05x05 - One False Move

[bunniefuu]

[music playing]

NARRATOR A man is found dangling over

the side of a footbridge, dead.

It's really odd.

He's got a g*nsh*t wound on the back of the head.

NARRATOR And as the clues begin to pile up,

this strange case just seems to get stranger.

It was a sh**t at the OK Corral.

Was he ambushed?

What's going on here?

NARRATOR And then, a young man turns up

dead, covered in vomit.

Now, they said he was drinking fast and furious.

He was really, really drinking.

NARRATOR But Dr. G. suspects there may be more to this story

than meets the eye.

A surprising finding on this fellow--

it shocked everybody.

[music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

these are the everyday cases of Dr. G. Medical Examiner.

DR. G. We're building this beautiful new morgue

and some of the planning is really exciting.

And some parts are just dull.

Today, we're going to look at chairs

and kind of determine the chairs you might like,

the guest chairs, things like that.

Is that-- is that good?

Sure.

Yeah.

With this one, the flexors are actually right here.

It doesn't have to be this color, does it?

No.

No, no, no.

Yeah, no.

Yeah, that's better.

OK.

Yeah.

This chair--

DR. G. I've just had about enough of furniture shopping.

I would rather do a decomp than go

through that furniture meeting.

NARRATOR If it's a medical challenge

Dr. G. is looking for, then she's about to get her wish.

This morning, we have a man, it appears he's got a g*nsh*t

wound to the back of the head.

NARRATOR And the circumstances surrounding

this case are particularly unusual, even for Dr. G.

[music playing]

It's just after PM and Michael Gordon

is on his way to get some fishing

in before the sun goes down.

But while crossing a footbridge near his home,

he stumbles onto a startling scene.

He saw an elderly male perched over the railing.

He knows that the person had been injured.

He was bleeding from the head.

And he notified the police.

NARRATOR Michael immediately dials --,

and police soon arrive, followed closely behind

by Detective Daric Harvey.

When I arrived on scene, one of the first things I noticed

was that the decedent was actually

perched on top of a railing and was balanced over the waterway.

That's very unusual.

There was blood coming from a small hole

in the back of his head at the top part of his neck.

NARRATOR Blood is still dripping from the wound,

but all life is drained from the man's body.

It looks as if he took a b*llet straight

to the back of the head.

A g*nsh*t wound to the back of a person

is usually indicative of a homicide.

NARRATOR Detective Harvey and his team waste no time

jump-starting their investigation.

Police identify the man as -year-old David Jacoby.

And they soon learned that he's an avid outdoorsman who lives

in nearby Kissimmee, Florida.

As we checked over the decedent's person,

we also noticed a black nylon holster on his right side.

The holster had a small caliber handgun in it.

Had he gone to meet someone there, things went badly,

and a confrontation ensued?

NARRATOR Detectives immediately begin interviewing friends

and family members looking for anyone who may have

had a beef with David Jacoby.

In the meantime, the body is transported to the district

nine morgue, where investigators are relying on Dr. G.

to shed some much needed light on this bizarre scenario.

DR. G. So basically we're at what happened?

Was it a sh**t at the OK Corral

or was it some type of ambush?

I need to look to see if there's evidence of a struggle.

Is there other trauma on the body?

I need to look at the angle of the wound.

I need to look at the location of the wound--

any other clues we can get from that body.

NARRATOR One person in particular

is desperate for answers, Shawna Jacoby, David's only child.
[ … ]

When we contacted the daughter,

the decedent was really the only family that she had,

and it was kind of like the end of her world.

The only thing that we can give her

is that we're doing everything we can to investigate the case.

NARRATOR First step-- morgue technician [inaudible]

x-rays of David's cranium.

We now have digital x-rays.

It's all computer now, as opposed to the old film x-rays,

which we had a couple of years ago.

Push a button, put it in the computer.

We can manipulate the image there and see

things a little bit better.

