03x04 - Deadly Consequences

[bunniefuu]

[music playing]

NARRATOR A man with full blown AIDS

is hospitalized for a week with a minor infection.

DR. G (VOICEOVER) He's in the hospital,

because he's not feeling well.

He goes and he ends up with candida, or yeast infection

in his mouth and his esophagus and they tune him up.

NARRATOR But only hours after his release,

he collapses suddenly and dies.

Oh my god.

The paramedics all around him, they say he

stopped breathing on his own.

NARRATOR Did the hospital miss this man's k*ller?

DR. G (VOICEOVER) I don't know how well they treated him?

How well did he get over?

Did they miss something at the hospital?

I mean, he'd just gotten out.

NARRATOR And then, a former drug addict

with end stage kidney disease is found dead

in a pool of his own blood.

It was a lot of blood, that's all I can tell you.

It was a big pool of blood.

NARRATOR Did he end his own suffering?

Or did someone take his life?

DR. G (VOICEOVER) When you see a fellow dead

in a pool of blood, could it be a homicide?

What's causing his wound?

What's going on?

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

Chief medical examiner Dr. Jan Garavaglia is only

one week away from her wedding.

And she's relieved to have finally found a dress.

Finding a dress has got to be the worst

part of the whole preparation.

Because it kind of sets the tone of the wedding.

And at first, I really didn't think I cared.

And I was even gonna wear a dress I had.

I actually have a beautiful black dress.

But my mother said, doggone it, she

was not gonna come to my wedding if I had a black dress on.

Did they say--

What does your dress look like?

Kind of girly.

I looked.

I found one.

I found-- tried two of them on.

One of them fit right and I bought it, right off the rack.

But the dress looks like kind of Lucille Ball-ish,

kind of strapless and then kind of flares.

So it's an off-white dress that hit right below the knee that

had some embroidery on the--

the top, the bodice, with no sleeves.

And then, I found a beautiful matching little wrap that--

that matched the dress.

And I felt I was ready to go.

I got his little nephew and my little niece,

who's only months, like--

Throwing.

Throwing the rose petals.

Oh, wow.

And then, you start feeling really special trying

on these really frilly things.

And-- and really-- and I can see why women like doing it.

I can see why women go out and buy these fancy dresses.

It was a lot of fun.

NARRATOR But Dr. G can't spend too much time fretting

over her wedding dress.

She has a full docket of unexplained deaths

waiting for her in the morgue.

Dr. G's first case today is a -year-old man

named Ricky Hawthorne, who d*ed suddenly yesterday evening.

Well, today, we have a man that just gets released

from the hospital in the morning and he's dead in the afternoon.

And he's sitting at the local bar

and collapses off his bar stool.

NARRATOR Before she begins her external examination,

Dr. G consults the investigators' report and Ricky

Hawthorne's medical records to learn

more about his unexpected journey

to Orlando's District Nine morgue.

According to the victim's case file,

Ricky Hawthorne suffered from full blown AIDS

and apparently was not regularly medicated.

His family adds that he was a smoker

with a history of both cocaine and alcohol abuse.

He just happened to have a drug and a alcohol habit,

you know?

But he was still my brother and I

loved him the same, no matter.

My love didn't change.

Dr. G's investigators' report also

states that only one week prior to his death,

Ricky was hospitalized with intense pain.

We know a week earlier, he'd gone to the hospital

complaining of abdominal pain, chest pain,

difficulty swallowing.

They do a complete workup on him.

A CAT scan of his abdomen, CAT scan of his chest,
[ … ]

all the lab tests, EKGs.

They even get a specialized consultant.

And they determine that all of his symptoms

are due to esophagitis, inflammation of the tube where

his food goes down.

NARRATOR During his hospitalization,

Ricky is treated for a fungal throat infection.

But doctors detect no other medical problems.

They test him from his head to his toe, I mean, everything.

NARRATOR Six days after being admitted for treatment,

Ricky is well enough to be released from the hospital.

