02x09 - Paths of Destruction

[bunniefuu]

[music playing]

NARRATOR A crazed man sh**t himself in the head

but doesn't die.

Just the look in his eyes.

Just never seen a look before that or after that that

looked that wild.

NARRATOR After two and a half weeks in the hospital,

he seems happy and healthy, until a nurse

discovers him dead.

Is the answer to this man's death as obvious as it seems?

I mean, dying--

two weeks earlier, g*nsh*t wound in the head.

Hmm.

NARRATOR Then pain and confusion

set in when a -year-old mother dies without warning.

My son called me at work.

And he said, Mom, I don't think she's alive.

NARRATOR When Dr. G gets the case,

she finds a report full of disturbing signs.

DR. G She's just in the hospital for abdominal pain.

Well, what's that about?

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

Alex, do you want a grapefruit?

Alex, what do you want?

NARRATOR It's just after AM.

And two very different sides of Dr. Jan Garavaglia's day

are already in motion.

And you have chicken for lunch.

Yeah.

NARRATOR Her boys are getting ready for school.

And her staff is getting ready for a day of autopsies.

We're not going to have any room in here to walk around.

NARRATOR As Chief Medical Examiner for Orange County

and Osceola counties in Florida, Dr. G supervises an average

of four autopsies every day.

But like any parent, one of her biggest challenges

each morning is simply getting out the door.

All right, let's go.

Oh, oh, oh.

It's trash day.

Oh, my god.

We're late.

We've got , , , --

so we've got minutes.

Let's see if we're going to make it.

Uh-oh.

We got bad traffic.

[inaudible] shoes.

Put them in your--

I can't [inaudible].

Bring the change.

You're going to bank it.

We got a good minutes.

Hey, sweetie, you have a good day, OK?

I love you, Mother.

Ooh, it's not bad.

Yeah.

Oh, gee, here we go again.

Oh.

Well, what we have this morning is a -year-old man

who about , days ago is walking down the street

with a bottle of liquor.

NARRATOR Dr. G's first case of the day, Tom Miller,

d*ed last night at PM.

He was transferred to District shortly after AM

this morning.

Her investigator's report provides Dr. G

with a thumbnail sketch of Tom Miller's life

and how he ended up in the morgue.

A Vietnam veteran and father of three grown children, his case

file states that Tom Miller had suffered from mental illness

and alcoholism for many years.

He's got a history of depression, history

of trying to k*ll himself numerous times,

history of chronic ethanolism.

NARRATOR Late one night three weeks ago, Tom was drunk,

disorderly, and stumbling through an apartment complex

with a bottle of liquor in his hand.

Police come upon him.

I guess they were trying to get him

off the street with the liquor.

BRAD LABYER I asked for him to stop.

He didn't listen.

And then I remember when he turned his head

and looked at me when I told him stop, this--

just the look in his eyes.

I've just never seen a look before that or after that

that looked that wild.

He told the officer to leave him alone

and said if he doesn't leave him alone, he's going to do it.

BRAD LABYER Then he pulled out a w*apon,

kept turning towards me, and you know, just using one expletive

after another, at which point he finally turned the g*n

on himself and sh*t himself.

Puts the old g*n in the mouth and does it.

[sirens]

NARRATOR But incredibly, after f*ring

a g*n into his open mouth, Tom Miller does not die.
[ … ]

Still breathing, he is rushed to the nearest

hospital, where doctors perform emergency brain surgery.

They quickly stabilize his condition.

And for the next two weeks, Tom Miller steadily improves.

JAN GARAVAGLIA So he is going along in the hospital.

And he was able to talk with some trouble,

but able to talk and recovering.

Well, he transfers from the one hospital to the other.

They think he's doing well.

They say he seems to be doing well.

NARRATOR Until the th day of his recovery,

when something goes horribly and mysteriously wrong.

They just find him dead in bed.

So the doctor really is not sure.

It was totally unexpected for them.

NARRATOR The hospital is deeply troubled by Tom Miller's death.

