scenario, that Victor was
pushed from the speeding train.
Well, I'm always worried about foul play.
NARRATOR And in this case, there might be good reason.
According to several train passengers,
Victor had been behaving oddly during the trip.
He was acting very bizarrely, supposedly making
people irritated on this train.
He stole a pair of shoes from a little girl.
He took somebody's pillow, and people
were getting agitated at him.
NARRATOR Perhaps Victor did something that pushed
a fellow passenger too far.
I would hope that this is not the scenario, but I don't know.
NARRATOR It's this possibility that have police and Victor's
family most concerned.
JUDY YANTIS Right away, we thought that someone
pushed him off or something.
Why, you know, would someone fall off the train?
JAN GARAVAGLIA He kind of disappeared off
the train and nobody saw it, or at least
nobody's saying they saw it.
NARRATOR As a first step, Dr. G begins documenting Victor's
injuries from the fall, hoping they might reveal
clues as to what happened.
She finds abrasions on his hands and ears.
That is odd. Look at that.
I have two of those on--
NARRATOR And superficial puncture wounds
to his arms and elbows, all consistent with a fall
from a moving train.
Oh, this should be interesting.
NARRATOR But it's Victor's head that seems to have
sustained the most damage.
JAN GARAVAGLIA The lacerations extend through the scalp
and go down to the bone.
So there are very significant lacerations.
I'm going to get a chart for his head.
NARRATOR Victor's head trauma might have been severe enough
to k*ll him, but Dr. G won't know for sure until she
performs the internal exam.
But we've got to see what's on inside the brain.
NARRATOR If that is the cause of death, however,
it may be impossible to say for sure what or who caused him
to fall from the moving train.
Certainly, I would love it if somebody pushes him
and I see handprints.
But I'm sorry, it's not that easy.
It doesn't work like that in the real world.
NARRATOR Coming up next, Dr. G makes
a shocking discovery about what happened
to Victor after his fall.
There's a lot of pus in there.
It's clear.
You can see it with your eye.
NARRATOR When "Dr. G Medical Examiner" continues.
[dramatic music]
Dr. G reflects the scalp of -year-old Victor Gust.
While traveling by rail from Wisconsin to Arizona,
Victor somehow fell from the train
and d*ed two weeks later in the hospital.
Dr. G is almost certain Victor d*ed as a result of the fall.
But the question is, what caused that fall in the first place?
JOYCE OLSEN Someone must have done something bad,
you know, pushed him off or threw him off.
I would hope that's not the case.
But I have also had more senseless
murders that I've autopsied.
So what is it?
I don't know.
NARRATOR As Dr. G gets her first look
at the surface of Victor's skull,
she is surprised by what she doesn't find.
I don't see any skull fractures
at the top of his skull to the bottom of his skull.
NARRATOR Her assistant then uses the oscillating
saw to open his cranium.
Here, Dr. G does find trauma, a subdural hematoma
or bleed in the brain.
Oftentimes, with trauma, we see blood collecting
between the dura and the brain.
And the dura is that tough covering over the brain.
And the blood collects fast enough or enough,
it can press on the brain and really cause trouble.
NARRATOR But when Dr. G carefully
examines the collection of blood on Victor's brain,
[ … ]
she determines that the hematoma is minor.
With his, he's got just a little bit--
just a little bit of blood there.
It's layered out.
It's what we call non-space-occupying.
I wouldn't think that that was enough to k*ll him.
NARRATOR This is a surprising finding
that could take the case in a completely different direction.
Dr. G's initial suspicion that Victor
d*ed from head trauma sustained in the fall is not the case.
In fact, the injury may not even have
been severe enough to render him unconscious
or required a stay in the hospital.
I don't know what his problem is yet.
NARRATOR But that fall might still
have caused other fatal internal injuries,
and that's what she'll search for next.
Dr. G opens Victor's torso with the standard Y incision.
JAN GARAVAGLIA I look in the chest, I look in the abdomen,
but I don't see any trauma.
I don't see any broken ribs.
I don't see anything major as far as traumas concerned
in his chest or abdomen.
NARRATOR Incredible as it seems,
-year-old Victor fell from a train going miles per hour,
and he sustained no significant internal injuries.
