06x01 - Lethal Intake

[bunniefuu]

[music playing]

NARRATOR A young man dies unexpectedly

after eating a fish sandwich.

What went on between the fish sandwich and the next morning?

NARRATOR And as Dr. G puts the pieces together,

all signs point to a bizarre case of food poisoning.

To die from it would be very unusual.

But we see the unusual here.

NARRATOR And then a woman is k*lled

in a tragic car accident.

That oncoming car was a drunk driver.

NARRATOR But Dr. G knows there may be more to this accident

than meets the eye.

I can't just put down car accident, cause of death, here.

How did this happen?

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

It's been a grueling week for chief medical examiner, Dr. Jan

Garavaglia.

She's seen more than her fair share of trauma and tragedy.

There's a little baby, got run over by a golf cart.

NARRATOR But now, Dr. G is off duty and on her way

to a relaxing dinner with her husband at one

of her favorite restaurants.

But during the course of the meal,

something goes seriously wrong.

I was eating fish at a very nice restaurant.

And I started to actually have some swelling in my face,

and I was getting a little bit of a problem with breathing.

I said, I think something's happening to me.

I was afraid I was going to die because it

just came on so suddenly.

NARRATOR That evening, Dr. G suffers from a frightening bout

of food poisoning.

She is one of many.

Each year in the United States, there

are a staggering million reported

cases of food poisoning.

And of those, approximately , result in death.

I was one of those million cases that year that suffered

some type of ill effect from food,

but I certainly didn't die from it.

NARRATOR Unfortunately, Dr. G's next case may not be so lucky.

It's PM on a warm afternoon in May,

but -year-old Hector Nolasco is

spending it inside suffering from extreme nausea

and vomiting.

He's been sick for three days now,

and Hector's symptoms are showing no signs of letting up.

He was continually vomiting, to the point

where the sister was a little worried

and spent the night with him.

The following morning, Hector's sister Layla

is in the kitchen making breakfast

when she hears a strange noise.

She runs upstairs and he had collapsed while vomiting

into the trash can.

She immediately calls .

NARRATOR Within minutes, the paramedic team

arrives on the scene.

JAN GARAVAGLIA They take him to the hospital.

They try to resuscitate him, but it's too late.

NARRATOR Hector Nolasco is pronounced

dead in the ER, just three weeks shy of his th birthday.

Now, it's up to Dr. G to figure out

exactly how and why he d*ed.

OK, I got to get my act here.

These two are working and I got to catch up with 'em.

NARRATOR Dr. G's first step is to review Hector's

somewhat slim case file.

He's a -year-old fellow.

He's an architect, no known medical history,

and according to his sister Layla,

Hector was in perfect health.

JAN GARAVAGLIA She said he didn't use illicit dr*gs,

didn't smoke.

Seemed to live a very healthy lifestyle.

NARRATOR But then, Layla reveals

a surprising detail that sheds new light on the investigation.

Hector believed he knew what made him so sick.

What happened is that he had a fish sandwich

about four days prior to death.

After that, he started having vomiting and abdominal pain,

he's pretty sure that the fish sandwich gave him

some type of food poisoning.

NARRATOR In fact, Hector's abdominal pain

becomes so severe, that within hours of eating the fish,

he schedules an emergency appointment with his doctor.

He had told the doctor he had fish poisoning

and the doctor was treating him.

NARRATOR But just two days later, Hector is dead.

Initially, Dr. G is skeptical of Hector self-diagnosis.

Just because he went into the doctor

and said I have food poisoning, and the doctor believes him,

doesn't mean I'm going to believe him.

NARRATOR Truth is, deaths from fish-related poisonings

are rare in the United States, especially in healthy adults.

But Dr. G does have cause for alarm.

Two months earlier, a health alert from the FDA,
[ … ]

the Food and Drug Administration,

came across her desk.

It warned of a ciguatera outbreak

among people who had eaten toxic fish caught

in the northern Gulf of Mexico.

Well, we're in Florida.

You know, we're part of the Gulf of Mexico.

So it did pique my interest.

Maybe he could have one of those rare cases

of ciguatera poisoning.

NARRATOR But despite her years of work in the morgue,

Dr. G has had little experience with this rare type

of food poisoning.

Luckily, she has the perfect teacher on hand.

