02x10 - Needle in the Haystack

[bunniefuu]

[music playing]

NARRATOR A mentally challenged young man

d*ed suddenly and unexpectedly while eating lunch.

At first, I thought maybe he choked on a sandwich.

NARRATOR But when Dr. G performs the autopsy,

she makes one of the most shocking

discoveries of her career.

I've been doing autopsies for over years

and I've never seen this.

That's an interesting case.

NARRATOR And later, no one's heard from Greg Porter for five

days, until his next door neighbor

makes a horrifying discovery.

He's decomposed in an unlocked apartment,

found dead on his couch.

He's green, he's bloated.

It was a big mystery, you know?

And I was like, what else was in the house?

NARRATOR Can Dr. G find a cause of death

inside a body this decomposed?

It just became liquid in my hands--

I mean, literally, liquid in my hands.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

Every morning at the District morgue begins the same.

They want it early, because--

Today?

NARRATOR Dr. G and her staff meet and go over the day's

events, some trivial--

That will be a nice, long weekend before you

have to do the holiday.

Yeah, that's fine.

NARRATOR --some of great consequence.

So we have a lady who's very depressed.

They find her in the pool.

NARRATOR But the meeting's most basic function is divvying up

the day's cases between she and three other staff pathologists.

We've got the drowning, the decomposed heavy drinker,

and Mr. Platelets.

NARRATOR Dr. G chooses a man named Jeffrey Ortiz, who

may have choked to death while eating a sandwich the day

before.

She begins by reviewing the investigative report.

OK.

Well, let's see.

We've got just an assortment of things here.

-year-old white male, unwitnessed, collapsed at home.

A sandwich was found under his leg.

Mother wants a call with the cause of death.

NARRATOR According to the report,

Jeffrey Ortiz's tragic trip to the morgue

began about hours earlier during lunch

at his suburban Orlando home.

I called him in the kitchen.

I'm like, you know, I'm making, you know, lunch.

Do you want to come, you know?

Is there anything else you'd want?

NARRATOR He follows his cousin into the kitchen.

Then there's a sudden crash.

For no apparent reason, Jeffrey falls.

His cousin saw him fall and hit his head on a cabinet

in the kitchen.

BRENDA I was holding his head, then he hit his head.

And I was like, but you're sure you're OK?

And he's like, I'm OK, I'm OK.

NARRATOR Physically, he seems fine.

But in moments, Jeffrey begins to sulk like a child.

There's a good explanation for his juvenile behavior.

He's a -year-old men who has the mental ability,

supposedly, of a nine-year-old.

NARRATOR Although Jeffrey has been

mentally disabled since birth, he is a vital part

of a loving family.

BRENDA Jeffrey was a person everyone wanted to be around.

He was very talkative.

He loved to talk about sports, about whatever

is current in the news.

He loved to have conversations.

He loved to be around people.

NARRATOR But while his family has always

accepted the behavior associated with Jeffrey's

mental disability, they've recently become alarmed

about the onset of several disturbing physical ailments--

sleep apnea, severe leg pain, headaches, and mood swings.

He started just becoming, you know, more irritable.

Even his personality sort of started changing.

NARRATOR Still, other than the fall,

Jeffrey is having a good day.

And after lunch, he returns to his room

with a second sandwich.

For nearly minutes, Brenda hears nothing

from her usually chatty cousin.

Then the unthinkable happens.

I noticed, like, about a half-hour went by and I

didn't hear from him again.

And I go to his room to check on him.

And I found him on the floor.

Like, I knew, but I was telling myself, he's just sleeping,
[ … ]

you know?

NARRATOR But he's not asleep.

When EMS arrive, they declare Jeffrey dead on the scene.

KATHLEEN I was at work.

And I was kind of in denial when my daughter

told me that he was-- you know, that he had passed away.

And I told her, stop.

Just help him get up.

He'll be all right.

And she was like, Ma.

I didn't want to hear it.

