05x08 - Secret Lives

[bunniefuu]

[music playing]

[music playing]

NARRATOR A young woman dies suddenly,

with no apparent cause.

I love a mystery.

I wouldn't be in this job if I didn't love mysteries.

NARRATOR But as the questions multiply,

the autopsy takes an unexpected twist.

And there is where we got a surprise.

Look what we have.

It was something I'd never seen before.

It was black.

NARRATOR Then, a man and woman are found dead in bed.

[siren]

It looks like it could be a double homicide.

NARRATOR And the only way to help police catch a k*ller

is to put the investigation, itself, under the microscope.

I find something totally unexpected.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of "Dr. G--

Medical Examiner."

DR. JAN GARAVAGLIA The bottom line-- it may just be alcohol.

NARRATOR How well do we really know those closest to us?

Says he drinks and smokes.

NARRATOR As Dr. Jan Garavaglia, chief medical examiner

for the District Morgue in Orlando, Florida,

sees all too often, it is the people

we claim to know the best that can surprise us the most.

Do we get that a lot, where families think they know

somebody, they tell me it couldn't be,

and then we find the truth?

We get that a lot, unfortunately.

So I let the family tell me the story as they know it.

Oh, I didn't know that.

And then we build the facts.

NARRATOR It's PM on a Friday night,

and -year-old Maria Flores has just left the office where she

works as a medical technician.

Unmarried, she divides her time between her job, her friends,

and the occasional boyfriend.

Maria also shares a special bond with her grandmother, Berta.

So when Maria begins to feel sick,

her grandmother is the first person she turns to.

Abuelita.

She called her grandmother up and said

she wasn't feeling very well.

No, [spanish].

She felt, ew, like she'd had flu-like symptoms,

you know-- aches and pains.

NARRATOR Berta doesn't think too much of it.

She advises Maria to get plenty of rest

and promises to check up on her in a few days.

DR. JAN GARAVAGLIA About two days later, she called her,

knowing that her granddaughter wasn't feeling well.

[phone ringing]

Pick up, pick up.

And she couldn't get a response from her cell phone,

from her apartment phone.

And she started to worry about her.

So she went over to see what was wrong.

NARRATOR Berta lets herself into Maria's apartment.

At first glance, everything seems normal.

But as she rounds a corner in the kitchen,

the -year-old gets the shock of her life,

her only grandchild unresponsive on the floor.

Panicked, she immediately calls .

But it's too late.

Maria is pronounced dead on the scene.

Her sudden and mysterious death is now in the hands of Dr. G.

Woo, today, we have a woman, years old.

She's found dead in her apartment.

The grandmother found her.

NARRATOR As the body is prepared for transport

to the morgue, Dr. G's field investigators

begin searching the apartment for any relevant clues.

To me, this is going to be, is it natural?

Is it accident?

Is it trauma?

Is it heart?

Is it brain?

Or is it something we just don't know?

Hola, Abuelita.

NARRATOR Devastated by the news of Maria's death,

Berta paints a heartwarming picture of her granddaughter.

Happy and well-adjusted, Maria was in normal health

and led a quiet life.

According to the grandmother, she didn't smoke.

She drank socially, didn't use dr*gs.

NARRATOR But back in Maria's apartment,

Dr. G's investigators quickly uncover evidence that shatters

this picture-perfect image.

Hey, look at this.

They do find cigarettes, although the grandmother

said she didn't smoke.

And they do find alcohol in the refrigerator.

NARRATOR The grandmother's account

does reveal one unsettling episode

from Maria's medical past.
[ … ]

months earlier, she'd been hospitalized for a concussion

after a mysterious fall.

Dr. G turns to Maria's medical records for more details.

We got those records, and it's nothing

to do with a concussion.

She literally had bleeding over the brain.

She had a subdural and a fractured skull.

It looks like she'd passed out and hit the back of her head.

NARRATOR A subdural hematoma occurs

when blood from a damaged vein becomes trapped

between the surface of the brain and the layer of tissue

just beneath the skull, the dura.

It's most often caused by a head injury.

Maria was found lying dead on the kitchen floor.

The question is, could a second fall have k*lled her?

DR. JAN GARAVAGLIA She's on that tile floor.

She's had a subdural before.

So there is a possibility that head trauma

played a role in her death.

Hm.

NARRATOR Then, as Dr. G continues

to pore through Maria's medical records,

she stumbles across a startling and unexpected clue.

On that admission, she tested positive for cocaine.

