04x02 - Derailed

[bunniefuu]

[dramatic music]

NARRATOR An elderly man dies after mysteriously falling

from a high-speed train.

JAN GARAVAGLIA He kind of disappeared off the train,

and nobody saw him.

At least, nobody's saying they saw it.

NARRATOR Did he simply fall or is there

a darker side to this story?

JOYCE OLSEN Right away, we were thinking

that someone did it someone.

Someone pushed him off.

NARRATOR And then, a young woman

collapses during a romantic dinner with her husband.

JAN GARAVAGLIA Basically, she's brain dead by the time

she gets to the hospital.

NARRATOR Now, her distraught husband

needs to know if a deadly habit finally took its toll.

She does like to use dr*gs, particularly cocaine.

NARRATOR Or is something else to blame?

We don't know.

I mean, there are a lot of odd things that could occur.

Altered lives, baffling medical mysteries,

shocking revelations.

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

You don't have to live inside Dr. G's jurisdiction

to end up on her autopsy table.

You just need to die there.

And all too often a traveler ends their journey prematurely

with a visit to the morgue.

If you've d*ed in the jurisdiction that I cover for,

we're going to need to find out why you d*ed.

We don't care where you came from.

If you've d*ed in our jurisdiction,

we're going to do that.

NARRATOR Such is the case of Victor Gust, who passed away

while traveling through San Antonio,

Texas during Dr. G's tenure at the Bear County

Medical Examiner's Office.

As Dr. G reads through the case file,

she's surprised to learn that -year-old Victor

Gust was a resident of Wisconsin,

over , miles away.

Oh, boy.

Well, we don't get too many people

from Milwaukee, Wisconsin.

NARRATOR To those who knew him, Victor

was the life of every party.

JUDY YANTIS He was a bit of a clown,

and my mom always referred to him

as the jokester of the family.

JOYCE OLSEN Well, as far as I remember

from back in the younger days that he

had a good sense of humor.

I just remember that we had fun.

We had a lot good times.

NARRATOR Afraid to fly, Victor was traveling through Texas

by train on his way to his sister's

funeral in Phoenix, Arizona.

But when the train arrived at the Phoenix station,

Victor didn't get off.

JUDY YANTIS My sister and I went down to the train station.

We waited and waited and waited.

The train came in, people got off,

and we'd be looking, going you know, is that him?

Is that him?

We were telling ourselves that maybe he fell asleep.

NARRATOR Conductors searched through the cars for Victor,

but he's nowhere to be found.

JOYCE OLSEN We all were thinking

that maybe he got off somewhere and didn't

get back on that train.

We just had no idea what to think.

NARRATOR Two hours later, Joyce gets a call from police.

They found her uncle Victor, but he's miles away

just outside of San Antonio and lying

unconscious beside the train tracks.

They find him alive but pretty much unconscious.

He can't really talk.

They helicopter him to a hospital

that is in my jurisdiction.

NARRATOR Victor remains in critical condition in a San

Antonio hospital for two weeks.

But he never regains consciousness.

JAN GARAVAGLIA He was very ill in the hospital,

on a ventilator.

They eventually had to put a tracheostomy tube in.

His respiratory state got worse and worse,

and he eventually d*ed.

NARRATOR For Victor's family, the loss is bitter.

His death was an especially sad time, because like I say,

we had just lost my mother.

We were all just shook up by the whole thing.

JUDY YANTIS Then for this to happen, it just was--

just one thing after another was just compiled.

NARRATOR What happened to Victor Gust on that train,

traveling through San Antonio at AM?

There's no witnesses.

They don't know how he got off that train.

So it's kind of a mystery.

NARRATOR The first scenario Dr. G considers is su1c1de.
[ … ]

His sister was the only immediate family

Victor had left.

And the long trip to her funeral may have

simply been too much to handle.

JAN GARAVAGLIA He's very upset, and maybe he

feels what's the point?

He doesn't want to face that funeral,

and he commits su1c1de.

I've had more impulsive suicides that I've autopsied.

NARRATOR Another possibility is that Victor could have simply

suffered a fatal accident.