They fear that he may have overdosed on painkillers while

in their care.

The hospital is very concerned.

They don't want to be accused of letting him commit su1c1de.

NARRATOR These are the facts of the case

as Dr. G understands them.

And for the Chief Medical Examiner,

the facts could lead to several possible conclusions.

There are three possibilities for me

that I'm thinking on my hypothesis.

He could have tried another way to commit su1c1de,

particularly with dr*gs.

He could have d*ed as complications

from that brain injury.

Maybe a seizure, a bleed.

Maybe a blood vessel was damaged and it bled.

Or maybe it was something totally unrelated.

So what we have to do, we have to bring the body in,

and we have to do the autopsy.

That's the only way I'm going to figure it out.

I go to see what I can find and to look from head to toe,

look at the back, even look at the anus,

look at his genitalia.

I look at everything, see if anything is going to talk to me

here.

NARRATOR Only minutes into the exam,

Dr. G finds indications of trauma on his body.

But nothing unexpected.

But then Dr. G finds something that is surprising.

The dead man's pupils are constricted.

Usually, I don't see that at autopsy.

NARRATOR Certain dr*gs can have direct effect upon the dilation

of the pupils.

Opioid painkillers, such as codeine and morphine,

are known to constrict the pupils.

It's a discovery that might indicate

what his doctors feared most--

their patient k*lled himself by overdosing on pain medication

while he was in the hospital.

Would not be my first in the hospital of somebody

overdosing by hoarding pills.

So that's a possibility in this case.

And I see the pinpoint pupils.

NARRATOR One thing is clear.

If Dr. G is to solve the mystery of Tom Miller's death,

she must look inside the body.

Coming up next, Dr. G opens Tom Miller's body and searches

for answers to his unexpected death.

So the bottom line is, what can I connect the dot to?

NARRATOR But answers are not forthcoming.

We couldn't find anything wrong.

NARRATOR When "Dr. G, Medical Examiner" continues.

At the District morgue in Orlando, Florida,

the day is off to a swift start.

Dr. G's staff of medical investigators

is keeping track of new cases being

transferred to the morgue.

Yes, ma'am.

Child fatality and three adults transported to ORMC.

NARRATOR And as an investigator is dispatched

to the scene of another unexpected death,

Dr. G is examining her first case of the day, Tom Miller.

So far, it appears that this self-inflicted g*nsh*t victim

might have k*lled himself with an overdose of pain medication

while recovering in the hospital.

He's got pinpoint pupils.

We often see that with opiates overdoses.

NARRATOR Was the hospital negligent

for letting Tom Miller take his own life

while under their care?

Dr. G is ready to probe for answers

inside Tom Miller's body.

Oh, I'm sorry.

We're getting a late start.

NARRATOR First, Dr. G cuts a y incision across Tom Miller's

chest and down his torso.

If Tom Miller consumed a fatal overdose of pain medication,

she'll find traces in his body fluids

and perhaps in his stomach.

I take something away from everybody

that I do an autopsy on, how they lived

and how they got to this point.

And sometimes it's positive.

Sometimes I learned good lessons.
[ … ]

And sometimes I learned a little something to avoid.

NARRATOR Once the body is opened,

Dr. G and her forensic technician, John Gilmartin,

draw toxicology samples for lab tests, which

can determine the level of dr*gs in a body at the time of death.

It will take six weeks to get the toxicology results back.

But there may be a way for Dr. G to find

the answer she needs today.

If Tom Miller consumed a large quantity of pills,

it might be possible that some were not completely

digested before he d*ed.

To verify this, Dr. G examines the contents of his stomach.

But after a thorough examination,

she finds no traces of any pills.

I don't see any pills.

NARRATOR While Dr. G will have to wait for toxicology

to rule out a drug overdose, it now appears less likely.

The lack of progress and answers is frustrating.

But I have to look for other reasons.

Because if you don't look, you don't find them.

