04x13 - Once Bitten

[bunniefuu]

[music playing]

NARRATOR He's the picture of health.

He was perfectly healthy, muscular, athletic guy.

NARRATOR But looks can be deceiving.

He coded in the trip to the hospital

and arrived dead on arrival.

NARRATOR And the only clue to his death

is a mysterious incident.

Something really odd happened several weeks ago.

They thought it was odd that they both had spider bites.

NARRATOR And then, a family's dream comes true--

We've always wanted to go to Orlando.

NARRATOR --only to have it end in a nightmare.

It must be devastating to have a family member die when you're

there having fun and something you

dreamed about doing together.

[music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

these are the everyday cases of Dr. G, medical examiner.

[music playing]

It's the beginning of the work week in Orlando.

At the district morgue downtown,

chief medical examiner Dr. Jan Garavaglia

combs through the files of individuals

who d*ed over the weekend and require examination.

Ah, here's his medical record-- let's see.

NARRATOR The first case on her list

is a -year-old man named Eric Brody.

He d*ed while in Orlando on business,

leaving friends and family back home in California in a state

of heart-wrenching disbelief.

They're like, how can this happen?

He left me, and he was perfectly healthy--

muscular, athletic guy.

And now, you're telling me, he's dead?

And nobody knows why.

NARRATOR According to the investigator's report,

Eric Brody had arrived in Orlando a week earlier,

for a marketing convention, feeling great.

But shortly after checking into his hotel,

he begins to develop a minor backache.

He gets here and he tells his friends that he kind of pulled

his muscle and really wasn't feeling well

and had to stay in bed.

And so he stays in bed and doesn't even

go to the convention the first day.

[coughing]

He calls his doctor back home, and his doctor

told him to take some acetaminophen

and an inflammatory over-the-counter medication,

and maybe that would help.

NARRATOR But it doesn't.

Eric-- usually active and healthy--

is confined to his hotel bed for two more days.

His colleague, Sarah, continues to keep

daily tabs on his condition.

[phone rings]

JAN GARAVAGLIA She calls up the next day.

But lo and behold, this time, EMS answers his cell phone.

NARRATOR According to the paramedic,

Eric had called minute earlier,

and they were now on their way to the ER.

And they tell her, he's not doing very well.

You better meet us at the hospital.

I'm on it, all right?

The next thing she knows, he coded in the trip

to the hospital and arrived dead on arrival.

NARRATOR For Dr. G, the young man's death

is extremely disturbing.

Eric Brody was healthy--

an avid rugby player--

and had no known medical problems.

The immediate question is, what could k*ll a man in the prime

of his life so swiftly?

He's supposed to be in good health,

no known medical diseases.

It's unclear exactly what's going on.

NARRATOR Given his symptoms, EMS and the hospital

suspect that Eric d*ed from either a massive heart att*ck

or a ruptured abdominal aneurysm, both of which

are known to trigger back pain.

You can get really severe back pain

with aortic aneurysms where the blood dissects

into the wall of the aorta.

Certainly, he could have a heart att*ck.

Sometimes, people have some really referred pain.

I said, think , male--

a little young, but I've seen them that age.

Maybe-- you know, I don't know.

It's a very odd complaint for such a young man,

and then to die suddenly.

Another possibility is he plays rugby,

and that's a fairly rough sport.

And he did play rugby the weekend before he got here.

So maybe there's some type of internal injury that occurred--

like a hematoma maybe, at the spleen--

that then ruptured.

I'm thinking something along that line--

some internal trauma that slowly bled and then burst at the end.
[ … ]

Or even maybe the aorta--

maybe it's a traumatic problem with the aorta.

NARRATOR Disease or injury--

both are potential suspects in Eric Brody's unusual death.

But then, Dr. G discovers a notation

in the investigator's report--

a curious piece of information the investigator

learned from Eric's wife, Angela.

She said something really odd happened several weeks ago

and that they both had spider bites.

His spider bite was kind of on his back, she said.

And he was complaining of back pain.

Hers cleared, and his cleared.

