08x05 - Clue Game

[bunniefuu]

[music playing]

NARRATOR A retired gentleman is found dead on his porch,

surrounded by bizarre clues.

DR. G There are so many things in play

that it's almost like a mystery board game.

NARRATOR And that autopsy, Dr. G is in for the surprise

of her life.

Whoa.

Oh my gosh.

Totally unexpected.

Totally out of the blue.

Something that trumps everything.

NARRATOR Then a mother and father come face to face

with their worst nightmare.

DR. G Can you imagine, your beautiful daughter, and you

walk in and she's dead in bed?

NARRATOR Now Dr. G is determined

to find out what happened to her, but it won't be easy.

Something is not quite right.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of "Dr. G Medical Examiner."

[music playing]

It's AM at the District morgue and the case

has just come in that threatens to shock even a year

autopsy veteran like Dr. G.

Oh. Oh.

Oh. He's got problems.

But I haven't been on that side of the body yet.

We have a -year-old man that's kind of a mystery.

What is on the back of that one?

There's something funky right there.

What's going on here?

NARRATOR It all began hours earlier.

[music playing]

It's PM and most of the staff is wrapping up,

but Bill Stratton, the medical investigator

is just starting his shift.

It's impossible to work a to .

We're the ones that respond to the scene to initiate

the death investigation.

It's kind of like a waiting game.

We never know what to expect.

People don't make appointments to die.

We never know when it's gonna occur.

There is no way that we're gonna tell when it's gonna

be busy and when it isn't.

NARRATOR This afternoon seems like a slow one, but all

too soon the phone rings.

Medical examiner's office, Bill Stratton speaking.

The police give me a call.

They have a -year-old male and the scene

that suggests oddities.

Something doesn't add up.

Something's not right.

They want me to respond right away

and help them get to the bottom of this.

OK.

Well, let's go take a look at this gentleman.

Bill loves these kind of cases.

He is a great investigator because he's so inquisitive.

If anybody is going to see detail, it's gonna be Bill.

And he gets excited about every case.

That's the beauty of Bill.

That's why I like so much.

He's very enthusiastic.

We'll get a better idea once we get out to the scene,

but it could be anything.

[music playing]

NARRATOR On a sunny afternoon in February,

Phil Dempsy walks over to visit his neighbor,

retired factory workers -year-old, Ernesto Vasquez.

DR. G When he gets up to him, he realizes

something is not quite right.

He immediately calls authorities.

EMS comes out.

NARRATOR Paramedics arrive right away,

but sadly they're too late.

DR. G He is already clearly dead, and they pronounced him.

And Bill goes out and investigates the scene.

BILL STRATTON As I walked up to the front of the house,

sitting on the porch is a man in a chair dressed

in a robe and undershorts.

And on the table there was a handgun,

a Kn*fe, and three vials of--

of medications and the caps were off.

So the scene was just very odd.

DR. G There's certainly no evidence

that he used the Kn*fe or the g*n, but two of these vials

are pretty powerful narcotics.

They're both oxycodone in two different forms.

The third one is a benzodiazepine,

an anti-anxiety drug.

BILL STRATTON After looking at the medications

and seeing the date that they were prescribed

and the amount that were filled, there

were about pills absent from the vials

that should have been there.

DR. G Those prescriptions were just gotten two days ago.

So that's a boatload of pills missing.
[ … ]

Something bad is going on.

BILL STRATTON Once I completed my examination,

I was trying to move the body to the medical examiner's office.

DR. G I have a lot of bizarre cases,

but this is bizarre in that there

were so many different clues.

I don't know why the g*n, the Kn*fe, and the vials are there,

but this case is starting to become like a Clue board game.

[music playing]

What you got, Bill?

Well, we have a -year-old white male

sitting on the front porch.

Natural death maybe.

Suspicious death maybe.

Looks like a mystery.

- It is a mystery. - All right.

Thanks, Bill.

NARRATOR Dr. G begins by reviewing Bill's report

for any information on Ernesto's history that could prove

useful to her investigation.

We don't know much about this fellow.

He's a -year-old gentleman who's retired.

He was a factory worker up north, came here to retire.

His wife has d*ed a couple of years ago,

and the only next of kin is an adult son,

uh, that lives up north that had little contact with him.

