04x01 - Toxic Forces

[bunniefuu]

[dramatic music]

NARRATOR A young woman is stricken

with an aggressive illness after volunteering in the Hurricane

Katrina relief effort.

She was fine one minute.

She started getting short of breath.

NARRATOR Within a day of falling ill,

she dies in the ICU.

JIM REESE She was just gone.

NARRATOR Will Dr. G be able to tell her grieving parents

what k*lled their only child?

JIM REESE There was no reason for this to happen.

She was a really healthy, strong person.

When you lose a child, it's got to be the worst

event that can happen on earth.

NARRATOR And then, a man with a history of mental disease

is found dead in his home.

And the chief suspect is a tragic su1c1de.

Suicides are always the saddest cases,

always the saddest cases.

NARRATOR But findings in the autopsy

thr*aten to turn the investigation upside down.

When I first saw that tox, I went how unusual.

I mean, it's not what I expected.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

It's early on a Tuesday morning in Orlando, Florida

when Dr. G arrives at the District morgue.

While most mornings are busy at the morgue,

today brings a brief but unusual respite for the staff.

Oddly, there is only one case waiting examination,

the body of a -year-old woman named Amanda Reese.

For now, she is Dr. G's sole focus.

As a first step, Dr. G consults her investigator's report,

which describes the circumstances

surrounding the young woman's sudden and unexpected death.

JAN GARAVAGLIA This case, I knew about this poor girl

coming in before my investigators did,

because I got a call from one of the doctors at the hospital.

NARRATOR According to the physician,

Amanda became abruptly ill on her way to a basketball game

with friends.

JAN GARAVAGLIA She got hot.

She started getting hives and started

getting short of breath.

NARRATOR Amanda's friends call --,

and she's rushed to the hospital.

Initially, ER doctors believe she

is having an aggressive and potentially fatal

allergic reaction known as anaphylaxis.

But in the hospital, Amanda does not respond to treatment.

JAN GARAVAGLIA They do all the medications

for an allergic reaction and anaphylaxis,

but it didn't seem to do anything for her.

NARRATOR When Amanda's condition doesn't improve,

doctors are immediately alarmed.

They wonder if she might have a massive infection, not

anaphylaxis, as they first suspected.

To fight a possible deadly infection,

they treat her with powerful antibiotics.

But Amanda's condition continues to worsen.

Within only hours, she slips into a coma

and is placed on life support.

JAN GARAVAGLIA She continues to have problems.

Her blood pressure couldn't be maintained,

and she's on a ventilator almost right from the beginning.

She's on, even actually having to put on pressors or something

to help that blood pressure be maintained.

That didn't even work.

NARRATOR Within only hours, -year-old Amanda Reese

suffers a fatal heart att*ck while in the ICU.

To the shock of her parents and friends,

she is pronounced dead at PM.

We were hoping she could just hold on

long enough to come out of it, but her heart

failed in the end.

JIM REESE She was just gone, and all of her organs

shut down, and there wasn't anything anybody could do.

So that was it.

NARRATOR According to the investigator's report,

physicians suspect an infection ultimately

caused Amanda's death.

Her sudden decline is one reason for this conclusion.

Her recent work is another.

Amanda was a volunteer for AmeriCorps,

a national volunteer community service organization.

Several days before she grew ill,

Amanda had been in Biloxi, Mississippi,

helping in the Hurricane Katrina relief effort.

While no widespread outbreaks of serious illness

had been detected in the area, health care officials,

including the Centers for Disease Control,

were closely monitoring the Gulf region

for a potential infectious disease epidemic.

Amanda's death now raises concerns.

JAN GARAVAGLIA They're very worried that she has

some weird infectious disease.

They called me and pleaded with me on the grounds

of public health.
[ … ]

NARRATOR Is it possible Amanda contracted

an infection from a hurricane victim in Biloxi?

The hospital asks Dr. G to test for a number

of potentially deadly contagions, some of which

are very rare.

JAN GARAVAGLIA And they were even thinking SARS.

They were thinking hantavirus, which

is a hemorrhagic lung disease.

They were thinking all sorts of different viruses,

like maybe hemorrhagic fever, maybe some weird virus

or some weird bacteria.

NARRATOR If Amanda's recent work in Hurricane Katrina

isn't cause enough for concern, her medical history presents

troubling information as well.

