01x05 - The Chain of Life and Death

[bunniefuu]

[MUSIC PLAYING]

NARRATOR A -year-old woman passes away

following a stay in the hospital,

but why doesn't anyone want to sign the death certificate?

DR. G She made it through surgery,

and then she just dies suddenly.

NARRATOR Can Dr. G bring solace to a grieving family?

Closure is not what I felt.

NARRATOR In an instant, a year old's bicycle ride

turns out to be his last.

TODD HASTINGS Bam, over the curb, and right

in the center of that lane.

NARRATOR Did this young man have a secret?

And did he have an inkling of what was to come?

MARIA PEREZ One month before he died, he said, if I die,

I want to be cremated.

NARRATOR A woman who makes her living as a stripper

enjoys the company of friends.

Hours later, she is found dead.

Did a secret cost her her life?

DR. G It's one more new kind of way

that now I know you can die.

[MUSIC PLAYING]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

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

It's , and six-year-old Rita Harris is about to suffer

a moment of sheer horror.

When she was a small child, her mother was

doing laundry out in the yard.

NARRATOR In those days, laundry was often

washed using liquid lye, a highly

caustic abrasive that today is used in drain cleaners.

They made their own lye soap.

And somehow she got into this laundry water

with lye soap in it.

NARRATOR Oblivious to the danger,

little Rita swallows a mouthful, searing the lining

of her throat.

She recovers, but for the rest of her life,

she never forgets the terror of her throat on fire.

years later, Rita, now , is in the hospital

suffering a fatal convulsion.

By the time help arrived, she is dead.

However, old age is not the only culprit in this passing.

Incredibly, a complex series of seemingly unconnected

medical events has transpired to take Rita's life, events

that may have been connected to her poisoning years earlier.

Rita's recent medical history took a turn

for the worst just weeks earlier,

when she visited the hospital for a routine procedure,

an endoscopy to remove a piece of food

that was lodged in her throat.

The operation reportedly goes off without a hitch.

But in recovery, Rita runs into trouble.

On her way to the bathroom, she falls, breaking her hip.

Now, two weeks later, she is dead.

Her family is grief stricken.

The doctor came into the room to talk to us.

He said they weren't sure exactly what had happened,

that they weren't sure if it was a heart attack

or if it was a stroke.

He had said they were having a hard time finding anyone

to sign the death certificate.

He wasn't going to sign it.

She was dead when she got there.

And he said they had--

they had spoken with her personal physician,

and he didn't want to sign it, because he hadn't

seen her in about a month.

NARRATOR Because no one has signed the death certificate,

the case is automatically forwarded to the Orlando

County Medical Examiner, Dr. Jan Garavaglia,

better known as Dr. G.

What is the deal with him?

WOMAN There you go.

DR. G OK.

[MUSIC PLAYING]

DEAN SMITH What we have is an elderly white female,

was DOA at a local hospital last night.

Today, the family has called up and questioned

the possibility of this being related to a recent accident

this lady's had.

We're getting conflicting stories.

So the case was made a medical examiner's case

for further examination of the medical examiner

to determine the manner and cause of death at that time.

DR. G Well in this case, there's

a lot of misinformation, a lot of information

that was unclear.

It initially came in as just an old person dying

suddenly at a nursing home.

And then more information comes in, in that, no,

this was a person who died as that she just had a hip repair.

Well, hip fractures are certainly

an accidental death, not a natural death,

so we have to get involved.

NARRATOR A -year-old woman's life expectancy

is about and / years.

But what deeply concerns Dr. G is a kind of epidemic.
[ … ]

DR. G This is very much a public health problem,

old ladies who break their hip.

Chances of dying after you break your hip are very, very high.

She made it through surgery.

She does have supposedly an enlarged heart.

And then she just died suddenly.

NARRATOR Despite Dr. G's suspicions,

it is possible that Rita's death had

nothing to do with her fall.

One of Rita's attending physicians

suggests that Rita might have died from a heart

attack or a stroke.

And, in fact, Dr. G learns from Rita's medical records

that she had suffered a stroke six years earlier.

Dr. G will be on the lookout for these and other clues

when she begins the external exam.

OK, She's got arthritis in her knuckles.

