06x06 - Bruised and Battered

[bunniefuu]

NARRATOR When a perfectly healthy

-year-old boy goes to sleep one night and never wakes up--

I can't imagine anything worse than this.

NARRATOR --his grieving family turns to Dr. G for answers.

RICK BARBER You look at a perfectly healthy boy

that goes to sleep and just passes,

you know something's happened.

Something wrong.

NARRATOR Then a man is found dead on his floor, naked

and covered in bruises.

This could be foul play.

NARRATOR Now police are counting on Dr. G

to find proof of m*rder.

They don't plan on doing anything else until I

tell them it's a homicide.

NARRATOR Altered lives baffling, medical mysteries,

shocking revelations--

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

All too often, Chief Medical Examiner Dr. Jan Garavaglia

sees families reeling from the unexpected loss of a child.

It's the tragedies of all tragedies.

The little -year-old boy with a mom, a dad, a sister.

NARRATOR And even after years,

cases like these still tug at her emotions.

This is a horrible situation for the parents.

I can't imagine putting my child to bed, and then you wake up,

and he's dead.

I mean, I can't imagine anything worse than this.

NARRATOR In the spring of , Garion Barber

is a happy go lucky -year-old with big blue eyes

and a contagious smile.

Real big-hearted kid-- wanted to make

sure everybody was happy.

DAWN BARBER MOM Hey, Garion.

You having fun?

Yeah.

would

Go out of his way to talk to people and introduce himself.

DAWN BARBER Garion used to come up out of the blue

and would just give me a big old bear hug and, I love you mommy.

NARRATOR And he was also a loving brother

to his older sister Adara.

We liked to swim together.

We went horseback riding one time.

He used to beg me to fly with his light sabers with him.

He had a couple of them so he could sword fight.

RICK BARBER Those two were best friends.

They did everything together.

They had separate rooms for a short period of time

and asked to move back in the same room together.

This house was full of giggles and laughs

and carrying on all the time.

NARRATOR But no one in the close knit family

could have ever imagined that their lives

were about to change forever.

[chatter]

NARRATOR On March , , Rick Barber is out of town

for the weekend.

But his family isn't missing a b*at.

His wife Dawn has a full agenda planned,

including ice cream sundaes and a long anticipated movie.

DAWN BARBER We were all laughing

and having a good time.

The kids watched their movie and ate their ice cream,

and then it was time for them to get a bed.

And Garion asked me if they could sleep with me that night.

I told him yeah.

And so they went off and went to bed.

NARRATOR A few hours later, Dawn climbs

into bed next to her kids.

And they all sleep peacefully through the night.

I didn't wake up until about o'clock.

And when I woke up, Garion was still

laying down, which was odd because Garion

wakes up really easy.

Garion.

DR. JAN GARAVAGLIA She nudges him.

He doesn't get up.

And she realizes he's not breathing.

Oh my gosh.

DR. JAN GARAVAGLIA She immediately calls .

NARRATOR Within minutes, paramedics arrive.

And while they rush Garion to the nearest hospital,

dawn call her husband Rick.

RICK BARBER The phone rang, and there was just

screaming on the other phone.

She said, Garion's not breathing.

They're taking him to the hospital.

I just hit my knees, you know, and started praying.

They took us straight back into a family room at the ER.

It wasn't long after that when the doctor

came in and told us then that they

couldn't do anything for him.

They called back, and they said, we lost him.

NARRATOR In an instant, the family's world

is turned upside down.

I think the hardest thing to realize

is when you look at everything you have

and you say, I'll never have a new picture of Garion.

You know?
[ … ]

Time for him stopped.

He's a piece of the family that will be missed.

You will never replace.

You know, nobody would ever be able to fill that hole.

DR. JAN GARAVAGLIA Well, this is a sad case.

I could get wrapped up in the emotion of us.

But what people need are answers.

According to his family, he's a happy kid.

He doesn't really have a lot of problems.

NARRATOR But despite a relatively clean slate,

Dr. G spots at least one red flag in his medical history.

From birth, Garion had sometimes experienced

involuntary eye movements, which were later

diagnosed as partial seizures.

He just has this strange kind of disturbing eye movement.

That didn't seem to be a huge problem.

He takes Carbamazepine for it, anti-seizure medication.

And he's been doing that for years.

NARRATOR But his doctor had warned the Barbers

that as Garion grew older, there was

a chance his seizures could intensify

and progress into epilepsy.

Given this history, Dr. Gene must keep in mind SUDEP,

or Sudden Unexplained Death in Epilepsy,

as a possible cause of death.