Before leaving, he receives a flu sh*t

and then returns to the home he shares with his sister Carroll.

But he doesn't stay long.

CARROLL (VOICEOVER) He was impatient.

He ready to get out.

He want to talk with his friends.

He wanted to see the fellas that he hang out with.

NARRATOR Only hours after leaving the hospital,

Ricky walks to his neighborhood bar to visit friends.

It is the last time his sister Carroll will see him alive.

CARROLL (VOICEOVER) I was sitting on the porch.

And one of Ricky friends come up the street from the trail.

And she's just screaming and calling my name.

Carroll, Carroll, you're got to hurry up.

Come on. Put your drink down.

CARROLL (VOICEOVER) And she said, come on.

Come on. Ricky, Ricky, Ricky.

NARRATOR Carroll rushes to the bar

and finds her brother strapped to a stretcher.

[interposing voices]

CARROLL (VOICEOVER) They were giving him oxygen then.

They say he stopped breathing on his own.

I told him, I said, please, please,

don't let my brother die.

At the same time, this paramedic,

was looking at his watch.

And he was talking about how the blood pressure was going down

and that his heart had stopped.

NARRATOR Carroll watches helplessly as the paramedics

try to save Ricky's life.

I go, please, please.

And I kept trying to get closer to him.

And they kept telling me, I couldn't come any closer.

I said, it's my brother.

[interposing voices]

NARRATOR Ricky is rushed to the hospital

in full cardiac arrest.

But after numerous attempts, doctors

are unable to revive him.

Then, they walked in.

And he say, we couldn't save him.

He's gone.

NARRATOR Ricky's sudden death leaves his sisters

with many questions.

For Dr. G, the list of possible answers

is long and complicated.

So he had a myriad of problems, any one of which

could lead down a road that could've k*lled him,

you know something to do as acute alcoholism.

I don't know how much he was drinking that day.

I mean, he could have fallen off the bar

stool associated with being drunk and then broken his neck.

Something to do with his cr*ck cocaine habit, something

to do with his AIDS, certainly.

He certainly wasn't well controlled.

He didn't like to take his medicine.

It certainly could be some natural disease.

I don't know how well they treated him.

Or did they miss something at the hospital?

I mean, he'd just gotten out.

Maybe it is nothing related to his hospitalization.

Maybe it does.

Maybe they released him too soon.

I don't know.

NARRATOR And Ricky's sisters have their own suspicions.

They worry that since Ricky suffered from AIDS,

he should not have received the flu sh*t at the hospital

and fear that it may have provoked a fatal reaction.

They're worried that a flu sh*t may have k*lled him.

That's impossible.

That flu sh*t did not k*ll him.

They're recommended for people with AIDS.

So we're just gonna have to look elsewhere.

NARRATOR And Dr. G has plenty of other places to look.

There are so many possibilities on this fellow

that we couldn't wait to get in there and see what happened.

Well, I'm viewing the body. he looks like very thin,

not very well cared for man.

He looks older than his stated age of .

And he had reported that he had recently lost a lot of weight,

which is not unusual if you have AIDS

and you don't want to take your medicine.

You're gonna get a wasting disease.

NARRATOR Dr. G notes the personal items found on Ricky's

body by her death investigator.

A condom, candy, spare change, and evidence of his cocaine

habit, a glass pipe.

She also notes the stabilization collar around Ricky's neck,

a precaution taken by the ambulance crew in case
[ … ]

Ricky broke his spine in the fall from the bar stool.

However, after a thorough external examination,

Dr. G finds no clues as to the cause of Ricky sudden death.

Apparently, the key to his k*ller lurks somewhere within.

But if so, why did the hospital miss it?

I didn't know if they'd missed something or not.

NARRATOR Coming up next, Dr. G opens Ricky Hawthorne's body

and finds the astounding cause of his death.

DR. G (VOICEOVER) I mean, this is an acute event.

This is an acute event that occurred,

probably just prior to him collapsing.