She's got interosseous muscles.

She's got old lady disease, somewhat obese,

the old gallbladder scar.

She actually looks really good for .

NARRATOR It's an observation confirmed by Rita

Harris's granddaughters.

She was on less medication than you or I.

Oh, yeah.

Before she was at that hospital,

she was on less medication than either one of us are.

NARRATOR Having completed the external examination,

Dr. G turns next to perform the internal autopsy.

We got a bunch, right?

NARRATOR Immediately, it's clear that Rita's bones

were ravaged by osteoporosis.

This woman's bones are very thin, very thin.

She had CPR and pretty much all her ribs are fractured.

People think, oh, I'm going to die from heart disease.

Well, you know, it's a simple fall, you break your hip,

and there's a chance you can die.

NARRATOR Given the severity of Rita's osteoporosis,

it's no wonder her hip broke when she fell.

She turns next to examine Rita's -year-old heart.

A lot of people will have really bad hearts,

and just the stress of breaking your leg and all the pain,

they can have an arrhythmia right away.

Let's see what she's got here on her aortic.

Yeah, some slight sclerosis around her aorta, not so bad,

though.

There's calcium in the walls, but the lumen, where

the blood goes, is just fine.

So, I mean, she's got a lot of old, -year-old stuff,

but nothing--

nothing too bad.

NARRATOR And so her heart checks out.

What about evidence of a stroke?

Rita suffered one some years ago.

Did fracturing her hip trigger a repeat?

To find out, Dr. G examines her brain.

Switch gears again--

NARRATOR With both heart attack and stroke ruled out,

Dr. G moves on to other possibilities.

When "Dr. G, Medical Examiner" continues,

the question remains--

did breaking a hip cause Rita's death?

And was her childhood poisoning, nearly a century earlier,

somehow a factor?

It was a real shock.

Closure is not what I felt. I was devastated.

NARRATOR And later, the puzzle of this cyclist's

untimely death.

DR. G It's very difficult to die walking, talking, or riding

your bike one second, active, talking,

and their dead the second.

[MUSIC PLAYING]

NARRATOR For Rita Harris's family,

the cause of her passing is a heartbreaking mystery.

For countless others, it holds a warning.

Well into Rita's s, people took her for being

years younger than her age.

But does Rita's death fit the common causes

of death following hip surgery?

A lot of times they die during surgery, or just

before surgery, from just the stress

of the pain and the incident.

Some even have allergic reactions to some

of the cement they used.

I've had a couple like that.

NARRATOR For a medical examiner,

some cases take months to unravel.

Other times, the cause of death is revealed

over a matter of seconds.

[MUSIC PLAYING]

I know why she died.

Two blood clots went to her lung.

Yeah, you can see them when I cut the-- see, I'll show you.

See them?

NARRATOR To Dr. G, this is very familiar territory.

Blood clots in the lungs, pulmonary embolisms,

are often a fatal complication following hip surgery.

In fact, they're to blame almost % of the time.

So these, we just pulled out of the heart.

There are more going into her lung.
[ … ]

These are blood clots that were-- you

can even see the vessels, the tributaries in the veins.

These were loose, somewhat loose in her heart

and going towards her lungs, going

into the pulmonary artery.

It's definitely a complication of the hip fracture.

And it's a very big problem with older people and falling.

NARRATOR When Dr. G calls Rita's family,

all the pieces of the puzzle start to come together.

Her arteries looked pretty good.

NARRATOR And incredibly, it also becomes

clear that the chain of events that led to Rita's death

stretch back to her childhood accident, years earlier.

After six-year-old Rita drank lye and burned her throat,

scar tissue developed in her esophagus

as part of the healing.

And for the rest of her life, she had difficulty swallowing.

Always, all her life, she had to be very careful when she ate

and make sure that she chewed her food thoroughly

before she tried to swallow it.

We had-- a couple of times a year,

we had to take her to the emergency room

to get something removed from her throat.

NARRATOR That's exactly what happened

a few hours prior to breaking her hip,

two weeks before she died.

DR. G The story was is that she'd

actually come into the emergency room

for some difficulty swallowing.

Some food was stuck.