NARRATOR Then technicians discover

something under his left leg--

a partly eaten sandwich.

And to the family, that means one thing.

They're worried he choked.

Because he had just eaten a sandwich.

NARRATOR Which leads to a troubling question.

In the beginning, I just thought, like, if--

if there was something I could have done to have prevented it,

or if I would've went in there sooner

and gotten medical attention faster, if his life

could have been saved.

NARRATOR Dr. G's mission is clear--

determine Jeffrey's cause of death

and answer the family's difficult question.

Could they have done anything at all to prevent it?

And this is really nice of them.

They brought in the sandwich.

It is kind of helpful sometimes.

It is, when we see the stomach contents.

NARRATOR At the start of the autopsy,

two theories about what might have k*lled Jeffrey

are already established.

I mean, there's a possibility he choked.

But you know-- and that's certainly

something we had to look for.

But I'm thinking, he might hit his head in one of these falls,

and that he's bleeding in his brain.

Could I have a tape measure?

TECHNICIAN What?

Tape measure.

NARRATOR As she prepares for the external exam,

Dr. G measures Jeffrey's legs.

They thought he was falling because he has club feet.

I want to see if they're even.

NARRATOR The measurement leads to an odd discovery.

DR. JAN GARAVAGLIA One was larger than the other.

And sometimes that's what we see with blood clots.

The one with the clot is a little bit larger.

And then I started thinking, well,

maybe there's a possibility of a pulmonary embolism.

NARRATOR Pulmonary embolisms are

large blood clots that often form in the legs

and move to the lungs.

There, they can block crucial blood flow,

leading to a deadly stroke or heart att*ck.

So I'm thinking, hm, maybe add that to our hypothesis

that that could be a risk for sudden death.

It certainly would go along with him just going down like that.

NARRATOR Coming up next, Dr. G finds remnants of a sandwich

deep in Jeffrey's throat, a finding

that could turn the family's worst fears into a reality.

What if he choked on the sandwich,

you know, and I was like--

and I didn't hear him, you know, and I could have helped him.

NARRATOR When "Dr. G, Medical Examiner" continues.

As the final step in the external exam of Jeffrey Ortiz,

Dr. G looks for outward signs of head

injuries consistent with Jeffrey's fall before lunch.

Well, certainly, I'm looking for trauma.

I'm looking for any types of abnormalities.

NARRATOR Preliminary evidence suggests

that the -year-old mentally disabled man may have choked

to death on a sandwich, been the victim of a pulmonary embolism,

or a fatal head injury.

Meanwhile, the victim's family desperately

wants to know if they could have done anything to save him.

BRENDA If would've went to the room faster

and gotten medical attention faster, if his life

could've been saved.

It looks like he went down pretty fast.

NARRATOR After a thorough external investigation

of Jeffrey's head, Dr. G finds hardly any sign of trauma.

But the absence of bruises or bumps

often means little to a forensic pathologist.

Certainly, I was looking for his head

to see if there's trauma.

There is none.

But you know, there's a lot of people

that die from head trauma.

Believe it or not, I don't see anything externally

until I look internally.

NARRATOR Dr. G is hopeful that the internal exam

will provide some answers for Jeffrey's bereaved loved ones.

To begin the internal exam, Dr. G makes a Y incision

across and down the chest.

He's still young.

So his cartilaginous or cartilage component of his ribs

are still uncalcified, except at the top.
[ … ]

NARRATOR Once the rib cage is open,

she can begin inspecting the internal organs.

DR. JAN GARAVAGLIA Take a look at the belly.

The belly looks good.

Big gallbladder.

NARRATOR She starts with the search

for a pulmonary embolism.

And I was specifically wanting to look at that heart

and look at those pulmonary arteries, the blood vessels

that go through the lung.

NARRATOR If there is one, it will

appear as a large tube-shaped clump of coagulated blood.

So far, I don't really see much.

NARRATOR As she examines the inside of one artery,

she notices something suspicious.

