07x05 - Deadly Circumstances

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[music playing]

NARRATOR When a man is found dead outside a rundown motel,

Dr. G fears the worst.

So a man down, kind of a seedy part of town,

this could very well be a homicide.

NARRATOR But during the autopsy,

she discovers something so shocking she

can hardly believe her eyes.

What I found was one of the most remarkable things

I'd ever seen.

NARRATOR Then a teenage boy is traumatized

when he finds his father's lifeless body at the foot

of their attic ladder.

He's obviously devastated to find his dad dead.

NARRATOR And now, his grief stricken family

is desperate to know what took his life so suddenly.

Why him?

Why that day?

Why that moment?

That's $, question.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

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

As a rule, chief medical examiner Dr. Jan

Garavaglia prefers to work with as few distractions as

possible.

I don't like a lot of people talking

while I'm doing my autopsies.

And a lot of people don't understand

that, that, you know, you're actually concentrating

when you're doing an autopsy.

I'll have my gloves on.

I'll have a scalpel in my hand.

And I'm getting ready to autopsy,

and a detective will ask, what do you think he d*ed from?

I'm like, hold your horses.

I don't like to guess.

I like to get to the answer.

NARRATOR And it will take a whole lot more than guesswork

to solve the mystery in this next case.

What I found during the autopsy

was one of the most remarkable things I'd ever seen.

NARRATOR On a brisk winter morning,

Hank Johnson arrives at his maintenance job

at the Blue Sky Lodge.

He had gotten to work around in the morning.

And he was making his rounds.

NARRATOR But as he's taking out the trash behind the motel,

he comes upon a startling sight.

A man is lying face up on the sidewalk.

And as Hank moves in for a closer look,

he gets the shock of his life.

The man is clearly dead.

Must've been scary.

NARRATOR Shaken, Hank immediately dials .

Police soon arrive on the scene, followed closely by one of Dr.

G's medical investigators.

My investigator goes to the scene to be my eyes and ears.

NARRATOR And her foremost priority is to ID the body.

And in this case, there was an identification

with a photo that looked just like this fellow.

NARRATOR The mystery man now has a name--

Victor Morales, a -year-old Hispanic male

from St. Cloud, Florida.

But outside of that, investigators

have precious little to go on.

His body is transported to the District morgue,

and now Dr. G and her team are determined to figure

out what claimed his life.

We've got a fellow down.

We don't know anything about him.

So we gotta look for clues.

All right, let's see here.

Let's see here.

NARRATOR She begins by reading through the investigator's

report, searching for any insights

into what could have led to his sudden death.

We don't have much history.

Nobody's telling us much about this fellow.

NARRATOR According to the few who knew him,

Victor was a loner who lived in a nearby trailer park,

until a few days earlier, when a fire destroyed his home.

He just had his home b*rned down and all his possessions.

So he is kind of forced to go into this hotel.

But now he's dead.

It sounds like terrible luck.

NARRATOR But while Victor's misfortune provides little

in the way of clues, it isn't long before Dr. G

gets her first promising lead.

A hotel proprietor stated that he just

checked in about two days ago and that he was kind

of yellowish and kind of shaky.

The proprietor really thought he looked ill,

so certainly natural disease could have played a role.

NARRATOR Unfortunately, the vague description

isn't a lot to go on.

Victor could have been suffering from a myriad

of ailments, from kidney failure to heart disease.

But based on the circumstances, Dr. G
[ … ]

can't help but wonder if the -year-old

may have been wrestling with a dangerous addiction.

I really thought he sounded like he

might have been an alcoholic.

There's many ways you can die from alcohol.

And one always has to worry about dr*gs.

NARRATOR But there's an even more unsettling possibility--

foul play.

JAN GARAVAGLIA What's really disturbing is my investigator

said he's got a small abrasion at the top of his forehead

near his hairline.

So that's somewhat suspicious.

A man down, kind of a seedy part of town--

one always has to worry about foul play.

The police are waiting to see if this

looks suspicious for homicide.

But we don't know what this is.

This is truly a mystery at this point.

It's just a wide open game.

We won't know until we do the autopsy.

All right, let's see.

Oh, wow, he looks old.

Overall, he looks a little older than years old.

He looks a little disheveled, and he looked ill.