NARRATOR Next, Dr. G turns her attention back

to the reason Tom Miller went to the hospital

in the first place, the b*llet wound in his head.

Could it have played any part in his death?

You ready?

NARRATOR Using a specialized reciprocating saw,

John Gilmartin cuts open Tom Miller's cranium

and removes the skull cap, revealing the damaged brain.

With the organ exposed, Dr. G can finally

unravel the mystery of how Tom Miller survived

a direct g*nsh*t to the brain.

The angle of the g*n launched the b*llet

through the tip of the left frontal lobe of his brain,

not the vital brain stem.

Well, he didn't k*ll himself because he

didn't put the g*n right.

He put the g*n up instead of back.

And unfortunately, if you put it in your mouth and just go up,

it doesn't hit the vital structures of the brain.

It's just going to go up, like where your base of your nose

is, to give you a frontal lobectomy

and just may not k*ll you, especially

if you're using a caliber.

And that's exactly what happened to the poor guy.

NARRATOR In Tom Miller's case, Dr. G knows that he

survived the initial injury.

The question is, could it have set off a deadly chain reaction

that k*lled him weeks later?

According to Dr. Ira Goodman, death following traumatic brain

injury can occur in many ways.

IRA GOODMAN Oh, there's a lot of possibilities.

What happens is the b*llet goes in, and it causes irritation.

It causes inflammation, it causes bleeding.

You get infection in the skull.

You get infection along the lining.

In the brain itself, you develop an abscess.

When you have a communication between the outside

and the brain, you always have a higher risk of developing

meningitis or other infection.

So the bottom line is what can I connect the dot to?

NARRATOR Dr. G continues her examination of the brain,

looking for any potentially lethal complications.

And she comes to a surprising conclusion.

We couldn't find anything wrong, He was healing.

He was getting better.

He was on his way to recovering from that g*nsh*t wound.

No catastrophic event happened.

No blood vessel burst.

No--

We couldn't find anything.

No infection, nothing.

I really didn't see how that g*nsh*t wound

played a role in this case.

NARRATOR But if Tom Miller didn't die from the g*nsh*t

wound, and it seems likely that an overdose didn't

cause his death either, then what

did k*ll this Vietnam veteran?

The bottom line is, what caused his death?

NARRATOR Coming up next, will the case of Tom Miller

close without any solid answers?

I start taking out his organs.

I just look at everything, see what I find.

NARRATOR And later, when a young mother dies,

her family is left to care for her infant son.

Will Dr. G be able to tell them what

took her life so unexpectedly?

JAN GARAVAGLIA She's down in the bed,

and she's got frothy fluid coming out of her mouth.

NARRATOR When "Dr. G, Medical Examiner" continues.

A typical autopsy lasts only minutes.

It's a brief window to peer into a lifetime.

And for Dr. G, that window is about to close

without determining a cause of death for Tom Miller.

The victim entered the morgue as a suspected su1c1de

from the belated effects of a g*nsh*t

wound to the head or a possible overdose of pain medications

while in the hospital.

But Dr. G has found no evidence to support either theory.

There's really nothing acute.

He just has the trauma to that left frontal lobe.
[ … ]

NARRATOR If neither the g*nsh*t wound nor an overdose

k*lled this man, what did?

JAN GARAVAGLIA I start taking out his organs.

Take out his bowels, look at his kidneys.

Take those out.

Follow the ureters for the bladder.

Take the bladder out.

Take the prostate out.

Look at his spine.

I look at everything.

I just look at everything, see what I find.

In this case, I found a very bad heart.

Wow, that's a pretty big heart.

A normal heart-- this man isn't that big.

A normal heart should maybe weigh , grams max.

His heart is like grams.

It's big, and it's dilated.

The muscle is kind of soft.

I mean, normal heart, maybe, you know, my fist.

His is like this.

NARRATOR Dr. G discovers that Tom Miller's heart disease,

which was described in his medical records,

is much more severe than anticipated.