He really doesn't know what had been going on.

He just knew his dad was depressed

and trying to work through it.

NARRATOR Based on this history, along with the biggest

clue of all, missing prescription pills,

Dr. G can't help but fear the worst.

Was he thinking about how to commit su1c1de?

Probably contemplating the Kn*fe?

Eh, too messy.

The g*n?

Oh, but violent.

I'll go with the medication.

NARRATOR It's also possible that

Ernesto unintentionally OD'd.

BILL STRATTON An accidental death from an overdose

of medications is possible.

You take a couple of pills, pain pills, makes your pain go away.

You take a couple of more, you feel a little bit better,

and you keep taking them.

You forget that you took them.

Maybe that's why the lids are off.

NARRATOR Even though the scene is a strange one,

she'll have to keep in mind this -year-old might

have simply succumbed to the effects of old age.

DR. G Natural disease is something

that is a possibility.

Certainly a heart att*ck or coronary artery disease

or heart disease from hypertension

would be the number one reason why somebody would die suddenly

and unexpectedly.

NARRATOR Dr. G also considers that it might have just

been a tragic fatal accident.

DR. G I've had people just sitting in a chair

and they have brain trauma from a previous fall

earlier in the day, or something happened to them.

He could have fallen earlier in the day,

had a-- a head injury that was a very slow bleed,

and then finally it caused his death sitting in the chair.

NARRATOR But on everyone's mind is the specter of foul play.

BILL STRATTON We know there's a w*apon right next to him.

There's a handgun and a Kn*fe.

That's a little suspicious.

It's possible this man could have been m*rder*d.

It could be foul play, a homicide.

You never know what's going on, and this is a bizarre case.

[music playing]

We do have his height somewhere, right?

MAN I put it on there.

NARRATOR Dr. G is preparing for the autopsy on retired factory

worker Ernesto Vasquez.

There are so many things in play

that it's almost like a mystery board game.

NARRATOR Meanwhile, his sudden death has left his son

Michael desperate for answers.

BILL STRATTON He felt despondent

and emotionally upset about the loss of his father.

DR. G He was really worried that this was a su1c1de.

There's always that guilt that surrounds people

when someone commits su1c1de.

Could they have prevented it?

I think that's what that son was most anxious about.

I feel bad for him.

NARRATOR Now it's up to Dr. G to sort fact from fiction

and determine exactly what claimed Ernesto Vasquez's life.

That's why the medical examiner's office exists.

I have to do an autopsy and--

and find out what the facts are.

So we'll see what we can find.

[music playing]

All right.

Let's see.

He must be pretty old.

When I first look at him, he looks older

than the stated age of .
[ … ]

He shows some chronic kind of sun exposure,

like he's really tanned himself over the years.

NARRATOR And on his face, Dr. G notices another clue that makes

this case even more twisted.

Oh.

He's got a scar there.

I see little scars at the hairline.

The guy's had a facelift.

Facelift?

That's just so weird to see that on a man his age.

NARRATOR Dr. G can tell that this surgery

was performed recently, most likely in the last few years.

This is gonna be weirder than I think.

Oh god.

Then I see he's got these loop earrings in his ear.

He's got a gaudy--

gaudy watch on, and an open back toe ring.

Then underneath his clothes, she

discovers an unexpected detail that

sheds more light on Ernesto's taste in jewelry.

Oh my god.

Look at his nipples.

You open the robe and you realize

things are really bizarre.

This -year-old man has nipple piercings with rings in place,

and they look rather fresh.

NARRATOR Dr. G is surprised these recent piercings seemed

out of character for Ernesto.

According to his son, he'd always been quite conservative.

DR. G This guy has some kind of funky lifestyle

after his wife d*ed.

Maybe he's trying to cope.

It's not your typical grief reaction,

but we all grieve in different ways.

NARRATOR But Dr. G can't let the strangeness

distract her from the goal.

She continues searching his body inch

by inch for any evidence that might reveal

what happened to Ernesto.

Of course I look to see if there's

evidence of previous su1c1de.

Let me see his wrist.

He's got a little scar on one of his wrists,

but not what we typically see.

It looks like some kind of healed trauma.

I look at his head for evidence that maybe he fell.

