08x03 - Deadly Holiday

[bunniefuu]

[ominous music]

[music playing]

NARRATOR A man d*ed after a hunting trip,

and doctors fear the worst.

They're very, very worried about rabies.

NARRATOR And when the body arrives at the morgue,

Dr. G. and her staff's own lives could be in danger.

There is a huge worry about doing this autopsy.

[ominous music]

NARRATOR Then, a son is riddled with guilt, when

his mother dies unexpectedly.

I felt like, what could I have done differently?

NARRATOR And Dr. G. may be the only one

who can give the family some semblance of peace.

I'm worried, am I going to get a cause of death?

[music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

[music playing]

It's Wednesday, PM.

And it's been a grueling day for the dedicated staff

at the District morgue.

That's it.

I've had it for today.

I'm tired.

NARRATOR At last, Dr. G. is ready to head

home, when suddenly--

[telephone ringing]

DR. JAN GARAVAGLIA Morgue, Dr. G.

I get a call from a very anxious infectious disease

doctor from one of the local hospitals.

NARRATOR The doctor informs her that one of his patients

has just d*ed mysteriously, after being hospitalized

for just a couple of days.

Unfortunately, he dies before they diagnosed

what's wrong with him.

What a tragedy.

The family is besides themselves.

How could this man die so quickly?

The sad part of this story is he's

got a -year-old daughter, who is very close to him.

She watched her dad die in front of her eyes,

so she's very anxious to find out what the answer is.

So they asked me if I could take this case for public health

because they're not sure why he d*ed.

Clearly, this case is a mystery.

And I love these kind of cases, where, you know,

the doctors are baffled.

So in comes the autopsy, and hopefully I'll have

an answer on what happened.

[ominous music]

NARRATOR days ago in Kissimmee,

Florida, seemingly healthy -year-old

Leroy Williams began complaining of severe headaches.

His wife is worried about him because he

starts becoming confused, disoriented, memory loss--

and she immediately takes him to the emergency room.

They were frantically trying to help him.

But unfortunately, he has a very rapid downhill course.

He goes from having confusion, disorientation, and then coma.

[machine beeping]

All in a very short period of time.

Then they did an emergency MRI.

And they found some swelling of the brain.

NARRATOR Doctors also ran a battery of blood tests

on the -year-old.

As it turns out, all those tests were essentially normal.

Now, at this point, they're thinking, what's going on here?

Maybe we need a better history.

And they go back to the wife and say, what can

you tell us about your husband?

Why is this happening?

The wife is saying, about days, two weeks, ago,

he'd gotten back from a hunting trip

with his brother in Southern Georgia.

They were sleeping in a tent for about

a week exposed to the bats, and maybe even raccoons.

NARRATOR Based on this information,

the doctors consider a new and alarming theory.

They're worried that he's gotten

encephalitis, of some type of infection going on.

And they're very, very worried about rabies.

[ominous music]

Rabies is a virus that you usually get from other animals.

[inaudible]

DR. JAN GARAVAGLIA Wild animals have

rabies, the bats and the foxes and the coyotes, the raccoons--

in fact, that's where you're usually going to get it.

The brother clearly states they were

exposed to bats on this trip.

You'd think that he would at least told somebody

that he was bitten by a bat.

But sometimes, the bat bites are very

innocuous, and you you're not even aware that you got bitten.

But another way that you can get rabies

is aerosolization of bat guano, like bat poop.

So we know there's a question whether you

can get it by breathing it in.

Once the rabies it gets into your brain,
[ … ]

it's k*lling off cells.

You get a lot of brain swelling, and you start getting

these mental status changes.

NARRATOR If Leroy was infected and had gone to the hospital

before he had any symptoms, he could have

been treated with a vaccine.

But he d*ed too quick.

Once you start showing symptoms, it's

pretty much uniformly fatal.

And it's a relatively rapid death, very scary.

That said, rabies is incredibly rare in the United States.

We have maybe two to four cases a year.

