06x02 - Last Gasps

[bunniefuu]

[intro music]

[theme music]

NARRATOR A devastated mother finds

her baby dead in his crib.

JAN GARAVAGLIA Four-month-old little boy, has a twin sister.

NARRATOR Can Dr. G solve this heartbreaking case

and save the twin from a similar fate?

JAN GARAVAGLIA There is a chance

this child has an undetected congenital abnormality,

and that other twin is in danger, too.

NARRATOR Then, a young father dies

under mysterious circumstances.

JAN GARAVAGLIA They say he's in perfect health.

How could he have d*ed?

NARRATOR Now Dr. G must uncover what

took a father from his children in the prime of his life?

JAN GARAVAGLIA Something is going on,

and I don't know what it is.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of Dr. G Medical Examiner.

Despite her years as a medical examiner,

Dr. Jan Garavaglia still find certain autopsies

especially difficult.

Nobody likes to do babies, but unfortunately, we

do get them in the morgue.

Poor thing.

Baby.

Gosh, how old is he?

months old.

This is a true tragedy, a true accident.

I can't imagine, as a parent myself,

how hard that must be to lose a child.

It would devastate me.

NARRATOR But these cases are not

just devastating, they're also some of Dr. G's

most complex medical mysteries.

They're difficult cases in that they're subtle changes

that could cause death.

We're looking for, sometimes, very minor evidence of trauma.

The belly is a little distended.

Very minor changes indicating an infection.

NARRATOR Each year, the District morgue

sees approximately infants who die without warning

or a parent cause.

Sadly, Dr. G's next case is one of those unfortunate few.

[drumroll]

[suspenseful music]

NARRATOR It's AM on a quiet Monday morning,

and -year-old Sarah Price wakes to the hungry cries

of her -month-old twins.

Half asleep, the young mother nurses

them both, first Charlie, and then his sister Robin.

After about a half an hour, she returns them both to their crib

and heads back to bed.

Then she woke up at about to check on the twins.

I'm on my way.

NARRATOR But as Sarah approaches Charlie's crib,

she realizes something is terribly wrong.

Charlie?

She heard the twin girl crying and noticed that the little boy

was not moving.

Charlie!

NARRATOR Right away, she turns Charlie over on his back,

but it's clear that he's not breathing.

Terrified, she calls .

Paramedics arrive on the scene in minutes.

But it's too late.

They try to resuscitate it, and they couldn't.

NARRATOR Now it's up to Dr. G to find out

exactly what caused this seemingly healthy

baby to die so suddenly.

[suspenseful music]

JAN GARAVAGLIA So today, we have a baby.

It's just d*ed this morning, at least found this morning.

Four-month-old, little boy, has a twin sister.

NARRATOR According to the investigator's report,

Charlie and his sister were born nine weeks premature.

JAN GARAVAGLIA They weighed just

about four pounds, each one of them when they were born.

They were hospitalized for an extended period of time.

Hmm.

NARRATOR But looking at the medical records, baby

Charlie's health problems appear to have

been a thing of the past.

JAN GARAVAGLIA He's been gaining weight.

He's been doing well.

He hasn't had any real problems.

NARRATOR However, Dr. G knows all

too well that premature babies like Charlie often

fall victim to infections.

MARTY ELLINGTON Premature infants

are more at risk for infection because their immune systems

are immature.

Their bodies cannot react to those infections.

JAN GARAVAGLIA Every year, we have several

who die from pneumonia, and every year we have one or two

that die from meningitis.

NARRATOR And Dr. G must also consider
[ … ]

another likely culprit, a previously

overlooked birth defect.

You know it's always a possibility

that this child has an undetected congenital

abnormality.

MARTY ELLINGTON A congenital defect is any other abnormality

in the structure of the body.

The most common abnormalities we see usually

have to do with, actually, the heart.

The other organs are probably the solid organs

of the abdomen, so the kidneys and the liver.

It's actually very important to find whether or not a child has

congenital anomalies as early as possible

because often, those defects can be repaired.

NARRATOR But an even more disturbing possibility

is that baby Charlie was the victim

of accidental trauma, or worse, abuse.

I always suspect foul play or trauma

because there's at least % to % of these

actually turn out to be homicide.