Whatever k*lled Victor Gust, it wasn't his fall from the train.
OK.
But I gotta clean my hands.
NARRATOR With this shocking discovery,
Dr. G is back to square one.
All she can do now is push on with the internal exam,
removing and dissecting each vital organ in turn,
hoping for a clue.
And it's not long before she finds one.
Oh, my gosh.
That left lung is just full of fluid.
His lungs look terrible.
They were full of fluid.
NARRATOR But it's not just fluid buildup she sees.
There's a lot of pus in there.
It's clear.
You can see it with your eye.
Yes.
They're very congested.
They've got some edema too them.
NARRATOR This tells Dr. G that Victor
has contracted pneumonia, a significant bacterial infection
in his lungs.
It's very common to get pneumonias
and infections in your long when you're on a respirator.
Patients on ventilators are at high risk for bronchial or lung
infections, because the breathing tube bypasses
the normal defenses of the respiratory tract
and can even harbor bacteria.
Up to % of patients placed on a ventilator
for more than two days develop ventilator-associated
pneumonia.
Up to % of them die as a result. After his fall
from the train, Victor was on a ventilator
for nearly two weeks.
When you have a breathing tube down into your airway,
you can get colonized with a lot of different bacteria.
NARRATOR Dr. G believes this infection wasn't just severe,
she believes it's what ultimately k*lled Victor Gust.
JAN GARAVAGLIA I can clearly see that he d*ed
from unable to be oxygenating.
He just cannot exchange oxygen anymore from the air,
from the respirator.
The lungs are too badly damaged.
NARRATOR In many autopsies, this discovery would be
the final piece to the puzzle.
But not in the case of Victor Gust.
It's clear he d*ed from an infection
he contracted from a respirator in the hospital.
But for Dr. G, what led him to be on that respirator
is the real culprit, the true cause of death.
JAN GARAVAGLIA I mean, that's clearly the end result.
But what is it that started this?
He clearly didn't have lung damage
when he was on the train.
I mean, this is just all a result
of whatever happened to him.
NARRATOR Coming up next, Dr. G zeros in on a k*ller.
But will it be enough to close the case on Victor Gust?
So how am I going to figure that out?
I don't know.
NARRATOR When "Dr. G, Medical Examiner" continues.
[dramatic music]
Dr. G is pulling out Victor's organs one by one
and dissecting them.
-year-old Victor Gust was hospitalized
two weeks ago after falling off a moving train.
Dr. G has since discovered that Victor
d*ed of pneumonia he contracted while on a ventilator.
Although this is his cause of death,
Dr. G isn't satisfied, because to her,
whatever caused Victor to be in the hospital
in the first place, an accident, an as*ault,
or a natural disease, is what really k*lled him.
[ … ]
JAN GARAVAGLIA The bottom line is, what happened to him?
NARRATOR Dr. G's next stop is the heart.
And here, she soon finds a clue in Victor's coronary artery.
He's got bad coronary arteries.
NARRATOR It contains a dangerous buildup
of plaque, a condition known as coronary artery disease.
He has some coronary artery disease,
but what's really troubling is that he's got a thrombus.
In one of the coronary arteries, in one of the vessels
that supplies blood and oxygen to the heart,
he's got a thrombus.
It looks like there was a little clot.
NARRATOR A thrombus or blood clot is clearly obstructing
Victor's coronary artery.
JAN GARAVAGLIA The blood flow then can't
get through that thrombus.
It's blocking it.
It's damming it so no blood can get in.
NARRATOR The blockage of the artery
deprives the heart of blood and oxygen,
ultimately causing injury to the muscle itself.
JAN GARAVAGLIA When I look at the muscle, it's yellow,
it's soft, it's necrotic, because the muscle
fiber actually is dying.
That's what the yellow is.
It's just disintegrating and dying.
It's a huge heart att*ck.
NARRATOR Could this heart att*ck
have set off the chain of events that led
to the death of Victor Gust?
Or did Victor simply suffer the heart att*ck during his two
weeks in the hospital?
To find out, Dr. G will have to try to determine exactly
when the heart att*ck occurred.
