05x11 - Hidden Hazards

[bunniefuu]

[music playing]

NARRATOR The sudden death of a -year-old man baffles Dr. G.

But what's going on, we don't know.

You just really have to keep an open mind.

NARRATOR And when the thr*at of a deadly bacteria surfaces,

all bets are off.

Basically, you're putting the TB bacteria back in the air.

We're definitely going to have to use our masks today.

NARRATOR Then a man is found dead in bed

and his family is left fearing the worst.

They're worried about depression.

They're worried about a su1c1de.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations, these are the everyday cases of Dr. G,

medical examiner.

DR. G So we have to pick up Eric tonight,

and then we have to go to dinner.

Do you have anything--

NARRATOR Dr. Jan Garavaglia's husband, Dr. Mark Wallace,

is her best friend, confidant, and also

her most trusted colleague.

Oh, thanks for stopping by.

Mark and I talk about cases so much

he's become our official infectious disease

consultant for our office.

See all that fat?

You'll see fat, clear cells?

Yes.

It's funny.

We've always-- when we were in medical school together,

we used to love to study together

and talk about medicine.

I mean, that's just so much of a part of our relationship.

Infectious disease and pathology

have a lot of overlap, actually, so I enjoy

hearing about her perplexing cases

and seeing what input I can have into those.

NARRATOR Recently, one such case especially

piqued Mark's interest, that of a -year-old immigrant

named Diego Cardoza.

DR. G So today's case is really quite sad.

We have a -year-old Guatemalan man

that's living in a kind of ramshackle house

with no electricity.

He's borrowing electricity from his neighbors

with extension cords.

NARRATOR Diego has been working as a day laborer

for the past several years.

But with construction jobs rapidly drying up,

life is becoming tougher than ever.

Obviously doesn't have a lot of money.

NARRATOR He's also recently divorced,

but he and his ex-wife Clara share custody

of their daughter, Michelle.

Unfortunately, it's during one of Michelle's weekend visits

that tragedy strikes.

It's a bright and beautiful Sunday,

and Michelle finds her father on the couch feeling tired.

She offers to make him breakfast so he can get some extra rest.

She just thought he was sleeping.

NARRATOR When the meal is ready, she goes to wake him.

But no matter what she does, her father won't open his eyes.

She finds him unresponsive and realized

something was really wrong.

She runs over the neighbor's.

He runs over.

Diego?

DR. G He calls and they try CPR.

But they try to work on him, but they don't even transport him.

He's obviously dead.

NARRATOR Michelle is confused.

And when her mother, Clara, arrives,

she too is frightened by the unexpected turn of events.

DR. G What's going to cause a -year-old man to die

in front of his daughter?

NARRATOR Now Michelle and Clara's hopes for an answer

lie in Dr. G's hands.

But as she reads through Diego's case file,

she is dismayed to find it contains

no medical records that could help her investigation.

Because he doesn't go to the doctor.

He's from Guatemala, he doesn't have a lot of money.

NARRATOR Even worse, her investigator

is only able to gather shreds of information

from Diego's family.

DR. G There's a problem.

The history is not real good because there's

some language barrier.

His family doesn't speak English.

The neighbor speaks very little English,

and we don't seem to be able to get what's going on.

NARRATOR But the investigator does manage

to uncover one key piece of evidence,

and it has to do with the well water system in Diego's house.

DR. G Even though we have some problems with translation,

their theory came out very clear to us.

Their theory is that he has got bad well,

there's something wrong with the well,

and it's the bad well water that k*lled him.

DR. MARK WALLACE When people have private wells--
[ … ]

and about or million Americans

have private wells as their source of drinking water--

they can get contaminated by a number of different ways.

One of the more common ways is if contaminated water

like sewage leaks into your well.

NARRATOR Sewage can contain harmful bacteria

such as Salmonella and E. coli, which when ingested

can infect the intestines, causing severe diarrhea.

Now, does this man have diarrhea?

That's not coming through the translation.

But maybe he's not telling anybody he's got diarrhea.

NARRATOR Most people would eventually recover.

But if Diego was already sick or had a weak immune system,

the infection could have easily grown deadly.

DR. G So I'll keep it in the back of my head and we'll see.

NARRATOR But then Dr. G discovers

another major red flag in the report,

one that spins the case in a completely different direction.

