05x02 - Deadly Encounter

[bunniefuu]

[ominous music playing]

[dramatic music playing]

NARRATOR A man is found bludgeoned

in a motel parking lot.

He's covered with blood.

A lot of broken bones.

NARRATOR And as police begin a full-scale m*rder

investigation, they're asking Dr. G for the impossible.

They want me to figure out what the m*rder w*apon is.

This is going to be trouble.

I knew this was going to be trouble.

NARRATOR And then a man with a history of chronic pain

is found unresponsive in bed.

JAN GARAVAGLIA (VOICEOVER) The wife calls .

They work on him for about minutes,

but they realize he's dead.

NARRATOR But in this case, forensics alone do

not give Dr. G all the answers.

Now the question is, how did this happen?

This is the million-dollar question.

How did this happen?

[exciting music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

It's early on a Wednesday morning

when chief medical examiner Dr. Jan

Garavaglia arrives at the District

Morgue in downtown Orlando.

Today will not be an easy one.

I was not looking forward to coming to work today.

I knew this fellow was coming in.

And I knew that it was going to be difficult.

I knew this was going to be trouble.

[intense music playing]

[machine whirring]

NARRATOR The case that awaits Dr. G this morning is that

of -year-old James Duncan.

Okey-dokey.

Oh, boy, we've got a tough one today.

We've got a -year-old white male who's been in the hospital

for a month due to a--

they say an as*ault and battery.

He was beaten about the face.

And he spent the last month in the hospital

trying to recover from his wounds,

is what they're telling me.

NARRATOR According to the police,

James Duncan was a motel desk clerk

working in a crime-ridden neighborhood of Orlando.

He's kind of a gruff old guy.

He's always having trouble with people.

He's not well-liked, to put it that way.

NARRATOR Several weeks ago, he was working the night shift

when he had a verbal altercation with one of the guests, whom

James accused of trespassing.

He was very difficult to deal with.

He would stop anything and everything that moved

or that would trespass on the property.

NARRATOR Police are uncertain what transpired next,

but minutes after the run-in, they

find James bludgeoned and bleeding

in the motel parking lot.

He had severe--

what appeared to be severe facial injuries.

A lot of facial trauma.

Broken bones, cheekbones.

He's got a large chunk of tissue probably missing

from the back of his head and multiple lacerations

of the face.

Dispatch to Unit .

Come in.

And they asked him what happened.

And he said, I don't know.

I don't know what happened.

He was fully conscious, not disoriented,

but he didn't know what happened.

NARRATOR James is rushed to the hospital.

His facial wounds are serious, though not

thought to be life-threatening.

But by the time he arrives at the ER,

his condition has rapidly deteriorated.

His blood pressure is unstable.

His breathing is labored.

And his heartbeat, irregular.

Doctors wonder if the stress of the as*ault

could be triggering other more serious problems.

The emergency department doctor is pretty smart

and figures, well, you know, maybe he's

had some type of heart att*ck.

NARRATOR Doctors check James's blood for a protein

called troponin.

This could indicate whether or not he's

suffering from a heart att*ck.

But his troponin level is normal.

And further tests reveal no signs

of any other life-threatening conditions.

They do a CAT scan.

They do x-rays.

No brain trauma, and no other trauma anywhere else.
[ … ]

NARRATOR Doctors surgically repaired

James's facial injuries.

And yet, in the coming weeks, even though his wounds

begin to heal, his condition continues

to worsen without explanation.

JAN GARAVAGLIA (VOICEOVER) They had problems

again with his blood pressure.

He started getting a lot of fluid in his lungs.

NARRATOR Then, four weeks after entering the hospital,

James contracts an aggressive blood-borne bacterial infection

known as sepsis.

The infection is too much for his weakened body to handle,

and he dies in the intensive care unit.

His body has now been transferred to the District

Morgue in hopes that Dr. G can pinpoint why he was

unable to recover from facial injuries, which

initially didn't seem to be at all life-threatening.

But already, doubts are looming.

This case is not simple.

After a month in the hospital with this stormy course,

that he comes to me for an autopsy.

And I don't have hopes that I'm going

to be able to tell them much.

NARRATOR Since James Duncan's death followed what

police believe was an as*ault, the case

is now considered a homicide.

