03x12 - Deadly Destination

[bunniefuu]

[dramatic music]

NARRATOR An elderly man dies at home

from apparent natural disease.

He has severe coronary artery disease.

He has hypertension, he has diabetes.

NARRATOR But when his family discovers his car is missing,

they wonder if something more sinister is to blame.

JAN GARAVAGLIA I think everybody is thinking,

could this be foul play.

NARRATOR Now, Dr. G must solve this puzzling mystery.

JAN GARAVAGLIA We're going to bring him back

from the funeral home, and I'm going to make sure there's

no evidence of trauma.

NARRATOR And then, a -year-old grandfather

takes a relaxing trip to Orlando with his family,

only to find himself wracked with pain on his first night

in town.

JAN GARAVAGLIA The next morning,

he eats breakfast and then just doubles over in abdominal pain.

As soon as he went down, he was dead.

NARRATOR Can Dr. G determine what suddenly overwhelmed

this seemingly healthy man?

I have to think a what could cause the abdominal pain

and then k*ll you?

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

This morning, Dr. G's day won't start in the morgue.

Instead, in an effort to stay fit and healthy,

she's off for a jog.

JAN GARAVAGLIA I got the radio on, the Bee Gees going.

I listen to some great music.

Usually something to get your blood going.

And then I'll start running, and I can run a couple miles.

Even though I have a hectic home life,

you gotta make time for yourself in one good way,

and you can k*ll two birds with one stone,

I find, is if you exercise, because you're

doing something good for yourself,

and it's a great stress reliever.

I would love to be a couch potato,

but I know it's good for me, and I it's a good way to relax.

NARRATOR But by AM, she is in the morgue, ready to start

work on the day's autopsies.

This morning, Dr. G's first case is a man

who was found dead in his home in Deltona, Florida

late last night.

JAN GARAVAGLIA So this is a fellow

we got a call from yesterday.

He's an older man, .

He has a locked apartment.

NARRATOR As a first step, Dr. G reviews the case

file of Ricardo Sanchez and learns the events

leading to his death.

According to investigator, Bill Stratton, friends and family

last saw Ricardo four days earlier

when he left a small get-together just before dusk.

BILL STRATTON The decedent was going

to drive home before dark, because he

didn't like driving at night because

of his age and his eye--

he had some minor eye problems.

NARRATOR Bill Stratton learned from his family

that Ricardo was an energetic man

with a great sense of humor.

During the last several years, he had spent most of his time

with his close-knit family, enjoying his retirement.

Like many of the elderly, Ricardo,

who had lived alone since his divorce years earlier,

clung to his independence.

He insisted on driving rather than rely

upon others for transportation.

He also refused any professional home care

despite his failing health.

As far as his family and friends knew,

Ricardo made it home safely that evening.

However, four days later, no one has heard from him.

JAN GARAVAGLIA His family worried about him.

They did a welfare check on him and found him deceased

in his locked apartment.

NARRATOR Ricardo's son and sister discover him face down

on the floor wearing the same outfit he had

on at the family get-together.

JAN GARAVAGLIA He is just dead right

there as if he had collapsed.

NARRATOR According to the police officer who was called

to the scene, the body is already beginning to decompose,

but there were no signs of foul play.

HAROLD FELSHAW There was nothing

that appeared to be out of the ordinary or suspicious

in nature.

His door was locked.

There was nothing in disarray.

He had his car keys in his pocket.

He had his billfold in his pocket.

He had his jewelry on.

His clothes were intact.

Everything seemed fine.

It looked as if he had just collapsed.

Our belief, the police department's belief,
[ … ]

and the medical examiner's office

was that this was a natural death.

We didn't have any reason to believe otherwise.

NARRATOR And when contacted, Ricardo's private physician

agrees with the assessment.

JAN GARAVAGLIA We called the doctor,

the doctor said, yeah, he has severe coronary artery disease.

He has hypertension.

He has diabetes.

He could have d*ed at any time.