NARRATOR And later, a man is found dead in his kitchen,

sitting in a pool of blood.

Did he take his own life or was he brutally m*rder*d?

Which one of these plays a role in his death,

we're not sure.

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

Dr. G is about to begin the internal exam of Ricky

Hawthorne, a -year-old man who d*ed suddenly

at a local Orlando bar only hours

after being released from the hospital

with a minor throat infection.

She learns from Ricky's sisters that the last few years

of his life were marked by a tragic struggle

with both AIDS and cocaine addiction.

Dr. G also learns that, despite his health and substance

abuse problems, Ricky's life was filled with kindness and humor.

He was the type of person, he would give

you the shirt off his back.

You know?

And all the older people in the neighborhood,

just crazy about him, loved him.

He couldn't do no wrong in their eyes.

He was a happy, carefree person.

NARRATOR Dr. G and Ricky's sisters

are concerned that the hospital may have

missed a critical diagnosis.

But Ricky has a host of other troubles

that may have k*lled him as well.

You know, smokes heavily, uses cr*ck cocaine, drinks heavily,

and he also has AIDS.

We can go down each one of those roads on how they can k*ll you.

NARRATOR But which road will lead to the truth?

Dr. G needs to open his body to find out.

As a first step, she cuts a Y incision from Ricky's

shoulder blades to his pelvis.

He's not looking good.

I'm gonna need an [inaudible] on this one.

NARRATOR And immediately, she takes

note of Ricky's declining state of health, particularly

in his lungs.

This guy is really congested.

So once we look at the body in situ and look at the organs

and I see that he's got bad emphysema,

he's got a lot of blackening from the smoking, the anthro--

what we call anthracotic pigment, that black kind of tar

in there.

NARRATOR But while the emphysema

may have been the cause of some of Ricky's chest pain,

it did not k*ll him.

Emphysema rarely kills so suddenly.

So we don't see this kind of death from emphysema,

where they're, you know, going to the bar and then

just collapse at the bar stool.

NARRATOR Next, Dr. G weighs and dissects

each of Ricky Hawthorne's organs,

looking for abnormalities.

She starts with the gallbladder.

Looking good.

Gallbladder-- as long as you don't stick me.

That wasn't on my agenda for today.

Thanks.

And so he doesn't look so bad.

NARRATOR She then moves onto the spleen.

Here, I'll give you the spleen.

Then, you can finish. Everything looks good.

Everything looks good.

Yeah.

I don't see any acute cause of death yet.

NARRATOR In fact, all of Ricky's organs

are checking out fine.

Even his heart seems to be in good shape.

Dr. G finds only minor evidence of atherosclerosis,

a % blockage in one of his coronary arteries.

I mean, in terms of coronary artery disease, if he--

he looked good.

He only had one coronary artery, the circumflex,

with a % narrowing.

That shouldn't have caused him any problems in and of itself.

NARRATOR But just as she's wrapping up

the examination of Ricky's heart,

Dr. G makes a stunning discovery.

Oh, now.

Look at this.

He's got a heart problem?

Yes.

He's got a heart problem.

NARRATOR And it's clear right away that this is the k*ller.

He's got acute coronary thrombus.

NARRATOR A coronary thrombus is a blood
[ … ]

clot that forms within the vessels of the heart.

If the thrombus is large enough to cut off

the blood supply flowing to the organ,

results can be quick and fatal.

It's the cause of death.

That's indicative of an acute heart att*ck.

And that's clearly why he d*ed.

NARRATOR A coronary thrombus is sometimes

associated with an event called a vasospasm.

A vasospasm is a spontaneous constricting

of a coronary artery.

This can cause damage to the lining

of the artery, which then can cause a blood clot to form.

This is more likely to occur in an area with existing

atherosclerotic plaque.

It probably formed, because there's

irregularities in that area where

the atherosclerotic plaque is.

NARRATOR Experts are not always certain about the causes

of vasospasms and coronary thromboses.

