06x12 - Disturbing Behavior

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NARRATOR A woman survives a brutal att*ck,

only to die five years later.

It's sad because she survived the mugging.

But now, she's dead on that couch.

NARRATOR And now, Dr. G wonders if her death is somehow

related to that as*ault.

Maybe she had severe brain trauma, who knows?

NARRATOR Then, a man tumbles feet to the ground.

They heard whoa, and this guy falls off the ladder.

NARRATOR But Dr. G believes there may be more to this case

than meets the eye.

Did he just slip and fall?

Or did he have some kind of physical illness

that affected him?

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NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

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I guess we start it at .

WOMAN Dr. G?

Yeah

NARRATOR When you were in charge of one of the busiest

morgues in Orlando, Florida, some days

it feels like the bodies just keep on coming.

They're dying like flies with that.

This has been an abnormal, Abby day.

Abby day.

NARRATOR So it's no wonder that Chief

Medical Examiner Dr. Jan Garivaglia

has learned to multitask.

Let me finish hers, and then I'll come back.

I'll be there in a second, Brian.

Believe it or not, I'm juggling multiple cases at one time.

Can we get this going?

I think I left my ruler, my big ruler over here.

I wish I could concentrate on one case,

and then not do anything else till it's done.

But they don't pay me for that.

I got to do multiple things at once.

This doesn't make any sense at all.

NARRATOR But sometimes, Dr. G encounters an autopsy

so challenging that it demands every bit

of her attention and focus.

It's a breezy march evening in downtown Orlando, Florida.

Tim Anders and his wife are just sitting

down to dinner when they're interrupted

by Tim's sister Cynthia.

The -year-old has been living with the couple

for the past five years.

But today, something about her seems strange.

The brother asked her if she wants to come to dinner.

She didn't.

She just kind of walked away.

NARRATOR But when Tim checks on her later that evening,

he can tell right away that something is terribly wrong.

She's got vomit on her shirt.

And she was unresponsive Tim immediately calls ,

but by the time EMS arrive on the scene, it's too late.

She was already dead.

NARRATOR Now, the distraught couple is desperate to know

what happened.

The brother is upset because his sister d*ed,

and he just wants answers.

NARRATOR When Dr. G. Arrives at the District morgue

the following morning, Cynthia Anders

is first up on her roster.

But before she even sees the body--

Where's those medical records?

NARRATOR --she knows that this will be no ordinary case.

was called.

She was pronounced at the scene.

None of us like to do middle aged women,

because oftentimes at the end of the autopsy,

you don't know why they d*ed.

For some reason, they tend to be more subtle.

Just means it's going to be more work to try to figure it out.

NARRATOR And at first glance, the possibilities seem endless.

Certainly, natural disease could've played a role.

Maybe pulmonary emboli.

Maybe heart disease.

At this point, it can be anything.

The circumstances surrounding this death

are kind of interesting.

NARRATOR By all accounts, Cynthia Anders

had been a fun loving woman with a zest for life.

She was a waitress.

She was married, and she had a normal life.

NARRATOR But one fateful day five years

ago, something happened that changed her life forever.

According to the brother's story,

she was mugged and beaten about the head

with the butt of a g*n.

This mugging supposedly had left her anxious, with depression,

and not wanting to talk.

She's not coping well with life.

NARRATOR And it wasn't long before Cynthia's family

and friends began to notice some alarming

changes in her behavior.
[ … ]

It appeared she suffered some brain damage from the att*ck,

and seemed haunted by the traumatic experience.

She starts acting very odd, kind of withdrawn.

Her social behavior kind of goes downhill.

She didn't care about the way she looked,

or how she took care of herself.

NARRATOR Eventually, Cynthia hit rock bottom when

she separated from her husband.

At that point, she had no choice but to move

in with her brother, Tim.

Their lives kind of spiraled out of control.

Now years later, she's dead on that couch.

What is really going on?

NARRATOR Dr. G. now wonders if the circumstances

surrounding Cynthia's att*ck could

have led to a drug addiction.

It wouldn't be unusual for people

to suffer some major injuries, and then

get addicted to pain medicine.

Maybe she d*ed for an accidental drug overdose.

NARRATOR But there is another, more disturbing possibility.

If her life is really out of control, it may be a su1c1de.