To help with the m*rder investigation,

police have asked Dr. G to undertake

a nearly impossible task.

Please take morgue photos to confirm the w*apon.

He spent a month in the hospital.

They say he's assaulted.

He's already had surgery.

He's got one medical complication after another.

And they want me to figure out what the m*rder w*apon is.

Well, when they asked me what kind of w*apon,

it's a little easier if you have a fresh victim,

they haven't had surgery, and they

haven't had their wounds heal.

So I really didn't have high expectations that I

would be able to say much.

[dramatic music playing]

The external examination-- we have

a man that clearly looks like he's been in the hospital

for a month.

He's diffusely edematous.

Just swollen with all the fluids they'd given him.

He looked very ill.

And he looked every bit of having

sepsis and pneumonia and problems

maintaining his blood pressure.

NARRATOR First, in an effort to identify what kind of w*apon

inflicted James's injuries, Dr. G must

record all trauma on the body and differentiate

wounds from surgical incisions.

I had to take everything I found on his face

and see what was surgery, what was done to him,

and what he came in with.

I'm just like, OK.

What they do, what he come in with,

let's see if we can match what he actually has now

and subtract what they did to him in the hospital.

NARRATOR As she charts the wounds,

it's clear that the injuries were substantial.

He suffered extensive fractures to his jaw bone, cheek bones,

eye orbit, nose, and maxillary.

JAN GARAVAGLIA (VOICEOVER) There

is some asymmetry to his face.

His left side was still kind of flattened.

His nose was still kind of flattened.

He looked a mess, honestly.

NARRATOR But the only wounds Dr. G finds are on his face.

This is the best wound.

JAN GARAVAGLIA Oh.

NARRATOR There were no defensive wounds

on his arms or hands to suggest that he fought

back against his attacker.

One of the things I'm looking at at the external

is to look for other--

maybe some minor injuries that the hospital wouldn't have

reported to me, that maybe indicate something else

was going on.

Or help me kind of figure out what the mechanism

of the injuries were.

He didn't have a scratch on him.

NARRATOR By the end of the external exam,

Dr. G has pieced together a full diagram

of the victim's injuries.

Okey-dokey.

I think that's it.

NARRATOR But the exam has still not revealed

what police need most--

the w*apon.

It was very inconclusive at that time.

JAN GARAVAGLIA (VOICEOVER) At the end of the external

I thought, oh, brother.

I don't know if I'm going to be able to tell anything.

[ominous music playing]

NARRATOR On the streets of Orlando,

police are on the hunt for a suspect
[ … ]

in an alleged as*ault that resulted in the death

of -year-old James Duncan.

As the investigation began, we tried to contact any witnesses

or anybody that may have been at the business

at the time, anyone that may have

witnessed what had happened.

We put out flyers for the area to try and locate

any and all witnesses in the beginning,

was where we started.

NARRATOR As police try to close in on the k*ller,

Dr. G is ready to open the body of the victim,

looking for any internal trauma that may have

been missed by the hospital.

[intense music playing]

JAN GARAVAGLIA I'll get those out [inaudible]..

NARRATOR Dr. G opens the body with a standard y-incision.

She is assisted by her morgue technician, Brian Mikulski.

You want me to start working on this side, Dr. G?

As long as you can't hit my hand, you can work on it.

Yeah, that wouldn't be good.

No, it wouldn't.

I'm still on probation.

Oh, I see.

So when I do my y-incision, it's very wet.

Edema fluid is just pouring out.

I see a tremendous amount of fluid that has accumulated

in his abdominal cavity.

I see a tremendous amount of fluid that accumulated

in his pleural cavities.

Yeah, he's got a lot.

NARRATOR Edema is a swelling caused

by the buildup of abnormal levels of fluid in the body.

We knew we had problems with his blood pressure.

They were giving them a lot of fluids to try

to maintain his blood pressure.

And as he got sicker and sicker, he

couldn't maintain the fluids, actually, inside his vessels.

And it would be leaking into his tissues.

And a lot of it.

NARRATOR Once toxicology samples are taken,

Dr. G begins searching for any internal trauma that

might have been overlooked.

I'm looking very carefully for any kind of trauma.

I'm looking for broken ribs that they may have missed.

I'm looking for evidence of bleeding under the skin.

And he doesn't have any at all.

All righty.