Dr. G learns from her parents that Amanda had suffered

complications from several insect bites, one of them

only a day before she grew ill.

JAN GARAVAGLIA Well, we do know that she's

got some medical problems, especially for somebody

so young, .

She had Lyme disease a couple years

ago from the bite of a tick and supposedly had

gotten over that.

And recently, within the past year,

she'd had a spider bite that she'd had some problems with.

I was also told that she was recently stung in her left arm,

and I was curious about what that would look like.

Does her doctor say she--

NARRATOR In this case, it is difficult for Dr. G

to untangle the significant from the inconsequential.

But she hopes that through an autopsy,

she will find answers for Amanda's

grief-stricken parents.

JAN GARAVAGLIA When you lose a child,

it's got to be the worst event that can happen on earth.

And I'm not sure knowing exactly why she d*ed is peace to them

or not, but at least it might give

them a little bit of an answer.

CAROLE REESE Stunned.

That's the only word.

I wasn't thinking about her dying.

I never expected it, and I'm still stunned.

Why to her?

I ask myself that every day.

But that's-- that's the way it goes.

She was a great person.

She really was.

NARRATOR Dr. G carefully examines

the body of Amanda Reese and comes to her first conclusion.

JAN GARAVAGLIA She looks very ill.

And believe it or not, when your dead,

sometimes you can look good and sometimes you can look ill.

And she looked ill.

NARRATOR And then Dr. G sees something curious.

On the inside of Amanda's left upper arm is a small mark,

perhaps the bite Amanda reported the day before she d*ed.

JAN GARAVAGLIA I incised it with my scalpel,

and I certainly looked under the microscope

to see if there was any reaction to it.

There really wasn't.

It looked very benign.

Couldn't really see a stinger or anything

like that when I cut into it.

NARRATOR Unfortunately, the external exam of Amanda

Reese yields very little.

JAN GARAVAGLIA There just wasn't a lot of significance

to our external exam.

Nothing that I could pinpoint or give a better idea

of why she d*ed.

NARRATOR Whatever k*lled Amanda left no trace externally.

Whether any clues linger internally is yet to be seen.

Coming up next, in the internal exam, Amanda Reese's body

is opened, and Dr. G sees the ravages of her k*ller

but not the k*ller itself.

JAN GARAVAGLIA At this point, we're back to square one,

and I don't know what direction I'm going to go.

[dramatic music]

NARRATOR At the District morgue in downtown Orlando,

the body of -year-old Amanda Reese

is prepped for internal examination

to discover the cause of her unexpected death.

Amanda d*ed the day before from an aggressive and unknown

illness.

The doctors who treated her in the hospital

worry that she may have contracted

a rare infection while volunteering in the Hurricane

Katrina relief effort.

JAN GARAVAGLIA There were some weird--

it was more of the weird kind of viruses

that they were worried about.

NARRATOR Dr. G opens Amanda's body with a Y incision

from the shoulder blades to the pelvis.

The effects of Amanda's acute illness

are immediately apparent.

JAN GARAVAGLIA When I do the Y incision,

I see a lot of fluid in her subcutaneous tissue.

I see evidence of end-organ failure.

Her organs-- her body wasn't getting enough blood.

Her blood pressure wasn't maintained enough.

So parts of her body were pretty much dying.
[ … ]

NARRATOR But what could have caused

this young woman's major organs to fail so catastrophically?

A critical part of this examination

will be toxicology, which can determine

what substances were in Amanda's body at the time of her death.

JAN GARAVAGLIA I'm going to do just

the general bacterial cultures on her blood.

I would take some of viral cultures,

send it to microbiology to see if they

can see anything growing.

I am taking regular blood check for substances,

our normal urine screen, then looking for some of the dr*gs

of abuse as well as dr*gs of--

prescription dr*gs that we can find.

NARRATOR Once samples are drawn,

Dr. G begins to remove and dissect

each organ, looking for any abnormalities or disease.

Yet, outwardly at least, she sees

no indication of an infection.

JAN GARAVAGLIA I mean, I could have lucked out

and found a pocket of pus that would have been

the source of her infection that would

have just given us the answer or some type of infected organ.

And unfortunately, that wasn't the case.

NARRATOR Like the external examination,

the internal exam of Amanda Reese

is yielding few solid findings.

Amanda's heart is normal.

Her lungs are very heavy, triple the weight that they should be.

But Dr. G finds no signs of infection in the tissue.