There's a lot that this could be.

Ultimately I may not find an answer.

NARRATOR And if Dr. G is unable to determine exactly

how Charlie d*ed, his death may end up

being ruled as SIDS, or Sudden Infant Death Syndrome.

These are infants under one year of age that after

a complete investigation, X-rays,

all the ancillary tests, toxicology,

review of the medical records, after all of that,

there is no cause of death.

Nobody knows the reason for SIDS.

It's probably multi-factorial.

MARTY ELLINGTON The reality is that we don't know,

but it's probably related to brain and cardiovascular system

maturity.

NARRATOR But Dr. G hopes that she won't

have to rule this a SIDS death.

All right.

There's really no joy in that.

We have this nice term, Sudden Infant Death Syndrome,

and it makes everybody feel good because we know.

We don't know.

We don't know.

It's unexplained.

NARRATOR At this stage, only one thing is certain,

time is of the essence.

If baby Charlie d*ed from an infection or congenital defect,

there's a strong possibility that his twin sister,

Robin, could also be at risk.

The mother is also concerned that whatever k*lled

the little boy is going to k*ll the little girl,

and so she is really on pins and needles

waiting for the results of that autopsy.

[music playing]

[theme music]

NARRATOR In Dr. G's morgue, on a cold stainless steel gurney,

the tiny body of four-month-old Charlie Price paints

a heartbreaking picture of a life cruelly cut short.

And this autopsy will be particularly

difficult for her tech on the case, Brian Machulski.

How I feel about autopsy in babies

is I don't particularly like it.

Distress tends to be a little bit higher on babies,

and it also depends on the circumstances

in which the baby passed.

NARRATOR But neither Brian nor Dr. G

can afford to let the added stress

get in the way of their work.

Uh, boy.

It's just a really sad situation,

but my concern is to get the right answer.

[theme music]

NARRATOR Dr. G's first step is to scan

the infant's entire body, keeping her eyes

peeled for any visible clues.

I know he was born weeks, which is premature,

but he's looking good now.

He's gained weight.

Do you see his hair, how pretty it is?

He looks well-cared for.

OK, chest is .

I want to do very accurate measurements on its length,

on its crown rump, basically the top

of its head to its buttocks.

Crown rump is .

I want to measure the head circumference, the chest

circumference, abdominal circumference.

This will help me tell how it's grown since its birth.

When I look at the baby's legs, he's got needle marks.

Uh, it's a needle puncture.

But he's got needle marks where we'd expect them,

so it looks like that's from resuscitation.

Babies are very hard to get intravenous catheters in.

They're hard to give them fluid and medicine.

So what they do is they put a needle

in, what we call an intraosseous needle,

a needle right into the bone, and then give them

medication or fluids that way.

So he's got some on the shins, and that's

where we'd expect to see them.
[ … ]

NARRATOR Next, she checks for signs of possible abuse,

starting with Charlie's face and head.

JAN GARAVAGLIA I look very carefully in his oral cavity

because when I'm looking for signs of suffocation,

I'm looking for maybe the mouth being pressed down, smothering.

After a very thorough examination,

I see no evidence of trauma.

Of course, I look at the neck very carefully.

And I look in the eye, look for broken blood vessel.

Usually, it means they're somehow trapped or wedged

between the bed and the wall, and that certainly

can be a cause of death.

Eyes, OK.

But he doesn't have any of that.

NARRATOR Still, despite the absence of obvious trauma,

a fatal head injury remains a prime suspect.

Just because I don't see trauma

doesn't mean there's not trauma on the inside.

NARRATOR But before she looks inside,

there's one more step in the external exam, X-rays.

OK.

That's good.

JAN GARAVAGLIA We're looking for subtle fractures

to the spine, to the ribs, to the extremities.

NARRATOR And it isn't long before Dr.

G spots something suspicious.

What I'm seeing is some possibility

of some rib fractures on the left side,

and that's worrisome.

Hmm.

It just kind of heightens my worry that this

might be an abusive case.

NARRATOR If her suspicions are correct,

Charlie's twin sister, Robin, could be in immediate danger.

This is important because if it truly is,

we need to get the twin out of there as fast as we can.

