04x08 - Shock to the System

[bunniefuu]

[ominous music]

[dramatic music]

NARRATOR An anonymous call leads police to the dead body

of a -year-old man lying in an empty field

and surrounded by sinister clues.

A straight razor, a syringe.

There was blood on his face.

NARRATOR All the signs point to m*rder.

What's he doing in the middle of that field?

If Dr. G finds evidence of m*rder,

it then launches into a much deeper investigation.

NARRATOR And then a horrific highway

crash leaves a semi in flames, with the driver trapped inside.

They have a completely charred body in the cab of the truck.

NARRATOR The cause of the crash is a mystery.

Could it have been alcohol?

Could he have fallen asleep at the wheel?

NARRATOR And the evidence may have gone up in flames.

The more destroyed the body, the less I'm

going to be able to say and do.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

[guitar music]

I'm cutting downstairs today.

It's my day to be in the morgue, and we have about six bodies

down there.

We're going to go over the cases that we

did yesterday at our morning meeting with the other doctors.

So that one went he hit her left chin,

hit her tongue, back of the neck, hit C, C,

and through the spinal cord and out the back of the neck.

Through her chin?

I have oodles of paperwork to hope to get out some old cases,

then I'm going to have to dictate the cases that I did.

I don't think I'm going to be done downstairs

until about one or two.

Then I've got to come back up and dictate.

It's a crazy morning, but they all are.

[somber music]

Today, I have a -year-old man who was found

face-down in an empty field.

The problem is it's in a bad part of town.

NARRATOR According to the investigator's report,

yesterday morning the Orange County Sheriff's Office

received a disturbing tip.

The caller refused to give his name,

but urged police to go to a wooded area

near the city's edge, because someone

needed their help right away.

Dispatch sends a nearby patrol car to check out the area.

At first, the grassy field appears undisturbed.

But then in a secluded spot about feet from the nearest

roadway, they find a man lying face-down with his arms

folded underneath him.

He is cold and has no pulse.

Immediately, the officers call for homicide detectives, who

in turn request a medical investigator from the morgue

to join them at the scene.

They're not quite sure here if it's foul play,

if it's just collapse.

They don't know what's going on.

NARRATOR And the case grows stranger by the minute.

In a neighborhood frequented by the homeless,

the man seems out of place.

Just his overall appearance did not

seem to be consistent with what you normally

see transients wearing.

He's dressed in a short sleeve,

you know, shirt with khaki colored

cotton slacks, some shoes and socks,

and so he's nicely dressed.

NARRATOR As soon as they roll over his body,

they discover a startling array of clues.

A straight razor that was open also.

In his hand, he was clutching what looked like a syringe,

and there was blood on his face.

[thud]

NARRATOR Once all the evidence is cataloged,

and bagged the body is immediately transported

to the District Morgue.

Now, it's up to Dr. G to piece together

the strange set of clues.

He's definitely not your typical

found dead in bed kind of guy.

NARRATOR Fortunately, a driver's license identifies

the man as -year-old Andrew Hopper,

and police are soon able to track down his daughter

Marilyn in North Carolina.

[phone ringing]

MARILYN Hello?

NARRATOR At first, she refuses to believe that the man found

dead in a sketchy neighborhood could possibly be her father,

but she comes around when she hears

about the syringe in his hand.

She explains that her father used a syringe every day

for good reason.

His daughter said he is diabetic.

NARRATOR Hospital records confirm her claim.

He takes insulin, and he also has
[ … ]

no history of any illicit drug use, alcohol use.

Doesn't even smoke, according to his records and his family.

NARRATOR Confronted with her father's strange and sudden

death, Marilyn finds herself wracked with feelings

of guilt and remorse.

[dramatic music]

She'd been worried about his state of mind

in the wake of a recent divorce and impending retirement.

But now, she desperately regrets not having approached him

with her concerns.

JAN GARAVAGLIA He has had some problems.

NARRATOR Given this new information,

Dr. G wonders if Andrew had simply

searched out a desolate spot in order to commit su1c1de.

You know, the hair on your back,

your neck starts to rise up a little bit when you see a razor

and you see blood.

Maybe he is trying to k*ll himself somehow.

NARRATOR But what concerns detectives is the specter

of v*olence, and there are no witnesses

to Andrew's death except possibly the anonymous caller.

The area where the victim was found is a high-crime area.

The important thing is to first treat this

as though it is a homicide.

He could have been really taken by surprise

from behind, possibly.

NARRATOR If Andrew had been att*cked,

police have a k*ller on the loose.