NARRATOR Given that foul play is

high on her list of suspects, Dr. G zeros in on the abrasion

on Victor's head.

He does have a little bit of head trauma.

I don't know if somebody has hit him.

I don't know what this abrasion is all about.

NARRATOR She won't know if the injury was fatal until she

completes a full cranial exam.

But as Dr. G's eyes move down Victor's body,

she spots a clue that just may hold the secret

to his untimely death.

You see these?

Oh, jeez.

Gosh.

Something is going on with him.

It looks like it could very well be a homicide.

NARRATOR Dr. G has just discovered a telling clue

on the body of -year-old Victor

Morales, who was found dead on the sidewalk

outside a rundown motel.

He's got kind of scratch abrasions on his arm.

NARRATOR This, along with the abrasion on his forehead,

has moved foul play up the list of suspects.

The scratches on his arm may indicate

somebody is grabbing him.

So maybe there's an altercation going on.

NARRATOR But the only way to know for sure

is to look inside Victor's body.

And she'll start with the head.

It could be foul play.

It could have been accidental that he'd hit his head.

But I need to see if we can really piece this together.

Let's see what happens when we get inside.

NARRATOR Using an oscillating saw,

morgue technician Brian Machulski opens the skull.

So we go to the head really looking for trauma.

But there is no evidence of bruising, no skull fractures.

There's no hemorrhage over the brain.

There is no evidence of trauma.

All right, he's fine.

So he's got no trauma to the head.

That's what we're looking for.

But there's still a possibility of broken ribs

and maybe fractured a spleen or, you know, tore the liver.

So being hit or falling is still in the mix.

Clearly, I need to open the rest of the body to get my answer.

OK.

We do our typical Y incision from the shoulders

down to the lower abdomen and open it up.

I make sure there's no free fluid in that abdominal cavity.

There's nothing in there.

And there isn't any.

Go ahead.

I move the chest plate.

Of course I'm looking for any rib fractures,

and there is none.

There's nothing there.

We know that we're not dealing with trauma.

NARRATOR Dr. G can now safely rule out both foul play

and an accidental follow.

But this only deepens the mystery.

If he wasn't the victim of an as*ault,

how did he wind up in the lot behind the motel,

and why all the scratches and abrasions?

Her next step is to collect blood and urine

samples for toxicology.

JAN GARAVAGLIA Of course we check if there's any alcohol.

And I need to check for any type of dr*gs,

whether it's prescription or illicit.

It's important to take tox because that

might be our answer.

NARRATOR With the samples drawn,

Dr. G scans Victor's abdominal organs one by one,

looking for any abnormalities.

When I look in the abdomen, everything looks pretty good.

He's looking pretty good on the inside.
[ … ]

NARRATOR But based on the circumstances surrounding

Victor's death, there's one organ in particular

that Dr. G must examine.

When I hear that he's yellow and shaky,

he could be dying from liver disease.

But his liver, which I thought was going to be

cirrhotic and show evidence of chronic alcohol abuse,

really didn't.

Let's see what's going on here.

NARRATOR No closer to his cause of death,

Dr. G turns her attention to the organs

in Victor's chest cavity.

And she can see right away that something isn't right.

Oh, something's wrong with his lungs.

Normally, our lung should be nice and airy,

kind of like a sponge.

There's little tiny air air spaces.

But when I look at his lung, the entire lower lobe

of that right lung was firm.

He clearly has a bacterial infection.

And this has progressed to the entire lobe and almost

solidified because so much pus is filling

up those alveolar air spaces.

He's got a low bar pneumonia.

NARRATOR But Dr. G can't tell with just her naked eye

if the infection was severe enough to k*ll him.

JAN GARAVAGLIA It's hard to say.

I will, of course, culture that, and I will, of course,

look under the microscope.

All right.

But the next thing I want to look at

is his heart, because you always worry

about maybe a heart att*ck.

NARRATOR Carefully, Dr. G pierces

the pericardial sac with her scalpel,

exposing the heart inside.

And right away, she makes a shocking discovery.

Oh, look at that.

When I open up this pericardial sac, I am absolutely floored.

Wow.

What I found was one of the most remarkable things

I'd ever seen.

Oh, look at that.

