04x10 - In the Dead of Night

[bunniefuu]

[ominous music]

[dramatic music]

NARRATOR A man wakes in the middle

of the night gasping for air.

Paramedics rushed to save, him but it's all in vain.

He's dead by the time he gets there.

NARRATOR And a series of seemingly unrelated clues

reveal little about his fate.

He had a toe infection, diabetes, diarrhea.

NARRATOR Has Dr. G finally found a case she can't cr*ck?

And I pretty much ruled out everything that it could be.

NARRATOR Then a young man in his s

winds up dead in a motel room after a wild night

out with friends.

There's a question of possible drug use.

NARRATOR His parents are desperate for answers.

But will the truth be more than they can handle?

I just didn't know what to think.

I didn't understand it.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

I'm one of those early bird specials.

You know, I'm always here a little

bit earlier, because I like to get everything situated,

so I know when the doctors come down in the morning,

it runs smoothly.

I usually unlock the cooler, and I wheel the bodies out,

and then I go and start my day's work.

Dr. G is a good person, and she's always been kind to me,

and very patient with me, especially when I first

started out, and I really didn't know

much about how to do this job.

That'll be a first.

You've got to laugh and joke around because at times, it

can get heavy.

That's a big part of what gets you through your day here.

You never know what's going to come in,

and you never know what you're going

to deal with for that day.

You know, I see people in the morgue for a million

different reasons.

It's of all shapes and sizes, including all people.

But it's unusual that I'd have to autopsy an older gentleman.

We're more apt not to do an autopsy on an elderly person

because they're often expected to die.

Well, you know, we just don't live forever.

So it was odd when I came in in the morning

to see an older gentleman that it looks like I'm

going to have to autopsy.

[ominous music]

NARRATOR Dr. G opens the file on Jerry Richards

and quickly discovers why the elderly man

is here for an autopsy.

But the doctor's refusing to sign

a death certificate because he says he

really is not sure why he d*ed.

[somber music]

NARRATOR A third-generation steel mill worker, Jerry

was a tough man with a soft spot for his wife

Elaine and daughter Melissa.

Upon retiring, he convinced them both to trade

Pittsburgh for Sunny Orlando.

There, they'd found a more relaxing life together.

That is, until last night.

[thud]

[ominous music]

AM, Jerry wakes up with an unpleasant feeling.

He's short of breath.

His wheezing worries Elaine, and before long,

she gets Melissa out of bed.

He's not doing well.

They call the doctor, and the doctor says

get him to the emergency room.

They leave him sitting on the bed.

They leave to go get dressed.

NARRATOR Moments later, they return,

but are shocked to discover that Jerry is no longer conscious.

He's collapsed on the bed, and his eyes kind of rolled back.

NARRATOR He's not breathing, and they can't find a pulse.

Elaine ones for the phone--

She immediately calls .

NARRATOR --while Melissa fights to bring them back.

The daughter attempts to start CPR.

EMS arrives.

He's dead by the time he gets there.

[piano music]

NARRATOR At years old, Jerry was no young man.

Still, his sudden death stuns both Elaine and Melissa.

They're now hoping Dr. G's findings will give

them some sense of closure.

Based on Jerry's age and the circumstances,

Dr. G strongly suspects he d*ed for a tragic yet simple reason.

You know, elderly people who d*ed suddenly,

and unexpectedly, and they're walking talking one minute,

and they collapse the next, it sounds like a cardiac death.

NARRATOR Yet clearly, his doctor was unconvinced.

And the more she reads about Jerry,

the more she understands why.

He's got a pretty complicated history.
[ … ]

NARRATOR First and foremost, Jerry had diabetes.

When you have diabetes, you have a lot

of problems that can develop.

One of the problems is you're more prone to get

atherosclerotic plaque.

NARRATOR Plaque buildup in the coronary vessels

can lead to a heart att*ck, America's

number one cause of death.

A heart att*ck would fit with the circumstances of Jerry's

death, but Dr. G spies an important detail

in this report that suggests another thr*at to his life.

He had a toe infection.

The doctor just treated him for that.

NARRATOR This infection could also be

a complication of his diabetes.

Toe infection's a common problem.

You have some nerve damage from the diabetes,

and you don't feel things as well,

so you're more apt to injure tissue peripherally,

and you're a setup for an infection.

NARRATOR From Jerry's toe, bacteria

could have launched a deadly att*ck on the rest of the body.

Certainly, we've seen it before where you get

an infection, and it's not fully treated,

and then it gets into your bloodstream.