JAN GARAVAGLIA Her lungs are very, very heavy.

But I'm looking for pneumonia.

I'm looking for pus.

I'm looking for white cells or what type of process

is going on.

But with her, she looks like she's got lungs

from being on a respirator and not being able to maintain

her blood pressure, something we see all the time,

a lot of fluid build up in her lungs and changes

consistent with that.

After I do her chest and abdomen,

I still have to look at her head.

Certain meningitis, certain bacterial infections

of the meninges, the covering of the brain,

can cause you to die really quickly

and have symptoms very quickly.

NARRATOR Dr. G opens Amanda's brain

and carefully inspects the organ.

But once again, there was nothing suspicious.

No inflammation, no infection, no disease.

There is nothing classic about an infection

here that I can find.

NARRATOR A -year-old woman is dead,

but at the end of the autopsy, Dr. G has no explanation.

It is a difficult conclusion for her

and an unbearable one for Amanda's parents.

She was a really healthy, strong person.

And to try and figure out now what had happened,

we don't know.

And that's difficult for us.

At this point, we're back to square one,

and I don't know what direction I'm going to go.

NARRATOR The most frustrating cases

for a forensic pathologist are those deaths that

thr*aten to remain mysteries.

Dr. G is loath to allow Amanda Reese's

case to become one of them.

JAN GARAVAGLIA I'm going to take the route of starting

at the basics again and starting at the basics is I think I need

a better description of what she was like before she

got to the hospital.

NARRATOR Coming up next, Dr. G finds one of the witnesses

to Amanda's sudden illness and refocuses her investigation.

I actually got my investigator to track down the girl that

was with her in the van that day when

she started having symptoms.

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

[dramatic music]

Hi.

Steve Hansen at the ME's office.

NARRATOR Dr. G asks her chief death investigator, Steve

Hansen, to track down a witness to Amanda Reese's fatal illness

in hopes of speaking to her directly

about the events that day.

And you want DL number?

JAN GARAVAGLIA I really needed to get

information on how she was before she

made it to the hospital.

I've got the hospital records, but I don't have the story

very well on what happened prior to her

making it to the hospital.

And so I really needed a firsthand witness.

NARRATOR Several days later, investigator Steve Hansen

locates one of Amanda's friends, an AmeriCorps

volunteer named Michele, who was with Amanda

on the day she fell ill.

And what she tells Dr. G redirects the course

of the investigation.

According to Michele, Amanda's illness

unfolded swiftly and without warning
[ … ]

on the way to a basketball game.

MICHELE DZIEDZIC We got in the van,

and we noticed Amanda was lying down in the back seat.

And we asked her, we're like, Amanda, are you OK?

And she's like, I'm just feeling really hot right now.

Then she sat up, and she was like, I think

I'm having trouble breathing.

And at that point, she started breaking out in hives.

It was all over her, her face, her arms, her chest, her back.

And we were all like, oh, my God.

Because I've never seen bumps like that.

NARRATOR The testimony turns the investigation on its head.

Dr. G is now convinced that Amanda

did die from anaphylactic shock, a fatal allergic reaction,

despite the fact that Amanda had no known allergies

and the hospital's treatment for anaphylaxis was unsuccessful.

JAN GARAVAGLIA The story she told

me was not anything closely resembling an infection.

What she told me is that she was fine one minute.

She started getting short of breath,

clearly had hives, and was getting

more and more short of breath.

Clearly, looked like an allergic reaction from that story.

NARRATOR But her suspicion will not be easy to confirm.

Anaphylaxis is difficult to diagnose post-mortem.

One of the only ways to diagnose anaphylaxis

is to check a person's blood for a substance

called tryptase, an enzyme that is

released into the bloodstream during an allergic crisis.

JAN GARAVAGLIA Tryptase can only

truly be measured for several hours after the initial event.

And then it really starts to go down,

and it may go back to normal.

NARRATOR Dr. G requests blood samples

that were drawn when Amanda was first admitted to the hospital,

because that is when the most accurate

readings of tryptase levels would be detectable.

JAN GARAVAGLIA I said, if you do have any original blood,

please send off a tryptase level,

because a tryptase would indicate

then an allergic reaction.

NARRATOR Dr. G also orders tests on blood samples drawn

at autopsy in case some of the tryptase enzyme

lingered in Amanda's system.