Some people are simply more prone to develop them.

And Ricky may have been one of those unlucky individuals.

In and of itself, if I just found his heart

and I didn't know anything about him,

I'd say, yeah, this is an unfortunate fella.

NARRATOR Dr. G believes that Ricky's

coronary thrombus was not brought on by his AIDS

or his throat infection.

And she knows that the hospital could not

have diagnosed the thrombus, because it

didn't exist at the time.

He certainly did not have that heart att*ck

when he was in the hospital.

That thrombus was very fresh.

And it occurred after he got out of the hospital.

NARRATOR But vasospasms and coronary thromboses

are known to be triggered by a certain external factor,

cocaine abuse.

And in Ricky's case, this is a real possibility.

Smoked some cr*ck, caused his blood pressure to go up,

caused his vessel to clamp down.

The plaque ruptures and a clot forms over it.

NARRATOR The critical step now will be the drawing

of toxicology samples.

They will be key in determining whether or not cocaine

played a part in Ricky's death.

I-- I don't know for sure.

And I won't know for sure, until I test his blood.

So I actually am gonna wait until I

get that cocaine level back.

Cause the only thing I have that he's smoking

cr*ck is the pipe in his--

hey, maybe he's just one of those unfortunate individuals.

NARRATOR Did Ricky Hawthorne's drug abuse

cause the fatal clot to form?

Or was it simply a tragic natural event?

Coming up next, the toxicology results

arrive and Dr. G finally has the answers she's been seeking.

But will Ricky's family accept her conclusions?

To be honest with you, I really

didn't want to believe it.

NARRATOR And later, Dr. G investigates

the bewildering death of a diabetic man

discovered in a pool of his own blood,

challenging her knowledge of a typical homicide.

DR. G (VOICEOVER) I would wonder,

well, where's the struggle?

You know, nobody's going to let you just come up

and put a Kn*fe into me.

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

Dr. G has just discovered the cause

of -year-old Ricky Hawthorne's death, a coronary thrombosis,

or blood clot.

But she does not know why the clot formed.

Was it a natural event or was the clot

caused by cocaine abuse?

I just have to prove that the cocaine contributed to it.

So I actually am gonna wait until I

get that cocaine level back.

Hey, maybe he's just one of those unfortunate individuals.

NARRATOR Dr. G can not close the case until the toxicology

reports are completed, a long hard wait

for a grieving family.

It took so long, to me, you know, that--

for the autopsy, the report.

Basically, they was waiting on the toxicology report

to come back, which takes the longest,

you know, to come back.

And there was nothing I could do, you know, but wait.

If I get the tox back and there's

no cocaine in his blood, I will say that this is just

an unfortunate natural event.

If I get his blood back--

and not-- now, I'm not talking the urine, not that he

used cocaine three days ago.

I'm not talking about that.

I'm talking about acutely using cocaine, which sets up

the process for him to have that thrombus,

I will call this an accidental death.

NARRATOR Several weeks later, the results finally arrive.
[ … ]

Cocaine, acutely in your blood,

is sometimes hard to find, because it continues

to break down in your blood.

NARRATOR But in the death of Ricky Hawthorne,

the results are obvious.

There is cocaine in his blood.

We know that he was under the influence of cocaine

at the time he d*ed.

And we know that it was used very near the time he d*ed,

within hours.

NARRATOR Despite a long list of suspects, AIDS, trauma,

neglect, or natural disease, ultimately,

it was drug abuse that k*lled Ricky Hawthorne.

The lab results provide the last remaining piece of the puzzle.

Now, Dr. G can finally replay the chain of events that

led to Ricky's untimely death.

A week before his death, Ricky Hawthorne,

a man suffering from AIDS, is hospitalized with intense pain.

When he comes in, he's complaining

of abdominal pain, some questionable chest pain,

and not being able to eat.

And they do extensive work-up.

NARRATOR After a week of treatment

for a minor throat infection, Ricky

is released from the hospital.

That evening, he visits friends at a local bar.

