05x01 - Under the Kn*fe

[bunniefuu]

[suspenseful music]

[theme music]

NARRATOR A strange man staggers up to a woman's front door,

dazed and bloody.

He just stared, and then he walked away.

NARRATOR Hours later, a passerby

finds him in the woods dead.

JAN GARAVAGLIA And I looked, and I-- woo, that looks bad.

I mean, what is going on here?

NARRATOR And then, a seemingly healthy mother of two

dies without warning.

JAN GARAVAGLIA The kids are devastated.

The husband is devastated.

She's now in my morgue, and we don't know why she d*ed.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

[theme music]

[music playing]

NARRATOR It's AM at the District Orange/Osceola

County Medical Examiner's Office,

but Dr. Jan Garavaglia is already hard at work.

Oh, did my investigators have it?

He does have an enlarged heart.

Yeah, the cause of death is pending.

No.

Might be, you know, weeks and sometimes, you know, months.

I've got families calling, wanting answers.

I don't know why some of the micros are late.

I'm going to have to go to cut more tissue.

You know, there's people to call.

Just thinking about what else I could do.

And multiply that by numerous cases.

New ones coming in every day.

NARRATOR Today's newest body arrives

under suspicious circumstances, even by morgue standards.

And although Dr. G is extremely busy,

this case demands her immediate attention.

Wow.

NARRATOR It's almost noon, and Deer Park,

Florida resident Debbie Balcombe is

busy fixing lunch when she hears a knock at the front door.

She assumes it's just one of the neighbors dropping

by for a visit, but what she sees on her front stoop

comes as a complete shock--

a disoriented, disheveled, and bleeding young man.

Must have been scary, because he had blood on his shirt.

It looks like he's been beaten up.

He just stared at her, and then he walked away.

NARRATOR Shaken by the encounter,

Debbie quickly locks the door.

But neither she nor anyone else in the apartment complex

crosses paths with the man again.

In fact, he seems to disappear entirely until a few hours

later when recently retired Jim Weisberg goes

out for his afternoon walk.

As he passes through the woods beside Debbie's home,

he gets the shock of his life.

The body of a man on the ground, dead.

Jim calls , and within minutes

the police arrive on the scene.

JAN GARAVAGLIA It's unclear what's going on here.

The detectives are very suspicious that there's

foul play.

NARRATOR The homicide unit's first step

is to locate the man's wallet.

His name is Gregory Flynn, and a background check reveals

another more curious fact.

JAN GARAVAGLIA He doesn't live anywhere in these houses.

He doesn't live in the apartment complex.

NARRATOR And a few minutes later,

police make another discovery.

JAN GARAVAGLIA The investigators looked around.

They found his-- what appears to be his car

in a ditch in this wooded area.

This wooded area separates these houses

from an apartment complex.

NARRATOR Looking for possible witnesses

to Gregory Flynn's death, detectives begin

knocking on apartment doors.

JAN GARAVAGLIA Canvassing the area,

they found out that he was seen driving

about four hours earlier.

NARRATOR And it isn't long before the detectives

find Debbie Balcombe.

She views Greg Flynn's body and identifies him as the man who

came to her door hours earlier.

Meanwhile Medical Investigator Jack Cuccia of the District

morgue arrives on the scene.

He takes photographs of the body for Dr. G

and prepares it for transport to the morgue.

But the detectives need more information.

At that point, they really didn't

know what they were dealing with until we

were able to see if there was any traumatic injury to him.

NARRATOR The detectives want permission

to examine Greg's body for chest and face wounds on the scene.

JACK CUCCIA The law enforcement agencies, they do not

have the authority to examine the body,
[ … ]

remove the clothing, without making contact

with the medical examiner because we don't want to lose

any trace evidence or disturb the wound in any way

until the doctor has seen that firsthand.

NARRATOR Jack Cuccia calls Dr. G.

Dr. G?

NARRATOR He explains the situation

and asks for permission to inspect the body.

OK, Dr. G. Thank you.

And I said, fine, you know, examine him at the scene.

NARRATOR Turning over the body, they reveal quite a sight.

Greg Flynn's right eye looks swollen,

and his face is bloody.

There's also a large amount of blood on his shirt.

So I said, just go ahead and bring him in.

We'll X-ray him and look for the wounds.