Still got a-- a full head of gray hair,

but I don't see any trauma there.

There's certainly no laceration.

Just absolutely nothing wrong.

I can't totally rule out foul play,

but there's certainly no evidence of trauma externally.

Let me look at the rest and see what else is going on.

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We're looking for any trauma to his head, bleed to his head,

uh, any kind of natural disease.

Are we gonna find anything on this fellow?

I remove the calvarium, look at his brain.

Now, his brain shows some mild atrophy.

Just a little bit shrunken.

It could indicate some dementia, but when I section the brain,

it seems very mild.

So I suspect it's just some age related, uh, atrophy.

It's not something that would have k*lled him.

NARRATOR After the through examination,

Dr. G comes up empty handed.

We've ruled out all the natural disease

that could occur to his head.

The stroke, the bleeds, and we've

certainly ruled out a fault for any kind of trauma to his head.

NARRATOR No closer to Ernesto Vasquez's cause of death,

Dr. G will have to dig deeper for answers.

Dr. G does enjoy the difficult cases

that are a little more complicated

than your routine, sudden, unexpected death

or violent death.

I mean, she will get to the bottom of this.

All right.

[music playing]

We do our typical Y incision.

When I open him up, what we're looking

for with our first glance is evidence of trauma,

evidence of bleeding.

But there's no rib fractures.

He doesn't really have anything.

All right, that's-- there's nothing.

NARRATOR At this point, Dr. G can rule out

foul play as a cause of death.

But if Ernesto wasn't m*rder*d, what did k*ll him?

We need to now take our toxicology

because this may be the key.

We are really worried that this is an overdose

because I do have pills missing.

We're gonna have to wait for tox on that.

OK.

Let's see what his liver looks like.

When I look at the abdominal cavity, the liver looks fine.

The spleen is fine.

Uh, it all looks normal.

NARRATOR Everything inside Ernesto Vasquez's body
[ … ]

is bafflingly perfect, until Dr. G reaches an organ

deep inside the abdomen.

DR. G He had a kidney cancer in not just one kidney,

but both kidneys.

That's a serious cancer.

It was getting advanced.

It looks like he would have had problems with it,

but it doesn't look at this point

that it's his cause of death.

It's hard to say for sure.

OK.

So we'll go ahead and take the heart out.

Maybe he just has a heart att*ck,

and would be the number one reason why

somebody would die suddenly.

Threw it away.

It's big.

The heart is enlarged.

It weighs grams.

I look at the coronary arteries.

The blood vessels that supply the blood to the heart,

it was narrowed about %.

This-- this guy was a ticking time b*mb.

He certainly could have just sat down and had an arrhythmia.

Why he has the g*n, the Kn*fe, and the pills next to him,

I don't know.

NARRATOR This is shaping up to be even more of a mystery

than Dr. G expected.

Is it the cancer?

Is it the dr*gs?

Is it the heart?

Any one of these things could have k*lled him.

NARRATOR But suddenly, she starts a surprising new piece

of evidence.

That's nasty.

That's nasty.

Oh my gosh.

Totally unexpected.

Totally out of the blue.

Something that trumps everything.

[music playing]

NARRATOR In the mysterious clue game

that surrounds -year-old Ernesto Vazquez's death,

su1c1de, cancer, or an arrhythmia

are all possible K*llers.

He's got a lot of bad things going on.

NARRATOR But as Dr. G sections his lungs,

she makes a shocking discovery.

DR. G Oh my god.

That one's just full of clot.

He's got bilateral pulmonary thromboemboli, blood clots that

totally occlude or fill up the blood

vessels that go to his lungs.

They look like long worms.

They literally look about the size as my finger.

They're dark.

It's like a big blood clot, but it's like the cast of the vein.

NARRATOR Without seeking help, there's no way Ernesto

could have survived this.

Incompatible with life.

Huh?

This trumps everything.

So the last thing I do is I have to find

where those clots come from.

NARRATOR Dr. G dissects the legs, the place where

blood clots most commonly form.

And lo and behold, that's what I find.

He's still got the blood clot, uh, in the calf vein.

So I have a cause of death, but I still have a mystery.

I don't know why the g*n, the Kn*fe, and the vials are there.

The missing pills are a problem for me.

