03x08 - A Deadly Business

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NARRATOR It's Doctor G's first case

ever as a medical examiner.

This is my first real job.

I mean, it was a little scary to go into that.

NARRATOR And suddenly, she's thrust

into a gruesome, high profile investigation

involving bodies.

We had some that were mummified,

some that were skeletonized, some that were decomposing.

NARRATOR And then a Vietnam veteran d*ed suddenly in bed.

Will his psychological condition provide

clues to his cause of death?

For years, he was being treated for post-traumatic

stress syndrome.

NARRATOR But his grieving widow thinks his symptoms

may have been misdiagnosed.

I had thought that David had had a couple of heart att*cks,

and I wanted somebody to pay attention to me.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

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

Yeah, I never go anywhere.

OK, it takes a lot of guts to appear on national TV

with this thing, but I have no pride.

NARRATOR Multiple homicides, tragic accidents,

mysterious deaths.

Well, I can't make heads or tails.

This brain is even worse than most.

NARRATOR As chief medical examiner for the District

morgue in Orlando, Florida, Dr. Jan Garavaglia

has gained national respect for her ability to handle

complex, high profile cases.

Basically, you know, you make or break your career on,

are you honest?

What is the truth?

What do I know and what do I don't know?

How can I prove what I know?

You just have to consistently work on that.

NARRATOR Today, she is one of America's

top forensic pathologists.

Yeah, let's put a mask on.

NARRATOR But there was a time when

she had to prove herself in this unforgiving high stakes world.

So I'm not doing Tuesday.

NARRATOR This is the story of her very

first case, the story of how she became Dr. G, medical examiner.

Earning the right to practice as a licensed medical examiner was

no small feat for Dr. G. It required

determination, resolve, and nine years of rigorous postgraduate

education.

JAN GARAVAGLIA Four years of college, four years

of medical school, then four to five years of pathology,

and then another year of forensic pathology.

I trained in Miami, which was just a hotbed of homicides

back then.

NARRATOR And in , this intense training

finally paid off.

Dr. G got her first real job as an ME

at the Duval County Medical Examiner's Office

in Jacksonville, Florida.

Well, it seemed like a very nice office.

My husband at the time thought that he

would like to move up there.

We thought it would be a nice place to live.

NARRATOR But then two stunning events

changed her life from perfectly planned

to completely unpredictable.

One concerned a personal first.

As, you know, these things happened, I became pregnant.

NARRATOR In addition to dealing with her first pregnancy,

Dr. G was about to receive some shocking news concerning

her new job in Jacksonville.

The news came suddenly one afternoon, just three weeks

before her start date.

I was sitting at my desk in Miami trying to get some cases

out, and somebody came up to me and said,

you may want to reconsider going to Jacksonville.

They're going to have a mess when you get up there.

And I go, why?

And they said, oh, you need to look at the news.

NARRATOR According to the news article,

the Duval County Medical Examiner's Office,

her new employer, had just embarked

on an astonishing investigation.

Several weeks before, two state officials

on a routine inspection made a gruesome discovery

at the Howell Morning Glory Chapel, a funeral home

in a low income neighborhood in Jacksonville.

And they noticed that there are

two bodies in a hearse that shouldn't be there,

that appear to be rotting.

NARRATOR The corpses were clearly decomposed,

and they suspected there could be many

more inside the house itself.

You know, funeral homes have certain rules.

They're supposed to either embalm the body

or refrigerate that body.

So this was a huge problem.

Who were these people?
[ … ]

Did their families know they were here?

You know, what was going on here?

NARRATOR Officials immediately called the Sheriff's

office to notify them of this bizarre and disturbing

situation.

And then they elicit the state attorney, who, like, what

do we do with these bodies?

Well, whenever you have bodies, you know, who do you call?

You call the medical examiner.

NARRATOR Now authorities are counting

on the local medical examiner's office

to fully investigate the scene.

And that local office happens to be Dr. G's new employer.