Sometimes, you'll see medical devices that [inaudible]

person had or old injuries.

You're like, Oh, what's this?

It's like Christmas.

You find things in there you weren't expecting.

NARRATOR What these x-rays ultimately

reveal could be crucial to the police investigation.

The biggest piece of evidence that we

were looking for at the autopsy was really the projectile.

If there was a projectile in the cranium of the decedent,

we needed to find out exactly how

that b*llet wound got there.

NARRATOR And examining the x-rays,

Dr. G. discovers that the key piece of evidence police

are seeking is still lodged inside the man's brain.

When I x-ray the body and I find the b*llet, that's great,

because that's a piece of evidence, uh, that

helps us determine the angle.

We need to follow the track.

We need to retrieve the b*llet.

There's a vital piece of evidence.

NARRATOR But before Dr. G. can recover the b*llet,

she must first complete her external exam.

When I initially look at the body, what's

interesting about him, he's got a tremendous amount

of petechiae, little broken blood

vessels of his face, his eyes, the upper portion of the body.

NARRATOR Unfortunately, this finding quickly leads Dr.

G. to an unsettling conclusion.

He's clearly alive when he's dangling over that railing.

NARRATOR The presence of broken blood vessels

indicates that Joseph's heart was

still pumping blood while he was suspended over the water.

These little facts, you kind of put away in your brain,

and you wonder, is this a key piece of the puzzle?

NARRATOR And is Dr. G. continues to scan David's body,

she hones in on what could be another key piece

of the puzzle.

DR. G. He had a holster on his right side, hooked to his belt.

What was interesting about the holster

is that there was blood on it.

There was blood on the outside of the snap,

and there was blood on the inside of that flap.

Give me the swab.

NARRATOR Dr. G. collects blood samples

from the thick leather pouch to submit for DNA analysis.

Next, she inspects David's hands.

At the crime scene, Doctor G.'s investigators covered them

with paper bags to preserve evidence,

and it's a good thing they did.

There was a lot of soot on his hands,

particularly on the left hand, in the webbing,

between the thumb and first digit.

NARRATOR The soot can only mean one thing.

So he's got soot on his hands and he's

in possession of the g*n, it probably means

he's been sh**ting that g*n.

NARRATOR David wasn't just ambushed on the bridge.

He sh*t back.

The question is at whom?

[music playing]

Dr. G. has just discovered something

shocking during her external exam of David Jacoby.

He wasn't just sh*t.

He also fired his own g*n.

But this is just one piece of a larger puzzle.

How are we going to put this all together?

I'm not sure yet.

NARRATOR To gather as many clues as possible,

Dr. G. must complete a meticulous exam

of David's entire body.

The g*nsh*t wound is on the back of the head,

and I'm going to wait till I finish the internal exam

before I go there, because I'm going

to have to flip the body over.

I need to look to see if there's evidence of a struggle.

Is there any other clues we can get from that body?

I open up his body with a Y-incision.

I make the shoulder-to-shoulder incision,

then down to the pubic bone.

NARRATOR Dr. G. reflects the skin,

examining the rib cage for signs of trauma, such as fractures.

But she sees none.

No trauma on the inside.

NARRATOR Next, she cuts down the sides of the rib cage

and lifts it to expose the network of organs beneath.

Here, she searches for signs of injury
[ … ]

in the form of bruising, bleeding, or perforated tissue.

There is no evidence of any struggle.

No evidence of trauma to that abdomen.

NARRATOR But there's one last place to look

for evidence of an as*ault--

David's neck.

So I do, you know, the regular neck

dissection, where I do the layers of the strap muscles.

NARRATOR And as she folds back the surrounding tissue,

she's surprised by what she sees.

Oh, boy.

He clearly had a lot of degenerative disease

to the neck and a metal plate that

had been put on top of the front portion of his neck.

So clearly, he's had surgery.

He's had some orthopedic device in.