NARRATOR While medical records do indicate that Jerry took

antibiotics for his toe infection,

Dr. G wonders if it may have been too little, too late.

There is a chance it could be somewhere else,

and it wasn't totally treated, but we'd have to see.

[dramatic music]

NARRATOR But then she discovers a third possibly fatal

complication in Jerry's recent health history.

The antibiotic gave him diarrhea.

NARRATOR One serious complication of diarrhea

is rapid dehydration, the loss of water

and electrolytes in the body.

This can be especially disastrous to the elderly, who

are sometimes more frail and less

able to cope with the changes.

Dehydration causes death usually

by generalized weakness.

You know, you're losing a lot of fluids,

and your sodium can build up, and then

that, really, you can end up with a cerebral edema

and seizures.

NARRATOR Dr. G notes that Jerry was given a prescription

to combat the diarrhea.

But so far, he'd only taken a few doses.

And it is possible that the medication

had yet to take effect.

And there's another danger from diarrhea.

I mean, it's possible that he had

a megacolon or toxic megacolon.

NARRATOR A megacolon develops when severe diarrhea causes

harmful bacteria to inflame the bowel to a point

where it expands unnaturally to more than six

centimeters in diameter.

And then the dilated bowel kind of perforates,

and then you get the leakage of everything

that should be in your bowel, which

is stool and bacteria, into the abdominal cavity, which

isn't a good thing.

NARRATOR Bottom line, Jerry's complex history

obscures the truth about his death, which makes

Dr. G's mission crystal clear.

So I think it's worth doing the autopsy to kind of figure

this out.

[ominous music]

Dr. G begins by exploring the possibility of dehydration.

Externally, with dehydration, we'll often see the eyes sunken

in their sockets.

You've all seen people who are dehydrated.

They look kind of gaunt.

Their skin turgor is kind of loose and tense.

You've just lost a lot of fluid.

NARRATOR After a thorough exam, however,

she finds none of the telltale signs.

He certainly didn't look dehydrated at all.

NARRATOR But to completely rule out dehydration,

she'll have to search for signs internally.

For now, she continues the external exam

and quickly uncovers a puzzling clue.

He's got a few little excoriation, like little scabs.

I think he probably was scratching himself.

Hard to say what that was from.

NARRATOR And far more concerning,

she detects a reddish congested look to Jerry's face and chest.

We see that a lot, actually, in heart att*cks.

NARRATOR Jerry was an aging diabetic,

which put him at a higher risk for coronary problems.

It's looking more and more as if a simple heart

att*ck may have ultimately been the culprit here.

[thud]

The rest of the external exam yields nothing more.

Aside from the congestion, his body

seems in good shape, including his toe.

Well, I certainly checked his feet, because, you know,

I'm wondering, you know, if this is what started the whole chain

reaction of what's going on.
[ … ]

And his toe actually looks pretty good.

NARRATOR But the fact that the toe is healed on the outside

does not necessarily mean that the bacteria

has been eradicated.

That bacteria then could get into his blood,

and start multiplying, and then your body reacts to that

by your heart b*ating fast.

You breathe fast.

Your blood vessels dilate.

You can't maintain your blood pressure,

and you go into shock, and then you die if not treated very

aggressively, very quickly.

NARRATOR But could something as basic as a cut on the toe

have led to this man's untimely death?

Only the internal examination can see for sure.

[ominous music]

Dr. G's scalpel is so sharp, it can slice through human skin

like a Kn*fe through butter.

A scalpel is probably the most dangerous

thing we have to deal with.

Cutting yourself is our biggest injury.

NARRATOR Now, she uses her scalpel

to cut a Y incision across the chest

of -year-old Jerry Richards.

Dr. G's first task is to see whether or not

the diarrhea brought on by his antibiotic medication triggered

life-threatening symptoms of dehydration.

So I'm going to cut that.

NARRATOR And it doesn't take long

to determine that Jerry's internal organs

are neither dull nor dry.

His tissues were glistening.

In fact, there appears to be maybe a little extra edema

fluid, which certainly doesn't go along with dehydration.

NARRATOR She then checks for a second possible cause of death,

sepsis, or a rampant infection that

may have spread from Jerry's toe into his bloodstream

and organs.

A lot of times, people who die of sepsis, you

get a vague appearance at autopsy they look really sick,

and they start to decompose a little faster on the inside

than we normally see.

Can I quantitate that?

No.

That's just, like, years of experience

you just get this, like, sixth sense

that they're just not right.

NARRATOR In this case, her expert ion instincts

tell her there's no raging infection here.