DR. G The next door neighbor stated he'd been complaining

of chest pain for a couple weeks and he

hasn't been feeling well.

NARRATOR And there's something even more alarming.

The neighbor thought he was coughing up some bloody fluid.

Now, that does open up a whole list of things

that it could be because you shouldn't be coughing up blood.

Some serious symptomatology if that's true.

Could be pneumonia, could be lung cancer.

It appears he does smoke.

But you know, I really--

I'm more concerned that he's got TB.

TB can be very destructive to your lungs.

It can cause you to cough up blood.

NARRATOR TB, or tuberculosis, is a lung disease most common

throughout the developing world, but it's also still

present in the United States.

Highly contagious, it's caused and spread

by airborne bacteria.

Usually, you catch it from another infected person

who's coughing or speaking.

And you inhale the bacteria, the tuberculosis bacteria,

and it lodges in your lungs.

And it may produce an infection quite rapidly.

DR. G Keep in mind, he's coughing up a storm at home.

So if he's really coughing due to TB,

you know, the people that are around him-- his daughter,

his neighbor, any of his family members

that have seen him-- are at definite risk of getting TB.

NARRATOR But given the lack of information,

it's impossible to say for sure what was behind Diego's cough.

It's now up to Dr. G to figure out exactly what took

the life of this young father.

DR. G You just really have to keep an open mind

of what could happen.

NARRATOR Dr. G and her staff begin Diego's

autopsy with a critical step--

gearing up with extra protection.

We always take precautions.

We always use universal precautions

as far as gloves and gowns.

But since there is a possibility of TB, there is some infection,

we're definitely going to have to use our masks today.

The greatest infectious danger to people

who work in the morgue, like my lovely wife, is tuberculosis.

The person is not coughing anymore for sure,

but as organs are removed or dissected or cut up,

basically, you're putting the TB bacteria back in the air.

OK.

NARRATOR Fully protected, Dr. G begins

Diego's external examination, and her first impression

is not a good one.

He looks ill.

You know, some people--

I know everybody's dead that comes through my morgue,

but some people look better than others, and he looked ill.

NARRATOR The question is, what made him so ill?

Dr. G begins scouring Diego's body for clues.

And as she peels back his lips, she finds a peculiar one.

I do notice in his mouth something

odd for a fellow that's never been,

supposedly, to the doctor.

Looks good.

NARRATOR He has braces on his teeth,

but half dismantled with only the brackets in place

and no connective wire.

DR. G I found it really are they need to have

these brackets on his teeth.

NARRATOR But that's not all.

DR. G We do see that he's got some periodontal disease,

some gum disease.

NARRATOR Gum disease is caused by bacteria in the mouth,

and severe cases can lead to serious infections

elsewhere in the body.

But Diego's case looks benign.

DR. G I would classify him as having periodontal disease,

you know, mild to moderate.

Let's see.

NARRATOR Dr. G Now focuses on the possibility

that Diego d*ed from drinking contaminated well water.

She first looks for signs of dehydration, the hallmark

of severe diarrhea.
[ … ]

DR. G The way you diagnose diarrhea

externally is by looking at his skin texture,

by looking at his eyes, if they kind of have

that dry, sunken appearance.

NARRATOR Carefully, she examines

his eyes and the elasticity, or turgor, of the skin.

In this case, you know, his skin turgor looked fairly good.

He doesn't look dehydrated externally.

NARRATOR But then a subtle clue catches her eye.

DR. G He does have a slightly distended

abdomen, a little firm.

NARRATOR And this distinction could very well

be from diarrhea expanding his bowels.

Dr. G now wonders if the family's

theory is correct after all.

DR. G You know, the family still

thinking he's dying from the contaminated well water.

So you know, I'll look for evidence of diarrhea

in his bowels.

Certainly, we won't know until we get in.

We'll see.

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NARRATOR Dr. G cuts down the torso

of -year-old Diego Cardoza.

His family believes that he d*ed from drinking

contaminated water.

Now she's on the hunt to see if this was indeed the case.

So we open up his body and I look in his abdomen.

I can see right away that his bowels are distended,

and there looks to be some early decomposition already.

NARRATOR The rate of decay in a dead body varies greatly,

depending on environmental conditions

and how long it's been since death.