Based on the condition of his heart,

Dr. G can see that he suffers from a type

of heart disease known as dilated cardiomyopathy.

It is a degenerative condition that causes the heart muscle

to become so weakened, it cannot contract enough to pump out

the blood that flows into it.

JAN GARAVAGLIA The muscle is getting weaker.

And the blood actually kind of dilates

the heart, because you're not pumping all the blood out.

You're too weak.

The heart muscle is too weak to pump the blood out.

So eventually, it gets a little more dilated.

NARRATOR Dilated cardiomyopathy can be caused by many factors,

including genetics, diabetes, high blood pressure,

coronary artery disease, alcoholism, and in rare cases,

even complications from pregnancy

and rheumatoid arthritis.

The five-year survival rate for people with

that severe of congestive heart failure

is worse than most cancers.

NARRATOR But determining if Tom Miller's damaged heart was

his k*ller is not yet possible.

JAN GARAVAGLIA I have the heart,

but that doesn't give me the answer.

Last week, he had a big heart too.

Why is he dead now?

I got to rule out everything else.

NARRATOR Dr. G puts the case on hold and waits for toxicology.

There is still a slim chance that Tom Miller did overdose

on pain medications, even though no pills

were found in his stomach.

Several weeks later, the results arrive.

Tom Miller does have antidepressants

and anti-seizure medications in his blood.

But the amount is not excessive.

It is clear that the dr*gs he took

were done so under a doctor's direction, which for Dr. G

means that he did not overdose and that the hospital

was not negligent in his death.

It is an unlikely coincidence and unanticipated.

days after putting a g*n in his mouth

and pulling the trigger, Dr. G believes the victim most likely

succumbed to a natural death from heart disease

and not his su1c1de attempt.

When you have that kind of heart,

you are at risk for cardiac arrhythmia.

So I gave them the benefit of the doubt.

Now is this, you know, clear and precise science?

No.

But with the best information I have,

based on putting the pieces together,

based on what I see at autopsy, I

think the chance that he had d*ed

from a sudden cardiac arrhythmia outweigh anything else.

This is Dr. Garavaglia from the Medical Examiner's office.

NARRATOR Now Dr. G can explain to Tom Miller's family

how his life ended days after he tried to k*ll himself.

Late one night, Tom Miller, drunk and suicidal,

sh**t himself in the head with a caliber handgun.

The b*llet punches through his upper palate and lodges

in the left frontal lobe, but does not k*ll him.

However, even though Miller miraculously

recovers from the trauma to his brain, in the hospital,

another completely unrelated and hidden thr*at

begins to transpire deep within his body.

His heart muscle is deteriorating

from severe congestive heart failure.

At almost double the size of a normal heart,

it pumps at only % of its capacity.

The heart's already damaged.

The muscle has started to dilate.

NARRATOR Sometime in the early morning of his th day

in the hospital, Tom's heart muscle

begins to b*at erratically under the strain of its size.

These people are set up for sudden arrhythmias.

NARRATOR Within moments, this irregularity begins

shutting Tom's heart down.
[ … ]

Eventually, the organ can no longer pump blood

and Tom dies from natural causes.

JAN GARAVAGLIA I have to go with preponderance of evidence.

He definitely d*ed suddenly and unexpectedly,

consistent with the cardiac arrhythmia.

And this is what I found, and this is the way I'm ruling.

NARRATOR And so nature achieves for Tom Miller

what he failed to do himself.

A sad end to a troubled life.

Coming up next, a mother of three

is found dead in her apartment.

Did she die trying to improve her health?

She had some definitely major problems in her life.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G's next case is taken from the morgue's

refrigerator, where it has been stored overnight.

The victim's name is Melissa Wrightsell.

Oh, wait a minute.

Let's see.

Initially, what my investigator tells

me is that we have a -year-old black female that's found dead

on a mattress in her residence.

NARRATOR The investigator's report

provides Dr. G with vital medical history

and information about the circumstances

of the young woman's death.

According to her investigator, the decedent's story

begins three days ago.