JAN GARAVAGLIA He could have accidentally just tripped

and fallen off the train.

NARRATOR Finally, Dr. G considers

the most disturbing scenario, that Victor was

pushed from the speeding train.

Well, I'm always worried about foul play.

NARRATOR And in this case, there might be good reason.

According to several train passengers,

Victor had been behaving oddly during the trip.

He was acting very bizarrely, supposedly making

people irritated on this train.

He stole a pair of shoes from a little girl.

He took somebody's pillow, and people

were getting agitated at him.

NARRATOR Perhaps Victor did something that pushed

a fellow passenger too far.

I would hope that this is not the scenario, but I don't know.

NARRATOR It's this possibility that have police and Victor's

family most concerned.

JUDY YANTIS Right away, we thought that someone

pushed him off or something.

Why, you know, would someone fall off the train?

JAN GARAVAGLIA He kind of disappeared off

the train and nobody saw it, or at least

nobody's saying they saw it.

NARRATOR As a first step, Dr. G begins documenting Victor's

injuries from the fall, hoping they might reveal

clues as to what happened.

She finds abrasions on his hands and ears.

That is odd. Look at that.

I have two of those on--

NARRATOR And superficial puncture wounds

to his arms and elbows, all consistent with a fall

from a moving train.

Oh, this should be interesting.

NARRATOR But it's Victor's head that seems to have

sustained the most damage.

JAN GARAVAGLIA The lacerations extend through the scalp

and go down to the bone.

So there are very significant lacerations.

I'm going to get a chart for his head.

NARRATOR Victor's head trauma might have been severe enough

to k*ll him, but Dr. G won't know for sure until she

performs the internal exam.

But we've got to see what's on inside the brain.

NARRATOR If that is the cause of death, however,

it may be impossible to say for sure what or who caused him

to fall from the moving train.

Certainly, I would love it if somebody pushes him

and I see handprints.

But I'm sorry, it's not that easy.

It doesn't work like that in the real world.

NARRATOR Coming up next, Dr. G makes

a shocking discovery about what happened

to Victor after his fall.

There's a lot of pus in there.

It's clear.

You can see it with your eye.

NARRATOR When "Dr. G Medical Examiner" continues.

[dramatic music]

Dr. G reflects the scalp of -year-old Victor Gust.

While traveling by rail from Wisconsin to Arizona,

Victor somehow fell from the train

and d*ed two weeks later in the hospital.

Dr. G is almost certain Victor d*ed as a result of the fall.

But the question is, what caused that fall in the first place?

JOYCE OLSEN Someone must have done something bad,

you know, pushed him off or threw him off.

I would hope that's not the case.

But I have also had more senseless

murders that I've autopsied.

So what is it?

I don't know.

NARRATOR As Dr. G gets her first look

at the surface of Victor's skull,

she is surprised by what she doesn't find.

I don't see any skull fractures

at the top of his skull to the bottom of his skull.

NARRATOR Her assistant then uses the oscillating

saw to open his cranium.

Here, Dr. G does find trauma, a subdural hematoma

or bleed in the brain.

Oftentimes, with trauma, we see blood collecting

between the dura and the brain.

And the dura is that tough covering over the brain.

And the blood collects fast enough or enough,

it can press on the brain and really cause trouble.

NARRATOR But when Dr. G carefully

examines the collection of blood on Victor's brain,
[ … ]

she determines that the hematoma is minor.

With his, he's got just a little bit--

just a little bit of blood there.

It's layered out.

It's what we call non-space-occupying.

I wouldn't think that that was enough to k*ll him.

NARRATOR This is a surprising finding

that could take the case in a completely different direction.

Dr. G's initial suspicion that Victor

d*ed from head trauma sustained in the fall is not the case.

In fact, the injury may not even have

been severe enough to render him unconscious

or required a stay in the hospital.

I don't know what his problem is yet.

NARRATOR But that fall might still

have caused other fatal internal injuries,

and that's what she'll search for next.

Dr. G opens Victor's torso with the standard Y incision.

JAN GARAVAGLIA I look in the chest, I look in the abdomen,

but I don't see any trauma.