The next day, the morgue's chief forensic investigator,

Lou Eliopulos, leads the team on their first step

in the process--

conducting a thorough search of the funeral home, which

is also where the funeral director, Lewis Howell,

lives with his wife.

We were going to look in the ceilings.

We were going to look in the walls and stuff

for any hidden bodies.

NARRATOR As investigators explore the premises,

their worst fears are realized.

They find bodies strewn throughout various rooms

in plain view, in Howell's office, hallways, and garage.

It appears that Lewis Howell had not been doing his job,

burying or cremating all of the dead bodies left in his care.

He wasn't doing it for whatever reason.

NARRATOR Faded remains wrapped in plastic, limbs

festering under lime dust, some stuffed in caskets, two

to a box.

And in the kitchen--

We found a large woman, maybe pounds,

lying on a stretcher.

And this was just a couple of feet from the counter

where food was prepared.

You know, what I do everyday, I

have to deal with dead bodies, and I treat everyone

with the utmost respect.

And it's honestly disgusting to me

that he would treat a dead body like that, that he would just

pretty much throw it in the corner and let it rot

and pretty much just step over it every day.

NARRATOR But the most shocking discovery lies behind the wall

of a large closet.

They found what looked to be like a false wall.

And when they broke into that, they found

many more bodies piled up.

LOU ELIOPULOS We had some that were mummified,

some that were skeletonized, some that were decomposing,

some that were liquefied remains,

some that hadn't been dead for very long.

One of them was actually flattened like a pancake.

NARRATOR Nine grueling hours, fighting the stench, the heat,

and sheer disgust, the team uncovers rotting bodies

and transports them all to the morgue.

LOU ELIOPULOS I remember never being more tired in my life

than that night when I drove home.

NARRATOR The Morning Glory case ignites outrage

across the country toward Lewis Howell,

especially among those who feared their loved ones could

be among the recovered dead.

A lot of them wanted him thrown in prison right then

and there because of these actions.

NARRATOR But shockingly, prosecutors' hands are tied.

There is no Florida law in against such horrifying neglect

of the deceased.

They wanted to charge him with something,

and they couldn't charge him just with the way

he treated the bodies.

NARRATOR Now they need to identify the victims

in the hopes of proving that the man's actions were not

just abhorrent, but illegal.

This will be Dr. G's first assignment

as a medical examiner.

And I knew that was going to be a huge job.

NARRATOR A huge job for any medical examiner and especially

challenging for a rookie just embarking on her career.

Coming up next, Dr. G could end up over her head

on her very first assignment.

It was on TV.

It was on the radio.

It was on the newspapers.

My mom was in St. Louis, and she had heard about it.

She was like, oh, no, look at the place you're going to.

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

Dr. G is only years old.

She's four months pregnant, and she's

about to begin her first real job as a medical examiner.

But this is no typical first day of work.

Her new employer, the Duval County Medical

Examiner's Office, has just become embroiled

in a huge national case.

This is my first real job.

It was mixed emotions.

I mean, it was a little scary to go into that.

NARRATOR Investigators have found

rotting bodies in the Howell Morning Glory Chapel.

And since then, they've uncovered
[ … ]

some telling information about the funeral director, Lewis

Howell.

For years, Duval County has been paying Howell

to provide funeral services to Jacksonville's poorest

residents.

His fee?

Up to $ for every decedent.

He was given money to bury these people.

Often, they were indigents.

The county was giving him money to bury these people.

NARRATOR This discovery gives prosecutors a vital lead.

If Howell had been paid for burials

and had pocketed that money instead of doing his job,

they could charge him with fraud and theft.

But to prove this, they need to identify the decomposed victims

and match them against the list of people

Howell was paid to bury.

JAN GARAVAGLIA The identification was key

because he could have said these were people who

never paid for their funeral, so I never did anything with them.

NARRATOR And there's another disturbing aspect to the case.