NARRATOR And if this is the case,

it could be devastating for her family.

If we find that it's a su1c1de,

they may feel terribly guilty, because she

did it right in front of them.

NARRATOR But it's also possible that Cynthia's death

was completely unrelated to her depression.

Maybe she had severe brain trauma from the mugging

five years earlier.

And this is what caused her symptoms.

NARRATOR And despite the time that's passed since Cynthia's m

if Dr. G. can make the connection

that the complications from brain trauma caused her death,

this becomes a homicide investigation.

If we can link her cause of death,

and connect it to the incident of when she was mugged,

then this would be a homicide.

Why can't they find that hospital record?

Hold on.

Let's get some info, and I'll be right back.

NARRATOR years of experience tell

Dr. G. that this case will be anything

but a walk in the park.

You're on tomorrow?

Yes.

These kind of deaths, these are very difficult because you

do have to connect the dots.

Thanks.

I think we've got our work cut out for us.

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So this woman looks like she's got a lot of chronic problems.

This should be funny.

Oh my god, this woman's a mess, isn't she?

I'm shocked.

I'm really shocked at the way she looked.

She looks terrible.

She looks much older her stated age of .

She's very thin and gaunt.

She has clearly lost a lot of muscle mass.

Don't take any blood out of here.

Let me see her hands.

She's got inner osseous muscle wasting.

When you start losing muscle, you kind of

see these little shallow dips in the backs of your hands,

because your muscles are atrophying between the bones.

She's got that.

She's got vomit on her shirt.

That's not unusual for a terminal kind of event.

That part doesn't bother me so much.

Don't take that out until--

Her eyes are sunken within her eye sockets.

Her hair is a mess, and her fingernails

are long with what looks like feces underneath of them.

She clearly is not taking care of herself.

She's very difficult to autopsy.

All righty, let's try her this way.

I guess there's a possibility that she could have

fallen, and just hit her head.

I palpate her scalp, but I don't really

feel anything except some matted, unkempt hair.

NARRATOR Given Cynthia's emaciated state,

Dr. G will be on the lookout for any signs of drug use.

She almost looks like she may be a methamphetamine user,

or a chronic cocaine user.

But I certainly don't see needle tracks, or any clear evidence

of drug use.

But of course, the toxicology results

would play a major role.

NARRATOR But when Dr. G removed Cynthia's shorts,

she makes another shocking discovery.

Oh, my.

There's something wrong here.

Oh my.

Let's see what we find under that.

When I take off her shorts, she's

got to an adult style diaper on, held together with duct tape.

Why is she not taking care of herself?

Why is she looking like this?
[ … ]

Something is really wrong with this woman.

What's going on here?

She looks terrible on the outside,

and I'm wondering what does she look like on the inside?

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Oh, gosh she's a mess.

This one is bad.

NARRATOR From the external exam,

Dr. G can tell that something is terribly

wrong with -year-old Cynthia Anders.

She's been having some definite problems.

I think her life is falling apart.

The brother is telling me she's depressed, withdrawn,

anxious, not acting right.

Well, you know, this is a -year-old woman

whose fingernails are lined with feces underneath?

Oh my.

And she's got an adult diaper on.

This is more than just not acting right.

This is much worse.

NARRATOR She now believes that Cynthia's erratic behavior

and sudden death could very well be connected to an as*ault five

years earlier.

Is it just a psychological event of the mugging,

which has caused depression?

Or is it really some type of a brain injury from that trauma

she suffered?

I'll definitely save this brain.

If we have enough evidence to say that that lugging is

what ultimately caused her death,

then this would be a homicide.

I've got doctors I'm calling.

NARRATOR Looking for anything that

could shed light on Cynthia's case,

Dr. G's investigators do their best to track down more

information about the att*ck.

Bye now.

Nobody could find any kind of report.

There was none that existed.

OK.

NARRATOR But it's also possible that Cynthia's death

had nothing whatsoever to do with her mugging.

All right.

Then, I'll be back.

It's really unclear what this is going to be.

I don't know what that body is going to tell me.

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OK, we're ready, right?

As soon as I do my y incision, I make sure

all the abdominal organs are intact, and they're fine.

NARRATOR Her first order of business

is to collect samples of Cynthia's blood and urine

to send to the lab.