And I want to pin this for the toxicology.

NARRATOR Unfortunately, this means

that Ernesto's son Michael will have to continue

waiting for an answer.

It's difficult whenever I pend a death certificate.

He's still anxious to know what happened, but the son was OK.

I told him I'm just not sure what

all these clues are telling me.

BILL STRATTON She's a fantastic doctor.

She's very thorough, very efficient.

Uh, she really gets emotionally involved in the cases.

She's very good with the families,

and she's gonna get the answers one way or another.

[music playing]

NARRATOR A few weeks later, the reports finally arrive,

and Dr. G settles in at her desk to analyze the results,

and then she flips to the first page.

She sees yet another bombshell.

When I get his toxicology, I'm really

kind of shocked at what I saw.

He's got a potentially lethal level of oxycodone,

but there's some other telltale things going on here.

He also had methadone in his system,

another powerful narcotic, and he's got

two anti-anxiety medications.

He certainly has enough medication

to cause him to go unconscious.

So he still could have taken an overdose for suicidal reasons.

Maybe, ultimately, why he has this blood clot is
[ … ]

he took the medication and he's just unconscious in this chair

for so long.

Being immobile is a risk factor for those blood clots.

If he tried to commit su1c1de with the dr*gs

and he gets the pulmonary thromboemboli,

is that a su1c1de or is that a natural?

NARRATOR The only way to know for sure

is to find out which came first, the blood clot or the dr*gs.

I really need to look at the micros

to help me with the timeline.

NARRATOR And there in one of the microscopic slides,

Dr. G finally finds the answer.

Now I know the chain of events and I can

really put this case together.

[music playing]

NARRATOR In Pine Hills, Florida,

Ernesto Vasquez has been grieving

the death of his beloved wife in his own unique way.

He gets his ears pierced.

He gets his nipples pierced.

He wears gaudy jewelry.

He probably is leading a different life than the one

he led with his wife.

NARRATOR But unbeknownst to Ernesto, inside his body,

a deadly chain of events is set into motion.

DR. G There is a cancer growing inside

of him within his kidneys.

Having those cancer cells in your body

causes blood to clot much more readily.

Because of this, a clot starts developing in his leg.

NARRATOR From the micros, Dr. G sees that days before Ernesto

takes the dr*gs, the blood clots had already formed in his legs

and little pieces started breaking

off and lodging in his lungs.

He's got multiple emboli.

Not the mass of clots, but little ones that

are causing havoc to his lungs.

I can tell under the microscope those were there prior to him

taking that medication, at least the day prior.

NARRATOR But Ernesto is unaware of what's happening inside him

and on the morning of his death he begins popping pills.

DR. G He takes several pills of oxycodone.

Maybe three, maybe even four, but not .

It's a high level.

It could k*ll a lot of people.

It would have k*lled me, but it didn't k*ll him.

I think what happened is he was tolerant to that medication.

He's used to taking this narcotic.

He abuses this narcotic.

Because he's not just got oxycodone, he's got methadone,

and he's got two different anti-anxiety dr*gs,

one of which he has no prescription for.

The combination of this medication

is something that we often see when people

abuse, uh, prescription dr*gs.

This isn't a su1c1de.

This is prescription drug abuse.

NARRATOR Dr. G doesn't think Ernesto

was trying to k*ll himself.

Instead she believes he was a drug abuser.

In fact, the medication doesn't play a role at all.

It only puts him to sleep.

Before he even takes the pills, pieces of the blood clot

already started showering his lungs,

then comes the fatal blow.

DR. G While he's sitting there, a massive clot

plugs the vessels in his lung, and he dies suddenly.

The medication has nothing to do with his death.

He had the clot before he took the medication and the clot

k*lled him.

So this is clearly a natural death.

NARRATOR Now she can finally call Ernesto's son

Michael with an answer.

He was relieved when I ruled that this was a natural death.

He didn't know what was truly going on down here.

And he thought the worse.

So the fact that this was really unavoidable, unpredicted,

I think made him feel better.

NARRATOR But for Dr. G, one part of the game still remains.

I still have a mystery.

It's just very suspicious that so many pills are missing.

What's going on?

Where did the other pills go?

And what's with the g*n and the Kn*fe?

I go to bed thinking about this.

