06x08 - Fatal Flaw

[bunniefuu]

[music playing]

NARRATOR When a seemingly healthy infant dies suddenly--

Oh my god!

The mother notices the lips are turning blue,

she takes it out of the car seat and it kind of

gasp and dies in her arms.

NARRATOR Dr. G finds herself knee deep in what

could be an unsolvable case.

There's a lot of subtleties in trying to figure

out why the baby d*ed.

NARRATOR Then, a man rushes to the hospital

with stomach pains, but his discharge that same afternoon.

The abdominal pain subsided, so they let him go home.

NARRATOR And when he dies just two days later,

his wife believes the hospital is to blame.

The wife is devastated.

So now we've got to sort out what's going on.

[opening theme]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

[music playing]

To an outsider, the busy District morgue in Orlando,

Florida with its strange sights, noises, and smells

can seem overwhelming.

But after years on the job, chief medical examiner Dr. Jan

Garavaglia--

That's a lot of trauma.

NARRATOR --has mastered the art of staying

focused no matter what.

[beep]

VOICE OVER PA Dr. Garavaglia, please call extension .

They're calling my name.

I don't like being interrupted in the middle of an autopsy.

I don't like phone calls in the middle of an autopsy.

What's up Tommy?

I don't like a lot of visitors in the morgue

because I don't like people chatting with me.

What is happened to-today?

MORGUE ATTENDANT It's a brain [inaudible]

I know, that brain fruit.

- What is that chitchat? - [laughs]

MORGUE ATTENDANT Chitchat.

If we don't chitchat, we get done fast.

OK, no talking.

You know, I'm working, and they don't

understand me being quiet.

It means I'm thinking.

[inaudible] wanted to come down for this baby, but we

didn't know what time to tell.

NARRATOR And no case requires more attention

and focused than the death of a child.

This is a little girl that was left in the car.

That's the tragedy of the day, It's always sad

when babies come to the morgue.

But also, the autopsies are harder in that.

There are so many subtleties in trying to figure

out why the baby d*ed.

This baby wasn't born alive.

Because each one is unique, and you never know

what the answer is going to be.

NARRATOR One of Dr. G's most confounding child deaths

occurred several years ago when she served

as medical examiner at the Bexar County Morgue

in San Antonio, Texas.

[suspenseful music]

It's a crisp September morning in Laredo, Texas.

And -year-old, Armando Gaytan is

changing the diaper of his six-month-old daughter, Anna.

[tense music]

Anna?

The father noticed that the baby wasn't quite acting right.

She just wasn't moving as much, particularly,

couldn't lift her head up where she could be for.

What's the matter?

Anna, wake up!

Sophia!

NARRATOR Panicked, Armando and his wife,

Sophia rushed their daughter to the nearest hospital.

[tense music]

DR. GARAVAGLIA The father's , driving

the mother's in the backseat with the baby.

They were moments away from the hospital.

Oh my god!

She notices that the lips are turning blue.

[inaudible]

DR. GARAVAGLIA She takes it out of the car seat,

and it kind of gasp and dies in her arms.

(CRYING) Oh my god.

DR. GARAVAGLIA They, of course, try to resuscitate it

in the hospital.

Charging three, two, one, clear!

Unfortunately, the baby didn't come back.

This family, it's a young mom and dad,

and they were devastated by it.

I can't imagine what they're going through.

Babies aren't supposed to die.

They deserve an answer.

[suspenseful music]

Today, we have a precious little six-month-old girl
[ … ]

that d*ed in the car while the parents

were taken her to the hospital.

In our office, we probably average

anywhere from to babies a year

that come through our morgue.

So maybe a little less than one a week.

When we see children in the morgue,

it tends to be infants, particularly,

six months and younger.

Once they get past a year, that's a very unusual group.

And then it starts picking up again in the pre-teen years

with suicides and accidents.

But certainly, it's that first year of life

that we see most often.

So Arden is taking a picture of her.

Let's see what I can find in here.

NARRATOR Dr. G's first order of business

is to carefully read through the investigators report.

Let's see.

NARRATOR According to the Gaytans,

their daughter was a perfectly healthy baby but had recently

suffered what doctors believed to have been

a mild respiratory infection.

DR. GARAVAGLIA The baby had just

finished about a -day course of antibiotics for a kind

of cold-like symptoms.

I don't know if that's going to be relevant or not.

NARRATOR But she knows that what

may seem like a harmless cold can

have disastrous consequences in an infant.

DR. GARAVAGLIA Babies tend to get infections very quickly.

Maybe it wasn't properly treated,

maybe it's gotten pneumonia, maybe it's gone to meningitis.