To help establish a frame frame, she'll
need to dissect the heart and examine it up close.
JAN GARAVAGLIA When you have a heart att*ck,
it changes from just pallor or paleness from lack of blood
to then some hemorrhage and then you can get some softening
and get some yellow, because the muscle fiber actually is dying."], index ,…}
And so his is at the stage where it's really, really necrotic.
The muscle is just as soft as can be.
NARRATOR Based on her examination of the heart,
she calculates that the heart att*ck struck about two weeks
earlier, around the time Victor was traveling on the train
and before he was admitted to the hospital.
But she can't narrow the time frame any further.
And that means that there is one question that she'll
never be able to answer.
JAN GARAVAGLIA Did he pass out from the heart att*ck
and fall off the train or was it the whole stress
of either being pushed or accidentally
falling off the train?
Now, when you have stress, your blood pressure goes up,
and that certainly could have ruptured that plaque
and caused the thrombus.
Here's the problem with this--
I can't date it within seconds or even within hours
at this point.
Which came first?
The chicken or the egg?
I cannot tell from just looking at that heart.
NARRATOR By the end of the autopsy,
Dr. G is certain that Victor Gust had a major heart att*ck,
which then caused him to be on a respirator
and contract pneumonia.
But she'll never know what triggered it.
Unfortunately, it's one of those few cases
that you don't know.
So we're never going to get an answer on this.
NARRATOR When she reports her findings,
Dr. G presents the scenario that seems
most likely, even though she knows
it's not the only possibility.
[train whistle]
-year-old Victor Gust is on a train
bound for Phoenix, Arizona.
According to fellow passengers, Victor
begins acting strangely during the second day of his journey.
JAN GARAVAGLIA He's irritating people on that train,
stealing shoes, stealing pillows.
People are starting to get irritated at him.
NARRATOR To Dr. G, this might be the first sign that he's
having a major heart att*ck.
Lack of oxygen going to his brain
because of the heart att*ck, it could
cause him to act funny from the heart just not pumping well.
NARRATOR Not completely in his right mind,
perhaps Victor opens a door or ventures between cars.
He's had a heart att*ck.
His heart isn't pumping very well.
He's acting somewhat bizarrely.
He's probably getting some shortness of breath.
He goes out to get some oxygen. He collapses
and tumbles off the train.
NARRATOR His head strikes the ground,
and a small hematoma begins to form,
but it is not life-threatening.
As the train clacks away down the tracks,
Victor's heart att*ck puts him into a state of unconsciousness
[ … ]
that he will never return from.
He's hospitalized, placed on a ventilator, and as a result,
contracts pneumonia.
Slowly and slowly, his lungs get worse and worse and worse,
and he d*ed.
NARRATOR For Dr. G, it's a poignant scenario,
but it's not the only possibility.
The heart att*ck could have simply
been the result of a fall from a fast-moving train.
JAN GARAVAGLIA It could have happened after he'd fallen off
the train and just the stress of falling off,
that heart att*ck could have occurred.
NARRATOR Victor's fate is something that forensic science
can never know.
He either jumped off that train,
he either fell off that train, or he
was pushed off that train.
So it's one of those very unsatisfying
movies where they do three different endings,
and you pick.
I hate those.
NARRATOR The lack of certainty also troubles Victor's family.
JUDY YANTIS The fact that we may never know what happened
to him really bothers me.
It does.
It still bothers me.
And I'm sure it probably always will.
JOYCE OLSEN I would hate to think that another person
actually did this to him.
I wish I could have given the exact answer to the family.
I feel bad about that.
I always do.
But I got as many answers as I could from that body.
I don't have a preponderance of evidence here.
So I'm going to have to leave this one as undetermined.
NARRATOR Coming up next, a young woman
suddenly collapses and dies in the middle of a restaurant.
JAN GARAVAGLIA People see her fall to the floor
and have a seizure.
NARRATOR Did a dangerous habit ravage
this healthy woman's body?
JAN GARAVAGLIA She's known to use cocaine.
She's known to use ecstasy.
She is known to drink on a daily basis.
NARRATOR When "Dr. G, Medical Examiner" continues.