I've got a firmness in areas in the--

in the lung.

NARRATOR It is a lump of coagulated blood.

But it's a false alarm.

On closer inspection, it's clear to Dr. G

that the clot-like obstruction formed in Jeffrey's body

after his death.

Usually, the post-mortem clots can have blood settling.

It's the pre-portem ones that will

all still be mixed together.

NARRATOR Dr. G now knows for certain that a blood clot

could not have k*lled Jeffrey.

I don't see really anything through those lungs

or heart that should necessarily k*ll him.

NARRATOR Behind the pulmonary arteries

is the trachea or windpipe, the very place

that Dr. G can search for the next potential culprit.

At this point, we're just dissecting the neck structures

without trying to disturb it too much,

so I can see within his throat.

NARRATOR If Jeffrey did indeed choke to death on his sandwich,

Dr. G should see remnants of it here.

He definitely has a lot of food in his mouth.

OK.

So we've got the heart and lungs and throat out.

Nothing else looks bad below the diaphragm.

So I'm just going to go ahead and finish

taking all those things out.

NARRATOR There are two openings in the back of the mouth--

one leading to the esophagus, where food travels

to the stomach, and the other to the trachea,

where air passes through to the lungs.

Choking or aspirating occurs when a piece of food

goes down the wrong pipe and gets stuck in the upper airway,

causing the victim to suffocate.

And we needed to wait until I got into the throat

and airway to see how extensive that was.

NARRATOR Her first discovery seems

to confirm everyone's worst fear,

that Jeffrey choked to death only

a few feet away from his cousin in the other room.

He definitely has food in his mouth.

He's got food in his esophagus, but also food in his trachea.

NARRATOR But then Dr. G notices that the piece of sandwich

in the trachea could not have k*lled him, because it is

not located in a place where it would

have blocked his breathing.

He did have some food in his mouth.

He did have a little bit in his larynx,

but certainly nothing obstructive.

I don't think he aspirated at all,

as far as causing his death.

I don't think that's his problem.

So he didn't choke to death and he didn't die from blood clots

to his lung.

NARRATOR Now, Dr. G has only one last theory to investigate,

that the young man sustained a death blow to his head

when he fell in the kitchen before lunch.

First, the morgue technician reflects the scalp

and, using a saw, removes the skull.

Now, if we find something in his brain,

I can throw this away, something I

can see with my eye that would cause his death.

NARRATOR Next, Jeffrey's case takes an unexpected turn

when Dr. G encounters something she's

never before seen in autopsy.

DR. JAN GARAVAGLIA I've never seen it before.

I've read about it.

My neurons are f*ring to try to come up with what this is.

NARRATOR When "Dr. G, Medical Examiner" continues.

So far, I don't really see much.

NARRATOR Two of Dr. G's most promising theories

have been eliminated during the autopsy of Jeffrey Ortiz--

choking to death on a sandwich and a pulmonary embolism.

Now there is only one place left to seek answers.

If we don't see something grossly in his brain,

then we're going to have to look at all his tissues

under the microscope.

NARRATOR Because the mentally challenged young man fell

and struck his head shortly before his death,

Dr. G suspects a fatal injury deep inside.

If the final stage of the exam yields no answers,

Jeffrey's death could remain a mystery forever.

That would have been just something that

would have stayed haunting us forever,
[ … ]

wondering what had happened to him.

NARRATOR With the scalp pulled back and the skull cap removed,

Dr. G begins the examination of Jeffrey's brain.

Usually, when I first peek after my assistant cuts

the calvarium or skull cap off, I can usually tell right away

if you've got brain trauma.

NARRATOR But when she examines the brain

still resting in the cranium, she is disappointed once again.

[moans] I don't think it's going to be the brain.

I don't see anything initially.

And my initial gut feeling is usually right.

So I don't see anything.

NARRATOR She finds no signs of trauma

resulting from Jeffrey's fall.

