01x02 - Hit and Run

[bunniefuu]

[EERIE MUSIC]

[POLICE SIREN]

NARRATOR The body of a hit-and-run victim

arrives at the morgue.

DR. G Some broken ribs, facial fractures.

NARRATOR Police are looking for answers,

but photos from the crime scene aren't adding up.

We're putting a two-inch circle around the body.

NARRATOR Will a surprise medical finding

challenged the police's theory?

Then, the routine autopsy of an -year-old woman

takes an unexpected turn--

DR. G She's got a nice bump on the back of her head.

NARRATOR --when Dr. G finds signs of trauma

and must dig deeper.

DR. G How do we know somebody didn't as*ault her?

NARRATOR And a man with a rare genetic condition

suddenly falls dead at his th birthday party.

He just collapsed to the ground.

I couldn't believe that he was gone.

NARRATOR The man's brother carries the same rare defect.

Can Dr. G tell whether he will suffer a similar fate?

I don't want to lose my other son.

[THEME MUSIC]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

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

[PHONE RINGING]

NARRATOR Late one February night Daniel Barrow

is found lying face down in the parking

lot of an Orlando hotel.

He is unconscious and covered in bruises.

NARRATOR When Florida highway patrol arrived at the scene,

the circumstances suggest a crime--

Daniel sprawled out with automobile skid marks

leading directly to his body.

SGT. BLACKWELL Our dispatchers notified our homicide units.

The Orange County Sheriff's Department

had arrived on the scene of an individual who was laying

in the parking lot that appeared to have

been run over by a vehicle, and the vehicle had left the scene.

[POLICE SIREN]

NARRATOR EMS workers managed to restart Daniel's heart,

but he never regains consciousness.

Two days later, he dies at Orlando county hospital.

[AMBULANCE SIREN]

Like a thief in the night, hit-and-run incidents

take the lives of people each day in the United States.

Designated as homicides, they fall under the jurisdiction

of the medical examiner.

In Orange County, Florida, that person is Dr. Jan Garavaglia,

better known as Dr. G.

So nothing going on today?

What's after school?

Just Spanish, right?

Tuesday.

All right, so who's picking you up today?

You.

DR. G OK.

NARRATOR When death strikes without explanation,

she's the one who must unlock the secrets

and answer the questions.

When Dr. G gets to the morgue at AM,

the bruised and lifeless body of Daniel Barrow

has just arrived from the hospital.

DR. G He was found, basically, in the parking lot, I believe,

on the th.

And I believe he dies two and a half days later.

Pretty much was dead when he got there.

They were just keeping him alive,

trying to get his heart to come back.

We're going to have to do some research.

We're going to have to get some info on what he's

been up to, who saw him last.

All we're getting is what the EMS

told the hospital, so we need to see if the police

have a written report on it.

NARRATOR Police arrive at the morgue hoping

for findings that could help them in their hunt

for the driver of the car.

It's got some dirt over here.

It doesn't looks like tire, but it's got dirt over here.

SGT. BLACKWELL (VOICEOVER) We brought the evidence

that we had, the clothing, all our field sketch, our notes.

SGT. BLACKWELL This is where the body was, here.

NARRATOR Police inform Dr. G that Daniel Barrow had been

living alone for several months in an efficiency apartment

at the Hawthorne Street hotel.

Neighbors hardly knew him, and officers

are alarmed by the condition of Daniel's

home, which is littered with empty bottles of vodka.

SGT. BLACKWELL The apartment was very disheveled.

It was a mess.

And they were kind of concerned as to

whether or not this man might have been--

someone robbed him or something like that.

NARRATOR As questions multiply, detectives manage

to track down Linda, a friend and former

co-worker of Daniel's.

He was all heart.
[ … ]

He was phenomenal.

He could talk just about anything.

His lifestyle-- very simply, he worked hard and he played hard.

NARRATOR According to Linda, Daniel

had started a new life in Florida

after a painful divorce years earlier.

He soon landed a job as a sales consultant,

and trained to run a marathon in his spare time.

But it was no secret that the divorce was hard on Daniel,

and that he too often drank his pain away.

LINDA I would think that it started off gradually.

You know, we all drink once in a while,

but then, he just got out of hand.

NARRATOR On first glance, Daniel's history

of alcohol abuse may suggest that drinking somehow played

a role in his death, yet hospital tests

revealed that he had no alcohol in his blood the night he died.