Yeah, forceps, I'm ready to go with him.

[theme music]

NARRATOR Baby Charlie may be the youngest decedent

in the morgue, but his autopsy will

unfold much like any other, with some subtle differences.

My instruments are pretty much the same.

I use smaller scissors and a smaller scale

because the little organs are so small,

they don't register on our adult scale.

So I have to use a little baby scale that measures in grams.

I have trouble even positioning the baby

because my-- what we call the head block that we usually put

under the back is just too big for a baby,

so I usually, just a little, roll a towel.

I put on the baby's back to help it put its head back.

So some subtle differences.

All right.

NARRATOR Dr. G starts with her standard Y incision.

She then peels back the skin to get a closer look

at Charlie's fractured ribs.

His left ribs, , , , and are fractured.

There is no hemorrhage associated

with those fractures.

NARRATOR And this absence of blood is a vital clue.

That means that those fractures are done when

that heart wasn't b*ating, so that clearly indicates

that those fractures occurred with

cardiopulmonary resuscitation.

JAN GARAVAGLIA We OK?

Yeah.

NARRATOR Next, she surveys the organs in situ,

looking for trauma, infection, or

any congenital abnormalities.

Let me look at the spleen.

I make sure that all the organs are in the right place

because sometimes with babies, there are some syndromes

where there are not.

OK.

That looks good.

Nothing screams out at us.

NARRATOR Then, she takes samples of baby Charlie's blood

for toxicology and removes his organs

one by one for dissection.

When I do dissect the heart, I look at the valves,

I look at all the vessels, I look at the heart musculature,

make sure there's no holes that shouldn't be there.

The heart looks completely normal to me.

NARRATOR The lungs, liver, and kidneys

all appear normal as well.

JAN GARAVAGLIA Unfortunately, even though I don't really

find anything, I can't rule out a congenital abnormality

or infection until I look underneath the microscope.

This is for the kidney?

Oh, absolutely.

NARRATOR Dr. G wraps up the internal exam still

puzzled as to what could have caused

baby Charlie's sudden death.

So I'm still not quite sure why he d*ed,

but I still would like to look at his head.

Uh.

In this age group, the most common way for them to suffer

abusive injury is to the head.

Yeah, go for it.

NARRATOR Another condition she'll
[ … ]

be looking for is bacterial meningitis,

an inflammation of the membranes covering

the brain and spinal cord.

JAN GARAVAGLIA The infant meningitis can come on

very quickly in this age group.

These children can go from looking good and looking

healthy to death within a day.

NARRATOR And if Charlie did, in fact, die of meningitis,

this could spell disaster for his sister, Robin.

There is a chance that if the baby

d*ed from meningitis, that, that other twin is in danger, too.

Oh, gosh.

OK.

Oftentimes, there are things riding on an autopsy.

The best I can do is stay objective and cool and try

to do the best job I can.

[theme music]

NARRATOR Dr. G is about to perform the cranial exam

on -month-old Charlie Price.

Let's see what's going on here.

NARRATOR She's hoping it will reveal what k*lled him.

Because in this case, another life

might hang in the balance--

that of his twin sister, Robin.

JAN GARAVAGLIA You might even say that,

that second twin's life is at stake

if I find trauma or some inherited problem

that that child has had.

If it's there, I got to find it.

NARRATOR As a first step, Dr. G cuts across baby Charlie's head"], index ,…}

and peels back his scalp.

When I reflect that scalp, I'm looking

for evidence of contusions.

NARRATOR But after great scrutiny,

she finds no indications of bruising.

Hmm.

NARRATOR Then morgue technician,

Brian Machulski carefully slices through the skull

using an oscillating saw.

The cranial exam is going to be

the same on the baby and the adult.

The cranium is a bit different.

Certainly, the bones are thinner, more pliable.

It's got a soft spot, meaning that the bones

haven't totally fused together.

Now if it's a neonate, a very young baby,

we could actually cut those sutures with our scissors

and just kind of open up the skull.

Although, at this age, at four months, we'll use the saw.

OK.

Let's see.

And as I immediately remove that skull cap,

I take a look at that brain.

Let's see.

There is no blood anywhere.