NARRATOR Once Greg Flynn's body is on its way to the morgue,

detectives make contact with his ex-wife, Rosanna.

Hello?

JAN GARAVAGLIA According to his ex-wife,

he didn't suffer from any major diseases

or chronic health problems.

NARRATOR Next an officer calls Greg Flynn's brother, Sean.

And as soon as they inform him of Greg's death,

Sean levels a stunning accusation.

The brother believes that the ex-wife had

something to do with his death.

NARRATOR The detectives don't know

if Sean is right about Greg's ex-wife,

but they do suspect foul play.

Detectives are highly suspicious that this

was a homicide.

They're really waiting for me to give them an answer.

NARRATOR But Dr. G has questions of her own

about his death.

JAN GARAVAGLIA Why was he acting so strange?

Why did he go up to that apartment and just stare?

It's just very odd.

NARRATOR Dr. G wonders if someone ran him off the road.

The car had only minor damage, but it's

possible that Greg sustained injuries in the crash.

JAN GARAVAGLIA Did he have a head injury?

Maybe he hit something when he stopped suddenly.

NARRATOR It's possible that the crash was an accident.

But at this stage, one thing is clear--

all clues point to m*rder.

JAN GARAVAGLIA Kn*fe wound, g*nsh*t wound,

blows to the head, and that's what

we're really looking for right now

in the external examination.

[music playing]

NARRATOR The first thing Dr. G notices about Greg Flynn

is how well dressed he is, but Greg's button down Oxford shirt

is heavily stained with blood.

Oh, Lord.

The one pattern was odd.

It was on front of his shirt only

and at the ends of his sleeves.

The other odd thing is that his clothes were also wet.

There is a small wet creek in those woods, but how did

he get wet?

NARRATOR But the strangest thing about Greg Flynn

isn't his clothes.

It's his skin.

It's slipping off.

He's already starting to show signs of early decomposition.

That's very odd.

NARRATOR Greg's been dead less than hours.

But when it comes to the stages of death,

he's way ahead of the curve.

Skin slippage normally doesn't appear

until hours post-mortem.

JAN GARAVAGLIA When we see somebody decomposing that

quickly, we really worry that maybe he

had an infection or an elevated body temperature

prior to death.

NARRATOR But that wouldn't explain

the blood soaking Greg Flynn's shirtfront

or his battered face.

He's got a huge bruise over here.

It looks bad.

He's got dried blood.

He's got this kind of big, swollen eyelid

with a lot of, like, little abrasions.

NARRATOR He looks like he's been in a fight,

and this makes Dr. G even more suspicious

of possible foul play.

But as she looks closer, Dr. G recognizes what did this

to him, and it wasn't human.

When you look closely, you see small rodent scratches

and excoriations.

NARRATOR But on Greg's face, the damage done by the animal

activity is mainly superficial.

And I still can't explain this blood on his shirt.

NARRATOR Dr. G suspects it might

have come from a nosebleed or mouth wound.

So she carefully checks both potential sources.

There's really no blood in his nose,

and I don't see a blood in his mouth.

I don't know where that blood is coming from.
[ … ]

NARRATOR As Dr. G moves down the body,

looking for a major wound, she notices

dozens of tiny cuts criss-crossing

Greg's forearms and hands.

He really was scratched up quite badly.

NARRATOR Was Greg running away from someone?

And if so, who?

And where did the blood soaking his shirt come from?

The answers to these questions may lie under his clothes.

JAN GARAVAGLIA A little can k*ll you,

and my investigator may not see that, particularly

if there is a lot of blood.

May have a small s*ab wound.

At this point, it can be anything.

[music playing]

[suspenseful music]

NARRATOR During the external exam of Gregory Flynn's body,

Dr. G found scratches that suggest

he may have been running from someone before he d*ed.

Greg's brother believes he was m*rder*d,

and now Dr. G is looking for the source of the blood

soaking Greg's shirt.

JAN GARAVAGLIA And I'm taking his clothes off,

and I'm examining inch by inch.

Where could this blood be coming from?

NARRATOR She searches the entire body

for a small b*llet or Kn*fe wound,

but what she finds surprises her.

I don't see any wounds that are

accounting for all that blood.

At this point, I don't know how he d*ed.

It's very odd.

I'm hoping I find something internally.

All righty?

MAN All righty.