DR. G (VOICEOVER) We don't know what happens.

But we do know he goes to the bar probably at least

sometime about o'clock.

Hold on one second.

I'll be back in a second.

[interposing voices]

Sometime, in those-- between and , he's using cocaine.

It sets up a process of some coronary artery spasm,

where the coronaries constrict.

It injures some of his epithelial cells on the inside.

And it sets up a process where a clot is formed,

so no blood can go through.

Yo, can I get another one?

Sure.

Just a minute.

And then, what happens, his heart gets very irritated.

He's even-- he's on cocaine, which is--

in and of itself, can cause arrhythmias.

Now, part of his heart isn't getting blood.

The blood clot isn't allowing blood

to that part of his heart.

And it can't pump and he's getting no blood to his brain

and he passes out.

NARRATOR Ricky falls from the bar stool

and his heart goes into cardiac arrest.

The damage to his heart caused by the cocaine is irreparable.

They can't bring that heart back,

because that heart is dying.

Ricky.

What's wrong with him?

[interposing voices]

There's is no blood going to that part of the heart.

And he dies on his way hospital.

NARRATOR For Ricky's sisters, Dr. G's conclusion is haunting.

And they still wonder why the hospital did not

diagnose and treat the % blockage

in Ricky's coronary artery.

Why didn't someone know that he had this blockage?

Why didn't someone know--

one of those tests show it?

NARRATOR But Ricky's arteries were only %

blocked, a problem that does not always pose

an immediate medical thr*at.

That % narrowing in that coronary artery,

there is a lot of men walking around

with much worse coronary artery disease that have no clue

they have it.

His coronary arteries probably didn't bother

him until he used the cocaine.

Because he's acutely under the influence of cocaine

at the time he had that coronary artery thrombus,

this is gonna be ruled an accident.

NARRATOR In other words, Dr. G believes that Ricky's heart,

in all likelihood, would not have k*lled

him if he had not used cocaine.

Unfortunately, her conclusion does little to console

Ricky's grieving sisters.

Time don't heal, when you lose a loved one.

Time don't heal and I know that, because I

have a daughter that I've lost.

It's been years and years and it still hurt.

It still hurt.

NARRATOR Dr. G cannot ignore the intense

pain that she sees every day as people lose their loved ones.

But her profession also affords her a unique attitude

toward death in general.

We can't ignore it.

It's out there.

And it's gonna happen to me.

And it's gonna happen to people I love.

But when I see it and I go to the morgue and I see death,

I think, you know, it hasn't happened to me.

My day is another gift.

And I'm very thankful.
[ … ]

NARRATOR Coming up next, when a terminally ill man is found

in a pool of his own blood, Dr. G

must determine if he committed su1c1de

or fell victim to foul play.

When you see a fella dead in a pool of blood,

could it be a homicide?

What's causing his wounds?

What's going on?

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

Dr. G's wedding is only two weeks away.

And there are still many plans to arrange, such as car pools.

Now, don't pack no big suitcase,

cause I don't have any room.

I have to have three outfits.

For what?

One to drive up in, one for the wedding,

and then one to wear back home.

No, because you have to wear--

That's three pairs of shoes.

And my car won't even pull a trailer,

so how are we gonna do that?

DR. G (VOICEOVER) I think the place

was abuzz with excitement.

Of course, you know in the morgue,

you tell a lot of your personal life

when you're there cutting bodies.

I mean, your morgue techs get very close to you.

Because every day, you're talking about,

you know, personal things in your life.

What's with you today?

And-- and I think people were just really, really

happy for me, because I know--

they knew I'd gone through some hard times with the divorce.

And so I think people were very excited.

Take your bathing suit.

I will not put a bathing suit on.

I would not be caught dead in a bathing suit.

That's not funny.

NARRATOR The district nine staff is also busy

preparing for Dr. G's next case, a -year-old man

named Peter Hanlon.

This is--

OK.