But as Dr. G removes the brain to complete her inspection,

she spots something that is nothing short of startling.

He's got an abnormality in his cerebellar hemisphere.

And I'm like, oh, brother, I have not seen

this with my own eyes before.

NARRATOR Dr. G has discovered that Jeffrey's brain has grown

into a place it doesn't belong, into the top

of his spinal canal.

The cerebellum is going down into his foramen magnum.

NARRATOR She recognizes the obscure abnormality,

but can't recall its name.

I've never seen it before.

I've read about it.

My neurons are f*ring to try to come up with what this is.

NARRATOR Dr. G immediately believes

this could be Jeffrey's k*ller.

To find out more about the deformity,

she calls in a neuropathologist.

If ever there was a case for Dr. Pearl,

since I've never seen one of these before,

I think we ought to save the brain for Dr. Pearl to look at.

NARRATOR The next day, Dr. Pearl arrives at the morgue

to dissect Jeffrey's brain.

Accompanying him is a group of students there to observe.

This is a virginal brain.

They tell me it's never been X-rayed.

He's , mental retardation.

And he's found dead.

Now he's got an abnormality in his posterior fossa.

And his cerebellum is going down into his foramen magnum.

Yeah, Chiari.

Arnold-Chiari, yeah.

I've been doing autopsies for over years

and I've never seen one.

OK.

interesting.

That's an interesting case.

I consult for Dr. G on cases that have

neuropathologic importance.

And in this case, it was a very interesting and unusual

finding.

What this condition was called was a Chiari abnormality.

NARRATOR A Chiari malformation is a cerebral abnormality that

occurs when the brainstem grows down

into the foramen magnum, the hole where

the spinal cord normally sits.

The unnatural intrusion can put pressure

on part of the brain and spinal cord,

resulting in all sorts of complications.

Although the cause of Chiari malformation is not known,

it is congenital, and occurs in only about one half

of % of the population.

Many sufferers show no symptoms at all.

But those like Jeffrey often have headaches, difficulty

swallowing, sleep apnea, and impaired ability

to coordinate movement.

Currently, it is believed that this

is a congenital malformation.

So this is something that he's probably had his whole life.

NARRATOR The discovery of Chiari malformation

answers one of the family's most pressing questions.

What caused Jeffrey's recent sleep apnea, falling,

headaches, and mood swings?

I think it makes sense, you know,

given what happened with him and his symptoms.

I mean, falling down and respiratory problems--

that's interesting.

NARRATOR But Chiari malformation

is not typically associated with one very important

aspect of Jeffrey's case.

I have never seen a case before with sudden death.

Previous cases I've seen with Chiari I malformation,

it's been an incidental finding, where

it was not contributory to the patient's death.

So I thought, this was one we've got to find,

you know-- get a little more information on.

NARRATOR When Dr. G and Dr. Pearl turn to medical journals

for answers, they discover one possible theory

about how Chiari malformation could cause sudden death.

One of them is that compression

of flow of the cerebrospinal fluid

may lead to an increase in pressure

inside the brain and death in that manner.

NARRATOR In other words, as the brain pushes into the foramen

magnum, it could put dangerous pressure

on the lower ventricles, leading to
[ … ]

catastrophic and sudden death.

So far, it's just a theory.

But when Dr. Pearl places a section of brainstem

under the microscope, he finds the proof

they've been looking for.

Ultimately, looking microscopically,

there's chronic changes evident on the surface of his brainstem

consistent with the chronic pressure.

And I think we have a good explanation.

Everything makes sense.

"NARRATOR " A long and complicated

autopsy has finally solved the mystery

of Jeffrey Ortiz's death.

Now, Dr. G can definitively reveal

what k*lled this -year-old man so suddenly.

For about a year, Jeffrey has been suffering from a series

of puzzling ailments.

DR. JAN GARAVAGLIA Shortness of breath and chest pain.

He had been falling.

And he was gasping for air when he was sleeping.