NARRATOR Dr. G opens Greg Flynn's chest with a y incision

and begins searching for evidence of trauma.

JAN GARAVAGLIA I'm looking for evidence of contusion

to his chest, maybe internal trauma to the organs.

NARRATOR As a first step, she removes Greg's chest plate

looking for free blood and other signs of injury,

but she doesn't find anything of significance

in the abdominal or chest cavity.

The source of all that blood is becoming

more mysterious by the moment.

All Dr. G can do now is continue searching for clues

within his internal organs.

[music playing]

SINGER Clinging to the trees.

NARRATOR Next, she extracts the heart

and prepares to dissect it.

But right away, she notices a striking abnormality.

He had a significant narrowing to his right coronary artery.

It was at least an % narrowing.

Odd for someone at a relatively young age.

NARRATOR This narrowing could have caused a heart att*ck,

which could explain why Greg drove his car into a ditch--

but not his behavior afterwards.

JAN GARAVAGLIA I would not expect

him to be acting odd like that, just because he's

got the heart disease.

He still has enough energy to go running through the woods.

I wouldn't really expect him to be doing

that with a coronary event.

So it's not making sense.

NARRATOR Other than signs of decomposition, the rest

of Greg's heart looks normal.

Dr. G's next stop is the lungs, and what she sees

here is disturbing.

JAN GARAVAGLIA You can also see that they

were starting to decompose.

NARRATOR In addition to Greg's lungs,

his other organs are clearly beginning to decay.

JAN GARAVAGLIA His spleen is soft and friable.

His bowels are starting to turn green.

These are all early signs of decomp.

NARRATOR Greg's accelerated decomposition

is extremely unusual.

It could be a sign that he was sick with a severe infection

right before he d*ed.

People who are infected and have high fevers

can start having early decomposition.

NARRATOR To confirm an infection,

Dr. G takes blood samples to be tested

for the presence of bacteria.

And as standard practice, Greg's blood

will also be screened for dr*gs and alcohol

at a toxicology lab.

By the end of the internal exam, Dr. G still has

no idea how Greg Flynn d*ed.

The chest and abdomen just didn't tell us too much.

NARRATOR And as she readies her scalpel for the cranial exam,

she's hoping the brain and skull will yield the clues

she's been looking for.

I am hoping that the brain gives me the answer.

[suspenseful music]

NARRATOR Dr. G and the Orlando homicide unit

both believe that -year-old Gregory

Flynn may have been m*rder*d.

There's blood on his shirt.
[ … ]

He's faced down in kind of a dark area in the dirt.

NARRATOR So far, she's found no evidence of foul play,

but she's yet to examine Greg's skull and brain.

Head trauma could indicate that Greg

was the victim of a fatal as*ault.

Dr. G will also look for signs of natural disease.

JAN GARAVAGLIA Maybe he's got a ruptured aneurysm or stroke,

something else going on that caused him to kind

of act odd and lose control.

I don't know.

NARRATOR Dr. G reflects Gregory's scalp,

looking for any sign of a fracture or wound.

Going on in here, no impact site,

no wound, no small g*nsh*t wound that I missed, nothing.

NARRATOR But she can't entirely rule out trauma yet.

A blow to the head could fatally injure the brain

without fracturing the skull.

There's no skull fracture, but that doesn't mean there's

no bleeding in the brain.

NARRATOR Next, morgue technician

Brian Machulski cuts through the skull with an oscillating saw.

And Dr. G performs a thorough examination of the brain

itself.

I don't see any blood.

The brain looked good.

I was disappointed.

I was hoping for something.

There is no trauma anywhere on his body.

I'm sorry we have to rule out trauma.

I mean, we have a lot of things it isn't.

We just don't have what it is.

NARRATOR By the end of the autopsy,

big questions still remain.

There is no drama, but he's got blood all over him.

I'm still suspicious that it's from his nose.

I just don't see any residual blood in his nostrils.

I told the detectives if it's homicide,

I don't know what kind of homicide

it is besides a poisoning, because there

is no trauma there.

NARRATOR The police accept Dr. G's initial findings,

but Greg's brother, Sean, finds it more difficult.

I am getting multiple phone calls from his brother.

He is sure his ex-wife m*rder*d him.

NARRATOR Sean now thinks Greg's ex-wife, Rosanna,

must have poisoned him.