There is no evidence of brain swelling.

There is no clear evidence of trauma.

NARRATOR Dr. G immediately informs

investigators that she's found no evidence of abuse.

This finding clears Charlie's mother of any wrongdoing.

There's always a huge sigh of relief

when I tell the detective that there's no signs of trauma

because they do not like investigating baby homicides.

NARRATOR But the cranial exam is far from over.

Next, Dr. G carefully examines the baby's meninges,

the membranes that protect Charlie's

brain and spinal cord, for any signs of bacterial meningitis.

I look to see if the meninges are clear.

I look to see if the cerebral spinal fluid looks clear.

And they do.

All right.

If it was meningitis, it looks very cloudy.

So nothing that I could pinpoint to his head that would have

k*lled him.

NARRATOR As the autopsy comes to an end,

Dr. G still has no clue as to how baby Charlie d*ed.

Now she realizes that the only hope of finding out what

k*lled him may very well lie outside the morgue.

I need a scene recreation.

I need my investigator to go out to the scene.

Hey Carol, could you give me the--

I need to see how the baby was put to sleep,

how the baby was found, could the baby have gotten

trapped in its crib, could the baby have gotten

wedged along a side of an adult mattress,

how is the baby sleeping.

NARRATOR Dr. G dispatches investigator

Carol Crosby to Charlie's home, the scene of his death.

What my job is for Dr. G, I'm the eyes

and ears when I go out.

I go and obtain the information.

When I got there, the mother was very, very Distraught.

And the covers--

She just didn't know what she did wrong.

I explained that I would need to take a re-enactment doll in

to place the child in the position

that the child had been found.

I took pictures of the bedding beforehand,

then I placed the baby down, and I took

pictures from different angles.
[ … ]

NARRATOR When Carol returns to the morgue,

Dr. G carefully examines the new evidence.

And to her surprise, she spots an important clue.

OK.

Thanks.

Well, with that scene recreation,

that case is starting to make sense.

It doesn't mean we have the answer.

I still have to rule everything else out.

OK.

We still need to look under the microscope,

and we need to look at the cultures for the bacteria.

We need to get the toxicology.

No answers can be complete until all those pieces are together.

[theme music]

NARRATOR Four weeks later, the reports arrive

at the District morgue.

The results come trickling in, and there was no evidence

of infection in his blood.

I look under the microscope at all as tissues,

there was no abnormalities, no other congenital defects.

I'm not finding anything.

NARRATOR And these negative results lead Dr.

G to one undeniable conclusion.

Now that we've ruled everything else out,

we know what happened.

[baby crying]

NARRATOR It's AM, and after nursing her hungry twins,

Sarah Price places both infants back in their crib.

Little does she know that in doing so,

she may be endangering their lives.

JAN GARAVAGLIA What my investigator find out

is that there is tremendous unsafe sleep

practices with these children.

NARRATOR The re-enactment photos

confirm that Charlie was placed face down on his stomach,

a known risk factor for sudden death in infants.

But that's not all they show.

Not only does the mother put the babies to sleep

on their tummies, she puts them to sleep on their tummies,

on a soft, soft pillow.

The baby probably liked having that pillow over his face.

NARRATOR And what the mother thinks

is a cozy and comfortable position for the baby,

is actually a deadly one.

JAN GARAVAGLIA If you put the baby on a soft pillow,

the baby's going to sleep completely face down

and not move their head about %, % of the time

if they're on a soft surface.

That causes a rebreathing of their own carbon dioxide

and not getting enough oxygen.

NARRATOR This should have triggered Charlie to wake up

and turn his head, but instead, the -month-old

falls into a deep sleep.

And with every breath, his oxygen intake decreases.

JAN GARAVAGLIA His respiratory rates go down.

His heart rate goes down to the point where he ends

up dying from lack of oxygen.

NARRATOR It's a tragic ending that raises a major question.

Why couldn't the baby just move its head?

He should have been capable of that.

NARRATOR It's a mystery that may never be solved,

but experts do believe that some infants suffer

from an unknown congenital defect

in which low levels of oxygen simply

don't rouse them from sleep.

There's probably some predisposed problem

with the child.