I do toxicology because that might be our answer.

Maybe this is an overdose.

We'll have to see what the tox shows.

Depending what kind of dr*gs she has in her system,

it may take anywhere from two weeks to weeks for me

to get that toxicology result back.

NARRATOR The next step is to examine Cynthia's heart.

Her heart is a normal size and weight.

The blood vessels that supply blood to the heart look good.

The heart muscle looks good.

Everything looked fine.

Heart looks good.

NARRATOR Dr. G then turns her attention to Cynthia's lungs.

Because she's clearly sitting a lot,

not doing a lot of movement.

I would worry that maybe she does have pulmonary emboli.

NARRATOR People like Cynthia, who are physically inactive,

are at greater risk of developing

blood clots in the legs.

These clots can break loose, travels

through the bloodstream, and lodge themselves in the lungs,

cutting off all blood supply to the lungs,

and in turn, the heart.

That would cause you to die suddenly.

Let's see what's in her lungs.

But when I cut the lungs out, the main pulmonary arteries

are without blood clots.

Well I'm looking.

I don't see any.

And I cut the lungs themselves, and there's

no pulmonary emboli.

She doesn't have any.

But it isn't long before Dr. G spots something

else, something curious.

Oh, wow.

There's something going on in that lung.

Her lungs don't look right.

Her lungs are heavy, and kind of dense.

The bronchi have some kind of creamy, white material in them,

that look kind of like pus.

I'm very worried she might have pneumonia.

NARRATOR Pneumonia is an infection of the lungs,

usually caused by bacteria.

Look at this.

This is nasty.

I really need to look under the microscope

to see how extensive this disease is in her lungs.
[ … ]

NARRATOR Dr. G collect tissue samples from Cynthia's lungs

and prepares to send them to the lab for processing.

I'll take a little biopsy of tissue

from each lobe of both lungs.

I usually have all my cassettes laying

next to my cutting board, with the case

number on the cassette.

So I'll take little snippets of lung,

and put each snippet in a different cassette.

They come back to me, usually within a week or two weeks,

and then I can read those slides under the microscope.

NARRATOR If the micros confirm the presence of pneumonia,

she could have her cause of death.

All right, then I'll be back.

NARRATOR For now, all Dr. G can do

is wait until the slides come back from the lab.

So, I guess another one we're not

going to know until we look at the micros,

are going to look at the tox.

NARRATOR But Cynthia's gaunt appearance gives Dr. G an idea

as to where to look next.

Because she is so thin, could she have something wrong

with her GI tract?

I need to still look at those bowels.

Any time you do an autopsy, you're looking

at their digestive tract.

Their esophagus, their stomach, they're

large and small intestine.

Let's see what's going on in this little belly.

That doesn't look bad.

NARRATOR But right away, she can cross the organ

off her list of suspects.

Her bowels look perfectly normal.

NARRATOR Unfortunately, the rest of the internal exam

provides little in the way of answers.

No gallstones.

Should doesn't look bad.

Her liver.

She has a spleen.

Her spleen, her kidneys, all look pretty good.

It's already done.

I did it.

NARRATOR But there's something about this case

that still troubles Dr. G.

What surprises me is her bizarre behavior.

Her not taking care of herself.

My question is, what's causing her to be like this?

I still need to look at her head,

because that's where I think the answers are going to be.

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NARRATOR Dr. G's morgue technician, Tom Hemphill,

carefully saw through Cynthia's cranium.

We're going to look to see if there's evidence

and maybe an old skull fracture, evidence of a blood,

maybe contusions or bruising on the brain.

And she could still have natural disease in her head.

Who knows?

So, I reflect the scalp.

Now five years later, I certainly

wouldn't expect a bruise.

But I could see possibly evidence

of an old skull fracture.

Well, it's underwhelming.

But everything looked fine.

Scalp looks completely normal.

NARRATOR Dr. G gingerly removes the skull cap,

and exposes the brain.

Ah!

And I'm shocked.

I don't see anything that looks like old trauma.

She doesn't have any evidence of old blood.

I see no old skull fractures.

She doesn't have any of them.

NARRATOR One thing is now clear,

there is no evidence of any brain damage

as a result of her mugging.

Oh my god.