Why don't we just take a overall before I--

NARRATOR The hospital was right.

James did not suffer any additional trauma

in his abdominal cavity.

Dr. G documents the findings for the investigative team.

All righty.

The picture's always worth a thousand words.

Thank you.

NARRATOR As a next step, she opens

James's chest cavity to begin examining his internal organs,

one by one.

[beeping sound]

First organ I look at is his heart.

And in the examination of the heart,

I always start with just looking at the external aspect,

looking at the shape.

NARRATOR And what she finds is troubling.

Whoa.

Something here.

We got a big heart.

JAN GARAVAGLIA (VOICEOVER) His heart looked very dilated.

Both right ventricle and left ventricle were dilated.

And I look at the coronary arteries.

NARRATOR Here, too, all is not well.

His left main coronary artery was % narrowed.

But his left anterior descending was about % narrowed.

His circumflex, going to the side, had about an % to %

narrowing.

The right coronary artery had over an % narrowing.

Thanks, Brian.

NARRATOR Her conclusion?

He had extremely bad atherosclerotic coronary heart

disease--

extremely bad.

NARRATOR But as she slices into the heart muscle,

Dr. G discovers that severe coronary artery disease wasn't

James Duncan's only problem.

I went ahead, then, and I bread

loafed the heart muscle to see if there

was any damage to the heart.

And lo and behold, he's got a large myocardial infarction

or heart att*ck that's about a month old.

NARRATOR The timeline is shocking.

The heart att*ck appears to have occurred

near the time of James's as*ault,

perhaps as a result of the trauma.

And yet the hospital failed to diagnose or treat it.

For some reason, the hospital just didn't pick up on it.

NARRATOR Now the question is, what

else could they have missed?

[ominous music playing]

[rock music playing]

Dr. G's morgue technician, Brian Mikulski,
[ … ]

opens the cranium of James Duncan.

Considering the hospital's failure

to diagnose James's heart att*ck,

Dr. G is concerned that the doctors

may have also overlooked an injury to his brain.

Examining his head trauma, I would hope that maybe it

would add something that they didn't

pick up on in the hospital.

NARRATOR Dr. G extracts James's brain for examination.

In the hospital, CAT scans, or computed

axial tomography, of James's brain

detected no internal trauma to the organ.

But it's possible that the images may have

given doctors a false reading.

CAT scans are wonderful, but they can miss some injuries.

They can particularly miss some subarachnoid hemorrhage.

They can miss some fractures to the base of the skull.

And so I was hoping maybe we'll find

some more injuries that would shed some light on something.

[intense music playing]

NARRATOR But her hopes are quickly dashed.

No fractures to the calvarium.

No fractures to the base of his skull.

I didn't find anything in his brain

that was out of the ordinary.

There is no trauma.

There is no natural disease.

NARRATOR Despite his severe facial wounds,

it appears as if James's brain remained unharmed.

This means that head trauma likely played

no part in his downward spiral.

[water hissing]

The autopsy is now complete.

And yet for Dr. G, the case is far from over.

The findings, or lack of findings,

are simply not adding up.

JAN GARAVAGLIA (VOICEOVER) Well, the end of autopsy,

I had more questions than I had answers.

I knew that he'd had a heart att*ck.

And this looked like it dated at or about

the time that he suffered these facial injuries.

I knew that they missed this heart att*ck in the hospital.

And the injuries are so well healed that I can't really

say much about a m*rder w*apon.

NARRATOR What's more, police have found no witnesses

to the alleged as*ault.

Nobody saw anything.

Nobody saw an altercation.

Nobody saw anybody with a w*apon.

Nobody saw anything.

[dramatic music playing]

NARRATOR After thoroughly reviewing the autopsy findings

and re-evaluating information provided

by the police investigation, Dr. G begins

to formulate a new hypothesis.

What if James's trip to the hospital had

nothing to do with an as*ault?

I really don't have any evidence

that there was an as*ault. But I have another theory.

And I'm wondering if this theory was thought

of at all in the hospital.

But I don't--

I'm not so sure it was.

NARRATOR Dr. G compiles her findings

and prepares to record them in the report of autopsy.

But instead of describing a death brought about by injuries

from an as*ault, she will articulate her new and radical

theory on how she believes James Duncan d*ed in the motel

parking lot and why doctors failed to fully understand

his condition in the hospital.