Maybe just has some mild abnormalities

in the brain stem or the heart.

Will I ever know what his weakness was,

what his vulnerability was?

No, I won't.

NARRATOR But she does know that Charlie's

inherent vulnerability, combined with his unsafe sleep position,"], index ,…}

ultimately led to his death.

So you have to have almost a perfect storm

where these overlap, and that's why every kid

doesn't have a problem.

In fact, most of them won't.

How do we know which kid is vulnerable?

How do we know?

We don't, and we just have to assume all kids are vulnerable,

and we don't put them in these unsafe sleep practices.

NARRATOR Finally, Dr. G can close

the case on Charlie Price.

She rules his cause of death as SUID,

Sudden Unexpected Infant Death.

In this classification, there's a known external factor

that contributes to the death.

In Charlie's case, his sleep position.

Now the only thing left is the difficult task

of reporting her findings to Charlie's mother, Sarah.

JAN GARAVAGLIA She's shocked.

She said this is the way her mother taught

her to put the babies to sleep.

And you know what, we've progressed since then.

Unfortunately, not everybody puts the kids on their back

even in the United States.

At least % to %, % still put the babies on their tummies
[ … ]

because the babies like it that way, they sleep better.

Well, that's just the problem.

They maybe sleep too good.

NARRATOR As sad as this story is,

Dr. G takes comfort in the knowledge

that her work may have helped save an innocent life.

Although we can't do anything for this baby,

and it's a tragedy, at least, we can do something for the twin.

We know that the unsafe sleep practice probably played a role

in this death, but that's something

we can correct for this baby and possibly,

save it from the same fate.

[theme music]

NARRATOR It's all too often that Dr. G sees families

devastated by the loss of a child,

but similarly tragic are the countless cases

in which a young parent dies, leaving their children behind.

JAN GARAVAGLIA A typical healthy -year-old guy

collapsed suddenly in front of the four-year-old.

It's going to be traumatic for the kid.

[theme music]

NARRATOR At the busy District morgue in Orlando,

Florida, approximately new cases

come through the doors each week.

JAN GARAVAGLIA So we've got that, we've got that,

shall we take this off now?

NARRATOR Most of these are routine.

JAN GARAVAGLIA Yeah, this guy is not looking good.

It's clear why he d*ed.

NARRATOR But Dr. G always welcomes a challenging case.

OK, wait, I'm not doing anything

till we figure this out.

That's the part of forensics I love.

Look at that.

When you can go a little bit deeper for the answer,

and particularly, when it means something for somebody,

[theme music]

[music playing]

NARRATOR It's PM on an unseasonably, chilly October

afternoon in Kissimmee, Florida.

-year-old Roman Glabinski is busy spending some quality time

with his kids.

I got some bananas.

NARRATOR Victor, aged four, and Maruska, aged two.

The mom went out shopping, and left him with the two kids.

NARRATOR But when Anita returns home,

she's stunned to find her husband collapsed on the living

room floor unresponsive.

She calls the EMS, and they come

and take him to the hospital.

They tried to shock him, but they could not get him back,

and he d*ed in the emergency room.

I think it's got to be fairly traumatic for the kids

to have seen their dad collapse, but the wife's devastated also."], index ,…}

NARRATOR Dr. G begins by reviewing

the investigator's report.

Well, we have a -year-old male with no prior

medical history, and doesn't go to the doctor,

takes no medications.

I mean, there's really not much to sink your teeth on here,

except that it appears he d*ed suddenly.

NARRATOR But Dr. G does take note of one seemingly minor

detail in the medical history.

Hmm.

His wife said that as a child, they had told him

that he'd had a heart murmur.

A heart murmur is basically when the doctor listens

to your heart with a stethoscope,

and he hears more of a swish sound instead

of the beep, beep, beep sound.

And basically, all that tells him is that the blood is not

going the way it usually does.

NARRATOR It's considered a dangerous symptom for an adult.

But for a child, it's a fairly standard finding.

THOMAS CARSON Heart murmurs are quite common in children.

About % to % of all children at some point

get told that they have a heart murmur,

and the vast majority of them have

what we call innocent murmurs, where the physician

is just hearing the sound of blood

as it flows through the heart.