He appears to have d*ed suddenly and during his sleep.

And that would fit SUDEP, but I really

have to see from his medical records

how severe these seizures are.

NARRATOR But SUDEP leaves behind no physical evidence.

So the only way she'll know for sure if it k*lled him

is to rule out everything else.

All right.

NARRATOR Along the way, Dr. G will be on the lookout

for another potential culprit--

a congenital heart defect, a common and potentially fatal

abnormality in children Garion's age.

I'm worried about heart defect.

In fact, I would think a heart defect even more than SUDEP.

In this age group, most of the major heart defects

would have been picked up by his pediatrician.

But a few of them will still slip through that may

not cause symptoms until later.

NARRATOR But Dr. G must also consider one other tragic,

although unlikely, scenario.

I'd have to rule out dr*gs.

We always wonder.

Could he have gotten into somebody

else's medication or his own medication and taken too much?

RICK BARBER You never want to think about in an autopsy,

but at the same time, you know, it will give us clues

as to what happened to him.

DR. JAN GARAVAGLIA This is just a sweet looking kid.

You ready?

He is cute as a button.

He looks like he could be sleeping.

He looks well cared for.

He is the appropriate height and weight for an -year-old boy.

NARRATOR First, she documents the obvious resuscitation

efforts made by emergency personnel.

These are all from CPR.

Look at this.

We see needle puncture marks on the back of the hand.

We see an endotracheal tube.

He was intubated.

We see EKG pads.

We see resuscitation pads.

NARRATOR But as Dr. G scans the body,

something immediately catches her attention.

He's got frothy fluid coming out of his mouth

consistent with pulmonary edema--

fluid buildup in the air spaces in his lungs.

What happens is when you have this fluid going into your air

sacs, and you're still trying to breathe,

it whips it up almost like egg white.

And it forms a frothy fluid that actually

comes up the column of the windpipe

and then comes out the mouth.

That's a very non-specific finding.

We will let the body and the tox speak to us to tell

us why it has pulmonary edema.

Did you get this?

ASSISTANT Yes, both sides.

Oh.

At this point, this external exam doesn't

rule anything in or out.

I've really got to put the pieces of the puzzle together.

I mean, that's what I'm here for,

and that's what I'm hoping to eventually do.

NARRATOR And no one is more eager for answers

than Garion's family.

You look at a perfectly healthy boy that goes to sleep

and just passes--

you know, you know something's happened.

Something's wrong.

NARRATOR Dr. G is prepping for the internal exam

on -year-old Garion barber, whose

sudden death has left his family in a state of crisis.

RICK BARBER Everybody spent sleepless nights wondering

what in the world had happened.
[ … ]

DAWN BARBER He'd start worrying about

what it may be like if you don't-- if you don't find out.

Give me a scalpel with a sterile blade.

I'm not sure the autopsy will necessarily

give us the answer for sure.

There you go.

But it will rule many things out.

All righty.

The first thing I do is take my normal toxicology.

So we've got the blood.

Did you get the bile.

I'll take blood, and I'll take bile.

And those I'll check for dr*gs.

And I'll certainly check for any electrolyte abnormality,

any evidence of diabetes, because a kid

going into diabetic ketoacidosis is another possibility.

Although we don't have any symptoms,

maybe the family didn't pick up on them.

And then I'll start looking at the organs one by one.

NARRATOR Peering into the chest cavity,

you can see right away that the lungs are swollen with fluid.

FATHER The lungs are heavy.

They're consistent with pulmonary edema.

Oftentimes, it's associated with a failure of his heart.

It could be related to sudden unexpected death

of epilepsy, the SUDEP.

it's very non-specific.

I'll be there in a minute, [inaudible]..

NARRATOR Next, Dr. G heads straight to an organ high

on her list of suspects--

the heart.

Here, she'll be on the lookout for an undetected congenital

defect, a k*ller that claims thousands of young lives

each year in the US.

When I get to the heart, the first thing I want to look at

is the general shape.

And it looks normal.

So that heart's about normal size.

It's a normal shape, and the consistency of the muscle

appears normal.

Everything looks good.

I carefully make sure all the parts

are going to the right place.

Then I'll look at the coronary arteries.

I look at the valves.

I look at the lining of the heart.

I look at the thickness of the wall.

And there appears to be no congenital heart abnormalities.

But there's still a possibility that I'm

not finding something subtle.

And so I need to look at the heart under the microscope.

NARRATOR Next, Dr. G turns her attention

to the abdominal cavity.

And there, something immediately catches her eye.

Oh, look at that.