Investigators suspect that Howell might have further

profited illegally by putting multiple bodies in the caskets

he did bury.

JAN GARAVAGLIA Is somebody visiting that grave thinking

they're visiting someone, their loved one, and are they there?

Are they not there?

Are they visiting multiple people?

NARRATOR To find out, investigators

ordered the exhumation of four caskets recently buried

by Howell in a local cemetery.

Those caskets, too, are sent to the

Jacksonville medical examiners.

Dr. G now has her first opportunity to prove

her skills as a professional.

As she enters the autopsy room, she quickly

realizes that her new colleagues have been working

around the clock for the past three weeks

and are desperate for her arrival.

I think everybody else was kind

of burnt out in the office.

And so I was the fresh blood.

I was the calvary coming in.

NARRATOR As a rookie ME, she expects

to play a supporting role in this investigation.

Instead, she's given a critical role.

The first day was the bombshell.

NARRATOR Her assignment?

Take charge of the four exhumed caskets.

She must first determine if the caskets

contain multiple bodies.

Then she must gather enough forensic evidence

to identify them as people that Howell was paid to bury.

The state could then bring charges of fraud against Howell

for pocketing the money he saved by improperly burying bodies.

And it was exciting.

I mean, it was making national news.

NARRATOR But working in the media spotlight

on a high stakes forensics case was not a role Dr.

G had envisioned for herself.

In fact, the idea of becoming a medical examiner never

crossed her mind until late in her medical school career.

She began studying internal medicine

and worked hard in medical school to become a physician.

But just one year into her residency,

she came to a troubling realization.

JAN GARAVAGLIA I was OK at internal medicine,

and people-- my patients liked me.

But I was just getting really burnt out.

You got to do something you have a passion for that you like,

or life can seem really long.

NARRATOR She started searching for another specialty

in medicine that would inspire her.

It was so fascinating, the forensic lectures.

So I decided to go ahead and go into pathology

to do a forensic pathology.

NARRATOR But that meant she would have

to train for an additional six years

for a job dealing with the dead that would pay far less

than working with patients.

And people thought I was throwing

away my medical career.

And my mother's like, you know, what are you doing?

What are you going into?

So you're not going to be a doctor anymore?

And I'm like, no, it's still a doctor.

It's like Quincy.

That was the only thing people knew back then.

NARRATOR Worst of all were her own doubts

about giving up her dream of helping sick people,

until she had a sudden revelation.

I realized, you know, in a different way,

you're helping people.

You're not helping the living.

But you are giving a voice to the dead,

and sometimes you can help the survivors cope and understand.

NARRATOR Now the years of specialized training

will finally count for something if she

can successfully give a voice to the dead in the Morning

Glory case.
[ … ]

If she can't, the man who mistreated them

may never be brought to justice.

It's the moment of truth as Dr. G

faces her first exhumed casket.

Immediately, she finds herself the center of attention.

Exhumations are always interesting because they're

not that common.

It always draws the crowd.

It's like opening a present at Christmas.

You never know what you're going to find.

NARRATOR After a minute or so of pushing and pulling,

the lid finally cracks open.

And the first thing I saw, I mean, it was

kind of a m*nled bit of mess.

NARRATOR With the eye of a trained forensic pathologist,

she takes a closer look at the remains.

But it doesn't take an expert to see

right away that this coffin has not one or even two bodies

crammed inside.

Howell had stuffed it with three.

When you open a casket with, you know, multiple bodies,

that's anything but routine.

NARRATOR Dr. G spends the day opening the other three caskets

and removing their contents.

Her final tally, a whopping eight bodies,

and all of them heavily decomposed,

reduced essentially to skeletons.

Now Dr. G must retrieve meaningful clues

from these exhumed remains while under the scrutiny

of her new colleagues.

Anybody that starts a new job, you

don't want to be thought of as stupid and a fool.

So whatever little experience I had working with the skeletons,

I was thrown into the frying pan.

And I had to learn quick.