Then, Amanda Reese's case becomes a waiting game.

Amanda's body is released to her parents,

and one week after her death, she is buried in her hometown

of Chicago, Illinois.

JIM REESE There were a lot of people

there, more than I even imagined.

The waiting line outside the funeral home

was probably a block and a half long.

We had people that came from Holland, people that came

from Washington, people that--

her pallbearers were her team from Charleston.

AmeriCorps flew them all in.

It was very nice.

CAROLE REESE We spoke to Dr. G from November

when Amanda d*ed till the middle of March.

They kept her autopsy open, searching

so many months for an answer, trying to solve this mystery.

There were a lot of people working on this whole thing.

She had two or three assistants working on it.

JAN GARAVAGLIA I think at some point,

they may have been just resigned to the fact they may never know"], index ,…}

what k*lled their daughter.

NARRATOR But after a grueling four months,

Dr. G finally receives the toxicology results on blood

and fluids drawn at autopsy.

And it is not what she hoped for.

Amanda's tryptase levels are normal.

JAN GARAVAGLIA And I was very disappointed

that the tryptase still wasn't-- it wasn't elevated.

So it looks like there was no way

that I was going to be able to prove

that this was anaphylaxis.

NARRATOR But several days later, Dr. G

receives the toxicology report on blood drawn when Amanda was

first admitted to the hospital.

This time, the numbers are significant.

JAN GARAVAGLIA It was very high.

Normal could be in the range.

Hers was in the s range, like almost .

So it was very high.

And that, with her history, was diagnostic

for anaphylactic shock.

So that was very satisfying to see that come in.

NARRATOR Dr. G finally has a solid conclusion.

Amanda d*ed from a rare and fatal allergic reaction, which

can cause airways to swell and blood pressure

to drop catastrophically, leading to death.

But unfortunately, there is one question

that will never be answered.

What triggered Amanda's deadly reaction?

JAN GARAVAGLIA Ultimately, we don't know what the antigen is.

Now, that sounds like that would be so rare.

But truly, with a large percentage of anaphylaxis,

some people say up to % to %,

they never really know what it is that caused

them to go into anaphylaxis.
[ … ]

NARRATOR Anaphylaxis typically occurs immediately

after exposure to an offending antigen, which is a substance

foreign to the body.

But Dr. G cannot find any triggers in Amanda's death.

JAN GARAVAGLIA Sting in her arm.

That happened too far away from the event

to have been the antigen that would have tipped her over.

There's too many hours.

The same with her lunch.

I was worried that maybe it was something she ate.

But that was at least a five-hour delay

between when she ate and had the anaphylactic reaction.

And that's really out of the timeframe

that we would expect with food to cause anaphylaxis.

You get the reaction much more immediate when

you're exposed to that antigen.

NARRATOR Her conclusion?

Amanda suffered from an att*ck of what

is known as idiopathic anaphylaxis, anaphylaxis

from an unknown cause.

JAN GARAVAGLIA When we don't know something,

we'll call it idiopathic anaphylaxis.

And with this poor girl, we just cannot figure out why she went

into anaphylaxis, what it was, what antigen it was that caused

her to go into this anaphylactic shock that was so refractory

to their medication.

NARRATOR By piecing together testimony from Amanda's friend,

toxicology tests, and Amanda's autopsy results,

Dr. G can finally tell Amanda's parents why their daughter d*ed

and record her findings in the Report of Autopsy.

Although Dr. G cannot say for certain exactly when or what

Amanda was exposed to, she knows some antigen caused a severe

and catastrophic reaction in Amanda on the way

to a basketball game.

JAN GARAVAGLIA In most people, the main reasons

for anaphylaxis are insect bites,

a drug, or food allergies.

NARRATOR For reasons unknown, Amanda's immune system

significantly overreacts to the antigen. In response,

her body releases a flood of reactive chemicals, one of them

being tryptase, into her bloodstream,

which triggers immediate physical manifestations.

Amanda's bronchial passages begin to swell shut,

blood vessels throughout her body

begin to dilate, causing her blood

pressure to drop precipitously.

Hives erupt upon her skin.

At that point, Amanda was having trouble breathing.

JAN GARAVAGLIA They knew they had to get her help.

They called --.

At that point, she was so short of breath,

she started getting combative and kind

of losing it mentally, because she wasn't getting

enough blood to the brain.

They tried to give her medication in the ambulance.