In Diego's case, his daughter Michelle

remembers only an hour passing between the time

she saw him alive and when she found him dead.

DR. G Now, it was hot in Florida in this time of year.

He d*ed in the summer and the temperatures in the mid-s,

and so you are going to decompose quickly.

But he really wasn't out there that long.

His decomposition is a little more accelerated than I expect.

NARRATOR The condition of Diego's distended bowels

could indicate that he was fighting a waterborne infection

shortly before he d*ed and that the bacteria

had spread into his blood.

Part of the process of decomposition

is the bacteria that get into your tissues

and start breaking down your tissues.

And this gets accelerated when you're sick

and you've already got the bacteria in your bloodstream.

So did he have diarrhea that then went systemic?

NARRATOR As a next step, Dr. G carefully cuts

through several sections of his intestines.

But they just seem to be distended with gas.

Really, nothing about his bowels suggested he'd had diarrhea.

NARRATOR So far, she has no evidence

that substantiates the family's fears about contaminated water.

But Dr. G now faces a daunting question--

if bad well water didn't k*ll him, what did?

DR. G Well, he had a cough for two weeks

and he didn't go to the doctor, and he's coughing up blood.

So I think the money is going to be in his chest area.

So I cut through the ribs and take that off,

and that'll expose both the right and left

pleural cavity and the pericardial sac

where the heart sits.

And that's where I see trouble.

In the right pleural cavity, he had , ccs

of bloody brown fluid.

That's a lot of fluid.

That's, like, more than a liter of soda,

you know, poured into your cavity where your lung sits.

There's something terrible going on.

This is pleasant.

NARRATOR Right away, she extracts

and dissects Diego's lungs, and what she discovers is alarming.

DR. G He's got necrosis, or dead tissue,

inside of his lungs with bloody, kind of gelatinous material.

NARRATOR But there's a major problem.

The tissue is so damaged she can't tell with her naked eye

what caused it.

DR. G So I definitely can't make this diagnosis so clearly

from just looking at his lungs because whatever

he has going on in those lungs, it's been going on for a while.

It's more than pus.

I don't know what's going on with this guy.

But to me it looks infectious.

So it's worrisome.

It's a bad sign.

There's a lot of destruction to the lung.

We see that with TB.

NARRATOR To find out if Diego d*ed of TB,

Dr. G carves a few pieces of tissue from each lung.

She also takes samples from every abdominal organ

and sends them off to the lab to have them stained and mounted

onto microscopic slides.

All she has left to do now is examine the heart and brain.

But the heart looks fine, and there

is nothing to indicate that his brain was the cause of death.

NARRATOR With the autopsy complete,
[ … ]

Dr. G is convinced that Diego's lungs

hold the key to his death.

But how and why remain complete mysteries.

What is causing the severe damage to the lung?

I'm definitely going to have to put together what's going on

here, really see what happened.

[music playing]

OK, tell me what you want in your salad, though.

NARRATOR At the end of a long day at the morgue,

Dr. G makes time to unwind with her son Eric and her husband,

Dr. Mark Wallace.

DR. G OK, more cutting and slicing over here.

NARRATOR But it's not long before the conversation

turns to work.

DR. MARK WALLACE There's a lot of overlap and our two jobs,

so it's very easy give and take.

And occasionally we get good ideas from each other.

NARRATOR Tonight they discuss Dr. G's most recent case, that

of -year-old Diego Cardoza.

And I said, you know, I had a guy,

and his family keeps thinking he's sick from the well water.

But he's coughing up blood, and at autopsy he's got a bad lung.

DR. MARK WALLACE It's an unusual case

to see this much lung destruction,

and especially in somebody who dies at home.

DR. G Is it TB?

I'm still very worried about TB.

The problem is we don't know the cause of his lung problem.

I'm going to have a look under the microscope.

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NARRATOR A week after Diego's autopsy,

Dr. G receives the complete set of his microscopic slides.

DR. G Let's see.

NARRATOR First, she quickly scans

through his various organs, searching

for any disease she may have missed with her naked eye.

And there in his liver, she spots an unexpected clue.

There is evidence of some early cirrhosis,

early fibrosis in his liver, which suggests--

because in this country, still the most common cause

is going to be alcohol abuse.

NARRATOR But from what she can see the trauma to his liver

was not severe enough to k*ll him.