NARRATOR When Jeffrey's cousin calls him

into the kitchen for lunch, he experiences one

of these troubling symptoms.

BRENDA He was walking into, like, the sun room

where he eats.

And he had fell--

just lost balance.

And he was so frustrated.

NARRATOR He strikes his head against a cabinet,

but sustains no serious injury.

DR. JAN GARAVAGLIA I was really worried

that maybe he had fallen a little harder

then had some bleeding in his brain.

There is none.

NARRATOR Jeffrey grabs a sandwich and heads to his room.

He takes a bite, but he doesn't choke on it.

Instead, at the base of his brainstem,

his undiagnosed Chiari malformation

is about to take his life.

What's happening is, his cerebellar hemispheres

are protruding through the circle for much

longer than they should.

This is where your spinal cord is.

There's only so much room.

And it compresses the brainstem and the spinal cord

for having that extra tissue come out.

NARRATOR The pressure that has been building

on his brainstem and spinal cord finally

reaches a critical point.

Jeffrey's respiratory and cardiovascular systems

begin to shut down.

He falls to the floor and his heart stops b*ating.

He dies almost instantly.

Six weeks after Jeffrey's autopsy,

Dr. G can finally call his family with answers

to their questions.

KATHLEEN My daughter had called me

and she had told me she spoke with Dr. G

and that there was a rare disease

and that he probably was born with it.

And it was just overlooked.

We would cry together and say, did we do something wrong?

Was there something we could have did?

And she called me and she said, no, Ma, there's

nothing we could have done.

Dr. G said he was born with it and that we need to stop crying

and just thank God we had him all these years.

I think, by the end of the autopsy,

they're relieved that nothing they did

caused his death That's the part of forensic medicine

that I like.

Because I do get to put everything together.

I get to look in hindsight and have the luxury of seeing,

how do these pieces all fit together?

I just want everyone to know that he lived a life, you know,

of "fulfillness."

He enjoyed it.

He was very loving person.

Everybody loved him.

NARRATOR Next, a man disappears for five days

until a neighbor uncovers a gruesome scene.

He's decomposed in an unlocked apartment,

found dead on his couch.

He's green.

He's bloated.

NARRATOR When "Dr. G, Medical Examiner" continues.

years ago, Greg Porter was a hard-working construction

engineer and a happily married father of one,

until a serious work accident changed everything.

He was on a forklift, dropping a large valve that weighed

several tons on a chain.

And the chain broke.

And the valve came down and catapulted my son

or feet.

And he landed on his back.

And I don't think that his back was ever the same.

NARRATOR Over the years, Greg sustained

several additional work-related injuries.

And he eventually developed chronic back pain

and, according to his now ex-wife,
[ … ]

a growing alcohol problem.

THERESA My ex-husband really has a problem with drinking.

That is the reason we got divorced, was over alcohol.

And it just got worse and worse and worse.

And I'm sure it's because he was in more and more and more pain."], index ,…}

NARRATOR After nine agonizing months on disability,

he's about to return to his high-paying construction job.

But Greg will never work again.

One Sunday night, his ex-wife notices something amiss.

He would call his son everyday.

And I noticed that he had not been calling.

And then it was, like, Monday, I kept calling.

And then, like, Tuesday, I kept calling his house.

And then I think it was Thursday it really started eating at me."], index ,…}

He hasn't been seen in about five days.

THERESA So Friday morning, I get to work,

and I call his next door neighbors.

NARRATOR Later that day, the neighbor

enters Greg's front door.

Inside, she encounters a gruesome scene.

He's decomposed in an unlocked apartment,

found dead on his couch.

He's green.

He's bloated.

NARRATOR Local police and morgue investigators

arrived soon afterward.

Greg appears to have been dead for days.

It was a big mystery, you know?

And I was like, what did they find in there?

You know, I was thinking to myself,

what else was in the house?

NARRATOR Police immediately suspect foul play and treat

the house like a crime scene, collecting

evidence and checking for signs of forced entry.