They'd gotten, supposedly, some antibiotics.

And they didn't think much of it.

But they thought it was odd that they both had spider bite.

NARRATOR A spider bite as a cause of death,

especially in a healthy -year-old man,

would be very uncommon.

Only a handful of people die annually in the US

from spider bites, and the victims

are typically either very young or in poor

health to begin with.

Now, I've never had a patient who d*ed of a spider bite.

A brown recluse would be the most, or the black widow

with a neurotoxin.

But they're very rare.

They certainly shouldn't cause you to die acutely.

NARRATOR And yet, given the reported location of the bite,

the back, and Eric's pain, Dr. G cannot dismiss

the possibility out of hand.

I don't ignore any little bit of information

that anybody gives me.

You just never know if it's going to play a role or not.

So I'll look into it.

I'll look and see if he has anything that

looks like an old spider bite.

Maybe he's got a big necrotic area.

I don't know.

I don't know until I look.

[music playing]

It's not on the back.

Let's see this side.

NARRATOR Dr. G begins by turning Eric on his side,

searching for any suspicious marks or swelling on the back.

I look on his back and on the back side.

I look very carefully.

I don't see any evidence of trauma.

I don't see any evidence of a spider bite.

NARRATOR But as she continues to inspect

the rest of Eric's body, she's taken aback by its appearance.

Oh, let's see.

Everybody, obviously, that comes through here is dead.

But some people look better than others.

I mean, some people really look sick when they die.

And he's one of them.

NARRATOR When Dr. G examines the skin more closely,

she can tell right away that it's mottled, or blotchy.

People who are real sick often will

get this mottled appearance.

The lividity goes all over, and you get this kind

of mottled, sick-looking.

And he had that, which really made me think,

maybe he's got meningitis.

NARRATOR Meningococcal meningitis

is a highly contagious bacterial infection

of the brain and spinal fluid.

If Eric d*ed from meningococcal meningitis,

then anyone who's come in contact with him--

alive or dead-- is now at increased risk of infection,

including Dr. G and her staff.

[music playing]

[radio chatter]

He was exposed to people on the airplane.

He was exposed to his friends and some of the people

at the hotel.

He certainly exposed the EMS people

and the people who worked on him from the hospital.

And he'll expose my staff.

NARRATOR It's only a few hours into the work week,

and suddenly, Dr. G has a potential public-health

emergency on her hands.

[music playing]

Dr. G has just examined the body of -year-old Eric Brody

and realized a worrisome possibility.

He might have d*ed from bacterial meningitis,

an acute infection of the brain and spinal fluid.

The discovery could pose a health thr*at to the public

and the district nine morgue.

So we definitely need to put on a mask.

Everybody in the room probably needs to put on a mask today.

People say, oh, my god, you're exposed

to all these horrible things.

Aren't you worried about it?

Well, think about it.

I have disposable gowns on.

I have two layers of disposable material on me.

I have two layers of gloves.

We bleach our instruments.

And these people aren't breathing on us, either.
[ … ]

I am more worried of live people, which I can't control,

than a dead person that I'm doing an autopsy on

that I can control.

We're not going to take any chances.

We'll take a microbe and a culture.

So I want to look at his brain very quickly.

I want to send some samples over to the hospital

so we can get this diagnosed quickly.

[whirring]

So I go ahead and we reflect the scalp.

And I take the calvarium off and look at the meninges, that

thin covering over the brain.

Now, the tough covering-- that white covering that

fits against the bone-- that's the dura.

But what I'm talking about is that thin

covering over the brain.

NARRATOR Dr. G carefully examines

the meninges, looking for the telltale sign

of an acute infection--

pus.

With meningococcal meningitis, we usually see that a bit

cloudy, because of the pus--

the white cells in there, and the bacteria.

NARRATOR And yet, Eric Brody's meninges look normal.

It looked really clear to me.

We took some fluid, but it looked normal.

I don't think this is why he d*ed.

I don't think we're going to need the mask anymore on him.

He's fine.