That is a real possibility.

Do you want to look at the back too?

No, that's all.

Just overall.

NARRATOR But Dr. G must also rule out

another likely culprit, a birth defect.

There are some that are just very difficult to diagnose.

And they present with sudden death.

It can be everything from bowels,

to heart, to lungs, even some brain congenital abnormalities.

NARRATOR But if all the suspects on her list,

none is more sinister or heartbreaking

than the possibility of physical abuse.

[baby crying]

It's hard to believe anybody would inflict trauma on a baby.

But unfortunately, I see it multiple times a year.

You know, the baby's been sick.

I'm sure it's been fussy.

It's a relatively young parents.

Maybe they got to their wit's end.

[suspenseful music]

[baby crying]

[tense music]

DR. GARAVAGLIA It's usually very poor parenting skills.

They do it in frustration, and they're

very sorrowful afterwards.

Not all of them, but it often is an impulsive act.

And one parent may have no idea what the other parent did.

[suspenseful music]

The father is alone with the baby changing the diaper

and then comes up with the story that it's not acting right.

Is it not acting right after he threw

it and hit its head on the edge of the changing table?

Or is that story true?

We never take anything at face value.

We always have to further investigate.

We'll take their story as true but take it

with a grain of salt and see if there's

any forensic evidence that either proves

it or disputes it.

So we're hoping that we have an answer when we do this autopsy,

but I have a feeling it's going to take a long time.

There's a lot of possibilities here, everything from trauma,

to infection, to congenital abnormalities,

there's a lot of things that can happen to an infant.

[suspenseful music]

A lot of people have trouble dealing

with autopsies on babies.

I know, my staff do not like to all watch them.

NARRATOR But when Dr. G approaches

the examination table, it is as an objective scientist.

DR. GARAVAGLIA I'm in the medical examiner doctor mode.

You want to give me the tape measure?

I'll measure, I'll weigh the baby.

It's a beautiful little baby as most of them are.

I'll look for any kind of dysmorphic features,

meaning, the face isn't right or the hands aren't right.

Anything that maybe points to any kind

of congenital syndrome, but everything

looks normal on this baby.

Big dark brown eyes.

Routinely, we'll look at the palms of the hands.

If you look at the creases on your hand,

you'll see they criss-cross.

Sometimes, with some congenital abnormalities

of strictly down syndrome, they'll have

some abnormal palmar creases.
[ … ]

This is one that just goes across the palm from side

to side.

NARRATOR But the palm creases on baby Anna are normal.

DR. GARAVAGLIA We look to see if the baby looks sick.

If there's any rashes or bleeding underneath the skin.

Eyes, OK.

NARRATOR But a thorough inspection reveals

nothing out of the ordinary.

Beautiful baby.

It's hard to believe that it had been sick.

The baby looks really healthy.

Her trained eye does pick up subtle puncture marks on

the surface of the baby's skin.

But these are hardly surprising.

That baby also has a lot of needle marks.

Clearly, they tried to resuscitate it.

They were trying to get vascular access to give that baby

medication and fluids to bring its blood pressure up,

to bring its heart back.

Unfortunately, they were unsuccessful.

NARRATOR Finally, she checks for any signs

of physical trauma.

I palpate the head.

I don't see anything wrong with the facial features.

The neck is normal.

There's no bruises to the abdomen.

The genitalia looks normal.

I don't see any evidence of any external trauma.

NARRATOR But unfortunately, this doesn't mean

that the baby was not abused.

DR. GARAVAGLIA No trauma on the outside

doesn't mean no trauma on the inside.

Believe it or not, in at least % of the cases,

you're not going to see anything external.

And it's not until we do the autopsy

that you discover the trauma.

We'll just have to wait and see.

NARRATOR In the meantime, Dr. G is determined

to leave no stone unturned.

Please do.

NARRATOR So she orders an X-ray of the infant's entire body,

including her arms and legs.

So we'll make sure there's no problem on her.

We're looking for old fractures and recent fractures.

Because that often will be indicative of abuse.

But on this baby, I don't see anything.

NARRATOR Despite the absence of fractures,

abuse is still a prime suspect.

Just because the X-rays are normal,

that doesn't mean they're still not internal trauma.

We'll see what we find at autopsy.

[music playing]

DR. GARAVAGLIA Everything is still in play.

It still can be everything from trauma,

to infection, to congenital abnormality.

I don't know.

I'm hoping the autopsy will give me the answer.

[tense music]

NARRATOR At the Bexar County Morgue in San Antonio, Texas,

Dr. G is ready to autopsy six-month-old Anna Gaytan, who

d*ed suddenly after recovering from an apparent respiratory

infection.