This new evidence, however, does little to help

Dr. G get to the bottom of the hit-and-run homicide.

Her first task is to examine and evaluate Daniel's

bruises, over of them.

DR. G He's got some bruises around the knees,

pretibial region, and bruises on both hip regions.

So this one's a little more lateral,

got some abrasion with it.

You can see that's a linear abrasion.

That would not be inconsistent with a fall either.

NARRATOR Daniel even has injuries on his mouth.

DR. G He's got some bruising on the lips, too.

Two little bites to the lip with some bleeding around it,

but he also bit his lip-- he bit his tongue pretty bad.

NARRATOR Dr. G documents all of Daniel's bruises,

but her eyes are peeled for a pattern

of injuries that can tell her where the car struck his body.

DR. G Typically, what happens is they get the lower bumper

fractures on the legs, depending on how high the car

is, how fast the car is going.

NARRATOR The force of the impact

then throws the body upward.

They'll get the bumper fracture on the leg.

It'll toss him up, and he'll hit the hip, impaling on the hood

somehow.

NARRATOR Hitting the windshield is often the fatal blow.

A lot of times, they'll hit the windshield with their head.

It depends on the speed.

NARRATOR But Dr. G's findings aren't adding up.

For all the bruises on Daniel's body,

he bears none of the tell-tale hit-and-run signs--

no fractures on his skull, hips, or legs.

DR. G There's no way a car hit him and caused him to go down.

He's just got nothing here that's consistent with that.

NARRATOR But this conclusion raises

another important question.

Could Daniel have collapsed to the ground

and then have been run over?

DR. G The only thing I was worried about

is, hey, he could be down and a car go over him.

That's still a possibility.

It's not just blood.

NARRATOR To find the answer, Dr. G turns to police

photos from the scene.

Hopefully, another look at them will

offer a clue to understanding Daniel's injuries.

This photo shows the tire mark and the outline

where Daniel's body was found.

Immediately, Dr. G spots something amiss.

We're putting a two-inch circle around the body.

How's the tread going over him if it

goes right through the outline?

And there's nothing forensically that suggests it.

NARRATOR If Daniel had been run over by a car,

the treadmark would not travel through the outline

of his body.

The tire marks at the scene had been burned into the pavement

before Daniel fell.

I don't see how the car had any much

to do with the whole thing.

I don't have any evidence of it.

We don't either.

NARRATOR Suddenly, this open and shut case of hit-and-run

has become anything but shut.

If an automobile did not cause Daniel's

bruises, what or who did?

Could he have been the victim of an as*ault?

We're going to look, see if there's

any signs of a struggle, see if any signs that he's fighting

anybody off, basically.

Your hands tell a lot.

So we're going to really look for bruises

on his hand, bruises that indicate

he may have been in a fight.

He definitely has abrasions over the

proximal interphalangeal joint.

NARRATOR It's not just the number of contusions,

but their color, which start to give Dr. G more of the story.

DR. G Two little purple contusions,

a little green contusion--

I'm trying to determine if they're

all different ages, if they're all about the same time.

Different ages indicate that he's constantly
[ … ]

falling kind of thing.

NARRATOR As a bruise ages, the color changes from red

and purple all the way to yellow, green, and brown.

Daniels bruises run the full spectrum.

The range of colors lead Dr. G to believe

that Daniel's contusions could not

possibly be the result of a single incident

on the night of his death.

From the outside, it doesn't seem

that he was in a fight at all.

DR. G But, you know, we've got multiple bruises

of various ages on his, you know-- his little-- some

on his buttocks.

That's a little odd for a beating.

They're not, like, kicks or anything,

just little small bruises--

two green, two blue.

You know, we've got bruises around the knees,

abrasions around the knees.

Of course, he could have fallen and somebody still beaten him.

I don't know.

The only thing--

NARRATOR But as always, the internal autopsy should

provide a clearer picture.

It's time to open Daniel's chest.

After a Y-incision is made, pruning shears

are used to gain the leverage needed

to cut through the tough bones of Daniel's sternum.

Once inside, Dr. G finds that Daniel has two broken ribs.

Could this be evidence of an as*ault?

--hemorrhage is or the rib fracture is.

Do you see any hemorrhage here?

I don't either.

Look at this one.

A little bit of hemorrhage here.