NARRATOR Finding no preliminary signs of meningitis

is a relief for Dr. G and her staff,

and everyone else who came in contact

with Eric over the past week.

It means that, in all likelihood,

they were not exposed to the deadly infectious disease.

But the good news is tempered by disappointment,

because she still has no idea what

could have cut Eric Brody down so quickly

in the prime of his life.

It's really a mystery.

I'm not really sure why he d*ed.

NARRATOR With the brain removed,

she takes tissue samples to examine under the microscope

to make sure there are no unseen pathogens, such as bacteria,

or virus.

Then, she prepares to open his body.

Sometimes, these cases are like opening

a can in your cupboard that has no label.

I mean, you kind of look at the size, and you can shake it.

But ultimately, you don't know what's in that

can until you open it up.

And that's what we're going to have to do with this guy,

because I really am not quite sure what's going on.

[music playing]

So I make the Y incision, and I peel off

the skin and subcutaneous tissue,

and most of the muscles, almost like you're opening up a book.

Those fall to the side.

And I don't see any free fluid, or free blood,

in the abdominal cavity.

NARRATOR In situ, or in their natural position in the body,

the abdominal organs look normal.

There are no obvious signs of trauma

from a sports injury or bleeding that may have

come from a ruptured aneurysm.

At this point, I would go on each

side of your sternum with my pruning shears-- or loppers--

and go up the ribs, up to where they

connect, your sternum and your clavicle, and make that cut.

That's usually my hardest cut.

And then, I'll remove that chest plate.

I take the chest plate off.

And I look in the pleural cavities, and I see trouble.

He's got some kind of exidative material on the surface

of his lungs bilaterally.

His lungs look sick.

Nasty.

When I first see these lungs, my first guess

is that he's got pneumonia, but I don't know what's going on.

Certainly, his lungs look bad.

NARRATOR To determine exactly what's going on with Eric's

lungs, Dr. G takes a culture and tissue samples to examine

under the microscope.

I will actually do my procedure,

or I'll use a sterile scalpel handle

and go deep into the lung, make a puncture,

and then swab that, and then send that to the lab

to see if any bacteria grow.

NARRATOR But with her expert eye,

she can see right away that Eric has a severe infection--

certainly severe enough to have caused his death.

And yet, she still isn't positive.

This may be the cause of death,

or it may be just something else going on with him.

We're just going to have to see where this autopsy takes us.

NARRATOR As a next step, Dr. G begins

removing the rest of the organs from the body, one by one.

His heart looks great.

It's clear that Eric did not suffer

from any cardiovascular disease.
[ … ]

His liver, kidneys, and spleen all appear normal, as well.

JAN GARAVAGLIA At this point, his heart looks pretty good.

I mean, it's a OK size.

His liver looks good-- didn't have cirrhosis,

didn't appear sick.

His spleen was OK.

There's no trauma.

So then, I start taking the bowels out.

And there, we have big trouble.

[music playing]

NARRATOR Dr. G has just removed the bowels

from -year-old Eric Brody's body

and discovered a horrendous sight along the back wall

of the abdominal cavity.

My, my, my.

What I see there is a terrible infection.

He's got an abscess in the area of his psoas muscle.

NARRATOR The psoas muscle is a long, powerful muscle

that runs along the spine of the lower back and down

into the thigh.

It supports the body and enables it

to bend and flex at the waist.

I got to tell you, it kind of looks like a pork tenderloin,

or a beef tenderloin.

That's what it looks like-- kind of a bundle of muscle,

coming down.

And it goes from your pelvis into your femur.

NARRATOR In Eric's body, this muscle

is so infected that it's dying.

JAN GARAVAGLIA This abscess and pus goes down the muscle.

It goes, actually, all the way to the spine.

He's got a terrible infection going on.

NARRATOR Just looking at the muscle,

it's obvious why Eric Brody suffered from back pain.

This infection clearly has been sitting there for a while

now.

He must have been feeling terrible.

It looks like he probably had sepsis, where the bacteria

gets into his bloodstream.

At this point, I know he d*ed from overwhelming infection.