But they can only launch a full-scale investigation

after Dr. G determines his cause and manner of death.

Homicide, su1c1de, natural, or accident?

Everything's up for grabs here.

[dramatic music]

Tom, could you hand me a male chart please and an internal?

Yeah.

NARRATOR The first thing that Dr. G

notices on Andrew Hopper's body is the object

clutched in his palm.

It's interesting he still has an insulin syringe in his hand.

The needle's a little bent.

NARRATOR She immediately removes the syringe

and then inspects his hands and wrist for any signs

of a su1c1de attempt.

He had a razor blade underneath the body.

I'm looking, maybe there's hesitation marks.

I've had that many, many times, those kind of deaths

where they start out with a razor

and decide that's not the way to go.

NARRATOR But Andrew's arms are devoid of both cuts and scars.

I don't see anything.

SANDY No?

NARRATOR She turns her attention to the bloody wounds

Andrew does have--

Oh, poor guy.

NARRATOR --on his face.

One of his eyes, both the upper lower

lids are very swollen.

It has the appearance of somebody

hitting him in the eye.

It could be just from him falling face down,

but I'm not sure at this point.

NARRATOR She leans in for a closer look at the injuries.

Tiny details catch her eye, and they're moving.

Definitely some ants over all his body,

which is very typical dying in an open field.

NARRATOR This finding confirms that the att*ck

on Andrew's face was not inflicted by human hands.

The aunts here in the South, we have fire ants.

And so they will actually start eating away

and cause these little kind of excoriations

that really can look like you've been beaten up.

[rock music]

NARRATOR But then, just as a possibility

of a homicidal att*ck seems to be fading,

Dr. G makes an alarming new discovery.

Oh, what's going on here?

I just saw that.

This isn't looking good.

[ominous music]

NARRATOR Dr. G spreads open the lids

of Andrew Hopper's right eye.

The normally white parts are bloody red.

He's got little burst capillaries from an increased

pressure in those tissues.

NARRATOR This bleeding, known as a subconjuctival hemorrhage,

can occur spontaneously when a person coughs or sneezes.

But in forensic pathology, seen in decedents,

it often indicates something much more ominous--

strangulation.

We're going to hold this.

Because you have stopped the blood,

pressures build up to the point where

those capillaries can burst.

NARRATOR Dr. G can see no contusions, cuts,

or other signs of trauma on Andrew's body.

But decomposition could be camouflaging

the more subtle hints.

The skin is starting to slip, a little bit of discoloration,

so I'm going to have to interpret

that more on the inside.
[ … ]

If Dr. G finds evidence of m*rder,

it then launches into a much deeper in-depth investigation.

NARRATOR Justice for Andrew and his daughter

could be in the hands of Dr. G.

[sinister music]

OK, Sandy.

All righty.

I'm going.

NARRATOR Slicing from shoulder to sternum,

she makes the Y incision.

JAN GARAVAGLIA So the first thing I need to do

is rule out trauma.

I open up the chest cavity.

I open up the abdominal cavity.

NARRATOR The internal organs come into view,

and on first glance, they look undamaged.

I take the chest plate off.

I don't see any broken ribs.

I don't see any free blood anywhere.

So if there's trauma, it's going to be in the head or the neck.

NARRATOR Her first stop is the neck.

I'm looking for trauma.

That's why I'm doing the neck.

But you have to be really careful underneath that furrow,

because you're more apt to cut the skin.

NARRATOR If Andrew was asphyxiated,

this is where the k*ller would leave the evidence.

Yeah, so you want to make sure you don't

cut the carotids to far out, and so they

can still embalm the face.

[rock music]

NARRATOR But after a thorough search of the area,

Dr. G is left with a surprising conclusion.

And I do a layerwise neck dissection,

and I don't find any hemorrhage.

He has absolutely no trauma to his neck, no evidence

of fracture, no hemorrhage.

And I don't see any broken hyoid bone, which is

where your tongue's attached.

That often breaks with strangulation, or other trauma

to the neck structure.

NARRATOR It appears that Andrew's eye

hemorrhage was unrelated to any foul play after all.

That could be from him falling and then lying there.

NARRATOR She needs to examine the head before completely

ruling out a homicide.

But with that likelihood fading, Dr. G

must now consider the possibility of death

by natural disease.

And she knows exactly where to start looking.

People with diabetes have a much higher risk

of dying from heart disease, and it

has to do with the effects of the diabetes

on their cardiovascular system.