NARRATOR Ricardo's death is classified as natural,

and his body is transferred to a funeral home for burial.

But only hours later, his family makes a startling discovery,

one that raises new suspicions.

His car is missing.

JAN GARAVAGLIA The detective gave us a call

and said, you know, the fellow that we released,

everything was still--

it was fine, except where's his car?

So that right there is kind of a red flag to indicate

that something's not right.

I think everybody is thinking, could this be foul play?

I said, well, you know, we should look at him.

We should go back.

We should go to the funeral home,

bring him in, at least do X-rays and look at him externally.

NARRATOR Based on this new information,

Dr. G wonders if Ricardo did not die from natural causes

after all.

JAN GARAVAGLIA We'll go ahead, we'll

check on him any type of trauma, and we'll

go ahead and do X-rays and see if we see anything.

NARRATOR Before the examination,

morgue technicians take extensive X-rays

of Ricardo's body.

JAN GARAVAGLIA We did an X-ray of his skull.

We did an X-ray of his ribs and long bones.

NARRATOR While soft tissue internal injuries may not

be detectable in an X-ray, if Ricardo

sustained any fractures in an att*ck,

these will show up on the film.

While the images are being developed,

Dr. G prepares for the external exam.

She will search for any signs of trauma

that might indicate Ricardo was the victim of an as*ault.

JAN GARAVAGLIA But I certainly didn't

see any major trauma on him.

NARRATOR And when Dr. G reviews the X-rays a few minutes later,

she finds no fractures or skeletal injuries either.

JAN GARAVAGLIA We really don't have any foul play.

We don't have anything really that suspicious.

NARRATOR Because she finds nothing out of the ordinary,

Dr. G decides not to perform a full autopsy.

Instead, just after noon, Ricardo's body is

returned to the funeral home.

However, with explanations wanting,

the Sanchez family remains unsettled

by the elderly man's death.

JAN GARAVAGLIA They're concerned what happened to him.

But they're more concerned what happened to the car

and did it relate at all to his death?

NARRATOR Then, just hours after Ricardo's body

is released from the morgue, the Orlando

Police Department calls Dr. G with startling new information.

[phone rings]

Ricardo's vehicle has been located in an auto wrecker lot.

Yeah.

We ran into a little difficulty.

Now we knew that this man was involved

in a motor vehicle crash.

JAN GARAVAGLIA Now I have to worry,

was he injured from the car accident?

NARRATOR Given the unusual circumstances surrounding

Ricardo's death and to bring closure to his family,

Dr. G must perform a full autopsy.

JAN GARAVAGLIA And so lo' and behold,

this changes the complexity of the case.

NARRATOR When his family receives the disturbing news

that Ricardo's death may be due to a car accident,

their distress and grief are compounded by another emotion.

JAN GARAVAGLIA The family feels a lot of guilt

because they know that their loved

one's older family member's driving

skills aren't probably as good.

But yet, they don't want to take it away, because then

you take away their freedom.

NARRATOR The body must be immediately transported

from the local funeral home to the morgue for a second time.

JAN GARAVAGLIA So what we're going to do

is figure out what k*lled him.

NARRATOR Coming up next, Dr. G opens

the body of Ricardo Sanchez, and the case takes a sharp turn.

JAN GARAVAGLIA He was a walking time b*mb.

He could have d*ed at any time.

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

[dramatic music]

Early in the morning, the body of -year-old Ricardo Sanchez

returns to the District morgue in downtown Orlando.

Orlando police have just discovered

that he was in an auto accident on the day of his death.
[ … ]

Now, his family and Dr. G want to know if Ricardo's death was

caused by an injury in the accident and not

natural disease, as they had suspected.

JAN GARAVAGLIA If I hadn't have called that booty back,

I would have been remiss in my duties as a medical examiner.

NARRATOR Before beginning the examination,

Dr. G learns the specifics of the crash

from the investigating officer at Orlando PD.

JAN GARAVAGLIA Classic kind of old-person accident.

He fails to yield and makes the turn in front of a car

that's coming in that lane.