NARRATOR And that's not all.

Also interesting is that I doubt that she just drinks

a moderate amount of alcohol because she has been

in the hospital for alcohol-related illnesses,

including pancreatitis.

NARRATOR Pancreatitis is simply the inflammation

of the pancreas, a vital organ that aids in digestion

and helps regulate sugar in the blood.

The condition can have several root causes.

But in Maria's case, the doctors at the hospital

concluded that her pancreatitis was caused

by chronic alcohol abuse.

So there's, you know, cocaine, alcohol, trauma,

maybe another fall.

We have a lot of possibilities.

We're really learning a lot about this woman

that this grandmother doesn't know.

NARRATOR It would appear that Maria

had not one but several dangerous secrets, any one

of which could have k*lled her.

Maybe she tripped and fell in the kitchen.

Maybe she was, you know, drinking.

Maybe it's just a drug overdose from her cocaine.

How bad was this habit?

NARRATOR It's time to take a closer

look at Maria Flores' body.

But Dr. G will not be conducting this autopsy alone.

You get into the picture.

And we'll let-- yeah.

NARRATOR Today, she will don her teachers hat--

You're a little dirty, but that's OK.

NARRATOR --as Dr. G's morgue prepares

to receive some new visitors, medical residents

from the Orlando Regional Medical Center.

If this was a homicide, the valuables would be put away.

These are doctors who've graduated

from medical school, who are now getting specialized

training in pathology.

It'd go right through here into the brain.

And pathology residency requires that they

do a month in a morgue.

You see how the brain--

And most of them don't want to go into forensic pathology.

And we realize this when they come in.

So usually, the grosser, the better.

No, no, no.

[chuckles]

We try to encourage them.

That stretchy--

But I'm sorry, you know, gross is

a part of forensic pathology.

And they have to see that part, too.

That clearly turns off a large percentage of our trainees.

Above the dura, right?

Did you notice how hard it was for me to tear that off?

So that's--

Well, what's special when they're

there is you have to watch them like a hawk [chuckles]

because you don't know if they're going to miss anything

or not.

So you have to be really careful,

be in the room with them.

You try to give them some autonomy

but keep watching them.

You have to see everything.

You just don't take their verbal.

I've been burnt by that before.

You just don't, oh, that looked fine.

No, let me see that.

So-- because they don't know.

You know, there's hardly any autopsies anymore done

in hospitals, very, very few.

And it's a shame because so much can

be found out by the autopsy.

You can sit here.

So in this case, we have Dr. Altenburger down here.
[ … ]

She's one of the trainees that come and spend a month with us

to not only learn forensics but also

learn the art of an autopsy.

We already have made fun of you with your GI thing.

It's true.

It's a great month, actually.

Being over there, you get to see a lot

of cases, a lot of variety.

We just thought it was cute that you want to go do GI,

and you can't stand stomach contents.

OK.

Dr. G's a great role model for women in medicine,

and especially in pathology and in training.

She's very to the point.

She's sort of a no-nonsense person.

And that's how I am.

And that's why I felt we always worked well together.

You can start taking off her clothes.

She's got some--

She is a shapely woman, attractive for

but kind of rough.

She looks like she might be a party girl.

What are her nails like?

Fits what I'm reading in her medical records

more than the sweet, school marm that I'm

getting from her grandmother.

She's out of rigor already.

NARRATOR With Maria's history of brain injury,

Dr. G focuses her attention on the head.

Yeah, I'm concerned about head trauma,

because we know she's already got one subdural hematoma.

She's got really thick hair.

I don't feel anything.

But it's, you know, when you have that, you know,

nice head of hair, it's kind of hard to feel.

I don't know.

You can see if you feel any.

NARRATOR Despite the absence of any obvious trauma,

a fatal head injury is still a likely suspect.

But Dr. G won't know for sure until she

performs the cranial exam.

That's why, you know, we'll really see

it once we cut the scalp off.

What are her nostrils like?

NARRATOR For now, she continues with a physical examination

of Maria's nose.

And here, she spots something amiss.

Uh-oh.

She's got one.

She has a huge nasal septal perforation,

I mean, a hole between the two sides of her nose about that

big.

You want to take her picture?

Yes, ma'am.

NARRATOR The nasal septum is the tissue

in the nose that divides the nasal cavity into two nostrils.

Based on her experience, Dr. G knows that a hole this large

usually means one thing.

That tells me she's a sniffer of cocaine.

And it's not just once or twice.