Look at that.

But I do see something very odd.

What's shocking is the frontal lobes were all shrunken down.

NARRATOR In fact, the entire front part of Cynthia's brain

has atrophied, or wasted away.

Something's wrong here.

It was such an odd appearing brain,

that I really wanted Dr. Pearl, my neuropathologist to see it.

Let's see.

We got a brain Kn*fe?

Brain pathology is difficult, and it takes

a lot of special knowledge.

I enjoy working with Dr. G. We review

cases together every two weeks.

Her cases are always very interesting.

Yeah, that's right.

In this case, the striking finding

was severe atrophy of the frontal lobes of the brain.

That's not normal.

I love those cases that you think gets going one way,

and then the autopsy changes the whole direction.

I mean, how cool is that?

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[ … ]

NARRATOR Dr. G and Dr. Pearl have just

made an unexpected discovery during the cranial exam

of -year-old Cynthia Anders.

She's got something wrong with her brain.

Her frontal lobes are all shrunken down.

I've never seen it that bad.

NARRATOR In order to determine what is causing this wasting

of the front part of her brain, Dr. Pearl

collects tissue samples to examine under the microscope.

He has special stains that I don't have access to.

I wish I could look at those slides right that second.

But it has to be processes, that has to be returned

a couple of weeks later.

NARRATOR In the meantime, Cynthia's toxicology

report comes back from the lab.

And she doesn't have a thing in her system, not a thing.

The fact that her toxicology was negative,

it ruled out a su1c1de, or an accidental drug overdose.

When I looked at the eye fluid, the electrolytes,

it did show that she was dehydrated.

Not dehydrated enough to k*ll her.

But kind of went along with her general appearance

of not taking care of herself.

NARRATOR Two weeks later, the micros from Cynthia's lungs

are delivered to the District morgue.

When I get the slides, and I put

those long slides under the microscope,

I have my suspicions.

I believe she's got pneumonia.

NARRATOR And all it takes is a quick look under the lens

to prove her right.

There it was.

She had extensive bronchi pneumonia,

and that's ultimately why she d*ed.

NARRATOR Dr. G is now certain of the cause of death.

But this crucial finding raises more questions than answers.

We have the reason for her death,

but why would a -year-old woman have pneumonia?

And what's causing her behavioral problems?

NARRATOR Dr. G believes that the missing

link may lie in the stain samples prepared by Dr. Pearl

I just need all the pieces of the puzzle

together on this one.

NARRATOR Finally Dr. Pearl reviews

his much anticipated findings with Dr. G.

When he showed me his slides, that he had prepared

of the brain and the special stains,

it confirmed our suspicions.

I had my answer.

Oh, yeah.

I see it.

All of that makes sense now.

NARRATOR It's PM, and Tim Anders has just sat down

to dinner with his wife, leaving his sister Cynthia

to relax on the couch.

Little does he know, she's slowly

dying and has been for years.

I suspect she probably did start her symptoms

at least five years earlier.

NARRATOR But in a cruel coincidence,

just as Cynthia begins to exhibit strange behaviors,

she gets mugged.

Everybody is attributing her behavioral changes

to this mugging, when this had nothing to do with her mugging.

She has said neurologic degenerative disease

called frontal lobe dementia.

NARRATOR Dementia is a loss of mental function severe enough

to interfere with daily life.

So behavior and personality, reasoning, language functions,

any of those can be affected.

NARRATOR There are many different types of dementia,

each with a different root cause.

Not all dementia is the same.

We all think of Alzheimer dementia,

where it starts out initially as memory loss,

or being unable to recognize people.

But frontal lobe dementia has to do

with the way you act, the way you take care of yourself.

Sometimes your language.

So they may not have problems with reasoning or memory,

but they'll have problems with social interactions.

Her bizarre behavior, her not taking care of herself,

her feces under the nails, her diaper, for all of that

is classic for a frontal lobe dementia.

I know people think , that's too young to have dementia.

But frontal lobe dementia is much younger onset than some

of the other dementias.

It's not uncommon to start with those behavioral problems

at a very early age.

NARRATOR And while the condition is often

known to influence behavior, it can affect

basic motor functions as well.

In Cynthia's case, her gag reflex no longer

works properly, and bacteria from her saliva

is inhaled into her lungs.