Certainly, he didn't look septic

when we looked at his organs.

Everything looked OK as far as just grossly in the abdomen.

NARRATOR Through the abdominal cavity,

she can also check the condition of Jerry's bowels.

One thing I am very curious about

was when I look in his abdomen to see

if there's any toxic megacolon or any perforation

of the abdomen.

Now, we don't have any history of abdominal pain,

but, you know, it could have come on very quickly.

NARRATOR Yet his intestines, too, are perfectly normal.

And he doesn't have any perforation.

His bowel really doesn't look that inflamed.

NARRATOR At this point, Dr. G is fairly certain of how

Jerry did not die.

It looks like he's toe infection's completely cleared,

and he doesn't have any signs of an infection anywhere else.

And I don't really don't think the diarrhea k*lled him.

NARRATOR Of the possible K*llers

she's flagged in Jerry's medical history,

she suddenly left with only one.

Fortunately, it's her prime suspect, the heart.

The way he d*ed just a cardiac death.

NARRATOR And Dr. G knows that as a diabetic,

Jerry's heart was at grave risk.

You can get, you know, accelerated atherosclerosis,

and you get plaque buildup in your coronary arteries.

NARRATOR If Jerry had developed atherosclerosis,

it could have reduced the flow of blood to the point

where it set off a deadly heart att*ck.

[heart b*ating]

Now assisted by her morgue technician Ashley Shaughnessy,

Dr. G removes Jerry's internal organs

and goes straight for the heart.

He has some pretty severe coronary artery disease.

His left anterior descending coronary artery,

that's the coronary artery that supplies

the front of the heart, was about %

narrowed by atherosclerotic plaque, which was calcified.

That right coronary artery, which

supplies the posterior part of the heart, was about %

occluded.

NARRATOR Blockage this bed could have easily ended

Jerry's life, but there's another piece of evidence

within the network of blood vessels

that may suggest otherwise.

You can have % occluded and it not be the cause of death.

Well, how is that?

Your heart has a way to compensate

for that slow buildup of atherosclerosis
[ … ]

by forming collaterals, meaning another coronary artery will

form new vessels to supply that part of the heart.

NARRATOR Jerry's body had done just that, formed collaterals

to help the blood bypass the blockage

and prevent a full-on heart att*ck.

It certainly puts your heart in a weakened condition

by having that % occlusion.

But with the collaterals, it gives it kind of a Band-Aid

on it, that it can survive.

NARRATOR Still, without a clear cause of death, Dr. G cannot

rule out the heart just yet.

Nothing acute looking.

He certainly could have d*ed of a cardiac arrhythmia,

but I have to finish the rest of the autopsy.

OK, let's see.

[easy listening music]

NARRATOR With no suspects left, this

means starting from scratch, checking every internal organ

for signs of any acute illness.

She begins with the lungs.

As I'm taking the lungs out, I'll certainly

look for a pulmonary embolus.

NARRATOR A pulmonary embolus is a large blood clot that

forms in an outlying vessel and travels

to the pulmonary artery, where it

blocks the blood supply to the lungs

and strikes the victim down.

It's often seen in bedridden patients.

He may be staying in bed, not moving as much

because of the sickness.

But as soon as I took the lungs out,

he didn't have any major pulmonary emboli.

NARRATOR Next, she inspects the organs

from Jerry's abdominal cavity.

It's hard to see because the ligaments are holding it in.

NARRATOR But here, too, she finds nothing acute.

His kidney show some nephrosclerosis.

They were granular.

And that goes along with maybe even some diabetes, also.

NARRATOR Then, she checks to see if there's something

going on in the brain.

Ah, yeah I worry about maybe a stroke or a hemorrhagic bleed.

OK.

NARRATOR After careful examination, however,

all of the remaining organs appear healthy.

[sawing]

Nothing in his brain that would suggest why he d*ed.

NARRATOR It's clear now that the autopsy of Jerry Richards

has hit a brick wall.

And I've pretty much ruled out everything obvious

that it could be.

NARRATOR But Dr. G isn't ready to throw in the towel just yet.

Well, at this point, I'm going to really have

to think about everything I've found

and reassess the whole autopsy.

NARRATOR She takes a moment to review

all her notes so far alongside the original investigator's

report.

At least the unfortunate chain reaction in Jerry's health

is very clear.

Well, he's got diabetes, which then set him up for the toe

infection, which then had to be treated

with an antibiotic, which gives him diarrhea,

which then has to be treated.

NARRATOR The first thing she notices is how briefly he'd

been on his new prescription to combat

diarrhea, an antibiotic called metronidazole.