She's got a chronic problem with sniffing cocaine.

NARRATOR Dr. G completes her external exam with

an inspection of Maria's mouth.

In her mouth looks fine, no bite marks to the tongue.

And she has no lesions in her mouth.

And her teeth look pretty good, especially

for a chronic cocaine user.

NARRATOR So far, the external exam has shed some light

on Maria's unhealthy lifestyle.

But there is still no concrete clues as to how she d*ed.

This death could go in a lot of different directions.

NARRATOR Her hope now is that the internal autopsy will offer

up some definitive answers.

And there is where we got a surprise.

It was something I'd never seen before.

It was black.

[music playing]

NARRATOR -year-old Maria Flores was discovered

collapsed on her kitchen floor.

During the external exam, Dr. G was unable to find

any sign of head trauma.

We would go ahead and take it to there.

NARRATOR Now, she's about to open Maria's

head to take a closer look.

But Dr. G has another reason to be especially

interested in Maria's brain.

Unbeknownst to her family and friends,

Maria was wrestling with some internal demons--

cocaine and alcohol addiction.

I think there are some real possibilities dr*gs and alcohol

played a role in her death.

NARRATOR Cocaine use can cause a hemorrhagic stroke

or bleeding inside the brain from a burst blood vessel.

Cocaine elevates your blood pressure.

And when your blood pressure goes up

with that next cocaine dose, it might be enough to blow

that blood vessel.

I'm coming up on your left, Dr. G.

NARRATOR First, morgue technician Sandy Ludwig

uses an oscillating saw to open the skull.
[ … ]

Then, Dr. G steps in to remove the skull cap.

SANDY LUDWIG No?

I think I can get it.

NARRATOR It's the moment of truth.

All righty.

Now, when I take the calvarium off-- when I cut the brain--

No, no, no, no.

Look what we have.

--we have no fresh changes in the brain.

They all look old, from old trauma.

NARRATOR Dr. G also fails to see

any evidence of hemorrhaging.

Save the dura.

DR. DANA ALTENBURGER All righty.

NARRATOR After a painstaking examination of Maria's brain,

she's still without a cause of death.

Dr. G makes a standard Y incision across the torso,

cutting carefully from shoulder to sternum

to reveal the internal organs.

I don't really see anything too abnormal.

NARRATOR But as she takes a closer look

inside the abdominal cavity, one organ in particular

grabs her attention.

Oh, my. Look.

There is something that stands out.

She has a huge fatty liver.

Mm, that is one yellow liver.

NARRATOR A quick glance at the liver is all it takes for Dr. G

to reach another startling conclusion.

Maria's drinking was out of control.

It was one of the worst I've seen.

Oh, my.

For a -year-old woman, she must be a huge drinker.

Oh, thanks, Sandy.

NARRATOR But Dr. G is still concerned

about possible damage caused by Maria's

other addiction, cocaine.

And the organ most at risk--

the heart.

Cocaine can damage the heart in several ways.

One, because it does elevate your blood pressure,

it makes your heart work harder.

[heart b*ating]

NARRATOR With long-term use, cocaine can also

damage the lining of the blood vessels,

accelerating plaque buildup and narrowing

the coronary arteries.

So there's many ways it can affect your heart

and cause you to go into arrhythmia and die.

Oh, sh**t, she's got pleural effusions here.

SANDY LUDWIG There was a-- do we need to measure that much?

Yeah, let-- you might as-- well, this one's a little

worse than the other.

What's going on in here?

NARRATOR But after a thorough inspection,

Dr. G is surprised to find no signs of trouble whatsoever.

Her heart actually looks pretty good.

Coronary arteries were fine, no atherosclerosis.

There's nothing wrong with her heart.

You know, it's surprising that there's no heart

damage from the cocaine.

She skated the effects of cocaine on her heart.

And some people are like that.

Some people use cocaine once, and it kills them.

Some people use it for years and have no problem with it.

NARRATOR Next, Dr. G turns her attention to the lungs.

Now, I look at her lungs.

Now, her grandmother said she didn't smoke.

We did find some cigarettes in the apartment.

And I say, you can't lie.

There's black pigment in her lungs.

NARRATOR This finding confirms that Maria

was, indeed, a smoker.

But Dr. G notes nothing else remarkable about Maria's lungs.

My Kn*fe is dull already.

I'll get a new one.

That's fine.

NARRATOR Next stop, the pancreas.

Dr. G knows from Maria's medical records

that she had been treated for pancreatitis

associated with alcoholism.