It doesn't seem to be affecting her.

By the time she gets to the ER, her blood

pressure is already low, and she's in refractory shock.

They just can't get her blood pressure

back up enough to maintain enough oxygen

to the rest of her body.

NARRATOR At the hospital, Amanda is treated

aggressively for anaphylaxis.

But for unknown reasons, her condition

is so severe that medications are ineffective,

leading doctors to believe that perhaps

Amanda is sickened with a life-threatening infection.

But by this point, the damage caused

by the anaphylactic reaction is irreversible.

JAN GARAVAGLIA They gave her all the right medication,

but she was already too far gone for it to work.

NARRATOR Amanda's internal organs

begin to die, starved of oxygen from the effects of extremely

low blood pressure.

After hours, she dies in the ICU of massive organ failure.

JIM REESE Dr. G said I have to come to some conclusion here,

and that's all I can come up with.

And she's very nice about it, and I said thank you.

And that was about it.

I think she did the best she could.

Well, I can't say I'm relieved, because we

still don't know why she d*ed.

JAN GARAVAGLIA I think they were glad to put all that rest

of what she d*ed from.

I think they would be even like it better

if they knew what it was that caused

her to go into anaphylaxis.

But I just can't give them all the answers.

You just never know what life's going to throw at you,

and it's just very scary.

And I think what it tells me is life is precious,

and you just never know when it's going to be taken away.

NARRATOR Coming up next, a troubled man

threatens to commit su1c1de and hours later is found dead.

Was his death intentional, as investigators believe?

JAN GARAVAGLIA Now, law enforcement and my investigator

really thought for sure this was going to be apparent su1c1de.

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

[dramatic music]

% of the fatalities brought to the District morgue each year"], index ,…}
[ … ]

are categorized as natural.

JAN GARAVAGLIA -year-old white male left his residence

at as usual, morning walk.

NARRATOR But out of every bodies

that require an autopsy in Orlando and Osceola counties

are suicides.

For Dr. G and her staff, these are some of the most

wrenching cases to work on.

JAN GARAVAGLIA Suicides are always the saddest cases,

always the saddest cases, because there's

always that sense of anguish.

You know they had to have that horrible anguish

before they did it.

NARRATOR But suicides are perhaps

most heartbreaking for the victim's loved ones, who

are left to agonize about whether there

was anything they could have done to prevent the death.

Such is the case in Dr. G's next autopsy, the suspected su1c1de

of a troubled -year-old man with a history

of mental disease.

The decedent's name is John Kent.

JAN GARAVAGLIA We have a -year-old black male

who my investigators think is an apparent intentional overdose.

NARRATOR Dr. G consults the investigator's report

to learn the details of the events

leading up to John Kent's suspected su1c1de

only hours earlier.

According to the report, the previous night John

and his longtime companion Greg were on their way home

from a restaurant when the two men

got into a heated and physical argument.

JAN GARAVAGLIA They're in the car,

and they're continuing their argument

to the point where our victim here hits his friend

and hits the windshield.

And he mentions maybe I should k*ll myself.

NARRATOR Shortly afterwards, Greg

drops John off at their home in Kissimmee to calm down.

JAN GARAVAGLIA The boyfriend doesn't want

to put up with this anymore.

He leaves.

He thought it would be best since they're arguing.

He'd get out of the picture for a while,

maybe let the guy cool down.

NARRATOR But a few hours later, Greg returns home to find

his partner unconscious.

JAN GARAVAGLIA -- comes, they

attempt to do resuscitation.

But they realize that he's dead and don't transport him.

NARRATOR When the police arrive at the residence,

they discover copious amounts of medications

belonging to the decedent.

JAN GARAVAGLIA There is a lot of medication in the house.

There's antidepressants, there's antipsychotics, tranquilizers.

There is erectile dysfunction medication.

There is aspirin, there's acetaminophen.

NARRATOR The arsenal of medication

is not shocking given the fact that John, who had worked

as a computer technician all his life,

suffered from mental illness and depression for many years.

In recent months, he'd grown increasingly

despondent and self-destructive.

JAN GARAVAGLIA He's had su1c1de attempts

before with an overdose, and just

three months prior, he tried to s*ab himself with a Kn*fe.

A lot going on here.

NARRATOR Given the dr*gs found at the scene, John's history

of self-destructive behavior, and threats to take his life,

Dr. G suspects that he k*lled himself

with a suicidal overdose.