[dramatic music]
As chief medical examiner of the District Morgue in Florida,
Dr. Jan Garavaglia's job is to open and examine dead bodies
as soon as possible.
Oh, my goodness, though.
NARRATOR Unless the decedent is an organ donor.
Somebody has already peeked in.
But that's OK.
We'll deal with that.
NARRATOR Today, an organ recovery agency
wants to remove the liver of a local -year-old woman,
if Dr. G approves.
They do have to get our OK.
It certainly makes things a little bit harder
to find sometimes.
NARRATOR According to the agency representative,
the donor d*ed in the hospital after a sudden collapse
and three days in a coma.
JAN GARAVAGLIA We can work around it.
These are lifesaving measures, and I'm certainly not going
to refuse an organ just because it would
make my job a little easier.
NARRATOR Ultimately, she allows the procedure to move forward.
So they went ahead and then procured
the liver, transplanted that.
And then we got the body.
NARRATOR The next morning, Dr. G finds the donor, Jesse Davis,
in the day's lineup.
Hi mom.
Hi dad.
NARRATOR An aspiring cookbook writer, Jesse had a passion
for playing with recipes.
But according to the investigator's report,
her dreams were cut short three days earlier
while enjoying a meal at a favorite local diner.
JAN GARAVAGLIA She was having dinner
with her husband late at night, kind of early in the morning.
And while she's eating, she falls
to the floor, starts seizing.
NARRATOR Her husband, Aaron, springs into action.
Starts CPR.
They call --.
They're able to get her heart going,
but basically she's brain dead by the time
she gets to the hospital.
[siren]
NARRATOR Doctors immediately put Jesse on a respirator
and begin searching for a way to save her.
Desperate, Aaron tells them everything he can.
JAN GARAVAGLIA She doesn't have a history of seizures.
She's got a family history of heart disease,
but it's a little bit vague.
And the husband didn't really know that much about it.
NARRATOR He also reveals that his wife
has a history of drug abuse.
[ … ]
JAN GARAVAGLIA She does like to use
dr*gs, particularly cocaine.
NARRATOR But when the hospital runs a urine test,
it comes up negative for all illegal substances.
A CAT scan of her brain and a chest X-ray
also reveal nothing.
And they never could figure out why, what happened to her.
NARRATOR With nowhere else to turn,
doctors must finally tell Aaron, there's no hope for recovery.
Three days later, he agrees to take Jesse off the respirator,
and she dies.
Now it's up to Dr. G to answer the question
ER doctors could not.
What caused her to suddenly collapse
and then start seizing?
NARRATOR Based on the information thus far,
she believes that whatever caused the seizure is likely
the k*ller.
JAN GARAVAGLIA When people present with a seizure,
they don't usually die from it.
And it's usually from something else.
NARRATOR Unprecedented seizures are a symptom,
signaling that the brain has been suddenly deprived of blood
and oxygen. But numerous ailments, including
strokes, heart att*cks, and an overdose
can trigger this condition.
Dr. G can only speculate as to what
was behind Jesse's seizure.
JAN GARAVAGLIA Could be dr*gs, could be her heart,
or it could be something we don't know.
I mean, there are a lot of odd things that could occur.
Bottom line, is we don't know why she just all of a sudden
collapsed at the restaurant.
So that's what we're going to have to figure out.
OK.
We'll start.
NARRATOR As Dr. G begins Jesse's external exam,
one glaring wound provides a glimpse of her journey
to the morgue.
JAN GARAVAGLIA She's got the large incision
from the post-mortem organ retrieval.
NARRATOR She also takes note of Jesse's
white antiembolic stockings.
JAN GARAVAGLIA These are stockings
they put on to compress the legs so blood
clots don't readily form.
NARRATOR Clots are the result of abnormally coagulating
blood in the veins.
Blood clots can be life-threatening
if they travel through the vascular system to the lungs.
She removes the stockings and sees no anomalies on the skin
beneath.
In fact, she finds nothing inexplicable
anywhere on the body until she inspects the arms.
She has needle puncture marks.
She's got a lot of them.
NARRATOR These could be from the intravenous feeding
she received while on the respirator.
Were these needle puncture marks from the hospital?