You know, most of the pancreatitises, about %,

are mild to moderate.

Severe pancreatitis, where the pancreas

literally starts necrosing and dying,

that's a medical emergency.

And you can die from that.

NARRATOR But once again, she's caught off guard by what

she sees, or doesn't see.

When I look at it, I see the evidence of old pancreatitis.

But I don't see anything, ugh, that

would cause her death today.

NARRATOR As Dr. G reaches the end of the autopsy,

she is still empty-handed.

And her options are running out.

You know, I've got some possibilities, why she d*ed.

But we've got our work cut out.

NARRATOR Dr. Altenburger begins the dissection of the stomach

and the esophagus, the muscular tube

which allows food and liquid to pass from the mouth
[ … ]

to the stomach.

And there is where we got a surprise.

And so the esophagus you sort of open

after you open the stomach.

And I was opening it.

And I didn't-- it was black.

And then she goes, oh, we've got something weird.

And I'm thinking, oh, you know, she's

not used to doing autopsies.

Probably something that we see all the time.

So I go over.

Oh, wow.

And lo and behold, it is something weird.

Huh.

It was something I'd never seen before.

It was a black esophagus.

NARRATOR A healthy esophagus is usually

white with a pink tinge.

Maria's is as black as coal.

When you see something like that, when you're in training,

you don't know if it's rare because you've never seen it

before or it's a rare entity.

And she says, what is that?

And I look.

And I said, it's a black esophagus.

I've never seen that before.

I don't know what that is.

I don't know.

NARRATOR The question now is, what could have

triggered this bizarre symptom?

And did it have something to do with Maria Flores' death?

I love a mystery.

I wouldn't be in this job if I didn't love mystery.

So I have to go figure this out.

[music playing]

DR. JAN GARAVAGLIA That is black.

NARRATOR Dr. G and medical resident Dr. Dana Altenburger

are still reeling from the discovery

that -year-old Mario Flores' esophagus is black,

a first for Dr. G.

You know, this is part of the process.

You don't know everything.

You can't be ashamed to say you don't know things.

NARRATOR Dr. G's next step--

figure out what caused Maria's esophagus to turn black

and what, if any, role it played in her death.

Dr. G's first thought is that Maria could have swallowed

something, either accidentally or intentionally,

that was poisonous enough to destroy her entire esophagus.

DR. JAN GARAVAGLIA You know, something caustic

could do that.

You know, one of the things that I was worried about

is maybe lye that had maybe caused damage to the Esophagus.

NARRATOR Lye is a caustic substance commonly used

in the manufacturing of products, such as paper, soaps,

detergents, and drain cleaners.

Because of its corrosive properties,

lye can be highly toxic.

But Dr. G is forced to quickly abandon this theory for one

very good reason.

Maria's external exam showed no damage to the mouth.

Usually, people who drink lye will

also have lesions on their lip.

She had no lesions in her mouth.

NARRATOR Dr. G also notes that the black coloration stops

abruptly at the GE junction, the gastroesophageal junction,

where the esophagus meets the stomach.

And what's in her stomach?

Mostly nothing.

Huh.

And her stomach didn't have any lesions with it also.

I've never seen this before.

A caustic agent wouldn't just affect her esophagus.

I'm not sure what it is.

NARRATOR At this point, the physical examination

of Maria Flores has gone as far as it can go.

We definitely need to look under the microscope.

And we need to hit the books.

We have to figure out what is causing this black esophagus.

NARRATOR Dr. G begins by looking at sections of Maria's

esophagus under the microscope.

And I look at those sections, and it's necrotic.

It's dead.

NARRATOR Her next stops are the morgue library

and the internet.

After several hours of painstaking research,

she finally hits on a diagnosis, acute esophageal necrosis.

In this study, we analyze--

NARRATOR Acute esophageal necrosis, or black esophagus,

is an extremely rare condition in which

the esophagus literally dies inside a living body.

It's not in any book.

I had to find some articles on it.

I've been in practice years.

And I've probably seen it three or four times

spanning my entire career.

In one article, they looked at all the cases

that have been reported in the literature

over a -year period.

And there were only .
[ … ]

But there's clearly, this is underreported.

I know for over years of doing autopsies,

I've never seen it.

Nobody in my morgue had seen it.

NARRATOR Acute esophageal necrosis was first described

in and is found in approximately

out of every , endoscopies.

It has a mortality rate of %.

If it's caught early, half the patients can survive.