NARRATOR But as a precaution, Dr. G. wastes no time

in reaching out to the Center for Disease

Control and Prevention, just in case it is rabies.

DR. JAN GARAVAGLIA It's important for public health

to know how much rabies there is in the country.

Because if he is exposed to it, other people could

be exposed to the same animal.

Bye.

[ominous music]

There is a huge worry about doing an autopsy on someone

with rabies.

Because with any kind of aerosolized virus,

you can breathe that in.

This is definitely one we've got to be careful with.

I don't want to expose anybody to anything

that they don't feel comfortable helping me with.

So we're definitely going to gown-up from head to toe.

We're going to wear these special N masks,

and we're going to have a shield on.

[ominous music]

DR. JAN GARAVAGLIA Are you ready?

I am excited about this case because some

of the stuff I have to do is out of the ordinary.

And I want to do it fast.

The CDC are really anxious for this answer.

So there's a lot hanging on this autopsy.

[ominous music]

NARRATOR Dr. G. is under the g*n

to solve this strange case of Leroy

Williams, an accountant who d*ed suddenly

after a recent camping trip.

DR. JAN GARAVAGLIA He's had exposure

to possibly rabid animals, both bats and raccoons,

on this hunting trip of his, up in South Georgia.

The family is very worried of what happened to him.

And now I have the CDC on call because they're

waiting for this tissue to be sent to help me diagnose it.

That helps them with public health.

I don't know if he has rabies.

The doctors are very worried about that.

But we'll keep our-- our mind open and just see what happens.

OK, Brian.

[ominous music]

All right.

Let's see what's going on with this guy.

Poor guy.

He looks pretty good.

I mean, they say he's .

But he looks much younger.

Good shape-- muscular fellow.

NARRATOR Dr. G. painstakingly scans every inch of Leroy's

skin, eyes peeled for any evidence of rabies

and any other signs of infectious disease.

DR. JAN GARAVAGLIA Does he have a rash?

Does he have any bites?

Does he have anything?

So I look very carefully.

I do see some scratches.

You can see that he'd been out in the woods.

No rash, nothing.

I certainly don't find any bites on him.

NARRATOR But it's much too early

to rule anything in or out.

To find out what k*lled Leroy, Dr. G.

must look inside his body.

DR. JAN GARAVAGLIA All right.

We have to open him up.

[suspenseful music]

I think we'll go ahead and do a complete autopsy.

You never know what you're going to find internally.

And oftentimes, there's surprises.

[ominous music]

NARRATOR Scalpel in hand, Dr. G.

opens Leroy's torso with the standard line incision.

I look at his heart.

The heart muscle looks pretty good.

The valves look good.

The aorta looks good.

NARRATOR No closer to an answer,

Dr. G. now moves on to the lungs.

DR. JAN GARAVAGLIA Let's look at this.

The lung's kind of congested and heavy.

But that's a very non-specific finding.

They're a little congested, but they're not that bad.

They found some swelling of the brain.

And oftentimes, when the brain swells,

the fluid starts building up also in the lungs.

So until I get all my pieces of information back,
[ … ]

I don't think I'm going to know what's going on here.

OK.

Let's see.

Liver looks good.

Spleen looks good.

Kidneys look good.

That's fairly normal.

OK.

Let's do the head.

I'm thinking it's probably an infection of the brain.

What type of infection?

I'll keep an open mind.

Maybe it's tuberculosis, there's a possibility

even encephalitis, meaning inflammation in the brain.

There's so many weird things that could go on.

But I'm gearing up for rabies.

[ominous music]

NARRATOR As Dr. G. gathers her tools,

the atmosphere in the morgue is unusually tense.

DR. JAN GARAVAGLIA You sure you want to do this?

BRIAN MACHULSKI Yes.

When they do that saw to get into the brain,

cutting the bony top off the skull, the calvarium,

oftentimes, if you're not skilled,

you cut that brain tissue.

And that's where the rabies virus lives.

NARRATOR If the brain is cut accidentally by an oscillating

saw, it could make a gash and splatter tissue,

causing the rabies virus to be released

into the air, potentially infecting everyone in the room.