This could explain why he ran his car into the ditch

and stumbled around in a state of delirium in the hours

before his death.

But the only way Dr. G can prove it was m*rder

is with the results of microscopic and toxicology

tests.

[music playing]

NARRATOR It takes two weeks to get Greg Flynn's processed

tissue samples back from microscopic evaluation,

but only moments to find a significant abnormality

in his heart tissue.

He's got a lot more fibrosis in his heart than I'd expect.

When you look at cells and a normal heart,

you see the pink muscle cell.

But with him, instead of nice pink cells,

we see scar tissue replacing those cells.

NARRATOR The fibrosis or scar tissue

tells Dr. G that Greg's heart has been damaged

over a long period of time, though she doesn't think it

could have k*lled him suddenly.

Seeing it gives her a crucial clue.

She now thinks she knows how Greg Flynn d*ed,

but she can't prove it without the results of the toxicology.

[suspenseful music]

NARRATOR Back in her office, Dr. G

digs into the lab reports--

and it isn't long before they confirm her suspicions.

It turns out that the theory that Greg was poisoned

was partially correct.

JAN GARAVAGLIA He was poisoned, all right.

He poisoned himself.

He was high on cocaine.

Extremely high on cocaine.

NARRATOR Cocaine overdoses are hard to prove because drug

levels fall after death.

But even though his blood sample was taken hours

after his death, Greg Flynn's blood

still had an extremely high level of cocaine.

Now the entire chain of events is beginning to make sense.

The side effects caused by cocaine use

can explain many of the curious details

of Greg Flynn's final hours.

JAN GARAVAGLIA Sometimes we see excited delirium

with excited, kind of bizarre behavior, which

looked like he was having.

It's a marker that he's having a bad reaction to the cocaine,

and you can get this elevated body temperature.

NARRATOR Dying with an abnormally high body

temperature causes accelerated decomposition.

This explains why Dr. G observed advanced decay

in Greg Flynn's body.

And cocaine even answers the question about the blood

on Greg's shirt.

JAN GARAVAGLIA Cocaine is a stimulant,
[ … ]

making the heart b*at faster, making

your blood pressure go up.

The bloody nose was probably associated with the high blood

pressure from the cocaine.

NARRATOR Dr. G now believes prolonged use of cocaine

probably caused the fibrosis and coronary artery

disease she found in his heart.

And I think he's probably a chronic cocaine user.

NARRATOR But what ultimately k*lled

him was a straightforward narcotic

overdose, most likely triggering a fatal seizure

or heart att*ck.

When the blood pressure goes up,

the heart beats harder, the coronaries constrict.

The terminal of it is usually the heart arrhythmia.

NARRATOR An arrhythmia with the heart's normal rhythm

is disrupted can often result in a heart att*ck.

And although this is a common effect of cocaine overdose,

Gregory could have also succumbed

to a fatal brain seizure.

Just like it can disrupt the electrical component

of your heart, it disrupts the electrical aspect

of your brain and precipitate seizures,

and you can die that way, also.

There are many ways that cocaine can k*ll you.

NARRATOR But all it takes is one.

Dr. G can now piece together the bizarre series of clues

and describe step by step the last moments

of Gregory Flynn's life.

[suspenseful music]

[music playing]

NARRATOR On a cool September night,

chronic cocaine abuser Gregory Flynn

goes on yet another binge, snorting cocaine for hours,

but this time is different.

By the next morning, he's awake and high.

And although he's a frequent user, he begins to feel ill.

The cocaine was starting to affect his brain,

and his blood pressure was going up.

NARRATOR Greg is disoriented, and his heart is pounding.

His high blood pressure most likely

triggers a severe nosebleed as he's driving,

so he steers his car into the parking

lot of an apartment complex.

He makes a u-turn, his car goes into a ditch,

then gets out of the car.

NARRATOR By now, Greg's face is covered

in blood from the nosebleed.

Looking for help, he knocks on Debbie

Balcombe's apartment door.

At this point the cocaine is beginning

to affect his thinking process, possibly inducing delirium

and paranoia, and his body temperature

is getting dangerously high.

He's getting disoriented, confused.

NARRATOR Unable to speak, Greg panics and runs into the patch

of woods bordering the complex.