That bacteria is coming from her oral cavity,

and making a home in the lung, where it's not supposed to be.

NARRATOR The bacteria begin to multiply,

and that causes a deadly pulmonary infection.

She doesn't even know she's sick because her brain
[ … ]

has shrunken down that much.

She had no ability to even realized something was wrong.

She was getting sicker and sicker,

and she slowly succumbs, and slips into a coma, and dies.

You know, if her pneumonia was caught earlier, sure,

they'd have saved her this time.

But there was no stopping the progression of her dementia.

And ultimately, that's what did k*ll her.

NARRATOR With all the information in hand,

Dr. G is finally ready to contact Cynthia's brother

Tim to share her findings.

Yeah, this is Dr. Garavaglia.

He was flabbergasted.

He had no idea.

He really thought that she just had some kind of depression.

NARRATOR But nothing can prepare Tim

for what she tells him next.

You know, in many of these people it's a genetic defect.

Oftentimes, it's inherited.

So that had huge implications for the family.

I'm really sorry.

NARRATOR Sadly, there is no test

that can predict whether someone will develop this condition

or not.

There's nothing he can do.

They just have to wait and see.

NARRATOR As for the alleged mugging,

it's unclear whether it ever happened.

We never could find a police report,

and I didn't really see any clear cut evidence of trauma.

Maybe the as*ault never occurred.

Maybe because of her dementia, she

fabricated that whole thing.

I don't know.

I don't think we'll ever know.

What did we end up doing?

Six cases, right?

Four full autopsies?

MAN Yes.

Oftentimes in forensics, you come across cases that

have misleading circumstances.

But you ultimately have to let the body speak to you.

I love how an autopsy can give you just unexpected answers

sometimes, and that's what makes this job great.

It's the surprises.

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NARRATOR Despite this seemingly simple circumstances

of her next case, Dr. G knows she must

dig deeper to find the answers.

He fell and he hit the ground, but did he

have some kind of physical illness that affected him?

Or did he just slip and fall?

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When I come in to see our cases in the morning,

this report states that this is a man that's years old.

He's Puerto Rican, and it looks like he fell off of a ladder.

Today, we have a case that seems pretty cut and dry.

NARRATOR According to the investigators report,

Leo Guzman worked as an independent contractor.

Yesterday afternoon, he and a small crew of men

were outside painting a house in nearby Kissimmee, Florida.

DR. GARAVAGLIA He's got his ladder up, ladders pretty high.

About feet.

He's up near the top rung.

People below heard whoa.

And this guy falls off the ladder.

Once he hit the ground, they could see that he

clearly had a broken leg.

It's kind of all cattywampus.

He's unconscious.

NARRATOR Workers at the scene immediately call .

Paramedics arrive within minutes,

and rush Leo to the ER.

But he's dead on arrival by the time

they make it to the hospital.

NARRATOR Leo's body is then transferred

to the District morgue.

Now, it's up to Dr. G to determine the cause of death.

And on first glance, this one looks pretty straightforward.

Sounds like a pretty simple case, no mystery.

Ladder's pretty high, it's about feet.

And that's about the height when we start seeing

some very dangerous things.

My number one theory is if he just falls off the ladder,

and most likely hits his head.

The number one way to die from a fall from a height.

OK. That's good.

That's what I needed.

Thanks.

NARRATOR But Dr. G can't discount

the possibility that Leo's death was more

than just a simple accident.

He fell and he hit the ground.

But is there anything else that may have played a role

in him falling off that ladder.

Although he's at work, believe it or not,

% of people who fall off ladders tend to be intoxicated.

I would hope he's not on the job intoxicated,

climbing the ladder, but I've seen stupider things.

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[ … ]

NARRATOR It's also possible that Leo's death

is one of the many electrocutions

that come through the morgue.

I get a lot of people, there doing things

and they hit the electrical wire,

and that shocks them, and causes them to fall.

That's the first thing we always ask the witnesses.

Was there anything that could have caused an electrocution?

And in this case, no.

NARRATOR Or could the Florida heat

have contributed to his death?

The investigators report states it was a steamy

degrees the day Leo d*ed.

degrees here in Orlando in the summer is lovely weather.

But it's hot to work outside in that temperature.