NARRATOR Dr. G has just stumbled

across a tantalizing and unusual clue inside the heart sac

of -year-old Victor Morales.

It is the most remarkable pericardial sac

I have ever seen.

It looks as if somebody took a shag rug,

lined the pericardial sac, and covered the heart.

Oh my god.

Look at that.

He's got clearly a pericarditis, an inflammation

of the sac lining the heart.

Untreated bacterial pericarditis is % fatal,

if this is what he has.

But this pericarditis is unbelievable to the point

where it's too unbelievable.

So I'm a little worried about what's going on there.

Is there truly just an infection,

or is there something else going on?

It can be a lot of natural diseases causing it,

everything from rheumatic fever, some connective tissue

diseases, or it could be from a TB or from a fungus.

I have to take micros of it.

NARRATOR Dr. G collect samples of his heart

to be made into slides.

She hopes a magnified view of the tissue

will help shed light on the bizarre finding.

I need to look under the microscope.

What is the etiology, the cause of all this?

So I think what we're going to do is be prudent

and [inaudible] until we get those micros back.

NARRATOR As the autopsy comes to a close,

so does Dr. G's day.

But although she leaves the morgue,

her mind doesn't leave the case.

MARK WALLACE Dr. G brought up this case when we're

driving home from work one day.

She was excited about talking to me about what

this might represent.

It's always fun to talk about cases with Mark.

He's a very wise fellow.

He really brings out the best of you

kind of discussing it and thinking of new angles.

He just thought it was a great case.

So we were interested to see what the micros would show

and what the cultures would show.

NARRATOR For three weeks, Dr. G has

patiently waited for the lab experts to work their magic.

And today, the waiting game finally comes to an end.

JAN GARAVAGLIA The tox, actually, in and of itself,

didn't show anything.

You know, it was negative all across.

NARRATOR She can now officially rule out a drug

or alcohol related death.

Next, Dr. G slips the micros of Victor's heart

and lungs underneath the lens.

And what she discovers is telling.

The lining of the pericardial sac and lining of the heart
[ … ]

was definitely an acute infectious pericarditis.

And when you look at his lungs, he clearly

has a low bar pneumonia.

NARRATOR Two severe infections, one in the lungs

and one in the heart, both caused by the strep bacteria.

This confirms Dr. G's findings at autopsy.

But when she zooms in on the bronchus, the main air

tube inside the lungs, she spots something that she couldn't

see with her naked eye.

The bronchus inside the lungs show necrosis

and some chronic inflammation.

What is causing all this?

NARRATOR And at this point, Dr. G has only one place

left to look--

the viral culture report.

And when I get my culture, that's the smoking g*n.

All the pieces fit together.

And I love that when that happens.

NARRATOR Dr. G has just reviewed the lab results

of -year-old Victor Morales.

And after a three-week investigation,

she's finally found the missing link

to a strange and sudden death.

When I get my cultures back, I have all my pieces together.

And I clearly see the progression of what happened.

NARRATOR In the winter of , Victor Morales

checks into the Blue Sky Lodge after a devastating fire

burns down his home.

JAN GARAVAGLIA He looked kind of yellow and kind of shaky

when he checked into the hotel.

The clerk thought he looked sick.

He is sick.

And he's dying.

NARRATOR Thanks to the culture of Victor's bronchus,

Dr. G now knows the identity of this ruthless k*ller.

The cultures came back positive for HN influenza.

NARRATOR HN, also known as swine flu,

is a strain of influenza first detected in the United States

in April of .

In extreme cases, it can be life threatening.

MARK WALLACE It's thought that there

was about million Americans who

got HN over the last year.

Out of that, about , d*ed.

This flu bug was different in that it didn't k*ll

our typical demographic of the older person

with a lot of chronic diseases.

You tended to see it more in young people.

We saw a lot of people who were obese having a lot of problems

with it.

We had pregnant women die with it.

We had kids dying with it.

And we even had, you know, people

years old dying with it.

NARRATOR Dr. G suspects that Victor contracted HN

about days before he d*ed.

Whether someone sneezed on him or he touched the virus

and then touched his mouth or nose or eyes,

that virus took hold.

He started feeling sick.

He's feeling achy.

He's got a headache.

At this point, he could have gotten treatment,

but he didn't.