I don't see any broken ribs.

I don't see anything major as far as traumas concerned

in his chest or abdomen.

NARRATOR Incredible as it seems,

-year-old Victor fell from a train going miles per hour,

and he sustained no significant internal injuries.

Whatever k*lled Victor Gust, it wasn't his fall from the train.

OK.

But I gotta clean my hands.

NARRATOR With this shocking discovery,

Dr. G is back to square one.

All she can do now is push on with the internal exam,

removing and dissecting each vital organ in turn,

hoping for a clue.

And it's not long before she finds one.

Oh, my gosh.

That left lung is just full of fluid.

His lungs look terrible.

They were full of fluid.

NARRATOR But it's not just fluid buildup she sees.

There's a lot of pus in there.

It's clear.

You can see it with your eye.

Yes.

They're very congested.

They've got some edema too them.

NARRATOR This tells Dr. G that Victor

has contracted pneumonia, a significant bacterial infection

in his lungs.

It's very common to get pneumonias

and infections in your long when you're on a respirator.

Patients on ventilators are at high risk for bronchial or lung

infections, because the breathing tube bypasses

the normal defenses of the respiratory tract

and can even harbor bacteria.

Up to % of patients placed on a ventilator

for more than two days develop ventilator-associated

pneumonia.

Up to % of them die as a result. After his fall

from the train, Victor was on a ventilator

for nearly two weeks.

When you have a breathing tube down into your airway,

you can get colonized with a lot of different bacteria.

NARRATOR Dr. G believes this infection wasn't just severe,

she believes it's what ultimately k*lled Victor Gust.

JAN GARAVAGLIA I can clearly see that he d*ed

from unable to be oxygenating.

He just cannot exchange oxygen anymore from the air,

from the respirator.

The lungs are too badly damaged.

NARRATOR In many autopsies, this discovery would be

the final piece to the puzzle.

But not in the case of Victor Gust.

It's clear he d*ed from an infection

he contracted from a respirator in the hospital.

But for Dr. G, what led him to be on that respirator

is the real culprit, the true cause of death.

JAN GARAVAGLIA I mean, that's clearly the end result.

But what is it that started this?

He clearly didn't have lung damage

when he was on the train.

I mean, this is just all a result

of whatever happened to him.

NARRATOR Coming up next, Dr. G zeros in on a k*ller.

But will it be enough to close the case on Victor Gust?

So how am I going to figure that out?

I don't know.

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

[dramatic music]

Dr. G is pulling out Victor's organs one by one

and dissecting them.

-year-old Victor Gust was hospitalized

two weeks ago after falling off a moving train.

Dr. G has since discovered that Victor

d*ed of pneumonia he contracted while on a ventilator.

Although this is his cause of death,

Dr. G isn't satisfied, because to her,

whatever caused Victor to be in the hospital

in the first place, an accident, an as*ault,

or a natural disease, is what really k*lled him.
[ … ]

JAN GARAVAGLIA The bottom line is, what happened to him?

NARRATOR Dr. G's next stop is the heart.

And here, she soon finds a clue in Victor's coronary artery.

He's got bad coronary arteries.

NARRATOR It contains a dangerous buildup

of plaque, a condition known as coronary artery disease.

He has some coronary artery disease,

but what's really troubling is that he's got a thrombus.

In one of the coronary arteries, in one of the vessels

that supplies blood and oxygen to the heart,

he's got a thrombus.

It looks like there was a little clot.

NARRATOR A thrombus or blood clot is clearly obstructing

Victor's coronary artery.

JAN GARAVAGLIA The blood flow then can't

get through that thrombus.

It's blocking it.

It's damming it so no blood can get in.

NARRATOR The blockage of the artery

deprives the heart of blood and oxygen,

ultimately causing injury to the muscle itself.

JAN GARAVAGLIA When I look at the muscle, it's yellow,

it's soft, it's necrotic, because the muscle

fiber actually is dying.

That's what the yellow is.

It's just disintegrating and dying.

It's a huge heart att*ck.

NARRATOR Could this heart att*ck

have set off the chain of events that led

to the death of Victor Gust?