So, I always worry about heat stroke.

Heat stroke is your body's inability

to get rid of produced heat, and your temperature

can go up to .

So the first thing I'll look at is the EMS run sheet.

And in this case, when I look at those records,

his temperature is ..

Not heat stroke.

NARRATOR Still, years of experience

also tells Dr. G that an underlying medical condition

could have just as easily triggered the fall.

Did he have some kind of physical illness

that affected him?

We did find out that he had a sister here

in the United States with him, and she felt

that he was in great health.

But you always worry that there may

be some natural disease, even at the age

of , that's going untreated.

So I'm worried about a stroke, or maybe a heart att*ck.

He doesn't have a regular job.

He just freelances.

He doesn't have health insurance.

And people like that tend to not get a lot of preventative care."], index ,…}

He's certainly, as a man, more apt not

to go get preventative care.

NARRATOR And sure enough, as she

reads through Leo's medical history,

Dr. G spots a red flag.

A-ha.

He'd been complaining of leg pain.

And when people have leg pain, and then

die suddenly, and unexpectedly well

we think of a pulmonary embolism.

NARRATOR But a pulmonary embolism

isn't her only concern.

Some things are not--

Even though his sister says he's in great shape,

she did hint that he may have diabetes.

There are a lot of silent K*llers,

high blood pressure, coronary artery disease, even diabetes.

So to me, they're not in great shape

until the autopsy says he's in great shape.

So basically, we'll let the body speak to us.

Is there anything that we'll be able to get

from that autopsy that'll help us understand what

happened to this poor fellow?

Well right now, I'm not quite sure.

It's hard to say.

When I first see him, I notice he looks the stated

age of , maybe even younger.

Fairly muscular.

A lot of intravenous lines on him.

They were trying to pump fluids in him,

in his neck, and his groin, in his arms.

And they have him intubated.

None of that seemed to work, because he was dead on arrival.

It looked like he was a painter.

He's got shorts on with some paint.

He's got high top boots, safe appearing shoes.

His shirt has already been cut off.

That didn't come in with him.

NARRATOR As a first step more technician,

Brian Muholski carefully removes Leo's clothing,

while Dr. G inspects his personal belongings.

In his personal effects, there is something really telling.

He had cigarettes and cigarette lighters.

I'm venturing maybe those insides aren't as good

as that sister says.

NARRATOR Next, Dr. G inspects Leo's body,

looking for injuries he may have sustained in the fall.

He certainly shows evidence that he hit his head.

He's got an abrasion on the right side.

He's got a laceration between his eyebrows.

He's got a broken leg that you don't even want to look at,

you know?

One part of his legs one way, and the other parts is another.

NARRATOR Moving down the leg, she turns

your attention to Leo's calves.

One of the ways we look for a pulmonary embolism

is to look to see if the legs are symmetrical.

Maybe there's a deep vein thrombosis that's

causing the leg to swell.

NARRATOR But in this case, Leo's broken leg makes

this task close to impossible.
[ … ]

So I would have to wait until I get to his lungs

to see if he has an any pulmonary emboli.

NARRATOR Finally, Dr. G spots a potentially telling clue.

Leo has creased ear lobes.

The medical issue has gone back and forth

for years about the meaning of the creased ear lobes,

because many papers said it was associated

with coronary artery disease.

Well as it turns out, as you get older, a lot of people

get creased ear lobes, and it is not associated

with coronary artery disease.

Now in the younger male population,

there is some correlation, but it's pretty weak.

NARRATOR But before she goes digging into Leo's heart

and lungs, Dr. G has a much more likely suspect

to investigate, the head.

I think the other possibility on this one

is going to be the head.

Head trauma is how most people die

when you have a fall from a height of feet or higher.

So I'm going to go to where I think the money is, the head.

[music playing]

What I'm going to be looking for in the head are two things.

One, document the trauma, which I suspect there is.

And two, check to see if there's any natural disease.

Anything that was going on in his head that caused

him to fall off that ladder.

NARRATOR Dr. G begins by slicing Leo's scalp from ear

to ear.

And as she peels back the skin, something

takes her completely aback.

Something shocking occurs when I reflect that scalp.

Oh my gosh.