As with all cases of infant death,

abuse is always high on her list of suspects.

We'll make sure that the autopsy

doesn't show any foul play.

NARRATOR And with so much at stake, the pressure to close

the investigation is mounting.

DR. GARAVAGLIA The parents are under a cloud of suspicion.

If we find any type of inflicted trauma,

I will immediately call law enforcement.

I have to get the answers.

NARRATOR To completely rule out abuse,

she must look for evidence internally,

starting with the head.

It just something to hold her head a little bit.

The head trauma is the number one

inflicted trauma in infants.

Although there is no external trauma,

I've been fooled before.

Believe it or not, sometimes you just don't see it.

[music playing]

NARRATOR Dr. G begins by cutting a slit

across the back of Anna's head from ear to ear,

freeing the scalp.

I'll reflect the scalp and look for contusions.

I'll look for evidence of impact,

but I don't see anything.

Go hit her.

NARRATOR Morgue technician, Arden Monroe,

uses an oscillating saw to cut through Anna's soft skull.

Babies skulls are different only that they're thinner,

and they're a little smoother.

They're a little easier to cut.

But we still need a saw.

The only ones that we can actually

open through the sutures are the newborns, the really, really

young babies.

We can just open up where the bones are coming together.

But once you get to be six months,
[ … ]

the bone is firm enough that we need a saw

NARRATOR Next, Dr. G opens the calvarium or skull cap,

exposing Anna's brain.

We're looking for any kind of blood,

and there isn't on this baby.

There is no evidence of bleeding that would indicate trauma.

I don't think we'll need the brain bucket.

There's still a possibility of trauma

in the chest and abdomen, but that's

going down on my probabilities.

NARRATOR But this cranial exam is far from over.

Before she can proceed with the rest of the autopsy,

one last suspect must be eliminated,

bacterial meningitis.

Meningitis is an inflammation of meninges or of the covering

of the brain.

And babies can get meningitis and go downhill very quickly.

And if left untreated, it can often prove fatal.

[suspenseful music]

DR. GARAVAGLIA Babies have different symptoms than adults.

With an adult, they'd complain of a headache.

Well, baby is not going to complain of a headache.

They just may be irritable, or they

may just get sicker and sicker and being real lethargic.

NARRATOR If Anna d*ed from bacterial meningitis,

chances are Dr. G will be able to tell

by examining the thin membrane covering her brain.

We look to see if that's cloudy

or any evidence of infection.

And in this case, there isn't.

The brain looks completely normal.

All righty, I'm going to leave it in your capable hands.

NARRATOR But her many years in the morgue

have made her wary of jumping to conclusions.

Just because it's not cloudy, it

doesn't mean that the baby doesn't have a meningitis.

I've been fooled before.

Let's cut that brain.

You never can rule out anything with a baby

until you look under the microscope.

NARRATOR But first, she's hoping

that the internal exam will provide

some more definitive answers.

[tense music]

Surprisingly, performing an autopsy on an infant

is easier than on an adult.

Babies don't have a lot of heavy fat on them.

Things are usually pink.

They don't have signs of smoking or obesity.

They're beautiful, perfect little specimens and either

just usually so pristine.

NARRATOR But they do require an entirely

different set of tools.

When you autopsy a baby, I'll use the same scalpel.

But we'll use smaller scissors, we'll use, usually, smaller

needles, smaller syringes.

And I have to use a smaller scale because the organs

are so much smaller.

They don't weigh on my-- our regular hanging scale.

So we'll use a small digital scale for the baby organs.

NARRATOR As with an adult, Dr. G begins by performing

the standard Y-incision.

Immediately, when I open the body,

I look to see if there's any evidence

of trauma, blood collected in any of the body cavities.

And I really don't see anything.

There is no free blood in the belly.

They take the chest plate off.

I look for any rib fractures.

Everything looks fine.

There's no evidence of any kind of inflicted injury.

NARRATOR At this point, she is still without a cause of death.

But one thing is certain.

We know that trauma didn't contribute

to this baby's death.

We've cleared the family of any kind of wrongdoing.

NARRATOR Dr. G's next priority is to collect blood

samples for forensic analysis.

DR. GARAVAGLIA Before I do anything else,

let's see if we can get a little bit of blood here.

I'll take blood sterilely.

How are we doing?

And we'll send that off to see if any bacteria

is present in the body.

NARRATOR With the organs exposed,

She can now carefully inspect them for any signs

of congenital abnormalities.

We give a once over to all the organs

while they're still in the body, and everything

looks relatively normal.