An infectious disease specialist named Dr. Mark Wallace, who

also happens to be her husband.

JAN GARAVAGLIA Oh, I love worry with Mark.

You know, you just bounce things off of him.

By trying to [inaudible]---- so when I got word that I had

a possible food poisoning in the morgue, well, he's the first

person I turned to.

And I mean literally turned, because we

drive to work together.

Mark what do you know about food poisoning?

Oh, by George, I just gave a lecture on fish food poisoning.

I don't know have that in my knowledge base.

Yeah, we can look it up.

OK.

He's very helpful, besides being sweet.

Ciguatera is a serious illness,

and it occurs when people eat grouper, or jacks,

or barracuda, in particular.

Those reef fish can be contaminated with this toxin.

And when people ingest this, they can get very sick.

NARRATOR In fact, people suffering from ciguatera often

experience the exact same symptoms as Hector.

Nausea, vomiting, and abdominal pain.

But there can also be strange neurological side effects.

People can describe all sorts of weird neurologic things.

When they touch things that are cold,

they think they're hot, or vice versa.

They think that their teeth are loose and about to fall out.

NARRATOR The mechanism of death with ciguatera

is either cardiac or respiratory failure.

People either stop breathing due to profound weakness,

or the toxin can actually depress

the function of the heart and they can have heart failure.

NARRATOR But there's one problem with the diagnosis.

Ciguatera is rarely fatal.

It's thought that about one in , people who get ciguatera

die from it.

JAN GARAVAGLIA To die from it would be very unusual,

but we see the unusual here.

I love it when we have weird things in the morgue.

NARRATOR Still, Dr. G knows that there's a lot more

at stake here than cracking the mystery

behind a sudden, unexplained death.

Bottom line, if Hector d*ed from Ciguatera poisoning,

a whole lot of people could be at risk.

If it is food poisoning and he got it from that restaurant,

that restaurant needs to know and the health

department needs to know.

Now, Dr. G's first priority is to identify

the exact type of fish Hector ate, and test it.

Oh yeah, it's absolutely.

NARRATOR To that end, she wastes

no time enlisting the help of the county health department.

We went ahead and asked them, could you

check and figure out what kind of fish it was for us?

NARRATOR In the meantime, Dr. G and her team prep

Hector for the external exam, to see what clues can be gathered

directly from his body.

I can't wait to do the autopsy and see what I find.

So when I look at him, He certainly

looks like he was healthy.

NARRATOR Dr. G's first step is to examine

Hector's face and mouth.

Oh, bad, huh.

NARRATOR Immediately, she notices a contusion

on his upper forehand.

Look at that.

Did you take a facial that time?

His face has a bruise--

Yeah, let's get it.

Right there?

--which I'm assuming is when he fell onto the trash can,

which he was vomiting in.

That's not a pleasant way to die.

- [inaudible]. - No.

Let me see his mouth first.

Hold on.

And his oral cavity has some bite marks to the lips.

Oftentimes, I'll see that from resuscitation,

pressing the lips onto the teeth.

Boy, whoever did CPR on him really did it aggressively.

All right.

NARRATOR But it isn't long before Dr. G discovers

something highly unusual.

Oh, gosh.

NARRATOR Something that could change the entire course
[ … ]

of the investigation.

I can't sit there and worry about what

the ramifications are.

I have to focus on getting the answer.

That's my job and that's why I do it.

[music playing]

NARRATOR Dr. G is carefully examining the body

of -year-old Hector Nolasco, whose

family believes that he was a victim

of fish-related food poisoning.

And with a recent alert from the FDA about a ciguatera outbreak,

Dr. G could have a potential health scare on her hands.

We have a lot of people just standing by

to get some things in motion.

Health department, his family.

They want to know why he d*ed.

NARRATOR But in the morgue, assumptions can be dangerous.

One mistake you make in forensics

is you come up with a hypothesis,

and then you kind of blind yourself

to any other possibilities.

You have to keep your options open.

Maybe he has something else wrong with him.

Maybe he's got an infection in his belly,

maybe he's got something wrong with his bowels.

There's maybes, maybes, maybes, and I can't be blindsided by,

he thinks he's got food poisoning.

You get the sides of the neck, to?

NARRATOR Sure enough, just as Dr. G's

wrapping up the external exam, she spots something

completely unexpected.