Or did Victor simply suffer the heart att*ck during his two

weeks in the hospital?

To find out, Dr. G will have to try to determine exactly

when the heart att*ck occurred.

To help establish a frame frame, she'll

need to dissect the heart and examine it up close.

JAN GARAVAGLIA When you have a heart att*ck,

it changes from just pallor or paleness from lack of blood

to then some hemorrhage and then you can get some softening

and get some yellow, because the muscle fiber actually is dying."], index ,…}

And so his is at the stage where it's really, really necrotic.

The muscle is just as soft as can be.

NARRATOR Based on her examination of the heart,

she calculates that the heart att*ck struck about two weeks

earlier, around the time Victor was traveling on the train

and before he was admitted to the hospital.

But she can't narrow the time frame any further.

And that means that there is one question that she'll

never be able to answer.

JAN GARAVAGLIA Did he pass out from the heart att*ck

and fall off the train or was it the whole stress

of either being pushed or accidentally

falling off the train?

Now, when you have stress, your blood pressure goes up,

and that certainly could have ruptured that plaque

and caused the thrombus.

Here's the problem with this--

I can't date it within seconds or even within hours

at this point.

Which came first?

The chicken or the egg?

I cannot tell from just looking at that heart.

NARRATOR By the end of the autopsy,

Dr. G is certain that Victor Gust had a major heart att*ck,

which then caused him to be on a respirator

and contract pneumonia.

But she'll never know what triggered it.

Unfortunately, it's one of those few cases

that you don't know.

So we're never going to get an answer on this.

NARRATOR When she reports her findings,

Dr. G presents the scenario that seems

most likely, even though she knows

it's not the only possibility.

[train whistle]

-year-old Victor Gust is on a train

bound for Phoenix, Arizona.

According to fellow passengers, Victor

begins acting strangely during the second day of his journey.

JAN GARAVAGLIA He's irritating people on that train,

stealing shoes, stealing pillows.

People are starting to get irritated at him.

NARRATOR To Dr. G, this might be the first sign that he's

having a major heart att*ck.

Lack of oxygen going to his brain

because of the heart att*ck, it could

cause him to act funny from the heart just not pumping well.

NARRATOR Not completely in his right mind,

perhaps Victor opens a door or ventures between cars.

He's had a heart att*ck.

His heart isn't pumping very well.

He's acting somewhat bizarrely.

He's probably getting some shortness of breath.

He goes out to get some oxygen. He collapses

and tumbles off the train.

NARRATOR His head strikes the ground,

and a small hematoma begins to form,

but it is not life-threatening.

As the train clacks away down the tracks,

Victor's heart att*ck puts him into a state of unconsciousness
[ … ]

that he will never return from.

He's hospitalized, placed on a ventilator, and as a result,

contracts pneumonia.

Slowly and slowly, his lungs get worse and worse and worse,

and he d*ed.

NARRATOR For Dr. G, it's a poignant scenario,

but it's not the only possibility.

The heart att*ck could have simply

been the result of a fall from a fast-moving train.

JAN GARAVAGLIA It could have happened after he'd fallen off

the train and just the stress of falling off,

that heart att*ck could have occurred.

NARRATOR Victor's fate is something that forensic science

can never know.

He either jumped off that train,

he either fell off that train, or he

was pushed off that train.

So it's one of those very unsatisfying

movies where they do three different endings,

and you pick.

I hate those.

NARRATOR The lack of certainty also troubles Victor's family.

JUDY YANTIS The fact that we may never know what happened

to him really bothers me.

It does.

It still bothers me.

And I'm sure it probably always will.

JOYCE OLSEN I would hate to think that another person

actually did this to him.

I wish I could have given the exact answer to the family.

I feel bad about that.

I always do.

But I got as many answers as I could from that body.

I don't have a preponderance of evidence here.

So I'm going to have to leave this one as undetermined.

NARRATOR Coming up next, a young woman

suddenly collapses and dies in the middle of a restaurant.

JAN GARAVAGLIA People see her fall to the floor

and have a seizure.

NARRATOR Did a dangerous habit ravage

this healthy woman's body?