DR. JAN GARAVAGLIA So we're definitely going to be very

careful when we cut that bone.

And we're going to try not to cut into the brain.

A couple of my brain techs volunteered to help me.

Now, just take your time.

[surgical saw buzzing]

NARRATOR With a steady hand, morgue technician,

Brian Machulski, carefully opens the skull.

It's very difficult when the brain is swollen.

He's got a very little margin of error.

[ominous music]

[electric saw buzzing]

NARRATOR Morgue technician, Brian Machulski,

has just begun to saw into Leroy's skull,

so Dr. G. can examine his brain.

One slip of his hand could be dangerous for the whole team.

There is that chance that we could aerosolize some rabies

and breathe that in.

Be careful.

But he did a beautiful job.

He never went into the brain.

Oh, nice job.

Look at that.

I then very carefully remove the brain.

NARRATOR If Leroy does have rabies,

the only indication visible to the naked eye will be swelling.

DR. JAN GARAVAGLIA Oh, yeah.

Look at that.

His brain is swollen, but I knew that from the MRI.

That's very nonspecific.

You can see swelling from anybody with lack of oxygen

to the brain.

Oh, don't see anything.

I was hoping maybe the mininges, that

thin covering over the brain, would be cloudy.

That would give me an idea that maybe it's an infection.

So far nothing.

But I don't see any evidence of clouding or discoloration.

The brain looked normal, except for that swelling.

I don't see anything.

I just didn't see any hints of anything unusual.

At this point, I'm thinking it very well could be rabies.

But we needed to look at the brain tissue.

I need some microbes on this guy.

So while the tissue is fresh, I'll take

certain sections of the brain--

NARRATOR A portion of the samples

will be frozen and sent to the CDC,

and the rest will be made into microscopic slides.

I'm really eager to get those slides back.

Take that one.

I have the CDC waiting for this tissue.

NARRATOR But the results won't come in immediately.

And while the CDC is worried, it's even more

agonizing for the family.

Dr. G. puts a rush on the microbes.

And the next day the slides are ready for her to review.

I was excited.

This is where the money's going to be, I hope.

[music playing]

NARRATOR Dr. G. carefully places the first slide

under the powerful lens and brings

the image sharply into focus.

At this point, I'm thinking it must be rabies.

And I'm excited because rabies is so rare that you don't get

that very often in the morgue.

NARRATOR But when she appears through the eyepiece,

she's completely taken aback.

I'm actually quite shocked.

I'm expecting to see these little kind of pinkish kind
[ … ]

of blobs inside the cells of the brain

that indicate that it was rabies.

But I don't see anything.

Huh.

I did not see any evidence of rabies, nothing.

The brain tissue looks great.

So at this point I'm frustrated.

Like, oh, what a letdown.

I now have no idea what's going on.

NARRATOR But then in a slide from the meninges,

the membrane overlying the brain, Dr. G.

spots something that stops her dead in her tracks.

That thin covering over the brain

is just packed with little blue cells.

I don't even know what those blue cells are.

Where did they come from?

What are they?

I don't know.

And these blue cells are everywhere, over the brain, not

in the brain, over the brain.

I'm like, what's going on here?

NARRATOR Based on the sheer number of these strange cells

and their position outside of the brain,

Dr. G. suspects they must somehow

play a role in Leroy's death.

They were everywhere.

And they're crowding in there.

So I think we have the cause of death.

I just don't know what it is.

NARRATOR To solve this bizarre mystery,

she enlists the help of neuropathologist,

Dr. Gary Pearl.

Hey, Dr. Pearl.

I couldn't wait till Dr. Pearl looked at this.

He's an expert on brains.

That's what he does.

He knows everything, but he really knows brains.

But when Dr. Pearl looks at it, he can't

tell what they are either.

It's really a mystery at this point.

I ran a very extensive battery on this case

because it was so unusual.

NARRATOR Finally, Dr. Pearl's findings

revealed the hidden k*ller.

And Dr. G. is stunned.