This is the kind of stuff I think about at night.

[music playing]

NARRATOR Dr. G has closed the case on Ernest Vasquez,

but she's still wondering why he was

filled with a Kn*fe, a loaded g*n, and

missing prescription pills.

He's sitting there with pills missing

and he just had those prescribed the day--

a couple days before.

So where did the other pills go?

What's going on with that medication?

He doesn't have a level high enough that

matches pills being missing.

Dr. G reviewed his medical records

and all her findings from autopsy
[ … ]

and comes up with a theory that ties it all together.

Now it all makes sense.

Not only don't I know how he d*ed,

I think we know a little bit more about him.

Now we know how this Clue game ends.

[music playing]

A couple things were interesting from his medical records.

He is asking for narcotics because he claims he has

back pain and he has hip pain.

He's constantly asking his doctor

to renew his prescription before its time saying,

I lost the prescription.

I need another.

So he's clearly got some problems

wanting more of that drug, but he certainly

didn't have in his system.

So those pills are gone some other way.

I suspect he was selling that medication.

He sells them.

He trades them.

He does something with them besides take them.

The methadone, which he didn't have a prescription for,

he probably got, uh, for one of his associates

in which he trades or sells pills with.

He's making money.

He knows what kind of people buy that medication.

That's why he had the Kn*fe and the g*n there.

Not to think about committing su1c1de,

but to protect him when he's selling that medication

off his front porch.

NARRATOR Dr. G will never know for sure if Ernesto was a drug

dealer, and if so why.

All she knows is that in the case of Ernesto Vasquez,

nothing was as it seemed.

What looked like this really distraught man,

I see as a guy who's abusing dr*gs

and wearing gaudy jewelry.

He's got nipple piercing, selling medication

from his front porch.

Who would suspect a -year-old man?

BILL STRATTON Things aren't always what they appear to be.

The surprising cases are the ones

that make this job interesting and keep us on our toes.

DR. G Never judge a person by their age.

Always keep an open mind.

If this case doesn't tell you that, no case would.

[music playing]

TOM HEMPHILL You need me to cover him back up?

DR. G Yeah, sure.

NARRATOR There's never downtime for Dr. G.

I just got back from court on a guy that was just

beaten to a pulp and stabbed.

So that took a while, and then, uh,

Dr. Stephanie was nice enough to do

the other two autopsies today.

NARRATOR But just when one case is closed,

tragically another opens.

Today we have a -year-old woman that is just

found dead in her apartment.

Didn't look like there had been any kind of foul play.

There isn't anything suspicious, and yet, she's dead in bed.

She lives by herself and she works as a marketer

with an internet firm.

She's very close to her mom and dad.

She's an only child, and her family's devastated.

I don't know why she d*ed.

And clearly why she's here is clearly

why I'm gonna do an autopsy.

[music playing]

NARRATOR -year-old internet marketer Rebecca Davis

and her parents Mark and Susan get together as often

as their busy schedules allow.

It's been a few weeks since they've seen each other,

but they're planning on catching up this weekend on Saturday.

She was supposed go out for dinner with her family,

but she's not feeling well.

She thought she was getting the flu.

So she decides to stay home.

They didn't hear from her the rest of the weekend.

She didn't show up for work on that Monday.

The firm called her parents to go check on her because they

couldn't get a hold of her.

NARRATOR Mark and Susan call Rebecca throughout the day,

but when she doesn't answer their repeated calls,

they become increasingly worried.

They go over to the apartment.

They use their key.

MAN Rebecca?

Rebecca, honey?

NARRATOR As they enter the bedroom,

they come face to face with a parent's worst nightmare.

MAN Rebecca?

DR. G They find her dead in bed.

Can you imagine being the parents and this

is your only child, your beautiful daughter,

and you walk in and she's dead in bed?

It must have been horrible for them.

NARRATOR Now there's only one person

they can turn to for answers.

They're devastated.
[ … ]

They just don't know what happened to her.

They really didn't think she'd be dying at the age of .

[music playing]

NARRATOR Dr. G just received the body

of Rebecca Davis, the -year-old only child

of parents Mark and Susan, who are shocked and grief

stricken after discovering her dead in her apartment

earlier this morning.

They were very devastated to find her daughter like that.