NARRATOR But the question now is, what caused the infection

in the first place?

And could it indeed have been the result of a spider bite?

Thanks, Brian.

NARRATOR Dr. G take samples of the muscle

for bacterial cultures.

She also wonders if this infection is related

to the one in his lungs.

I'm thinking everything is connected, at this point.

Before I put it all together, I want to look at what

my cultures are showing.

So at this point, I pretty much end the autopsy

and wait for some of these results, which I

know are going to come quickly.

NARRATOR Eric Brody's body is transported back

to California for his funeral.

Then, all Dr. G can do is wait for the culture results.

[music playing]

MAN (SINGING) Some things just take time, feel strange.

This one feels like home.

Patience brought you home.

Patience brought you home.

Patience brought you--

JAN GARAVAGLIA Hi.

NARRATOR Two days later, Dr. G gets

the phone call from the lab, and she's intrigued

by what they tell her.

And I was really surprised at what the lab told me had.

He has MRSA.

NARRATOR Methicillin Resistant Staph Aureus, or MRSA,

is a highly resistant form of a staph infection.

Staph is a common bacterium found in the nasal passages

and sometimes on the skin.

MRSA has been called the perfect human pathogen.

It's readily spread from person to person.

So a lot of people are just carrying MRSA

around in their nose, or maybe on their hands,

or they're not very impacted by it.

NARRATOR But these bacteria can become dangerous

if they enter the body through a break

in the skin or inhalation.

At this point, they can trigger an infection

in the lungs or bloodstream.

MRSA outbreaks were once largely confined to hospitals

and medical facilities.

But in the past several years, this potentially deadly strain

of staph bacteria has spread to the general population

and has been slowly developing into an alarming public health

epidemic.

We're all hearing about it--

breakouts on athletic teams, breakouts in schools, where

they even have to close the school

down because it spreads so quickly from person to person.

This is a very virulent bacteria.

In , there were over , estimated

deaths from invasive methicillin resistant staph aureus.

NARRATOR This virulent and contagious superbug

is also what k*lled Eric.

Dr. G now understands not only what

k*lled him but, incredibly, how the infection began--
[ … ]

as a misdiagnosed spider bite.

The interesting thing about the story on him

is that his wife and him were convinced

they have spider bites.

NARRATOR But when Eric and his wife thought were spider bites

were actually localized MRSA skin infections,

a common but potentially dangerous and frequent

misdiagnosis.

A majority of the tens of thousands

of spider bites reported in the past few years

have actually turned out to be MRSA infections.

It is such a common story with the MRSA skin infection

that people think they have spider bites.

That's such a common presenting complaint.

Oh, I got this spider bite, now it's all infected.

But these are MRSA infections.

Patients come in every day and say

they were bitten by spiders, and now they have this soft tissue

process that's going.

If you ask them, almost no one ever saw a spider.

I mean, usually, spider bites are not all that impressive.

They're not all that common, and we find MRSA in these wounds.

So I think spiders get a bad rap.

One study showed that of the five people with necrotizing

fasciitis, which is similar to what this man had,

three of them thought they had spider bites.

These people all don't have spider bites.

These are MRSA infections.

NARRATOR In the case of Angela, Eric's wife,

her immune system was able to fight off the infection.

But unfortunately, his wasn't.

JAN GARAVAGLIA The bacteria got into his blood.

And a lot of times, that's a very insignificant thing.

A lot of times, even brushing your teeth,

you can get bacteria in your blood, and that's fine.

But probably what's happened is he either maybe had a strain.

Maybe he did hurt his muscle-- he strained his muscle,

and the bacteria settled there when it went through his blood.

NARRATOR It's an unsettling conclusion,

but Dr. G now knows exactly what caused this young man's

untimely death and can record her findings in the decedent's

report of autopsy.

[music playing]

It's PM on Wednesday, and Eric Brody

has been confined to his hotel bed

for two days with terrible back pain.

Little does he know that his pain is due to a massive MRSA

infection that has invaded his body through a cut

or scratch on his back and then festered in his psoas muscle.