NARRATOR Now, Dr. G must determine

if Ricardo Sanchez's death was in fact caused

by a tragic car accident.

JAN GARAVAGLIA So what we're going to do is look for trauma,

look for natural disease.

Bottom line, figure out why he d*ed.

And so I do the Y incision.

Keep in mind, he's decomposed.

He won't have any blood left.

So I'm having a hard time doing tox.

He does have some maroon bloody decomposition

fluid that we typically see in his chest cavity.

I would remove that for toxicology.

NARRATOR Dr. G then examines Ricardo's internal organs.

She's looking for any signs of internal trauma

that may have been sustained from the accident.

JAN GARAVAGLIA One thing that I'd worry about

is maybe a delayed complication would be a spleen that

had ruptured or maybe a liver laceration,

where blood is accumulating.

I was worried about that.

Didn't have that.

Didn't really have any trauma to his abdomen.

OK.

I don't see anything.

NARRATOR But Dr. G sees no ruptures or lacerations.

And she finds no sign of internal bleeding.

JAN GARAVAGLIA And I don't see any free blood anywhere.

I don't see any free blood in his chest, just

that decomp fluid in his belly.

NARRATOR Based on these findings,

it seems that Ricardo's death was not related to the accident

after all.

Dr. G is now left with the original hypothesis,

that the -year-old man d*ed of natural causes.

His medical history certainly supports this possibility.

According to Ricardo's doctor, he

suffered from high blood pressure,

emphysema, and heart disease.

Dr. G will now weigh and dissect each organ to search for signs

of fatal natural disease.

She starts with the heart.

He has narrowing of every vessel sectioned.

They were at least % narrowed in every section

that I looked at.

So he was a walking time b*mb as far as dying from that heart.

NARRATOR At this point, Ricardo's diseased heart

is looking like the culprit.

JAN GARAVAGLIA And that is a possibility.

And that's right now all we can find.

NARRATOR But she must complete the full autopsy

to know for sure.

JAN GARAVAGLIA I have to make sure there's

nothing that trumps that heart.

NARRATOR Coming up next, Dr. G examines another organ,

and the case veers off course yet again.

JAN GARAVAGLIA I find blood, and it's fresh blood.

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

[dramatic music]

OK.

So he's ready to go up to the head.

- Up to the head. - OK.

NARRATOR Dr. G prepares to examine the brain

of -year-old Ricardo Sanchez.

Internally, she's discovered evidence of extensive heart

disease and suspects that he may have suffered a fatal heart

att*ck only a few hours after being involved

in a minor car accident.

This would mean that Ricardo did,

in fact, die of natural causes, as was first suspected.

JAN GARAVAGLIA He certainly had enough heart

disease to have k*lled him.

NARRATOR But before she can close the case,

she must complete the autopsy and rule out everything else.

Was there anything else that could've k*lled

him instead of that heart?

NARRATOR As a next step, Dr. G examines

the skull of Ricardo Sanchez to feel for any softness

that might indicate trauma.

But this exam is particularly difficult due

to the state of decomposition.

It was just a little bit mushy throughout because

of the decomp.

You know, a lot of gases form and fluid collects.

And particularly, as you're on your back,

there's some fluid that collects in the back.

NARRATOR Next, she cuts open the scalp

and reflects it to expose the top of the skull.

And there she sees for the first time something unmistakable.
[ … ]

He's got a bruise on the back.

There was just a bruise there.

This was quite clear as soon as I cut open.

It was a bruise in the back of his head,

and it was also what we call subgaleal.

It was over that thin covering over the bone.

How that relates to any of this, we're not sure yet.

We just know he bumped his head.

So the next thing we have to do is look inside the brain.

And I know I only have a second here, because that brain

is going to be very soft.

NARRATOR As the brain decomposes,

it turns into a semi-liquid state, which can obscure

signs of trauma or disease.

JAN GARAVAGLIA I'm not going to be

able to see subtle things on his brain,

because it's going to be green and pasty.