JAN GARAVAGLIA Certainly, when we see a past history

of su1c1de attempts like this fellow,

it makes us think that he does at least have

suicidal ideations at times.

NARRATOR But her suspicions are devastating for John's

partner, Greg, who is overwhelmed

with remorse over John's death.

For many years, Greg had tried to help

John overcome his problems.

His deepest fear now is that he failed

John when he needed him most.

JAN GARAVAGLIA I'm sure the fellow is

feeling some guilt about that.

I'm sure he is.

NARRATOR Greg now is counting on Dr. G

to tell him exactly how and why John d*ed.

Though all signs point to an intentional overdose,

Dr. G must approach each case with an open mind.

JAN GARAVAGLIA We'll check his blood.

We'll certainly look for natural disease.

We'll certainly look for trauma.

There's a lot we're going to look for here.

So we're going to have to keep our mind and eyes open

and just see what we'll find.

NARRATOR Dr. G begins the external exam.

She notes John is a heavy man, weighing nearly pounds.

This right away raises the suspicion

that he could have suffered from a range

of obesity-related diseases.

As she searches his body, she also
[ … ]

discovers some recent trauma.

His knuckles are bruised.

There was a contusion on his lip and a mark on his side.

But these are likely all a result

of the fight he had with his boyfriend

the night of his death.

JAN GARAVAGLIA That fits to what

the boyfriend had said, that he hit him and hit the windshield.

So that fits.

I really don't see any other trauma on him.

NARRATOR There is nothing externally at least

to indicate that John d*ed from trauma

or some sort of foul play.

What's more, Dr. G also finds no external evidence

that John abused illicit dr*gs.

I see no needle puncture marks to suggest that he had recently

sh*t up or that he'd use them.

So I doubt that he's an IV drug abuser.

NARRATOR But if John d*ed from a fatal intentional overdose,

there may be no traces externally.

Dr. G will have to look internally,

beginning with the stomach.

Coming up next, Dr. G opens John Kent's body

and doesn't like what she sees.

su1c1de is still a very real possibility with him.

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

[dramatic music]

At the District morgue in Orlando,

Dr. G's staff prepares for the internal examination

of John Kent.

The victim, who struggled with emotional problems,

was found dead in his home by his companion

after an argument.

At this point, his death is considered a likely su1c1de.

And this fellow, we know, has had

at least one previous su1c1de attempt, which

makes you think that at least he's

got some suicidal ideations at times.

NARRATOR Now, his distraught boyfriend, Greg,

wants to know if he is responsible for John's death.

He is counting on Dr. G to tell him if he could have

done anything to prevent it.

Dr. G opens the body of John Kent with a Y incision,

and it isn't long before she encounters

what may be the first forensic evidence of an overdose.

John's bladder is full, a common finding in drug deaths.

JAN GARAVAGLIA Oftentimes, that gives us a clue that he may

have laid there for a while before he d*ed, because he

doesn't feel that sense of needing to relieve his bladder,

because he's is possibly a coma.

NARRATOR And when she examines his stomach,

she finds another clue that suggests

a possible drug-related death.

JAN GARAVAGLIA He's got a lot of fluid

in his gastric contents, almost a liter of fluid.

And there appears to be some granular material in there.

It makes me worry that maybe he's

got a lot of pill material.

NARRATOR The granular matter may be the remains

of partially digested pills.

JAN GARAVAGLIA A lot of times with the suicides,

they'll take , pills of something.

And then we'll see, it maybe doesn't all

absorb from your stomach.

NARRATOR Dr. G preserves the gastric contents

for toxicology, along with samples of Johns

blood, urine, and eye fluid to determine

what exactly was in his system at the time of death.

JAN GARAVAGLIA I'm obviously still worried about su1c1de.

NARRATOR The findings so far support the su1c1de theory,

but toxicology results won't be in for several weeks.

In the meantime, Dr. G continues to look for clues

to John's death in the autopsy.

However, as she examines John's chest cavity,

she is suddenly met with an unexpected abnormality,

one that threatens the very notion of an intentional death.

JAN GARAVAGLIA He's got a big heart, you know,

a big heavy heart that we would see with somebody

with high blood pressure.

NARRATOR John's heart weighs over

grams, nearly double the weight

of a normal adult male heart.

It is likely a deadly consequence of his obesity.