But if it is a deep injury, death is inevitable.

And it's usually within a few days.

NARRATOR In Maria's case, the damage to her esophagus

was so extensive that Dr. G's certain it trumps

any other cause of death.

At first glance, Mario Flores would

seem to be an unlikely candidate for such a rare disease,

except for one thing.

It does, in the literature, seem to be

associated with some things.

And you know what it's associated

with a lot of the cases?

Chronic alcohol abuse.

In the cases I've seen over the years,

there's either been alcohol and a predisposed individual

who has other medical problems, or alcohol and substance abuse.

NARRATOR Armed with this new information,

Dr. G can now piece together the final moments

of Maria Flores' short life.

It's PM on Friday evening, and Maria has

just returned home from work.

Feeling unwell, she calls her grandmother for some support.

Clearly, she's sick.

Flu-like symptoms, probably just not feeling well.

[coughing]

NARRATOR But what's going on inside of her body

is far from the flu.

[coughing]

NARRATOR Maria's esophagus is damaged beyond repair.

Black esophagus is caused by loss of blood supply

of the esophagus, whether that's injury due to a chemical

constricting the arteries or a loss

of blood supply of the esophagus due to other causes.

So it's probably multifactorial,

meaning, you know, the perfect storm that a lot of things

have to come together to cause this.

NARRATOR Due to this loss of blood,

Maria's esophagus begins to die.

When you start having necrotic tissue

or dead things inside of you, you know,

your body starts reacting--

[coughing]

DR. JAN GARAVAGLIA --to that.

And it starts sending off chemicals that start a cascade.

She's probably wondering what's happening to her.

She's getting lightheaded.

She's probably throwing up blood.

She's getting sicker and sicker.

And she probably just loses consciousness,

and hits the floor-- [thump]

--and dies.

NARRATOR But why this happened to Maria remains a mystery.

How does it happen, though?

And that's really the million-dollar question

that nobody seems to know.

Whatever this perfect storm is, alcohol

seems to play a prominent role.

Why it occurs in some people and not others,

and why it's so rare, nobody knows.

NARRATOR It's a tragic end to a life that came all too

soon for those she left behind.

Yeah, this is Dr. Garavaglia.

NARRATOR Finally, Dr. G is able to give Maria's

grandmother some conclusive answers

about her granddaughter's death.

DR. JAN GARAVAGLIA Her grandmother

was really surprised when I told her the cause of death.

But I think she was most surprised

about her cocaine habit, and her alcoholism, and her lifestyle.

She had no idea that her granddaughter was like this,

even though she felt very close to her.

You're only here a day or two, right?

NARRATOR As resident-in-training Dr.

Altenburger prepares to leave the morgue,

she reflects on the challenges that

come with doing Dr. G's job.

I think being around death every day is kind of hard.

But it definitely makes you appreciate

being young and healthy, and having your family around,

and having a good family.

NARRATOR As for Dr. G, the case serves

as a reminder of why she became a medical examiner

in the first place.

This case is what makes forensic pathology fun for me.

You've never seen it all.

It's fun to see things you've never seen before that occur

inside the body, to look up what's going on,

to teach it to trainees.

That's what makes forensics so wonderful.

You're always seeing something new.

[music playing]
[ … ]

NARRATOR And Dr. G's next case is even twice the mystery,

a bizarre double homicide.

They were not only in bed naked, they were dead in bed

naked.

[music playing]

NARRATOR Orange and Osceola Counties'

chief medical examiner Dr. Jan Garavaglia

starts her day like any ordinary working professional.

First, she checks in with her staff.

NARRATOR Then she settles into the office.

This is where Dr. G's job becomes different from most.

And today's case is even more out of the ordinary than usual.

DR. JAN GARAVAGLIA Today, I've got a double.

We have a -year-old woman and a -year-old man.

NARRATOR The woman's name is Carla Belden,

and the man is Dylan Wright.

Right now, they're on separate trays.

But yesterday they were together in bed.

NARRATOR It's Thursday afternoon.

And Dylan's brother Jason stops by for an impromptu visit.

JASON WRIGHT Dylan.

NARRATOR After finding the door unlocked, he lets himself in.

But no one appears to be home, until he gets to the bedroom.

From the hallway, he can clearly see

his brother is still in bed.

And he's not alone.

He found his brother on top of this woman, naked.

NARRATOR Embarrassed, he turns to leave.

But then he makes a horrifying realization.

They are not moving, and the pillows are soaked in blood.