NARRATOR The extent of degeneration and reconstructive

work, leaves little doubt that David's suffered

from chronic neck pain.

All right, let's see.

NARRATOR Dr. G. notes this finding

and resumes her search for signs of trauma.

DR. G. The hyoid bone, which is at the base of the tongue,

was fine.

Thyroid cartilage was fine.

There's no evidence of trauma to the neck.

NARRATOR After a painstaking internal examination,

it's looking like the only acute injury David sustained was

the g*nsh*t wound to his head, and she's

counting on that wound to tell her the story

behind this fatal sh**ting.

[music playing]

Training her eyes on the back of David's head,

Dr. G. immediately discovers a critical clue.

Oh, look at that.

There is soot and searing just on the edge of that wound.

NARRATOR Soot is a byproduct of the gunpowder combustion

that occurs when a g*n is fired.

As soon as Dr. G. sees it, she knows

that the g*n was fired at very close range to David's head.

The closer your skin is to the end of that barrel,

different things get put on that skin.

So if you're a couple feet out, you're

just going to get that g*n powder that hits the skin.

But as you get closer, that soot is going to go

on edge or inside the wound.

Huh.

I also see a muzzle imprint.

That's where the barrel of the g*n

kind of slaps against the skin when the b*llet goes off,

and it indicates a hard contact.

It clearly was a contact g*nsh*t wound.

NARRATOR This finding raises new questions for Dr. G.

DR. G. Was he ambushed?

Was he being forced to walk against his will with the g*n

to the back of the head?

You know, what exactly happened?

NARRATOR Her next step is to figure out what angle the g*n

was held at when it was fired.

Doing so could help her work out where the sh**t was standing.

Often, a muzzle print can supply Dr. G. with this information.

But this time, she's not so lucky.

There was kind of a partial muzzle imprint,

so I can't really say how the g*n was turned.

OK.

I need to cut the scalp and look at the inside of the wound.

NARRATOR Next, Dr. G. gently slices through the scalp

and reflects the skin around the b*llet wound.

It was in the middle of the upper portion of his neck,

right where the skull connects to your neck.

NARRATOR She begins to trace the trajectory of the b*llet.

The wound goes through the upper neck muscles,

and then hits into the base of the skull.

NARRATOR Morgue technician, Brian Mahulsky

uses an oscillating saw to cut into the skull,

taking extreme care not to disturb the b*llet hole.

Then I take the skullcap off and look at the brain itself.

NARRATOR Dr. G. carefully dissects the tissue

as she follows the track of the b*llet through the brain,

until at last, she strikes pay dirt.

There in the cerebellum, the part of the brain that controls

movement, balance, and coordination,

sits a tiny piece of metal, the b*llet that blasted

its way through David's head.

Ooh, look at that.

When I retrieved the b*llet, it is m*nled.

NARRATOR But she's still able to determine its caliber.

It was a .

NARRATOR She records this information,

and then, as she maps the path the b*llet

cut through David's brain, a startling picture

begins to emerge.

I realize, this is an odd trajectory.

This is not what I would expect.

NARRATOR And suddenly, Dr. G. has

a whole new theory about David Jacoby's fatal sh**ting.

[music playing]

Dr. G. has just traced the path of the b*llet

that tore through David Jacoby's skull and into his brain.

It's really odd.
[ … ]

This changes the whole complexity of the case.

NARRATOR Suddenly, she's forced to consider a whole new theory."], index ,…}

I relook at my pictures.

I relook at my notes.

NARRATOR Just then, medical investigator Dean

Boyd Smith arrives with news he's

received from Detective Harvey.

Is that all there is on that [inaudible]??

NARRATOR He's confirmed that the g*n found in David's

holster was a , the same caliber as the b*llet

Dr. G. removed from his brain.

And Detective Harvey has also gathered some new information

from David's daughter, Shawna.

She told us that the decedent had,

had quite a bit of pain recently [inaudible] neck area,

to the point that when someone touched his shoulder,

he screamed in pain and had to sit down.