NARRATOR Peter Hanlon, a recovery IV drug user,

d*ed unexpectedly last night after a long battle

with end stage kidney disease and a host

of other medical conditions.

DR. G Well, he's got a bad medical history.

He's got hepatitis C. He's on a--

he's on dialysis.

And he's got a history of IV drug use.

NARRATOR All of Peter's illnesses point

to a natural death, not the typical jurisdiction

of a medical examiner.

But the reason his case has landed in the district nine

morgue is because his death appears

to be completely unnatural.

According to the investigators' report,

Peter spends the evening before his death

with his wife Allison.

He isn't feeling well, a common complaint for people

undergoing life-sustaining dialysis treatment.

Dialysis is the artificial cleansing

of the body's blood supply when the kidneys fail to function.

It is a vital treatment.

But for many patients, like Peter,

it typically leaves them feeling weak, listless, and nauseated.

DR. G (VOICEOVER) It is not the most

pleasant thing to go through.

And it's fraught with a lot of problems and complications.

NARRATOR Later that evening, Allison

leaves to visit a friend.

Concerned about her husband, she asks her sister

to stop by and check on Peter.

But the young woman is not prepared for what

she is about to find.

He's basically found dead at his kitchen table,

just sitting in the chair, in a pool of blood.

LT. JOEL AGUERO GONZALEZ (VOICEOVER)

It was a lot of blood.

That's all I can tell you.

It was a big pool of blood.

I mean, it's kind of like it;s poured out.

You know, that's the way it looked.

NARRATOR According to Lieutenant Gonzalez, the first

to arrive on the scene, Peter is bleeding from an open wound

on his left arm.

Oddly, however, Peter's right hand is completely clean.

LT. JOEL AGUERO GONZALEZ (VOICEOVER)

The other arm didn't have any type

of bloodstains, his hands, his arms, indicating to me that--

that when this happened, he never

attempted to apply pressure to actually stop the bleeding.

NARRATOR Authorities immediately

suspect that Peter Hanlon, a dying man dependent on dialysis

for survival, committed su1c1de by cutting

an artery in his arm.

For Dr. G, it is certainly a strong possibility.

People with chronic illnesses are at risk for an increase

of su1c1de, particularly on-- there's some articles that
[ … ]

state people who were on dialysis,

especially when they first start dialysis, it's very, very

hard to get adjusted to that.

It's a total different way of life.

You've lost a lot of freedom.

You're hooked to a machine at least two to three times

a week for four hours at a time.

Difficult to travel.

I mean, it's difficult to do much in life,

when you've done--

when you're hooked up to a dialysis machine for so much

of the day.

NARRATOR But for Dr. G, even though it seems

a likely possibility, su1c1de isn't the only potential cause

of death she's considering.

The other is homicide.

DR. G (VOICEOVER) They don't know.

I mean, what's going on?

You know, when you see a fella dead in a pool of blood,

could it be a homicide?

What's causing his wounds?

What's going on?

NARRATOR At first, Peter Hanlon's death

seemed like a likely su1c1de.

Now, Dr. G wonders if someone else

might've slashed Peter's arm.

DR. G (VOICEOVER) Which one of these

plays a role in his death, we're not sure.

NARRATOR The only way to get to the bottom

of Peter Hanlon's mysterious death is through an autopsy.

Coming up next, Dr. G gets a close look at Peter's wounds.

And it's not what she expected.

He's just got arterial blood, basically,

pouring out of his arm.

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

At the district nine morgue, there

can be up to four autopsies occurring simultaneously

in the exam room.

This afternoon, while her staff works on other cases

in the day's lineup, Dr. G prepares

to examine the body of -year-old Peter Hanlon,

a terminally ill man who was discovered

dead in a pool of blood at his home yesterday evening.

Given the massive blood loss, there are two possibilities Dr.

G is considering in this case.

Peter opened up his own vein or someone else did.

OK.

NARRATOR Starting at the head, Dr. G carefully catalogs

the state of Peter's body and searches

for any signs of foul play.