NARRATOR In some diabetics, the excess glucose or blood sugar

can attach to proteins in the walls of blood vessels,

making them thicker and stiffer.

This, in turn, constricts the blood flow.

When that blood sugar has been high for that long,

it affects your large vessels and your small vessels.

NARRATOR If Andrew had developed this condition,

his heart muscles could have d*ed

from a lack of blood and oxygen, resulting

in a fatal heart att*ck.

Usually diabetics, when we see them dying suddenly,

it's usually from heart disease.

NARRATOR To explore this theory further,

she first removes the heart from the chest cavity.

I weigh it.

It's very enlarged, at least twice what it should be.

NARRATOR Next, she dissects the organ,

cutting all the way through to his arteries.

And here, the case takes another curious turn.

As expected, he has narrowing to the blood vessels

that supply blood and oxygen in the heart.

NARRATOR But the narrowing is barely at %.

It looks relatively mild.

We really often see it when they die suddenly closer to %, %

or beyond.

NARRATOR And there's another problem.

Dr. G can find no signs of a major heart att*ck,

like areas of pale, dead muscle.

You know, like, there's no little sign that says,

this trumps everything else.

NARRATOR Nearly halfway through the autopsy

and with no hard evidence to speak of, Dr. G finds

herself back at square one.

I've really got to, again, put the pieces together

and see how everything fits.

NARRATOR Now, she reconsiders two clues that could

add up to a cause of death--

Andrew's diabetes and the empty syringe.

And it looks like he d*ed maybe right after he

gave himself the insulin sh*t.

[dramatic music]

NARRATOR Insulin is a hormone that allows the body to control

glucose or blood sugar levels.

Without insulin, glucose levels can get too high

and lead to complications.

Many diabetics need insulin sh*ts because their bodies
[ … ]

don't produce enough insulin, or their bodies have

become resistant to insulin.

But too much insulin can also have a catastrophic and sudden

effect.

You worry about hypoglycemia or insulin shock.

Your blood sugar is really low to the point

where your brain can't function.

Your brain needs sugar.

And if you don't have it, you can go into a coma.

NARRATOR To help determine whether this scenario is

likely, she will examine one organ in particular.

The stomach contents are interesting to me,

because people who get in trouble with hypoglycemia

means that maybe they haven't eaten.

NARRATOR If Andrew hadn't eaten,

his blood sugar was probably already low,

and an insulin injection on top of that

could easily have been fatal.

She cuts open the stomach and peers inside.

And it's completely empty.

Most likely, Andrew had not eaten for three

or four hours before his death.

So the fact that I find in his stomach

no food really makes me worry that maybe

this is a hypoglycemic att*ck.

Blood sugar is getting lower and lower.

He's starting to feel it.

He misreads his symptoms, and he ends

up giving himself some insulin.

The insulin actually causes the blood sugar to go even further,

and he collapses and dies from the low blood sugar.

NARRATOR Unfortunately, this scenario is nearly impossible

to prove, because post-mortem changes in the blood

can throw off toxicology analysis.

Hypoglycemia is very difficult to diagnose post-mortem,

because as you die, your glucose goes down anyway.

So oftentimes, people have a glucose of zero,

but when they d*ed, it was perfectly fine.

NARRATOR With no way to know for sure, Dr. G must press on.

JAN GARAVAGLIA So then I do the rest of the exam,

just looking to see what I can find.

NARRATOR As she dissects the other organs,

she does detect hints of illness.

Some, she expected from his diabetes.

Kidneys definitely show some signs of chronic disease,

most likely the combination of the diabetes

and high blood pressure.

NARRATOR Some come as a surprise.

His lungs show signs of emphysema.

Usually we definitely see it with somebody

who smokes, although his family says he doesn't

have a history of smoking.

I bet at some time in his life, he probably did.

NARRATOR But none of the remaining organs

reveal anything definitive about Andrew's sudden death,

not even the brain.

I reflect the scalp.

I remove the brain.

A stroke is another possibility, and I don't

see any evidence of a stroke.

I don't see any evidence of trauma.

[tense music]

NARRATOR At the end of the autopsy,

she can finally eliminate trauma and homicide as the cause

and manner of death.

But the remaining clues still point in different directions.

He still could be hypoglycemic,

or if he d*ed from his heart, it would be a cardiac arrhythmia.

NARRATOR And Dr. G isn't convinced either is the answer.

What's he doing in the middle of that field?

It just doesn't make any sense.

NARRATOR For now, she gives police a brief update.

Andrew was not m*rder*d.