At some point, he likely uses his shirt

to stop his nosebleed, soaking up the blood.

He probably jumps into a nearby creek in an attempt

to cool off, which gets his clothing wet

and also clears his nostrils of blood.

Delirious, Greg races on through the woods, hitting branches

and razor-sharp grass along the way, which scratched his arms.

And then he collapses.

He collapses either from the seizure

or from the heart arrhythmia, and then dies in that field.

[music playing]

NARRATOR Dr. G immediately contacts the investigators

to report her findings.

Hi, this is Dr. Garavaglia from the Medical

Examiner's Office.

NARRATOR She then calls Greg's brother, Sean,

and breaks the news.

He, at first, refused to believe it.

But I think over time, he's accepting it.

NARRATOR Sean's brother, Gregory,

kept his addiction well-hidden from everyone in life.

But in death, nothing can hide from Dr. G.

Greg Flynn's death is a sad irony.

Although it originally seemed tangled in mystery, in the end,

it was tragically predictable.

It's just another one of our drug deaths down here.

It's epidemic.

It's epidemic.

NARRATOR Some days for Dr. G, it

seems like every death is an accident

that could have been avoided.

But her next case stands out in the morgue

as a truly unforeseen tragedy.

JAN GARAVAGLIA It is devastating

that those two children are left without a mom.

[suspenseful music]

NARRATOR For Dr. G, juggling multiple cases at once

is just part of the job.

But when it comes time to perform an autopsy,

it's critical that she focus solely on the task at hand.

The autopsy itself is beautiful

because although I have hundreds of cases upstairs

that I have to think about, when I'm doing the autopsy
[ … ]

I'm just doing one, and I'm only thinking about that one case,

and nothing else in the world matters.

NARRATOR But for Dr. G, cases aren't an escape.

They're a challenge.

He should have some scars around his face, too.

Yeah, see it?

I always prefer cases that are more of a challenge.

I love unusual cases.

You know, I get enough heart att*cks down here

that I don't need another one.

When a really unusual case comes in, those are really the best.

NARRATOR And her latest case definitely

qualifies as unusual.

This morning, we have a -year-old woman that just

had abdominoplasty surgery.

She's got two kids.

She's married, and she dies suddenly.

Two days after the procedure.

[music playing]

NARRATOR Michelle Rohn's tragic story actually started

three years earlier, shortly after the birth

of her first child.

It was then that her battle with obesity began.

By the time she had her second, the stay-at-home mom

was over pounds.

At that point, Michelle decided she'd had enough.

[upbeat music]

She committed to a strict diet and exercise regimen,

and lost more than pounds.

She felt great, except when she looked in the mirror.

If someone's been overweight or obese for a long time

and then they lose weight, then the skin will

hang over in various areas.

The most common place is the lower belly.

NARRATOR Michelle is clearly unhappy with the excess skin

around her middle.

And after talking it over with her husband, Kevin,

she decides to go ahead and schedule

an abdominoplasty, or tummy tuck.

This is to remove some of that skin,

tighten, those abdominal muscles,

remove some of that excess fat.

, people will lose a tremendous amount of weight

over this next year, and probably %

will seek a plastic surgeon to help them contour their body

because of this excess skin.

This is clearly an elective procedure for her,

partly doing it to please her husband, partly

doing it to please herself.

NARRATOR By all accounts, the operation

goes according to plan.

And after three hours in surgery,

the procedure is pronounced a success.

The next day, her doctors send her home with a prescription

for painkillers.

But despite the powerful medication,

the pain becomes so intense that Michelle is unable to get

out of bed for hours.

Still, it seems like a relatively routine

recovery from major surgery.

Nothing unusual, until AM the following morning.

She goes and takes some medication,

and as she's going back to bed, she collapsed suddenly.

NARRATOR Kevin scrambles out of bed

and attempts to revive her--

Michelle!

NARRATOR But to his horror, he realizes

that she stopped breathing.

Frantic, he dials .

My wife had surgery.

NARRATOR Paramedics arrive within minutes.

They rush her to the emergency room, where doctors work

on her for almost a full hour.

And they tried to resuscitate her, but she was dead.

They never could revive her.

At this point, her husband and family is devastated.

They can barely even talk, and I'm sure they

just want to know why she d*ed.

Just like, you know, any of us would.