DR. G (VOICEOVER) I would look for evidence of a struggle.

If I see a lot of blood and I see some type of trauma,

I would wonder, well, where's the struggle.

What-- you know, nobody's going to let you just come up

and put a Kn*fe into me.

NARRATOR But after a thorough search,

Dr. G finds no clear signs of foul play on Peter's body.

I don't really see much evidence of foul play,

as if he was in a struggle with anybody.

NARRATOR At this point, Peter's death is looking more and more

like a case of su1c1de.

Examining the wound on his arm will tell Dr. G for sure.

If he had done this to himself, like with a Kn*fe

or with a--

some type of cutting instrument, we would see,

forensically, it would be very distinctive.

It would be clear cut edges and clean lines or ragged lines,

but very fresh.

NARRATOR However, when Dr. G gets

her first look at the victim's arm,

it's not at all what she expected.

As soon as I look at him, I see the wound in his left arm.

This isn't a fresh wound.

It's clearly not something he acutely did.

NARRATOR Peter did not slash his arm

and neither did anyone else.

The wound is where doctors had surgically

created an arterial venous fistula for dialysis.

One way to access the body's blood supply for dialysis

is through the surgical creation of a fistula,

a connection made between a vein and an artery in the forearm.

The fistula is done to increase the size of the vein,

to give you access to get your blood in and out

for the dialysis machine.

Once they surgically connect the vein to the artery,

it causes blood to flow at a higher pressure into that vein

and enlarges that vein, because getting

a place to put those two needles is one of the hardest--

one of the biggest problems with dialysis.

NARRATOR Because the sight of Peter's fistula

appears to be infected, Dr. G elects

to dissect it right away.

What she discovers takes her completely by surprise.

DR. G (VOICEOVER) There is a patch, a synthetic patch,

over the vein.

NARRATOR It appears that Peter's fistula

had been surgically repaired.

At some point, doctors had reinforced the vessel

with a patch, much like a bandaid.

DR. G (VOICEOVER) These areas have chronic problems.
[ … ]

You're constantly putting big bore needles into that vein.

And that traumatizes that vein.

And there's many complications that occur.

Sometimes they thrombosis.

But sometimes they weaken and the walls of those veins

weaken.

Sometimes they get infection.

They get infections of the skin, which

then go down into the vein.

NARRATOR However, in Peter Hanlon's case, the patch

itself has begun to break down and is leaking.

DR. G (VOICEOVER) That patch has eroded through.

And he's got a wide opening.

He's got blood continually coming out

from the edge of that patch, which

is just kind of falling apart.

It's kind of pulled away from the vessel.

So he's just got arterial blood, basically,

pouring out of his arm.

NARRATOR Dr. G now knows why Peter d*ed.

It's a rare finding that she has never

before encountered firsthand.

The man succumbed to an abrupt bleed

from his dialysis fistula.

DR. G (VOICEOVER) Yeah.

I found the reason why.

He d*ed he bled to death, because

of chronic complications of his vascular access for dialysis.

It looks like a chronically infected fistula that

tried to be repaired before.

And it just continued to break down and it opened up.

The vessel opened up and he bled to death.

NARRATOR Vascular access complications are a major cause

of death in dialysis patients.

But someone bleeding to death as a result of a sudden rupture

of a fistula is very rare.

Dr. G continues with the autopsy.

But regardless of what she finds next,

she is convinced that Peter bled to death.

DR. G (VOICEOVER) Whatever I found internally in that body,

could not-- could not Tr*mp a hole in your vessel

with blood coming out of it with you sitting in a pool of blood."], index ,…}

It cannot Tr*mp that.

So in this case, no matter what I

found on the internal examination,

it would not have changed that cause of death.

NARRATOR Yet before closing the case,

there is one baffling question that remains.

If Peter was bleeding to death, why didn't he

attempt to stop the blood loss?

Well, my first instinct, if I started seeing blood oozing

through my shirt was to unbutton my cuff

and to see what's going on.