I'm going to say the cause of death

is pending, because I just don't have one.

Typically, it's at that point that we'll

close our investigation.

NARRATOR But for his daughter, closure is yet to come.

What I'm going to do is pend the case until I can

tell what really is going on.

[ominous music]

[orchestral music]

JAN GARAVAGLIA Okie-dokie, Ashley.

We're ready, right?

NARRATOR Dr. G draws blood from Andrew Hopper's

body for toxicology testing.

But there's something that blood drawn from a dead body

can't be tested for--

glucose levels.

So Dr. G next inserts a two-inch needle into Andrew Hopper's eye"], index ,…}

and draws clear fluid to send off to the lab.

After completing the autopsy, she still

doesn't know what k*lled him.

ASHLEY We are good on tox.

OK.

NARRATOR Toxicology is her last hope.

Hopefully, he's got a clear cut cause of death

and we lay all these suspicions to rest.

If he doesn't, this may be an albatross around my neck

for months to come.
[ … ]

[ominous music]

NARRATOR Six weeks later, the results arrive.

So his first thing I look at is his eye fluid for glucose.

If I have a very high glucose level,

at least I'll know for sure he didn't die from hypoglycemia,

the low blood sugar.

NARRATOR She finds the number right away,

but it is not good news.

And his glucose is zero.

So now, I don't know if he's hypoglycemic.

He may have been normal, or he may have been low.

NARRATOR A glucose level of zero

doesn't reveal anything, because glucose

levels continue to decrease after a person dies.

Fearing that she may never be able to pinpoint

a cause of death, Dr. G scans through the rest of the report,

and suddenly in the blood test result,

she sees something incredible.

A -year-old man, I'm expecting

them to inject insulin, because he's diabetic

and he's on insulin.

But lo and behold, the -year-old fella has

a super high level of morphine.

It's certainly in the lethal level.

[ominous music]

NARRATOR A powerful opiate, morphine is medically used

for pain control.

But as far as Dr. G knows, Andrew

has no reason to be on it.

The family tells me he doesn't use any illicit dr*gs.

The guy himself told the hospital on his last admission

he doesn't use illicit dr*gs.

Does he have a tumor?

Does he have chronic pain?

I don't have any history of that.

I certainly didn't find a tumor.

Why is he taking morphine?

What's he up to?

NARRATOR The answer, she discovers,

is on the last page of the toxicology report,

trace evidence on the syringe.

That syringe came back as diacetyl morphine,

which is heroin.

[ominous music]

So he is injecting heroin.

In your body, heroin breaks down the morphine,

and it's the morphine that you're getting

the high from with heroin.

You know, I'm shocked by this.

Now, why I should be shocked after these years

in forensic pathology, I don't know.

But a -year-old man, you know, I'm a little bit surprised.

So although he has a bad heart, although he has diabetes,

none of that is what k*lled him.

He d*ed from a high level of morphine from injecting heroin.

NARRATOR The anonymous call, the bad neighborhood,

even the razor blade all suddenly makes sense.

Now, Dr. G can finally, explain how it all fit together

in Andrew's mysterious death.

[tense music]

Tuesday, PM, Andrew Hopper steps

into a rundown neighborhood miles outside of Orlando.

Most likely what's happening is that day,

what forever reason, he probably goes

ahead and buys some heroin.

NARRATOR Dr. G believes Andrew next found a secluded spot,

though possibly not alone.

He's with some people most likely

sh**ting up in this field, and they're

probably using that razor to divide the dr*gs up.

NARRATOR As for Andrew, he brings a tool that he normally

uses to treat his diabetes--

the syringe.

He's got the insulin syringes anyway,

and he went ahead, and mixed the heroin,

and injected it into the syringe.

[whoosh]

NARRATOR The heroin courses through his veins,

quickly transforming into morphine.

In a matter of seconds, the morphine

attaches to receptor sites in his brainstem,

causing his central nervous system

to immediately shut down both respiratory

and cardiac functions.

He has a sudden cardiac arrhythmia, sudden respiratory

depression, and he goes down very quickly, probably

with the syringe in his hand, and he's probably

dead by the time he hits.

NARRATOR Maybe the others shake him, check his pulse,

but they quickly realize he's gone.

And, of course, the other people scatter.

[ominous music]

You know, they know why he d*ed.

If they're around and if they call the police,

they're implicated, and they're implicated for drug use.

NARRATOR Alone in the field, Andrew's body

begins to attract ants.

Only the anonymous caller saves him from more indignity.