At AM on Sunday morning, Melissa Wrightsell

is in the throes of a drinking binge.

She's been consuming alcohol since the night before.

But on this morning, her binging leads to another problem.

She can no longer care for her infant son.

My mom had gotten a call from Melissa saying, you know,

to come and get the baby.

She wasn't feeling well.

So we got the baby, and we brought him

home over to my mom's house.

JAN GARAVAGLIA The family gives a pretty good history

is that they know she drinks.

When they talked to her on Sunday,

she was highly intoxicated, slurred speech.

So they went over there to pick up her child,

who is seven months old.

NARRATOR According to family members,

Melissa's alcohol problems had emerged only recently.

Really had been just within the five years.

Just within five years.

That's it.

And she didn't do it every day, not even every weekend.

NARRATOR But the traumatic events that her family believes

led directly to her drinking problem

had haunted her since childhood.

As a young girl, Melissa was a victim

of sexual abuse and r*pe.

JOANNE It had such a devastating effect on her.

Melissa had such a kind and gentle spirit.

And for the longest time, she could not

understand how another human being

could hurt another human being.

And you have to find a way to cope.

Her choice was alcohol.

JAN GARAVAGLIA It sounds like she has a very sad life.

She's divorced for two years.

She has two twins, but they live with the father in England.

She doesn't work anymore.

NARRATOR Dr. G's report states that on Sunday evening,

several hours after Melissa's family picked up her son,

they called to check on her.

But they get no answer.

The remainder of Sunday, to the best

of everyone's knowledge, no one has had contact with her.

On Monday, again, there appeared to be

no contact by family members.

ANN I kept calling.

And she kept had her answering machine on.

[phone rings]

MELISSA (ON RECORDING) Hello, you've reached Melissa.

I'm unable to--

ANN And I kept thinking that maybe she,

after while, she'll call me.

If I hadn't heard from her in a while,

I'm going to get really concerned about it, you know.

I'm her mother.

You know, I hadn't heard from her in a while.

She will call.

She always pop up and call.

NARRATOR But by Tuesday, Melissa's family is frantic.

They have not heard from her in hours.

That afternoon, Melissa's cousin is sent to check on her.

The cousin stopped by for a well check.

Knocked on the door.

There was no answer.

So he unlocked the door and found

her apparently unresponsive on a mattress in her bedroom.

She's down in the bed, and she's got frothy fluid

coming out of her mouth.

My son called me at work, and he said, Mom,

I don't think she is alive.

I said, David, please don't say that.
[ … ]

Please don't say that.

I just prayed the hardest I've ever prayed.

Just God, please don't let anything happen to her.

I lost it.

That's it, basically.

I lost it.

Today is Wednesday.

So they found her on Tuesday.

NARRATOR After learning the circumstances of Melissa's

death, Dr. G makes note of Melissa's

history of binge drinking.

Often associated with college students,

binge drinking is generally defined

as consuming an excessive amount of alcohol

in a short period of time with the intent

of becoming highly intoxicated.

Some risks of binge drinking over time

include cancer, liver cirrhosis, memory loss, and even

shrinkage of the brain.

And sometimes, it can even result in death

from acute alcohol poisoning.

It's rare.

You have a mechanism that most people pass out

or most people vomit and get rid of some of that alcohol

before they get to that point.

NARRATOR But Dr. G finds another looming issue

in Melissa Wrightsell's medical history.

One week before her death, Melissa was rushed to the ER

with severe abdominal pain, something

she had been suffering from since undergoing

a radical weight loss procedure-- gastric bypass

surgery.

She had abdominal pain about a week ago.

She's just in the hospital for abdominal pain.

Well, what's that about?

NARRATOR The incident raises an immediate question.

Could Melissa's past surgery and recurrent abdominal pain

have something to do with her death?

It's a question Melissa's family waits

anxiously to have answered.

JOANNE First thing I said when I was allowed to finally

see her was I'm sorry.

I'm so, so sorry.