NARRATOR To remove it, Rita was sedated and then

underwent a routine endoscopy.

They gave her the relaxants.

And they also give her something to help calm her,

to keep her a little bit calmer, some sort

of a mild tranquilizer.

NARRATOR The endoscopy was uneventful

and the food was successfully removed from Rita's esophagus.

They got that out.

There wasn't a problem.

After the procedure, she relaxes in bed, until she

gets up to go to the bathroom.

DR. G This is a woman who was fairly independent.

NARRATOR Rita makes her way to the bathroom unassisted.

And at some point, falls.

While she was in the hospital she fell?

They said, yes, that's what happened.

NARRATOR When she falls, her hip, severely weakened

from osteoporosis, breaks.

After her surgery, Rita spends most of her time in bed.

The lack of mobility takes a toll.

Within the deep veins of her legs,

her blood begins to pool and clot.

DR. G There's a lot of things that

predispose you to blood clots--

obesity, immobility, a hyper-coagulability

of your blood, increased estrogen. The only thing

it really applies to her is immobility.

And that's usually what happens, is they stay in bed,

and the blood doesn't move is as much.

NARRATOR At some point, several clots

break free and are swept through the venous system,

upwards towards her heart.

Rita's heart, still vigorous at ,

pumps the blood clots into the pulmonary artery, which

supplies blood to the lungs.

And there the blood clots stop, obstructing

the blood flow into the lungs.

DR. G They get caught up into the lungs,

and no blood can then go into the lungs.

And thus, they get bilateral, both sides, pulmonary embolism.

NARRATOR In her bed, Rita struggles to breathe.

Deprived of oxygen, her brain begins to seize.

Within minutes, she is dead.

VERTA HARRIS It was a real shock.

She had been in very good health for a -year-old woman.

Mm-hmm.

And-- I'm sorry-- and then she was gone.

NARRATOR Over many years, Dr. G has

found that her autopsy reports often

help families come to terms with their loss, but not always.

For her to die for something so stupid, I was very angry.

NARRATOR For Dr. G, Rita's passing

triggers thoughts about the chain of life and death.

Well, if she had not swallowed the lye, which then caused

the chronic problem with her esophagus

and caused her chronic choking problem,

she wouldn't have gone into the hospital.

But that's fate, and that's not what caused the hip fracture.

The hip fracture is what started the chain of events that

then caused her ultimate death.

A lot of people say, you know, it's your time,

and when it's your time, it's your time.

I don't really believe that.

I think we have a lot of control over that.

I think you can control what you eat.

You can control driving fast.

You can control driving recklessly.

You can control buying dr*gs.

All of those things causing you to have an early death.
[ … ]

So I don't believe that, that the fate--

just, it's your time, no.

[MUSIC PLAYING]

Next on "Dr. G, Medical Examiner,"

was riding without a helmet this man's fatal mistake?

DR. G We'll see when we open him,

but it doesn't look like he has any trauma from falling.

NARRATOR And later, the death of a stripper.

Did hiding a secret cost her her life?

[MUSIC PLAYING]

It's in the morning and Eric

Perez is cycling along a busy roadway

outside Orlando, Florida.

With each mile, the -year-old closes

in on his new ambitions--

lose weight, join the Navy, cycle across Europe.

They're the goals of a reformed workaholic, who's

finally learning to enjoy life.

He worked with coffee shops.

He became a manager.

Then he worked at Disney.

He just did any job.

And he'd work hours.

And then he'd save up money.

MARIA PEREZ Now he want to be riding his bike,

be relaxed, write a book maybe.

In his free time--

He would just say, oh, I'm not going

to work as much now, because I have a lot of money saved up.

I'm going to start taking--

I'm going to buy a bicycle and I'm going to start

taking trips everywhere.

And meet different people in different countries,

different cultures.

NARRATOR But the drivers traveling behind Eric

know nothing of this young man's hopes and dreams.

To them, he's just an anonymous cyclist, until he goes down.

Remarkably, Eric's accident is witnessed by a trained

paramedic, Todd Hastings.

TODD HASTINGS It was almost like he

tried to miss something, but there was nothing there.

I mean, he went right off the road to the left, just bam,

over the curb, and right in the center of that lane.