[eerie music playing]

According to the police report, -year-old James Duncan

was working the night shift at the motel

when he got into a verbal dispute

with one of the patrons.

But Dr. G now believes that's where the altercation ended.

Well, the new theory is that perhaps none of this

is from an as*ault. Perhaps he suffered a heart att*ck.

He fell on his face, unconscious.

And people just jumped to conclusions

that his facial fractures were from an as*ault.

NARRATOR Based on her forensic findings, including

microscopic reviews of heart tissue,

Dr. G is confident that after the argument,

James suffered a severe heart att*ck when a small clot formed

in one of his severely narrowed coronary arteries, obstructing

blood flow to the heart muscle and causing

him to lose consciousness and fall face forward.

He doesn't brace himself.

That would have softened the blow.

I mean, your reaction is to brace yourself

and not let your face hit.

NARRATOR The impact fractures the bones of James's face.

It's a scenario Dr. G has seen before.

I've had several cases where people

get terrible facial lacerations and facial fractures

after suffering a heart att*ck.

NARRATOR Doctors successfully patch up his injuries.

But tragically, they failed to diagnose

his other significant condition, a severely damaged heart.
[ … ]

Dr. G discovers that while the doctors do test for the protein

troponin, which is released into the blood

during a cardiac event, they do so too early and only once.

The problem with troponin is, just because you have

heart muscle damage or a heart att*ck,

it's not elevated right away.

It takes about four hours.

So you're not going to see it, even if you've suffered a heart

att*ck, for about four hours.

So that's why you always order a series of troponin.

NARRATOR Given that the test is run so soon

after the heart att*ck, James's initial troponin levels

come back normal.

No further tests are performed.

And surgeons incorrectly conclude

that his heart is fine.

It kind of fell through the cracks in the hospital.

NARRATOR Over the next few weeks,

James's facial wounds heal, but his damaged heart is weakening

and beginning to fail.

Had doctors recognized James's heart att*ck,

they might have been able to stabilize him.

But without treatment, his condition only worsens.

He has a very rocky course with his blood

pressure, which is probably because his heart is dying.

NARRATOR Then, four weeks later,

in a final blow to James's battered body,

he contracts a fatal blood-borne bacterial infection

called sepsis.

And in his weakened condition, the aggressive infection

is just too much.

As you get the bacteria in your blood,

your body reacts to that bacteria.

You start releasing chemicals that start

your blood vessels to dilate.

Once your blood vessels start to dilate,

your heart has to b*at harder and it has to b*at more

to keep the blood pressure up.

He's already having a hard time maintaining his blood

pressure with his heart, and he's already

starting to go into failure.

So this just makes it even worse.

And ultimately, he eventually dies.

[dramatic music playing]

NARRATOR Because of the complex nature of James Duncan's death,"], index ,…}

involving both disease and a fall,

Dr. G ultimately rules that the manner of his death

was not simply natural, but accidental.

Pinpointing the exact cause is more difficult.

So what k*lled him?

Well, clearly, what started it all is the heart att*ck.

But if not for him falling with that,

would he have ultimately d*ed?

And I'm not so sure.

So it's not only just the heart att*ck,

it's probably a combination of the heart att*ck, now,

with the injuries that he suffered from the fall

with the heart att*ck.

And with all the problems he suffered in the hospital

for being there so long.

NARRATOR When Dr. G presents her new theory

to the detectives investigating the case,

they agreed that they no longer have a homicide on their hands.

Dr. G mentioned that she had run into one or two cases

similar to his, where she actually had worked

on individuals that had had a heart att*ck and fall

straight down onto their face and cause

the same type of injuries.

Her findings were very conclusive in the sense

that there was no other injury to him.

There was no defense wound on him,

no indication that he was fighting

or struggling with someone.

All we have is facial injuries.

And we all determined that what happened to the victim

was basically an accidental death.

[MUSIC - THE HIGHWAY BEAUTIFUL, "DREAM OUT LOUD"]

JASON JUREWICZ (SINGING) And so you cut yourself to bleed,

hoping they will see, asking them in not so many words.

NARRATOR As Dr. G expected, the case was difficult,

but not for the reasons she anticipated.

You know, my favorite cases are when I find something

that nobody else suspects.