JAN GARAVAGLIA Those hearts are prone to have

sudden arrhythmias, because they're thickened,

and the blood has a harder time getting

into that thickened muscle.

And they are prone to sudden arrhythmias and sudden death.

NARRATOR With this one finding, Dr. G

is met with a new possibility.

What k*lled John Kent?

A fatal arrhythmia or an overdose?

Answers will not be easy to come by.

Fatal arrhythmias leave no traces in the heart tissue.

That is not something that we can say happened in this fellow

until you rule out everything else.

NARRATOR Which means Dr. G must first

scrutinize the toxicology reports to rule

out a suicidal overdose.

Coming up next, toxicology is in.
[ … ]

So too are unexpected conclusions.

JAN GARAVAGLIA The tox kind of surprised me.

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

[dramatic music]

Several weeks after the death of -year-old John Kent,

the toxicology results arrive at the District

morgue in Orlando.

Initially, the case was a suspected

suicidal drug overdose.

But at autopsy, Dr. G discovered an enlarged heart,

opening the possibility that John Kent simply d*ed

of a fatal heart arrhythmia.

Waiting for answers is John's longtime companion,

Greg, who still worries that John may have k*lled himself.

Dr. G goes through the toxicology results

with a fine-tooth comb.

JAN GARAVAGLIA So when we look at the toxicology results,

it kind of gives us a window, again, more

information on what's going on.

I suspected one of his dr*gs is going to be super high.

That's not what I found.

None of his medications suggested that it

could have been an overdose.

If anything, they were therapeutic,

which was at the level it should be, or low.

Very surprising.

So when I first saw that tox, I went, how unusual.

It was not what I expected.

But then, there was something else on the tox

that I didn't expect--

cocaine.

He had been using cocaine right before he d*ed.

But the amount of cocaine he has in his system

is just slightly above what we normally

see with people getting high.

And I don't think you would suspect

that that would've k*lled them.

NARRATOR After reviewing the toxicology report

and autopsy findings, Dr. G concludes that John Kent's

death was not intentional.

He d*ed from a fatal combination of cocaine and heart disease.

JAN GARAVAGLIA Cocaine is a drug that

can cause sudden cardiac arrhythmias,

and he's already got a damaged heart.

That's a bad combination.

It certainly suggests that that's why he d*ed.

He had recently used cocaine just before he d*ed.

NARRATOR With the unexpected findings in hand,

Dr. G can now record the cause of John Kent's death

in the case file and describe in detail the events that

led to his accidental fatality.

John is a -year-old man who suffers from mental illness

and depression.

He takes several prescription medications

that mediate his conditions, all in therapeutic

and recommended dosages.

Little does he know he also suffers from heart disease.

On the night of his death, John gets

into an argument with his companion, Greg,

while driving home from a bar.

JAN GARAVAGLIA They continue their argument in the car.

He hits the boyfriend.

He hits the windshield.

The boyfriend's had enough.

He leaves.

And it looks like as he leaves, this gentleman then

decides to use some cocaine.

NARRATOR Though he uses only a recreational amount of cocaine,

its effects are deadly.

The powerful stimulant causes his enlarged heart

to b*at erratically in an unstable arrhythmia.

As his heart begins to fail, his brain is deprived of oxygen,

and he falls into a coma.

Within only a short time, the erratic heartbeat

results in his death.

His manner of death is not su1c1de but accidental.

JAN GARAVAGLIA Although he says that he wants to k*ll himself,

although he's tried to k*ll himself before,

I don't see that this is a su1c1de attempt.

His cocaine use is what k*lled him.

NARRATOR When informed of the findings,

John's longtime companion, Greg, is

both surprised and comforted.

JAN GARAVAGLIA He was relieved when he found out

that it wasn't a su1c1de, because that really

is a lot of guilt for him.

NARRATOR But for Dr. G, John's death

typifies the ravages of dr*gs, something she sees all too

often in the District morgue.

JAN GARAVAGLIA It's like Russian roulette.

You don't know what dose of cocaine could k*ll you.

It can be the same dose you used last week,

but you just gotta know you're taking a chance.

It's like spinning the cylinder on the g*n.

I certainly see the end result of it.

I see the family grieving over those who d*ed from dr*gs,

and I see the people dead from use of dr*gs.

Why people don't realize it's a dead-end road,

literally, I don't know.

[music playing]