At some points, he couldn't even walk.

NARRATOR Dr. G. considers these new clues.

The odd trajectory of the b*llet through his head,

the caliber matching his g*n, and the news that David

had been living in severe pain.

Each piece of new information supports the theory

that Dr. G. has been turning over in her brain

since she completed the cranial exam.

I think at this point, you can put all the pieces

of the puzzle together, and the preponderance of evidence

is that this is a su1c1de.

NARRATOR But how could David have sh*t himself

in the back of his own head.

And if he did, why would the g*n be tucked

neatly back in his holster.

Despite the strange circumstances,

Dr. G. is confident she can answer these remaining

questions and replay for detectives, step by step,

the final moments of David's life.

[music playing]

David Jacoby is years old, and lately, his body has been

feeling the effects of time.

He had terrible excruciating neck pain.

He was having a lot of problems.

He's had surgery before.

But the pain seemed to be getting worse and worse.

NARRATOR Suffering near constant discomfort,

David can no longer enjoy life the way he used to.

They've pretty much done everything they could, and it's

not going to get any better--

how he's having difficulty walking at times and has

had to give up hunting.

He can't put up with this anymore.

He goes and drives to a very rural area of Florida.

NARRATOR According to the police investigation,

it was a location David had visited many times before.

He was very fond of this location.

A person traveling back to an area that

was very fond for them, it's a very strong

indicator towards a su1c1de.

NARRATOR On the bridge, David takes out his g*n.

He aims it at the back of his neck, the very spot that

has caused him so much pain.

Surprisingly, I see that quite often,

that when people are very upset over their health,

they will sh**t themselves in that part of the body.

NARRATOR It's an awkward position for his arm,

so he uses his left hand for support.

He's got a lot of soot on the left hand

where he could have cupped the end off the barrel

around, steadying it.

This trajectory went clearly from right to left at a very,

uh, a sharp angle.

And it's very consistent with him taking his right hand,

putting it to the back of his head, and sh**ting.

It's an uncommon place for a su1c1de, but it's still seen.

NARRATOR The b*llet immediately rips through David's neck

and into his skull.

It goes right to left, slightly upward,

and grazes the cerebellum.

It hits a very hard part at the base of the skull,

and then just kind of bounces back in to the cerebellum.

NARRATOR But unbelievably, the g*nsh*t does not k*ll him.

By doing the autopsy, we know that, that wound is not going

to cause him to die instantly.

In fact, he would still have function left.

NARRATOR This explains why the police found David's

g*n tucked back in its holster.

A lot of people survive g*nsh*t wounds to head.

You wouldn't necessarily be passed out right away.

He may have easily holstered that g*n.

He certainly has blood on the inside of that holster flap.

NARRATOR Wounded, bleeding, and stunned that he's still alive,

David staggers forward.

I suspect he staggered to the edge,

possibly realizing he didn't k*ll himself with that g*nsh*t,

takes a few steps, maybe to hurl himself over the bridge or just"], index ,…}

collapses, but for whatever reason,

he then passed out, and teetered on that railing.

NARRATOR David dangles from the rail unconscious,

but still alive and breathing.

Blood rushes to his head, and he begins

to develop burst blood vessels, or petechiae on his face.
[ … ]

He was probably still alive, causing those florid petechiae,

those burst blood vessels because his head

was hanging down and his heart was still pumping.

NARRATOR But once David's injured brain begins

to swell from the trauma of the b*llet wound,

his death come swiftly.

He started to have a little bit of swelling in his brain,

and the blood collecting around the brainstem, eventually

caused him to die.

This is, uh, Jan Garavaglia, over

at the medical examiner's office, Dr. G. If you could,

uh--

NARRATOR After delivering her report to the detectives,

Dr. G. shares the findings with David's daughter, Shawna.

DR. G. When I first told the daughter,

uh, she didn't want to believe that it was a su1c1de.