Now the kidneys are interesting.

He only has one.

Yeah, looks like a kidney.

He just wasn't born with his right kidney.

It's a relatively common finding in the morgue.

You see it in about between in , or in , people.

NARRATOR Truth is, most people can lead normal, healthy lives

with just one kidney.

But Dr. G knows that if the single kidney

was damaged or infected, the result may have been fatal.

[inaudible].

But the lone kidney appeared healthy.

NARRATOR Next, she checks the stomach contents for evidence

of an accidental overdose.

When I look in the stomach, I'm looking for pill fragments.

And I don't see any that doesn't mean that he doesn't have

an overdose or he'd gotten into somebody's medicine

only the tox will tell us that.

NARRATOR For now, Dr. G switches gears and heads

to a part of the body that just might give her the answers

she's been looking for--

the neck.

An often neglected part of the autopsy people

don't think about is the neck.

But the neck can give us a lot of information,

and it could be some possibilities

of death for this child.

Could he have choked on something?

Is there evidence of maybe an allergic reaction?

NARRATOR Layer by layer, Dr. G dissects the tissue.

FATHER He didn't have evidence that looked like he

had an allergic reaction.

There's no evidence of a strangulation.

So all of that appeared completely normal.

Ultimately, his neck doesn't give us the answer.

OK.

NARRATOR One by one, Dr. G examines the remaining

organs in Garion's body.

But after an exhaustive search, she comes up empty.

At this point, really, what do we have?

We have pulmonary edema, a normal appearing

heart, and a congenitally absent kidney but not much else.

OK.

Well, basically, so far, we don't have an answer.

But I still have the brain to go.
[ … ]

NARRATOR Using an oscillating saw,

morgue technician Brian Mahulsky carefully opens the skull.

FATHER I immediately see that there is edema to his brain.

Like, it just hasn't gotten enough oxygen.

It could be related to the SUDEP,

but we don't know the cause at this point.

Let's cut that brain, and then we'll be done.

NARRATOR But as Dr. G removes the brain itself,

she spots something that is nothing short of shocking.

Oh my god, look at that.

He's got some very prominent cerebellar tonsils.

And that's at the bottom of your brain

right next to your brain stem.

They actually extended down into the spinal canal

where the spinal cord should be.

NARRATOR It's clear that Garion's cerebellum

tonsils have extended out of his skull

and down his spinal canal.

Dr. G now suspects that he may have had a Chiari

malformation, a rare congenital abnormality that affects

about in , people.

Yeah, was that OK?

NARRATOR To be sure, she enlists the expertise

of neuropathologist Dr. Gary Pearl, who specializes

in rare brain disorders.

I really would like Dr. Pearl to look at this brain

to see if he concurs with me.

NARRATOR When Dr. Perl arrives at the morgue,

they get straight to the task at hand--

a careful examination of the cerebellar tonsils.

That helps.

Let's see.

We got a brain Kn*fe?

In this case, we saw downward herniation

of the cerebellar tonsils.

There was also some fibrosis and adhesions of the tonsils

to the brain stem.

This tells us that it's a chronic condition that's Chiari

malformation by definition.

NARRATOR This means that Garion had been

living with an undiagnosed brain malformations

possibly for years.

But while Chiari could present some uncomfortable symptoms,

it's rarely life threatening.

And if the condition did k*ll him,

it would have left no physical trace in his body.

Just like SUDEP, you have to rule everything else out,

and you see if this fits.

NARRATOR Bottom line-- after a complete cranial exam,

Dr. G is still not certain as to what k*lled Garion so suddenly.

So far, I don't clearly know why he d*ed.

I've got my work cut out for me.

I need a boatload of records, both from his pediatrician

and from his neurologist.

I need to look under the microscope,

and I need to get the toxicology results.

No answers can be complete until all those pieces are together.

So I have to call the family, and I'm basically telling them,

I don't know.

I'm not sure what it is yet.

RICK BARBER The not knowing, really not even having a clue,

was extremely frustrating.

You know, it was a long process trying to find

out exactly what happened.

NARRATOR It's been four long weeks

since the autopsy of eight-year-old Garion Barber.

But Dr. G still has no definitive answers,

and she's hoping that the lab work might

hold the key to his death.

DR. JAN GARAVAGLIA Is it SUDEP?

Is it Chiari ?

Is it something wrong with his heart

that I couldn't see with my eye?

Is it something in toxicology?

NARRATOR Today, however, could be the turning point,

as the long-awaited lab reports and microscopic slides

finally arrive at the morgue.