The heart is situated right, the great vessels go to the heart

correctly, everything looks to be in its normal spot.

NARRATOR Next, she begins the meticulous process of removing

and dissecting Anna's internal organs, one by one,

starting with the heart.

When I look at the heart, the heart looks normal.

OK, so her heart looks good.

But it's normal size, shape, normal size weight for its age.

NARRATOR Next stop, the lungs.

There's a little bit of congestion.
[ … ]

We often see that with resuscitation.

But overall, they don't look that bad.

NARRATOR But as Dr. G digs deeper inside Anna's tiny body,

she spots something amiss.

What's interesting is, there's no food in the stomach.

You don't want to cut that bowel when you open it.

What that tells me is that, this baby

hasn't eaten for a while.

NARRATOR It's too early to say whether this finding played

any part in Anna's death.

DR. GARAVAGLIA It could just be because the child

has been getting over a cold.

Possibly, there have been vomiting or diarrhea.

So it could be just a red herring.

NARRATOR And incredibly, as Dr. G

moves through the remaining organs,

they yield little in the way of clues.

She's looking pretty good on the inside.

NARRATOR That is until she gets to the liver.

DR. GARAVAGLIA It is one big liver, huh?

The liver looks a little large, it looks pale,

and it's a little soften.

Funky color.

It looks like a fatty liver, but you know,

the baby shouldn't have fat in the liver.

NARRATOR Something is clearly wrong with baby Anna's liver.

DR. GARAVAGLIA The liver is not looking good, I can tell.

NARRATOR But the question is, did

it play a role in her death?

Even though I can't say specifically

what's wrong with the liver, I'm hoping that will hold the key

to the answer to this case.

OK, let's see.

I have to take microbes of it.

I'll definitely need to look at that under the microscope.

I'll just grab a bunch of fluids.

NARRATOR Dr. G takes tissue samples of the infant's liver,

as well as her other major organs.

These will be mounted onto slides

for microscopic examination.

The autopsy of baby Anna Gaytan has now come to an end.

Unfortunately, her death certificate

still remains blank.

Well, the autopsy is done but I

think the work's just starting.

Everybody thinks once you finish the autopsy,

you're going to have all the answers.

And that isn't necessarily so, particularly, with babies.

Oftentimes, we have to look a little further for an answer.

If the answer comes simply, I will they please.

But I doubt very well.

NARRATOR The microscopic slides along with the blood cultures

are now Dr. G's last chance of uncovering the truth

behind Anna's tragic death.

I always worry whenever I do an autopsy that I'm

not going to have an answer.

That just comes with the nature of the job.

And sometimes I don't have an answer.

[tense music]

That one took a lot longer than I wanted it to.

NARRATOR It's been two weeks since the autopsy

of six-month-old Anna Gaytan.

And as Dr. G waits for her cultures and microscopic slides

to come back from the lab, she worries

that this could be one of those cases that never gets closed.

It's going to be difficult to figure this out

if it's not clear cut.

NARRATOR As for Anna's parents, it's an agonizing limbo.

DR. GARAVAGLIA Once a baby dies,

there's tremendous consequences for them.

Do they want to have another baby?

Why did this baby die?

Are we going to chance that again?

Maybe it's something wrong with us.

They want an answer.

Ah-ah-ah.

NARRATOR But when Anna's talks report

is finally delivered to the lab, it

unfortunately reveals nothing.

My cultures were negative.

Now I'm really worried.

My last hope is going to be in the microbes.

[music playing]

NARRATOR Four days later, she receives

the long awaited slides.

The heart, the lungs, and the brain, all of those organs

looked normal.

NARRATOR This leaves only one place left

to look for an explanation.

The liver, I'm hoping is what's

going to give us that answer.

NARRATOR Under the powerful lens of the microscope,

the liver cells come into view.

DR. GARAVAGLIA I can see that it's abnormal.

What it showed was a very fatty liver.

Much more fatty than I expected by just looking at the liver.

Once I see that there is fat in the liver,

putting it all together with what I knew about the way

it d*ed, the fact that there's no food

in its stomach, that sets in motion in my mind
[ … ]

a whole other cause of death.

NARRATOR Dr. G now believes she knows what k*lled baby Anna.

But speculation is not enough.

She will need to order a special and unusual

test to support her theory.

At the time, only a couple of research labs in the country

were conducting this test.

But Dr. G finds one at the University of Texas in Dallas.

And so I went ahead and sent a piece of liver, urine,

and blood off to the lab, hoping that they'll confirm my hunch.

And as soon as I got the results back from the lab,

I knew I had my answer.