But then when she thought about it a little more,

and she contemplated it, uh, she kind of

thought about all the clues he was giving,

and the chronic pain, and it started

making more sense to her.

NARRATOR For Dr. G., the story David's body tells

is undeniable.

You put the pieces together to make the jigsaw puzzle scene

for us.

And when you do that, you clearly come up with su1c1de.

[music playing]

NARRATOR Dr. G. is often able to bring a sense of peace

to those who've lost a loved one,

but sometimes, the truth she uncovers

can be the last thing a grieving family wants to hear.

It's always hard to think someone you love d*ed

from choices that they made.

[music playing]

DR. G. I have a really important announcement to make.

You all have to hold off for a second.

Dr. Stefani passed his anatomic boards.

He got it.

WOMAN All right.

[applause]

WOMAN When do we go drinking?

We go-- the first thing out of your mouth is drinking?

I said congratulations.

You didn't say-- what did she say?

What time?

[chatter]

NARRATOR The victim in Dr. G.'s next case

also had cause for celebration, but unfortunately, he

did not survive the party.

[music playing]

It's PM on a muggy night in early June.

Christopher Castro and his roommates

are headed out to a local bar in Maitland, Florida.

A few hours earlier, Chris graduated

from community college.

And now, it's time to celebrate.

[cheering]

This whole celebration involved alcohol.

He's drinking beer.

He's drinking sh*ts.

[music playing]

Have just one more drink with me.

Start another dance party.

I guess he felt free to really belt them down.

NARRATOR As the night wears on, Chris's friends

noticed that he's becoming more and more intoxicated.

One more beer.

NARRATOR But they don't think much of it.

They've seen him this drunk before.

It's nearly dawn when the guys finally stumble

out of the bar and head home.

The following afternoon, everyone's

awake, except for Chris.

His roommate goes to wake him up.

At first, he thinks he's just sleeping,

and he tries to shake him.

He turns him a little bit and realizes

there's a lot of vomit in his mouth and kind of on his face.

And he realizes something's not right, and, uh, calls --.

NARRATOR As soon as EMS arrives,

they clear Chris's airway and try several times

to resuscitate him, but it's too late.

They just pronounce him dead.

NARRATOR Right off the bat, Dr. G. has a good idea as to what

may have caused Chris's death.

DR. G. A one-night drinking binge can k*ll you

by just pure alcohol poisoning.

It can put you into a coma and cause your death.

A couple of those cases come through my morgue each year,

usually young people, and they're

usually drinking very fast.

My condolences on his death.

Oh, I'm very sorry.

NARRATOR As a first step, Dr. G.

calls Chris's devastated mother to see if she can

gather any further information.

Right.

She says, he has a history of-- of drinking.

It looks like it's more like a binge type thing,

when he goes out and celebrates with his friends.
[ … ]

NARRATOR She also tells Dr. G. that in spite

of his outgoing nature, Chris had a history of anxiety.

He has a prescription, uh, for Alprazolan, which

is an anti-anxiety medication.

The day prior to him being found dead,

he had just gotten a new prescription

for the Alprazolan.

NARRATOR It's a drug that doesn't mix well with alcohol.

DR. G. A combination of the alcohol

with the anti-anxiety drug, clearly could k*ll him.

We're going to have to do the autopsy, the toxicology,

and see where those facts lead us.

You know, when I first see him, I can tell that he's, you

know, overweight, almost obese.

But, you know, he's only .

I'm not really expecting that, that has

anything to do with his death.

The obesity doesn't usually k*ll you until you're older.

NARRATOR Dr. G. continues her external examination

by checking Chris's skin for irregularities,

and she spots something on his arms.

He's got needle puncture marks.

They appear acute.

NARRATOR The marks could look like evidence

of intravenous drug abuse, but Dr. G.

can tell that they were left by the IV

Chris had in his arm while paramedics

were attempting to revive him.

That's part of the resuscitation.