NARRATOR It's now up to Dr. G to provide Michelle's

family with some answers.

Given the circumstances of her death,

she suspects that complications from the surgery

could have k*lled Michelle.

Wow.

NARRATOR % to % of patients develop

complications during or after cosmetic surgery.

Most are not serious, but abdominoplasty

is one of the most invasive cosmetic procedures.

Abdominoplasty is not an operation

that should be taken lightly.

What you're doing is you're making a large incision

across your lower abdomen.

You're removing part of your skin.

CHRISTINE REN-FIELDING Essentially, the underlying

fat plus the skin is removed.

Sometimes the muscle underneath is

then tightened by an extra stitch,

almost like a baseball stitch, sort

of corsetting you together.
[ … ]

And then the skin is sewn together.

NARRATOR And the list of potentially adverse outcomes

is long.

For one, Michelle could have contracted

a fatal infection either during surgery or while recovering.

The CDC estimates probably about

, to , deaths from hospital-acquired

infections each year.

Whenver you open the skin with surgery,

you are decreasing your skin barrier from infection

and increasing your risk of infection.

NARRATOR Another possibility is that Michelle

developed blood clots in her legs

at some point during her recovery.

They conform after long periods of immobility,

then travel through the blood vessels to the heart, lungs,

and brain, cutting off blood supply with deadly results.

But because Michelle underwent liposuction,

she's also at risk for fatal fat emboli,

a problem specific to the procedure.

JAN GARAVAGLIA The liposuction, you're breaking up the fat when"], index ,…}

they're trying to suck it out.

Then you can cause damage to some of the small veins.

These fat molecules and globules get into your vascular system,

and then could go to any organ.

NARRATOR And with the fat emboli displacing blood supply,

the body cannot absorb the oxygen it needs to survive.

However, there's a chance that the culprit

had been developing undetected in Michelle's body for years.

Could just be natural disease, and that the surgery

had nothing to do with it.

NARRATOR Although Michelle was no longer obese,

her past weight gain could have triggered heart problems.

If someone is obese or overweight,

their heart has to pump much harder

to carry that extra weight, and that can affect its health.

NARRATOR Dr. G also can't ignore

another potential scenario--

Michelle may have overdosed on her powerful pain medication.

JAN GARAVAGLIA She's given some potent narcotics,

and possibly, she's taken too much.

NARRATOR And there's one even more tragic possibility.

If Michelle did overdose on painkillers,

it may not have been an accident.

JAN GARAVAGLIA There is clearly a syndrome of depression

after these body-contouring surgeries.

After the surgery, you're in pain.

Things are looking bad down there.

You kind of get this depressive effect because stress hormones

go down.

NARRATOR Could Michelle have succumbed

to a post-surgical depression and taken her own life?

Michelle's family is desperate for answers.

But with no immediate clues, only a full autopsy

can solve the mystery of her sudden death.

There's a lot of possibilities here.

It'll be interesting to see what we find.

[suspenseful music]

OK.

We're just gonna go.

NARRATOR The first thing Dr. G notices

as she begins the external exam is how hard doctors

worked to save Michelle's life.

They have lines in both arms.

They have a line in her neck, and they tried very,

very hard to resuscitate her.

NARRATOR It's a sad reminder of what a tremendous loss

this was for Michelle's family.

She's got two kids, four and two,

which is just devastating to die and leave two children.

NARRATOR But she has no time to dwell on the tragedy.

As Dr. G begins examining Michelle's skin,

she keeps an eye out for small, reddish,

purple dots called petechiae.

They occur when fat clots travel through the bloodstream

and congest the small capillaries

near the skin surface.

Petechiae could indicate the presence

of deadly fat emboli, one of Dr. G's leading suspects.

I don't see any of the petechiae,

but that doesn't mean she doesn't have fat emboli.

It's still a possibility.

NARRATOR The only way to rule out fat emboli for sure

is to examine tissue samples of Michelle's heart, lungs,

and brain under the microscope.

Another thing that Dr. G is hoping

to find in the external exam is evidence of blood clots.

These often form in the legs, causing one leg to swell

up larger than the other.

Brian, could you lift the leg up for me when I measure?

Her legs don't look asymmetric.

There's no pulmonary embolism that has obviously developed

in her lower extremities.

NARRATOR In fact, as she works her way up the entire body,

Dr. G doesn't see any red flags at all.