With all the information now in hand,

Dr. G can officially rule Andrew Hopper's death an accident.
[ … ]

Most people don't commit su1c1de

in the middle of an empty lot with drug paraphernalia.

Could it be?

I doubt it.

NARRATOR Her only remaining question

is how the family will reconcile Andrew's

tragic and shocking death.

If they didn't know about it, I am sure this

was a complete shock to them.

But believe it or not, they could have just lied to us.

NARRATOR All she can do is communicate her findings

and be there to support them, whatever

their reaction to the truth.

I let the death certificate speak for itself.

I wait until they get it and see if they

have any questions for me.

[inaudible] or her body, which is concentrated--

I never got a call.

[rock music]

NARRATOR A series of strange clues

helped lead Dr. G to the truth behind Andrew

Hopper's tragic death.

But after a fiery crash, all the clues to a truck drivers death

may have gone up in flames.

[sirens]

At this point, they don't even know who the truck belongs to,

it was so badly b*rned.

[ominous music]

[blues music]

NARRATOR AM, every morning,

like more than million Americans, Dr. Jan Garavaglia

drives to the office.

As a veteran medical examiner, however, she's

developed a particular habit.

A lot of times, I don't necessarily

want to listen to the news, because that really will

tell me what my workload is.

NARRATOR But sometimes, there's no avoiding it.

One memorable morning back when she was working at the Bear

County Morgue in San Antonio, Texas,

every radio station was abuzz with breaking

news of a local death.

And it was a huge fire on the side of the freeway.

It made all the news.

They had the helicopter, so it's--

it was a much more horrific sounding

accident than our typical bread and butter accidents.

[thud]

NARRATOR As expected, the crash victim's remains

arrive at Doctor G's morgue.

Her investigator's report gives her

the real scoop on the story.

Huh.

At least he had his seat belt on.

NARRATOR According to the first trooper on the scene,

the emergency call came from the southbound interstate

shortly before dawn.

The crash occurred at approximately AM.

You can see that there was an obvious fire, vehicle fire,

as a result of the crash.

NARRATOR The full impact of the devastation is staggering.

An -wheel big rig has run off the freeway,

and the flames have simply devoured it.

It was a huge tractor trailer full of cotton,

and so it just b*rned, and b*rned, and b*rned.

NARRATOR Just and / months on the road, Trooper Evans

has never seen anything like this.

This was the first -wheeler crash that I

had worked since graduating the Patrol

School Academy in Austin.

NARRATOR Quickly, he learns that no one

has emerged from the truck.

But with the fire at full force, his hands are tied.

It would have been impossible to rescue

or attempt to rescue a driver.

[crackling]

NARRATOR Firefighters quickly arrive on the scene.

After a few tense minutes, they managed to tame the blaze,

but not in time to save anyone caught inside.

Through smoke and steam, rescuers

approach the charred wreck.

The tragic sight is enough to rattle even the most seasoned

of them.

[piano music]

[thud]

There was a subject that was sitting in the driver's seat,

or what was left of the driver's seat.

They have a completely charred body in the cab of the truck.

NARRATOR Now, it falls on Dr. G to answer

a multitude of questions surrounding

this dramatic deadly crash.

Was it a case of mechanical failure or reckless driving?

Could it have been alcohol?

Could he have fallen asleep at the wheel?

An immediate concern of ours was that the driver might

have been possibly intoxicated.

NARRATOR But whether or not the driver was drunk,

Dr. G must determine the official cause of death,

though it seems pretty cut and dried.

Looking at the crash scene, it was obvious
[ … ]

that the driver d*ed from the crash itself

or from the following fire.

I think they'd already made up their mind that he probably

ends up with a lot of trauma, and then dies of his injuries,

and a fire ensues.

NARRATOR But before looking into what k*lled the driver

or what caused the accident, Dr. G has

an even more urgent mission.

She must first find out who the driver is.

At this point, they don't even know who the truck belongs to,

it was so badly b*rned.

NARRATOR Putting a name to the remains

will require an extraordinary two-pronged effort.

On their end, police will investigate the wreck.

In a truck-tractor-trailer combination,

the problem is that they're--

typically, your drivers are not always

the owner of that vehicle.

NARRATOR But if they can salvage a license

plate or vehicle tag, it could lead

them to a trucking company.

Once they figure out who owns the truck

and who should have been driving,

we're going to have to match characteristics to see

if it could be the same person.

NARRATOR She'll put all her efforts

into building the victim's biological profile, a list

of physical characteristics that can be used for identification."], index ,…}

Height, weight.