They give him this medication.

He only took a few of them.

NARRATOR Then, she also recalls something she saw in Jerry's

chest during the external exam.

Thinking back, he's got these scratch marks on him.

NARRATOR The two details suddenly click, and Dr. G

knows exactly what to do next.

I need to look at the neck.

[thud]

[ominous music]

NARRATOR Dr. G continues the internal exam

on Jerry Richards, dissecting the skin covering his neck.

The neck is my last hope.

If she's wrong, she may never have a definitive answer

for what suddenly k*lled this -year-old husband and father.

After a few cuts, she reaches the larynx.

And there, her suspicion is confirmed.

Jerry's airway is almost completely blocked off--

not from choking on food or a foreign object,

but because the tissue itself is swollen with edema, or fluid.

I couldn't even pass my little finger

into the opening of his larynx.

NARRATOR This narrowed, the airway

clearly gave paramedics trouble as they tried to help.

They had a hard time intubating, you could tell,

because I can even see injury from the intubation.

But they never were able to get the endotracheal tube

into that pharynx.

NARRATOR Dr. G has no doubt as to what this means.

It's clearly looking like it was an allergic reaction.

NARRATOR An allergic response occurs

when the body's immune system overreacts to an antigen

or foreign substance.
[ … ]

It can trigger a host of symptoms, from sneezing,

to coughing, to itchy hives.

[gentle music]

At its most extreme, however, it can induce a sudden drop

in blood pressure and a rush of fluids

that constrict the airway.

Plus, you get contraction of the small muscles of the lungs

surrounding the bronchi, so you have a harder time

getting air even deeper in.

NARRATOR And if the victim isn't treated immediately,

the lack of oxygen can trigger a deadly heart

att*ck in the space of just a few minutes.

These anaphylactic reactions probably in the United States

k*ll anywhere from several hundred to a thousand people

a year.

Most of the people, it's going to be dr*gs, usually

the penicillin, or a bee sting, or something they ate,

like usually shellfish or peanuts are very notorious.

NARRATOR Based on Jerry's history,

Dr. G believes that in his case, the trigger was metronidazole,

the antibiotic he took to combat diarrhea.

An allergic reaction to metronidazole is very rare.

But really, there are case reports

of people having anaphylactic reactions to that medication.

NARRATOR To be absolutely sure of Jerry's fate,

Dr. G request a toxicology screen, checking his blood

specifically for elevated levels of tryptase and IgE,

two indicators of an allergic reaction.

When I get my tox, it does confirm

what I thought at autopsy in that his tryptase was very high

and his IgE was very high.

NARRATOR The shortness of breath, the mysterious scratch

marks, the congested look on Jerry's face,

it all fits with the cause of death

that trumps heart disease.

He had anaphylaxis.

And even with a good heart, you're going to die from that.

NARRATOR Now, after what seemed like a series of dead ends,

Dr. G can finally give Jerry's wife and daughter the answers

they've been waiting for.

[ominous music]

It's early Saturday morning.

Jerry Richards wakes up with labored breathing.

Alarmed, his wife and daughter convince him

the best idea is to go to the hospital,

and they leave him just briefly to get dressed.

What neither of them could possibly realize

is that a string of related health problems

is about to end his life in a bizarre final twist.

It's an unfortunate chain of events, to put it mildly.

So he gets the diabetes, which then sets

him up for the toe infection.

The toe infection is then properly treated

with antibiotics, and then the antibiotics appear

to be giving him diarrhea.

NARRATOR To treat the diarrhea, his doctor

prescribes metronidazole, a different antibiotic

that for most patients would have mild or no side effects.

But for Jerry, it is a catastrophe.

Nobody did anything wrong.

He didn't know he had an allergic reaction to that drug.

NARRATOR Jerry's immune system, weak as it is,

goes into overdrive.

There was a little bit of a red flag

because he probably starts itching from the hives.

NARRATOR Unaware of the warning,

he continues taking the medication,

every dose reacting like a toxin to his body.

By Saturday morning, he's in the full throes of anaphylaxis.

And his blood pressure goes down,

his tissues start to swell.

It swells so much that he isn't able to get air in.

NARRATOR His face turns red in the struggle to breathe.

His throat constricted, he can't even call out for help.

By the time his wife and daughter return, he's out cold.

They immediately call .

NARRATOR But it's too late.

Within minutes, he dies before EMS arrives.

For Jerry's family, this is shocking news

that will take them time to come to terms with.

But for Dr. G, it's something she

faces every day in the morgue.