NARRATOR Dr. G is now able to reconstruct the simple tragedy

of baby Anna Gaytan short life.

I was excited.

It was great to feel right.

I felt like I did some real, true medical detective work.

[suspenseful music]

NARRATOR For the first six months of her life,

baby Anna's tiny body functions normally.

This child doesn't have any problems until it

gets a viral infection.

NARRATOR For most infants, a cold is harmless.

But in baby Anna's case, it's set into motion

a fatal chain reaction.

It's stress on its body.

And it also makes it not want to eat.

NARRATOR With no food coming in,

Anna's body finds itself quickly running out of fuel.

At this point, a normal baby would simply

tap into its reserves of stored body fat

to get the energy it needs to survive.

But with baby Anna, there's an unexpected problem.

This is probably one of the first times in its life

that it's really trying to break down a fat

because it was being fed well.

But once it got that viral infection and it wasn't eating,

and then all of a sudden, Hey, I need some fuel here,

let's break down so fats.

Well, then it comes to light.

There's something wrong with the baby.

NARRATOR The lab results confirm that baby Anna was born

with an extremely rare genetic disorder called

a fatty acid oxidation defect.

What that means is that--

this poor kid can't break down fat.

[tense music]

NARRATOR Because her body can't break down the fat,

it starts accumulating in her organs,

mostly in the liver, which explains it's fatty appearance.

And that's not all.

Because it couldn't utilize the fat for fuel,

its blood sugar plummeted.

The combination of these two things

are causing the baby to become lethargic

and causing its muscles not to be

as strong as they normally are.

NARRATOR When his father, Armando, comes in

to change her diaper, she barely has

the strength to raise her head.

Anna, wake up!

NARRATOR That's when he and his wife, Sophia,

decide to rush their baby to the hospital.

But by then, it's too late.

DR. GARAVAGLIA I don't think the baby's in pain.

It's dying from lack of fuel.

And its brain's not going to function anymore.

And that coupled with probably an arrhythmia

causes the baby to die suddenly.

NARRATOR A sad and abrupt end to a life cruelly cut short.

This is Dr. Garavaglia at the medical examiner's office.

NARRATOR All that remains is for Dr. G

to report her findings to Anna's parents.

The family was shocked because the baby

acted normal to this point.

How could it have such a thing.

NARRATOR And the Gaytans are still

reeling from the astonishing news

when they're dealt another blow.

What k*lled their baby girl could potentially

affect their future children.

It's inherited, and that means that they have a % chance

of another child having this.

If you have any questions, give me a call.

NARRATOR But fortunately, in recent years,

there have been tremendous advances in newborn screening

tests for this rare condition.

Medicine has progressed since I did this case,

and the technology's gotten better.

Now it would be no problem getting this tested.

This is a very fulfilling case for me

because I came up with the answer.

In years, this isn't my only fatty acid deficiency.

They're very rare, but you still have to keep the rare

in the back of your mind.

Because if you don't think about it,

you're not going to find it.

[music playing]

NARRATOR Dr. G uses every tool in her arsenal to solve a case,

no matter how rare the cause of death may be.
[ … ]

But sometimes, the answers can only be found

in the most unlikely of places.

I'm really just left with no clues.

There's nothing that screams of why he d*ed.

[music playing]

Time to bring him on.

Oh gosh.

DR. GARAVAGLIA I just still can't believe you smoke.

SANDY I came on a smoke.

I know that smoking is addictive.

We all live with somebody who smokes,

somebody who's close to us.

And I have Sandy.

I want to stop.

You should really try.

She sees everyday the effects that tobacco

can have on your body, and she's still

has a difficult time quitting.

That's how addicted she is.

NARRATOR Dr. G knows it's not easy to kick the habit, which

is evidenced in the case file of a young auto

mechanic named Jason Mitchell.

DR. GARAVAGLIA Well, this case is

about a -year-old white male who would actually just been

in the ER two days earlier.

So now, we've got to sort out what's going on.

[suspenseful music]

Well, we have this fellow that for about two days ago,

starts having severe abdominal pain.

[groaning]

NARRATOR In fact, the onset of pain

is so sudden and so intense that Jason's wife, Patty, insists

he go to the emergency room.

Upon his arrival, doctors begin running a battery of tests.

They find a whopping amount of cocaine in his system.

NARRATOR The medical team quickly

concluded that the cocaine is causing blood vessels

in Jason's stomach to spasm.

And the pain would go away once the drug leaves his system.

They just thought that this guy was just all high on coke.

They didn't seem to have any other problems.