JAN GARAVAGLIA It's a very invasive bacteria.

It settled there, and then it started to grow.

NARRATOR The infection eventually

spreads through the bloodstream to other vital organs,

such as his lungs, causing severe pneumonia.

JAN GARAVAGLIA This infection is growing bigger and bigger.

And eventually, he gets sepsis, where that bacteria starts

multiplying in his blood.

NARRATOR Finally, Eric realizes that something is terribly

wrong and calls for help.

JAN GARAVAGLIA He waited till his last breath to call .

NARRATOR But the call is too late.

The infection has already set off a catastrophic reaction

in Eric's vascular system.

JAN GARAVAGLIA It causes the blood vessels to kind of lose

their integrity and dilate.

And he just can't maintain blood to his vital organs anymore.

NARRATOR Blood flow to Eric's brain and heart

becomes drastically reduced, and he goes into shock.

It's a very high mortality once you go into shock,

even if you're in the hospital.

NARRATOR En route to the hospital,

Eric goes into cardiac arrest.

Paramedics are unable to revive him, and he dies.

It's a tragic end to a mysterious case.

Sadly, had Eric been aware of his condition,

a course of antibiotics would have

most likely saved his life.

JAN GARAVAGLIA I don't want to scare people.

Be careful if you have any cuts.

Make sure they're clean and covered.

And don't touch other people's bandages or cuts,

and I think you'll be OK.

And if you do get these so-called spider bites,

just call up and let your doctor know about it.

There's no reason that you have to really worry.

If you do get a little infection, call your doctor.

NARRATOR Sometimes, simple steps

can prevent unnecessary death.

But in other instances, as with Dr. G's next case,

death can come swiftly and unexpectedly,

leaving no time to act.

[music playing]

NARRATOR By late afternoon, Dr. G

is already preparing for her next case,

which also involves the death of a visitor to Florida--

a -year-old man named Luis Antonio Ornelas.

The father of two sons was in Orlando

on a long-awaited family vacation when

tragedy unexpectedly struck.

JAN GARAVAGLIA He's only .
[ … ]

NARRATOR According to the investigator's report,

Luis and his family had just arrived

in Orlando after a cross-country drive from California.

CHRISTIAN ORNELAS My dad planned

out this entire road trip.

He made the reservations, got everything planned.

He even bought a new car for that trip.

I was pretty excited.

NARRATOR The vacation was everything

the Ornelas family hoped for, until yesterday afternoon.

That's when Luis climbed aboard one

of the popular amusement park rides

and almost immediately began to feel ill.

He couldn't walk, and he felt out of wind,

and he wanted to throw up.

I didn't think much of it, because I

thought it was just the ride.

But he felt really bad, and he just wanted to go home.

NARRATOR But a short while later, Luis

is back to his old self, and the family returns

to their hotel in good spirits.

JAN GARAVAGLIA They were laughing in the room.

They were having a good time.

I guess they were kind of recapping their day.

And he starts to seize, and goes unconscious.

CHRISTIAN ORNELAS He's shaking, and then he's turning purple.

I was just shocked.

I was just-- I didn't know what's going on.

NARRATOR EMS is immediately dispatched to the hotel room,

and Luis is rushed to the hospital,

but doctors are unable to revive him.

To the disbelief of his family, he

is pronounced dead in the emergency room at AM.

[music playing]

It must be devastating to have a family member die when you're

there having fun and something you

dreamed about doing together.

NARRATOR In the wake of their overwhelming loss,

the Ornelas family hopes that Dr. G can

tell them what took Luis's life so suddenly and unexpectedly

and bring some sense to the heartbreak.

JAN GARAVAGLIA One of the reasons

that this case is reported to us is that he collapses and goes

unconscious outside of a hospital

and dies in the emergency room-- pretty much dead on arrival.

So that fits our jurisdiction to be reported to us to try

to figure out why he d*ed.

We also get involved because we don't really

know his medical history.

We're told that he has high blood pressure.

But he's not taking any medication here,

so I'm assuming it must not be that severe.