They were not only in bed naked, they were dead in bed

naked.

And he immediately is freaked.

NARRATOR Jason calls in a panic.

[siren]

Within minutes, police arrive and tape off the area,

declaring it a crime scene.

Looks like they were in the act of love,

and something bad happened, because it

looks like they both have g*nsh*t wounds to the head.

NARRATOR Investigators immediately begin

to document the crime scene.

And as they separate Carla and Dylan,

they discover a surprising piece of evidence.

There's a g*n there.

And the g*n is still in his hand.

[camera]

NARRATOR Two lovers sh*t dead, with the potential m*rder

w*apon lying between them.

Now, it's up to Dr. G to figure out exactly what happened.

Dr. G begins her examination by ordering

X-rays on both victims.

When you have a g*nsh*t wound, X-rays are always taken first.

We want to see if there's a projectile

that needs to be recovered.

Or should I be looking for an exit wound?

NARRATOR While technician Brian Machulski

X-rays Carla and Dylan, Dr. G pours

over the investigator's report.

Shoes were in the bathroom, clothes

on the top of the dresser.

NARRATOR And midway through, a critical detail

catches her eye.

This is not his wife.

This is his girlfriend.

Hm.

This is a married woman.

And her husband is alive and well.

JASON WRIGHT They've been together for a while.

NARRATOR Police learn from Dylan's brother

that Carla's marriage had been failing for years,

and that she was working up the courage to leave her husband,

Lee.

Now, investigators wonder if Lee finally

discovered Carla's affair and decided to put

an end to it permanently.

DR. JAN GARAVAGLIA I don't know about the husband.

Maybe he caught them by surprise and sh*t them.

Maybe the husband just put the g*n in his hand.

So it could be a double homicide.

We know that they both d*ed of g*nsh*t wounds.

That's not the mystery.

The mystery is going to be, really,

who sh*t who, what happened?

NARRATOR From the X-rays, Dr. G can clearly

see that both Carla and Dylan each have

one b*llet in their brains.

The b*llet completely goes through the brain

but only partially exits the skull.

Now, people think that a b*llet is just

going to make a little hole right through your brain,

and that's the only damage you get.

No, because there's kinetic energy, which gets

departed from that b*llet to your brain.

And at-- and it's almost as though

like a temporary cavity forms.

So the b*llet may be only, you know, / of an inch across.

But the damage to your brain is much wider

than the width of that b*llet.

NARRATOR But the extent of the damage
[ … ]

doesn't tell Dr. G who fired the g*n.

For that, she must scour the bodies

for any evidence that could point her

in the direction of a suspect.

So we've got our work cut out.

And we're going to have to get started.

I think I'm going to do her first.

NARRATOR Right off the bat, Dr. G observes a possible sign

of trauma on Carla's face.

Huh.

The upper eyelid is swollen and kind of blackish-blue.

There's blood coming out of her nose.

There's blood coming out of one of her ears.

If you looked at her face, it would

look as if somebody hit her.

Let's get a towel.

We'll clean it up, and just take another picture this way.

I think it's a little easier--

NARRATOR Now, Dr. G considers the possibility that Carla was

beaten before she was m*rder*d.

Maybe they held her down.

Somebody-- there was a struggle.

There was a fight, you know, bringing her to the bed.

Yeah, she's got a little on her face, too.

NARRATOR But on closer examination,

she recognizes that there is another explanation

for these gruesome injuries.

You have to look at the whole picture.

Sorry.

The bruising of the eye is not bruising of the eye.

It's actually blood seeping down from a fracture

of the base of her skull, from that g*nsh*t wound.

The blood coming out of her ears,

from a fracture, same as the blood coming out of her nose.

NARRATOR Dr. G concludes that these injuries

appear to be the direct result of the g*nsh*t wound.

But she must examine the wound to be sure.

As she completes Carla's external exam,

she finds no further indication of trauma

or a physical struggle.

But she's still no closer to answering who sh*t Carla

and how.

I really need to look at the wound.

We need to know all the facts.

[music playing]

NARRATOR Using a digital camera,

morgue technician Tom Hemphill assists Dr. G as she documents

Carla Belden's g*nsh*t wound.

And I'll look at that wound very

carefully before I do anything.

But all that blood there makes it difficult to really see

what's going on.

So we gently clean the wound.

NARRATOR Yesterday afternoon, Carla was found with her lover,

Dylan, naked in bed, each with a b*llet wound to the head,

and a g*n in Dylan's hand.