It doesn't appear to be from drug use.

There's no vascular scars from previous drug use.

NARRATOR Dr. G. is more concerned with what she sees

in and around Chris's airway.

He's still got an endotracheal tube with vomit in it.

And it looks like he's aspirated his vomit.

NARRATOR That means at some point before he d*ed,

Chris inhaled vomit into his respiratory system.

DR. G. A lot of people when they are found

will have vomit around them, in their mouths.

And people think, Oh, that's probably why they d*ed.

They choked on their vomit.

But in reality, we don't usually see that.

The vomit is a result of the death,

and the death is actually caused by something else.

NARRATOR But what that is, Dr. G. has yet to figure out.

Now, I'm not going to jump to the conclusion

until I see what the rest of the autopsy shows.

[music playing]

After I do my Y-incision, I need to take my toxicology.

That may be key in this case, and we

need to take that right away.

Uh, let's see if we can get tox.

NARRATOR Only the toxicology results

can reveal exactly how much alcohol and Alprazolan

was in Chris's body.

Continuing with the internal exam, Dr. G.

turns her attention to Chris's lungs.

Now let's see what have here.

When I remove his lungs, there's no evidence

of pneumonia, tumor, hemorrhage, other infections.

NARRATOR But as she cuts into the soft tissue,

Dr. G. notices something unusual.

Wow.

With somebody going into a coma from alcohol poisoning,

I will expect the lungs to fill up with fluid,

especially with Alprazolan.

It's not really clear why that happens,

but for whatever the reason, you know,

when we see people die from an overdose,

they get very heavy lungs.

NARRATOR But Chris's lungs contain almost no fluid.

Suddenly, Dr. G. must consider a whole full new set of suspects."], index ,…}

Is it some kind of natural disease,

and that the partying and the alcohol,

had nothing to do with it.

[music playing]

NARRATOR Dr. G. has just finished examining

-year-old Chris Castro's lungs,

and they're not at all typical of a death by overdose.

Now, she wonders if alcohol even played a part in Chris's death."], index ,…}

We're going to have to figure out what are those--

the other things that could've caused his death.

So then I go to his heart, and his heart surprised me.

Let's see what this heart weighs.

It's a big heart.

It was enlarged.

It weighed almost twice what I would expect.

It is known that people who have an enlarged hearts,

are more prone to have sudden death.

NARRATOR And that's not all.

Surprisingly, when I cut his coronary arteries,

I found a plaque, or a cholesterol buildup,

which is unusual for somebody .

It was at least an % narrowing,

and that's a dangerous narrowing, even for just

one coronary artery.

I don't usually see it in somebody so young.

It could be partly his diet and his lack of exercise.

He's probably got a genetic component to that,

that he is genetically prone to coronary heart disease
[ … ]

to have it so young.

NARRATOR It now appears possible that Chris's narrowed

coronary arteries could have been

causing his heart to struggle for critical blood supply.

He could have d*ed from this heart.

The heart could have gone into a sudden cardiac arrhythmia.

Certainly, people die suddenly and unexpectedly with that.

Heart arrhythmia is an irritation

in the electrical system of the heart,

where instead of that electrical b*at,

uh, pumping out that blood, the electrical system

quivers instead of b*ating.

And you can't send blood to any parts of your body.

You pass out, and you die.

NARRATOR Add alcohol to the equation, and Chris's heart

becomes even more vulnerable.

Even at all low level of alcohol,

it would more likely bring that heart into an arrhythmia.

NARRATOR But a fatal heart arrhythmia often leaves

no physical trace whatsoever.

In order to determine if this is what k*lled him,

Dr. G. will have to eliminate all other possibilities.

But what does everything else show?

I mean, there's many things that could Tr*mp that.

It's got to be a diagnosis of exclusion.

We've got to rule everything else out.

NARRATOR She cuts out a sliver of the heart tissue

to be sent out and made into microscope slides

that she will examine later.