Unresponsive, possible seizure.

NARRATOR It's immediately clear to Todd

that this is not a typical bike accident.

The gentleman appeared to be having a seizure.

NARRATOR Moments later, the ambulance arrives.

But it's too late.

Eric's vital signs have disappeared.

He stops breathing and is never revived.

TODD HASTINGS It was a shame, a young man.

My thoughts were possibly, I wish I could have done more.

NARRATOR Over people die each year in bicycle accidents

across America, many because they weren't wearing helmets.

For now, Eric's death is a mystery.

Did he lose control of his bike and injure

his unprotected head?

Or did something else caused Eric

to collapse without warning?

It's up to Dr. G to find out.

He's years old, way too young to die.

And unfortunately, I see people dying of all ages.

When they die younger, it presents

a different set of possibilities of why they died.

And I just-- I have a job to do.

I have to find the facts.

I have to help the family figure out why they died.

And that's why I'm there, not to get emotional about the death.

NARRATOR From witness reports, Dr. G

knows that whatever took Eric's life did so

suddenly and without warning.

She get some more information from his medical records.

DR. G The doctor diagnosed high blood pressure on him already,

at the age of , obesity, and what he said

was mitral valve prolapse, with mitral valve insufficiency,

meaning that the valve wasn't particularly competent.

It was kind of leaking, you could say.

NARRATOR Mitral valve prolapse is a congenital heart defect

that causes enlargement of the mitral valve flaps

in the heart's left atrium.

In a healthy heart, the mitral valve acts like a floodgate,

controlling the flow of blood from the left atrium

to the left ventricle.

But with mitral valve prolapse, the valve flaps

do not close tightly.

Instead, they collapse backward.

And with every pump of the heart, a bit of blood leaks

back through the valve.

Just breathe normal.

NARRATOR But mitral valve prolapse is

usually not a fatal condition.

In fact, it's one of the most common

heart valve defects, affecting out of every people.

That doesn't stop Eric's mother from wondering,

could the condition have been responsible for Eric's death?

The doctor told me he doesn't need any treatment at all,

that he can live his entire life with that condition

and it wouldn't give him any problem.

NARRATOR But Eric's life was not problem free.
[ … ]

He grew up without a father.

And by the age of , he worked as

many as two full-time jobs to support his mother and sisters.

MARIA PEREZ His birthday, he told me,

mom, you know what, I want for my gift

be that you take me to anyplace and I can apply for a job.

And that is what we did.

And he started to work the next day.

He was almost like the man of the house.

He was very good working, and saving

money, and helping the family.

ALMA PEREZ Growing up with him was kind

of like having a second dad.

My sister and I, he took us everywhere.

And we were like his little babies.

When we needed something, he was the first one

there, without questions asked.

Anything, he was just right there-- anything-- financially

supportive, anything.

NARRATOR Now his grieving family wants to know,

did Eric's faulty mitral valve, which doctors told him

not to worry about, k*ll him?

Or was it something else?

Dr. G learns from his mother that in the days

before his final bike ride, Eric seemed somehow different.

In a notebook he had just purchased,

he had begun to write letters.

To his mother, Maria, the letters

read eerily, like a farewell.

MARIA PEREZ One to mom, and the other one

says to the father I never had.

That letter, he explained to his dad

how much he suffered when he was a little kid, because the dad

was not with him.

In that letter, he forgive him for how he hurt us.

And he is still loving him.

And he know that his dad loves him.

And the letter really is almost like he say goodbye.

Because he was explaining everything,

was like a poetic letter, the way that he write it.

And he was a very tough guy, that you

never would believe that he write letters like that.

NARRATOR And in hindsight, there

was other strange behavior.

Eric also told his mother what he wanted done with his body

if he were to die.

MARIA PEREZ Like one month before he died,

he has started to talk about death.

He has started to say, if I die, I want to be cremated

and I want you to spread my ashes in Puerto Rico.

NARRATOR Dr. G can't know what may have been on Eric's mind,

but she is confident that his body

will reveal the cause of death.

She must begin with the obvious--

was it the fall from his bike that k*lled him?

As Dr. G begins the external exam, a tattoo on Eric's arm

immediately draws her attention.