Now I've got to look to make sure, of course, no foul play.

That's my main job.

NARRATOR They find no evidence of a break-in or a struggle.

But they do find signs of Greg's medical problems.

DR. JAN GARAVAGLIA They find a lot of medication in the house.

They find an empty bottle of oxycodone

in the trash can, which is a pain medication, a narcotic.

They find syringes upstairs in the bathroom with diazepam,

which is a tranquilizer.

NARRATOR So far, the report has given Dr. G little to go on.

Now, it will be up to her to determine what

exactly k*lled Greg Porter.

I mean, as far as I know at the beginning,

this could be a heart att*ck.

This could be alcoholic liver disease.

It could be many things.

It could be clearly unnatural.

We've got a pack of Marlboros and a Bic lighter.

Look inside the Marlboros.

TECHNICIAN Ooh, yeah.

Let me.

People hide all sorts of dr*gs in their cigarette packs.

It appears to be all cigarettes.

Nothing inside.

NARRATOR But what most grabs Dr.

G's attention are the used syringes an empty pill bottles.

We've got an empty vial of oxycodone in the trash.

And we've got another vial that was prescribed days

earlier with pills missing.

NARRATOR Oxycodone is a powerful painkiller.

If Greg ingested pills at once,

it would likely mean that he took his own life.

We brought in one, two, three empty syringes.

NARRATOR Next, Dr. G examines the empty syringes.

We've got the two vials.

NARRATOR Because diazepam, which is the prescription named

for Valium, is almost always taken orally,

she is suspicious about the needles.

It is unusual for somebody to have syringes with diazepam.

I don't know if those were prescribed to him or not.

And in fact, the syringe has a little liquid in it.

NARRATOR Presence of the empty pill bottles and syringes

leads to an initial hypothesis.

When you see that kind of medication

and an empty vial in the trash, you really do worry

about an intentional overdose.

Could it be a su1c1de?

NARRATOR Coming up next, Dr. G suspects a suicidal overdose.

But how can she prove it if there

are no viable fluids to test in Greg's decomposed body?

It just became liquid in my hands--

I mean, literally, liquid in my hands.

NARRATOR When "Dr. G, Medical Examiner" continues.

We've got to see things inside too.

Because once we start taking them out,

they're going to fall apart.

So looking at things inside the body.

TECHNICIAN Here.

I brought this syringe.

NARRATOR Dr. G is attempting to take blood and urine samples

from the body of Greg Porter to see

if he has fatal levels of Valium or oxycodone in his system.

But because bodily fluids deteriorate

quickly in a decomposed body, she encounters a problem.

hours earlier, he was found decomposing

in his Orlando home.
[ … ]

And there was evidence to suggest

that Greg took his own life with a fatal drug overdose.

DR. JAN GARAVAGLIA He was found in an unlocked apartment.

Hasn't been seen in about five days.

But in his bathroom, he's got two syringes and two

empty diazepam liquid vials.

NARRATOR su1c1de accounts for an astounding %

of deaths in the morgue.

But to see if he fits the profile,

Dr. G must first look deeper into Greg's medical history.

My son had a really happy childhood.

He was an active kid, very athletic.

He had lots of friends.

He was Mr. Optimistic and Mr. Charisma.

NARRATOR But years of debilitating physical injuries

turned the once exuberant husband and father into a shell

of his former self.

Greg soon became one of the estimated to

million Americans crippled by chronic pain,

a condition marked by overwhelming pain that

lasts six or more months and is often incurable.

But what gets Dr. G's attention is the dark secret

of chronic pain sufferers.

Many resort to su1c1de when the pain becomes intolerable.

Yeah, I'm not, obviously, a pain medicine doctor.

Because by the time I see them, the pain is over.

But I do know what type of people commit su1c1de.

And I do see that people with chronic pain, people

with chronic illnesses that just don't want to take it anymore

do commit su1c1de.