Most of the ones in pediatrics,

it really doesn't indicate anything.

NARRATOR The heart murmur on first glance

would seem an unlikely suspect.

You want me to clean [inaudible]??

JAN GARAVAGLIA You know, in your s is not

a common age for sudden death.

NARRATOR But Roman does indulge in a risky habit

shared by over . million men in the United States, smoking.

He does smoke one pack of cigarette a day.

NARRATOR But Dr. G doesn't think this habit

caused Roman's death.

JAN GARAVAGLIA I don't expect to see changes that

are severe enough to cause death at the age of

because he smokes one pack a day.

That doesn't mean you should smoke one pack a day

because it's going to catch up with you sooner or later.

I just doubt that it caught up with him at .

OK.
[ … ]

Let's see.

NARRATOR But when someone this age

dies with no apparent cause, there's

one unfortunate possibility that does come to mind.

JAN GARAVAGLIA Somebody this young,

we always worry about dr*gs.

His wife said that he does smoke marijuana,

but she says, as far as she knows,

he doesn't use other illicit dr*gs.

But sometimes, they'll admit to the marijuana,

but they won't to admit to the other things.

So that is definitely going to be a possibility.

Tom, could you hand me a male chart, please, and an internal.

NARRATOR But Dr. G knows that there's only one way

to get the truth from Roman.

I will certainly figure out the cause once I do my autopsy.

[theme music]

NARRATOR Dr. G begins the external exam

by carefully noting the appearance of Roman's body.

First thing I notice is he's overweight.

Hm.

He's only about '", but he's about pounds.

Write it.

Oh, well.

At , you don't get that belly as you do as you get older.

But he was just kind of a big guy.

It looked like he was not particularly out of shape.

I mean, he still kind of looked muscular,

but he clearly was carrying too much weight.

NARRATOR Obesity is linked to numerous life-threatening

conditions, such as high blood pressure,

blood clots in the lungs, and cardiovascular disease.

We've got three really deadly things here, any three of which

could be possibly lethal.

NARRATOR For now, Dr. G continues scanning

Roman's body for more clues.

Yeah, a little bit of a scar here.

He's definitely got evidence of resuscitation.

They've clearly worked on him.

He's got some resuscitation burn over a sternum.

He's got intravenous catheters in, trying to give him fluid,

EKG pads.

Scar here.

NARRATOR Given that an overdose is a prime suspect,

she keeps an eye out for the telltale signs of drug use.

I'm looking for a needle puncture marks.

NARRATOR And scanning Roman's arms,

Dr. G does spot some recent marks that may have

been left behind by needles.

Here, there.

NARRATOR But she can tell right away that they are not

the result of illicit drug use.

JAN GARAVAGLIA All of his needle puncture marks

have gauze over them, indicating to me

that the hospital was attempting to draw blood or start IVs.

NARRATOR She continues her search

for evidence of drug use.

JAN GARAVAGLIA I'm looking for a septum

that may be perforated from chronic sniffing of cocaine.

He doesn't have any of that.

See what else we got.

NARRATOR But Roman's face holds a clue

that raises her suspicions,

JAN GARAVAGLIA He has some frothy fluid in his oral cavity

and a little bit in his nose.

That's worrisome.

Oftentimes, we will see that with drug overdoses.

That's not good.

NARRATOR As she concludes her external investigation,

Dr. G is more concerned than ever

that her findings could spell bad news

for Roman's grieving family.

JAN GARAVAGLIA It's a guy that I think is using dr*gs,

but we'll see when we get in there.

[theme music]

NARRATOR Dr. G sinks her scalpel

into the skin of -year-old Roman

Glabinski's chest and abdomen, creating a Y incision.

Let's see what we got going on in here.

NARRATOR She's now worried that what

she'll find inside his body will confirm her darkest suspicions."], index ,…}

Hm.

Yes, sudden death, -year-old, while the wife's gone.

Maybe he was using dr*gs.

It certainly would be high on my list.

NARRATOR Dr. G carefully peels back

the skin to expose the front of Roman's chest cavity.

There, I do find rib fractures,

ribs , and on both sides, and very minimal

hemorrhage surrounding it.