DR. G OK, now I got to see what this banner says.

Is this like-- I don't get it--

to live is to suffer.

What are you reading?

His tattoo.

To live is to suffer.

WOMAN Survive is to--

DR. G --find meaning in the suffering.

NARRATOR But as Dr. G examines Eric's body for injuries,

she finds none.

DR. G I don't see a bit of trauma on him.

We'll see when we open him, but it doesn't look like he

has any trauma from falling.

And that the witnesses account that he

just collapsed off the bicycle is true, appears to be true.

NARRATOR The external exam yields nothing and leads Dr. G

to wonder more and more whether the answer

to Eric's fatal collapse lies somewhere else.

To find out for sure, Dr. G must look inside.

First, she makes a Y incision across the torso,

cutting from shoulder to sternum,

to fully reveal the internal organs.

Once inside, her instincts take her

to the organ she most suspects.

DR. G OK, I'm going to take the heart then.

NARRATOR Immediately, it's obvious to Dr. G

that Eric's heart is defective in more ways than one.

Well, his heart is definitely abnormal.

There's no question about it.

His heart is way too big for him.

-- about .

A -year-old young man shouldn't

have a heart more than grams, maybe at max.

This heart weighed grams.

That's huge.

NARRATOR An enlarged heart can be

caused by, among other things, high blood pressure.

Over time, it's a condition that could

cause heart disease or stroke.

To find out more, Dr. G must dissect the heart itself.

His corners look fine.

Because they have a normal take off

from the aorta, which is good.
[ … ]

There's no acute angle.

They have no atherosclerosis or narrowing.

NARRATOR She also finds Eric's mitral valve, the one that was

diagnosed as having a defect.

I'd have to agree with that doctor-- very minor.

He has a little bit of abnormality

in his papillary muscle, but I don't think

it's causing him any problem.

So his valve really doesn't look--

really look that bad at all.

NARRATOR It appears that Eric's doctor's

diagnosis had been correct.

The faulty mitral valve was not anything to worry about.

DR. G Physically, mitral valve prolapse

is kind of a ballooning.

It doesn't balloon that much.

NARRATOR With this discovery, every assumption about Eric's

death is thrown into question.

If the mitral valve defect didn't k*ll him, what did?

Coming up, did Eric harbor a secret vice, one

that he knew could k*ll him?

MARIA PEREZ I said maybe someone give him some dr*gs.

Maybe he took some dr*gs.

NARRATOR And later, she seemed full of life.

So what caused this stripper to fall into a coma.

And die?

[MUSIC PLAYING]

Eric Perez was only years old when he suddenly

fell off his bike and died.

With no trauma from the fall, Dr. G knows that something

inside Eric caused his death.

A diagnosed faulty heart valve is her chief suspect,

until she discovers that it is too

minor to have caused his death.

Dr. G's leads are drying up fast when

Eric's family raises the question of possible drug use.

MARIA PEREZ I said maybe someone give him some drug.

Maybe he took some dr*gs.

I know that he don't use dr*gs, but you know,

always it's a possibility.

NARRATOR At the outset, Dr. G orders a battery of tests that

will detect the presence of dr*gs and other toxins

in Eric's system.

We're going to make sure there's

nothing toxicologically wrong.

NARRATOR For Dr. G, death by dr*gs

would certainly not be unusual.

Nearly one in every cases that

pass through the Orange County Medical Examiner's Office

is drug related.

DR. G You can die from an overdose of drug

the very first time you use them.

NARRATOR Eric's blood, urine, and eye fluid samples

are sent to the forensic pathology lab, where they will

be screened on a gas chromatographic mass

spectrometer, which can identify the presence of dr*gs

by their molecular structure.

But despite suspicions, the tests come

back absolutely definitive--

Eric Perez had no dr*gs in his system.

The only thing that even registers

is a small amount of caffeine.

For Dr. G, Eric Perez's autopsy is not revealing any secrets

to the cause of his death, yet.

DR. G It's not over till the fat lady sings.

It's not over until every organ's cut.

So you never know.

NARRATOR But as she wraps up her internal exam,

there is still no clear answer.

No pulmonary thromboemboli, no blood clots going to his lung.