And it's going to lose a lot of its contour.

So I'm hoping there's something either

very obvious or nothing at all.

NARRATOR And in this case, it's very obvious.

JAN GARAVAGLIA As my assistant cuts open the calvarium,

and I'm kind of looking.

I'm the one that then takes it off

and immediately looks and, oh.

I find blood overlying the cerebral hemispheres,

overlying the brain, and it's fresh blood.

You know what?

Let's get time to collect this, my love.

NARRATOR What Dr. G finds is a subdural hematoma, a bleed

in the brain that occurs under the dura,

the protective membrane that covers the brain.

And these little bridging veins with some trauma

can shear, and then blood starts collecting.

Well, where's that blood going to go?

It doesn't have a lot of places to go,

because you have that brain usually up tight against there.

So it starts pushing on the brain.

Well, at this point, it's fairly clear.

He definitely has trauma to the brain.

NARRATOR It's a shocking discovery.

Lo' and behold, that's his cause of death.

NARRATOR Dr. G now knows for certain

what k*lled Ricardo Sanchez, a significant head injury.

And she also knows how the fatal trauma must have occurred.

JAN GARAVAGLIA And it's consistent with a car accident.

It's typically what we will see with a car accident

with shearing forces tearing those bridging veins.

Wow, he really hit hard.

Lo' and behold, he did die from the car accident.

It's an accidental death.

You know, initially we thought it was going to be natural.

You could not see the trauma.

Do you have one that's kind of clean?

At least we eventually got the right answer.

NARRATOR It's an unexpected ending

to a highly unusual case.

After several stops and starts, Dr. G

can at last inform Ricardo Sanchez's bereaved family

of her tragic findings.

According to family and friends, Ricardo

leaves a get-together to drive himself

home sometime near dusk.

JAN GARAVAGLIA He is a smart enough fellow

to know he has to leave the party

before it gets dark, because his vision is not as good.

He has trouble with glare, most likely.

NARRATOR Unfortunately, only a few miles from home,

his trip is cut short.

JAN GARAVAGLIA He's trying to make a left-hand turn.

He probably either doesn't see the car

or doesn't react well enough to the car coming

and turns right in front of the car,

causing that car to hit him.

NARRATOR The force of the impact

causes the blood vessels beneath his dura to tear

and slowly begin to bleed.

JAN GARAVAGLIA The subdurals are venous blood,

and it may not bleed real fast.

NARRATOR Had he requested medical attention at the scene,

Ricardo might have survived.

But Ricardo likely did not realize

the severity of his condition for two reasons.

Initially, the bleeding can be slow

and often does not cause any problems.

Also, like many elderly individuals,

Ricardo's brain has atrophied with age

and is actually better able to accommodate the bleeding.

JAN GARAVAGLIA As you get older, your brain shrinks.

Now that is the reason why he might not have noticed it right

after the accident, because there is a little space there

for the blood to collect, not causing

so much trouble to his brain.

NARRATOR After the accident, Ricardo's car

is towed to an auto wrecker yard and someone from the yard

drives him home.

Once in his apartment, the delayed effects of the injury

begin to hit full force.

JAN GARAVAGLIA He probably isn't home

very long when the blood just starts
[ … ]

accumulating more and more.

It gets to the point, by the time he gets home,

that there is no space left.

But the blood keeps pumping, and then it puts

too much pressure on the brain.

NARRATOR As Ricardo gets up from his chair,

the increasing pressure on the vital centers of his brain

suddenly causes him to lose consciousness.

Soon, he slips into a coma.

JAN GARAVAGLIA If you increase the pressure

into the cranial cavity, you're putting

pressure on the whole brain, the cerebral hemispheres.

Eventually, you're going to pass out.

You're going to stop breathing, and your heart will stop.

NARRATOR The news devastates Ricardo's family.

They now know that his death may have been preventable, if only

he had requested medical treatment

or if he had not insisted on continuing to drive.

It was sad for the family to know,

because this is their loved one driving.