Oh, what was that?

His hands have classic clubbing of the distal aspects

of the fingers.

And the nail is kind of curved upward,

then you get a bulbous appearance.

NARRATOR The physical finding of clubbed fingers

is nonspecific.

It can indicate anything from heart and lung disease,

to some forms of cancer.

But the deformity, along with Hector's symptoms,

raises a possibility that Dr. G had not previously considered.

I'm wondering if this guy has Crohn's disease.

NARRATOR Crohn's is a debilitating autoimmune disease

in which the body's immune system literally att*cks

the gastrointestinal tract.

He does have clubbing and that is

associated with Crohn's disease, which is

associated with abdominal pain.

So that'll be interesting to look for.

All right, let me take your picture.

NARRATOR Although Hector had no history of chronic illness,

and the disease is rarely fatal, Crohn's

is a definite possibility.

But considering the recent FDA alert,

ciguatera is still high on Dr. G's list of suspects.

JAN GARAVAGLIA So at this point,

we're just kind of putting the building blocks together

of what I'm finding.

NARRATOR Dr. G begins the internal exam

by performing the standard y incision,

fully revealing the internal organs.

Let's see what we have here.

NARRATOR And immediately, she spots something amiss.

JAN GARAVAGLIA Wow, look at that.

I see that he's got about CC's

of a amber color fluid collected in his abdominal cavity.

NARRATOR CC's Is a significant amount of fluid,

almost two cups worth.

So that's our first hint that something's wrong.

NARRATOR Dr. G goes on to discover more

of this fluid in Hector's pleural space,

the body cavity that contains the lungs.

But in order to determine what caused the strange buildup

of fluids in the first place, she'll

need to take a closer look at Hector's heart and lungs.

JAN GARAVAGLIA Heart looks good.

It's nice to see a normal heart, and he had one.

NARRATOR And the lungs, though heavy with fluid,

do not look especially disease or infected.

There's many things that can cause fluid.

So it's a nonspecific finding, but he's certainly ill.

NARRATOR And given Hector's symptoms of stomach pain

and nausea, she wastes no time zeroing

in on the abdominal cavity.

Immediately, you can see there's

something wrong in the abdomen.

He's got reddening of the mesenterial of the tissues that

hold the bowel.

It's inflamed.

And there's little patchy areas of little necrosis,

little pieces, areas of fat just appear to be dying.

NARRATOR This discovery only furthers Dr. G's theory

that Hector indeed suffered from Crohn's disease

because Crohn's causes inflammation

in the bowel wall, which can lead to perforations, or tears,

ultimately damaging the mesentery.

JAN GARAVAGLIA Oh, what else we got going on here.

NARRATOR But to find out for sure, she must examine

all feet of Hector's bowels.
[ … ]

I need to still look at those bowels.

And you got something for me to put them in?

NARRATOR The bowel examination is

a standard step in most autopsies,

but it's not a popular one.

JAN GARAVAGLIA Well, it's never fun to have

to open the entire bowel.

It's not something my techs like to do.

In fact, I know they dislike it so much

that I usually open it myself, because I

know what I'm looking for.

NARRATOR Yet despite an exhaustive inspection,

the initial findings are disappointing.

There's really nothing here.

His bowels look completely normal on the inside.

Nothing out of the ordinary.

Everything looks good.

NARRATOR At this point, Dr. G still

doesn't know what caused the inflammation to the mesentery.

But she can now be certain of one thing.

He had absolutely no evidence of Crohn's.

NARRATOR But if Hector didn't suffer from Crohn's, what

caused his clubbed fingers?

Most likely, the clubbing of his fingers

is probably just inherited.

If I looked at the father, probably his father has it to.

NARRATOR Then, just as Dr. G is ruling out the Crohn's theory,

the autopsy is interrupted by her Chief Medical Investigator,

Steve Hansen.

I do get word that the health department contacted

the restaurant and the type of fish

that they use for the sandwich was tilapia.

NARRATOR Tilapia is a freshwater fish,

and is not associated with ciguatera.

JAN GARAVAGLIA It had nothing to do with the type of fish

that you get ciguatera poisoning with.

I still think ciguatera poisoning was

an interesting red herring, and I'm almost

disappointed it wasn't.

NARRATOR But if neither food poisoning nor Crohn's disease

k*lled Hector, what did?