DR. JAN GARAVAGLIA When I look at the toxicology,

he just has his anti-seizure medication.

And that was at a relatively low level.

So he certainly didn't overdose on anything.

So when I looked at the heart under the microscope,

there was no abnormalities that could be seen.

With all of these negatives, I'm pretty much left

with is it a sudden, unexplained death of epilepsy,

or is it a sudden death associated

with the Chiari malformation?

NARRATOR Dr. G has finally narrowed it down

to two possibilities, and there's only one thing left

in her arsenal that may help determine Garion's

ultimate cause of death--

his medical records.

DR. JAN GARAVAGLIA We start working on getting the records.

But they seem to be taking forever.

They're closed on the weekend.

OK, you try.

Thank you.

I really need to look at what symptoms is he

showing, what kind of seizures does he have.

I really need to get some medical history here
[ … ]

to put this together.

NARRATOR Four days later, Garion

Barber's medical records finally show

up at the district nine morgue.

And as she reads through the file,

she's amazed to learn that throughout his entire

childhood, Garion had been suffering from a host

of disturbing symptoms.

DR. JAN GARAVAGLIA Some of the symptoms was not

just the weird eye movements, but he

would sometimes see double.

And sometimes complain of headaches and some even

behavioral problems.

NARRATOR For Dr. G, these new symptoms

are a critical clue that lead her to a surprising conclusion.

Garion did not suffer from a seizure disorder at all.

The strange eye movements along with the other symptoms

were all being caused by the malformation in his brain.

I think his symptoms were all related to the Chiari .

NARRATOR And as she reads on, she's

surprised to discover that Garion's

neurologist had actually diagnosed him

with the condition a year earlier.

He did do an MRI scan, and I was shocked when I saw that.

NARRATOR It appears as if the neurologist simply

didn't associate Garrett's chronic symptoms

with his Chiari malformation and instead

attributed all the problems to the partial seizure disorder.

DR. JAN GARAVAGLIA I think the doctor felt

this Chiari was asymptomatic.

NARRATOR It's a tragic oversight

but not a surprising one.

Chiari malformation is a rare and often misunderstood

condition.

A lot of people are under the impression

that most Chiari s are asymptomatic.

As more and more is learned about it,

we're realizing people do have symptomatology,

and they can die suddenly from it.

I'll tell you, at the beginning of my career,

the neurologist wouldn't believe that there

was anything called SUDEP either,

that people d*ed from epilepsy.

And now it's an accepted diagnosis.

I think as time goes on, I think this

is a disease that we're going to learn a lot more about.

It's rare.

It's rare to die this way, but we know it happens.

NARRATOR But sadly for Garion, no one was able to figure

it out until it was too late.

I think once we put this all together,

when we look at his history, we look at his medical records,

the most likely explanation for his death

is clearly the Chiari malformation.

NARRATOR It's PM on Saturday,

and Garion is fast asleep in bed beside his mother and sister.

But unbeknownst to anyone, a Chiari malformation is

pushing down on his brain stem.

To date, his symptoms have been generally mild.

But on this night, Garion suffers a more dangerous side

effect of Chiari--

central sleep apnea.

He's probably had some central sleep apnea before.

He sleeps alone.

Nobody probably noticed it.

NARRATOR As he sleeps, the brain

temporarily stops sending signals to the muscles

that control breathing.

DR. JAN GARAVAGLIA The brain stem is compressed,

and it's telling your lungs not to breathe.

And then eventually, if you don't breathe enough,

your oxygen goes down.

NARRATOR As his oxygen levels continue to drop,

a deadly chain reaction is set into motion.

Garion's heart rate slows, and fluid begins to build up

in his lungs and brain.

He stopped breathing long enough

where he has a respiratory arrest and ultimately

also a cardiac arrest.

NARRATOR Sometime in the middle of the night,

Garion's heart simply stops b*ating,

and the -year-old dies peacefully in his sleep.

That same afternoon, Dr. G calls Rick and Don

barber to share her findings.

Although the results of the autopsy bring some closure,

they're shocked by the Chiari diagnosis

and insist the neurologist never shared

this discovery with them.

We were incredibly surprised to know

that the doctor knew about the Chiari

and never mentioned it to us.

DAWN BARBER Had I been told what it was then and had done

the research then, I could have changed his doctor

or I could have asked for somebody

to look at something else to at least try

to help him with his symptoms.

NARRATOR If they had known, they

might have opted for surgery.

But it is a high risk procedure and generally reserved

for the most extreme cases.
[ … ]

The treatment would be surgery, neurosurgery

on the base of your skull so that cerebellum is

not compressing the brain stem.