They think he's still probably OK to drive,

and it ends up k*lling him.

I think it was a little more comforting to think

that he just had an arrhythmia from his heart disease

and d*ed.

I mean, I wish I could have told them that.

But unfortunately, I have to tell them the truth

of what really happened.

NARRATOR Coming up next, a grandfather

travels from England to Orlando to visit his family.

But in an instant, his long-awaited vacation

turns tragic.

They were just very surprised and maybe a little guilty.

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

[dramatic music]

It's been a long day for Dr. Jan Garavaglia,

chief medical examiner of Orange and Osceola Counties.

And the stress of multiple cases is beginning to take its toll.

If it's a busy day, and I have a lot of cases,

you're basically on your feet the whole time

you're down here.

You're standing on your feet, and you're literally cutting.

Let's just think about standing at your kitchen counter,

constantly cutting for eight hours, six hours, seven hours.

And so it is very exhausting.

NARRATOR But she can't rest yet.

Well, I mean, you want to keep going, because everybody

wants your answer.

And you want to do a good job, and you

want to keep going because there's work to be done.

There's answers to be had.

NARRATOR Her last body of the day

is an elderly man named Julian Noble.

As a first step, Dr. G reads the investigator's report

and learns about the circumstances

surrounding Julian's death.

JAN GARAVAGLIA We have a -year-old man

this morning that I may or may not autopsy somebody that age.

But he's got a very interesting presentation.

He just comes in from Europe.

He's on vacation here.

So I don't know anything about him.

He's got atypical symptomatology of like doubling over

in abdominal pain and then just dying.

It'll be interesting to see what that is.

NARRATOR Yesterday, the widowed businessman from England

arrived in Orlando to visit his family,

whom he hadn't seen in over a year.

JAN GARAVAGLIA When he landed, the plane

landed, he started complaining of some of abdominal pain.

By that evening, he tries to eat some soup

and still has some abdominal pain.

NARRATOR His son, Thomas, is concerned.

But Julian assures him that he'll be fine,

and he goes to bed.

The next morning, he is able to eat breakfast but then just

doubles over in pain in his abdomen and then collapses.

NARRATOR Thomas immediately calls --.

In minutes, paramedics arrive on the scene and attempt

to stabilize Julian.

But their efforts are in vain.

By the time they get him to the hospital,

he's already without a pulse.

Dead on arrival.

NARRATOR Now, Julian's son is desperate to know what

k*lled his father so suddenly.

Because he's from abroad, there was little background

information on Julian, making it difficult to narrow down

the possible causes of death.

JAN GARAVAGLIA He's complaining of abdominal pain.

So it'll be interesting to see what we find on him.

There are many things that can cause

abdominal pain in the elderly.

And sometimes it can be a real fooler,

and it can be from other causes, even heart att*cks.

It can be a very atypical presentation.

But I have to think, what could cause the abdominal pain

and k*ll you?

NARRATOR Keeping this question in mind,

Dr. G hopes the external exam will provide some useful clues.
[ … ]

JAN GARAVAGLIA Well, what we're looking

for externally is anything that would give us

any hint about his lifestyle.

All I know is that he smoked some, and he doesn't drink,

according to the family, or drinks socially.

And so I'm looking for kind of lifestyle.

I look to see if he's obese.

He's not. he's normal weight and height.

NARRATOR Given Julian's complaint of stomach pains

immediately before his death, Dr. G pays close attention

to one particular area.

JAN GARAVAGLIA I feel the abdomen, and a lot of times,

like with a peritonitis or inflammation

in the abdominal cavity, I'll feel very tense abdomen.

Even after death, believe it or not,

they can get a very kind of bloated, tense abdomen.

NARRATOR But after careful inspection,

the external condition of the abdomen is yielding few clues.

JAN GARAVAGLIA His wasn't particularly tense.

But again, I've been fooled before after death.

The cause of death may still be there.

Once I open it up, I'll know.

NARRATOR To begin the internal exam,

Dr. G makes her standard Y incision

just below Julian's clavicles and all

the way down to his navel.