Dr. G suspects the answer may lie

in one of the organs underneath the inflamed mesentery.

This is an area where your stomach is, where your lower

portion of your liver is, and beneath

that is where your pancreas is.

One-by-one she carefully examines each organ,

and it isn't long before Dr. G uncovers a shocking new clue.

Oh, look at that.

Not what I expected, but that could

clearly explain everything.

[music playing]

JAN GARAVAGLIA All right, back to the case at hand.

Dr. G has just discovered a serious problem embedded

deep within the abdominal cavity of -year-old Hector Nolasco.

Oh my god, look at that.

The pancreas doesn't look good.

So I take the pancreas out, and it's clearly inflamed.

I've never seen it that bad.

That pancreas was bad looking.

That was an inflamed, dead pancreas.

NARRATOR There's no question Dr. G has found her culprit.

It's clearly an acute pancreatitis.

You know, most people, when they get pancreatitis,

it's usually mild and they get over it.

It's painful, it's uncomfortable,

but they get over it.

NARRATOR But in Hector's case, the damage to his pancreas

was so extensive that death was inevitable.

Still, there's a fundamental question left unanswered.

I wanted to know why.

Why did he get the pancreatitis?

NARRATOR One of the main causes of acute pancreatitis

is gallstones.

Gallstones are hard, pebble-like particles

that form in the gallbladder.

However, if they're flushed out of the gallbladder

and obstruct the pancreatic duct,

they can potentially block the pancreas'

release of digestive enzymes, with fatal results.

You block that pancreatic duct,

and then you have a build up of pressure.

And those enzymes start breaking down that tissue.

That's why your pancreas gets inflamed,

because it's getting basically digested inside of you.

NARRATOR But there's one problem.

During Hector's autopsy, Dr. G failed

to find a single gallstone.

He had absolutely no evidence of gallstones.

NARRATOR The second most common cause of pancreatitis

is alcohol.

But once again, Hector Nolasco appears

to be an unlikely candidate.

I have no history that he drank at all.

As far as I know, he gets the fish, he gets sick,

he goes home.

What went on between the fish sandwich and the next morning

when he really started vomiting.

NARRATOR Now Dr. G wonders if Hector

may be one of a small percentage of people
[ … ]

in which the cause of acute pancreatitis is simply unknown.

At a standstill, she reaches out again to the person who knew

Hector best, his sister Layla.

I talked to the sister, you know, she's devastated.

This is a guy that they all looked up to in the family.

He had a bright future ahead of him.

NARRATOR But then , Layla reveals a surprising

detail about her brother.

For Dr. G, it's the missing link.

And now, she can finally piece together

the last moments of Hector Nolasco's all too-brief life.

Four days prior to his sudden death, Hector orders

a fish sandwich while out to lunch with a friend.

But their day of fun doesn't end there.

After eating that fish, he actually

went out with his friend and they went to multiple bars.

NARRATOR According to his sister,

Hector was not a habitual drinker.

But that evening, he makes an exception.

JAN GARAVAGLIA You don't know how much he drank,

but he was possibly binging that night.

He goes home, sleeps it off, and in the morning

he is not feeling well.

He's vomiting, he has abdominal pain.

He thinks that it's just the food poisoning.

NARRATOR But Hector does not have food poisoning.

Instead, he's developed acute pancreatitis.

Although it's unusual for just one binge

to cause pancreatitis, it's not unheard of.

Nobody really knows why some people

with alcohol use get pancreatitis

and some people don't.

This guy drank a lot less than most people, most college

students, probably that night.

And yet, he got pancreatitis.

NARRATOR Unfortunately, it isn't long

before Hector's pancreas becomes severely inflamed,

triggering tremendous abdominal pain.

JAN GARAVAGLIA The cells of his pancreas

are actually breaking down and dying.

That's making him very nauseated.

Now, the biggest part of the pancreas

is the formation of digestive juices

that then help digest food.

NARRATOR These acidic juices proceed

to leak out of the pancreas, and literally

begin digesting the fat in Hector's abdominal cavity.

Now, if it's digesting food in your bowel,

think what it could do to the fat in your abdomen.

And that's exactly what was happening.

It was starting to actually digest and break down the fat.

That's all those little white spots

and inflammation and reddening that I see going

on in the abdominal cavity.