That's not a surgery you take lightly.

All right, bye bye.

NARRATOR But despite her troubling findings,

the Barbers are grateful for Dr. G's work and care.

I think very highly of Dr. G. I think I got more information

from her than I ever expected and, more

than that, a willingness to sit and talk

and to give of her time.

Dr. G has definitely give us, you know,

the closure that you have to have

to take the next step in life.

They have a wonderful attitude.

They know they still have to raise their daughter,

and they're not going to let this ruin their family.

They can't let the bitterness and the sadness

of losing a child ruin the second child's life.

RICK BARBER If you can take, you

know, one thing away from everything we've had to go

through, understand that--

that everything you do builds a memory.

And you know, every moment can be important,

and every moment can be something

that you can hold onto forever.

The thing I miss about Garion is his smile and his laughter

and the things he used to say and do.

If there's one more thing I can say to Garion,

it's I love you and I'll see you soon.

And just tell him that I love him.

You know, I love you, little man, and I'll see you soon.

DR. JAN GARAVAGLIA What the story teaches us

is appreciate your loved ones.

You never know.

Life changes on a dime.

I mean, this is a happy family with two beautiful kids,

and one dies suddenly.

We never know what life has in store for us.

NARRATOR Unexpected deaths are nothing new to Dr. G,

but in a potential homicide like that of -year-old Hank

Mosley, she finds herself facing a whole different set

of challenges.

DR. JAN GARAVAGLIA Law enforcement

is leaning on me a lot because they want

to know, well, how much further do we

have to investigate this case.

When you die suddenly, everything stops.

And it's a snapshot into the way you lived.

That actually is one of the best parts of my job

is just seeing how people live and what they do And even what

they have on when they die.

And then I'll investigate those final moments.

NARRATOR And in Dr. G's next case,

those final moments may in fact hold

the key to solving the mystery behind a man's sudden death.

DR. JAN GARAVAGLIA Oh, today, the police

are going to come by to see the results of this autopsy.

The police are very concerned because they're not sure

whether foul play was involved or not.

NARRATOR It's late afternoon on a Sunday

in the middle of March.

Orlando resident Maggie Shepard is catching up on some reading

when she gets a sense that something's happening upstairs.

[crashing]

Something not at all right.

She hears some goings on in the apartment above her.

She is so worried that she calls the police.

[sirens]

NARRATOR When police arrived, Maggie

informs them that a man named Hank Mosley

lives on the second floor.

She describes to the police that he's kind of a recluse,

and he's a chronic alcoholic.

She calls him the old man.

NARRATOR Next, police head upstairs to Hank's apartment.

And right away, they can tell that something's wrong.

The door is not locked.

Hello?

DR. JAN GARAVAGLIA Slightly ajar.

They walk in.

And initially, they think that the place is ransacked.

NARRATOR Cautiously, they make their way

through the apartment.

And it isn't long before the officers

make a horrific discovery.

DR. JAN GARAVAGLIA He's dead on the floor.

He's naked, and he's covered with bruises.

This could be foul play.

NARRATOR Police immediately secure the area

and wait for Dr. G's investigator to arrive.

My investigator looks around.

There's beer bottles around.

There's trash around.

But they can't even tell if it's ransacked or not.

They don't plan on doing anything else until I

tell them it's a homicide.

He's just a poor soul found dead.

NARRATOR As a first step, Dr. G reads

through the investigator's report.
[ … ]

And on first blush, all signs seem to support

the possibility of foul play.

DR. JAN GARAVAGLIA Well, certainly,

when you see a bruise, the first thing you'll think about

is trauma or foul play.

And in this case, it's a real possibility.

You're easy pickings for somebody when you're drunk.

Did he die because he's brought unsavory

people over to drink with him and they

bopped him on the head?

NARRATOR But from experience, Dr. G

knows there's a laundry list of other ways

that alcohol could have contributed to his death.

DR. JAN GARAVAGLIA It could be accidental.

Maybe he's an alcoholic that fell.

We always have to worry about trauma with alcoholics.

NARRATOR Or did years of chronic abuse

simply take a fatal toll on Hank's body?

Alcohol can k*ll you in many ways--

heart disease, liver disease, pancreatic disease, GI disease.

You know, there's a lot of problems.

DR. JAN GARAVAGLIA However, there's another theory

high on Dr. G's list.

Hm.

I'm not suspecting the acute alcohol poisoning

so much because he's definitely not a naive drinker,

but I worry.

Did he die from alcohol withdraw?