Police suspect that Carla's enraged husband, Lee,

discovered the affair and sh*t them both,

then planted the g*n to cover his crime.

Now, detectives are relying on Dr. G

to help them catch the k*ller.

The pressure is to come up with anything

I can to help them out.

All right, let's see.

The only thing that's going to give us a hint

is looking at the wound, itself.

So that's going to help me determine maybe what happened.

inches.

NARRATOR Dr. G's next step is to carefully

examine Carla's g*nsh*t wound.

What's the angle of the g*nsh*t wounds?

Were they distant g*nsh*t wounds?

TOM HEMPHILL Do you want the whole thing

or just close up here?

DR. JAN GARAVAGLIA Nah, I just want kind of like this,

just so you could see that the scalp

is, there's nothing else there.

You know, it would make my autopsy a lot faster if I could

just look at the wound, say, yeah, this is what it is,

and let's go.

But there are some steps you have to take.

That's good.

So I measure it how many inches above the ear

canal, and how many inches in front of the ear canal,

and then how far from the top of the head.

The central defect's a little more than a half

inch by half inch.

It's about an inch or so above and a little

bit in front of the ear, in the left temporal region.

NARRATOR After measuring the dimensions of the wound,

Dr. G prepares to look inside it.

When you fire a g*n, not just the b*llet comes out.

But you have gases that were produced

by the expl*si*n of the primer and the gunpowder.

You have the soot and the smoke, which is

the product of the combustion.

And you have also unburnt gunpowder that comes out.

NARRATOR If the sh*t was fired from a distance,

there will be little or no residue inside the wound.

With a steady hand, she cuts the scalp from ear to ear,
[ … ]

then peels it back.

And there, she gets her first look at the inner aspect

of the b*llet hole.

I see the soot.

And the gunpowder is deposited on the inside

of the wound, not the outside.

So what that tells me is it's a tight contact wound.

And the end of the barrel was in tight contact with the skin.

So it's not like she was sh*t from the other side

of the room.

NARRATOR Now that Dr. G is certain that Carla suffered

a contact wound, her next step is

to map the b*llet's fatal path.

The path goes through both the left

and the right cerebral hemisphere,

through the deep structures of basal ganglia,

and partially exits the skull on that right side.

Basically goes from left to right, slightly back to front.

NARRATOR This direct line from the left temple to the right

gives Dr. G a crucial clue.

Oh, gosh.

This is very consistent with a su1c1de.

NARRATOR And the unexpected finding

leads her to wonder about another even

more bizarre scenario, one that she

hadn't considered until now.

Could this be maybe a double su1c1de?

Maybe she sh*t him herself, and he gets on top

and sh**t himself?

Was it some kind of su1c1de pact?

NARRATOR Having already uncovered a trail of baffling

clues, Dr. G begins the next autopsy

in this mysterious double k*lling,

and is shocked by what she sees.

I find something totally unexpected.

[music playing]

NARRATOR Carla Belden and Dylan Wright

were both found naked and dead in the same bed.

Were they m*rder victims or driven to a bizarre su1c1de

pact?

We're hoping that, actually, his autopsy

adds a little bit more to this puzzle to give us some answers.

NARRATOR Repeating the same steps on Dylan

as she did with Carla, Dr. G methodically studies the b*llet

hole on Dylan's right temple.

Once I do all those measurements,

take all those pictures, and document it on my diagram,

then we can look on the inside and see what that wound did.

NARRATOR She carefully cuts through the scalp

and peels it back over the bone.

I see the same thing on the inside of his wound

that I saw on her wound.

I saw that blackening.

All the soot, all the gunpowder is deposited inside the wound.

And then there's a slight amount of searing

on the edge of that wound--

pretty classic contact wound.

NARRATOR Now, Dr. G can confirm that both Carla and Dylan have

contact wounds to the head.

But this finding alone is not enough to prove

either a homicide or su1c1de.

Next, Dr. G begins a careful review

of all the facts before her.

And it isn't long before she homes in on one

seemingly mundane detail.

That's one of the pieces of information we find out

is that she is right-handed.

The most telling part is that it's

on her left temporal region, and she's right-handed.

She didn't pull that g*n herself.

NARRATOR This, along with the findings from the scene,

leads Dr. G to conclude that Carla's death is not a su1c1de.

To really understand what's going on here,

you really have to do the totality

and see how all these facts are put together.

NARRATOR And with the clues falling into place,

she now has a clear picture of how Dylan d*ed.