The abdominal pain subsided, so they let him go home.

With the caveat, you better stop using cocaine.

Go home, get off the coke, you'll be fine.

NARRATOR Jason and his wife returned home.

And according to Patty, the medical scare

has a profound impact on him.

He clearly told his wife, he's going to give up cocaine.

But over the next hours, Jason continues

to experience unusual symptoms.

DR. GARAVAGLIA He's sleeping more, he's lethargic,

he's really down, he's just not himself.

A really groggy.

NARRATOR On his second day home,

he finally mustered the strength to get off the couch so he can

make himself something to eat.

And he collapses suddenly.

[thump]

NARRATOR Patty frantically calls .

Emergency crews arrive within moments

and discovered Jason on the floor, not breathing

and with no pulse.

They swiftly begin aggressive lifesaving procedures,

but it's too late.

They rushed him to the hospital,

but he's already dead.

[tense music]

[sirens wailing]

NARRATOR For Jason's wife, Patty,

his unexpected death is crushing.

The wife is devastated.

She was hoping that he'd really, truly

was going to overcome his addiction

and then have a new life with her without cocaine.

NARRATOR But cocaine addiction is difficult to overcome.

And now, Dr. G wonders if Jason actually

followed through on his promise to kick the habit.

It's a long process to try to give up cocaine.

It's not easy once you're a chronic abuser.

Most people have relapses.

NARRATOR And as a habitual cocaine user,

Jason was at risk for all kinds of medical problems.

Cocaine can k*ll you in multiple ways.

We've got strokes to the brain, we've

got blown out aneurysms to the brain

because of the elevated high blood pressure.

We can have problems with the heart.

NARRATOR But Jason's wife Patty is convinced

that he stopped using cocaine on the day he left the hospital.

On top of that, she suspects the doctors

there may have misdiagnosed his condition entirely.

They always tell everyone, you know,

if they've had a recent visit to a hospital or a doctor,

I mean, that's all the more reason

to do the autopsy because we're going to look

to see if they missed anything.

[suspenseful music]

You do the external examination

to see what you can learn about the person, about

maybe their lifestyle.
[ … ]

With him, they don't see a needle puncture marks.

I look for any chronic illnesses,

I don't see any of that.

And I certainly don't see any trauma.

NARRATOR But Dr. G does notice that Jason

has vomit in his mouth.

DR. GARAVAGLIA Typically, there are two orifices we have

problems with a death, It can be vomiting

and having vomit up your nose and mouth

or you can defecate at death.

Those are just sometimes reactions with the death.

And, you know, it really is very nonspecific for us.

It doesn't really give us totally

a hint of why they d*ed.

NARRATOR Next, she carefully inspects

Jason's nose for any physical evidence of his long term drug

addiction.

They can actually form a hole completely through the septum.

That's a cocaine user when you see that.

He didn't have that.

It's not the easiest thing to see.

MORGUE ATTENDANT [inaudible] with the light?

Nah, I'm fine. Fine.

What color of eye would you say that?

Green or blue green?

Yeah, I say green.

Green?

All right, let's go this way.

NARRATOR Then, Dr. G examines Jason's scalp

to see if there are any injuries from hitting

his head when he collapsed.

DR. GARAVAGLIA When I palpate the external aspect

of his head, I don't see any bruises.

I don't find anything abnormal.

[suspenseful music]

NARRATOR Next, she turns her attention

to the area that was causing Jason's pain, his abdomen.

DR. GARAVAGLIA I do see that his abdomen

is a little distended.

It just as a little bigger than I expected.

He was innovated.

And a lot of people, once they get

innovated or they're CPR being done,

their stomachs do fill up with air.

So it could just all be due to resuscitation.

At the end of the external, I'm really

just left with no extra clues.

We have no idea if this is a natural death,

or we have no idea if this is a an accidental death

from using more cocaine.

Certainly, the wife would like to know.

Maybe there's legal complications with even

the ER missing a diagnosis.

We don't know.

We're just-- we just-- let's get the facts out

there and look what they are.

[suspenseful music]

NARRATOR Dr. G is ready to open the body

of -year-old Jason Mitchell.

Just two days ago, Jason went to the ER with stomach pains.

But doctors attributed it to a cocaine binge

and sent him home.

Yet, his wife Patty is convinced that the doctors initially

misdiagnosed Jason's condition and is now anxiously

awaiting word from Dr. G.

DR. GARAVAGLIA She is really worried.

She does know that he wasn't right.

It just wasn't right after he came home from the hospital.

[tense music]

NARRATOR Dr. G begins with the cranial exam

because she knows that cocaine can wreak havoc on the brain.