NARRATOR Alcohol withdrawal syndrome

occurs when chronic alcoholics abruptly stopped drinking

either because they are trying to quit

or they simply run out of alcohol.

Your body gets so physically addicted to alcohol

that you will have symptoms if you don't continue that alcohol

at a certain level, particularly seizure and delirium tremors,

that you can actually die from the withdrawal of alcohol.

So I will look to see if any alcohol is in his body.

A lower level or no level of alcohol

may indicate alcohol withdrawal syndrome.

NARRATOR But just as alcohol is looking like a good suspect,

the investigator's report provides

Dr. G with another insight into Hank's medical history.

DR. JAN GARAVAGLIA My investigator

finds insulin in the refrigerator and syringes.

He is a known diabetic.

Being an alcoholic, being a diabetic--

that's a bad combination in of itself.

NARRATOR It's definitely possible

that Hank d*ed from complications

related to diabetes.

But right now, it's just one potential culprit

on a long list.

DR. JAN GARAVAGLIA So you know, what are we thinking of?

We're thinking of, of course, foul play.

Is it accidental?

It could be from the chronic effects of alcohol on his body.

It could be alcohol withdrawal.

So there's a lot of things it could be.

So the autopsy should be interesting.

All righty.

NARRATOR Dr. G is preparing to examine

the body of -year-old Hank Mosley, who

was found naked and bruised yesterday in his home.

And because Hank's death is a suspected homicide,

police are on hand to observe the autopsy.

DR. JAN GARAVAGLIA Well, at this point,

law enforcement is leaning on me a lot

because they want to know, well, how much further do we

have to investigate this case?

Do we go in there and look for more evidence,

or is it just natural or accidental death?

NARRATOR In most cases, Dr. G's first step is to remove

the decedent's clothing.

But in Hank's case, that step has been eliminated.

Now the body being naked, who knows what this means?

A lot of people, they don't realize how many people

walk around their house naked.

Even little old ladies walk around their residence naked.

Well, that's the beauty of my job.

You see a snapshot of how people live.

And sometimes it's not pretty.

Well, he drinks and he smokes.

Drinks and smokes?

MAN Yes, definitely.

DR. JAN GARAVAGLIA He's only years old,

and the neighbor called him the old man.

And I see why.

He looks much older that the stated age,

and that's a testimony of what chronic alcoholism will

do to you.

NARRATOR Dr. G begins the external exam

by scanning the body for clues.

[chatter]

NARRATOR And right away, she notes a red flag.

His legs are swollen with pitting edema.

DR. JAN GARAVAGLIA The fluids build

up in the tissues of the legs.

We see that with congestive heart failure when

the heart can't b*at, strong enough and the fluid

starts backing up.
[ … ]

NARRATOR But she won't know if his heart

played a role in his death until she examines it.

DR. JAN GARAVAGLIA Ah, what else we got going on here?

NARRATOR For now, she turns her attention to Hank's bruises.

There isn't a portion of his body

that doesn't have a bruise.

He's got contusions on his arm, particularly on the forearm.

That could be self-defense.

There is bruises on his chest--

huge bruise over here and a big contusion

on the right side of his abdomen.

And he's got a black eye.

NARRATOR Carefully, she documents each

and every bruise starting on his torso.

There is a lot of bruises on his chest.

You know, that certainly could have caused a fractured rib

that punctured his lung.

He's got a bruise on the left side of his abdomen.

The abdomen is a little bit distended.

That could go along with bleeding into the abdomen,

a ruptured spleen.

Spleens tend to be larger in alcoholics,

and a larger spleen is more prone to injury.

You know, we are worried.

Certainly raises the possibility he either fell or was hit.

But for the most part, just skin bruises

are not going to k*ll you.

What did it do on the inside?

We don't know until we get in there

and put all the pieces together.

But without a doubt, he looks like an alcoholic.

He smells like an alcoholic.

He's got the history of an alcoholic.

But how that plays a role in his death, we don't know yet.

I just keep going--

NARRATOR And given Hank's black eye,

Dr. G knows just where to start.

DR. JAN GARAVAGLIA That is oftentimes

where they're going to get the blow to the head for foul play.

So we're going to go ahead and look at his head.

NARRATOR Dr. G begins by slicing open the scalp from ear

to ear.

Then, she carefully peels back the skin.

I look on the inside of the scalp

to see if there's any bruising.

And he doesn't have any.

NARRATOR With the help of her morgue tech,

she saws through the bone and removes the skullcap,

getting her first look at the brain.

I don't see any blood.

I don't see any fresh hemorrhage.