NARRATOR The next day, Dr. G begins

by arranging the first skeleton on an autopsy table

and carefully inspecting its condition.

We just would slowly--

you know, what we're doing is documenting what we're seeing.

We're photographing what we're seeing.

NARRATOR But then, an object in the chest cavity

grabs Dr. G's attention.

It's something she never encountered in all her years

of training.

In fact, it's something that definitely does

not belong in a human body.

Coming up next, will the team be able to figure out

what this bizarre object is?

Instead of a heart inside their chest cavity area,

it's a m*nled mess kind of just junk.

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

Investigators have recently discovered

corpses left to rot by funeral director Lewis Howell.

Now as Dr. G begins her first case as a professional ME,

prosecutors are counting on her to identify

enough victims to charge the man with fraud and grand theft.

The county had paper trails that they did pay him,

and we had to prove that these people were still there.

NARRATOR But now in her first autopsy

as a professional medical examiner,

Dr. G has made a baffling discovery.

She closely examines what lies inside the rib

cage of this decedent.

It's not an internal organ, but something far more disturbing.

Instead of a heart inside that chest cavity area,

it's a m*nled mess of kind of nesting material and weeds

and kind of just junk.

NARRATOR Dr. G and her new colleagues

quickly determine that this bizarre clump of material

is, in fact, a rat's nest.

The implications are staggering.

Because no rat is getting into a sealed casket.

That body probably laid in this funeral home for a long time.

NARRATOR Ironically, the nest contains

useful forensic evidence-- newspaper scraps printed

with the publication date.

The newspapers were important to us

because at least it gave a rough time estimate as to when

this person may have d*ed and been

handled by a funeral director.

So we were interested in that.

NARRATOR Dr. G's findings further confirm that this body

was improperly buried.

Now she must ID the body as one that Howell was paid to bury.

She takes detailed measurements of the specific bones that

can reveal identifying characteristics,

such as sex, race, height, and age.

Certainly, the skull holds a lot of information for us.

Brow ridges are very prominent on men.

Women tend to have much more delicate features.

They don't have the brow ridge.

With the race, it tends to be the nasal aperture,

the shape of the orbits, the shape

of the mandible and maxilla.

NARRATOR From this skull, she discovers that this victim

is a white male.

Now the age is difficult sometimes.

One of the things we'll look at are ends of ribs,

and we'll look at where your pubic bones go together,
[ … ]

your pubic synthesis to see how much wear,

how much rigidity that they have.

NARRATOR From this man's bones, she

can tell he didn't die young.

His bones are thin and fragile, typical of osteoporosis,

the bone disease that plagues one in five men

and one in three women over the age of .

Dr. G hopes this information-- the man's approximate age,

race, and medical history--

will be enough to determine his identity.

The information goes straight to Sheri Blanton, an assistant

from the state attorney's office,

later to become one of Dr. G's closest friends.

She handles the next step in the identification process--

comparing the profile to the list of decedents

Howell had been paid to bury.

We had to take that list, and then we

used our physical characteristics

of their bodies to match it up.

Every time you found an identity

and you could make a positive ID, it was a good feeling.

NARRATOR As Dr. G continues to examine and document

the remaining bodies exhumed from the caskets,

it becomes clear she's a natural born medical examiner.

She wasn't afraid to ask questions.

She wasn't afraid to dissent.

I think Dr. Garavaglia was incredible in that way.

She was extremely intelligent, and she was

extremely fair and scientific.

And I think that's all you can ask

for in a forensic pathologist.

NARRATOR In the end, Dr. G and her colleagues

are able to identify the male skeleton in question,

along with more of the bodies discovered,

enough for prosecutors to file criminal charges

against Lewis Howell.

He was receiving city funds to cremate

or bury these individuals.

And in fact, he didn't.

NARRATOR And now, after weeks of grueling exhumations

and examinations, Dr. G and the entire investigative team

can replay the chain of events that led to the mistreatment

of more than human bodies.