[music playing]

NARRATOR Dr. G has just made a surprising discovery

in the cranial exam of -year-old Leo Guzman,

who fell off a foot ladder yesterday in Kissimmee.

There is no scalp contusions.

And one would suspect that when falling feet,

hitting your head.

That doesn't mean he didn't die from head trauma,

but I won't know until we get in.

NARRATOR Using an oscillating saw,

morgue technician Kelly Wood saws open the skull cap,

then Dr. G steps in to get her first look at the brain.

I notice that there's no blood over the brain.

No blood, no trauma.

NARRATOR But as she carefully removes the organ,

something catches her attention.

Oh my god.

Look at that.

What was remarkable was that he has

after a atherosclerotic plaque on the vessels

at the base of his brain.

We tend to see that in much older people.

But it wasn't enough to really cause him any problems.

NARRATOR However at age , this finding

suggests that something else may be going on inside Leo's body.

Just the fact that it was there

made me think he's not quite as healthy

as his sister thought he was.

I got to look at it.

NARRATOR Next, Dr. G begin slicing through the brain

tissue itself, looking for any signs

of trauma or natural disease.

When I cut his brain, he's two too little what we would call

lacunr infarcts.

It's basically a tiny little stroke.

This guy was not going to live to a ripe old age,

I don't think.

Now they're sometimes considered associated with high blood

pressure, diabetes, but nobody really

knows truly what causes those.

NARRATOR It's a suspicious discovery,

but his Dr. G examines the tissue more closely,

she can see that the damage is not recent.

They appeared that they've been there for a while.

So his lacunar infarcts are probably not the reason

he fell off of that ladder.

NARRATOR So far, none of the findings in Leo's brain

indicate a definitive cause of death.

He also doesn't have anything that

would indicate why exactly he would

have fallen off that ladder.

He doesn't have any trauma.

NARRATOR But she still must search

for fatal injuries and signs of natural disease

inside Leo's body.

So next, since his head isn't giving us the answer,

we need to do the rest of the autopsy.

[music playing]

NARRATOR With scalpel in hand, Dr. G cuts through the skin

and performs a standard Y shaped incision.

So when I reflect his skin, and subcutaneous tissue,

I noticed right off he's got a rib fracture.

NARRATOR But as she takes a closer

look at the broken bone something

catches her attention.

There's no hemorrhage surrounding it.

That indicates to me that his heart isn't pumping.
[ … ]

So in this case, most likely that's from resuscitation.

NARRATOR Once the body is open, Dr. G draw samples of Leo's

blood for toxicology tests.

I need blood to check for dr*gs and alcohol,

because about % of people who fall from a height

will be intoxicated, even people who are working.

NARRATOR But the results won't arrive for several weeks.

In the meantime, Dr. G examines Leo's organs in situ

for any signs of fatal trauma.

DR. GARAVAGLIA Let's see what we've got here.

So when I remove the chest plate,

there's no evidence of any kind of puncture to the lungs.

The heart sac is intact.

The liver's intact, the spleen is intact.

There's no free blood, and there's no evidence of trauma.

NARRATOR Suddenly, it's looking like the case of Leo Guzman

may not be as cut and dry as it once seemed.

What are we missing?

At this point, we're changing our focus.

I'm starting to suspect that it might be natural disease.

NARRATOR And at the top of her list

of suspects is a pulmonary embolism.

So her first stop is the lungs.

When I take out his lungs, immediately you

can see that his lungs, even at the age of ,

are already starting to break down

because of the chronic effects of smoking cigarettes.

But that's not what caused him to die.

NARRATOR Still on the hunt for blood clots,

Dr. G begins a careful dissection

of the lungs themselves.

I cut the pulmonary artery, and when I look at that,

there is no blood clot.

Everything looks good.

NARRATOR With the lungs now ruled out,

she turns her attention to another likely culprit,

the heart.

Immediately when I see the heart I see it's enlarged.

Like I would see in high blood pressure.

That's a big heart.

This is a fellow that's not very big.

He's of rather small frame, but his heart weighs grams.

That is a big heart.

It shouldn't weigh more than .

NARRATOR As a next step, Dr. G slices through the muscle,

and into the coronary arteries.

The left coronary artery has a % narrowing

by atherosclerotic plaque.

But it gets worse.