NARRATOR But Greg's family strongly believes that he could

not have taken his own life.

And when he d*ed, he felt that he

was about two weeks away from being able to return to work.

So he had a lot of hope there.

NARRATOR And then there was his son.

And I was like, no way.

You know, he just wouldn't do that.

For one, he loved his son dearly.

You know, he was-- he liked being a father.

There is no question in my mind

that his death was accidental.

NARRATOR But Dr. G requires more than family conviction

to decide any su1c1de case.

She needs forensic evidence.

Dr. G now performs the Y incision, opening the torso.

But because this is a decomp case,

it is anything but routine.

There's a sudden hiss.

Those were all the gases that were built

up in his abdominal cavity.

NARRATOR Unfortunately, much of the evidence

that could confirm a drug OD has decayed

along with all of the organs.

Well, I can't make heads or tails.

This brain is even worse than most.

TECHNICIAN Yeah.

It just became liquid in my hands--

I mean, literally, liquid in my hands.

NARRATOR When Dr. G begins her examination of the lungs,

she finally gets some good news.

Here, she finds fluids suitable for toxicological testing.

In this case, he had some pleural fluid

that I could collect.

And that's what we used for our toxicology.

NARRATOR Toxicology results may tell all.

If extremely high levels of one narcotic are found,

it's likely a su1c1de.

People who overdose will often take just a big, large amount

of one type of drug.

NARRATOR But there is another way

to find evidence of an intentional drug overdose--

by examining the contents of the stomach.

People who overdose will take pills at once.

And so consequently, I'll get a lot of pill residual in there.

I'll get, sometimes, even intact pills left.

He's got maybe five CCs, just a little bit of just kind

of "mucus-y," mushy material, and really no pill fragments,

nothing to indicate that he's got a lot

of residual pill material left.

We don't see anything that would make us suspicious or anything."], index ,…}

NARRATOR Although it's still too early to eliminate su1c1de

as the cause of death, findings from the internal exam

seem to contradict Dr. G's original hypothesis.

Let's see.

So we don't have a cause of death.

What am I left with at the end of the autopsy?

A big fat nothing, really.

I don't have anything to indicate one way or the other.

And I'm hoping the toxicology is going to give me the answer.

Otherwise, this case is going to be left undetermined.

NARRATOR Coming up next, the lab results come back

with numbers off the charts.

What he did have was a very high alcohol.

He had a ..

NARRATOR When "Dr. G, Medical Examiner" continues.

This is a -year-old female.

She's a restrained driver.

Three-vehicle crash.

She was supposedly not at fault.
[ … ]

NARRATOR Seven weeks and dozens of bodies

have come and gone since Dr. G's inconclusive autopsy

of Greg Porter.

We've got out work cut out for us.

NARRATOR Now, his results have finally arrived

from the toxicology lab.

Greg, a man suffering from chronic pain and depression,

had all the appearances of an intentional overdose.

But a battery of tests on his partially decomposed body

could not prove whether the death was a su1c1de.

Doctor G's only hope for an answer

may be in the pages of the toxicology kit.

One number immediately jumps off the first page.

What he did have was a very high alcohol.

He had, like, a ..

NARRATOR .% is three times the legal definition

of intoxication, not enough to k*ll a man,

but possibly enough to contribute to his death

indirectly.

Oftentimes, people who commit su1c1de will drink.

Because drinking decreases your inhibitions.

And drinking will then give you the nerve to commit su1c1de.

NARRATOR Then Dr. G notices another important finding

in the tox report.

He's got a high level of a narcotics analgesic--

basically, a pain medication--

oxycodone.

NARRATOR The oxycodone level is high, but not in a range

normally known to cause death.

Separately, the two substances at these levels

are unlikely K*llers.

But combining them could be another story.

Oxycodone is a great medication if you take

it like you're supposed to.

But it's certainly not supposed to be taken with alcohol.