JAN GARAVAGLIA She's known to use cocaine.

She's known to use ecstasy.

She is known to drink on a daily basis.

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

[dramatic music]

As chief medical examiner of the District Morgue in Florida,

Dr. Jan Garavaglia's job is to open and examine dead bodies

as soon as possible.

Oh, my goodness, though.

NARRATOR Unless the decedent is an organ donor.

Somebody has already peeked in.

But that's OK.

We'll deal with that.

NARRATOR Today, an organ recovery agency

wants to remove the liver of a local -year-old woman,

if Dr. G approves.

They do have to get our OK.

It certainly makes things a little bit harder

to find sometimes.

NARRATOR According to the agency representative,

the donor d*ed in the hospital after a sudden collapse

and three days in a coma.

JAN GARAVAGLIA We can work around it.

These are lifesaving measures, and I'm certainly not going

to refuse an organ just because it would

make my job a little easier.

NARRATOR Ultimately, she allows the procedure to move forward.

So they went ahead and then procured

the liver, transplanted that.

And then we got the body.

NARRATOR The next morning, Dr. G finds the donor, Jesse Davis,

in the day's lineup.

Hi mom.

Hi dad.

NARRATOR An aspiring cookbook writer, Jesse had a passion

for playing with recipes.

But according to the investigator's report,

her dreams were cut short three days earlier

while enjoying a meal at a favorite local diner.

JAN GARAVAGLIA She was having dinner

with her husband late at night, kind of early in the morning.

And while she's eating, she falls

to the floor, starts seizing.

NARRATOR Her husband, Aaron, springs into action.

Starts CPR.

They call --.

They're able to get her heart going,

but basically she's brain dead by the time

she gets to the hospital.

[siren]

NARRATOR Doctors immediately put Jesse on a respirator

and begin searching for a way to save her.

Desperate, Aaron tells them everything he can.

JAN GARAVAGLIA She doesn't have a history of seizures.

She's got a family history of heart disease,

but it's a little bit vague.

And the husband didn't really know that much about it.

NARRATOR He also reveals that his wife

has a history of drug abuse.
[ … ]

JAN GARAVAGLIA She does like to use

dr*gs, particularly cocaine.

NARRATOR But when the hospital runs a urine test,

it comes up negative for all illegal substances.

A CAT scan of her brain and a chest X-ray

also reveal nothing.

And they never could figure out why, what happened to her.

NARRATOR With nowhere else to turn,

doctors must finally tell Aaron, there's no hope for recovery.

Three days later, he agrees to take Jesse off the respirator,

and she dies.

Now it's up to Dr. G to answer the question

ER doctors could not.

What caused her to suddenly collapse

and then start seizing?

NARRATOR Based on the information thus far,

she believes that whatever caused the seizure is likely

the k*ller.

JAN GARAVAGLIA When people present with a seizure,

they don't usually die from it.

And it's usually from something else.

NARRATOR Unprecedented seizures are a symptom,

signaling that the brain has been suddenly deprived of blood

and oxygen. But numerous ailments, including

strokes, heart att*cks, and an overdose

can trigger this condition.

Dr. G can only speculate as to what

was behind Jesse's seizure.

JAN GARAVAGLIA Could be dr*gs, could be her heart,

or it could be something we don't know.

I mean, there are a lot of odd things that could occur.

Bottom line, is we don't know why she just all of a sudden

collapsed at the restaurant.

So that's what we're going to have to figure out.

OK.

We'll start.

NARRATOR As Dr. G begins Jesse's external exam,

one glaring wound provides a glimpse of her journey

to the morgue.

JAN GARAVAGLIA She's got the large incision

from the post-mortem organ retrieval.

NARRATOR She also takes note of Jesse's

white antiembolic stockings.

JAN GARAVAGLIA These are stockings

they put on to compress the legs so blood

clots don't readily form.

NARRATOR Clots are the result of abnormally coagulating

blood in the veins.

Blood clots can be life-threatening

if they travel through the vascular system to the lungs.

She removes the stockings and sees no anomalies on the skin

beneath.

In fact, she finds nothing inexplicable

anywhere on the body until she inspects the arms.