Her techs draw samples of Julian's fluids

to send to the toxicology lab.

And then Dr. G begins the exam, focusing on the abdomen.

JAN GARAVAGLIA I will think, wow, something in his abdomen

must have k*lled him.

He had abdominal pain, relatively acute onset.

NARRATOR Based on Julian's symptoms,

Dr. G considers several conditions

that could have k*lled him.

JAN GARAVAGLIA Abdominal aortic aneurysm, diverticulitis,

perforated bowel.

There's many things that could k*ll you relatively quickly

that we see in here that might be

preceded with abdominal pain.

NARRATOR First, Dr. G searches Julian's abdominal cavity

for signs of an aneurysm.

An abdominal aneurysm develops when the aorta, which

runs from the heart to the abdomen,

becomes blocked with cholesterol or plaque.

This blockage can in turn cause the aorta to weaken

and eventually rupture.

JAN GARAVAGLIA It gets a thinned wall,

and then it bursts.

NARRATOR Blood then quickly rushes into the abdomen,

and the victim dies within minutes from internal bleeding.

JAN GARAVAGLIA What I will look for as soon

as I open that abdominal cavity is free blood.

NARRATOR But Dr. G gets her first clue

in what she does not see.

JAN GARAVAGLIA He doesn't have free blood

in the abdominal cavity.

So he didn't die from an aortic aneurysm.

NARRATOR She next examines Julian's colon,

looking for signs of a deadly condition

called diverticulitis.

Diverticulitis develops when pouches form

on the outside of the colon.

JAN GARAVAGLIA You have out-pocketing of the colon

because of just pretty much a lifestyle problem, lack

of fiber, lack of exercise.

NARRATOR If the pockets of the colon

become inflamed and burst, this can lead to a fatal infection

in the abdomen.

JAN GARAVAGLIA And you can get severe abdominal pain

or infection in those.

And you can eventually die.

NARRATOR If this happened to Julian,

Dr. G would find the telltale signs of infection

in his abdominal cavity, free fluid or pus.

But after a thorough examination,

she comes up empty.

JAN GARAVAGLIA He didn't have free fluid in his abdomen.

So he didn't die from infection of his abdomen.

The walls of the abdomen looked fine.

NARRATOR But Dr. G still has one last condition

to look for within Julian's intestines, an infarcted bowel.

JAN GARAVAGLIA Another main reason why older people can die

from abdominal pain is infarcted bowel, meaning that the blood

doesn't get to the bowel.

Basically, the bowel itself dies inside the body.

NARRATOR Dr. G carefully dissects

Julian's bowels, looking for signs of dead tissue.

But once again, her search yields

nothing out of the ordinary.

JAN GARAVAGLIA It looks normal.

The bowels look good.

The walls of the abdominal cavity

look just smooth and pink and shiny,

just like they're supposed to look.

NARRATOR Dr. G now knows that Julian did not

die from an aortic aneurysm, an abdominal infection,

or infected bowel.

JAN GARAVAGLIA And lo' and behold,

we've ruled out a lot of things right from the start,
[ … ]

but what k*lled him?

I still don't know.

NARRATOR Coming up next, Dr. G makes an unexpected discovery.

JAN GARAVAGLIA It's peaking out at me.

I can see that it's inflamed and that it's thickened.

NARRATOR When "Dr. G, Medical Examiner" continues

[dramatic music]

Dr. G lifts up the intestines of -year-old Julian Noble

so she can examine the rest of his abdominal cavity.

Julian was on vacation from England

when he began experiencing severe abdominal pains.

The next morning, he collapsed and d*ed.

As soon as he went down, he was dead.

NARRATOR So far, Dr. G has ruled out three potentially

fatal conditions, an abdominal aneurysm, a fatal infection,

and an infarcted bowel.

Unfortunately, he's dead, and I still don't have a reason.

NARRATOR Next, Dr. G inspects the rest

of Julian's abdominal cavity inch by inch,

eventually coming to the gallbladder.