Because the kind of late relationship

that Melissa and I had was I always,

always took care of her.

And I felt like this was the one time when she needed me,

and I wasn't there.

NARRATOR Was there something that her family could

have done to save Melissa?

Dr. G will need to perform a full autopsy

on the victim's body before drawing any conclusions.

Coming up next, Dr. G begins the examination of Melissa

Wrightsell and gets her first look at the scar

from her bypass surgery.

It was a nasty scar.

NARRATOR Could her k*ller lie beneath it?

When "Dr. G, Medical Examiner" continues.

Before beginning the examination of Melissa Wrightsell,

it is the responsibility of Dr. G's

morgue technician, Arden Monroe, to take photos of the deceased."], index ,…}

After reading through her medical files,

Dr. G is concerned that this -year-old mother

might have d*ed from complications

of gastric bypass surgery.

With the photos complete, the autopsy can now begin.

Dr. G makes note of the large scar

from Melissa's gastric bypass surgery,

which measures and / inches down

the midline of the abdomen.

She used to be very obese, and she's had a bypass.

She's had bypass in that they have

reduced the size of her stomach for weight control.

NARRATOR There are several different kinds

of bypass surgeries, depending on a person's

anatomy and health.

But the goal for each is the same--

to permanently reduce the size of the stomach--

in Melissa's case, with staples--

and bypass a portion of the small intestine.

Usually, the surgery is very successful.

But it is sometimes fraught with the specter

of deadly complications and lifelong health consequences.

JAN GARAVAGLIA Well, gastric bypass

surgery for a weight control has a whole set of problems.

There is some problems with chronic malabsorption,

of particular with calcium and iron.

You're not absorbing it.

So they get anemia.

They get osteoporosis, or thinning of the bones

because they're not absorbing the calcium.

NARRATOR But for the , people

who undergo gastric bypass surgery annually,

one of the most dangerous complications

can occur from post-operative adhesions.

JAN GARAVAGLIA They do have problems with adhesions.

And that's the scar tissue in your abdominal cavity.

NARRATOR The invasive scar tissue

can adhere to inner organs, causing them

to twist abnormally, especially the bowel.
[ … ]

And in the death of Melissa Wrightsell,

this thr*at is what concerns Dr. G the most.

Basically, what happens is you get

scar tissue in your abdomen.

And depending on where the scar tissue is,

your bowel kind of gets caught up in that,

or it wraps around the bowel.

And then the food can't get past it, and you get obstruction.

And maybe she has some type of a bowel obstruction from that.

It certainly could cause death.

I've had several people I've autopsied with a bowel

obstruction and death.

NARRATOR The external exam yields

several other findings as well.

Based on Melissa's rigor and state of early decomposition,

Dr. G believes the young woman d*ed sometime Sunday night.

She probably d*ed at least, you know, over a day

before they found her.

NARRATOR Further, she finds no indications that Melissa

suffered any trauma.

Doesn't look like she's been beaten

or in any type of altercation.

Doesn't look like she's fallen to me.

NARRATOR Finally, Melissa's death was likely not sudden.

She's got some frothy fluid, some froth, around her nose

and in her mouth.

We will often see that in people who are in a coma.

NARRATOR At the close of the external exam,

Dr. G believes two things.

Melissa d*ed at least one day before she was discovered

and was probably in a coma.

What she doesn't yet know is whether the gastric bypass

surgery played a role in her death

or if her family could have done anything more to prevent it.

I just knew I would always be there for her, always.

And that would never end.

And it did.

So that leaves me deeply, deeply saddened.

And I feel a certain amount of guilt.

She's only .

NARRATOR Dr. G opens the body with a y incision.

On Melissa, the procedure is tricky.

The incision is drawn along the scar

from Melissa's bypass surgery, which is

thick with fibrous scar tissue.

There was a nasty scar, long and wide.

NARRATOR The question is how invasive is the scar tissue,

and is it attached to Melissa's bowel?