NARRATOR Finally, it appears that Dr. G has

enough information to determine exactly

what k*lled Greg Porter five nights before he

was found dead in his home.

It's a night like any other for Greg Porter.

In too much pain to sleep, he swallows prescription oxycodone

pills and sh**t up diazepam.

ROGER Pain was his companion.

He would be sleeping during the day and up all night.

One pain pill didn't quite take care of my pain.

Maybe three, four, or five pills are

going to take care of my pain.

NARRATOR But the pills are not getting the job done.

Greg then makes a deadly mistake.

He begins to ingest another drug--

alcohol.

So he's in his usual state of drinking heavily and takes

his usual amount of medication and maybe repeats that a couple

of times during the day.

NARRATOR The two depressants begin to mix

dangerously in the bloodstream.

Together, they can suppress your respirations

and eventually your heart.

NARRATOR In fact, oxycodone and alcohol

are both central nervous system depressants.

When combined, their effects are magnified,

slowing down the signals that keep

the body's organs functioning.

DR. JAN GARAVAGLIA And if you get high enough doses,

you can suppress your brain, suppress your breathing,

and go into cardiac arrest.

NARRATOR The separate non-lethal doses

of narcotic and alcohol together turn into a deadly cocktail.

They're tired and they want to take

enough to cause them to kind of zonk out or pass out.

NARRATOR But Greg doesn't just pass out.

He stops breathing.

And his heart stops b*ating.

Because he lives alone, no one knows Greg is dead.

Five days go by.

And he's already green and bloated and some kind

of firming of the skin.

NARRATOR Finally, a neighbor discovers his body.

ROGER The TV was still on.

And his body, obviously, after several days

had begun to decompose.

And his dog-- loving dog-- was still in the house,

was locked in the house with him.

He d*ed from an overdose.

They said that it was heart failure

due to the mixing of alcohol and dr*gs, specifically oxycontin.

NARRATOR Dr. G has successfully determined what

k*lled Greg Porter medically.

But the most crucial question remains.

Did he do it intentionally, or did he do it accidentally?

NARRATOR Sometimes, it's not what

an autopsy proves did happen that gives

Dr. G the answer to a case.

Often, it's what didn't happen.

DR. JAN GARAVAGLIA Well, we do know he has chronic pain.

We know that he's mixing things, dr*gs and alcohol.

People who try to commit su1c1de often don't mix.

NARRATOR And then there's what wasn't found at the scene.

There's no compelling evidence,

either from the levels or from any previous su1c1de
[ … ]

attempts, or previous suicidal ideations,

or that he's verbalized.

I have no note.

So I have no compelling evidence at this point

that it's a su1c1de.

NARRATOR In the end, Dr. G's answer comes

from what she can't prove.

I cannot prove this was a su1c1de.

And so we're going with the preponderance of evidence

that this is an accidental overdose by combining a pain

medication and an alcohol.

NARRATOR Dr. G now makes the official ruling

in the death of Greg Porter.

For the family, hearing that his case

will not be ruled a su1c1de provides

some degree of comfort.

Because I would hate to have to tell his son today

that, you know, his father took his own life.

So it's really relieving that, you know,

that doesn't have to be explained to him.

NARRATOR But the findings also arouse bittersweet regrets.

We all know that mixing pain relievers and alcohol

is a bad combination.

Obviously, he didn't have the awareness that he should have.

But I wish-- I wish to God that he would have been more aware.

NARRATOR There are tens of millions

of Greg Porters suffering in silence until they land

in the hospital or the morgue.

Pain itself doesn't k*ll, although some of the methods

to control it do.

If you're going to self-medicate,

you can keep taking that medication

to get rid of your pain to the point where you k*ll yourself.

And that's what happened.

OK.

Sometimes, people just have bad luck.

And sometimes, people make their own bad luck.

I don't know with this fella.

But ultimately, he did not have good judgment of drinking

and using his medication.

Can you say that it was an accidental death?

In a way.

But it's an accidental death that certainly can be avoided.