Next, she turns her attention to the damaged lungs.

Your lungs should be like a sponge, think of it,

but with tiny little holes.

And those holes, in this case, under the microscope,

are either filled up with white cells

or they're filled up with almost a fibrous tissue.

And that may not mean anything to the layperson, but to me

it means there is clearly an infection going on.

There's clearly an infection going on for a long time.

NARRATOR But she's surprised by one thing.

The infection doesn't look like TB at all.

It looks like it's something bacterial,

but it's not just one bacteria.

It's multiple bacteria.

It's called what we call a mixed flora, mixed bacteria.

He's got some rods.

Some are skinny, some are round.

NARRATOR This unusual discovery gets Dr. G thinking

about another finding, one she noted

at the very beginning of the autopsy that at first seemed

inconsequential.

Suddenly, it all comes together.

And with these two clues, Dr. G can finally

explain the chain of events that led directly

to Diego's tragic death.

It's PM on a Friday and Diego Cardoza

couldn't be happier.

His only daughter Michelle is visiting for the weekend,

and he's determined to enjoy his time with her,

even though he's been feeling a bit sick for the past couple

of weeks.

He's been complaining of some chest pain.

He's had some cough.

But Diego is more than a little sick.

He's contracted a massive bacterial infection

in his lungs that's slowly k*lling him.

And based on the mixed flora she saw in the microbes,

Dr. G has a strong suspicion as to where the infection began.

Those bacteria came from his mouth.

Those bacteria came from the periodontal disease.

They were hiding around the teeth.

NARRATOR Dr. G believes that Diego aspirated, or inhaled,

bacteria from his mouth down into his lungs

and developed a condition called aspiration pneumonia.

DR. G You know, many of us, believe it or not,

aspirate in our sleep.

But we have a mechanism, you know,

we have gag reflex that help clear that bacteria.

NARRATOR But Diego has a number of strikes against him

that may have compromised his ability

to fight off the infection.

First, the possible evidence of heavy alcohol

use Dr. G saw in his microscopic slides.

DR. G I think the fibrosis in the liver

gave us a hint that he probably did drink.

And the number one reason in the United States

where that gag reflex doesn't work well
[ … ]

would be alcoholism, being passed out.

So with that, I suspect that a couple weeks ago,

when nobody would know, he drank enough to pass out.

While he passed out, he probably aspirated some oral secretions."], index ,…}

And in those oral secretions there

were a heavy load of bacteria because

of his periodontal disease.

NARRATOR And with a weakened gag reflex,

the bacteria slip easily into his lungs.

That's strike two for Diego.

Those bacteria then start to multiply.

The body starts trying to fight off that infection.

And eventually, the infection takes over that long.

But most people don't die from that.

In fact, the mortality rate is probably less than %

because it's easily treated.

We have places in the city where people can

go to get care free of charge.

He could have even gotten the antibiotics, in this case,

free of charge.

But he didn't avail himself to these services.

NARRATOR Diego ignores his own symptoms,

and that's strike three.

Now, two weeks after inhaling the bacteria from his mouth,

his lungs are all but destroyed.

And that's when the bacteria move in for the k*ll.

Some of this infection spread through the rest of his body

and into his blood.

NARRATOR It isn't long before Diego

experiences a catastrophic drop in blood pressure.

Eventually, his heart loses its ability to b*at,

and Diego dies on his living room couch.

Through a translator, Dr. G shares her findings

with Diego's family, and they're shocked to hear that his death

is unrelated to the well water.

And they clearly didn't listen because they

went ahead they had the water tested anyway, which is fine.

But it turned out to be there was nothing

contaminated in that water.

Smelled bad because of the sulfur

in the water, which is like a lot of water here in Florida.

NARRATOR Ultimately, Michelle and Clara

must accept a painful truth.

DR. G You know, when we see deaths,

it's usually not just one thing that goes bad.

There's usually a whole series of bad behavior

that will land you in the morgue prematurely.

And in this case, let's talk about not having

good oral hygiene, drinking to excess

where you would pass out.

How about ignoring your symptoms on a type of pneumonia

that could be easily treated?

DR. MARK WALLACE If this gentleman

had come to see me a week before he d*ed,

he wouldn't have had to see my wife.

It's really disappointing to hear about things

like this going on.