The parents are very concerned.

They just don't know what happened to her.

NARRATOR Now it's up to Dr. G to find out.

She begins by reviewing the case file, on the hunt

for anything that might shed light on what brought Rebecca

to the morgue so unexpectedly.

The apartment door was locked.

Uh, so it didn't look like there had been

any kind of, uh, foul play.

Things were in order.

So I don't really know why this young woman

is just found dead in bed.

NARRATOR But as she scans the medical report,

one thing jumps out.

Eight years ago, Rebecca was diagnosed

with Crohn's, a disease that causes inflammation

of the GI tract and affects millions of people

around the world.

DR. G Typically the symptoms of Crohn's would

be cramping, abdominal pain, fever, diarrhea.

Those would be the classic symptoms.

Certainly what's interesting about Crohn's is some areas

of the world Crohn's is very prevalent, and a lot

of people will have Crohn's.

Like, in England and some of the northern latitude

European countries, there's like seven per every , people."], index ,…}

We know sometimes what some of the triggers are.

Like, smoking makes it worse.

Um, some medications make it worse.

But we really don't know why some people

get it and some people don't.

But Crohn's isn't really what we'd consider a fatal disease.

So chances are we're not gonna see them die suddenly

and unexpectedly.

NARRATOR According to the records,

Rebecca was followed closely by a doctor.

And other than the occasional abdominal pain,

she's been managing the disease for years with few problems.

Her doctor said it wasn't that bad.

She'd been dealing with it.

NARRATOR But there is something related to the disease

that Dr. G must consider.

DR. G People with Crohn's have a higher

chance of having a blood clot and thromboembolus.

She's just laying in bed because she's got the flu.

She's immobile and she's already got

a predisposition to clotting because of the Crohn's.

Maybe blood clots that form in her legs

break loose and then, uh, clog her lungs.

NARRATOR And given Rebecca's symptoms,

Dr. G wonders about something else.

Any kind of infection is a possibility with her.

Bacterial pneumonia, meningitis, even an infection of her heart."], index ,…}

The other thing I worry about with her

is that she's got chronic pain.

She has pain medication.

Could it be that she just took more

medication to treat her pain, uh, than she should have?

Prescription pain medication abuse

is a scourge of our society.

I see it in our morgue at least every other day.

NARRATOR But there's an even more disturbing

prospect Dr. G must consider.

DR. G How do I know she didn't commit su1c1de with a drug

overdose, intentionally?

The parents are very concerned.

They're certainly hoping she didn't commit su1c1de.

All righty.

NARRATOR At this point her death is a total mystery

and her grieving parents are counting on Dr. G

to cr*ck this case.

That's the beauty of an autopsy is I just

don't know what I'm gonna find.

maybe I'll find something totally unexpected.

There's-- there's a lot of possibilities on this girl.

[music playing]

Oh boy.

This is a sad one.

The first thing I look at when I see

her is what does she have on?

And she just has her nightgown on.

It looks like she had gone to bed.

I do look at her general condition.

She's a beautiful woman.

She's thin and weighs about pounds.

That's not uncommon with Crohn's disease.

Um, they lose their appetite.

They sometimes, if it's bad enough,

will have problems with, um, malnutrition,

absorbing enough nutrients.

NARRATOR Then Dr. G does a quick scan
[ … ]

for any signs of foul play.

There's certainly no evidence of trauma on her.

Um, it's something I always keep in the back of my mind,

but in this case, I'm not really thinking of it too strongly.

We'll definitely rule that out when we do the internal.

NARRATOR After removing the clothes,

Dr. G looks closer at the body and something else

catches her eye.

What you notice mostly on her is that she's

starting to decompose.

She's not in the best of, uh, smells.

For being so thin, her belly's kind

of sticking out a little bit.

It's starting to get green.

She's got that kind of darkening of the lips.

Her eyes are starting to sink in.

NARRATOR This is a disturbing but important clue.

Since Rebecca d*ed two days earlier,

Dr. G is surprised by the rate of decomposition.

A little more advanced than I'd expect--

that's weird.

--but there's great variability with decomposition and maybe

that apartment was kind of warm.

I hope the decomposition hasn't destroyed any evidence.

Otherwise this is gonna be a tough one.