In , Lewis Howell wins a city

contract to bury Jacksonville's poorest residents.

The city pays Howell $ for each decedent,

but instead of burying each body in its own coffin,

he accumulates them before interring several

together in a single coffin.

Meanwhile, he pockets the cash that he saves on coffins.

He was paid to do a job, and he did not perform that job,

yet took the money.

I think it's just pure greed.

I think some people rob Jiffy Marts, some people rob banks,

and some people rob through the dead people that they handle.

NARRATOR But Howell doesn't stop at burying

multiple bodies in one casket.

Sometimes he just doesn't bury them at all.

He decided to start stacking bodies in his closet,

and when he was through, they were stacked up like cardboard.

NARRATOR Howell's scam goes undetected for nearly years,

until one day, a routine inspection

finally brings him to light.

Armed with the identifications, prosecutors

charge Howell with six counts of grand theft and

misdemeanor counts of fraud.

His possible maximum sentence--

years.

Howell eventually pleads guilty to three of the theft charges.

And although the funeral director ends up

serving only weeks in prison, Dr. G

is still glad that her first case ended in triumph.

We fulfilled our duties to help the prosecution

to prove that there was a felony grand theft going on

because these people were not disposed of.

NARRATOR The case has also had a lasting impact on her life.

Through it, she discovered what it

means to be a medical examiner.

You never know in this job what's going to come your way.

You know, these truly weren't medical examiner cases,

but they needed our help.

And that's what I realized.

You know, this isn't just cause and manner of death.

This is all sorts of problems people have.

And, you know, this is just on a grander scale.

And I don't think I really understood

that until this case.

It's not glamorous, you know, working on your feet all day,

being exposed to terrible smells,

being exposed to infectious diseases,

being exposed to nastiness, you know,

maggots squirming all over, popping, jumping at you.

But it's really rewarding.

And I love the way I can still use my medical knowledge.

It's just tremendously fulfilling.

NARRATOR Coming up next, a man dies suddenly in his bed,

and his grieving widow thinks the hospital may

have missed some vital clues.

I thought that David had had a couple of heart att*cks,

that I wanted them to look for something different.
[ … ]

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

It's Saturday morning in Orlando, Florida,

and the sleepy city is slowly waking up.

For many, weekends offer the perfect opportunity

to relax or spend precious moments with loved ones.

But for Orange County chief medical examiner Dr. Jan

Garavaglia, this is one Saturday she won't

be spending with her family.

Eric's not a big breakfast eater.

We gotta really kind of like.

NARRATOR That's because she's off to work.

When Dr. G arrives at the District morgue,

the first case on her full roster is already waiting.

David Gilliam, a -year-old man in apparent good health,

d*ed suddenly and unexpectedly at home

just four hours earlier.

Now his distraught wife, Tina, is desperate to know why.

Well, this guy--

this is kind of a strange story.

He's .

NARRATOR Dr. G begins by reviewing the morgue

investigator's report to learn all she can about David

and the circumstances surrounding his death.

By all accounts, David Gilliam was

a loving and devoted husband, well-liked in his community.

He was a very, very generous person.

I mean, sometimes I'd have to come home,

make sure he didn't give the house away.

NARRATOR The night of his death begins uneventfully.

David and Tina, both tired from their busy work week,

head to bed early.

He's been gone for a week on business.

He's in bed with his wife.

What's wrong, honey?

What's wrong?

He just kind of reaches over to her,

doesn't really say anything, and then vomits.

TINA And I looked down.

I said, David, what do you need?

And his arm was kind of shaking, and I knew just immediately

that I was in trouble and that he was in trouble,

but that I was alone and I didn't know what to do for him.

She immediately calls .

I don't think he's breathing.

Please, help.

NARRATOR The paramedics quickly arrive on the scene and attempt"], index ,…}

to resuscitate David without success.

They then rush him to a nearby hospital.

Nobody was coming and saying anything,

and they were not working on him.