NARRATOR Not long after Victor is infected,

the virus invades his airways and att*cks the lining

of his bronchus, to the point where the tissue

becomes irritated and dies.

That lining is so inflamed, it can't do its job.

And part of its job is to help remove bacteria,

get it out of the lungs.

NARRATOR Eventually, the bacteria

begins to spread from the bronchus into Victor's lungs,

setting into motion a deadly chain of events.

That set him up for a serious bacterial pneumonia,

which developed in his right lower lung.

JAN GARAVAGLIA That infection, then,

spreads to his pericardial sac, which sits adjacent to it.

NARRATOR The raging infection triggers a pericarditis

so severe that the heart appears to be

covered in a thick shag carpet.

The pus starts developing these kind of fronds,

and eventually, that bacteria goes into his blood.

NARRATOR And once the bacteria is in Victor's bloodstream,

it isn't long before it sets off a life threatening

condition called sepsis.

It causes the blood pressure to drop,

and eventually, he doesn't get blood to his brain, his heart.

NARRATOR And as he staggers outside,

most likely to seek help, his heart finally gives out.

And he collapsed and dies on the sidewalk.

NARRATOR Dr. G can now close the book

on the case of Victor Morales.

But one question still remains.

How did he get the scratches and abrasions?

JAN GARAVAGLIA We may never know

why he had the scratches on his arm and the abrasions

to his head.

Oftentimes you don't know exactly what happened,

and you never will.
[ … ]

But it's really interesting that we started out

with a case that could have been homicide,

an accident, a natural, and the culprit ends up to be HN.

NARRATOR Dr. G immediately reports her findings

to the local authorities.

When you find something like this,

you contact the health department.

The health department keeps track of all the people

die from the flu.

All those numbers that you hear on TV,

all the statistics, all that information

is gathered one case at a time.

This man's death was preventable.

He didn't have to die from the flu.

He could have been treated along multiple stages of his illness."], index ,…}

There is antiviral medication that this flu was sensitive to,

and his pneumonia would have been

treated with clear antibiotics.

He probably spent the last week of his life miserable.

This poor guy had no one.

It's not good that people die alone.

That's really the tragedy of this case.

NARRATOR Dr. G is ultimately responsible for all cases that

come through the District morgue.

But she doesn't perform every autopsy herself.

[inaudible] he needs to be X-rayed.

Some people think I'm the only one here.

There's actually five of us.

Well, if you'd get here on time--

There's five physicians that work in this office.

NARRATOR And the youngest physician on her staff

is Dr. Joshua Stephany, who first came

to the morgue in , when he trained as a resident

under Dr. G.

He really had an inquisitive mind.

He really liked the cases, and the smells didn't bother him.

So I hired Josh immediately out of his fellowship

to work in our office.

You know, Josh is still young.

And there's still things that he hasn't seen.

And he still is learning the day-to-day.

You know what you're going to have to do,

is take some micros of that.

Yeah.

[inaudible]

I value her input just from the experience level.

She's been doing this longer than I have.

She's seen a lot more than I have.

JAN GARAVAGLIA I'm thankful for all the physicians

that work with me.

We have a really good team, and it's

nice to work with good people.

NARRATOR Every morning at AM, all five medical examiners

gather to discuss the day's cases.

JAN GARAVAGLIA It is very important to have multiple eyes

and ears because one medical examiner could come up

with an idea and kind of shed a new light and a new way

of thinking about a case.

NARRATOR At the end of each meeting,

the morgue workload is divvied up.

And the winner of that lottery was Dr. Stephany.

NARRATOR And today, it looks like Dr.

Stephany has landed a particularly interesting case.

We all like a mystery.

It's no fun to get a present when

you know what's inside already.

NARRATOR It's a Sunday morning in late June.

But for Dario Romano, a ninth grade teacher,

it isn't your typical lazy weekend.

He's knee deep in a home renovation project

that he's been working on for weeks.

Apparently, he was working up in the attic,

helping the family try to put an addition on to the attic.

NARRATOR Nothing about the -year-old

seems out of the ordinary.

But around noon, Dario San Miguel is on his way

to the laundry room--

Dad?

NARRATOR --when he stumbles onto a terrifying scene.

Dad!

He finds his father unresponsive at the bottom

of the ladder.