Do you see any hemorrhage on the outside?

Me neither.

NARRATOR If Daniel's ribs had been broken during a fight,

the injuries would most likely be

asymmetrical and show hemorrhaging,

internal bleeding.

Dr. G's experience tells her that Daniel's ribs

were probably broken by the EMS technicians.

DR. G The rib fractures are nothing.

He's got one, two rib fractures, minimal bleeding.

This guy's probably got them from CPR.

They're very minimal and they're bilateral.

I think they're from CPR.

NARRATOR With no internal injuries,

Dr. G is now certain that Daniel was not

att*cked on the night he died.

No hit-and-run, no as*ault, no crime, but she's

still perplexed by the battered condition of his body.

It's beginning to appear as if his injuries may have been

sustained from multiple, unrelated accidents--

falling down or bumping into things.

Dr. G finds her next clue in Daniel's medical records.

It turns out that Daniel had been hospitalized just four

months earlier after a strangely similar

incident to the one that k*lled him in the parking lot.

DR. G And it looks like this admission.

He's walking along the parking lot and he

just mysteriously falls--

trips, he says-- falls down, hits his face,

and becomes acutely confused.

Goes to the hospital.

They work him up, couldn't really figure out why.

I guess the confusion passed.

I guess they just contributed to concussion.

I'm not sure.

NARRATOR Falling down, disorientation, confusion.

What could cause this strange mix of symptoms?

Coming up next, Dr. G finds the clue

that could finally make sense out of Daniel Barrow's death.

And later, an accomplished woman,

admired by friends and neighbors,

is found dead at the base of a staircase.

DR. G The question is, is there trauma associated with it

or from something natural?

NARRATOR With no witnesses, can Dr. G reconstruct

the last moments of her life?

At first, -year-old Daniel Barrow,

a man found badly bruised and near death in a hotel parking

lot, appeared to be a clear cut case of hit-and-run

until he was examined by medical examiner

Dr. G. After proving that his injuries were not caused

by an automobile or physical as*ault,

Dr. G is determined that Daniel was not

k*lled as a result of a crime.

But she has discovered that the victim

had an inexplicable propensity for falling down.

Could that have something to do with his death?

[MUSIC PLAYING]

Inefficient way to--

NARRATOR After taking samples of Daniel's body fluids

and finding both heart and lungs normal,

Dr. G removes his liver.

Yeah, his liver looks alcoholic.

NARRATOR Looking at it, she can tell

that Daniel's drinking was more out of control
[ … ]

than even his friend suspected.

Oh, this is one big liver.

Liver looks bad.

This is a stage before the cirrhosis.

This is when your liver gets big, and swollen,

and it's full of fat.

It has to do with the toxic effects of the alcohol.

NARRATOR Daniel's liver is in a state of fatty metamorphosis.

The damaged liver cannot process fatty substances,

which then accumulate in the cells,

causing his liver to balloon to twice its normal size.

This finding explains Daniel's extensive bruising.

A diseased liver is less able to produce the factors

needed for blood clotting.

As a consequence, bruising occurs more frequently.

He had very bad liver disease, and he

would bruise very easily.

NARRATOR The liver is proof positive

of Daniel's severe alcoholism.

For Dr. G, it's also a crucial clue

that breaks the case wide open.

With blood alcohol tests showing an alcohol level of zero

on the night of his death, the discovery

that alcohol damaged his liver now

enables Dr. G to piece together the cause of death.

The final cause of death was complications

of chronic ethanol abuse.

Most likely, the mechanism is an alcohol withdrawal seizure.

NARRATOR Daniel was an alcoholic who died because he

had no alcohol in his system.

DR. G Alcohol withdrawal seizure

is a seizure due to the fact that your brain is not

exposed to alcohol anymore, believe it or not.

These people are so dependent on the alcohol.

NARRATOR The seizure not only affects motor coordination,

but in severe cases muscles that control vital functions.

This renders the victim unable to breathe or pump blood.

With this hypothesis, Dr. G now believes

she can explain what really happened to Daniel Barrow

three nights ago in the hotel parking lot.

Daniel Barrow is drying out.

He has no more alcohol left to drink.

Time passes.

Initial symptoms of withdrawal force him out of the building

in search of a drink.

As he walks across the parking lot, the seizures begin.

Nerve cells in Daniel's brain fire abnormally.

He is unable to control his movements.