It is truly a shame he d*ed from this.

Do you want to turn the light out?

I'd love to, dear.

What do you want to have for dinner tonight?

NARRATOR Unexpected deaths are always

tragic, especially when loved ones

are left grasping for answers.

And in Dr. G's next case, the pressure is on for her

to get to the bottom of another family's nightmare.

DR. G You know, I always start worrying I don't

have an answer for the family.

[music playing]

NARRATOR Today Dr. G takes time out from her busy schedule

to say thank you to the staff of the District Nine morgue.

DR. G We started this a couple years ago.

Instead of Secretary Appreciation Day,

we have Employee Appreciation Day.

The first year, I made a salad.

That's become a tradition.

The olives.

The olives.

Erica is assisting me today.

She's our computer person who you hardly

get to see because she hates dead bodies, she hates blood,

she hates gore.

I don't know why she works here.

You know, everybody in the morgue works really hard.

So it's really nice when we can get together and enjoy

each other's company and just get

away from the blood and guts.

I really like her salad.

Very tasty.

NARRATOR But sooner than they prefer, it's time for everyone

to get back to work, and for Dr. G

to turn her attention to the next case.

So we have a -year-old male that is

found dead bed by his brother.

NARRATOR Reading through the investigators report,

Dr. G quickly learns that Trey Mitchell

had spent the last three months of his life

in emotional turmoil.

His wife has left him, and so she took his kids with her back

to Great Britain.
[ … ]

This relatively recently happened,

and he's quite upset over this.

NARRATOR And Trey has been living with his older brother

Rick ever since.

To help him get over his depression

and is kind of down mood, the brother's

trying to get him out of the house

and they all go to dinner with friends.

NARRATOR At first Trey seems to be having a good time.

But about halfway through the meal,

he abruptly excuses himself.

DR. G He was having some severe knee pain.

He has osteoarthritis, or wear and tear or arthritis,

of his knee.

Not unusual.

He's been having knee pain for a long time.

NARRATOR Rick decides to stay and finish the meal.

When he gets home later that evening,

he assumes that Trey is already asleep

and head straight to bed.

The next morning, the brother went to work.

And when he came home in the afternoon,

he found him still in bed.

NARRATOR For several tense moments,

Rick tries to wake his only brother.

But Trey is blue and cold to the touch.

He calls , but it's already too late.

DR. G He was dead rather peacefully.

It looks like he just came home and laid in bed and d*ed.

NARRATOR Rick is beside himself with grief and terrified

by the prospect that Trey may have taken his own life.

You know, his kids were just taken away,

then he's not too happy about that.

They're worried about depression.

They're worried about a su1c1de.

NARRATOR And when Dr. G's medical investigators

arrive on the scene, they discover something that

only compounds Rick's fears--

two bottles of painkillers next to Trey's bed.

He had naproxen, which he took for the knee pain,

which is a non-steroidal anti-inflammatory.

It would be certainly difficult to die

from an overdose of naproxen.

That is very rare.

But he took propoxyphene.

Propoxyphene is a mild narcotic.

He certainly could have d*ed from an overdose

of propoxyphene.

I've seen that before in the morgue.

That may raise the red flags for su1c1de.

NARRATOR It's also possible that Trey accidentally

overdosed on his medication.

You know, we always worry if somebody has chronic pain

that they just can't take the pain anymore

and they over medicate themselves

with their own medication.

We've certainly have seen that before.

Determining if it's an intentional versus accidental

is not an exact science by any means.

And we see how acute the overdose

is, we check to see if there's any residual pill

material to try to get a calculation of how many pills

he took.

You know, in overdose, you take a large amount of pills.

With just accidentally over-treating,

you take just enough, usually, to k*ll you.

NARRATOR Still bearing in mind the circumstances

of Trey's death, Dr. G must consider

another suspicious culprit.

Certainly, you know, dying in your sleep,

no prior complaints, a heart att*ck

is certainly a possibility.

NARRATOR But until she autopsies the body,

all she has are theories.

It's like opening a can with no label.

You just don't know what you're going to find.

We're just going to have to let the facts speak for themselves

and see where it leads us.

So when I look at him externally,

he looked pretty good.

He's rather tall, medium build, no evidence of

any external trauma, no rashes.