This pear-shaped organ sits at the base of the liver

and plays an essential role in digestion.

And here, Dr. G gets her first clue.

JAN GARAVAGLIA I can see that it's inflamed

and that it's thickened.

NARRATOR As she cuts into Julian's gallbladder,

she immediately can see what's causing the inflammation.

JAN GARAVAGLIA I can feel that there's at least

three gallstones in there.

NARRATOR These gallstones are likely

the cause of Julian's abdominal pain,

but the question is, did they k*ll him?

Gallstones are a common condition that affect in

adults in Europe in America.

JAN GARAVAGLIA Oh, my.

They're so crunchy.

NARRATOR They develop when excess cholesterol

builds up in the bile.

JAN GARAVAGLIA You have this increased

amount of cholesterol, and these form stones.

NARRATOR In Dr. G's experience, gallstones are rarely fatal.

And at first glance, it appears that they

did not cause Julian's death.

He's just got a little bit of an inflamed gallbladder,

not by infection, but because of the gallstones itself.

So that in and of itself is not going to cause his death.

NARRATOR But it is possible that Julian's

gallstones could have led to a more serious disease.

JAN GARAVAGLIA Gallstones can k*ll you with pancreatitis,

and that's an inflammation of the pancreas.

Well, how does a gallstone cause inflammation of the pancreas?

NARRATOR If gallstones get stuck in the bile duct,

they can block the flow of digestive juices

in the tubes that lead from the pancreas.

JAN GARAVAGLIA It will cause then the pancreas to kind

of start digesting itself.

And you can die from that.

And sometimes you can die relatively quickly from that.

And so that's a possibility, and so I'll still

need to check the pancreas.

NARRATOR Dr. G lifts up the stomach

and liver to view the pancreas.

And there, she finds her answer.

His pancreas looks like normal,

kind of tanned, nice, lobular structure that I normally see.

So in no way did he have pancreatitis

and in no way did that k*ll him.

NARRATOR She now wonders if Julian's

abdominal pain was completely unrelated to his death.

Maybe

All of his pain was his gallbladder, which had

nothing to do with his death.

NARRATOR Or perhaps there is another explanation.

JAN GARAVAGLIA Maybe he's having

atypical heart pain, which is causing his abdominal pain.

OK.

I'm going to go ahead and take the heart.

NARRATOR With this thought in mind,

Dr. G next removes Julian's heart.

JAN GARAVAGLIA Could have had an arrhythmia

from lack of oxygen and blood to the heart from atherosclerosis,"], index ,…}

a common problem in my office.

And I guess that's part of why.

NARRATOR But when she sees Julian's heart up close,

she is shocked by the shape it's in.

JAN GARAVAGLIA His heart actually looked great.

I will be so lucky if at my coronaries look so clean.

And his heart muscle looked fine.

No anatomic reason for that heart to have k*lled him.

NARRATOR Now, she finds herself at a crucial crossroads.

I've ruled out any type of abdominal problem.

I've ruled out the next most common

culprit would be his heart.

We're pretty much back where we started.

NARRATOR Coming up next, an unexpected discovery

changes the course of the autopsy

and shocks Julian's family.

They had a hard time believing it.

You don't think that grandpa's going to die because you

took him to Orlando.
[ … ]

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

[dramatic music]

That's a good point.

NARRATOR Dr. G removes Julian Noble's lungs,

one of her last hopes for finding a cause of death

in the internal exam.

Her examination of Julian's abdomen and heart

yielded no clues.

In fact, his organs were in surprisingly good shape.

Now, Dr. G is more determined than ever

to unravel the mystery behind this seemingly healthy man's

death.

I want an answer at the end of the autopsy.

NARRATOR Dr. G begins the dissection of Julian's lungs,

hoping to find some sort of clue.

And right away, she hits paydirt.

Sticking out right at me are blood clots in both right

and left main pulmonary artery.

NARRATOR These blood clots in the arteries

leading to Julian's lungs are also known as thromboemboli.