He falls to the ground, causing more bruising to his already

battered body.

His muscles turn rigid and contract violently.

Two of his injuries are consistent with this.

They have a bite mark on his tongue

and a bite mark on his lip.

NARRATOR The convulsions last anywhere from seconds

to five minutes, during which time

his vital functions are failing.

As Daniel lies dying on the pavement,

an eyewitness calls .

SPEAKER (VOICEOVER) , what's your emergency?

CALLER (VOICOVER) Yes, I'm calling

from the Hawthorne Street Hotel, and I believe

someone just got ran over.

NARRATOR When police arrive on the scene,

the tire tracks adjacent to Daniel's body

and his severe bruising lead them to conclude

that he was struck by a car.

While EMS workers frantically treat him

for injuries they believe are caused by a hit and run driver,

Daniel's organs are failing and his brain is

no longer functioning normally.

He will never regain consciousness.

Daniel's case is not uncommon.

Every year, over , alcoholics

die from complications of long-term alcohol abuse.

In many instances, those who suffer from alcoholism

never reach out for help, leaving

behind friends and family who are confused

and saddened by senseless loss.

LINDA I couldn't help him because he didn't want help.

He wouldn't share himself.

He wouldn't reach out and say, this

is what's going on with me.

If there is a moral to this story, if there's anything

wrong with you, even if there's not anything wrong with you,

you can't do this life all by yourself.

Oh, It's terribly tragic.

He was just one of the most delightful individuals

I ever met.

NARRATOR With Daniel Barrow, Dr. G

dealt with a complicated case that ended up

with a common cause of death--

alcohol abuse.

Sometimes, though, a case that at first may seem routine

is anything but.

Sandra Collins was years old, an age fewer than % of us

live to see.

Early on the morning of March , her body

is discovered outside of her Orlando

area apartment, close to the base of an exterior staircase.
[ … ]

Did her elderly body simply fall prey

to a heart attack or stroke, or was this a case of foul play?

Because no one saw her die and her body was found

in a public area, these questions

are now in the hands of the Orange County

Medical Examiner's Office.

And what address are you at?

Where's the scene at?

OK.

I'll be leaving here in about five minutes

and I'll be en route.

NARRATOR Dr. G's field investigator, Dean Boyd Smith,

is sent to retrieve the woman's body and any information

about her death.

As Boyd returns from documenting the scene,

he offers up the case's first observations.

Another resident at the apartment complex found her.

It's kind of a retirement.

A lot of older people live there.

Her body conditions would indicate she's

been there probably all night.

There is no external trauma to the body that I can find.

Photography was done at the scene.

The steps were looked at very closely.

There's no evidence of hair or blood on the steps anywhere.

NARRATOR Dr. G reviews the case.

At first glance, the circumstances

and the woman's age both point towards a natural death--

a sudden heart attack or perhaps a stroke.

Now, the next one is an unfortunate woman.

She's .

You always hate to autopsy people who are ,

but trauma can happen to people , too.

NARRATOR But then, Sandra is not a typical retiree.

To Dr. G, her body seems more suited to climbing stairs

than lying lifeless at the bottom of them.

Her hair is very long hair--

beautiful hair, actually.

About inches in length.

Beautiful nails, beautiful hair, nice teeth.

She does seem in very good shape for somebody .

I'm sure she took very good care of herself.

NARRATOR Friends and family agree.

They know how full of life Sandra was for her age.

To think that she died of natural causes

just doesn't sit right.

She promised, actually, that she was going

to live until she was .

And if you knew her, everyone believed it.

It was so shocking because she was

a woman who was so determined.

Always did what she said she was going to do.

Big old bruise back there.

NARRATOR In the morgue, Dr. G's external exam

quickly uncovers something.

Now, she too questions whether Sandra died a natural death.

We've got it here.

She's got a nice bump on the back of her head.

Oh, yeah.

Get a bruise on her back.

NARRATOR Dr. G doesn't yet know the severity or nature

of Sandra's head injury.

But its presence opens up a host of new possibilities.

I do feel a bruise back there.

Question is, is there trauma associated with it,

or did she fall from something natural and then hit her head?

So we have to sort that out.

It was unwitnessed.

Heck, I mean, how do we know somebody didn't as*ault her?

The whole thing's unwitnessed.

She's just found outside at the bottom of the step.