Is it a male or female?

Certainly, there's a lot of female cross-country drivers.

NARRATOR Her findings will be critical, because there's

no guarantee that the driver on call

was actually behind the wheel.

Who should be driving that truck

may not necessarily be who was driving that truck.

NARRATOR Somewhere out there, a family

is missing a father, a mother, a son,

and only Dr. G can help reunite them.

[tense music]

To document the condition of the body,

one of the morgue technicians photographed the remains

as Dr. G prepares to take a closer look.

I'm expecting maybe a vertebrate

and some charred remains.

Oh, brother.

NARRATOR But on her gurney, she's got much

more than she bargained for.

He's pretty much intact.

He's just very badly charred.

It is horrific to look at.

Some of this bone is black.

There's exposed bone here.

NARRATOR Still, % of the body surface is destroyed.

Clearly burnt beyond recognition.

NARRATOR Dr. G begins searching the body

for clues that could indicate the decedent's

sex, ethnicity, age.

Fortunately, she makes a quick discovery.

Although charred and b*rned, I can still

see external genitalia on him.

You can clearly see that his male.

Burnt, but there.

NARRATOR She next takes basic measurements.

Six feet tall, weighs at least pounds, probably even

a little heavier, since he's lost some fluids

during that charring.

NARRATOR Simple observations like these carry great meaning.

If they tell me the driver is five-foot-six and weighed

pounds, I would say, no, because this

guy is six feet tall and .

NARRATOR But here, things get trickier.

With so much damage, there's no way to verify

ethnicity through skin color.

You really truly cannot tell one charred body from a next,

as far as visually identifying them.

NARRATOR Even the shape of the body is that

of the classic burn victim, with fingers drawn in

and elbows bent.

We call it a pugilistic stance, a fighter stance,

because during the fire, their muscles start to contract,

and they look as if they're in a boxing stance.

And that's what he had.

NARRATOR A DNA analysis would provide the most

reliable and irrefutable proof.

But for Dr. G, it's not a viable option.

The DNA may take weeks.

I know TV shows get it back in, you know, five minutes,

minutes, but that's not the real world.

The real world is there is such a delay in getting the DNA back

that it's not usually useful for us in cases like this

where we need a relatively quick answer,

and that the families would like the bodies back.

NARRATOR Doctor G's best bet is to examine

the toughest, most durable part of the body, the teeth.

[dramatic music]

The teeth will be the last things that are usually

consumed in the fire, and that's usually a great way

to identify somebody.

But I have to know really who we think you are,
[ … ]

but I'm expecting that from the trucking company.

NARRATOR When investigators provide a potential name

for the driver, Dr. G can simply track

down any existing x-rays and dental records

for a possible match.

Carefully, she pries apart the jaw and peers inside.

But what she finds is not at all what she expected.

I can't come up with these stories.

I couldn't make up the interesting twists and turns.

[thud]

[ominous music]

NARRATOR Dr. G taps on the charred

teeth she finds in the mouth of her unidentified crash victim.

For a moment, it looks like she has a full set to examine.

But then she realizes they're not teeth at all.

He's got dentures.

He doesn't have any teeth.

So teeth is not going to be the way I identify this fella.

NARRATOR The dentures do suggest he was not a young man,

but she still does not have a clear ID.

Her only option now is to try to uncover

some other unique characteristic that may shed

light on the victim's identity.

We're going to look for if he's had any surgeries, if he's

had any old trauma to the bone that may compare

to a history of old trauma.

NARRATOR Her only hope is that the inside of his body

survived the inferno.

[orchestral music]

But then, just before making the Y incision,

Dr. G gets breaking news from the police.

The driver was identified by the company as Robert

Clark of Appomattox, Virginia.

NARRATOR Robert Juan Clark.

We found out that he was around six feet tall, that he

did weigh roughly that amount.

He did wear dentures.

NARRATOR Given the circumstances

and the matching characteristics,

she is fairly confident that the decedent from the crash

is indeed Robert.

Death verification was actually made by phone

by me later that morning.

NARRATOR Robert Clark, an unmarried man with no children,

but he is survived by five siblings and a mother who

are devastated beyond grief.

He was not supposed to die.

You know, parents usually die first.

[somber music]

It was just awful.

It was terrible.

It was terrible.

I couldn't believe it.

NARRATOR As the oldest child, Robert naturally took

care of his family.

He was always there for whoever needed him.

He was just a very lovable person.

Biggest heart there is.