NARRATOR Misdiagnosed as food poisoning, Hector's

pancreatitis goes undetected.

Eventually, his pancreas dies, setting into motion

a deadly chain of events.

You have dead tissue inside your abdomen,

you don't do well.

It's actually causing organ failure.

His heart's not working as well, his kidneys probably

aren't working, as well.

His vessels are starting to leak.

NARRATOR Fluid rapidly begins to collect

in his abdominal and pleural cavities.

And he collapses.

NARRATOR Incredibly, the man who came in

as a possible victim of a rare fish toxin

is leaving as the casualty of something far different.

It's a sad end to a young, vibrant life,

that came much too soon for the loved ones he left behind.

The family couldn't believe it at first.

They all bought into it that it's food poisoning.

But the facts don't lie, we have the culprit,

and the culprit's pancreatitis.

NARRATOR But there is some consolation.

Hector's death may hold an important message

for his sister.

But when I asked his sister if there was anybody else

in the family that had pancreatitis,

or d*ed of pancreatitis, and she knew of no one.

It may not be hereditary, but some people

seem to be more predisposed to it than others,

and he must have been.

So maybe she is predisposed, and it

gives her something to think about if she's going

to drink a lot of alcohol.

It may be-- for her, it wouldn't be the best thing.

NARRATOR In the end, Dr. G knows

that had Hector's condition been identified earlier,

it's possible that his fatal pancreatitis

could have been prevented.

JAN GARAVAGLIA It's a shame the doctor didn't pick up on it.

I mean, that's one of the problems with having

that kind of tunnel vision.

He comes in, he says he has food poisoning

and the doctor treats him for food poisoning.

I don't think the doctor made a mistake.

The only thing he didn't pick up on
[ … ]

is how bad his pain was, because his pain was really

out of proportion for food poisoning, but very common

for pancreatitis.

JAN GARVAGLIA OK, you tried.

Thank you.

NARRATOR After years of performing autopsies,

Dr. G has seen her share of natural disease and the tragedy

it can leave in its wake.

But when it comes to sudden deaths,

there are few more overwhelming than the traffic

fatalities that have been arriving at her morgue

almost nonstop since the day she first walked through its doors."], index ,…}

When you work in a morgue and you see,

almost daily, somebody dying from a car accident.

That's a lot of people.

[music playing]

NARRATOR As Chief Medical Examiner of the district

morgue in Florida, Dr. Jan Garavaglia

is all too familiar with the dangers of driving.

JAN GARAVAGLIA It's typical for us on a weekend

to have an automobile case.

NARRATOR And now that her youngest son's

approaching driving age, that insight

is hitting very close to home.

It's a year and a half till he gets his permit.

I'm already dreading it.

Dreading it.

So I was telling him today about how dangerous it

is for young men to get their license because the statistics

of them having an accident their first year is

just extraordinarily high.

And I go, I just love you too much for you to get hurt.

And he just grabs my hand and squeezes it.

Aww.

He goes, I won't, mom.

NARRATOR But Dr. G still has good reason to worry.

JAN GARAVAGLIA In district , we

see car accidents a year.

And that's about % of my workload, which is quite a lot.

NARRATOR Sadly, her next case is another such victim.

A -year-old woman named Betsy Trumbell.

JAN GARAVAGLIA So we have a white female

who, yesterday, didn't know she was going to be in our morgue.

Who today is in my morgue.

According to the investigators report,

Betsy, a nurse at a local hospital, is on her way home

after a busy shift when her routine commute

takes a sudden and tragic turn.

She was trying to make a left hand turn,

and in that split second, she gets hit by another vehicle.

The driver of the other vehicle is a -year-old man

named Charlie Wilcox.

He's injured, but remains conscious

and manages to call .

When paramedics arrive, they find Betsy in her m*nled car,

barely clinging to life.

On the way to the hospital, they work

desperately to keep her alive.

But she pretty much was dead by the time they got there.

NARRATOR It then falls to highway patrol investigator,

Robert Blackwell, to deliver the devastating news

to Betsy's parents.

The fatalities are very very emotional,

but our job is to tell family members that their family

members have d*ed.

It's hard, a lot of times, to deal with the family's grief.

NARRATOR And their pain is only made worse when they learn

the circumstances of the crash.