NARRATOR Can Dr. G tell what tragic event took the life

of elderly Sandra Collins?

Was she beaten?

Did she fall?

Only the autopsy will tell.

We don't know until we open her.

NARRATOR And later, to understand

the strange and sudden death of a man living in a group home,

Dr. G calls for a second opinion.

Do you think doctors know everything all the time?

We are constantly learning.

That's the beauty of medicine.

You never can learn it all.

NARRATOR Inside the morgue lies the body

of -year-old Sandra Collins.

At her age, the likelihood that she died from natural causes

might normally rule out an autopsy.

But Dr. G suspects a hidden factor may be behind the death

of this active retiree who was found dead

at the bottom of a staircase.

We've got it here.

NARRATOR To start with, there is a good sized bump

on the back of her head.

Trauma can happen to people at , too.

Makes me want to think, though.

My mom lives alone, and I didn't call her last night.

So I better call her tonight.

NARRATOR The hit on the head Sandra suffered leaves

Dr. G with two questions.
[ … ]

Did the injury k*ll her, and if so how did it happen?

Dr. G believes the answer lies beneath Sandra's scalp

and skull.

So that's where she begins her internal autopsy.

Her assistant removes the upper portion of the skull,

exposing the woman's brain.

She's got blood.

You can see all the blood that was on top of her brain.

She's definitely got a subdural hematoma.

NARRATOR A subdural hematoma occurs when a damaged vessel

leaks blood between the surface of the brain

and its outermost membrane, the dura.

Dr. G also sees Sandra's skull is fractured

and her brain is badly swollen.

In severe cases like Sandra's, the subdural hematoma

and the brain swelling constrict the brain,

cutting off vital functions.

Dr. G now knows one thing for certain.

This woman did not die of a heart attack or a stroke.

Sandra's head injury was lethal.

She died from the craniocerebral injuries,

a skull fracture causing the contusions to the brain

with subdural hematoma.

So that was definitely trauma to the head that she died from.

NARRATOR But what caused the blow?

She's got some compression.

NARRATOR Did she simply fall down the steps,

or was she the possible victim of an as*ault?

As Dr. G examined Sandra's brain more closely,

the injury itself gives her the answer.

She's got one bruise to the back of her head,

right around the hat brim area, on the right posterior aspect.

So we know that's the impact site.

No other bruise is present.

But yet, underneath that bruise, we don't

see a whole lot of trauma.

NARRATOR Inside Sandra's skull, directly under the fracture

site, on the heads right side, Dr. G sees only

a small bruise on the brain.

But the subdural hematoma and the fatal contusion

is opposite on the front left side of Sandra's brain.

So the exact opposite would be the front part

of the brain on the left side.

And on there, she had very extensive bruising.

NARRATOR The bruising on the side

opposite to where her head was impacted

is known as a contrecoup injury.

It forms when the brain is slapped

hard against the far side of the skull,

opposite from where an impact occurred.

So the contrecoup contusion is opposite.

That's what contra means, opposite--

supposedly in French--

to the trauma.

NARRATOR This type of injury tells

Dr. G that Sandra's head was moving quickly,

when it came to a sudden, violent stop.

In other words, Sandra died because her head

smacked against something, not because something

smacked against it.

A blow to the skull would have produced a much

different injury pattern.

So everything is consistent with a fall.

NARRATOR Dr. G can now clearly state the cause of death.

Sandra fell down a flight of steps

and suffered a fatal head injury.

But Dr. G doesn't consider the case closed.

There is still a fundamental question left unanswered.

Why did Sandra Collins fall?

DR. G She isn't in perfect health.

She could've just fall and hit her head and tripped.

You just don't know.

NARRATOR Dr. G reaches out to Sandra's friends

and loved ones.

Hi.

This is Dr. Garavaglia at the Medical

Examiner's office in Orlando.

NARRATOR She tells them what she knows about how Sandra died

and probes for clues.

I automatically expected that the medical examiner

I was going to talk to was going to be a man.

I don't know why.

So I got on the phone with this woman, who was

extremely friendly and warm.

At the beginning, they thought it was probably

a natural disease, that maybe she'd had a heart attack

and just kind of collapsed down the stairs.

I was really shocked when the medical examiner

told me that her death had occurred

as a result of the trauma.

And then something happened that was funny.

She said, "I know that you are the one

that is supposed to ask questions to me,

but I have to ask you.