NARRATOR Dr. G is worried if the inside of the body

is also decomposed, it could spell

disaster for investigation.

Even a decomposition of two or three

days makes that autopsy a little more challenging for me,

but I like a challenge.

So I-- I still am hopeful, uh, that we're gonna

determine her cause of death.

[music playing]

Have you opened a head before?

Yeah?

OK.

Thank you.

NARRATOR Morgue technician Tom Hemphill opens the calvarium

to expose the brain, where Dr. G is on the hunt for anything

that will help her narrow down her laundry list

of potential causes of death.

We're gonna rule out everything, from trauma to even

a-- a hypertensive bleed.

Hypertension can be a-- a, uh, complication of some

of the medication she's taking.

So I removed her calvarium to look at the brain,

and it looks fine.

There's certainly no evidence of trauma or foul play,

but what I'm worried about more is meningitis

because she was feeling ill.

But when I look at the brain and the lining,

there's no evidence of clouding of those thin membranes

over the brain that would suggest a meningitis.

No trauma.

No meningitis.

It really looks like nothing going on in the head.

I need to do the rest of the autopsy.

I'm not gonna know until I--

I get in.

[music playing]

I do my Y shaped incision and remove the chest plate.

No evidence of trauma.

She's just got nothing there.

Let's get the tox.

I think toxicology may be very important in this case,

but it's gonna be harder to get blood because at this point

I know she's too decomposed to get it out of her vessels.

Here, let's try this.

I got it.

But I was able to get some blood out of her lungs.

NARRATOR Dr. G is eager to test for dr*gs

as an overdose is still on her list of possibilities.

Thanks, Brian.

Then I remove her lungs, first of all,

to look for pulmonary embolis because people with Crohn's

have about a three to five time increased risk

for having a blood clot form.

No pulmonary embola.

She didn't have any.

No blood clots that I could see, but her lungs

didn't look right.

I noticed some discoloration to the lower aspects of the lung.

They looked like they maybe even have an infection in them.

So I'm wondering if maybe she ended up

with a-- a bacterial pneumonia.

I'll do a couple micros.

That-- that lung may have pneumonia.

OK.

The next thing I do is go to the heart.

Heart's of normal size and shape.

It's a little-- it's kind of soft.

Looks a little bit soft.

Is that a myocarditis or an inflammation

or infection of the heart muscle, or is that just decomp?

She's looking worse on the inside

than she does on the outside.

So I will look at that under the microscope, uh,

to see if that's an infection of the heart muscle.

This decomp is making it a little harder for me.
[ … ]

NARRATOR As a result, so far Dr. G has no solid conclusions,

but she's determined to get answers for Rebecca's parents.

We had no idea why she d*ed, nor did the parents.

What could have gotten her at such a young age?

Why her?

It's devastating.

[music playing]

NARRATOR -year-old Rebecca Davis' parents are still

reeling from their sudden loss, and they're

counting on Dr. G for an explanation

as to what took her life.

It must have been horrible for them

and they really want to know what happened.

NARRATOR But the accelerated decomposition on the body

is making for a challenging autopsy.

She's decomposing very quickly on the inside.

It's gonna be harder to really sort

out what happened with her, but I like a challenge.

NARRATOR Now she heads to the abdomen in hopes

that even the faintest clue might shed light on Rebecca's

still elusive k*ller.

Oh my gosh.

When I open up the abdominal cavity, what I see

is horrendous. Wow.

Look at that.

What is wrong with her?

There's spilled bowel contents in the abdominal cavity.

And not just bowel contents has leaked out.

Bacteria has leaked out.

Oh my god.

There is an infection that has taken

hold in the abdominal cavity.

it's still coming.

Yeah.

Was a mess.

NARRATOR Now Dr. G needs to find

what caused the catastrophe.

She inspects the feet of intestines inch by inch

and finally sees what she believes is the source.

Then I see a huge problem.

Oh boy.

There is a section of bowel.

It's about a little over three feet long.

It was at the end of her small intestine.

There is something wrong with that section of bowel.

That is really weird.

It's bloated.

It's kind of a maroon, almost black color.

It's necrotic.

And when I mean necrotic, I mean dead.

You can't survive this. It's dead.

It's gross.

It's-- it's-- it's gone.