In this case, it wasn't the injury nobody suspected.

They worked that up quite nicely.

And they were able to repair that quite nicely.

But the whole heart att*ck was not suspected.

And when I find things on a case that aren't suspected and then

just kind of turn the way the investigation goes,

those are the best cases.

Those are actually a lot of fun to work with.

[guitar music playing]

NARRATOR Unfortunately, some of Dr. G's cases

leave her with more questions than answers,

and her next case is no exception.

The family is on pins and needles

that he committed su1c1de.

They really were worried.

[ominous music playing]

[upbeat music playing]
[ … ]

The county has a Service Award that's given every five years.

And this time, it's for our chief medical examiner,

Dr. Garavaglia.

So we're about to surprise her and give her her award.

I was told that a employee of this office

has successfully completed five years of service.

So on behalf of Orange County, we'd like to present

your five-year Service Award.

Here is your certificate.

Thank you, Sheri.

SHERI BLANTON Thank you.

Thank you, Orange County.

She works long and hard hours.

She works a lot longer than they pay her for.

It's nice. It's nice.

OK. Thank you.

SHERI BLANTON She's got work to do.

[laughs]

NARRATOR In fact, there's still one more body Dr. G must

autopsy before she can go home.

The man's name is Michael Reardon,

and he was found lifeless in bed by his wife late last night.

According to the investigators' report,

the decedent was only years old, married,

with two young children.

And from the case file, Dr. G can

see right away that he's had more than his share

of medical problems.

He's got a really sad, long history.

He ran into a basketball pole playing a pickup game

of basketball at least a decade ago

and has had chronic pain since then.

Numerous surgeries.

Hasn't really gotten over the pain.

Is on some pretty high-dose medication for it.

NARRATOR In fact, on the night of his death,

Michael's wife Alyssa administered a fresh dose

of pain medication.

In this case, a dermal, or skin patch,

that releases painkiller in a constant flow

over several days.

She's been controlling his medication for years.

And she changed his patch in the late evening.

And then he went to watch TV.

NARRATOR Not long afterwards, Michael dozes off.

JAN GARAVAGLIA (VOICEOVER) She hears

him snoring very, very loudly.

[snoring]

NARRATOR At around AM, Alyssa

decides to turn in herself.

But as she approaches the bed, she

makes a frightening discovery.

Michael is not breathing.

His face is purple and he's cool to the touch.

The wife calls --.

Yeah, I need someone here now, please.

JAN GARAVAGLIA (VOICEOVER) They work

on him for about minutes, but they realize he's dead.

Oh, my sweet Jesus!

NARRATOR The unexpected loss has devastated

Michael's wife and children.

Now, their only hope is that Dr. G

will be able to determine what exactly brought

about his untimely death.

After reading through the case file,

she has her suspicions about what may have k*lled

Michael Reardon as he slept.

We take things on face value.

And we come up with the most probable explanation.

NARRATOR In addition to suffering

from chronic, severe pain, Michael

was overweight and diagnosed with high blood

pressure-- both risk factors for a myriad of medical problems.

But it's what his wife Alyssa noted in her statement

to the investigator that draws Dr. G's attention--

Michael's snoring.

He's got a history of some snoring in the past, where

the wife has to shake him.

There's a question of whether he has sleep apnea.

That could be a possibility.

NARRATOR Obstructive sleep apnea is a common problem

in which the airway becomes blocked

during sleep due to the relaxation of soft tissue

structures in the throat.

It can lead to a temporary cessation in breathing.

And in some cases, trigger a deadly heart arrhythmia.

Well, a heart arrhythmia is an irritation

in the electrical system of the heart,

where it causes it to quiver.

And you can't b*at.

You can't send blood to any parts of your body.

You pass out and you die.

NARRATOR If Michael d*ed due to a fatal arrhythmia,

his premature death could be attributed to natural disease.

But there's another notation in the investigative report

that suggests the death may have been anything but natural.

The family is on pins and needles

that he committed su1c1de.

They really were worried.

NARRATOR Twice already, Michael has tried to take his own life."], index ,…}
[ … ]

Since his basketball accident damaged his facial nerves

years earlier, he has suffered from

chronic and unbearable pain.

Doctor G wonders if he just couldn't take it anymore.

It's a tough row to hoe.