NARRATOR But Dr. G also considers
Jesse's history of drug abuse.
Perhaps she'd injected a stimulant such as cocaine
and d*ed of an overdose.
Certainly, cocaine can precipitate a seizure.
NARRATOR The hospital drug screen did
test negative for narcotics.
But Dr. G knows from experience that these tests
are not always foolproof.
JAN GARAVAGLIA With the urine drug screen,
sometimes it won't pick up if you've
used the drug very quickly, before it gets a chance
to build up in the urine.
NARRATOR The only way to prove whether she
seized from an overdose is a comprehensive blood screen.
JAN GARAVAGLIA What we'll do is we'll get the initial blood
from the ER-- they said they'd save some of that--
and go ahead and test it ourselves.
NARRATOR But the lab work will take weeks.
For now, Dr. G must proceed with the internal exam,
hunting for any evidence the ER staff might have missed.
We're not going to know until we get inside.
NARRATOR First, she looks for signs of a stroke.
This ailment would have deprived a small part
of Jesse's brain of oxygen and could explain the seizure.
So we're going to go ahead and start with the head,
and then I'll do the chest.
NARRATOR But even before she reflects the scalp,
Dr. G knows a major challenge lies beneath.
A brain that grew soft while Jesse
was kept alive on a respirator, long after the organ
itself was dead.
JAN GARAVAGLIA We call these respirator brains.
If they're long enough on that respirator,
it'll be almost semi-liquid.
NARRATOR Coming up next, Dr. G struggles
with a tricky maneuver.
It's difficult to get this brain out.
I'm going to pulverize it.
NARRATOR When "Dr. G, Medical Examiner" continues.
[dramatic music]
[ … ]
Dr. G removes Jesse Davis's calvarium,
or the top of her skull, looking for signs
of a stroke or other disease.
Three days ago, while eating dinner,
the -year-old suffered a seizure
and never regained consciousness.
JAN GARAVAGLIA Has a sudden arrest, unknown etiology,
unknown cause.
NARRATOR With no diagnosis, her death is shrouded in mystery.
And Dr. G has little information with which to solve it.
We have no real history that she's got a family history.
She'd been in foster care, and I'm not so sure how
much she knew about her family.
NARRATOR Jesse's husband fears that drug
addiction, which she tried so hard to conquer, is to blame.
Now it's in Dr. G's hands to determine
the true cause of death and bring a measure of peace
to her grieving husband.
Dr. G attempts to extract the brain,
but it's a risky operation.
Well, this is really difficult to get this brain out.
She's been three days on a respirator brain dead,
and the brain has gotten very soft.
It's starting to break down.
I'm going to pulverize it.
NARRATOR It takes a very steady hand.
But after a few tense moments, she's
able to pull it out intact.
I got it.
NARRATOR Now, she must dissect it as best she can,
searching for any signs of a stroke.
This is interesting.
NARRATOR But after a thorough search,
she finds no abnormalities whatsoever.
JAN GARAVAGLIA And I didn't see anything in that brain
that was unusual or that would have precipitated her death.
NARRATOR So far, Jesse's k*ller is proving to be elusive.
Now, she's hoping to track it down in the internal exam.
Dr. G performs the usual Y incision.
Then she quickly homes in on a major organ,
whose failure could easily trigger a seizure, the heart.
She's got a family history of heart disease.
Most likely, that has something to do with atherosclerosis.
NARRATOR Atherosclerosis, or the narrowing and hardening
of the arteries, is one of the leading
causes of heart att*cks.
JAN GARAVAGLIA is pretty young,
but I've seen it before in young people of that age.
So it is a possibility, particularly
if you use cocaine.
NARRATOR She methodically dissects the organ, searching
for any visible abnormalities.
I'm looking at the thickness of the wall
of the heart muscle.
I certainly will look at the coronary arteries.
NARRATOR But it doesn't take long
to determine that Jesse's heart, like her brain,
was perfectly healthy.
I don't really see anything that
would indicate a chronic heart history from her family.
I don't see a lot of the chronic changes
that I see with cocaine.
That doesn't mean she would not have gotten it in the future.
But at , she did not have any heart disease.