You couldn't get a bigger heart.

NARRATOR Now, the family is shocked to learn police believe

their Robert might have caused this accident by drinking

and driving, falling asleep at the wheel,

or even taking dr*gs.

Absolutely no way.

No way, no way.

NARRATOR And most of all, they're

terrified that he may have suffered terribly in the crash,

or worse, in the heat and smoke of the fire.

That was devastating, to think about he b*rned

up and was stuck in that truck.

NARRATOR The nightmare is all too real.

But now that the victim has been identified,

Dr. G can start searching for answers

to these difficult questions.

Being a medical examiner means you don't get

caught up in any kind of drama.

You just kind of put the pieces together and help sort it out.

NARRATOR To her, the facts of the case,

an -wheeler tumbling off the freeway,

strongly suggests an answer that doesn't involve fire.

We're in a-- a tractor trailer.

It goes off the road and flips.

I am going to certainly be looking for head trauma.

[rinsing]

NARRATOR With gloved hands, Dr. G feels four injuries

on Robert Clark's charred head.

I see a lot of fracture to the skull.

The suture lines have kind of burst open.

NARRATOR Suture lines are remnants

of where the bones of the skull fused together during childhood

and early adulthood.

The fact that Robert's sutures have burst open

indicates that some kind of enormous pressure

had been exerted on his skull.

Yet Dr. G believes they're not from a crash impact at all,

but rather from the fire's heat.

[thud]

The fire will actually cause especially this outer table

of bone to really fracture.

NARRATOR In fact, the head shows
[ … ]

no external injuries that he could have

sustained during the accident.

But she knows trauma, even fatal trauma,

can still be hiding inside.

Normally, she'd reflect the scalp at this point

to look for hemorrhage and to prepare for sawing open

the skull to expose the brain.

But with Robert, there's not much for her to remove.

[somber music]

There's nothing to reflect.

The only piece of scalp was a little piece

on the back lower aspect with a tuft of hair,

which was actually burnt, too.

NARRATOR So Dr. G proceeds directly with the next step.

With an oscillating saw, her assistant cuts through the top

of Robert's skull.

[sawing]

[tense music]

All right.

Have you got the key?

The calvarium's a little more fragile than normal,

but we can still use the saw.

NARRATOR Gently, with a steady hand,

she removes it then extracts the brain.

The brain is really kind of cooked.

It gets a little firm and a little bit shrunken.

NARRATOR She dissects it, looking not only for trauma,

but anything else that might have

contributed to the accident.

I cut the brain to see if there's any trauma internally

that I couldn't see externally, any stroke, any hemorrhage,

anything that may have explained why he

went off the side of the road.

But his brain looks completely normal,

except for the fact that there's some heat effect to it.

[whoosh]

NARRATOR This finding rules out injury to the head

as a cause of death.

But this is just the first step in the hunt for trauma.

[rock music]

There's a whole host of other things that I could find--

multiple rib fractures, multiple internal organ trauma,

lacerated liver, a lacerated spleen.

Sometimes even the heart can tear open,

so I have to open the rest of his body.

NARRATOR Unlike the brain, however,

his organs don't have a solid protective shell.

If they're as damaged as his skin,

the entire autopsy could come to a screeching halt.

The more destroyed the body, the less I'm

going to be able to say and do.

[ominous music]

NARRATOR Dr. G puts her scalpel to crash victim Robert

Clark's charred shoulder.

We're ready to open him and now document

the injuries internally.

I do the standard Y incision, just cut through that charcoal,

and then cut down the middle.

Some areas are completely devoid of any type of skin or muscle,

but I just try to cut what's left so we can open that up.

NARRATOR Slowly, the abdominal and pleural cavities

come into view.

[ominous music]

Surprisingly, she finds that the extreme temperatures

from the fiery truck accident had actually spared his organs.

The burning was just on the outside.

The rest of his tissues are still nice,

and glistening, and the normal color on the inside.

His lungs looked fine.

His bones of his pelvis are fine, no free blood.

I don't see any trauma on him.

It seems pretty amazing that he could get through this accident

and not have any injuries, not even a broken rib.

NARRATOR The pristine condition of his organs

suddenly puts a very disturbing twist on the investigation.

Well, he certainly didn't die from trauma.

And now, I'm wondering, could he have been trapped in the cab?

NARRATOR This possibility haunts Robert's family.

I was thinking the worst, you know,

that he had suffered terribly in the fire.

It couldn't happen.

It just couldn't happen.