To have recurrent chronic facial pain,

you know, you start getting into a frame of mind

that you're hopeless.

That things can't change, and there's no other solution.

And after years of trying to control that pain,

maybe that's how he's feeling.

It's well-known that chronic pain patients and depression

often go together.

And we know that depression often can lead to su1c1de.

So you can't say that all patients with chronic pain

lead to su1c1de.

But those that have chronic pain, that

are profoundly depressed, certainly

can have an increased risk for su1c1de.

NARRATOR Did Michael finally succeed at ending his life,

as his family fears?

Or was his death due to a disorder such as sleep apnea?

For answers to these questions, there's

only one place to turn--

Michael's body.

[dramatic music playing]

On the external examination, the general state in the body

is a little bit overweight.

You know, the weight's kind of in his belly area.

NARRATOR Dr. G begins the exam in the place

that gave Michael so much trouble--

his face.

He clearly has had a lot of surgeries in the face area.

You can see the scars from that, you

know, pretty much going all the way

from his jaw down to his neck.

A little-- another scar on the other side.

NARRATOR Next, she searches the body for the pain patch

that Michael's wife administered the previous night.

The patch, called a transdermal, administers

a constant flow of pain medication to the patient.

In this case, the narcotic fentanyl.

Fentanyl is about or times

more potent than morphine.

Very small amounts are needed for pain relief.

You can take fentanyl orally.

You can inject fentanyl.

Fentanyl can be put in a patch and absorbed through the skin.

And it's a small enough molecule,

and you'll need a small amount for it to work.

A fentanyl patch is basically a gel reservoir of fentanyl

in an adhesive skin patch.

So the fentanyl trickles through the layers of the skin

in a controlled manner and is picked up by the blood vessels

underneath the skin and distributed

to the rest of the body for pain management.

I'm looking all over to see if they left any patches on.

NARRATOR But she doesn't find one.

From what I can tell, as soon as he got to the hospital,

they removed it.

I would have liked to have seen it.

That would have been important evidence for me,

but it got thrown away.

NARRATOR Dr. G then combs the body for any signs

of past su1c1de attempts.

I do look on the inner aspects of the wrist

to see if there's any scars.

A lot of times, people will attempt it that way.

But I don't see any.

But that's not how he attempted su1c1de.

He attempted su1c1de by medication, which is worrisome.

That's because that's what I'm suspecting.

NARRATOR But she wanted to know if Michael actually overdosed

until she completes the autopsy and gets

the toxicology results.

At the end of the the external,

we don't have a lot, as often is the case.

And we're going to have to see what's on the internal.

I don't know what bad thing happened to this guy.

[ominous music playing]

NARRATOR Dr. G suspects that -year-old Michael Reardon may

have taken his own life, but his family is praying she's wrong.

I think they were really on pins and needles

waiting for that answer.

[dramatic music playing]

NARRATOR She starts the internal examination

by opening Michael's chest with a standard y-incision.

Well, when I open the y-incision, I look around.

Nothing unusual.

Always keeping my eyes open, seeing what's there.

Now, let's see what we have, here.

I take off his chest plate.

No fluid, no abnormalities.

And I do my toxicology.

NARRATOR Dr. G draws fluid, urine, and blood samples

from the eyes, bladder, and large blood vessels.

These will be sent to the lab and tested for dr*gs.

The results will be critical in determining

if Michael committed su1c1de.

We take the blood from his iliac veins,
[ … ]

as peripheral as we can get from the rest of his body.

Just as they're going into the femorals.

And that's where we draw our blood.

We put it in our tubes and get that ready for toxicology.

Well, look at that.

NARRATOR With the samples in hand,

she begins her examination of Michael's chest cavity.

And almost immediately, she discovers something unusual--

something that raises doubts about a drug overdose.

Oh, wow.

NARRATOR Michael's lungs seem normal, which in drug overdoses

is very odd.

So when I do the autopsy, his lungs are not very edematous.

His lungs are a little over normal weight,

but not that bad.

NARRATOR Typically, a drug overdose would cause the lungs

to fill with fluid, or edema.

Nobody knows exactly why we get this bad edema

with the drug overdoses.

But we see it trickle in these kind of slow deaths,

which is what I suggest he had.

So I don't know.

I'm surprised his lungs aren't a little more edematous.