She looks like she's lost weight recently.

But overall, she looks pretty good.

The only thing that really doesn't look good

is that incision across her abdomen.

Whoa, whoa, whoa.
[ … ]

That looks painful

NARRATOR Dr. G carefully examines

the -inch incision for telltale signs of infection.

Now, the one thing, though, when you look at the scar

is that it doesn't look infected.

NARRATOR There's also no swelling under the wound.

Blood or serum can clot there, but I don't see any hematoma

or large amount of blood.

NARRATOR Still, Michelle's surgical site looks extremely

painful, and this moves one of Dr. G's initial theories

to the forefront.

Just by looking at it, I'm thinking,

oh, she must have overdosed on medication.

[suspenseful music]

NARRATOR Although Dr. G now suspects that Michelle Rohn may

have overdosed on painkillers following a tummy tuck

operation, she still hasn't ruled

out other causes of death, such as an infection

or a botched surgery.

I won't know for sure until I open that incision up.

[music playing]

NARRATOR Because of Michelle's recent surgery,

Dr. G does not begin the internal exam

with a typical y incision.

In this case, I actually open up the incision--

the -inch incision, it goes around her lower abdomen,

because I want to see what that one looks like.

NARRATOR Dr. G carefully cuts through Michelle's stitches

and reflects the skin.

It looked painful.

Where are those things coming from?

But it didn't look infectious.

All right.

NARRATOR Finding nothing suspicious at the surgery site,

Dr. G uses her scalpel to make a y incision, opening up

the torso from each of Michelle's shoulders

through her chest, all the way to the pelvic bone.

First, she'll check the organs for any sign

of accidental injury from the surgery.

[music playing]

JAN GARAVAGLIA Her liver looks normal.

Her spleen looks normal.

There's no free blood, no pus in her abdominal cavity.

There's no perforation in her bowel.

NARRATOR With no evidence of infection

or surgical injury to Michelle's organs,

it's looking like the surgery itself had absolutely

nothing to do with her death.

You know, I'm still wondering, maybe she took an overdose.

NARRATOR An overdose of painkillers

could have been accidental--

or not.

Some patients have been known to suffer psychologically

after plastic surgery.

There's some serious depression that can occur

post body contouring surgery.

They were feeling good before surgery.

They're feeling terrible after surgery.

They have these horrible scars.

They're in a lot of pain.

And they second-guess their decision.

NARRATOR Dr. G slices open Michelle's stomach, looking

for evidence of an overdose.

There's really nothing in her stomach.

I don't see any pills or pill fragments, or a bunch of pills

that I would expect with an overdose.

NARRATOR But there's only one way to tell for sure,

and that's by drawing blood from Michelle's

body for toxicology testing.

JAN GARAVAGLIA So if this autopsy is negative at the end,

I'm hoping that toxicology ends up positive.

NARRATOR But toxicology aside, there's

still critical work to be done.

Dr. G must push on with the autopsy.

Michelle's body has yet to reveal what k*lled her,

and the possibilities are dwindling.

Maybe it's just some natural disease process.

Maybe she's got a bad heart.

Maybe she's got something else going

on that we don't know about.

NARRATOR In the meantime, Michelle's husband

and two young children anxiously wait for any information

that may help them begin to come to terms with this tragic loss."], index ,…}

I just hope we find a cause of death.

There's nothing worse than a middle-aged woman

that dies suddenly with no cause of death.

[suspenseful music]

NARRATOR So far, Dr. G hasn't found any evidence

to suggest that -year-old Michelle Rohn d*ed

from her recent tummy tuck.

But Michelle's sudden collapse does

point to a likely culprit--

the painkillers she took minutes before.

We see prescription drug, narcotic overdoses

all the time in this office.

Some of them are intentional.

Some of them are unintentional.

NARRATOR But it will take weeks to get the toxicology

results back from the lab.

In the meantime, Dr. G continues the autopsy,
[ … ]

looking for any clue as to what might have caused

Michelle to die so suddenly.

Based on the circumstances of her death,

I'm going to really still look for natural disease.

I'll look at her heart.

That's really going to be where the money

is for dying suddenly.

NARRATOR Dr. G opens Michelle's rib cage and removes the heart."], index ,…}

She then meticulously dissects every chamber

and artery in the organ.