Well, there's a lot of ways cocaine can k*ll you.

Everything from stroke to a baloney aneurysm.

NARRATOR Using a scalpel, she cuts around the circumference

of Jason's head.

Dr. G is careful to draw the incision behind his ears.

DR. GARAVAGLIA I just was talking the funeral home.

They were mad about another medical examiner's

office that didn't quite do it behind the ears.

That's really important because you

don't want to see the incision if you have an open casket.

So you don't want it above the ears,

you don't want it cut in the ears.

So you want it behind the ears and kind of low.

[surgical saw running]

NARRATOR Morgue technician, Ashley Shaughnessy,

opens Jason's skull with an oscillating saw.

And right away, Dr. G can see that something's wrong.

DR. GARAVAGLIA When I look to the base of the skull,

there's no blown aneurysm.

But he does have, at the age of , a fairly significant plaque

or narrowing at the base of his brain from atherosclerosis.

NARRATOR Atherosclerosis refers to a buildup of plaque

within the blood vessels.

And it's commonly associated with cocaine use.

Are you hardly ever see it at the base

of the brain at this age?

, that's a really young.

I see it in people that are , , .

So that's unusual.
[ … ]

So that confirms that he probably

is a big time cocaine user.

Cocaine causes accelerated to atherosclerosis and narrowing

to the blood vessels, which increases

your chances of a stroke.

NARRATOR But as she examines Jason's brain more closely,

she can find no signs of an actual stroke.

DR. GARAVAGLIA I didn't find any evidence of that.

It actually looks normal on the inside.

There's nothing that screams of why he d*ed.

So I need to finish my autopsy at this point.

[intense musical buildup]

NARRATOR Dr. G opens Jason's body with a Y-incision

and immediately draws blood for toxicology testing.

DR. GARAVAGLIA I want to draw my toxicology

to confirm what the ER said.

Because they claim he was high on cocaine.

I don't want to presume that their test is right,

so I'd like some confirmation.

NARRATOR She then turns her attention to the abdomen.

Dr. G wonders if the stomach pain could have been

a sign of something more serious and unrelated

to Jason's cocaine use.

There's a lot of reasons to have abdominal pain.

Everything from appendicitis, to your bowels turning

on themselves, you know, you just don't

know until you get in there.

NARRATOR Carefully, she searches each organ

for any abnormalities that might help

explain Jason's stomach pain.

DR. GARAVAGLIA The abdominal cavity looks normal.

There's no fuzz, there's no blood, there's no free fluid.

His appendix looks good.

These bowels are OK.

At this point, I don't know what caused his abdominal pain.

Maybe that whole abdominal pain was a red herring

and that the ER was right.

It was just some temporary spasm.

But I haven't totally given up on that yet just

because I don't see anything.

It still could play a role.

NARRATOR Unfortunately, Dr. G is running out of suspects.

And her next stop is the last one

on her list, the chest cavity.

I make my usual snip, snip, snip

up the sides of those ribs.

And I remove the chest plate.

And then I see trouble.

This guy's got problem.

Oh boy.

[suspenseful music]

Something's going on here.

NARRATOR Dr. G has just opened Jason Mitchell's chest

and come face-to-face with a shocking discovery.

There was something wrong with the pericardial sac,

the protective membrane surrounding the heart.

That sac has filled up with blood

and distended like a taped balloon that's ready to pop.

NARRATOR When the sac fills with blood,

the heart doesn't have enough room to b*at properly.

This is a deadly condition called a cardiac tamponade.

That's constricting that heart so it can't pump.

That's just incompatible with life, I'm sorry.

We know why he d*ed.

NARRATOR But the autopsy is far from over.

DR. GARAVAGLIA So then, you have to look for the cause.

Why does he have a cardiac tamponade?

How does his pericardial sac get filled with blood?

It shouldn't have any blood in it at all.

It should just have a little bit of fluid in there.

NARRATOR Now she must examine the heart itself.

But to do that she has to first drain the blood

from the pericardial sac.

So to get that blood out, I just make a little cut.

I don't want to make it too big, too fast

because it's going to blow.

So I make a little cut and the stream comes up

and then I collect that.

The first thing you see is that heart is huge.

NARRATOR In fact, Jason's heart is

triple the size it should be.

This means, he most likely suffered from high blood

pressure or hypertension.

If you have hypertension, the last thing you need is cocaine.

And I've said it before, that's adding fuel to the fire.

You do not want to add a stimulant

to someone who already has high blood pressure.

NARRATOR Over time, high blood pressure

can damage the heart by eventually

weakening the muscle.