They form when blood in the veins

begins to harden and congeal.

Basically, blood clots are platelets

and a protein called fibrin and then enmeshed

in that are your cells.

And basically, for whatever reason,

the platelets start sticking together and forming a clot.

NARRATOR In Julian's case, these clots

lodged in his lungs, cutting off his blood and oxygen supply.

JAN GARAVAGLIA Once they clog up

your main vessel that goes and brings blood to the lungs,

you can't live.

Incompatible with life.

No question, this is why he d*ed.

NARRATOR After an exhaustive examination,

Dr. G has finally found Julian's k*ller.

However, one mystery remains.

So the question is, where did these emboli come from?

These are blood clots that formed

in another part of the body.

NARRATOR Dr. G knows the vast majority of pulmonary blood

clots form in the legs.

And this is the first place she looks.

I dissect the backs of the legs

to look at the veins in the legs,

and sure enough, he still has residual thrombi in the veins.

NARRATOR Now that Dr. G has discovered exactly what k*lled

Julian, she can at last piece together

the chain of events that led up to his tragic death.

Julian Noble has just flown more than , miles

from London, England to visit his son

and grandkids in Orlando.

But the long flight has had an unexpected effect.

Hours of immobility on the airplane

have caused Julian's blood to become sluggish.

And if it's sluggish, the platelets start sticking

together and forming a clot.

NARRATOR When Julian walks off the plane, pieces of this clot,

which formed in his legs, break off and flow

up through the vascular system.

He started complaining of some of abdominal pain.

Sometimes these pulmonary emboli are asymptomatic.

Maybe all of his pain was his gallbladder.

I don't know.

It was atypical referred pain to his abdomen

or was his pain all the time due to his gallbladder, which had

nothing to do with his death?

I don't know.

NARRATOR The next morning, the pains are still there,

but Julian joins his family for breakfast anyway.

He eats breakfast and then just kind of doubles

over in abdominal pain.

Falls to the floor and they have to call an ambulance

to take him to the hospital.

NARRATOR Two large blood clots have traveled to his lungs

and lodged in the pulmonary arteries, the blood

vessels leading to the lungs.

He's not even responding.

JAN GARAVAGLIA It's a death sentence.

You're not getting any oxygen. You have no way to get oxygen.

NARRATOR As his family looks on in horror,

paramedics arrive and attempt to save Julian.

Stop.

I'm going to check for pulse.

Still no pulse.

All right.

NARRATOR But before they even reach the hospital,

Julian's heart, deprived of oxygen-rich blood,

ceases to b*at, and he dies in the ambulance.

Flying is one of the safest ways to travel.

In fact, times more people die in car accidents

than in plane crashes each year.

But deep vein thrombosis is a hidden danger

that Dr. G sees several times a year in her morgue.

JAN GARAVAGLIA It's a syndrome.

It's called economy class syndrome.

You're like squished up in the little economy seats,

and you don't move.

You have no way to stretch.

You get a little bit dehydrated, which
[ … ]

then predisposes you also.

And the immobility and the probably

little bit of dehydration causes the blood

to just kind of not move.

NARRATOR Fatal deep vein thrombosis resulting

from air travel is uncommon.

But Julian Noble was among the unlucky few.

But for anyone who is about to fly,

Dr. G has a few words of wisdom.

JAN GARAVAGLIA It is scary.

And you know, when I'm sitting in the airplane, and I'm cheap.

I fly economy class.

What I make sure is that I'm well hydrated.

You need to exercise your legs.

You need to put pressure on them.

You need to squeeze your calf muscles,

move around, try to get up every hour.

NARRATOR Unfortunately, this advice

has come too late for Julian Noble and his grieving family.

JAN GARAVAGLIA They're surprised,

because a lot of people have no clue that a risk

factor for dying is sitting on an airplane

for a long period of time.

And so I think they were shocked.

They had a hard time believing it.

You don't think that grandpa's going

to die because you took him to Orlando

and made him sit on an airplane.