That's another reason somebody can just go down pretty fast.

His kidneys look fine.

I think the rest of him is going to look normal.

It's very difficult to die walking, talking, or riding

your bike one second, active, talking and then dead

the second.

And almost, that really makes us think of cardiac arrhythmia,

something with your heart.

Without any symptoms whatsoever and you just got out like that,

usually it's your heart.

NARRATOR With all other possible explanations

exhausted, Dr. G's instincts tell

her to take a closer look at Eric's unusually large

heart, all grams of it.

DR. G I'm impressed by how big his heart is

on somebody just years old.

Usually, you see this after really long

standing high blood pressure.

So I'm really worried that maybe something else

is going on here.

NARRATOR While high blood pressure could cause

an enlarged heart, it usually takes many more

years than Eric's been alive.

And for Dr. G, that raises a concern.

DR. G So we're going to look under the microscope

at that heart muscle.

NARRATOR As she examines the muscle tissue itself,

Dr. G makes a critical discovery--

Eric's heart is far from normal.

Muscle cells in a healthy heart align
[ … ]

in a parallel structure, each cell neatly stacked in a row.

But Eric's heart cells are zigzagged and full

of scar tissue.

DR. G You look under the microscope,

and the heart, the fibers are enlarged,

there's fibrosis between the fibers.

And even small places where the fibers have been replaced

by fibrosis or scar tissue.

And there's some disarray to them.

When we see that under the microscope,

you actually see muscles in disarray.

NARRATOR From examining his misaligned muscle structure,

Dr. G is able to finally diagnose Eric's condition.

He had a congenital heart defect, known

as hypertrophic cardiomyopathy.

And no one knew it.

DR. G Hypertrophic means big.

It's hypertrophied-- the muscle's gotten big.

Cardiomyopathy, meaning cardiac muscle--

so big cardiac muscle.

And that's what he had.

This is something he was most likely born with.

It just is manifesting itself now.

It's a congenital problem.

It's something that's in their genes,

in their chromosomes, that's causing

that heart to get enlarged.

NARRATOR Unlike Eric's mild mitral valve defect,

this congenital heart condition is sometimes fatal.

DR. G The way hypertrophic cardiomyopathy kills someone,

you have that increased heart muscle,

harder to get blood into.

It disrupts the electrical system.

And they end up dying suddenly and unexpectedly.

About % to % a year will die from sudden cardiac arrest,

from an arrhythmia, from an abnormal electrical rhythm

in their heart.

NARRATOR So it wasn't Eric Perez's

mitral valve that k*lled him.

It wasn't his high blood pressure.

And it wasn't dr*gs.

What k*lled Eric was hypertrophic cardiomyopathy,

a congenital heart defect that went completely undiagnosed.

DR. G The biggest contributing factor, you're born with it.

You're not going to predisposed to it.

You need to be checked.

If it's in your family, if you have a history

of hypertrophic cardiomyopathy, you probably know it,

and you need to tell your doctor, without a doubt.

Or if one of your siblings died from hypertrophic ,

cardiomyopathy you need to tell your doctor so that

they can put you on treatment.

NARRATOR Having confirmed the defect microscopically,

Dr. G can now put together the events that led up to Eric's

death on the Orlando roadway.

Eric is riding his bike home to meet his mother.

His heart muscle, more than % larger than normal,

struggles under the increased strain of exercise.

His malformed cardiac cells begin to short circuit.

You have that increased heart muscle.

They have that interstitial fibrosis.

It's just-- it disrupts the electrical system.

NARRATOR Eric's heart goes into cardiac arrest

while on his bike.

From inside his car, paramedic Hastings witnesses Eric

swerve suddenly into traffic and collapse.

But even though he's not wearing a helmet,

it's not the fall that kills him,

it's his heart, now in a deadly arrhythmia.

On the ground, Eric's brain is deprived of oxygen

and he begins to seize.

DR. G Once your heart isn't in an arrhythmia,

once your heart isn't pumping correctly

and you're not getting enough blood to your brain,

you may seize.

NARRATOR Within moments, Eric's defective heart

ceases to beat entirely.

And so he's pretty classic for the

hypertrophic cardiomyopathy.