[crackling]

[rock music]

NARRATOR The only way to determine

whether Robert did perish in the fire

is to examine his airway passages.

I will often open up the trachea

to see if there's any soot or discoloration from the heat.

And then I'll take out the larynx,

and to see if there's any red inflamed look to the mucosa.

NARRATOR If there's soot or inflammation in the windpipe,

it will be a telltale sign that Robert

was alive during the fire, and most likely succumbed

to either smoke inhalation or a heat-related death.

[crackling]

Much of the muscles are already burnt off,

but the trachea's intact.

So I'll just incise that.

NARRATOR She slices open the trachea and larynx,
[ … ]

searching for damage to the airway passage.

But after a careful examination, she comes

to an unmistakable conclusion.

This trachea is nice in pain with no evidence

of soot inside.

There's no heat effect at all.

NARRATOR For Dr. G, this rules out the family's worst fear.

There is really no evidence that he

was alive during the fire.

NARRATOR At this point, Dr. G knows that Robert didn't

die from trauma or the fire.

So what did k*ll him, and what caused the accident

in the first place?

Why did he go off the road?

NARRATOR The police have had their suspicions

from the beginning.

Most accidents on the interstate late at night

are drivers falling asleep or crashes that

involved an intoxicated driver.

NARRATOR Intoxication is one theory, but Dr. G has another--

natural disease.

Is there anything that could have

made him pass out prior to going off the side of the road?

NARRATOR With the help of her assistant,

Dr. G begins inspecting all of Robert's organs one

by one for evidence of a disease that could have struck suddenly"], index ,…}

and fatally.

She starts with a likely suspect for sudden death, the heart.

First, she removes and weighs the organ,

and this is where the case takes a final left turn.

The heart, it was over grams.

It probably shouldn't have weighed more than .

NARRATOR Dr. G recognizes the unusual size of his heart

as dilated cardiomyopathy, a condition

caused by abnormalities in the heart muscle.

The muscle gets thicker.

and then over time, as the heart muscle starts to fail,

the heart dilates, because it can't

effectively pump the blood out.

He's in congestive heart failure.

It didn't fail because of the accident.

It didn't fail because he's in the fire.

His heart's been failing for a while, whether he knew it

or not.

NARRATOR And with a disease failing heart,

Robert was in constant danger of cardiac arrest and death.

His heart was a walking time b*mb.

He could have d*ed at any moment.

Unfortunately, he just happened to be driving a truck.

NARRATOR But to prove to the police

that nothing else drove Robert off the road, Dr. G

must first perform the required toxicology tests.

The insides are fine on him, and so I'm still

able to remove liquid blood.

NARRATOR The results, however, show no trace

of alcohol, and only one drug--

aspirin.

Maybe thinking he's not feeling well,

he takes some aspirin.

That's the only drug we find in him.

NARRATOR Now, Dr. G can finally explain what really k*lled

the -year-old truck driver and caused his -wheel rig

to go up in flames.

[somber music]

[blues music]

Wednesday evening, PM, Robert Clark

hits the road for the last leg of his drive to Laredo, Texas.

He's already looking forward to his next trip,

if only he could shake off this nagging cold.

He probably thought he had some type of a chest cold.

NARRATOR Roberts shrugs off the symptoms with some aspirin.

He has no idea he's actually suffering

from a serious, life-threatening disease.

For whatever reason, possibly high blood pressure,

his heart's enlarged.

And then as he's driving, his heart's failing.

NARRATOR At around AM, Robert is speeding

down a quad stretch of freeway.

Then in the blink of an eye, his heart simply stops b*ating.

He has a fatal cardiac arrhythmia,

goes off the side of the road.

Even the jarring of going off the side of the road

doesn't wake him, because he probably d*ed very suddenly.

[crackling]

NARRATOR The vehicle goes up in flames.

But long before the fire consumes his body, he's gone.

[gentle music]

So there, he's got his eyes closed, but a real smile on him

anyway.

NARRATOR Robert's family is grateful

that Dr. G could save his reputation,

and above all, reassure them that he

had a quick, merciful death.

It relieves the whole family's mind

to know that he did not suffer.

[folk music]

And I hope that gives them some comfort that he

didn't experience that--

that fire.

MAN (SINGING) So my better judgment is lost,
[ … ]

to leave a message for my boss.

JAN GARAVAGLIA I'm sure they wished

it was in another years, but he did

die quickly and without pain.

MAN (SINGING) Drive away.

We won't miss a thing.

You know, this is just life anyway.

[tense music]

MAN Atlas.