I have a feeling about this woman."

I don't know what it was, but I was taken by the fact

that I know I would have liked her when she was alive.

I was so excited to share with the doctor

the things that I knew and loved about her.

NARRATOR As Marilyn shares what she knows about her old friend,"], index ,…}
[ … ]

she reveals a surprising detail about Sandra's last days.

For Dr. G, it is the missing link.

Now, we didn't get this in our medical records,

but from what her friends said, she

had had some type of a laser procedure that didn't go well.

NARRATOR According to her friends,

Sandra recently had unsuccessful laser eye surgery,

leaving her nearly blind.

It was a bit of a revelation, though,

when they told me that she had gone blind.

NARRATOR Now Dr. G can see the full picture

of Sandra Colins's death.

The night she dies, Sandra leaves

her second floor apartment.

She nears the stairs, but with poor eyesight,

she can't find her way.

Sandra loses her footing and falls

back, striking the right side of her head

hard against the steps.

Inside her head, Sandra's brain is whipped forward, slapping

against the front of her skull.

This slap creates her fatal contrecoup

injury, which swells, constricting

blood flow to the brain.

With the brain starved of oxygen, Sandra dies.

Her body is found the next morning.

I felt that her life had been cut short because of a surgery

that she probably shouldn't have had.

She still died too young.

I will miss her forever, and I'll always remember her.

NARRATOR Coming up, a man dies suddenly

at his th birthday party.

He was actually very happy yesterday.

It was his birthday.

He was smiling, and then he just collapses.

NARRATOR What could have caused such

a strange and abrupt death?

And why does Dr. G not want to perform an autopsy?

James Sadaikis is celebrating his th birthday.

He's surrounded by good friends and good food.

By all accounts, the party is a success.

RUBY He was very happy that day.

They never seen him so mild, so calm, so kind.

NARRATOR James lives in a group home

for the mentally handicapped.

He suffers from Laurence-Moon-Biedl syndrome,

a rare genetic disorder that caused

his brain to function at the level of a nine-year-old.

He also has a long, strange history of violent outbursts.

Moments after the birthday cake arrives, excitement

turns to horror and confusion.

James, trembling, leaps up from the table, charges at a nurse,

and grabs hold of her shirt.

He just stretched out his arms, grabbed onto her blouse,

and held on for dear life.

And just looked at her and couldn't speak.

NARRATOR James releases his grip

and collapses to the ground.

He is never revived.

Due to the unusual circumstances of his death,

James is referred to the Orlando Medical Examiner's office.

DR. G This is a -year-old man.

Looks like he's got a mental retardation.

He's got a IQ of about , knowledge of about a nine

to -year-old.

He lives in a group home.

He was actually very happy yesterday.

It was his birthday.

He was smiling.

And then all of a sudden, he became unable to speak,

and then collapsed, and then died.

NARRATOR But after reading through his medical records,

Dr. G isn't so sure James needs an autopsy.

His medical history is actually quite revealing,

in that he had a brain tumor.

And this brain tumor was known back in November,

several months ago.

NARRATOR But doctors felt that the tumor was

inoperable, too deeply embedded in his brain

to be removed safely.

Rather than subject him to a painful operation

with uncertain results, he would instead live out

his remaining days in comfort.

They've decided to just let him live

with this as long as he could.

And what a nice thing.

And he lived.

In his last day, he was happy and smiling.

It was his birthday, and then he just collapses and dies.

So it was probably the right decision.

NARRATOR Dr. G is certain the brain

tumor caused James's death and decides not to do an autopsy.

I know, right from the beginning,

that he has a history of genetic disease.

And I know he has a brain tumor.

It didn't seem to be a mystery.

NARRATOR She makes a call to James's

mother to let her know the brain tumor caused her son's death.

Hi.

This is Dr. Garavaglia at the Medical Examiner's office.
[ … ]

I believe I have your son, James, here.

She's a very nice woman.

Very upset over her son's death.

Her son is years old.

She speaks as if he's still a young boy.

NARRATOR Despite Dr. G's findings on the cause of death,

James's mother, Ruby, pleads for an autopsy.

She told me nothing could have been done.

But I had questions for her myself.

NARRATOR As a mother, she's haunted

by two lingering questions.

First, Ruby hopes to find a reason

for the violent outbursts that James had

suffered from since childhood.