JAN GARAVAGLIA There's no evidence

of scar tissue, any evidence of longstanding high blood

pressure.

Hair looks good.

NARRATOR Next, Dr. G turns her attention to Michelle's lungs.

At first glance they look healthy, judging

by their size and color.

You can't just look at the external aspect of a lung

and figure out what went on.

You gotta take it out and cut it.

NARRATOR Carefully, she lifts the lungs up and uses

her scalpel to detach them.

She then begins dissecting the delicate tissue,

and at that moment, she sees something horribly wrong.

She's got bilateral pulmonary thromboemboli.

Blood clots that formed and are occluding

the main pulmonary arteries.

The lung can't get anymore blood from the heart,

and it's incompatible with life.

This is what k*lled her.

NARRATOR But Dr. G's work isn't over yet.

Even though I have the cause of death,

I am curious what caused it.

I need to know, where did she get

these bilateral pulmonary emboli?

You know, inquiring minds still want to know.

NARRATOR The prime suspect, Michelle's legs, where blood

clots are most likely to form.

So we dissect the legs, and they

don't have any residual clot in those legs.

No, I can't see.

It's just all blood here.

I don't see any clots.

NARRATOR Determined to locate the source,

Dr. G slowly moves upward on Michelle's body--

and soon finds her culprit.

But not in the usual spot.

I find some residual clots still in her pelvic vessels.

NARRATOR Although blood clots usually form in the legs,

in Michelle's body they formed in her pelvic area,

then broke free and traveled through her bloodstream

before lodging in the lungs' pulmonary arteries.

A blood clot forming in the pelvic vein

is more dangerous than a blood clot forming in the calf vein.

The reason being is that the vein in the pelvis

is much larger than the vein in the calf.

So when a blood clot breaks off, if it breaks off

from the pelvis, it's a larger blood clot,

and then can be much more fatal.

NARRATOR This is the smoking g*n she's been looking for.

And finally, Dr. G can explain exactly how Michelle Rohn's

tummy tuck turned tragic.

[music playing]

NARRATOR After an uneventful abdominoplasty and liposuction,

-year-old mom Michelle Rohn is recovering at home.

She's bed-bound and in pain.

Still, on the outside, everything appears normal.

But inside her body, it's a completely different story.

The tissue destruction from the surgery and liposuction

causes blood to clot more readily,

and her immobility during recovery

makes it more sluggish.

JAN GARAVAGLIA And that can lead to pulmonary emboli

forming in the pelvic region.

NARRATOR At around AM, Michelle's pain wakes her up.

She crawls out of bed and makes her way

to the bathroom for another dose of painkillers.

But unbeknownst to her, the movement's likely

caused several blood clots to break

free from her pelvic region.

JAN GARAVAGLIA They go through her vascular system

and flog up the pulmonary arteries going to the lung.

NARRATOR As Michelle tries to get back into bed,

her body, deprived of oxygen, suddenly begins to fail.

She collapses, and within minutes, she's dead.

That's one of the few things that you're

walking, talking one minute, and you're dead on the floor

the next.

NARRATOR Michelle's sudden death

has left her grieving husband, Kevin, desperate for answers.

Now Dr. G calls him with her findings.

This is Dr. Garavaglia at the Medical Examiner's Office.

Yes.

He just got the cause of death and hardly said a word.

He certainly didn't want to talk to anybody about it.

Oh, I would imagine that there was some tremendous guilt.

NARRATOR It's unlikely that Kevin Rohn ever

thought his wife could die from the consequences

of such a common procedure.

The dangers for cosmetic surgery are minor,
[ … ]

but they're real.

Having pulmonary emboli, the complication of that

is little less than %.

About a .%, but it's real.

If she doesn't have anything that is going to put her

at increased risk for the surgery,

she's one of those unfortunate people

that had a bad complication.

NARRATOR For Dr. G, Michele's death

is a powerful cautionary tale when it comes

to elective plastic surgery.

As long as you know the risks and the complications,

and it's still worth it for you, you know, go for it.

And especially if it makes you feel better.

But the people she devastated the most with it

are her children.

You can't ever substitute for mommy.

[music playing]

SINGER I miss you, I miss you.

I love you, la la, bah, bah, bah.

And the smell of your--

[music playing]

MALE SPEAKER Atlas.