She has needle puncture marks.

She's got a lot of them.

NARRATOR These could be from the intravenous feeding

she received while on the respirator.

Were these needle puncture marks from the hospital?

NARRATOR But Dr. G also considers

Jesse's history of drug abuse.

Perhaps she'd injected a stimulant such as cocaine

and d*ed of an overdose.

Certainly, cocaine can precipitate a seizure.

NARRATOR The hospital drug screen did

test negative for narcotics.

But Dr. G knows from experience that these tests

are not always foolproof.

JAN GARAVAGLIA With the urine drug screen,

sometimes it won't pick up if you've

used the drug very quickly, before it gets a chance

to build up in the urine.

NARRATOR The only way to prove whether she

seized from an overdose is a comprehensive blood screen.

JAN GARAVAGLIA What we'll do is we'll get the initial blood

from the ER-- they said they'd save some of that--

and go ahead and test it ourselves.

NARRATOR But the lab work will take weeks.

For now, Dr. G must proceed with the internal exam,

hunting for any evidence the ER staff might have missed.

We're not going to know until we get inside.

NARRATOR First, she looks for signs of a stroke.

This ailment would have deprived a small part

of Jesse's brain of oxygen and could explain the seizure.

So we're going to go ahead and start with the head,

and then I'll do the chest.

NARRATOR But even before she reflects the scalp,

Dr. G knows a major challenge lies beneath.

A brain that grew soft while Jesse

was kept alive on a respirator, long after the organ

itself was dead.

JAN GARAVAGLIA We call these respirator brains.

If they're long enough on that respirator,

it'll be almost semi-liquid.

NARRATOR Coming up next, Dr. G struggles

with a tricky maneuver.

It's difficult to get this brain out.

I'm going to pulverize it.

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

[dramatic music]
[ … ]

Dr. G removes Jesse Davis's calvarium,

or the top of her skull, looking for signs

of a stroke or other disease.

Three days ago, while eating dinner,

the -year-old suffered a seizure

and never regained consciousness.

JAN GARAVAGLIA Has a sudden arrest, unknown etiology,

unknown cause.

NARRATOR With no diagnosis, her death is shrouded in mystery.

And Dr. G has little information with which to solve it.

We have no real history that she's got a family history.

She'd been in foster care, and I'm not so sure how

much she knew about her family.

NARRATOR Jesse's husband fears that drug

addiction, which she tried so hard to conquer, is to blame.

Now it's in Dr. G's hands to determine

the true cause of death and bring a measure of peace

to her grieving husband.

Dr. G attempts to extract the brain,

but it's a risky operation.

Well, this is really difficult to get this brain out.

She's been three days on a respirator brain dead,

and the brain has gotten very soft.

It's starting to break down.

I'm going to pulverize it.

NARRATOR It takes a very steady hand.

But after a few tense moments, she's

able to pull it out intact.

I got it.

NARRATOR Now, she must dissect it as best she can,

searching for any signs of a stroke.

This is interesting.

NARRATOR But after a thorough search,

she finds no abnormalities whatsoever.

JAN GARAVAGLIA And I didn't see anything in that brain

that was unusual or that would have precipitated her death.

NARRATOR So far, Jesse's k*ller is proving to be elusive.

Now, she's hoping to track it down in the internal exam.

Dr. G performs the usual Y incision.

Then she quickly homes in on a major organ,

whose failure could easily trigger a seizure, the heart.

She's got a family history of heart disease.

Most likely, that has something to do with atherosclerosis.

NARRATOR Atherosclerosis, or the narrowing and hardening

of the arteries, is one of the leading

causes of heart att*cks.

JAN GARAVAGLIA is pretty young,

but I've seen it before in young people of that age.

So it is a possibility, particularly

if you use cocaine.

NARRATOR She methodically dissects the organ, searching

for any visible abnormalities.

I'm looking at the thickness of the wall

of the heart muscle.

I certainly will look at the coronary arteries.

NARRATOR But it doesn't take long

to determine that Jesse's heart, like her brain,

was perfectly healthy.