RUBY He would get aggressive and take it out

on other children or other people.

Maybe go over and just hit them.

Something clicked in his mind, and he would just go for it.

We couldn't figure out why.

NARRATOR Since % of people diagnosed with brain tumors

exhibit mental changes, it's possible

that James's tumor could have played

a hand in his strange behavior.

Ruby wants to know, could James's tumor have

been there since childhood.

DR. G She really wanted to know,

how long the tumor was growing.

Because he'd had some very violent behavior

since a very young age.

NARRATOR Ruby also has another, more desperate

reason for an autopsy.

Her younger son who still lives at home

has Laurence-Moon-Biedl like his brother.

While his case is less severe, he too is mentally challenged.

Does having the same genetic condition

mean he is likely to develop the same type of fatal tumor?

I was worried if it was hereditary,

it would-- of course, I was scared to death.

I don't want to lose my other son.

I only have one other son left, and that's all I've got.

And that's a very good reason to do an autopsy.

If that'll give you some peace of mind,

I'll be more than happy to do it, then.

NARRATOR Can Dr. G prevent one death by exploring

the mysteries of another?

She feels that Ruby's questions are reason

enough to go above and beyond the call of duty

and perform the autopsy even though she

knows the cause of death.

But before Dr. G begins, she must know more

about James's genetic disease.

Could it have caused his tumor?

I just wanted to know a little bit of background.

I don't have any books on congenital abnormalities

in my office, but I had my husband.

NARRATOR Over the phone, Dr. G's husband,

a pediatric trauma surgeon of years,

gives her a quick tutorial.

I told you I'd call you back.

He had a congenital syndrome that

is called Laurence-Moon-Biedl.

I didn't know really anything about it.

He's a pediatrician.

He did.

NARRATOR Laurence-Moon-Biedl syndrome is a disease

passed through recessive genes.

The syndrome is very rare in the United States.

It wasn't until that scientists even discovered

the gene that causes it.

The neurologists had diagnosed him back when

he was about two years old.

Back then, they'd never even heard of that syndrome.

In fact, they asked me if he could

be in the historical books for medical discovery.

NARRATOR Dr. G's husband also gives her

a rundown of the strange symptoms

of Laurence-Moon-Biedl syndrome.

It's common for them to be obese.

It's common for them to have mental retardation.

It's common for them to have the polydactyly,

like he had the multiple fingers,

the extra fingers, extra toes.

NARRATOR Polydactyly, having more than the normal numbers

of fingers and toes--

it's one of the most distinctive indicators of the disorder.

Armed with new information about Laurence-Moon-Biedl syndrome,

Dr. G begins the autopsy.

She quickly sees the first abnormality linked

to James's genetic disorder.

One, two, three, four, five, six toes on that side.

One, two, three, four, five, six toes on that side.

NARRATOR But other than the superficial effects

of his syndrome, Dr. G notes nothing

remarkable about James's body.

So we're probably expecting everything to be negative

until we get to the brain.

NARRATOR Will the brain give Dr. G the answer she needs?

Was this tumor somehow related to the syndrome

of Laurence-Moon-Biedl?

NARRATOR If so, could the brother die
[ … ]

from the same type of tumor?

And was the tumor the cause of James's violent outbursts?

A worried mother waits for her dead son's diagnosis--

a diagnosis that can only come from Dr. G's autopsy.

[MUSIC PLAYING]

Dr. G is about to open the head of James Sadaikis, a man

with a rare genetic condition who died suddenly

at his own birthday party.

But she's not looking for a cause of death.

He was almost certainly k*lled by an inoperable brain

tumor diagnosed months earlier.

What she is looking for is evidence that could answer

a mother's lingering questions.

Could his fatal brain tumor have been growing

long enough to help explain a lifelong history

of violent outbursts?

And could the tumor be linked to his genetic condition,

Laurence-Moon-Biedl syndrome, a condition

that his younger brother also has?

My other son has medical problems, too.

And I was so worried if he were to have this kind of tumor

also.

I was scared to death.

This one's fresh, right? ASSISTANT Yes.

Gee, thanks.

Do you want me to cut this?

Yeah, go ahead and cut it.

Jean is going to go ahead and open his head up.

I don't know what kind of tumor it is.

Maybe it's even bled into the brain.

I don't know.

I have to see it.