She looks worse on the inside than she did on the out.

Again, her tissues are starting to really break down.

She's got a little bit of decomp fluid,

looks like, in her cavities.

Yeah, a little bit of odor too.

NARRATOR Dr. G carefully searches

the lengths of Melissa's bowel.

JAN GARAVAGLIA I've seen it.

I've seen where the bowel twists.

You don't expect it.

It's just a uncommon finding.

But I've had several of them in my career.

NARRATOR But after a thorough inspection,

she can find no evidence of any abnormalities.

That looked OK.

She doesn't have a bowel obstruction or a lot

of problems with adhesions.

NARRATOR It's an unambiguous finding.

Dr. G determines that the scar tissue from Melissa's

gastric bypass did not cause an obstruction

and therefore played no role in her death.

But if Melissa didn't die due to complications

from weight loss surgery, then what did

k*ll this young mother alone in her apartment,

seemingly without warning?

JAN GARAVAGLIA You know, we don't know.

We don't know what's going on.

NARRATOR Coming up next, the unsettling circumstances

behind the death of Melissa Wrightsell.

It's just a tragedy.

There's no question about it.

NARRATOR When "Dr. G, Medical Examiner" continues.

Before continuing with the exam, Dr. G

and her forensic technician, Arden Monroe,

collect body fluids for toxicology testing.

The vials of urine, blood, and eye fluid

will be screened for the presence of dr*gs and alcohol.

The deceased, a -year-old mother

named Melissa Wrightsell, was found dead in her apartment

the day before.

Her family is stricken with grief,

and they want to know the reason for her unexpected death.

She just will never know just how wonderful she was.

We find it really hard to talk about her.

NARRATOR But halfway through the internal exam,

Dr. G still doesn't know what k*lled her.

I don't know.

I don't know what's going on yet.

We don't have all the pieces to put together to try to recreate

what was really going on there.

So we keep going with the autopsy

and see what's internal.
[ … ]

NARRATOR Dr. G begins to remove Melissa's organs

to weigh and dissect them.

She notes that several of them are abnormally large.

for the heart.

Basically, the autopsy shows a slightly

enlarged heart, kind of heavy lungs,

a little congested heavy lungs.

She still has that froth up and down her airway

that I saw in her mouth.

It's coming up from her trachea.

NARRATOR And there's something else

that appears unusual as well--

Melissa's liver.

Instead of having a nice brown color,

it has a yellow kind of tan color.

Instead of having a nice sharp edge, there's a rounded edge.

Grossly, it looks like kind of a greasy orion,

which it usually doesn't.

NARRATOR It's a disturbing sign.

It means that Melissa has what is known as a fatty liver,

a liver whose cells have become overwhelmed with microscopic

amounts of fat.

It's not the same kind of fat we see under the skin,

but it's filled with triglycerides,

a fatty substance.

NARRATOR Fatty livers, like these from Dr. G's lecture

slides, are a known risk factor associated with obesity.

But there was another cause of fatty liver syndrome as well,

one that is linked to death--

excessive alcohol consumption.

Alcohol abuse, such as binge drinking,

can cause rapid and massive fatty changes to the liver that

can sometimes lead to death.

Just binge drinking, you can start accumulating

that fat without a doubt.

If you're just going out on a weekend binge

and having those prolonged three or four days of drinking,

your liver is going to start to show some fatty changes,

where that triglycerides are starting

to accumulate in that liver.

NARRATOR But having a fatty liver is not

necessarily a death sentence.

And doctors are uncertain exactly how the condition kills

and why.

We don't really know why the fatty liver causes death.

We just know it happens.

We see it all the time in the forensic community.

What does this heart weigh?

NARRATOR The question Dr. G grapples

with is could Melissa's fatty liver

be the cause of her death?

At the close of the autopsy, she still is uncertain.

She will have to review Melissa's toxicology reports

and slides of Melissa's liver before drawing any conclusions.

In the meantime, even though she doesn't have any clear answers,"], index ,…}

Dr. G calls Melissa's family to let them

know what she's found so far.