I don't really see anything that

would indicate a chronic heart history from her family.

I don't see a lot of the chronic changes

that I see with cocaine.

That doesn't mean she would not have gotten it in the future.

But at , she did not have any heart disease.

NARRATOR With that possibility ruled out,

Dr. G seems further than ever from determining

what cut down Jesse Davis in the prime of her life.

We've got the big two down, the brain and the heart,

so we're running a little bit low on options.

NARRATOR Now, she turns to the last major organ

that could trigger a sudden lack of oxygen

and a seizure, the lungs.

And as soon as she picks them up, she detects a problem.

They're kind of heavy and boggy,

and I can see some hemorrhage on the surface.

NARRATOR Quickly, she digs deeper,

and it isn't long before her scalpel hits the jackpot.

She's got these blood clots.

They look like little nubbins coming out of the blood

vessels, kind of a dark purple, and you

can see kind of whitish strands through them.

NARRATOR These are multiple pulmonary thromboemboli,

blood clots in the lungs.

It's an alarmingly common condition

that strikes at least , Americans a year, most of whom

are elderly or immobilized after surgery.

Typically, the clots originate in the legs

or pelvis, when the patient's blood

starts coagulating too much.

The cells that are in charge of clotting

in the blood, the platelets, start tacking onto each other

and accumulating, and eventually they

form a large, soft, gooey mass.

NARRATOR Then, when it breaks loose,

it travels through the cardiovascular system

until it gets stuck in the lungs.

Well, what happens if you get a blood clot in the smaller

vessels of the lungs is the blood to get oxygen

from the lungs can't get in.

NARRATOR The diminished access to oxygen
[ … ]

can cause shortness of breath, anxiety, and chest pain.

That is, if the patient has any symptoms at all.

OMAR KAYALEH Most of emboli can be asymptomatic.

And not all of them are necessarily very evident,

even in the tests that we do.

NARRATOR This explains why doctors

were unaware of Jesse's emboli.

JAN GARAVAGLIA X-rays don't show blood clots very well.

You're just not going to see them.

NARRATOR But in autopsy, Dr. G is

able to see dozens with her naked eye,

peppered throughout the lungs.

JAN GARAVAGLIA If you get enough of these

or if you get big enough ones, it

causes you to collapse from lack of oxygen.

So everything really fits with her.

NARRATOR The profuse clots Tr*mp

all other possible causes of the seizure,

including a drug overdose.

JAN GARAVAGLIA Clearly, the sheer number of them

is the reason why she collapsed and seized

and why her brain wasn't getting enough oxygen.

And this is why she d*ed.

NARRATOR Dr. G now has a definite cause of death.

But the discovery raises a new, baffling question.

JAN GARAVAGLIA A big piece of the puzzle that's missing

is why this young woman would have thromboemboli.

NARRATOR Unlike the classic victim,

Jesse was an active young woman.

And from the way the clots have attached to the lungs,

Dr. G can tell they developed before her fatal collapse.

This clearly predates her being just in the hospital.

So we really don't have anything that would put her at risk.

NARRATOR To fully explain her untimely death,

Dr. G must leave no stone unturned until she brings

the true culprit to light.

Coming up next, dead-ends and negative findings

plague the case.

JAN GARAVAGLIA She's not obese, doesn't

have cancer that we know of.

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

[dramatic music]

Another physical autopsy comes to a close.

Three days ago, Jesse Davis seized and collapsed

in front of her husband.

Dr. G discovered deadly clots in her lungs.

But why this young woman fell victim remains inexplicable.

Why would a -year-old have a risk factor for clotting?

NARRATOR Now, she must look for the answers back at square one."], index ,…}

As a next step, Dr. G reopens Jesse's original case file.

She pours through all the data, weighing

each against every known cause of blood clots.

She's not obese, which is a risk factor.

She doesn't have cancer, which is a risk factor.

She doesn't have a history of immobility

prior to this hospitalization, like being

on a long airplane flight.

That's a risk factor.

NARRATOR Dr. G also wonders if genetics played a role,

but as a foster child, Jesse's family

history is tragically slim.

Finally, she's left with only one option.