At the cellular level, Dr. G. might

be able to detect if something other than an arrhythmia

caused Chris's heart to fail.

Next, Dr. G. turns her attention to Chris's liver.

Let's see what his liver-- his liver is not looking good.

I can tell.

NARRATOR With one glance, she can

see that it, too, is abnormal.

A nice normal liver would be nice and brown

with a sharp edge.

His liver was yellow and it had a rounded edge.

NARRATOR She carefully removes the organ

and sets it on the scale.

DR. G. You know, somebody this-- this, uh, size,

maybe , grams would be a normal liver.

His liver was almost , grams.

NARRATOR The irregular color, size,

and shape of Chris's liver are indications of one defect.

It was clearly enlarged by fat, what we call a fatty liver

or steatosis.

NARRATOR It's a dangerous liver disorder that could eventually

have led to cirrhosis.

DR. G. There are many causes for a fatty liver.

In the United States, probably still the most common cause

is alcohol consumption.

I would venture to guess that it is due to his alcohol use.

NARRATOR But Dr. G. won't know if the damage to his liver

was severe enough to k*ll him until she examines

the tissue under a microscope.

At the end of her internal exam, Dr. G. has no clear indication

of what caused Chris's sudden death,

and there is just one place left to look.

We still have to go to the head.

[music playing]

NARRATOR As Dr. G. pulls back Chris's hair

to get a closer look at his scalp,

she discovers something striking.

Oh, look at that.

NARRATOR And it could be the key

that unlocks the entire case.

[music playing]

As Dr. G. examines Chris Castro's head,

she makes a surprising new discovery.

He does have a contusion, or a slight bruise to his scalp.

Maybe this is the unexpected that I was actually

looking and hoping for.

Maybe he fell while he was drinking

and his fellows didn't know about it.

And then over the ensuing hours, he

developed, uh, a bleed in his head

that was enough to compress his brain.

I'm not going to know that, until I

see how that affects his brain.

NARRATOR Morgue technician Kelly

Romance uses an oscillating saw to cut through the bone.

Well, when I take that calvarium

off and look at his brain, there is no evidence of any trauma.

And then I'll cut his brain.

There's no evidence of infection.

There's no evidence, uh, that I can see of anything wrong, uh,

inside his brain, grossly.

NARRATOR At the end of the autopsy,

Dr. G. is left with only two possibilities.

Natural disease is still in there, uh, because he does

have an enlarged heart and he has narrowing

of his coronary artery.

And I'm still worried about his alcohol use,

possibly mixed with that Alprazolan.

So those things are still in the running.

[music playing]

NARRATOR Before the tox results come in,
[ … ]

Dr. G. receives the microscopic slides

of Chris's organ tissues.

The first thing I get back is those microscopic slides.

NARRATOR She first focuses on a view of Chris's heart

tissue, magnified times.

The microbes still show us an enlarged heart,

but nothing acute.

I have no evidence of infection, no areas

that look like they were deprived of oxygen and blood.

NARRATOR She sees no further evidence

to show that he d*ed from an acute heart problem,

but this still does not rule out the possibility that his

severely blocked arteries caused a fatal heart arrhythmia,

an irregular heartbeat.

He certainly could have had an arrhythmia with no findings

microscopically.

NARRATOR She then moves on to examine

the slides of Chris's liver.

What you see when you look under the microscope is instead

of nice pink cells, we see cells which

have vacuoles of clearness, which is fat or triglycerides,

which have actually pushed the nuclei aside.

It's just filling up the cells, and they're like ballooning

out with these triglycerides.

They are a form of fat.

And that's what makes the whole thing

yellow and kind of enlarged.

And it almost feels greasy when you cut it.

NARRATOR Dr. G. can now see that Chris's

liver was bad enough that it could have caused his death.

We see people dying suddenly and unexpectedly just

with that fatty liver.

NARRATOR But just as with the heart,

she can't cite this is Chris's cause of death

without excluding all other possibilities.