NARRATOR But there's another pressing reason that Luis's

death will require an autopsy--

the amusement park ride.

Recently, there have been two other deaths

on the very same ride, one of them involving a stroke.

Given Luis's history of high blood pressure,

Dr. G worries whether he may have suffered the same fate.

JAN GARAVAGLIA He does have high blood pressure.

You are more apt to have a stroke

or bleeding into your brain.

And I really wanted to rule out a stroke,

because the last person that had d*ed on that ride actually d*ed"], index ,…}

from a hemorrhage in the brain.

And there has been some controversy whether that ride

could harm you.

NARRATOR What's more, if a link can be drawn between the ride

and Luis's death, there could also be major ramifications

for the park and its owners.

So it's very important that we can determine why he d*ed.

NARRATOR Dr. G begins with the external exam.

JAN GARAVAGLIA When I look at him,

he looks like a healthy guy.

He isn't particularly overweight.

He's about pounds, but he's about six feet tall.

NARRATOR While there were no reports that Luis sustained

any injuries on the ride, she must first look carefully

for any trauma to the body.

JAN GARAVAGLIA There is no question--

people get injured on amusement park rides.

The vast majority of those who do get injured on these rides

are usually due to the fact that they have been hit,

or they've been thrown out of the ride

from lack of safety devices and not being restrained.

NARRATOR These types of injuries

can lead to fatal head trauma or deadly internal bleeding.

But if Luis did sustain a fatal injury,

it is not discernible externally.

JAN GARAVAGLIA I don't, certainly,

see any signs of trauma.

Doesn't look like he's hit his head.

You know, he looks pretty good.

NARRATOR Working her way down the body,

she looks at Luis's abdomen and notes that it seems swollen.

JAN GARAVAGLIA There is something

a little bit odd about him.

His abdomen is a little bit tense and a little bit rounded.

NARRATOR This could be a sign of internal bleeding

from an injury or disease.
[ … ]

However, the bloating may also simply

be a result of air forced into Luis's abdomen during CPR.

It's usually from the resuscitation.

When they try to do cardiopulmonary resuscitation

and put air into your lungs, a lot of that air

will go into your stomach and actually

distend it quite prominently.

And that will cause then the abdomen to distend.

NARRATOR But then, Dr. G notices something

odd about Luis's left leg.

JAN GARAVAGLIA I look in his lower extremities,

and there is some asymmetry.

One is a little bit larger than the other.

And there is some edema.

NARRATOR Luis's left calf is swollen with fluid, or edema,

and measures / of an inch larger than the right.

This is a considerable disparity.

Edema, or swelling in the leg, can be a sign

of a pulmonary embolism--

a blood clot that develops in a deep vein of the leg

and travels to the lungs where it can cause a fatal blockage

of the pulmonary artery.

The clot can be caused by prolonged immobility,

such as hospitalization, paralysis,

extended air travel, or a multi-day

cross-continental drive.

JAN GARAVAGLIA He dies suddenly.

He just had a long car ride across the country.

And now, he's got somewhat asymmetric

lower extremities with edema.

So really, a pulmonary embolism is a real concern right now.

[music playing]

OK, it's good.

NARRATOR Dr. G is ready to open the body of -year-old Luis

Ornelas who d*ed yesterday only hours

after becoming sick on a theme park ride in Orlando.

Her first priority will be to examine Luis's head, looking

for any signs of a stroke.

JAN GARAVAGLIA Certainly, when I'm

doing my internal examination, I really

am interested in his head.

And I'm interested in his head because he

had just ridden a ride earlier in the day that made him sick.

I really would like to see if his nausea, his dizziness,

may have been precipitated by that ride he was on.

[music playing]

NARRATOR Morgue tech Ashley Shaughnessy opens Luis's skull

with an oscillating saw.

Head's ready, Dr. G.

JAN GARAVAGLIA Thank you.

NARRATOR Dr. G then carefully inspects the outside

of Luis's brain for any bleeding, which

would be evidence of a stroke.