And I knew at that moment.

NARRATOR David Gilliam is pronounced

dead in the emergency room.

Cause of death, unknown.

So what we want to know is, was there anything

else leading up to this?

NARRATOR As Dr. G reviews David's medical report,

she learns that he had a history of high blood

pressure and high cholesterol.

And that's not all.

He hadn't been feeling well the week before.

NARRATOR According to his wife, David

was experiencing a disturbing symptom

just a week before he d*ed.

He's got some chest pain, which makes us think that he's

maybe had a heart att*ck.

NARRATOR But according to his medical history,

David Gilliam had no known serious heart problems.

Then as she nears the end of the report,

Dr. G stumbles across an interesting piece

of information, one that promises

to open a precious window into David's life.

For years, he was being treated for post-traumatic

stress syndrome.

NARRATOR Post-traumatic stress disorder

is a debilitating condition that affects people who

have experienced or witnessed a traumatic event,

such as physical or sexual as*ault,

a violent accident, natural catastrophes,

or m*llitary combat.

What all of those events have in common

is the potential for a person to feel that their life is

threatened or that their physical integrity

or psychological integrity is threatened.

NARRATOR Dr. G calls his wife to learn more

about how PTSD affected David.

Tina tells her that as a young man,

David served in the Vietnam w*r.

And he came home a changed person.

David suffered from a range of PTSD symptoms,

including vivid flashbacks, increased irritability,

emotional distance, sleep disturbances, and feelings

of anxiety and depression.

Take your worst day on earth and magnify it by times,

and that's how David lives every day.

NARRATOR But what Tina reveals next raises the stakes

in Dr. G's investigation.

David, over the years, had chest pains quite often.

He didn't really know what it was,

but that it felt like that he was just
[ … ]

having a heart att*ck because he'd have

so much pressure in his chest.

NARRATOR But time after time, instead of treating him

for a possible heart att*ck, David's doctors

would dismiss his symptoms as harmless and send him home.

And they would say, no, you don't have any heart disease.

This is related to your post-traumatic stress syndrome,

and they were just panic att*cks.

NARRATOR That's because a person in the throes of a panic

att*ck may experience chest pains that can be easily

confused with a heart att*ck.

JAN GARAVAGLIA They feel like they're dying.

They feel like they're having a heart att*ck.

It's not a pleasant thing to live through.

NARRATOR But now, with David's sudden and unexpected death,

Tina is beginning to question the doctor's diagnosis.

She wanted to know, were these actually small heart att*cks

that he was having all along?

She was worried that they truly missed heart disease on him.

Even though that they listened,

I just could not understand why that they wouldn't

run some different tests.

NARRATOR Now Tina is counting on Dr. G

to tell her if David was misdiagnosed.

And if so, could his death have been prevented?

We don't know, and we're not going to know

until we do the autopsy.

NARRATOR A quick glance over David's body

reveals no outward signs of trauma or disease.

He's only .

NARRATOR But when Dr. G examines David's face and eyes,

she spots something suspicious.

He had a very congested appearance to his face,

a little bluish discoloration.

NARRATOR And David also has multiple broken blood vessels

inside his eyes and eye membrane,

a condition known as petechiae.

Basically that means to me that there

is a lot of increased pressures in his vascular system,

the head and chest region.

We often see that with people who

die of sudden cardiac deaths.

NARRATOR But Dr. G will need more

concrete evidence to determine exactly what k*lled David.

And there was only one place left to look for answers--

inside the body itself.

Coming up next, was David's wife right and his doctors wrong?

Or could there be another stranger explanation?

That's interesting.

This is a case of a sudden death of a patient

with no known disease that would cause him to die.

What was really going on with him inside?

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

Dr. G's morgue technicians are busy prepping

the body of -year-old David Gilliam

for the next part of the autopsy.

We gotta get this going.

NARRATOR She hopes the internal exam will provide the answer

to a pressing question weighing heavily on David's wife's mind.