But he's got some slight what we call xanthrochromic staining.

NARRATOR Xanthrochromic staining

is a yellow discoloration in the outer layers of the brain.

What that is is old blood that usually

indicates previous trauma.

So I suspect he's fallen before.

NARRATOR But after a careful examination

of the brain tissue itself, she can find

no sign of recent injuries.

We've ruled out trauma to the brain as a cause of death.

But we haven't ruled out foul play to the chest and abdomen.

OK, where's my scope?

NARRATOR With scalpel in hand, Dr. G

makes a Y-shaped incision from Hank's shoulders

to his pelvic bone.

DR. JAN GARAVAGLIA So you know, he's got multiple contusions

on the outside.

And when I do initial Y incision,

he's got a really bad bruise on his chest

that goes through the muscle.

I'm worried that that rib might be fractured.

The bruise on the left side of the abdomen also is fairly deep

and goes into the abdominal muscle.

It's really not good.

NARRATOR But Dr. G will need to look

deeper to survey the damage.

She cuts through the muscle to expose the abdominal cavity.

And right away, she's taken aback.

DR. JAN GARAVAGLIA There is no free blood

in the abdominal cavity.

All of the organs are intact but totally haven't

ruled out the broken rib.

NARRATOR But when she turns her attention to Hank's rib cage,

she's surprised by what she doesn't find.

I was looking to see if he had a rib fracture also, but he's--

I don't feel it.

There is no evidence that he has a rib fracture.

NARRATOR Next, she removes Hank's chest plate for a look

at his organs in situ.

DR. JAN GARAVAGLIA There's no tears or fracturing

of any of these organs.

There is no internal trauma.

We've safely ruled out trauma, foul play.

You don't see much trauma at all.

NARRATOR One thing is now clear--

Hank's death was not a homicide.

DR. JAN GARAVAGLIA We really have to figure out what is

the cause of this man's death.

NARRATOR Next, Dr. G draws samples of Hank's blood, urine,
[ … ]

and eye fluids and sends them to the lab for analysis.

DR. JAN GARAVAGLIA His toxicology

is going to be important because that may be the clue.

Is his alcohol so low that he went into alcohol

withdrawal seizures and death?

NARRATOR But the results won't arrive

for at least three weeks.

What's going on?

NARRATOR In the meantime, she pushes on with the autopsy.

Now I have to take each one of the organs

out and look if there is any disease

affecting any of the organs.

NARRATOR And given Hank's history, Dr. G

starts with a likely culprit--

his heart.

DR. JAN GARAVAGLIA So I'm expecting

the effects of alcohol, which would

be a dilated cardiomyopathy, or the effects

of diabetes, which would be a narrowing

of the coronary arteries.

Diabetics for greater than years old more than %

of the time will have heart disease associated with it.

Let's see what's going on here.

NARRATOR She gently removes the heart from the chest cavity

and weighs it.

His heart is just about normal size, maybe a little enlarged.

It's of normal shape.

The muscle looks good

NARRATOR Carefully, she dissects the organ,

slicing through the tissue and into the coronary arteries.

DR. JAN GARAVAGLIA His coronary arteries are not so bad.

He's got a % narrowing of one of his coronary arteries

but no acute changes, nothing that

really would have caused death.

And I don't see anything wrong with his heart.

His heart looks normal.

So nothing that really suggests a heart disease either

from alcohol or diabetes.

NARRATOR But there are still other organs

that could have been fatally damaged by his lifestyle.

So she turns her attention to the abdominal organs,

beginning with the GI tract.

We look at his GI tract because alcohol

affects the GI tract.

I'm looking for erosions.

He's got some gastritis, some superficial erosions,

but I don't see any hemorrhage.

So I don't believe the GI tract had

anything to do with his death.

NARRATOR She moves on--

Oh, that's not good.

NARRATOR --and immediately spots an

abnormality with one of them.

His pancreas does have evidence of pancreatitis

or previous inflammation.

NARRATOR But Dr. G doesn't think this finding

is related to his death

DR. JAN GARAVAGLIA It's old pancreatitis.

The injury to the pancreas is from that alcohol.

It's a chronic effect.

It's not anything that would affect him now.

NARRATOR But when it comes to chronic drinking, there's

one organ that takes more punishment

than just about any other--

the liver.

What's his liver look like?

Can't get a peak of it yet.

The liver should be nice and smooth and brown.

They describe it as like a football.

NARRATOR And all it takes is a single glance

at the -year-old's liver for Dr. G

to conclude that alcohol abuse may have

very well k*lled Hank Mosley.

It's lumpy.