He doesn't look particularly sick, so whatever came on him,

it looks like it came on him quickly.

NARRATOR Dr. G begins with a close inspection

of Trey's head.

DR. G Had a look at his eyes.

He does have some arcus senilis.

Now, arcus senilis, what is it?

It's that white pigment around the edges of your cornea.

You'll see it is sometimes just an arc

and sometimes circumferential around the iris.

It's actually in the cornea.

And that's actually lipid or fat that gets deposited there.

Well, really, all that it's associated with truly is age.

You tend to get it as you age.

NARRATOR Next, she gently price open his mouth,

searching for any evidence of him swallowing

a large number of painkillers.

DR. G Sometimes you take a lot of pills,
[ … ]

they'll leave some discoloration.

NARRATOR She doesn't see any pill residue on Trey's tongue,

but she does notice something else.

Oh, bad teeth.

Oh, bad, really bad teeth.

Well, he doesn't take very good care of his teeth.

I obviously see some cavities in his teeth,

some periodontal disease, a lot of plaque.

NARRATOR At the end of the external exam,

Dr. G has little to go on.

She must now continue her search inside the body.

Well, with an internal exam I sure well hope by getting

the answer to what's going on.

NARRATOR Dr. G slides her blade across Trey Mitchell's chest

then down his midline, in the classic Y-shaped incision.

She then peels back the skin and cuts down his rib cage

to expose the organs in his chest and abdomen.

DR. G Well, in this case before I start taking out the organs,

I will definitely need to draw toxicology because, certainly,

a su1c1de is a possibility.

NARRATOR Dr. G then surveys the organs

in their natural positions, and right off the bat

she sees something wrong.

His lungs are a little bit overinflated.

Each lung should be in its own cavity.

And when we see the two ends of the lungs touching

in the midline, we know that there's some

over inflation of the lungs.

And oftentimes, we'll see that with emphysema or with asthma,

so I'm going to be looking for that when I cut those lungs.

NARRATOR But as she carefully removes the lungs from Trey's

chest cavity, Dr. G uncovers a clue

that could very well confirm his brother's worst nightmare.

Could this be, maybe, a su1c1de?

[music playing]

NARRATOR Dr. G is weighing the lungs

of -year-old Trey Mitchell, who was found

dead in bed early this morning.

His lungs are a little bit heavy.

NARRATOR And it isn't long before her scalpel

reveals another alarming clue.

DR. G He certainly had some edema fluid in his lungs.

And whenever I see a little bit of edema fluid buildup,

I always worry that maybe it is a drug overdose.

NARRATOR Rick is desperate to learn if his brother

Trey, distraught over the breakup of his marriage,

took his own life.

But Dr. G can't be certain until she sees the results

of his toxicology report.

Let's see what we have in here.

NARRATOR As a next step, she dissects the lungs,

searching for any sign of natural disease

like asthma or emphysema.

I don't see evidence, necessarily, of asthma,

but he clearly has a history of smoking.

He's got some emphysema with that kind of black what

we call an anthracotic pigment.

This is just from smoking.

NARRATOR While it's clear that Trey's smoking habit did

some damage, Dr. G doesn't think it

was severe enough to be fatal.

But I don't see anything acute, then, going on.

NARRATOR Still no closer to explaining Trey's sudden death,

she turns her attention to another likely culprit--

the heart.

Heart looks good.

His heart didn't look too bad when

I first started looking at it.

Then I look at the coronary arteries.

NARRATOR And here she spots another red flag.

Cutting into the slender vessels,

she discovers a buildup of deadly plaque.

He has about a % narrowing to his coronary arteries,

but we don't usually see it as a cause of sudden death

till it gets to be about %.

He certainly has heart disease, but it certainly

didn't look bad enough that he would

have d*ed suddenly from it.

NARRATOR Despite another dead end,

the autopsy is far from over.

All right.

Where's his stomach?

At this point, I still have to go through the stomach

and look to see if there's any possibility of residual pills

or pill sludge.

NARRATOR Many people consider this the most

gruesome part of the autopsy.

I think looking at the stomach contents keeps a lot of doctors

from going into forensics.

Actually, there are a few of my techs that

cannot stand stomach contents.

Least favorite part of an autopsy,

got to be stomach contents.

Once you get in there and you open the stomach

and you get the contents out of the stomach,

it's hitting the air first time.