NARRATOR Once the brain is exposed,

Dr. G spots the tumor immediately.

It's huge, and we're not even seeing a lot of it.

A lot of it's gone into the base of the skull.

NARRATOR The tumor is enormous, about the size of a baseball.

And just as his doctors predicted,

it would have been impossible to remove without k*lling James.

So we've got it at least . centimeters by and /.

All this is tumor.

You can see it's caused the compression here.

That's usually not like that.

Tumor is just pressing on the brain.

NARRATOR When she sees the massive growth,

Dr. G has no doubt that it caused James's death,

and she now knows how it k*lled him.

Growing for some time, the tumor eventually

began to press into the centers of the brain

that regulate the body's heart and respiratory systems.

At the time of his party, pressure

was so great that his vital functions failed.

His brain was effectively cut off from his body

and could no longer tell his heart to pump.

He died as if someone had thrown a switch.

But now the real challenge begins--

answering questions about the tumor itself.

Did it affect James's behavior?

Was it caused by his genetic syndrome?

And will his brother develop the same tumor?

I'm definitely going to have to bring in an expert on this.

NARRATOR The tumor will have to be dissected and analyzed

by a neuropathologist, a specialist in the field

of forensic brain pathology.

I thought I'd get the neuropathologist,

because you know what?

If it's my son, that's what I want, too.

NARRATOR The brain is placed in a fixative,

and a section of the tumor is kept for examination.

That examination will be performed

by Dr. Gary Pearl, the ME office's neuropathologist.

We took a piece of the tumor and made

microscopic slides from it.

And if you take a look at some of his tumor cells,

you can see that they are massive

compared to what a normal cell would

be and very abnormal in shape.

NARRATOR From these findings, Dr. Pearl

feels he can positively identify the type of tumor

in James's brain.

This is what's called a chondrosarcoma,

a malignant tumor derived from cartilage.

And this is growing out of the base of his skull.

NARRATOR Though the tumor grew into James's brain,

Dr. Pearl discovers that it isn't a brain tumor at all.

Surprisingly, it's a tumor derived from mutated cartilage

cells, not nerve cells.

Chondro is cartilage, sarcoma is a connective tissue tumor.

So it's a basically cartilage kind of tumor.

It makes cartilage.

NARRATOR Dr. Pearl's examination

brings one more discovery--

the tumor's growth rate.

If you look at them, there's a low grade, intermediate,

and high grade, which tells you, more or less, how fast they

grow, how aggressive they are.

This is a chondrosarcoma of intermediate grade.

NARRATOR From this, Dr. Pearl concludes

that the tumor has only been growing for a few years--

not nearly long enough to have Jame's violent behavior,
[ … ]

which started when he was a child.

Did the tumor cause that behavior?

No.

We can say that for sure.

NARRATOR Dr. G can finally start

to give James's mother conclusive answers

about her son's life.

She believes, two to three years, maybe it was there,

and then it just grew very rapidly.

Nothing could have been done now.

NARRATOR While Ruby may never know exactly what contributed

to James's violent behavior, she can

at least rule out the condition that ultimately k*lled him.

This leaves just one final question to answer.

Is the chondrosarcoma associated with

Laurence-Moon-Biedl syndrome?

So we've looked in the literature-- both Dr. Pearl

and I looked in separate searches--

and we couldn't find anything relating the two.

So it's just one of those freaky things.

NARRATOR James's tumor was not connected to his syndrome.

It was simply a very rare bone tumor that grew into his brain.

That James suffered from both these extremely rare conditions

is, in the end, only an incredible coincidence.

Keep in mind, this isn't a typical tumor in the brain.

These are usually on bones.

NARRATOR And without a genetic link,

Dr. G can now ease the fear of James's mother, Ruby.

The chances of her younger son getting the same kind of tumor

are extremely remote.

When she found out what kind of tumor it was,

she ruled it out that it was hereditary.

It was very rare.

It was nothing to worry about with his brother.

I was glad to hear that.

NARRATOR A mother is given hope,

and a human connection is made.

Dr. G considers the day a success.

But tomorrow is guaranteed to present

its own set of new challenges.

DR. G Do you think doctors know everything all the time?

We are constantly learning, even the good doctors.

And the great doctors, they still have to look things up.

You don't know everything.

So you learn.

That's the beauty of medicine.

You never can learn it all.

[OUTRO MUSIC PLAYING]