Was he the victim of a medical misdiagnosis?

Tina Gilliam is not convinced that David's chest pains

were due to panic att*cks.

I thought that David had had a couple of heart att*cks.

I wanted them to look for something different.

NARRATOR First, Dr. G makes a standard Y

incision across David's torso, revealing the internal organs.

OK, go do your side.

NARRATOR Next, she cuts through the ribs and sternum

and slowly removes David's chest plate.

As soon as they take off the chest plate,

it's like, oh my gosh, I see there's a problem here.

NARRATOR The problem she spots is with David's heart sac,

or pericardial sac.

The heart sac is a tough membrane that surrounds

and protects the heart.

It's like a little bag that the heart sits in.

So the heart sits in this bag and then

you have both lungs on both sides,

and it pumps inside this bag.

NARRATOR Normally, this sac contains a small amount

of fluid that acts as a lubricant, cushioning the heart

and allowing it to b*at freely inside the sac.

But in David's case, Dr. G finds something else.

Looks like blood.

Yeah, his heart sac is full of blood.

NARRATOR This much blood in the heart sac is lethal.

The buildup of fluid presses back against the heart

and ultimately prevents it from b*ating.

This is called a cardiac tamponade.

The tamponade is clearly what k*lled David.

And as Dr. G carefully examines the walls of David's heart,

she quickly finds the source of the trouble.

Oh, my.

As I look at the heart, on the back side of the heart,

there's about a one-fourth inch tear to the heart muscle.

NARRATOR This tear proves that David's heart

burst open, flooding his heart sac with blood.

JAN GARAVAGLIA See, you can see the tear right through.

That's where the muscle blew out.

NARRATOR But Dr. G must now get to the bottom of a new mystery."], index ,…}
[ … ]

What caused the rupture in the first place?

She soon finds further evidence that there

was something terribly wrong with David's heart.

His heart muscle was yellow and soft and just necrotic.

I can see that.

NARRATOR This dead heart muscle is a clear indication

that David suffered a myocardial infarction, or heart att*ck,

some time before his death.

JAN GARAVAGLIA He's had a heart att*ck.

NARRATOR Dr. G has now uncovered the chain of events

that led to David's death.

First, he experienced a heart att*ck,

and a section of his heart began to die and decay.

Then the wall of his heart muscle

became so weak that eventually, it burst open, allowing blood

to pour into his heart sac.

And all the blood rushes out of the heart into that sac.

And it's a very, very quick way to die.

NARRATOR However, it appears that David suffered

his heart att*ck well before his death without ever knowing it.

When that man was having his symptoms,

that's when he was having the heart

att*ck about seven days ago.

NARRATOR Only a small portion of David's heart

was affected, which allowed him to carry

on his normal everyday activities unaware,

until it fatally ruptured seven days later.

She said the heart was a muscle

and that the muscle just exploded, so to speak.

And when I got to thinking about it later, I cried.

NARRATOR But Tina Gilliam is still

anxious to know if her husband experienced

earlier heart att*cks that doctors

misdiagnosed as panic att*cks.

I wanted to hear something that I didn't do wrong.

NARRATOR And in order for Dr. G to answer that pressing

question, she must figure out exactly what caused the heart

att*ck that started this fatal chain

reaction in the first place.

Coming up next, could David Gilliam's death

have been prevented?

Dr. G finds the answers, but will they

satisfy David's grieving widow?

This is a fairly rare complication of a heart att*ck.

Most people's heart att*cks don't do this.

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

Dr. G is on a quest to discover what caused

David Gilliam's heart att*ck.

She also hopes to answer Tina Gilliam's pressing question.

Were David's chest pains that he experienced

throughout the years panic att*cks related

to his PTSD or heart att*cks?

You really just want your loved one back.

You know your life is changing.

You cannot stop it.

But you're just searching for anything and everything

to tell you that you didn't do anything wrong.