JAN GARAVAGLIA He does have high blood

pressure, and long-term high blood

pressure damages the vessels.

It damages your vessels in your heart.

It damages the vessels all over your body--

your kidneys, your brain.

It weakens them.

And eventually, with the elevated blood pressure,

they can burst open.

NARRATOR But surprisingly, it doesn't take her long to make

an initial assessment.

JAN GARAVAGLIA There was no subdural hemorrhage.

There's no subarachnoid hemorrhage.

There's no hemorrhage coming into the vertebral arteries.

We have these arteries that come up kind of along your spine,

and I don't see anything along that line.

NARRATOR She then dissects the organ, searching

for any bleeding inside.

JAN GARAVAGLIA I section the brain.

I section it similar to how you would

cut bread-- very thin slices.

And the brain actually looks normal, grossly, with my eye.

NARRATOR The finding is conclusive.

Luis did not suffer a stroke on the ride, or any sort of trauma

to his brain, whatsoever.

His death is now more of a mystery,

and his family's hope of discovering

exactly what k*lled him seems further away than ever.

Me and my dad were very close.

We shared a lot of things.

Me and him had a really strong bond as father and son.

[music playing]

NARRATOR Dr. G opens the body with a Y incision.

Right away, she can see why his abdomen was so

swollen in the external exam.

He's got a lot of air from the resuscitation

inside his stomach cavity, which really

then pushes everything down, makes it a little bit more

distended.

NARRATOR First, she looks for any signs of trauma

in the abdomen that might have been sustained on the ride,

but finds none.

Then, with the abdominal cavity open,

she draws toxicology samples to test

his body fluids for alcohol, dr*gs,

or any other unusual substances.

JAN GARAVAGLIA That must be done before I start getting too
[ … ]

curious about anything else.

So my tech and I will get that done,

make sure it's done-- again, doing this in a methodical way,

so you don't miss anything.

So once my toxicology is taken and put in the proper vials

to be tested, then we can look at the rest of the organs now.

I'll go ahead and use my loppers to take off those ribs

and look inside his chest cavity.

NARRATOR Given the swelling Dr. G discovered in Luis's leg,

she still suspects that he could have d*ed

due to a pulmonary embolism--

a fatal blood clot in the pulmonary artery.

JAN GARAVAGLIA Well, if he d*ed of a pulmonary embolism, what

I'm going to have to do is take the heart out

and check the pulmonary artery.

That is the main artery going from the right side

of the heart to the lungs-- both lungs.

And you'll see that, when they die suddenly like that,

they'll often get totally occluded-- totally filled

and packed-- with these clots.

NARRATOR But what she finds next

raises new questions about Luis's medical history.

Well, why didn't anybody know about this?

That's a good question.

[music playing]

NARRATOR With Luis Ornelas's chest cavity exposed,

Dr. G gets her first look at the -year-old man's

lungs and heart.

She initially thought he might have d*ed

from a pulmonary embolism, a blood clot obstructing

the flow of blood to the lungs.

However, peering into his chest cavity,

Dr. G immediately spots a more urgent and grave problem.

JAN GARAVAGLIA Wow, that's a pretty big heart.

His heart cannot be ignored.

His heart-- just to give you an idea, this would be

a normal guy's heart for him--

, grams.

His heart is big, and round, and about that big,

and weighs grams.

It was huge.

NARRATOR It's clear right away that Luis suffered

from dilated cardiomyopathy, a term used to describe

an enlarged heart that has become weak and, in Luis's

case, swollen with blood.

A cardiomyopathy is a problem with the heart muscle.

It gets to the point where it can't pump very well.

And each time it pumps, there's a little bit

more blood that stays back.

The heart muscle gets weaker and weaker.

And as the heart muscle gets weaker and cannot pump,

more blood stays in there and fills it up,

and the heart starts to dilate.

NARRATOR Looking at the organ, there is no doubt

that it was the cause of death.

JAN GARAVAGLIA He was at risk for sudden death at any time.

And really, the mortality of once a heart

gets like that is worse than most cancers.