The left anterior descending has a % narrowing,

and then the circumflex coronary artery

has about an % narrowing.

NARRATOR And as her scalpel cuts into Leo's last remaining,

artery Dr. G discovers what could be the smoking g*n.

Wow.

This is a man that was a ticking time b*mb.

[music playing]

Using your scalpel, Dr. G slices into the right coronary artery

a -year-old Leo Guzman's heart,

and there she makes a key discovery.

Oh my.

When I get to the right coronary artery,

there's about a % narrowing, and just an adjacent

to that there's a clot.

That totally cut off the blood to that part of the heart.

It's a classic heart att*ck.

But that clot was already very aged.

You could see it's brown.

NARRATOR This tells Dr. g that Leo's heart att*ck didn't

happen the moment he fell.

And when she dissects the heart muscle itself,

Dr. G spots another clue.

There's already a hemorrhage in the back of his heart,

and his heart muscle was in the process of dying.

NARRATOR That means his heart att*ck

occurred, at least hours before he fell off the ladder.

Yeah, this isn't that old.

NARRATOR And just a few centimeters away

she surprised to find another, even older att*ck.

He'd already suffered a previous heart att*ck.

There's already scar tissue.

He has a severely damaged heart.

NARRATOR For Dr. G, This is the final piece of the puzzle.

The fact that he fell off of that ladder,

along with what I saw in his autopsy,

we know what k*lled him.

So it doesn't really matter what is in his tox.

This trumps anything else I found.

[music playing]

NARRATOR To everyone around him,

Leo Guzman is in seemingly great health.

But looks can be deceiving.

He had high blood pressure, but he probably

didn't know he even had it.

NARRATOR And left untreated, Leo's high blood pressure

begins to damage almost every vessel in his body.

And it didn't help that he smoked, also causing

injury to those vessels.

He had a history of diabetes.

Diabetes also caused injuries to the vessels
[ … ]

if it's not controlled.

So he had a triple whammy of the smoking, the high blood

pressure, and the diabetes.

NARRATOR Over the years, this triple whammy wreaks havoc

on the vessels in Leo's brain.

He had two small strokes to the brain,

and we saw the plaques in the blood vessels of his brain

also.

NARRATOR But the most lethal destruction

occurs within the vessels of Leo's heart.

He had changes in his heart from having

to pump against that high blood pressure.

High blood pressure also predisposes

you to coronary artery disease.

And at some point in the past, he had

had a previous heart att*ck.

NARRATOR Then on the day before his death,

he suffers yet another heart att*ck.

The blood starts forming a clot

totally occluding any blood from getting to that blood vessel.

So that heart muscle starts to die.

And that's an irritant.

NARRATOR But Leo doesn't seek medical treatment.

Why did he not go to the hospital?

He must have been having either a silent heart

att*ck, where he's not even feeling pain,

or is ignoring his symptoms.

NARRATOR The next morning, he reports to work as scheduled.

But his severely damaged heart can't

handle the combined stress of physical labor in Florida heat.

He just climbs that ladder like he's in great shape,

but he doesn't know that that heart muscle

is already starting to die.

The stress of probably climbing that ladder

was enough to cause his heart to go into an arrhythmia.

His heart starts to flutter.

No blood is going to the brain.

He starts feeling woozy, probably lets out the whoa,

and falls over.

He's dead before he hits the ground.

He never felt that fall.

NARRATOR With this, Dr. G can finally close the book

on -year-old Leo Guzman.

And for Dr. G, this case serves as yet

another lesson in the importance of preventative care.

This may or may not have been prevented.

Not everybody has the same symptoms,

but men tend to ignore their symptoms more.

Or he's rationalizing it as something else.

Men tend to do that more than women.

He could have done a lot, particularly stop smoking.

He should have known his blood pressure was elevated,

and he should have taken better control of his diabetes.

I'm sure he'd lived a lot longer.

You know, I think the important message on this case

is that you can look good on the outside.

You can feel good.

But if you're going to ignore knowing what

your blood pressure is, you're not going

to look good on the inside.

You just aren't.

You need some basic information about yourself.

You need to know what your cholesterol is.

You need to know what your glucose is.

You need to know your blood pressure is.

Those are silent K*llers.

And what you take away from this case,

is the silent k*ller strike again.