And you're just getting a big whiff

of whatever that person may have ingested in, so it's nasty.

It's not-- yeah, it's gross.

You've just got to grin and bear it.
[ … ]

There's no way out.

NARRATOR With an eye out for any remnants of Trey's

medications, Dr. G painstakingly combs

through the stomach contents.

I really don't see anything that looks like pill sludge,

but that certainly doesn't mean he didn't die from an overdose.

I'm going to still have to wait for the toxicology.

NARRATOR Meanwhile, she continues her inspection

of Trey's remaining organs.

DR. G His liver, his spleen, his lymph nodes,

his pancreas, his kidneys all looked relatively normal.

NARRATOR But she'll have to examine

the tissue samples under the microscope to be sure.

With our eyes we'll see the organ, but under the microscope

we'll see the individual cells.

And we can see sometimes better a disease process that we

may not see with our eye.

So what I will do is take a small piece of the tissue,

but that tissue can't be cut until it fixes and firms up.

And so that tissue will sit in formalin,

or formaldehyde, until it gets firmer.

And we send it out to an outside laboratory that then takes up

a small piece of tissue, and they will embed

that tissue with paraffin wax.

So the paraffin wax gets embedded in that tissue,

and then you can cut very thin sections of that tissue,

put it on a glass slide, and stain it.

NARRATOR Dr. G wraps up the internal exam

still puzzled as to what caused Trey Mitchell's sudden death.

So you know, I'm still not quite sure why he d*ed,

but I still would like to look at his head.

NARRATOR Dr. G slices through the scalp from ear to ear

and reflects the skin.

Once I remove the scalp, there is no evidence of trauma.

NARRATOR Morgue technician Brian Machulski

uses an oscillating saw to cut around the cranium

so that Dr. G can lift it off.

I remove the calvarium.

There's no evidence of trauma.

NARRATOR Next, she takes out the brain

and begins a thorough dissection.

All right.

Now, when I look at his brain, showed no evidence of trauma.

He had no stroke.

There's no tumor that we didn't know about, no infection,

so nothing that I could pinpoint to his head

that would have k*lled him.

So at the end of the autopsy, I've ruled out a lot of things.

We know some things that are going on,

but we don't know what k*lled him.

NARRATOR And as the autopsy draws to a close,

Dr. G is still at a loss as to what caused Trey Mitchell's

sudden death, and it's looking more

and more likely that Rick's worst fear has come true.

Well, you know, the families are

always upset when you call something

an overdose, a su1c1de.

So I'm going to still have to wait for the toxicology.

NARRATOR After a long four-week wait,

Dr. G receives the results from Trey's toxicology screen,

and right away she begins scanning

the report for the presence of pain K*llers in his blood.

Well, his toxicology was a bit surprising.

There's no naproxen, there's no propoxyphene.

In fact, there's really no evidence of anything

except caffeine and nicotine.

NARRATOR It's a stunning revelation.

Trey did not overdose, either accidentally or intentionally.

It makes a family much happier in that there

is no evidence of an overdose.

NARRATOR But disturbingly, Dr. G now

has no explanation for what could

have taken Trey Mitchell's life so unexpectedly.

DR. G I still don't have any conclusive findings.

You know, I always start worrying that the deaths may

remain undetermined, that I won't

have an answer for the family.

[music playing]

NARRATOR As her investigation draws to a close,

Dr. G is beginning to wonder if she'll

ever solve the mysterious death of -year-old Trey Mitchell.

The microbes are the last place I'm going to look,

but I really wasn't hopeful that I was going to get an answer

from the microscopics, either.

NARRATOR Dr. G begins by carefully scanning every sample

of Trey's lung tissue, looking for any abnormalities she

couldn't see with her naked eye.

DR. G Microscopic examination did not show any evidence

of asthma or pneumonia.

Certainly, I can see that black tar--

you know, pigment from the cigarettes,

but nothing what we call acute going on.

NARRATOR She moves on to examine the various slides

of brain tissue.

DR. G I've taken several sections of the brain,

including the covering over the brain,

and there are no chronic diseases,

no evidence of any kind of inflammation,

like maybe in encephalitis.

There's no evidence of any acute inflammation
[ … ]

like in a meningitis or bacterial infection,

so really nothing abnormal with the brain.