NARRATOR But there's one more organ

to check for signs of an overdose,

and that's the stomach.

JAN GARAVAGLIA (VOICEOVER) The stomach on a case like this

may be important because people who want to k*ll themselves

will take a lot of pills at once.

So are taking , , pills at once.

And some of those may still be in the stomach.

NARRATOR But after a careful inspection,

Dr. G comes up empty-handed again.

I certainly don't see any pills or pill fragments.

NARRATOR Normal lungs, an empty stomach.

One by one, Dr. G's findings are calling for her

to rethink the entire case.

It's making me kind of question

my whole overdose theory.

NARRATOR Now, she wonders if Michael Reardon's k*ller

was natural disease after all.

And one of the places that natural disease

is most likely to strike is the heart, so that's her next stop.

With the lungs removed from the chest cavity,

Dr. G gets her first look at the muscle.

I get to his heart.

His heart is big and somewhat dilated.

Definitely a big heart for his size.

Boy, that is a big heart.

NARRATOR An enlarged heart, or cardiomegaly,

is a form of cardiovascular disease, the number-one k*ller

of adults in the United States.

Certainly, an enlarged heart would be a risk factor

for the arrhythmia because as the muscle gets thicker,

it would be more prone to have problems

with a decrease in oxygenation.

And so when you combine a decrease in oxygenation--

let's say, from the sleep apnea--

with a thickened heart, you're more apt to have an arrhythmia.

NARRATOR In other words, Michael's

enlarged heart and his sleep apnea

may have been a fatal combination.

JAN GARAVAGLIA (VOICEOVER) So he

could have d*ed suddenly from an arrhythmia

from that heart, no problem.

NARRATOR But Dr. G can't be certain

because arrhythmias leave no physical traces behind.

It's going to be a diagnosis of exclusion.

We've got to rule everything else out.

NARRATOR Although she has a likely suspect,

she can't make her ruling just yet.

So at the end of the internal, we've got an enlarged heart.

And we have not much else.

We're just going to pend the cause and manner of death

until I get that toxicology.

[ominous music playing]

NARRATOR Soon after his autopsy,

the body of -year-old Michael Reardon is laid to rest.

But questions surrounding his untimely death

remain open, leaving his family searching for an explanation.

It's always a trying time for the families

waiting for the answers.

We always get a lot of anxious phone calls.

Is it done yet?

Is it done yet?

NARRATOR But Dr. G cannot close the case until the toxicology

results are back from the lab.

And three weeks later, they arrive at District Morgue.

So I'm looking through these pages of tox.

He had a therapeutic level of his anti-hypertensive medicine.

He had a therapeutic level of his antidepressant medication.

He had kind of a high therapeutic level

of oxycodone, a very potent narcotic

that we see a lot of deaths with.

But his was high therapeutic.

It certainly wasn't in the lethal range.

NARRATOR But then suddenly, something in the report

catches her attention.

And I turn the page on the toxicology, and there it is.

His fentanyl level-- lethal.
[ … ]

There is the rub, right here.

Without a doubt, he's got a lethal fentanyl level.

NARRATOR Fentanyl is the powerful pain

medication that Michael had been taking through a skin patch.

At first glance, the lethal level seems to confirm

the family's worst nightmare--

su1c1de.

The question is, how did this happen?

To overdose on a fentanyl patch

is really quite rare and unusual.

Assuming, of course, the patch is used in accordance

with a doctor's prescription, is not tampered with,

and there is no uncontrolled release of the drug

onto the skin, which could then absorb into the blood and cause

problems.

So how do people get into trouble?

Well, first of all, they put on too many patches.

Instead of one patch, I've seen some people with four patches.

I've seen it come through my office, where

heat applied to the patch can cause too

much medication to be given.

NARRATOR But for Dr. G, something

still isn't adding up.

She knows from her research that the fentanyl patch has been

linked to accidental overdoses.

Suddenly, it seems at least possible that Michael's death

was not intentional.

In Florida alone, we've got a lot of accidental deaths

from fentanyl a year.

Not necessarily in my office, but in the state.

NARRATOR Dr. G wonders if Michael

Reardon might have been the unfortunate

victim of a defective patch.

The FDA has recalled some of these patches.

And that was one of my worries, is

that maybe he had a bad patch.