Go back to the man who knew Jesse better than anyone.

JAN GARAVAGLIA We may not have all of her history.

Maybe we'll come up once I talk to the husband

why she would have these multiple

pulmonary thromboemboli.

Hi, this is Dr. Garavaglia at the medical examiner's office.

NARRATOR At first, it's appearing as if Aaron has

no new information to offer.

But then, he reveals two seemingly trivial facts,

with enormous implications.

She's recently started birth control pill, and she smokes.

NARRATOR For Dr. G, this new information

breaks the case wide open.

There is an association, although small,

between birth control pills and developing blood clots.

NARRATOR Normally, the human body

maintains a delicate balance between chemicals that promote

clotting to heal wounds and chemicals that prevent

thrombosis or unwanted clots.

JAN GARAVAGLIA So the body has this beautiful balance,

and it has a way to regulate this internally.

NARRATOR But in less than % of women, for reasons yet unclear,"], index ,…}

the hormones in oral contraceptives

upset the chemical interaction.

And smoking makes the problem worse

by constricting blood vessels and causing easy blockage.

OMAR KAYALEH If you're on oral contraceptives, and you smoke,

you are at increased risk of developing clots.

NARRATOR In Jesse's case, the odds

may have been stacked against her,

if she was genetically prone to clots and never knew it.

JAN GARAVAGLIA She developed them so quickly after taking

the birth control pills.

So I really suspect that she has a hereditary predisposition

for thrombosis.

And, in fact, probably about % of women who get birth control

pills, who then develop these thrombi,

have this predisposition.
[ … ]

It's probably even much higher.

NARRATOR Unfortunately, there's no way for Dr. G

to prove that the pills directly caused the blood clots.

JAN GARAVAGLIA We don't usually test

for these hereditary thrombotic diseases,

and there is nothing I can do to somehow correlate it

with the birth control pills.

It's just that you put the pieces of the puzzle together.

NARRATOR The pulmonary emboli, the oral contraceptives,

the cigarettes, and the obscure family history.

Now, with accumulative evidence, Dr. G

is confident she can say exactly what happened to Jesse Davis

on the night of her untimely death.

At years old, Jesse's life is in grave danger.

But it's not from her cocaine addiction or her family

history of heart disease.

It's from her new birth control pills.

JAN GARAVAGLIA Probably when she starts taking these pills,

the increased estrogen kind of throws off

that delicate balance your body has

to dissolve the little blood clots that normally

form in our bloodstream.

NARRATOR Soon, clots begin to develop

all over her pelvic vessels, and some begin a precarious journey"], index ,…}

through her body.

JAN GARAVAGLIA Several of these are

starting to break off and shower her lungs,

both sides, all lobes.

NARRATOR Unfortunately, like most who develop clots,

she has no symptoms from these smaller ones,

until one night when a large one finally breaks loose.

JAN GARAVAGLIA Once that blood clot breaks off,

it travels very quickly, seconds, into your heart

and then into your lung.

NARRATOR The embolus lodges firmly in one of her lungs,

completely blocking the blood flow.

JAN GARAVAGLIA And it just puts her over the edge.

She passes out and starts to seize.

NARRATOR No amount of CPR can fully resuscitate her.

JAN GARAVAGLIA They're never really

able to bring her brain back, which had already

d*ed from lack of oxygen.

NARRATOR Three days later, without ever

comprehending her fate, Jesse dies in her husband's arms.

While Dr. G can't say whether Jesse could have entirely

prevented the clots, there's no question that quitting smoking

would have helped her odds.

OMAR KAYALEH Nobody really needs

to be smoking, quite frankly.

But for those who do smoke, they need to realize that they are

at risk for developing clots.

NARRATOR And her genetic predisposition

may have come to light with a blood test,

if only she'd known more about her family.

JAN GARAVAGLIA Unless she had the family history,

they probably wouldn't test you for it.

It's a very small fraction of people that have it.

Otherwise, the pills should be very, very safe,

and it shouldn't be a problem.

She was just one of the unfortunate

ones that developed the clots.

I guess you could say it's just the luck of the draw.

Some people are just unfortunate.