NARRATOR Help arrives.

But EMS workers are unable to restore Eric's heart rhythm.

He dies on the scene.

With the truth behind Eric Perez's sudden death

finally revealed, Dr. G calls his family

to relate the circumstances of his collapse and the conclusion

that his death was one of natural causes.

When she explained me, I feel like she was--

she understand already my pain.

And she was able to explain me, almost like woman to woman.

I think they were very happy to find out

the definitive cause of death.

I think they were happy to find out

that there was a known cause and the mystery was solved.

NARRATOR But there is one last lingering

mystery of Eric's death, one that may never be solved.

When he wrote the letters to his mother and father,

did Eric sense somehow that his life was reaching its end?

His mother, Maria, still wonders.

MARIA PEREZ That letter, he explained me

how much he loved me and the thank
[ … ]

you for all the sweet things that I did before then.

And then he say, over every thing, thank you for my life.

NARRATOR Coming up, did this young woman

have something to hide?

Did she pay for it with her life?

[MUSIC PLAYING]

Most cities have their wild side and this Texas

town is no exception, with its topless bars and strip clubs.

This was how -year-old Kim Cantel

made her living, until one ill-fated summer evening.

It is around PM when Kim returns home

after running some errands.

Her brother, Joe, and his wife, Alice, are visiting.

Kim says she's feeling dizzy and nauseous.

She goes into the bathroom and immediately passes out.

Joe begs her to go to the hospital.

But Kim convinces them that all she needs

is some much deserved rest.

But less than hours later, Joe and Alice

find Kim dead in bed.

When emergency response personnel arrive on the scene,

there are no signs of trauma.

But something does stand out.

Fresh needle marks on Kim's breast

suggests possible drug use.

There was also several medications

found on the dresser, which also led

to some suspicion of some type of drug possible overdose.

NARRATOR Could Kim have OD'd?

With that suspicion in the air, her brother

shares a family secret.

He reveals to police on the scene

that his sister, Kim, was once his brother, Tim.

This was a person that was in the process of having

the sex change and had already come back,

after having the male organ removed

and the change up in Canada.

NARRATOR But while the disclosure of Kim's recent sex

change shocks the police, it still does not explain

Kim's strange and sudden death.

The mystery can only be solved by an autopsy.

At the morgue, gender is rarely in doubt.

When Kim's body arrives, Dr. G agrees

that Kim has all the appearances of a genetic female.

DR. G If I wasn't told that she'd

had a transgender operation, I may have not picked up on it.

NARRATOR Dr. G examines the field

report to get a better sense of Kim's complicated history.

She was born Tim Cantel in a small southwestern town.

But at the age of , Tim adopted the name Kim.

When she turned , a sex change operation finalized

her gender transformation.

STACEE REICHERZER It's a very difficult thing to have,

to be male and have an identity that's a heterosexual female,

for example.

Stacey Reicherzer, who counsels transgendered people,

has had male to female sex change surgery.

The drive is, in many cases, a need

to feel like what's on the outside fits what an individual

is experiencing in the inside.

NARRATOR In the United States, there are up to

sex change operations a year.

Basically, what you're going to have to do is, on the male

to the female, you're going to have to take that penis off

and you're going to have to make a vag*na.

NARRATOR In a male to female sex change,

an incision is made in the penile skin.

It is turned inside out and stitched

back together to form a vag*na, in a gap year the pelvic bone.

Though the procedure is usually safe medically,

it changes life irrevocably.

People do experience themselves as having

a new life, a new beginning.

NARRATOR While complications can occur with any surgery,

Dr. G doubts Kim's sudden death had anything

to do with her procedure several months earlier,

but she is mindful of another possible k*ller--

dr*gs.

And Kim's friends are more than suspicious.

DR. G They were very angry that she probably

died of a drug overdose.

They were very adamant that somebody should pay,

the pusher should pay.

NARRATOR But when the toxicology

reports finally come in, Kim's friends

are surprised by the results.

Well, we concluded it wasn't dr*gs, because the toxicology

didn't indicate dr*gs.

NARRATOR For Dr. G, ruling out a possible overdose

only deepens the mystery.

What could have stopped this otherwise healthy

-year-old in her tracks?