NARRATOR Dr. G painstakingly dissects

David's coronary artery, which is

the main blood vessel that supplies blood

and oxygen to the heart muscle.

She is searching for a possible blockage.

I got to make sure I don't cut myself.

NARRATOR Then after a few minutes

of fruitless searching--

Voila, a little thrombosis.

Blood clot right inside the coronary artery--

classic.

NARRATOR Dr. G has her culprit.

A blood clot or thrombus is obstructing

David's coronary artery.

So no blood is getting to that part of the heart.

That part of the heart starts to die.

And that's why he's having chest pain.

NARRATOR But for Dr. G, the case of David Gilliam

isn't over until she can answer the question closest

to Tina Gilliam's heart.

Was this the first or the last of many heart

att*cks for her husband?

I had thought that David had had a couple of heart att*cks,

and I wanted somebody to pay attention to me.

NARRATOR Typically after a heart att*ck,

the body will replace dead heart muscle with scar tissue

in an effort to heal itself.

The heart itself is kind of a reddish brown,

and the scar tissue is kind of white.

NARRATOR Had David experienced previous heart att*cks,

Dr. G should be able to see white scar tissue.

But when she examines David's heart further,

she finds nothing.

This absence of scar tissue can mean only one thing.

He's had no other heart att*cks.

So he's not having little heart att*cks.

He only had one big heart att*ck about one week before he d*ed.

NARRATOR Now Tina can at least take comfort in the knowledge

that David was not misdiagnosed.

The chest pains he'd been experiencing over the years

were panic att*cks after all.

With this last piece of the puzzle,

Dr. G is now able to reconstruct the final moments
[ … ]

of David's life.

About seven days before his death,

David Gilliam begins to experience

mysterious chest pains.

A thrombus, or blood clot, has developed

in David's coronary artery and is obstructing

the blood flow to his heart.

Unaware that he has just had a heart att*ck,

David fails to call a doctor and continues

his normal daily activities.

Meanwhile, his heart muscle deprived of oxygen rich blood,

continues to die, turning yellow, soft, and necrotic.

Then seven days after the initial heart att*ck,

tragedy strikes.

He's lying in bed with his wife.

He may have felt something funny, reaches out to her.

While he's reaching out, the heart muscle

broke open at that vulnerable spot where it had d*ed.

NARRATOR Like a burst dam, blood

begins to hemorrhage through the hole in David's heart.

Once that sac is under pressure,

as the blood's coming out of the heart,

it's pushing back on the heart.

And eventually, the heart can't b*at anymore.

It tamponades.

NARRATOR David collapses and never

regains consciousness again.

And he dies.

NARRATOR It is an end that came too soon for the loved

ones David left behind.

I would say to David, thank you for being part of my life

and for letting us know that life is about people.

And it's about taking care of one another,

loving one another.

It's not about the dead.

It's about the living.

NARRATOR But even as she grieves,

Tina remains grateful to Dr. G for giving her the answers

she so desperately needed.

Dr. G was fantastic on the phone with me.

She gave me a lot of understanding

about what happened.

The irony of it all is that he's having symptoms for years,

and he didn't have heart disease.

And it's kind of like the boy who cries wolf.

When he truly has the symptoms, he ignores it.

NARRATOR Had David seen a doctor

when he first began to experience his symptoms seven

days before his death, it is possible that his heart att*ck

might have been treatable.

But David never did make the call,

and Dr. G thinks she knows why.

You wonder that maybe because he's had all these episodes

of post-traumatic stress that that's why

he didn't go seek help.

It's a very real possibility.

NARRATOR As she wraps up her case,

Dr. G reflects on the wounds of w*r and the fact

that they are not always visible to the naked eye.

I think when we think of w*r, we think of people being

sh*t and k*lled right away.

And we don't often think of the huge toll

it plays on your psyche and how sometimes these men

have to live with it for years.

And it is a huge toll on human life in a very indirect way.

MAN Atlas.