It's on his right temple.

He's right-handed.

The g*n is in his right hand, and it

is also a tight contact wound.

NARRATOR The evidence of two contact wounds

provides Dr. G with the missing link needed to disprove

the double homicide theory.

You can maybe do one contact wound.

But the other person's going to get the heck out of there,

or at least move away.

I would find it difficult that the husband

could have surprised them both with two contact wounds.

NARRATOR This leads Dr. G to her final conclusion.

So it really looks as if this is a homicide-su1c1de.

She's a homicide, but he's a su1c1de.

And it looks like he did both of them.

NARRATOR Dylan k*lled Carla and then k*lled himself.

But the question now is why?

And as Dr. G turns this over in her mind,

she comes across a critical piece of the puzzle

that might just explain it.

I find something totally unexpected.

I forget about that g*nsh*t wound for a second
[ … ]

because there I see a mass.

I see a meningioma, a tumor.

NARRATOR For Dr. G, this finding

may impact the entire case.

And, finally, she can describe for the police

and the families exactly what transpired

in the couple's final hours.

[chimes]

It's a sleepy Sunday afternoon.

And Carla Belden is busy enjoying it with her boyfriend,

Dylan Wright.

Sadly, she probably has no idea that he's in the crosshairs

of a serious natural disease, a brain tumor

called a meningioma.

Finding that meningioma was a complete surprise.

Although we took an X-ray of his head,

you wouldn't see that, necessarily.

Well, it would be easy to see with a CAT scan or an MRI.

But we just took regular plain films to look at the bones

and to look for b*ll*ts.

And you don't really see the soft tissue very well.

This was a big mass.

This is about, you know, almost inches

in size, kind of a white-tan color.

And when you cut it, it's firm and kind of rubbery feeling.

And this is compressing into the brain

in the right parietal region, over the top of the brain.

And it's like driving itself into that brain

and causing a divot in that brain, which was quite deep.

OK.

So when you remove it, you could actually

remove this in a whole piece.

And the brain is left with an indent--

a very marked indentation.

Another, probably, of this one.

Just, like--

It's like an indentation, like you'd leave, you know,

a heavy object on a cushion.

And you'd leave it-- but this isn't going to bounce

back, at least anytime soon.

NARRATOR Dylan's family confirms

that he suffered severe headaches

and was increasingly despondent from the pain.

So whether this tumor could have affected his personality,

and maybe made him more depressed,

you know, that's a possibility, too.

NARRATOR And as Dr. G reviews the toxicology report,

she discovers another factor that

may have contributed to Dylan's fragile state of mind.

He's over twice the legal limit of intoxication,

which isn't surprising.

A lot of our suicides have alcohol on board,

maybe even up to a third, because what does alcohol do?

Alcohol decreases your inhibition,

maybe just enough to cause you to act

upon some of these impulses.

NARRATOR Under the influence of alcohol,

and suffering from the effects of a brain tumor,

Dylan does the unthinkable.

He wanted to commit su1c1de.

And on their weekly meeting, their little tryst,

he had the g*n hidden somewhere, possibly under the mattress.

NARRATOR Carla slips into bed with Dylan.

And when their bodies are fully intertwined, he makes his move.

He takes the g*n from his hiding place,

places it tightly to her left temple, pulls the trigger.

[g*nsh*t]

NARRATOR The b*llet explodes into her skull

and kills her instantly.

Why he wanted to take her with him

is only going to be known to him.

But, you know, maybe he truly wasn't in his total right

mind because of that tumor.

NARRATOR Now, it's his turn.

He takes the g*n, also puts it tightly

against his right temple, and pulls the trigger.

NARRATOR A victim of his own v*olence, Dylan

dies in a tragic embrace.

[music playing]

Dr. G's autopsy findings bring closure

to those whose lives were devastated

by this double sh**ting.

MALE SINGER (SINGING) In the background.

I think her husband's off the hook.

The forensic evidence suggests that he

didn't have a role in this.

He also had an alibi, which checked out quite well.

NARRATOR Most gratifying of all, Dr. G

provides Dylan's family with something tangible

to help them come to terms with the catastrophe.

DR. JAN GARAVAGLIA But I talked to the brother.

And I think the tumor, and finding that tumor, helped

them somewhat understand why their brother would have

just, out of the blue, do this.

[music playing]

You never know in forensics what piece

of information is going to be important and what piece isn't.

[chords]

MAN (WHISPERING) Atlas.