They did a breath test on the other driver.

He had a ..

That oncoming car was a drunk driver.

I think, when you find out that your loved

one is k*lled by a drunk driver, I think

your first response is anger.

You immediately want to blame that drunk driver.

NARRATOR Betsy's parents fully expect the driver to be charged

and ultimately jailed for his actions,

but it's not that simple.

And while it's clear Charlie was driving under the influence,

police can't just assume he's responsible for Betsy's death.

State law specifically states that a driver

under the influence of alcohol has to cause or contribute

to causing the crash.

NARRATOR That means if Betsy is deemed

to be the driver at fault, the drunk driver could walk away

with nothing more than a DUI.

However, if there's no evidence to suggest she played a role

in the crash, Charlie could be looking

at up to years in prison.

Each car accident is investigated

to try to figure out what happened the best we can.

And when we look at the human factor,

the autopsy is an integral part of that car

accident investigation.

NARRATOR In this autopsy, Dr. G has two main goals.

First, figure out exactly what k*lled Betsy.

And second, search for anything that

might suggest that Betsy herself was responsible for the crash.

One scenario she'll be paying particular attention to

is whether a heart att*ck or some other medical event
[ … ]

could have caused her to lose control of the car.

JAN GARAVAGLIA When you look at natural disease

playing a role in the accident, it's usually fairly small.

But it's something we still look at.

And also, she's on an antidepressant,

and she's on a benzodiazepine, or an anti-anxiety medication.

Now, these are medications, if high enough,

could certainly impair you.

So we just will have to do complete autopsy

to really figure out if toxicology or natural disease

played any role in causing the accident.

Okey dokey, let's go for it.

That's her hand.

NARRATOR Right off the bat, it's obvious that the crash

took a toll on Betsy's body.

When you look at her, she looks like she's

been in a car accident.

Oh, gosh.

She certainly has a lot of abrasions on her face,

a laceration on her chin.

Oh, a bruise there.

Very classic look for an automobile accident.

Bruised arm.

She's got contusions on her body,

she's got abrasions on the knees.

She's got an obvious arm fracture on the right.

Where is that fracture?

It's just right at the elbow, right?

TECH Yes.

NARRATOR Betsy's broken arm is especially typical of a crash.

We often see that with drivers.

They tend to have the forearm fractures more so

than passengers.

The theory is that they've grasped the steering wheel

and locked there with their wrists,

and that causes the fracture.

NARRATOR But as Dr. G zeros in on Betsy's torso,

she spots the most gruesome injury yet.

There's something's got to be going on there.

I see a very extensive abrasion across the abdomen.

NARRATOR And suddenly, she realizes the very thing that

could have saved Betsy's life may have

actually been what k*lled her.

Oh gosh, she's a mess.

[music playing]

NARRATOR Dr. G has just discovered

an enormous contusion across the abdomen of -year-old Betsy

Trumbell, who was k*lled in a car accident

by a drunk driver just hours earlier.

She's got a very vivid, very prominent abrasion

across her abdomen, with a larger

abrasion near her right hip.

And then an abrasion that's over inches

going across slightly diagonal on her lower abdomen.

NARRATOR And right away, she can tell that this injury

was caused by her seat belt.

Mainly, a seat belt is designed

to keep you from being ejected, slow your deceleration,

and it's designed to keep you from impacting things

on the inside of the car.

They clearly play a role in decreasing

the severity of the accident and keeping people alive.

But occasionally, they do cause injury.

NARRATOR And as she inspects Betsy's seat

belt injury more closely, the telltale pattern

gives her a clue.

She's got such a prominent abdominal abrasion, but not

a shoulder strap abrasion.

Dr. Jean now knows that Betsy was

wearing her belt incorrectly.

Although the lap belt was on, clearly,

the sash was not in the proper position.

ROBERT BLACKWELL We've done studies on use of seat belts

here in Orange County and Osceola County,

and roughly % to % of all motorists wear their seat belt.

I wouldn't have to say % to % of those

that are wearing your seat belt don't wear it properly.

They'll wear it underneath their arm,

they'll throw the shoulder harness back behind them.

If you're not wearing a shoulder harness at all,

you could be thrown around inside the vehicle

and cause internal injuries.

This can cause very severe internal injuries

to your bowel, to the mesentery that hold the bowel,

and to your spine.