NARRATOR Her options dwindling, Dr. G

reaches for her last slide the heart tissue.

And for a moment, she can hardly believe her eyes.

Now, the heart actually surprised me.

NARRATOR Staring back at her through the bowed lens

of her microscope is a definite sign of trouble.

In the microscopic examination was a large area of heart

necrosis and early hemorrhage.

That means a portion of his heart was deprived of blood

and now it's starting to die.

That's a classic heart att*ck.

NARRATOR Dr. G was unable to see the necrosis at autopsy

because Trey's heart att*ck occurred

just hours before his death.

DR. G It was at an early enough stage

that you will see it under the microscope

before you see it with your eye.

NARRATOR But Dr. G found absolutely nothing at autopsy

that would have suggested the -year-old d*ed of a heart

att*ck.

DR. G His coronaries weren't that severely narrowed.

He certainly didn't have any type of a thrombus

or clot that we'd normally see with an acute heart att*ck.

What's happening in this case is something a little bit

more unusual.

NARRATOR In fact, it appears as if Trey suffered a rare chain

reaction of coronary events.

And with all the information in hand,

at last, Dr. G can explain exactly

what led to his untimely death.

[music playing]

Trey Mitchell has been in a rut since his recent divorce.

But on this muggy September night,

his brother Rick is determined to get him off the couch.

DR. G So he went out for dinner with his brother,

with some friends.

NARRATOR Trey seems to be having a good time

until suddenly he excuses himself,

complaining that his arthritic knee is acting up.

But Dr. G has a different theory.

DR. G Certainly, most people don't leave a dinner because

of knee pain, but they will leave a dinner

if they have chest pain.

NARRATOR Based on her findings, she

suspects that Trey was actually suffering

from an acute heart condition called Prinzmetal's angina.

It's a fancy name, but it's just

spasm of the coronary artery.

NARRATOR There's no consensus among experts

as to exactly what causes Prinzmetal's, but one thing

is for sure.

Its effects can be extremely dangerous.

DR. G What's happening in his body is probably

about the time he's having dinner, or maybe even

a little bit before dinner, his coronary artery

starts to spasm.

NARRATOR During the spasm, the smooth layer

of muscle within the walls of the artery

quivers and contracts.

Even in a heart without coronary artery disease,

the spasms could be harmful.

But Trey's arteries are % blocked by plaque.

DR. G And with the blood vessel just kind of constricting down,"], index ,…}

it would be easier, then, to totally

cut off that blood supply if you already have some plaque there."], index ,…}

NARRATOR With each contraction, the spasm temporarily deprives

his heart of fresh blood and oxygen

until it finally triggers a devastating chain reaction.

The spasm is causing, then, this area of heart muscle

to die off because it's not getting enough blood.

NARRATOR At this point, Trey is suffering a heart att*ck.

But the symptoms are so mild, he never

imagines his life is in danger.

DR. G He's probably feeling maybe some indigestion, maybe

even pain.

He goes home, isn't feeling well.

NARRATOR Trey lies down in bed, hoping

that his chest pain will pass.

But it only worsens as the dying tissue

begins to cr*pple the heart's delicate electrical system.

Anytime you start k*lling off all that heart muscle,

the electrical component becomes very irritated

and kind of twitchy, and it can easily

set off a cardiac arrhythmia.

NARRATOR Trey's heartbeat eventually turns

erratic, disrupting the flow of blood

to all of his vital organs.

Starved of oxygen, they shut down.

And just hours after the coronary spasm, he dies.

With Trey's cause of death finally in hand,

Dr. G's first call is to his brother, Rick.

Family was just extremely grateful

that this wasn't a su1c1de.

[music playing]

NARRATOR But they're still in disbelief that Trey was

taken from them so suddenly.

They were shocked that he could

have d*ed from heart disease or when
[ … ]

he seemed to be in good health.

NARRATOR Dr. G explains to them that Trey actually

had at least one significant risk factor

that led to his heart disease.

We know he smokes, and we know that smoking

is clearly associated with increased

cardiovascular disease and death.

But nobody really knows why some people get

spasm and some people don't.

With him, individually, you'll never say for sure.

You never know when your time is up.

You never know, you know, when you go to bed at night,

if that's going to be the last time you see the sun.

[music playing]

MAN Atlas.