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

My condolences on the death of your sister.

I did the autopsy on Melissa, and I didn't

see an obvious cause of death.

So I have to wait for the toxicology.

And then, of course, I'll look under the microscope too.

Well, thank you.

You've been very, very helpful.

OK, bye-bye.

So then the tox report comes back.

Now, if my life was easy, it would just

give me the answer right off.

But you know, tox in post-mortem blood

is very, sometimes, difficult to interpret.

Her alcohol was-- blood alcohol was a little above a point .

Well, illegal intoxication is point .

I know she's illegal intoxicated.

That's not my problem.

You don't die from illegal intoxication

unless you run your car into the side of the--

you know, into the side of the wall or the tree.

But the bottom line is, her liver definitely

shows the fatty changes, the big vacuoles in the liver cells

all over.

No evidence of trauma.

No evidence of natural disease.

Everything points to her dying from that

acute and chronic alcoholism.

NARRATOR Although there is no single, clear cut answer

to Melissa Wrightsell's death, Dr. G now

has enough information to describe

the circumstances of her unfortunate and senseless

demise.

Melissa, a troubled woman who occasionally uses alcohol

to cope with the scars of childhood abuse,

descends into a drinking binge.

On Sunday morning, when she's too

intoxicated to care for her child,

she calls her family for help.

We got the baby, and we brought him

home, over to my mom's house.

NARRATOR Alone in her apartment, Melissa continues

to consume alcohol, racing her blood alcohol level to over
[ … ]

two times the legal limit.

Melissa is drunk.

But unbeknownst to her, she is also dying.

Unlike alcohol-induced liver diseases

that can take a lifetime to develop,

her binge drinking is causing rapid and fatal changes.

The alcohol actually affects some of the enzymes

in the liver, and the triglycerides just start

building up in the liver cells.

Look like little balloons when you look under the microscope.

They should be pink, and they all get cleared

out from those triglycerides.

NARRATOR By Sunday evening, Melissa's binge drinking

takes its toll.

She passes out in her bedroom and falls into a deep sleep.

But even though Melissa is no longer drinking,

the damaging effects upon her body continue.

Within her liver, accumulating fat

begins to overwhelm the organ's function.

Her respiration and heart rate become labored and slow.

Probably she was in a coma at some point.

NARRATOR But Dr. G can only speculate

what happens to Melissa next.

JAN GARAVAGLIA What the exact mechanism of why she d*ed,

I don't know.

So we just say that she d*ed of the effects

of acute and chronic alcoholism.

NARRATOR Melissa, Dr. G concludes,

was an acute alcoholic, even though she drank only

occasionally and for only five years,

the binges were enough to cause deadly consequences.

Alcohol affects every part of your body.

You learn how alcohol affects your body,

and you learn pretty much every system in your body.

You learn medicine.

Not everybody gets liver disease.

Not everybody gets the cardiomyopathy

or the heart disease associated with alcohol.

Everybody's genetically different.

Their patterns of drinking are different.

But the myriad of diseases you can get from alcohol

is unbelievable.

NARRATOR For her family, the news that Melissa actually d*ed

from binge drinking is a shock.

That is so baffling to me.

Because I've known people been drinking

for years and years and years.

So that is really, really baffling.

But that just shows you what alcohol can do.

It hurts.

That part of it hurts, you know, because I didn't see where

Melissa had to go that way.

NARRATOR The family now faces the daunting task

of raising Melissa's infant son without his mother.

But they have come to believe that Melissa

could not have overcome her alcoholism

without professional help.

You can love them unconditionally

and love them forever.

But you can't-- it's not within your power to treat alcoholism.

(SINGING) I was thinking about you last night.

JAN GARAVAGLIA So much of what we see in the morgue

is self-destructive behavior.

How you live your life starts you

on a road that eventually will lead

you here to a visit with me.

(SINGING) It's so hard to live a life or live life

until you're gone for good.