NARRATOR Why didn't Peter do just that?

Coming up next, to explain this odd behavior,

Dr. G will see clues inside Peter's head.

I did want to see his head, because it

didn't make a lot of sense why he wouldn't put pressure on it.

I wanted to make sure something else

wasn't going on in his head.

NARRATOR Will she find another surprise when "Dr.

G, Medical Examiner" continues?

Morgue technician Arton Monroe opens Peter Hanlon's skull,

so that Dr. G can determine if he had suffered a disabling

injury to his brain.

Dr. G has concluded that the -year-old bled to death

due to the sudden rupture of his dialysis fistula.

But why he didn't attempt to stop his own bleeding

remains a mystery.

Dr. G is now considering the possibility that he was

impaired due to a brain injury.

DR. G (VOICEOVER) Didn't make a lot of sense

why he wouldn't put pressure on it.

I wanted to make sure something else

wasn't going on in his head.

NARRATOR Dr. G is looking for anything that

might have impaired Peter's brain function,

such as bleeding or a bruise.

She removes the skull cap and examines the organ carefully.

But after a thorough search, she finds no abnormalities.

Dr. G now knows that Peter's brain

was normal, which leaves her with only

one possible conclusion.

The bleeding from Peter's ruptured fistula

must have been so swift and massive that he

had no chance to respond.

It probably bleeds very fast, so quickly

that he passes out very--

within seconds.

NARRATOR At the end of the examination,

Dr. G has the information she needs to close

the case on this unusual death.

She can now inform the family of her stunning conclusions.

Peter Hanlon is gravely ill.

He suffers from hepatitis C, diabetes,

and chronic kidney failure.

In order to survive, he undergoes

dialysis treatment three times a week,

four to five hours each time.

To gain access to his blood supply,
[ … ]

surgeons create a fistula in his forearm,

connecting a vein to an artery.

The fistula is done for easy access.

Because the biggest problem with dialysis is getting

vascular access.

NARRATOR However, within only a year,

Peter's fistula develops a complication

and is surgically repaired.

You could see a patch, like-- like

almost a tire patch put on that vein

where it had weakened before.

NARRATOR Unbeknownst to Peter, the patch

itself develops a complication.

It begins to break down.

After his wife leaves the house that evening,

the patch ruptures unexpectedly.

The blood loss is swift and catastrophic.

For reasons Dr. G will never know for sure,

Peter does nothing to stop the blood loss.

DR. G (VOICEOVER) I don't know.

It looked like he just didn't have the wherewithal

to try to stop the bleeding.

It would be actually very difficult to even if he did.

He'd have had to really put a lot of pressure on that.

NARRATOR Peter's body is rapidly drained

of a critical amount of blood.

His vital organs, including his heart and brain,

are quickly starved of oxygen and Peter dies.

The case of Peter Hanlon leaves Dr. G with conflicted feelings.

DR. G (VOICEOVER) Well, I mean, ultimately, we did our job.

I came up with the cause and manner of death.

But you know, some of the pieces, I don't always have.

And I don't always come up with a nice, clear, finished puzzle

at the end.

And I think on that case, I would

like to know that piece of the puzzle of why

he didn't try to stop that.

But I ultimately, I don't have that last piece of the puzzle.

And that's always-- leaves you a little dissatisfied.

But we have enough to know why he d*ed

and the manner of death.

NARRATOR With this tragic and puzzling case behind her,

Dr. G takes a moment to reflect on the deaths

she sees every day at the district nine morgue.

DR. G (VOICEOVER) You learn a lot

about how unhappy people are, I think, when I'm in this morgue.

I get a very skewed opinion, I think.

I see a lot of domestic v*olence.

I see a lot of people who just let themself go.

They don't want to just participate in life anymore.

So I see a very skewed population

of very unhappy people.

You know, it does-- it makes me--

it makes me want to enjoy life.

I would like more free time.

I would like to work less and spend it with Mark.