But we're not going to know exactly what

her internal injuries are by just looking at her externally,

we've got to go internal.

So when I do my y incision, right off, I find injury.

Uh-oh.

That seat belt injury actually cut the muscle,

cut the subcutaneous fat, and ended

up tearing also the mesentery the

tissues that hold the bowel.

NARRATOR But as Dr. G digs deeper,

the news only gets worse.

Oh my.

There's blood in her abdomen.

Most likely, she's gone across the seat belt,

and the seat belt acted like a Kn*fe,
[ … ]

cutting that abdomen completely in half

and that caused the blood,

NARRATOR With the help of her morgue tech,

Dr. G ladles the blood out of her abdominal cavity.

It can be messy, especially if it's a traumatic injury.

We just basically assist her by holding the pitcher there,

and we'll kind of shift around some organs

and she'll ladel out the blood.

We have a pitcher that actually has measuring

increments on it that'll tell us how many CC's of fluid

is in there.

NARRATOR Dr. G measures CC's.

JAN GARAVAGLIA Not as much as I thought.

NARRATOR But she doesn't believe this blood loss

was enough to have k*lled her.

OK.

NARRATOR Although the improperly worn seat belt

clearly inflicted significant damage,

it doesn't appear to have caused Betsy's death.

But the exam is far from over.

Let's see what's going on here.

Often, very common in mobile accidents,

are tears to the liver, tears to the spleen.

But miraculously enough, those are intact.

Next,

NARRATOR Dr. G turns her attention

to Betsy's upper body, and right away, she spots trouble.

Oh my goodness.

She's got , milliliters of blood in her pleural cavity.

That's a lot of blood.

That is enough to k*ll her.

Whatever caused that blood is really what caused her death.

So now, I have to figure out why does she have that.

NARRATOR Carefully, she inspects the chest organs,

searching for signs of injury.

Like a puncture or tear that would explain the bleeding.

I look at her heart and I look at her heart sac,

and that's still intact.

I looked at both of the lungs both of the lungs are intact.

But then, just behind the heart and lungs,

she finally spots the source of the fatal bleed.

KELLEY WOOD Wow, look at that.

She's got a transacted, or complete, tear

to her aorta, the main blood vessel that pumps blood

to the rest of your body.

This tear is right where the aortic arch

becomes tethered to her spine.

If you decelerate quickly, your body will stop quickly,

but the heart and the movable aorta

will keep moving until it rips off.

NARRATOR She now believes that because Betsy was not wearing

her shoulder strap, her upper body flew forward

on impact, tearing the aorta.

And with the body's largest blood vessel ripped open,

Betsy would have bled to death within minutes.

This is clearly the cause of death,

and it's clearly due to the automobile accident.

NARRATOR Dr. G now knows exactly how Betsy d*ed,

but there are still questions to be answered.

First and foremost, could some type of natural disease,

like a heart att*ck or stroke, have

caused Betsy to lose control of her car in the first place?

You know, occasionally, the medical condition of the driver

plays a role in the accident.

So you always want to do the complete autopsy

and make sure that something really bizarre hasn't happened.

ROBERT BLACKWELL It's a fine line,

but there's a lot of factors we need to take into consideration

just in a simple crash.

Obviously, something went wrong.

So what was happening at the time of the crash?

NARRATOR To find out, Dr. G examines

Betsy's organs one by one, searching

for signs of natural disease.

JAN GARAVAGLIA OK, let's see.

NARRATOR First, she dissects the heart,

looking for evidence of a heart att*ck

or other problems that could have hindered Betsy's driving.

JAN GARAVAGLIA And I look very carefully.

I don't see any.

NARRATOR She now has only one more place to look, the head.

Through my head, did she have a stroke, did she have a tumor,

did she have anything that would have caused

her to not act correctly.

Gently, she extracts the brain, searching for clues.

She doesn't have any skull fractures,

and I don't see any contusions or bruising of the brain.

NARRATOR She digs deeper, dissecting the organ

for any abnormality or illness.

But after a thorough inspection, she comes up empty handed.

I didn't find any natural disease.

These negative findings suggest that Betsy

was most likely in full control of her car when she crashed.

But before Dr. G can close the case,

she has one last thing to check.