In five years, only % would be alive.

NARRATOR But the finding leaves Dr. G perplexed.

Why would such a young man have such devastating heart disease?

For years old, he's already got end-stage heart disease.

What's causing this?

He's got a big, dilated heart.

What's the reason?

NARRATOR Dilated cardiomyopathy has many causes, including

coronary artery disease, heart infections, and even

congenital heart defects.

About % of these big, dilated hearts are congenital,

and you can actually trace them in the family.

NARRATOR This potential scenario is particularly

important for Luis's family.

If his dilated cardiomyopathy was congenital,

his sons might also be at risk for developing

the heart disorder.

In order to determine the exact cause of Luis's heart damage,

Dr. G must dissect the organ and examine it thoroughly.

JAN GARAVAGLIA I look at his corneas,

because one of the reasons you can have a big, dilated heart

could be chronic damage from your coronary arteries.

I look at the valves to see if they're normal

and that's the cause of it.

I look at the muscle itself to see

if there's evidence of maybe a myocarditis

or a previous inflammation.

And you see a lot of little fibrosis

where the heart just can't pump anymore and eventually dilates.

NARRATOR But after a painstaking inspection,

she finds nothing abnormal.

JAN GARAVAGLIA There is no evidence that it's

from coronary artery disease.

It's no evidence it's from a previous infection.

It's no evidence that it's even congenital,

although I can't say for sure.

NARRATOR But there is one critical clue--

the sheer thickness of the heart muscle itself.

Definitely thick here.

NARRATOR Luis's heart muscle is abnormally thick,

and this is the smoking g*n evidence

she's been searching for.
[ … ]

His extensive heart damage was most likely caused by something

completely treatable--

his high blood pressure.

Looks like it's the hypertension.

It looks like the type of heart you

see with end-stage high blood pressure.

This is a sick, failing heart.

NARRATOR Luis Ornelas d*ed from dilated cardiomyopathy.

But ultimately, what damaged his heart were the toxic effects

of his high blood pressure.

Putting all her findings together,

Dr. G can now describe exactly how and why

the -year-old man d*ed.

Luis Ornelas is in Orlando enjoying

a long-planned family vacation.

But little does he know--

Luis has a ticking time b*mb in his chest

that is ready to go off at any moment.

We talk about high blood pressure

causing the heart to thicken.

And we see kind of a firm, muscular, thick heart

that's b*ating hard, and it has a higher oxygen need.

Eventually, the heart weakens, because it then can't get all

the blood out, then it dilates.

And so from kind of a thick, muscular heart

you get kind of a big, globular heart

that just isn't pumping well.

NARRATOR In Orlando, Luis's dying heart is further taxed

by the rigors of his vacation.

JAN GARAVAGLIA He gets here, and he's

increasing his exercise.

He's making his heart work harder.

It's hot here.

That's another stressor on the heart.

NARRATOR Luis also rides on the amusement park attractions,

which may have put further stress on his ailing

heart, although Dr. G does not believe the rides directly

contributed to his death.

JAN GARAVAGLIA Did the right play a role in his death?

Probably not.

If it had stressed his heart so much,

I would have expected him to have the arrhythmia then.

Clearly, his symptomatology was more motion sickness,

and I had the same type of response

on those kind of rides.

NARRATOR But while the damage to Luis's heart from high blood

pressure took years to develop, his death

occurs with shocking swiftness.

After a day at the theme park, Luis

is in his hotel room when--

without warning-- his huge, dilated heart suddenly falls

into an unstable arrhythmia.

Instead of b*ating, the organ flutters.

Blood flow to other vital organs--

including the brain-- is interrupted,

causing Luis to seize.

Then, within only moments, Luis's ailing heart

ceases to b*at altogether, and the -year-old father of two

never recovers.

Every once in a while, I felt like I

could have done something.

But I try not to think about it, because then I

feel angry at myself.

So I just put that away, keep it sealed.

Getting your blood pressure under control

is one of the few things you can do, without question,

to extend your life.

He was .

[techno effects]

MAN Atlas.