NARRATOR In a panic, Miguel immediately dials .

And paramedics arrive on the scene within minutes.

He had no vitals, no heartbeat, no pulse.

He wasn't breathing.

NARRATOR Emergency technicians performed CPR

on Dario for over half an hour.

But despite every effort to save his life,

the beloved father and husband dies right there at the foot

of his attic stairs.

They couldn't bring him back.

The family's very surprised, very shocked.

JAN GARAVAGLIA It's really sad.

You know, the poor -year-old is obviously devastated

to find his dad dead.

NARRATOR And now, it's up to Dr. Stephany

to solve the mystery of Dario's tragic death.

JAN GARAVAGLIA But we don't know why he d*ed.

But by the end of the day, we're hoping to know.
[ … ]

NARRATOR Associate medical examiner Dr. Joshua Stephany

is preparing for the autopsy of Dario

Romano, whose family is still reeling

from their unexpected loss.

JAN GARAVAGLIA I think the worst part is that the family

just has no clue why he d*ed.

And we're hoping the autopsy gives us the answer.

JOSHUA STEPHANY Trying see what's going on with this guy.

NARRATOR Dr. Stephany begins by reading

through the detailed investigator's report.

We have a -year-old Hispanic male

found dead at the bottom of a ladder

that leads up to his attic.

I think trauma is a possibility on this fellow.

NARRATOR And a fatal head injury

is at the top of his list.

He could have hit his head up in the attic,

or he could have fallen coming down the ladder.

If there is trauma, there could be a buildup of blood.

A buildup of blood affects you to the point

where you can pass out.

NARRATOR But Dr. Stephany must also consider a number

of alternate scenarios.

It was a hot day at the end of June.

JOSHUA STEPHANY That attic can get up to ,

degrees no problem.

So heat stroke is a definite possibility.

Heat stroke is when your body temperature

goes up, usually above .

It's a serious condition.

But that one's going to be difficult to prove because we

don't have a temperature.

EMS didn't take a temperature.

NARRATOR This means that in order to record heat stroke

as Dario's official cause of death,

Dr. Stephany will first have to rule everything else out.

And given the circumstances on the scene,

there's another theory he must consider.

We know he's working with the power tools up there.

So you're thinking, is there possible of electrocution?

JAN GARAVAGLIA He'd been in that very hot attic,

so he's probably sweating profusely.

You know, that sweat is a very good conductor of electricity.

You can still move after you've been electrocuted.

So there is a chance that he started walking--

he got electrocuted, started walking down the ladder

and fell off.

That's a possibility.

NARRATOR Next, Dr. Stephany leafs

through the -year-old's medical history,

and right away, he spots an important detail.

We have the history that he's got

a congenital cardiac anomaly.

NARRATOR Dario was born with a defect of the aortic valve,

the opening that regulates blood flow

from the heart to the aorta.

Over time, it can lead to a dangerous condition

called aortic stenosis.

The aortic stenosis causes those valves to be stiff

and then narrowed, letting less and less blood

get through them.

And that's a huge strain on your heart.

But we were told he is being followed by a cardiologist.

And up until you start getting that narrowing,

there's not a really high chance you're going to die suddenly

and unexpectedly.

Well, right now, if there is, given those circumstances,

it's pretty much open ended.

It can be anything.

He's going to let the body speak to him.

Let's take a look what we've got here.

NARRATOR Dr. Stephany begins with a meticulous examination

of the body, searching for any evidence of electrocution.

We often see just little burns where the electricity goes in.

They're kind of dry with raised white edges--

real classic for electrical burn.

NARRATOR With a careful eye, he studies the hands

and other extremities, on the lookout

for any suspicious markings.

No burn marks, no small charring

or discolorations of the body.

NARRATOR On first blush, death by electrocution

is looking less likely.

However, as with heat stroke, Dr. Stephany must rule it

out by diagnosis of exclusion.

But as he continues to scan the body for clues,

something else immediately grabs his attention.

Oh, look at this.

There are abrasions on the chest,

the lower back, the shins, the knees,

and on the upper extremities.

That could be from a fall, going down the ladder.

You get a clean picture of that one?

NARRATOR Now, he'll have to dig deeper for answers.

And he knows just where to look first.