She's waiting on one last piece of evidence

before she can draw any final conclusions.

I still have to wait for the toxicology.

NARRATOR Two weeks after the autopsy,

the toxicology report arrives, and what it contains

is nothing short of shocking.

DR. G. Well his toxicology was surprising.

Although he was drinking heavily,

his alcohol level was a .--

-- clearly intoxicated, but not enough to k*ll you.

Something that would k*ll him would be above a ..

And that's enough to put you in a coma and cause death.

I was expecting that, but that's not what the toxicology showed."], index ,…}

NARRATOR Chris's alcohol level alone was not

enough to k*ll him, but combined with Alprazolan,

it could have been lethal.

Dr. G. scans the report for the content of Alprazolan

in Chris's blood, and once again, she's

surprised by what she finds.

There was no Alprazolan.

NARRATOR But as she continues down the page,

something else catches her eye.

DR. G. I find something else, something totally unexpected.

This is his cause of death, and there is no question.

[music playing]

NARRATOR Christopher Castro and his three roommates

are out at a local bar, celebrating his graduation

from college just that morning.

DR. G. He's having a good time.

He was out partying.

[cheering]

One more.

NARRATOR But for Chris, the alcohol

apparently wasn't enough.

Somewhere along the line, he bought some methadone.

What was lethal on his toxicology was his methadone.

NARRATOR Methadone is an opiate best

known for its use as a treatment for heroin addiction.

It's a drug that Dr. G. didn't expect

to find in Chris's system, but one

she knows to be very dangerous.

He probably took it at a time when some of his other buddies

didn't notice.

NARRATOR But over an hour after taking the pill,

it's likely he's still not feeling

the effects he anticipated.

Methadone doesn't have the same kind of euphoric feeling

as some of these other dr*gs do.

It has more of a feeling like alcohol.

NARRATOR Possibly thinking he didn't take enough,

Chris pops another pill.

The problem is people will take more and more of it not

thinking they're getting high and they'll

just keep adding more.

NARRATOR But what they don't know

is that methadone stays in the system

much longer than most other dr*gs.

DR. G. It has a very long half life.

Particularly, with that long half life,

it builds up and builds up and builds up.

His buddies clearly recognized him as highly intoxicated.

Part of that was alcohol, but part of that was his methadone.

NARRATOR And by the time he goes to bed,

Chris's body is in big trouble.

There is, uh, no question he's got
[ … ]

a lethal level of methadone.

Add that to his alcohol, which is not enough to k*ll him

in itself, but add those things together,

and you've got a lethal combination.

Certainly, he has high enough levels to just

purely die from an overdose.

The exact mechanism of how he d*ed is unclear.

But there's still that component of his heart,

that he's-- already has heart disease.

It might be why I didn't see a lot of edema fluid

in his lungs.

[sirens]

NARRATOR But whatever the exact mechanism of Chris's death,

one thing is clear.

The bottom line is he d*ed from the effects

of that methadone, uh, with the alcohol.

NARRATOR Dr. G. contacts Chris's

mother to share her findings.

Well, we finished the autopsy, and, uh--

His family was shocked that he had methadone.

They didn't know anything about methadone.

Yes, it is.

They just think of it as a treatment for heroin.

They're like, well, he's not a heroin addict.

Where would he have gotten it?

NARRATOR But methadone is not just

used to treat heroin addiction.

For years, doctors have also been prescribing it

as a prescription painkiller.

It's much more readily available now.

And, you know, nobody really knows

how it's getting on the street.

[music playing]

Hey, where did you go?

I was talking.

DR. G. Deaths from methadone have sh*t up,

uh-- some statistics show over % in just five or six years.

[music playing]

You walk around in a loop and it gets you nowhere.

Prescription dr*gs have a part in people's lives,

if they're not abused.

But it's a dead end road when you start abusing these dr*gs.

This is a road to the morgue.

[music playing]

Atlas