NARRATOR With that possibility ruled out,
Dr. G seems further than ever from determining
what cut down Jesse Davis in the prime of her life.
We've got the big two down, the brain and the heart,
so we're running a little bit low on options.
NARRATOR Now, she turns to the last major organ
that could trigger a sudden lack of oxygen
and a seizure, the lungs.
And as soon as she picks them up, she detects a problem.
They're kind of heavy and boggy,
and I can see some hemorrhage on the surface.
NARRATOR Quickly, she digs deeper,
and it isn't long before her scalpel hits the jackpot.
She's got these blood clots.
They look like little nubbins coming out of the blood
vessels, kind of a dark purple, and you
can see kind of whitish strands through them.
NARRATOR These are multiple pulmonary thromboemboli,
blood clots in the lungs.
It's an alarmingly common condition
that strikes at least , Americans a year, most of whom
are elderly or immobilized after surgery.
Typically, the clots originate in the legs
or pelvis, when the patient's blood
starts coagulating too much.
The cells that are in charge of clotting
in the blood, the platelets, start tacking onto each other
and accumulating, and eventually they
form a large, soft, gooey mass.
NARRATOR Then, when it breaks loose,
it travels through the cardiovascular system
until it gets stuck in the lungs.
Well, what happens if you get a blood clot in the smaller
vessels of the lungs is the blood to get oxygen
from the lungs can't get in.
NARRATOR The diminished access to oxygen
[ … ]
can cause shortness of breath, anxiety, and chest pain.
That is, if the patient has any symptoms at all.
OMAR KAYALEH Most of emboli can be asymptomatic.
And not all of them are necessarily very evident,
even in the tests that we do.
NARRATOR This explains why doctors
were unaware of Jesse's emboli.
JAN GARAVAGLIA X-rays don't show blood clots very well.
You're just not going to see them.
NARRATOR But in autopsy, Dr. G is
able to see dozens with her naked eye,
peppered throughout the lungs.
JAN GARAVAGLIA If you get enough of these
or if you get big enough ones, it
causes you to collapse from lack of oxygen.
So everything really fits with her.
NARRATOR The profuse clots Tr*mp
all other possible causes of the seizure,
including a drug overdose.
JAN GARAVAGLIA Clearly, the sheer number of them
is the reason why she collapsed and seized
and why her brain wasn't getting enough oxygen.
And this is why she d*ed.
NARRATOR Dr. G now has a definite cause of death.
But the discovery raises a new, baffling question.
JAN GARAVAGLIA A big piece of the puzzle that's missing
is why this young woman would have thromboemboli.
NARRATOR Unlike the classic victim,
Jesse was an active young woman.
And from the way the clots have attached to the lungs,
Dr. G can tell they developed before her fatal collapse.
This clearly predates her being just in the hospital.
So we really don't have anything that would put her at risk.
NARRATOR To fully explain her untimely death,
Dr. G must leave no stone unturned until she brings
the true culprit to light.
Coming up next, dead-ends and negative findings
plague the case.
JAN GARAVAGLIA She's not obese, doesn't
have cancer that we know of.
NARRATOR When "Dr. G, Medical Examiner" continues.
[dramatic music]
Another physical autopsy comes to a close.
Three days ago, Jesse Davis seized and collapsed
in front of her husband.
Dr. G discovered deadly clots in her lungs.
But why this young woman fell victim remains inexplicable.
Why would a -year-old have a risk factor for clotting?
NARRATOR Now, she must look for the answers back at square one."], index ,…}
As a next step, Dr. G reopens Jesse's original case file.
She pours through all the data, weighing
each against every known cause of blood clots.
She's not obese, which is a risk factor.
She doesn't have cancer, which is a risk factor.
She doesn't have a history of immobility
prior to this hospitalization, like being
on a long airplane flight.
That's a risk factor.
NARRATOR Dr. G also wonders if genetics played a role,
but as a foster child, Jesse's family
history is tragically slim.
Finally, she's left with only one option.
Go back to the man who knew Jesse better than anyone.
JAN GARAVAGLIA We may not have all of her history.
Maybe we'll come up once I talk to the husband
why she would have these multiple
pulmonary thromboemboli.