You know, the simplest thing like a little toe infection,

it's scary.

Life is scary.

Even though sometimes everything goes right,

you still can get bad consequences.

And that's not that anything is bad,

or that people did things wrong.

There can just sometimes with bad luck have bad consequences.

[somber music]

NARRATOR But will Dr. G's next autopsy

be another case of bad luck or too much of a good time?

They were drinking heavily.

There's a whole group of them out.

They had a bag full of possible cocaine.

[ominous music]

Thank you, God, for the good food

and that we're here together, and healthy,

and that we have each other.
[ … ]

Amen.

And let's pray that Eric doesn't get hurt in football.

What other sport has an ambulance on standby?

Horse racing.

That's for the horse or the jockey?

One of each.

JAN GARAVAGLIA Dinner with my family

and occasionally having a glass of wine, you know,

it's one of my favorite ways of ending the day.

Do I get to toast?

What are we toasting?

Yes.

But I also teach my children that alcohol

abuse is one of the main ways that people

come into my morgue.

[ominous music]

NARRATOR Dr. G opens the file on -year-old Michael Torio.

Michael was very close to his family, living at home

and even working for his mother at a restaurant.

Michael was wonderful.

He was happy, full of life.

You know, we used to have a lot of fun together,

you know, going to movies, going to wrestling, this and that.

[orchestral music]

NARRATOR But there was something

else Michael loved to do, party with his friends all night.

And it was no different on the night he d*ed.

He called me and said, mom, I don't

think I'll be home tonight.

He says, I'm kind of chilling, was his word.

And he says, well, he said, I promise

I'll be to work on time.

And as always, I'd say, I love you, Mac.

And he said, I love you, too.

NARRATOR But little did she know that would be

their last conversation ever.

According to the investigator's report,

that night Michael and his friends

first met up at a local bar.

[rock music]

MAN (SINGING) Out again.

They've got a $ bar bill.

There's five of them, and the drinks are only $ apiece.

I don't know where they're drinking,

but that's pretty good, $.

[rock music]

So you can kind of do the math.

They're drinking a lot.

NARRATOR Closing time rolls around,

but they're just getting started.

They soon head over to a motel, where Michael gets a room.

They all continue the party at the hotel room.

NARRATOR Finally, at around AM, he calls it a night.

He goes to bed.

Some of his buddies leave.

I guess at least one of them stays back.

[ominous music]

NARRATOR The next morning, the friend wakes up

and notices Michael fast asleep in the bed next to him.

He's still sleeping in the same position

when he should be up getting ready for work.

NARRATOR But it isn't long before the friend realizes

that Michael's not sleeping.

JAN GARAVAGLIA He doesn't respond.

His friend calls .

NARRATOR The paramedics soon arrive, but they're too late.

They pronounce him dead.

[ominous music]

NARRATOR Meanwhile, across town,

Michael's mother is furious that her son

hasn't shown up for work.

[beeping]

I blew up his cell phone calling him and calling him.

[vibrating]

[phone ringing]

NARRATOR At PM, her phone finally

rings, but it isn't her son.

It was actually his-- one of his good friend's mother that

I hadn't spoken to in a while.

And she said, Marianne, how are you?

And I said, fine.

How are you?

And she says, oh my god.

You haven't heard?

And I said, heard what?

NARRATOR Her answer is at first beyond belief.

And at that moment when I turned to my office door,

there stood a police officer.

And that's how I found out about Mickey.

NARRATOR The sudden loss of their son

leaves Michael's parents groping for answers.

Michael was everything.

He was every breath I took.

I just didn't know what to think.

I just didn't understand.

I didn't understand it.

[whoosh]

NARRATOR Now, it's up to Dr. G to determine what k*lled him.

On first blush, she doubts it was natural.

Like most young men, Michael has no medical record,
[ … ]

except for one odd note, grand mal seizures.

And that's when a patient suddenly gets very stiff,

and then after a period of being very stiff,

will start jerking and shaking.

And you'll also see a frothing at the mouth.

NARRATOR Sometimes a grand mal seizure

can signal a serious condition, such as extreme low blood

sugar or kidney failure.

In Michael's case, the cause of the seizures

is a complete mystery.

According to his family, he had experienced four seizures

in the past year, all spontaneous

and with no other symptoms.

He didn't think nothing of it.

He'd have the seizure, and he'd be fine afterwards, you know?

His life went on just like normal.

Now, this is the sad part.

He doesn't go and get medication for the seizures

because he doesn't have any insurance.

He did not go to the neurologist.

I even said, Mac, make the appointment

and I'll pay for it.