It's necrotic.

That bowel has twisted on itself.

It has strangled itself, what we call volvulus.

It's like you're twisting a hose and the blood supply then

gets kinked, and that's not going then

to supply blood and oxygen and nutrients to that bowel,

and it starts to die, and then bowel contents

even start to leak out.

For people with Crohn's, that's a very unusual finding.

We just now have to figure out what's causing it.

NARRATOR Dr. G is now on a mission to discover

how this could possibly happen.

Finally, in the abdominal cavity,

she makes a discovery that helps her make sense of it all.

Oh.

Here it is.

It's right in there.

I clearly know why she d*ed, and the reason it occurred

is quite abnormal.

[music playing]

NARRATOR -year-old Rebecca Davis

has been living with Crohn's disease

for the past eight years.

She got diagnosed with Crohn's at the tender age of .

Hers comes and goes.

She has the bouts where she's having terrible abdominal pain,

cramping abdominal pain, uh, fever, bloody diarrhea.

She's getting used to that.

She was living pretty well with it.

NARRATOR But over the years, Crohn's

has damaged her bowels, causing minor scar tissue to form.

And unfortunately for Rebecca, this scar tissue

develops in the worst possible area, acting

as a pivotal point on which the rest of the bowel

rotates and twists on itself.

What she had was scar tissue in the belly,

causing it to twist and it just turned on itself

and strangled its blood supply to that portion of the bowel.

This bowel probably was cutting off its blood

supply over a period of time.

It probably didn't happen all at once.

This strangulation of the bowel is unusual because usually

people with Crohn's have so much scar tissue,

it doesn't even have that mobility usually.

So it can twist that's more frozen in place.

NARRATOR Ironically, the fact that Rebecca

had only minor scar tissue, but not the typical severe case,
[ … ]

is what seals her fate.

DR. G Her Crohn's probably wasn't

all that bad, just bad enough to let it

rotate and strangle her bowel.

She didn't know that that night the bowel's

totally cut off the blood supply and starts to die.

So she's having a lot of abdominal pain.

[phone ringing]

NARRATOR Tragically, Rebecca only

thinks she's coming down with the flu, or at the very least

another flare up of her Crohn's, and she cancels

dinner with her parents.

DR. G This is a true surgical emergency,

but she didn't really know what was going on.

NARRATOR And despite the pain, she

doesn't seek medical attention.

Usually people with chronic pain and a chronic condition,

they get very familiar with that condition.

I think she didn't recognize that this was a much worse, uh,

problem going on.

NARRATOR As she tries to fall asleep,

the dying bowel causes waste and bacteria

to leak from the intestines, which in turn triggers

a massive infection called peritonitis

in her abdominal cavity.

The bacteria got out of the bowel

and got into her abdominal cavity, which is not where they

should be, and then the bacteria start decomposing your tissues."], index ,…}

That's why she was looking a little more decomposed than I

would have expected, because the bacteria had already gotten

the upper hand on her with that terrible infection going

into her belly.

NARRATOR The infection soon enters your bloodstream

and rapidly spreads throughout her body.

At this point, it's too late.

The body is trying to fight that off,

and that infection just overwhelmed her.

She eventually loses her blood pressure and dies.

[music playing]

This is a rare complication of Crohn's.

Most people don't have this complication,

but unfortunately it was the perfect storm.

If you go to the hospital with the severe pain

and they take you to surgery to remove that bowel,

well, you have a-- a good chance of surviving it.

But without any surgery, it's % mortality.

Unfortunately she didn't seek help

because she thought she was just having

another one of her episodes.

[music playing]

NARRATOR A few weeks later, Rebecca's

toxicology results finally arrived

and they're perfectly clean.

Dr. G closes the case and calls Rebecca's parents.

I think the family was really surprised.

They knew it was a debilitating disease.

They knew she'd have problems with it down the road,

but at least it wasn't a su1c1de.

It was something that was out of her control.

And I think they felt a little better for that.

It-- it was a natural death.

Sometimes I get cases in our morgue

that you're fascinated by because they're so rare,

but then you think about just how random life is.

Why her?

Why'd she get it?

Some people just don't get dealt good hands.

Sometimes we try our best, but just bad things happen to us.

[music playing]