It's bumpy.

It's a yellowish orange.

It's very rough and irregular and shrunken.

Now could that have caused his death?

It could have.

Got the picture.

Yeah.

Yeah, that's a bad thing.

NARRATOR Dr. G has just discovered

severe damage in the liver of -year-old Hank Mosley.

He's got the small, lumpy, bumpy liver.

There's scar tissue.

And basically, the liver cells have been damaged.

It's not so pretty.

NARRATOR And this damage can only mean one thing--

Hank had cirrhosis.

Cirrhosis is a chronic liver disease

that occurs when healthy, thriving tissue is damaged

and replaced with scar tissue.

This is what we see with chronic alcohol abuse.

NARRATOR In fact, Hank's alcohol abuse has not

only damaged the liver, but it's also

greatly enlarged the spleen.

DR. JAN GARAVAGLIA And when the liver is all scarred down

like that, the spleen follow suit

by getting enlarged because the blood has a hard time
[ … ]

getting through that liver.

So the spleen is enlarged, the liver is shrunken,

all from alcohol.

Yeah, I'm done with everything.

We know his liver is not functioning.

Is it not functioning enough to cause death?

So we won't know for sure if it's

a complication of cirrhosis until we get the toxicology

and we rule out other causes.

NARRATOR Three weeks after the autopsy

of -year-old Hank Mosley, his lab

results arrive on Dr. G's desk.

DR. JAN GARAVAGLIA When the toxicology came back,

the first thing we look at is to see

if he's got alcohol withdrawal.

You know, the legal level for intoxication for driving

is a ., and his is a ..

He's got almost four times the legal limit to drive.

It's certainly not alcohol withdrawal.

NARRATOR This critical finding, along with his history

and what she found at autopsy, brings Dr. G

to one inescapable conclusion.

The toxicology results didn't let me down on this.

I think they added a very important piece of this puzzle

of what's going on.

NARRATOR It's a Sunday afternoon,

and Hank Mosley is spending it the way he spent

the majority of his life--

intoxicated.

DR. JAN GARAVAGLIA He's got all that we

typically see with alcoholism, and he's

got a . acute alcohol level.

For some people, a . could actually

put you near death's door.

For him, it probably was an everyday occurrence.

It's probably causing him to stumble, difficulty walking,

certainly slurred speech.

NARRATOR Hank's lifestyle of chronic alcohol abuse

has also taken a toll on his health, especially his liver.

DR. JAN GARAVAGLIA The alcohol started

k*lling off his liver cells.

And eventually, the liver can't do

what it's supposed to be doing.

The liver has many, many functions,

and one of the functions, besides detoxifying, some

of the chemicals in your body, making glucose, one

of the things that it does is it makes some of the clotting

factors for your blood to clot.

NARRATOR But years of heavy drinking

have compromised the liver's ability to produce

sufficient clotting factors.

On top of that, his enlarged spleen has begun to inhibit

the clotting process itself.

DR. JAN GARAVAGLIA That large spleen

sequesters the platelets, which add to his inability to clot.

So what happens?

Easy bruiseabilitiy, easy bleeding.

That's why he's covered with bruises from head to toe.

You know, it's not surprising that initially,

they thought he was b*at up.

But oftentimes, we find it's the effect of alcoholism.

NARRATOR But while the severe damage to Hank's liver

has been building for some time, on this particular Sunday,

the organ is probably pushed over the edge

by his continued excessive drinking.

DR. JAN GARAVAGLIA So ultimately, what's happening

is his liver is not functioning.

Toxins are building up because his liver is not detoxifying.

And these toxins basically build up in your blood,

affecting your brain.

NARRATOR And with Hank's brain exposed to toxins,

the organ malfunctions.

The result is a life-threatening condition known

as hepatic encephalopathy.

And in Hank's case, it's fatal.

DR. JAN GARAVAGLIA He goes into a coma and eventually dies.

And that thumping she hears, it wasn't foul play.

It was him not being able to walk around that apartment

and ultimately falling to the ground.

[music playing]

(SINGING) So long, so long.

I stand still on the ends of the earth.

You know, alcohol leaves devastation to your body,

to the way you live, and your family.

But I always wonder what happened.

What caused this?

[music playing]

(SINGING) When I was worth all the songs that I sang--

You know, we see alcohol as the ultimate problem.

But I always wonder when I see a fellow like this

is how did it all started.

Because you know, ultimately, he was

a cute little guy at some point in his life,

and somebody loved him.

I know how he d*ed, but I'm still

curious how it all started.

NARRATOR Atlas.