NARRATOR As recently as , the FDA

has issued a recall on defective patches that resulted

in the deaths of patients.

The FDA put out a recall warning for these patches

because they found that there were some patients being harmed

by them due to uncontrolled leakage out of the side

of the patch due to a tear.

There have been FDA warnings.

There was one right before this fella d*ed.

And I was initially worried about that.

But it was the micrograms.

And he had the .

Since that time, there's been other warnings about the ,

the , and the .

What happens with these bad patches

is that the reservoir is broken.

And that gel gets on the skin directly,

with the medication in it.

A lot of these defective patches,

you're going to have the gel ooze out in the packet.

NARRATOR With a defective patch,

the medication is absorbed into the skin

all at once, rather than being gradually

released over a period of time.

So did he have a defective patch?

I'll never know because the evidence was destroyed.

NARRATOR Unfortunately, emergency workers

removed the patch and threw it away

before Dr. G could examine it.

And as she prepares to close the case,

she's left with a number of troubling questions.

What really happened?

Did he put heat on it?

Does he know this?

This is a guy with long-term pain problems.

Did he do it intentionally, or did he do

it to try to relieve his pain?

Did he have a defective patch?

I don't know what bad thing happened to this guy.

All I know is he d*ed of a fentanyl overdose.

NARRATOR Based on the circumstances of Michael's

death and the autopsy findings, Dr. G

arrives at her conclusion.

I have nothing to indicate that it was a su1c1de.

And I'm going to give him the benefit of the doubt

because it happens with these.

NARRATOR Michael Reardon's official cause of death

will be listed as accidental overdose.

Now, Dr. G can record her findings

in the report of autopsy.

[eerie music playing]

It's a sunny afternoon, and -year-old Michael

Reardon is busy enjoying the company

of his wife and two kids.

At PM, as he does every day, he

makes sure to take his full regimen

of prescription medications.

He takes oxycodone, which is a potent narcotic.

He takes an antidepressant.

He takes a high blood pressure medication.

He takes a medication for nausea.

NARRATOR Based on forensics and the testimony of his wife

Alyssa, Michael's fentanyl patch is administered

around PM that same evening,
[ … ]

five hours prior to his death.

Unfortunately, what happens after he went to bed

remains a mystery.

You know, the wife really wasn't

seeing what was going on.

What was he doing there?

NARRATOR From the extremely high level of fentanyl

in his blood, Dr. G knows that the medication entered

his system very quickly, which is not the way

a patch is supposed to work.

Maybe it's an accident with a defect in the reservoir.

Maybe he perforated the reservoir

accidentally in getting it out and applying it.

Maybe he did it on purpose, just to give

himself more medication.

But what really happened?

I don't know.

All we know is that the fentanyl level got

higher and higher and higher.

NARRATOR As the fentanyl level escalates,

it circulates through his bloodstream,

ultimately reaching all of his vital organs,

including his brain.

It's going into his opiate receptors on his brain stem,

saturating those, causing more and more central nervous system

depression.

Slowly going deeper and deeper into a coma.

NARRATOR As Michael slips into the coma, he begins to snore.

But soon, his breathing becomes more labored.

Eventually, the fentanyl suppresses

his central nervous system so much that his heart ceases

to b*at, and Michael dies.

Dr. G immediately contacts Michael's wife

to inform her that she's ruled his death

an accident, not a su1c1de.

I think she just wanted to make sure it wasn't su1c1de.

At least, that's the sense I got.

NARRATOR At the District Morgue,

the vast majority of cases are closed

with confidence in the forensic evidence

and the conclusions drawn from it.

But for Dr. G, the case of Michael Reardon

is not one of them.

She continues to be troubled by his death

and the lingering question she'll never be able to answer.

Am I comfortable with my conclusion

that he didn't commit su1c1de?

No.

You know, we've investigated as much as we can.

And we're going to have to go with the preponderance

of evidence that this was an accident.

Because we have nothing to suggest otherwise.

You know, I wish they hadn't thrown the patch away.

I wish I really knew what was going on those five hours,

that nobody saw him between the time his patch was changed

and he d*ed.

I wish I knew all that.

It's so frustrating that I can't get

all the exact answers I want.

And I can only use the information I have.

So it's a very frustrating case, but you've got to move on.