And he said, no, I'm fine.

Don't worry about it, mom.

He says, you know, when I get insurance, I'll go.

[somber music]

NARRATOR Michael never did find out what caused his seizures.

But while seizures can be dangerous,

Dr. G knows they rarely end in death.

And when they do, it usually involves a risky activity.

Like swimming, and having a seizure,

and drowning, or driving when they're having a seizure,

or being on a ladder, having a seizure, and falling off.

NARRATOR On the contrary, Michael d*ed indoors in a bed.

Still, Dr. G can't rule out the possibility

that Michael's seizures or the underlying cause of them

could have ultimately led to his death.

However, as she reads through the investigator's report,

Dr. G is starting to suspect that by far,

the biggest thr*at to Michael's life was not his seizures,

but alcohol.

Alcohol's a central nervous system depressant.

If you drink enough of it, it will

cause you to stop breathing, and then eventually

cause your heart to stop.

I don't see it a lot in the morgue,

but I tend to see it in younger people who guzzle alcohol.

NARRATOR But then Dr. G discovers

something even more disturbing about Michael's night out.

There is a question of possible drug

use in this hotel room.

They had a bag full of possible cocaine.

NARRATOR A powerful stimulant, cocaine alone

can k*ll in a number of ways, often

as a result of cardiac arrhythmias

or skyrocketing blood pressure rupturing

blood vessels in the brain.

Combined with alcohol, the risks are even greater.

It actually forms a chemical in your body called

cocaethylene, and you're more apt to get

cardiac arrhythmias possibly when you even mix the two.

NARRATOR Cardiac arrhythmia is abnormal electric activity

in the heart.

It can lead to cardiac arrest.

More and more, Michael's party is

sounding like a deadly setup.

But for Dr. G, investigating dr*gs and alcohol as

possible K*llers won't be easy.

Their trail can be extremely elusive in autopsy.

Certainly, I don't expect to see much with the alcohol.

And the dr*gs, I may not see anything.

But if you don't look, you're not going to find it, either.

[frantic music]

The family just has a hard time.

It's like, well, he has no symptoms.

NARRATOR As Dr. G begins Michael's external exam,

she immediately notes a health issue unrelated to dr*gs.

He's morbidly obese.

He's over pounds.

NARRATOR Even in such a young man,

such obesity can cause problems, including heart disease

and high blood pressure, conditions

Dr. G will investigate in the internal exam.

But first, she opens Michael's mouth, looking for any evidence

that suggests he experienced a grand mal

seizure on the night he d*ed.

A bite mark to the tongue or bite mark to the buccal mucosa.

That's the inside of your cheek.

NARRATOR Victims of seizures often bite their tongues

or cheeks while seizing, and Michael's mouth reveals

definite damage.

Oh, poor guy.

He's got old bite marks.

I can see a lot of scarring on the inside of his mouth.

I just don't see anything new.

NARRATOR Fresh injuries which suggests

that Michael had a seizure the night of his death.

But Dr. G also knows it's possible to seize

without leaving bite marks, and that seizures often

come and go without a trace.
[ … ]

Just because you don't have evidence of a bite mark

does not mean he didn't have a seizure.

We certainly see a lot of people have seizures

that don't have bite marks.

Finding a bite mark just helps us say, yes, he probably did

have a seizure.

NARRATOR For now, Dr. G must set aside that history

and focus on one of her two prime suspects, drug use.

Looking at his skin won't tell if Michael smoked or inhaled

cocaine at his party.

But if he injected the dr*gs, she may find its signature,

a pale circular puncture wound.

I look for needle tracks.

I don't see any.

NARRATOR In fact, by the end of the external exam,

she's seen nothing that supports either drug

or alcohol abuse at all.

So basically, we have a very overweight young man

with no evidence that he uses IV dr*gs and really not much else,"], index ,…}

so I'm a little bit worried.

[tense music]

I have really no idea why he d*ed at this point.

[ominous music]

[sawing]

NARRATOR Still exploring a possible cocaine-related death,

Dr. G begins Michael Torio's internal examination by opening

not his chest, but his head.

I think I can get it.

Maybe using cocaine, he might have

an intercerebral bleed or a ruptured aneurysm from that.

NARRATOR As a first step, she extracts the brain.

On first glance, it looks normal.

But to be sure, she must dissect it.

Similar to just slicing bread, very thin slices,

looking for any type of abnormalities.

NARRATOR After a careful inspection,

it's clear Michael's brain has no trauma, no tumors,

no bleeding from cocaine.