So it doesn't appear to be from trauma.

It appears to be from CPR.

Hold that for me like that.

NARRATOR Immediately, she collects

blood and fluid samples to send to the lab for drug testing.

JAN GARAVAGLIA What is important

is that I remove my toxicology.

Because at this point, I'm worried that that is probably

going to be the answer.

If you can't see it, I'm going to [inaudible]
[ … ]

NARRATOR But while she waits for the results,

Dr. G must exhaust all other options.

She begins by examining the abdominal organs one at a time.

Anything interesting around here?

The liver looked fine.

The spleen looked fine.

The bowels all looked normal.

Pancreas doesn't look so bad.

There is nothing wrong with the kidneys.

There doesn't appear to be anything

acute going on in the abdomen that

would have caused his death.

NARRATOR Next, Dr. G removes the chest

plate to get a closer look at Roman's heart and lungs.

I remove his lungs first because of possibilities

that he has a pulmonary embolist.

NARRATOR A pulmonary embolist is a lethal condition that

occurs when a blood clot blocks the pulmonary artery that

carries blood to the lungs.

Roman's obesity puts him at risk for developing

these types of blood clots.

When I cut the lungs off and look

at the pulmonary artery going into the lungs,

there are no pulmonary emboli.

They looked completely fine.

Wow, no PE.

I can definitely eliminate pulmonary emboli.

NARRATOR But she does spot an abnormality.

Right lung is going to be heavy.

Ooh, .

There is definitely an increased amount of fluid in the lungs.

NARRATOR This fluid buildup, known as pulmonary edema,

supports her theory on how Roman d*ed.

JAN GARAVAGLIA When we say edema in the lung

when somebody dies suddenly, I think of a drug overdose.

NARRATOR But she can't be sure until she

gets the toxicology report.

In the meantime, there's one organ

left to examine, the heart.

And there, the case takes a shocking left turn.

Oh, my gosh.

When I open up the pericardial sac,

you can see this large globe of a heart.

Ooh, that's a big heart.

MAN Yeah, it s a big--

His heart should only weigh, at most, grams.

His heart weighs grams, more than twice what

it should weigh.

An -gram heart in a -year-old young man

is really unusual, and it's really remarkable.

The heart is clearly the cause of death.

NARRATOR Not only is she sure that Roman's heart was

responsible for his death, she's now

convinced that dr*gs probably had nothing to do with it.

This investigation's going in a different direction.

We don't have all the answers just because we

have an enlarged heart.

What is it that's causing his heart to be like that?

NARRATOR Dr. G begins with a careful dissection

of the organ.

She examines the coronary arteries, the vessels

which bring blood to the heart.

JAN GARAVAGLIA He's got about % narrowing, which

is significant, in one of his coronary arteries,

with the rest of him completely normal.

NARRATOR The extent of Roman's coronary artery disease

is more than she would expect to find for someone his age,

but it wouldn't have made his heart expand

to twice its normal size.

Something else must have caused the organ to enlarge.

There's clearly a lot of work I still have to do.

NARRATOR One chamber at a time, she inspects the heart valves.

The valves all look normal.

NARRATOR Next, she slices into the thick heart muscle itself.

And here, she discovers a subtle abnormality.

JAN GARAVAGLIA Hmm.

When I look at the heart muscle, it looks asymmetric,

meaning it's not the same width all the way

around that left ventricle.

This is a terribly ill heart.

We've got a-- oh, boy.

NARRATOR So ill, in fact, it looks like it's

been deteriorating for years.

It's an important finding.

All right.

NARRATOR But unfortunately, this

makes it even more difficult to ascertain exactly what's

behind Roman's heart problems.

JAN GARAVAGLIA Now you think, what difference does it make,

it's a heart disease, it's--

let's leave it at that and go home.

But there's a lot of questions to be answered, some of which

has some definite implications for those kids

that he has and left behind.

NARRATOR If Roman's heart was the result of a genetic defect,

his kids could have inherited the deadly condition.

JAN GARAVAGLIA They clearly are at risk for sudden death also.

So it's definitely something we need to answer for that family.

[theme music]

NARRATOR -year-old Roman Glabinski fell victim
[ … ]

to a heart condition he didn't even know he had,

and now it's crucial that Dr. G figure out what caused it.