JAN GARAVAGLIA It could be some of the medications

she's taking.

We know that she's on a benzodiazepine,

which at high enough doses, can cause

you to be under the influence.
[ … ]

We know she's on an antidepressant,

and high enough levels could cause her to be sleepy.

The autopsy report truly isn't finished and will not go out

until that toxicology is done.

[music playing]

NARRATOR One long month after Betsy Trumbell's autopsy,

toxicology results arrive from the lab.

So far, it seems that Charlie Wilcox, the drunk driver that

hit her, is entirely at fault. If that evidence holds,

he could be looking at significant jail

time for her death.

But Dr. G must still confirm whether Betsy's medication

was a factor in the crash.

Line-by-line, she begins reading through the report,

and at first nothing seems amiss.

I don't find any benzodiazepine in our system.

That didn't play a role.

And her antidepressant was at a very low level.

NARRATOR But as her eye move down the page,

one unexpected finding stops her dead in her tracks.

I'm actually quite surprised.

It's clearly the reason why she drove in front

of the oncoming vehicle.

NARRATOR And now, with all the facts laid bare,

Dr. G can finally piece together this sequence

of events that culminated in this fatal, yet

avoidable accident.

It's late afternoon in Orlando, and Betsy

Trumbell is on her way home.

But her driving is unsteady, and her judgment

and coordination are impaired.

And based on the toxicology report, Dr. G now knows why.

She has a blood alcohol level higher

than the guy that hit her.

She's got a ., that's twice the legal limit.

Although the other guy was drunk, she's even drunker.

NARRATOR This leads Dr. G to believe

that on the day of her death, Betsy did not

go straight home after work.

Most likely, she was out with friends and drinking.

She doesn't usually drink, but that night they were--

appear to be celebrating for whatever reason.

NARRATOR Betsy consumes more alcohol than her body can

process, and it isn't long before

her central nervous system begins to feel the effects.

I mean, at a blood alcohol level of .,

she's going to have some major problems with coordination.

Some people, they can barely stand at that level.

Her perception, her judgment, is off.

ROBERT BLACKWELL She would have a loss of critical judgment,

impairment of memory, and comprehension.

She's going to have a decreased sensory response.

NARRATOR Highly intoxicated, Betsy

makes a choice that's irresponsible

and extremely dangerous.

She gets into the car and decides to drive drunk.

A fatal mistake, very fatal mistake on her part.

NARRATOR And then, the final coup de gras.

When she gets into the car, she puts her belt on wrong.

Unprotected and very drunk, Betsy hits the road.

All is fine until she gets to the fateful intersection.

In that split-second, she misjudged the car coming

at her, cutting it a little too close, and gets

hit by the oncoming car.

Her car stops with a sudden deceleration.

Her pelvis is anchored, that belt cuts across her anterior

abdominal muscles.

And then when her body slams against the dashboard

or the steering wheel, the body stops,

but her heart and arch of the aorta keep moving forward.

NARRATOR At that moment, the aorta,

which is partially tethered to the spine, simply

rips wide open.

All the blood that's being pumped from the heart,

is going now into just your pleural cavity.

And as your heart beats, the rest of your body

isn't getting any blood.

Your blood pressure plummets.

And by the time the paramedics got there,

there was already too much internal damage,

too much bleeding, that anything could have been done.

Within several minutes, she's dead.

NARRATOR Dr. G reports her findings

to the Florida Highway Patrol.

The forensic evidence clears the other driver

of all charges except a DUI, and Betsy

is ruled the at-fault driver.

I truly believe that the cause of the accident

was because of her impairment in making this left hand turn.

NARRATOR Then, she makes the difficult call

to Betsy's parents.

I called the family with the results,

and they were devastated.

They knew she occasionally had a drink,

but they didn't have any clue that she drank excess.

NARRATOR It's a painful reality,

and Dr. G can only hope that ultimately, the truth

will help them come to terms with their daughter's

untimely death.

I doubt that she d*ed in a lot of pain.
[ … ]

That's always comforting to the family.

[music - mike testagrossa]

JAN GARAVAGLIA You know, what's interesting about the family,

he still thanked me for the care I gave

his daughter, the respect I gave her body,

and the way we treated her.

And that was very nice.

I mean, his worst time in his life,

he was still gracious enough to thank me for the care

I gave his daughter.