I don't see any abnormalities.

NARRATOR Still Dr. G can't yet rule out dr*gs without running

toxicology tests.

She's also no closer to finding the cause of Michael's seizures

or determining whether or not he even suffered

from one the night he d*ed.

The lack of clues is frustrating.

But as a mother of two, Dr. G can only

imagine the agony of Michael's parents

as they wait for answers.

Personally, I don't think there

can be anything worse than losing a child,

no matter how old they are.

He wanted to have a family.

That was his biggest dream was to be a father.

[dramatic music]

He's on my mind constantly.

I don't mean to get like this.

I still wait for him to come home.

It's hard.

[ominous music]

WOMAN I'm going.

You know, let me do--

let me do the initial and--

WOMAN Whatever you would like.

I'm just going to hose down the table

so we're not sticking as much.

NARRATOR Dr. G makes the Y incision

down to Michael's navel, exposing the abdominal cavity.

So he's got a lot of abdominal fat.

NARRATOR Her first stop, the stomach,

where she hopes to uncover some trace

of her other prime suspect, alcohol.

[tense music]

If Michael overdosed on alcohol, Dr. G

may actually be able to smell it in his gastric contents.

A good night of beer drinking, I'd smell it.

It gives us an idea maybe of what's going on.

Not the most pleasant part of the job.

And in fact, some people hate that part of the job.

It does often have a smell of vomit

and that we're all familiar with.

To me, it's just part of the territory.

NARRATOR First, she extracts the organ then ties

off both ends and cuts it open.

A good whiff, and she's got her answer.

It really doesn't smell that much like alcohol to me.

Huh.

That's interesting.

NARRATOR On the other hand, Dr. G

finds something else in his stomach

that could counter the effect.

I do see some greasy liquid things and some French fries.

It doesn't sound like the healthiest meal,

but then again, he's pounds.

I'm not thinking he's eating fruits

and granola bars all day.

NARRATOR The fries at least may have slowed the absorption

of alcohol into Michael's bloodstream

and prevented the binge drinking from taking his life.

But without the toxicology report,

Dr. G can't be sure of exactly how heavily
[ … ]

Michael drank before he d*ed.

One thing she does know, if he had also snorted cocaine,

any amount of alcohol could have mixed

with it to make cocaethylene.

And that can cause a fatal cardiac arrhythmia.

So it could be the combination of the dr*gs with the alcohol,

and that's what I'm guessing.

NARRATOR Though an arrhythmia leaves no physical evidence,

she must still check the condition of his heart.

So I take his chest plate off.

NARRATOR Underneath it are his lungs.

And as she removes them for better access to the heart,

she finds something intriguing.

His lungs are very heavy.

You know, a normal weight would be maybe , grams.

His are like over grams, very congested with some edema

fluid.

His lungs are just full of fluid.

NARRATOR Often, wet lungs are associated

with a drug overdose, but they can also

be a result of heart failure.

She must press on to find out.

What she uncovers next is a startling revelation.

I open his pericardial sac, and I notice

his heart is very enlarged.

NARRATOR To some extent, it's not unusual to find

a big heart in an obese person.

As you get bigger, your organs get bigger.

And part of that is because as you get bigger,

you have a bigger blood supply.

You are having more miles of capillaries

that have to be fed.

NARRATOR To pump that volume of blood,

the heart must also grow.

But even for an obese man, Michael's heart

seems abnormally large.

[thudding]

When Dr. G dissects the organ, she

finds that the walls of the ventricles

responsible for pumping blood out to Michael's body

have become thick and stiff.

He's got a cardiomyopathy of some type,

a heart muscle disease.

NARRATOR Cardiomyopathy, which has many causes from high blood

pressure, to genetics, to alcoholism,

lands hundreds of people in Dr. G's morgue each year.

There's something inherently wrong with his heart.

It could be partially worsened by his obesity,

but the muscle is abnormal.

NARRATOR And, yet how exactly Michael's

heart disease relates to his sudden death is still unclear.

In fact, they may have no relation at all.

Well, the end of the internal exam, I

have the history of the seizures.

That certainly could play a component again.

I've got still the dr*gs and alcohol,

and then I've got this heart.

That heart was a setup for sudden cardiac death.

[dramatic music]

Toxicology is going to be key for this case,

because I can't go anywhere yet until I

find what's in his system.

NARRATOR And when she does find out, nothing is what it seems.

[somber music]

Over four weeks after the autopsy of Michael Torio,

Dr. G finally receives the -year-old's

toxicology report, and the findings

turn the case upside down.