The number one traumatic injury for falling off a ladder

would be head trauma.

But you never know what you find in the head.

NARRATOR With his scalpel in hand,

Dr. Stephany slides the blade across Dario's scalp.
[ … ]

We'll make an incision going from the back of one ear

to the back of the other ear.

Our theory is that he hit his head,

that he has maybe a subdural, blood

collecting over the brain.

NARRATOR To gain access to the brain itself,

he cuts through the bone with an oscillating saw.

How do you breathe in this thing?

Everything's so foggy.

I know.

NARRATOR Eyes peeled for any abnormalities, Dr. Stephany

inspects the surface of the organ inch by inch.

But I don't see any subdural blood.

I don't see any blood around the cerebral hemispheres.

Nothing here.

This looks fine.

He didn't have a typical injury we

see with falling off a ladder.

He didn't have head trauma.

The head was not the cause of his death.

JOSHUA STEPHANY I'm not quite sure what's going on.

He's a mystery.

So we really don't know what's going on with this fellow.

I think it'll be interesting to see what the autopsy shows.

JOSHUA STEPHANY We take the scalpel,

make the incision from both anterior shoulders,

meet at the mid chest, and then go down the mid-abdomen.

NARRATOR Carefully, Dr. Stephany

peels back the deep layers of tissue to reveal

the inside of Dario's body.

And the instant the abdominal cavity is exposed,

he's completely taken aback.

That's not good.

This was quite shocking.

NARRATOR Dr. Stephany has just made

a stunning discovery inside the body

of -year-old Dario Romano.

That's not good.

He's quite surprised at what he finds.

He's got some blood in the abdomen, so I don't know.

I see a large amount of blood in the cavity,

so I want to know what's going on.

First of all, I want to measure it to see how much is in there.

Let's let all this blood out.

We need to measure that.

We actually take a soup ladle and slowly ladle it out

like we're ladling out soup.

NARRATOR And by the time he's done,

Dr. Stephany has measured out a staggering , milliliters.

That's a lot of blood.

That's over a third of his blood volume.

Now it's his job to figure out why has he got that blood.

Right now, I'm not really sure what the source of blood is.

Is it natural disease?

Did he rupture a spleen?

And what's going on in his chest?

Are there rib fractures involved here?

NARRATOR With these thoughts in mind,

Dr. Stephany removes the chest plate

and takes initial stock of Dario's upper body cavity.

I don't see any evidence of fractures on the ribs.

I don't see any lacerations.

I don't see perforations.

I need to look at his heart.

NARRATOR But given Dario's congenital abnormality,

Dr. Stephany is also eager to examine the heart.

So let's see.

NARRATOR He cuts through the pericardial sac

to expose the organ inside and immediately

spots something alarming.

Oh, that's a big heart.

What's noteworthy right off the bat with his heart

is it's enlarged.

The heart weighs almost grams.

That's a thick, big heart.

NARRATOR And as Dr. Stephany inspects the organ more

closely, he's surprised to see that it's in worse shape

than he expected.

It's clear now that Dario had developed a severe case

of aortic stenosis.

JOSHUA STEPHANY It doesn't look so good.

The valve is usually beautiful.

They're very thin and delicate, but this

is a gnarly looking valve.

It's all diseased and narrowed and stiff and calcified.

The heart, to push out same amount of blood

out through that narrow opening has to pump harder.

So because the heart's working harder,

the heart is a little thickened and a little larger.

JAN GARAVAGLIA This is a very bad heart.

If not for the blood in his belly,

I would have said that is probably the cause of death.

But he needs to figure out what has happened

that's created , milliliters of free blood

in his abdominal cavity.

So I don't know where the blood is coming from.

So I want look in the abdominal cavity.

NARRATOR One by one, Dr. Stephany

begins the arduous task of removing

and dissecting the abdominal organs,
[ … ]

starting with the GI tract.

We do a look around the organs,

but I don't see any perforations in the stomach, in the bowels,

in the intestines.

He doesn't find anything.

NARRATOR Next, he removes the liver.

The surface of the liver looks intact.

It looks nice tan brown color.

Nothing remarkable.

NARRATOR But as he cuts into the organ itself,

he finally strikes paydirt.

JOSHUA STEPHANY Oh, there it is.