All right. MAN It's from the heart?

Yeah.

He's got two kids.

And is it something that they could have inherited?

What I really need to find out is some more history.

So I called the wife.

She tells me that she thought he was perfectly healthy.

Uh-huh.

I want more information.

NARRATOR Dr. G asks medical investigator, Carol Crosby,

to contact Roman's parents.

JAN GARAVAGLIA The problem is that she has a very hard time

communicating with his family because they're

Eastern European, and they don't speak English.

NARRATOR But with the help of an interpreter,

Carol is able to glean some valuable information.

What she got from the family is that as a young child, about

, , he was being worked up for something wrong with his heart

that they wanted to operate.

And the father refused to let the operation occur,

and they just never took him back to those doctors.

Now that just piqued my interest.

Hey, Carol, could you give me--

So I asked, where was he treated?

NARRATOR Carol learns that Roman received treatment

at a hospital in Boston, but his parents can't recall which one."], index ,…}

I'm like, oh, brother.

Poor Carol, who-- having call every hospital in Boston,

try to go the extra mile to get those records for me

to see if we can piece it together.

I'll be back.

JAN GARAVAGLIA Meanwhile, because this

has been taking months, I didn't think

I'd ever get these records.

But I really, on my own, couldn't

come up with the cause.

At some point, I felt like just quitting,

but you know what, the answer has implications for the kids

and their future health.

NARRATOR Thankfully, the team's diligence eventually pays off.

I was thinking, oh, Hallelujah.

NARRATOR Carol locates Roman's old hospital records.

And as Dr. G expected, they provide a critical final piece

of the puzzle.

This is why I'm in forensics.

A, the answer means something to somebody.

B, I had to do a lot of detective work

to try to put it all together.

NARRATOR On the day of his death,

-year-old Roman Glabinski is at home with his two

young children, but little does he know that inside his chest,

his heart has deteriorated and ballooned to more

than twice its normal size.

In fact, the organ has been diseased

since the day he was born.

I get the medical records, and it

appears that he had the asymmetry

from the very beginning.

He was born with a primary hypertrophic cardiomyopathy.

NARRATOR It's a genetic defect that

triggers abnormal growth in the cells of the heart muscle.

Most likely.

The heart murmur that Roman's doctor

detected when he was a child was an early sign of this defect.

Maybe this benign heart murmur wasn't so benign.

NARRATOR When Roman was eight years old,

his doctors recommended heart surgery.

And it would have helped his heart.

NARRATOR But convinced the procedure

would be too dangerous, Roman's father declines.

And as the years pass, his son's heart grows larger and larger.

JAN GARAVAGLIA Unfortunately, hypertrophic cardiomyopathy

is a silent k*ller, meaning no symptoms until death.

NARRATOR Roman may feel fine, but on that ordinary October

morning, he's already in big trouble.

His heart is failing and dying.

NARRATOR As the heart dilates, the muscle weakens, and becomes

less and less capable of pumping blood,

until finally, it gives out.

JAN GARAVAGLIA The heart muscle could no longer pump,

and the pressure is starting to build up in his heart,

so the fluid starts going into his lungs.

NARRATOR It's the same frothy fluid

that Dr. G found in Roman's mouth and in his lungs

during the autopsy.

The final coup de gr ce came on very suddenly

for him in a sudden collapse.

That must have been very scary for the children.

NARRATOR But even scarier for Roman's kids

is what he left behind.

The problem is hypertrophic cardiomyopathy

is usually genetic.

There's a % chance that they would have inherited this.

NARRATOR It's frightening news for the children,

but also critical information.

Fortunately, medical knowledge has improved since Roman was

a child, and now, his kids can undergo

genetic testing to see if they've
[ … ]

inherited the condition.

JAN GARAVAGLIA I think the wife was so thankful that I

put the extra effort in to get the diagnosis

for her and her kids.

[music playing]

JAN GARAVAGLIA They may not have inherited it,

and they may have.

But at least, they can do something about it

now instead of just dying suddenly and unexpectedly.

Maybe he d*ed as a message to have his kids checked,

and his death saved his children.