Hi, this is Dr. Garavaglia at the medical examiner's office.
NARRATOR At first, it's appearing as if Aaron has
no new information to offer.
But then, he reveals two seemingly trivial facts,
with enormous implications.
She's recently started birth control pill, and she smokes.
NARRATOR For Dr. G, this new information
breaks the case wide open.
There is an association, although small,
between birth control pills and developing blood clots.
NARRATOR Normally, the human body
maintains a delicate balance between chemicals that promote
clotting to heal wounds and chemicals that prevent
thrombosis or unwanted clots.
JAN GARAVAGLIA So the body has this beautiful balance,
and it has a way to regulate this internally.
NARRATOR But in less than % of women, for reasons yet unclear,"], index ,…}
the hormones in oral contraceptives
upset the chemical interaction.
And smoking makes the problem worse
by constricting blood vessels and causing easy blockage.
OMAR KAYALEH If you're on oral contraceptives, and you smoke,
you are at increased risk of developing clots.
NARRATOR In Jesse's case, the odds
may have been stacked against her,
if she was genetically prone to clots and never knew it.
JAN GARAVAGLIA She developed them so quickly after taking
the birth control pills.
So I really suspect that she has a hereditary predisposition
for thrombosis.
And, in fact, probably about % of women who get birth control
pills, who then develop these thrombi,
have this predisposition.
[ … ]
It's probably even much higher.
NARRATOR Unfortunately, there's no way for Dr. G
to prove that the pills directly caused the blood clots.
JAN GARAVAGLIA We don't usually test
for these hereditary thrombotic diseases,
and there is nothing I can do to somehow correlate it
with the birth control pills.
It's just that you put the pieces of the puzzle together.
NARRATOR The pulmonary emboli, the oral contraceptives,
the cigarettes, and the obscure family history.
Now, with accumulative evidence, Dr. G
is confident she can say exactly what happened to Jesse Davis
on the night of her untimely death.
At years old, Jesse's life is in grave danger.
But it's not from her cocaine addiction or her family
history of heart disease.
It's from her new birth control pills.
JAN GARAVAGLIA Probably when she starts taking these pills,
the increased estrogen kind of throws off
that delicate balance your body has
to dissolve the little blood clots that normally
form in our bloodstream.
NARRATOR Soon, clots begin to develop
all over her pelvic vessels, and some begin a precarious journey"], index ,…}
through her body.
JAN GARAVAGLIA Several of these are
starting to break off and shower her lungs,
both sides, all lobes.
NARRATOR Unfortunately, like most who develop clots,
she has no symptoms from these smaller ones,
until one night when a large one finally breaks loose.
JAN GARAVAGLIA Once that blood clot breaks off,
it travels very quickly, seconds, into your heart
and then into your lung.
NARRATOR The embolus lodges firmly in one of her lungs,
completely blocking the blood flow.
JAN GARAVAGLIA And it just puts her over the edge.
She passes out and starts to seize.
NARRATOR No amount of CPR can fully resuscitate her.
JAN GARAVAGLIA They're never really
able to bring her brain back, which had already
d*ed from lack of oxygen.
NARRATOR Three days later, without ever
comprehending her fate, Jesse dies in her husband's arms.
While Dr. G can't say whether Jesse could have entirely
prevented the clots, there's no question that quitting smoking
would have helped her odds.
OMAR KAYALEH Nobody really needs
to be smoking, quite frankly.
But for those who do smoke, they need to realize that they are
at risk for developing clots.
NARRATOR And her genetic predisposition
may have come to light with a blood test,
if only she'd known more about her family.
JAN GARAVAGLIA Unless she had the family history,
they probably wouldn't test you for it.
It's a very small fraction of people that have it.
Otherwise, the pills should be very, very safe,
and it shouldn't be a problem.
She was just one of the unfortunate
ones that developed the clots.
I guess you could say it's just the luck of the draw.
Some people are just unfortunate.
04x02 - Derailed
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The unexplained deaths that Dr. G investigates can be attributed to various causes, such as undiagnosed medical conditions, accidents, or foul play.
The unexplained deaths that Dr. G investigates can be attributed to various causes, such as undiagnosed medical conditions, accidents, or foul play.