I see a nice big laceration of the internal surface

of the liver.

That tear is quite deep.

That's clearly where that blood is coming from.

NARRATOR But ironically, this discovery

only deepens the mystery.

Well, to me, it was strange, you know.

It's a surprising finding.

It's unusual to have a lacerated liver not related

to an automobile accident and really high falls,

like off of buildings.

Why did he lacerate his liver?

That's the $, question.

NARRATOR As the autopsy comes to a close,

Dr. Stephany still has his work cut out for him.

What is the chain of events that

led to that cause of death?

NARRATOR To figure that out, Dr. Stephany

will need to go back to square one,

reexamining all the evidence from the investigator's report

to the medical history to the internal and external exams.

In the morning, each of the doctors

shares what they found from the autopsy from the day before.

NARRATOR And after a night of intense deliberation,

Dr. Stephany believes he can finally

explain to his colleagues exactly what led

to Dario Romano's tragic death.

It's a scorching hot Sunday in Winter Park, Florida,

and Dario Romano is up in his attic,

laboring over a home improvement project.

He was working, laying planks up

there, using some electrical equipment, sawing some boards.

It's hot.

It's the height of summer.

The attic temperature can get easily to , degrees.

NARRATOR As the temperature rises,

Dario's body becomes overwhelmed by the heat,

putting a dangerous strain on his already damaged heart.

JAN GARAVAGLIA The heart is really working hard

to get the blood through that narrowed

opening at the aortic valve.

And when he's stressing himself in that attic,

in the heat, working, that's a lot for his heart to take.

NARRATOR The organs soon goes into overdrive,

struggling to pump fresh blood and oxygen

through the -year-old's body.

That could make him dizzy.

It could make him woozy.

Which led him to lose balance, causing him to fall.

He must have hit his side.

He's got a nice abrasion on that right side.

NARRATOR And given the odd manner in which Dario's body

goes down, what might have been a relatively harmless fall

turns into a catastrophic blow.

Unfortunately, you know, he hit just the right way

to lacerate that liver.

This gentleman must have fallen against something, must

have hit something with his abdomen to cause

that type of laceration.

JAN GARAVAGLIA Dr. Stephany thinks he

lacerated it up in the attic.

My theory is that he clearly can't get that liver

laceration with a minor fall.

I don't think there's enough force

up in that attic that would have caused that laceration.

I think it occurred that when he was walking down that ladder

and he fell.

NARRATOR But while Dr. G and Dr. Stephany

may disagree on the exact chain of events,

one thing is certain--

once the liver is lacerated, blood

begins gushing out of the wound and into the abdominal cavity

at an alarming rate.

He is losing blood flow to the organs

and losing blood flow to the heart.

He gets himself up, sits up against that ladder to rest.

He's just slowly losing consciousness.

NARRATOR One by one, the -year-old's organs

begin shutting down.

And within seconds, he is dead.

JAN GARAVAGLIA This is one of those cases

that you think is a sad accident.

NARRATOR In the end, no one can argue

that the sequence of events leading to Dario Romano's

untimely death were unusual--

a hot day, a compromised heart, and a flukish fall.

But sadly, to Dr. G and her team,

it's not an unfamiliar story.
[ … ]

Why him?

Why that day?

Why that moment?

People always assume that it's one thing that kills you.

And ultimately, there's many factors that play a role that

end up causing people to die.

NARRATOR Now, findings in hand, Dr. Stephany

reaches out to Dario's devastated widow, Gloria.

I relayed my cause and manner of death.

Let them know that there is nothing they could have done.

But I wanted to talk to her more about the aortic valve.

JAN GARAVAGLIA Dr. Stephany put extra effort-- just

make sure she understood how serious

his aortic stenosis was in that there is an increased

chance her son had this.

Because there is a possibility that congenital abnormality

could be genetic.

You definitely want to have her get

the son to see a cardiologist.

So she was thankful.

Dr. Stephany handled this case great.

I mean, he kept an open mind.

He let the body tell him what happened.

And then he kind of sat back and thought about it

and put the pieces together.

A lot of people think we don't-- you know,

the people are dead.

How do we help people if all we're doing

is examining dead people and [inaudible] cause of death?

This is a good example of helping a living person,

helping a family.