When the toxicology comes back to me, I'm actually shocked.

He has no cocaine in his system.

He has no alcohol in his system.

NARRATOR It appears Michael's alcohol intake the night

of his death was moderate enough that his body processed

it completely before he d*ed.

So he clearly had stopped the partying

long enough for those things to metabolize out of his system.

NARRATOR There's no trace of cocaethylene either, which

means neither alcohol, nor cocaine,

nor their compound could have taken Michael's life.

[dramatic music]

With dr*gs and alcohol out of the equation,

Dr. G must reconsider another possible thr*at

to his diseased heart, his seizures.

Some people die from seizures called sudden unexpected death

of epilepsy.

NARRATOR While the exact mechanism is unknown,

scientists believe death may occur when seizures disrupt

the brain's signals to the autonomic nervous system,

the part of the nervous system that

regulates the body's organs.

What happens during a seizure, there's

a misfiring or desynchronization of the autonomic nervous

system, which probably contributes

to cardiac arrhythmias or irregular heartbeats

during a seizure.

NARRATOR Most seizure victims never experience anything close

to major organ failure, but a heart

as diseased as Michael's could easily

stop being under such stress.

And while there's no physical proof that Michael had
[ … ]

a seizure the night he d*ed, Dr. G suspects the odds

were stacked against him.

He's been having these seizures for the past year,

mostly at night.

They're increasing in frequency.

Is he on medication for these seizures?

No.

NARRATOR Even his general health

could have been a factor.

People who are obese can have obstructive sleep apnea, where

they don't sleep well at night.

And if you're not sleeping well at night,

that's going to lower your seizure threshold.

So based on, you know, everything we know about him,

most likely it was an interplay between the two.

He d*ed consistent with sudden unexpected death of epilepsy

in conjunction with his bad heart.

Hi, this is Doctor Jan Garavaglia

dictating case for [inaudible]

NARRATOR Two unrelated conditions

converging one fateful night.

Dr. G can now tell Michael's grieving parents how and why

his life ended so abruptly.

[ominous music]

[interposing voices]

[thud]

It's Thursday night and the fun's just begun.

Michael and his friends are hanging out at a local bar,

but he has to work in the morning,

and assures his mom that he'll take it easy.

The party moves to a hotel room, but Michael keeps his word.

He's been drinking, but in moderation.

And by AM, he's in bed.

He goes to sleep.

He metabolizes off the alcohol that was in him.

NARRATOR It seems no different than any other night

Michael has spent partying with his friends.

But in his heart, a catastrophe has been

brewing, possibly for years.

It's thickened and enlarged.

You know, this is something that we

found at autopsy that clearly he didn't know anything about.

I wouldn't expect him to know anything about it, because he

didn't go to the doctor, and he wasn't having

any symptoms yet from it.

NARRATOR At the same time, for an unknown reason,

Michael's brain has become susceptible to seizures.

We have no idea what's causing them.

They start on their own.

NARRATOR And this night, the two conditions collide.

At some point during the night,

he has one of his nocturnal seizures.

NARRATOR An electrical storm erupts in Michael's brain,

triggering a chain reaction in his body.

His limbs flail, his jaws clench,

and most dangerously, his autonomic nervous system

malfunctions, losing control of his heartbeat.

Nobody knows the exact mechanism.

They do know that when people have seizures,

their heart goes down really slow.

NARRATOR Michael's heart, already in trouble,

now beats erratically, quivering,

until finally, it stops.

[whoosh]

MAN Mike?

NARRATOR By the next morning, there's nothing

his friend or anyone can do.

And they pronounce him dead.

[somber music]

NARRATOR Michael's grieving parents are thankful to finally

have some answers, but the revelation

is still difficult to come to terms with.

I never knew he had a heart problem, never.

I'm like, what kind of a mother was I?

I didn't even know my own son had an enlarged heart.

That's a very difficult thing to pick up, actually.

Even a chest X-ray, you know, you

don't do chest X-rays on -year-old men

that don't need it.

I don't think you're ever relieved to find out

why your son dies, but I think it

really helped her to know that it wasn't the dr*gs or alcohol.

I don't know how it made her feel, because he couldn't

get the help for his seizures.

You know, to me, that's still very sad.

[easy listening music]

NARRATOR Michael's family will never be the same,

but it's his memory that inspires them to keep going.

MAN (SINGING) Everyone come outside.

You just wake up, wake up every day

and do what you have to do.

Mickey lives in my heart.

When I need that hug or I need to see that smile,

I just look in my heart, and he's there.

[tense music]

MAN Atlas.