But after a thorough exam, she's surprised to find

nothing wrong.

Uh-hm.

I don't see anything acute, and the heart

muscle is nice and firm.

So it's not from a heart att*ck.

NARRATOR But when she removes the heart

from the chest cavity, she find something

completely unexpected.

There's a five centimeter rip in Jason's aorta, the largest
[ … ]

blood vessel in the human body.

The tear is located directly above Jason's heart.

DR. GARAVAGLIA The aorta goes up from the heart.

The portion that now yous see the tear in

is still in the pericardial sac.

All the blood that was being pumped from the heart

was going into the pericardial sac.

And that's what caused his death.

NARRATOR But it's clear to Dr. G that this is a fresh tear

and could not possibly have triggered Jason's

initial bout of abdominal pain.

That cardiac tamponade is something

that has happened very acutely.

That heart sac filled up moments before he collapsed.

So I know he didn't have a cardiac tamponade

two days earlier.

But when you follow that aorta down into his abdomen,

there's actually a smaller second tear.

And that tear is probably what he had two days ago.

And that's what was causing his abdominal pain.

NARRATOR The autopsy of Jason Mitchell is now complete,

but several questions still remain.

What caused the two tears in the first place?

And could cocaine have played a direct role in his death?

At this point, toxicology is important to me.

Because if it did have a role, it would be classified

as an accidental death.

And the wife of course, she's upset.

And the more of facts we can tell her, the better for her.

[tense music]

[music playing]

NARRATOR Several days later, Dr. G

finally receives the results of Jason's toxicology tests.

The levels confirm that Jason didn't use cocaine in the hours

before he d*ed.

But she does discovered trace amounts of cocaine metabolite,

a byproduct of the drug, which can linger in the body for days

after using it.

And for Dr. G, this finding is the key to the case.

Now that I see the traces of his cocaine use, it all fits.

[tense music]

NARRATOR It's early on a Tuesday morning,

and Jason Mitchell starts the day as he often does,

with a few lines of cocaine.

But what he doesn't realize is that his long term

addiction to the drug has taken a devastating toll on his body.

[snorting]

He's got some severe problems.

NARRATOR Jason has developed atherosclerosis in the blood

vessels of his brain.

His heart has grown enlarged.

And over the years, elevated blood pressure

compounded by cocaine use has made

his aorta dangerously weak.

So this guy has just about every complication

from cocaine you can imagine.

NARRATOR But on this particular day, one of those complications"], index ,…}

is about to erupt into a full blown medical crisis.

As Jason snorts another line of coke,

his body responds to the rush of the powerful stimulant.

His heart rate and blood pressure spiked dramatically,

and then disaster strikes.

A section of Jason's aorta near his abdomen

begins to dissect or split, causing blood

to seep into the aortic wall.

DR. GARAVAGLIA That elevated blood pressure

tears the inner lining, and the blood kind of goes

through the wall.

NARRATOR Almost instantly, he has overcome

with searing abdominal pain.

His wife, Patty, rushes him to the hospital.

But when he arrives, doctors dismiss the symptoms

as a benign result of his cocaine use.

DR. GARAVAGLIA Now, that is a serious problem.

They've missed that.

He should have been hospitalized.

There is a good chance they've had treated that medically.

But most ERs will miss about a third of those.

NARRATOR Jason returns home and promises

his wife to quit his cocaine habit,

and it's a promise he keeps.

The toxicology results show no evidence of cocaine,

only a trace amounts of cocaine byproduct

produced as the body metabolizes the drug.

He had recently used cocaine since they told him to stop.

Those two days, he wasn't using cocaine.

But the damage was already done.

NARRATOR As blood flows through the inner wall of the aorta,

the pressure rips through the layers of tissue.

DR. GARAVAGLIA That a section is going towards his heart.

A couple of days later, when he's

making his way to the kitchen, the second tear

occurs in the pericardial sac.

The blood just pours into the heart sac

until it gets to the point where it expands the heart sac

and constricts the heart because of the pressure on the heart,

so it can't expand and pump.

As soon as the heart can't pump, you're a goner

and it goes fast.

[suspenseful music]
[ … ]

NARRATOR When Dr. G delivers the report of autopsy

to Jason's wife, Patty, she receives

the news with mixed emotions.

DR. GARAVAGLIA You know, she's devastated.

I mean, she thought he'd finally was going

to turn it over a new leaf.

And ultimately, his old cocaine habit is what got him.

You know, what I take away from this case

is that people who are young think they're infallible,

but they're not.

If you start using dr*gs, there is

a good chance they're going to get you one way or the other.

[emotional music]