As she begins the external exam, Dr. g has an immediate focus.

If dr*gs were not the culprit, how

can she explain the injection marks on Kim's breast?

What we did find were the injection sites in her breasts,

very engorged firm breasts that just were very tense.

NARRATOR To explore the unusual condition of the breasts, Dr. G"], index ,…}

presses on the puncture wounds.

When she does, a clear viscous liquid leaks out.
[ … ]

DR. G We knew there was a problem

even before we opened her, once we started drawing her blood.

NARRATOR Dr. G recognizes the liquid immediately.

It's silicone, and there's lots of it.

Did Kim have silicone breast implants that were leaking?

Except for clinical trials in breast reconstruction,

silicone implants have been banned in the United States

since .

But they're easily obtained in other countries.

DR. G We were able to actually just gently press on the breast

and the silicone would pour into the vial.

NARRATOR Dr. G makes the classic y

incision to open Kim's chest.

But what she finds comes as a stunning surprise.

It's immediately obvious that Kim

does not have breast implants.

Silicone is indeed oozing, but not from fluid filled pouches.

The silicone is seeping from the body itself.

The silicone was under tremendous pressure

in her breasts.

NARRATOR In a desperate attempt to augment her breasts

on the cheap, Kim has been participating in rituals

known as pumping parties.

She'll be at somebody's apartment, or maybe at a motel.

And what's done is that the silicone doctor, who's

not really a doctor, will inject the liquid silicone directly

into the tissue.

NARRATOR Typically, the silicone used

is not medical grade, but the type found in hardware stores.

DR. G This is a procedure that's from even the s.

Women would do it to try to impress men,

particularly coming back after the w*r, some

of the Asian women.

And they would inject it.

NARRATOR While it's a brutal way to alter body shape,

silicone itself isn't automatically harmful.

DR. G Overall, it's kind of inert.

If it would just stay there, it would probably be OK.

But the problem is it can migrate.

And it goes other places.

We were then, at that point, hunting

for where that silicone had gone and how

dispersed it was in the body.

NARRATOR Had the normally inert silicone invaded

Kim's body with deadly effect?

The key to the mystery lies under the microscope.

DR. G We could see that in the blood vessels,

in the capillaries, where blood should be,

every once in a while we would see a hole, a clear space.

And that was the where the silicone had been.

And what's silicone going to do to the organ?

The silicone is keeping that organ from getting nourishment

and oxygen from the blood.

NARRATOR In other words, Kim had been suffocated

from inside her own body.

It's not a suffocation in that she's not getting

enough oxygen. Her body is getting

enough oxygen. It's just she can't get it

into where it's supposed to be.

NARRATOR Her investigation complete,

Dr. G is now able to recreate the chain of events

that ended with Kim's death.

Hours before she dies, Kim participates

in a dangerous ritual known as a pumping party,

where unscrupulous medical practitioners

inject Kim's breasts with store bought silicone.

While Kim has repeatedly undergone

the procedure with no ill effects,

her final procedure is different.

At some point during the procedure,

silicone is forced directly into Kim's bloodstream.

DR. G Whether it's due to a mass effect,

by just pure pressure being just pumped in so hard,

or maybe they even actually maybe hit a vein, or a vessel,

or an artery, they're hitting a blood vessel.

NARRATOR Because it is inert, the silicone

doesn't k*ll Kim right away.

But when it enters her bloodstream,

it triggers a deadly chain of events.

DR. G What's k*lling her is that her cells can't work

because they're not getting oxygen, because the silicone's

replacing the blood.

NARRATOR Had she agreed to be taken to a hospital,

Kim's life may have been saved, but she refused.

STACEE REICHERZER It wouldn't surprise me

for a transsexual to choose her looks over her life.

There's a fear of going back to a time when life was hell.

And I think that probably for Kim, for probably a lot of us,

most of us, the idea of going back to that

is worse than death.

NARRATOR Although the circumstances of Kim's death

are unique, for Dr. G, there's a broader

lesson to be learned about taking

risks with the human body.

DR. G It's just not natural to be injecting

silicone in your body.

It's one more new kind of way that now I know you can die.

[MUSIC PLAYING]