I was really shocked when he told me what it was.

And I've been doing this for, you know, years.

This is even rarer than rabies.

[ominous music]

[music playing]

NARRATOR Dr. G. Now knows that the answer to -year-old Leroy

Williams' mysterious death lies in the special

microscopic slides prepared by neuropathologist,

Dr. Gary Pearl.

DR. JAN GARAVAGLIA Looking at the brain tissue

is Dr. Pearl's specialty.

And he has access to special stains that we do not.

NARRATOR The results are startling.

Oh, yeah.

And I was really shocked when he told me what it was.

Now that we have our answer, we can really put this together.

It's a weird one, but we have our cause of death.

[ominous music]

NARRATOR Two weeks before his untimely death, Leroy Williams,

an accountant in Kissimmee, Florida,

treats himself to a well-deserved vacation,

his first in over three years.

He goes hunting with his brother,

out in a tent in rural Southern Georgia,

where they're exposed to bats.

And they're exposed to raccoons.

NARRATOR But Leroy's illness has nothing

to do with his exposure to wild animals

and has everything to do with something extremely rare

going on inside his brain.

This was a very unfortunate chain of events for him that

started before he was born.

NARRATOR Now Dr. G. knows what the mysterious cells

were that she saw in the microbes

of Leroy's brain tissue.

Those little blue cells are glial cells.

NARRATOR Glial cells are cells that

usually live inside the brain.

They play a critical role in supporting the nervous system,

essential to brain function.

DR. JAN GARAVAGLIA But he was born with glial cells that

didn't make it into his brain.

Thus, the brain's developing, and these

just don't make it in there.

About % of the population will have these little glial cells

outside the brain.

Normally, they would just sit there

and not cause any trouble.

NARRATOR But unfortunately for Leroy, his glial cells

become cancerous and multiply.

DR. JAN GARAVAGLIA As with so many cancers,

we don't know what triggers that cell on that period of time

in this guy to become malignant.

We just don't know.

This poor guy just had plain bad luck.
[ … ]

NARRATOR The cause of this cancer is not fully understood.

But one thing is certain, as the malignant cells

begin to multiply, it sets into motion

a deadly chain of events.

DR. JAN GARAVAGLIA These cancer cells then

start proliferating and crowding and irritating the brain,

causing then the brain to swell, causing him to have

the mental status changes.

His state of confusion, his forgetfulness

are all a result of these blue cells pushing in on

and irritating his brain.

NARRATOR Sadly, his cancer, visible only

under a microscope, is not detected

by any of the hospital tests.

And as Leroy's doctor struggled to figure out what's wrong

and keep him alive, the swelling inside his brain

reaches a critical point.

You know, there's only so much space in there.

And once the brain swells, that puts pressure

on the breathing centers.

NARRATOR With his brain deprived of oxygen,

Leroy quickly slips into a coma, and eventually dies.

DR. JAN GARAVAGLIA What a tragedy.

It is a very nasty disease, just like rabies.

It's pretty much uniformly fatal.

But in this guy's case, his time was up.

And there was nothing really medicine

could have done for him.

I immediately tell the CDC that this was a false alarm.

This wasn't rabies.

NARRATOR Dr. G's findings help bring a sense of comfort

to Leroy's loved ones.

DR. JAN GARAVAGLIA I know it doesn't bring them back.

But somehow, knowing at least why they d*ed helps them cope.

[music playing]

I have to say, it was interesting to learn

a new disease.

The beauty of this job is you will never see it all.

The day you say you've seen it all,

you aught to leave because you always have to keep learning.

And you shouldn't be ashamed of that.

I mean, that's what makes us grow.

And that's-- that's what makes life interesting.

[tribal music]

NARRATOR It's New Year's Day in Orlando, Florida.

But Dr. G. doesn't have the day off.

We do autopsies seven days a week, days a year.

And so a doctor has to be in the ward on every holiday.

And this year, I pull New Year's.

It's never where you want to be on the holiday.

I walk in, and there's about six bodies of people

who d*ed New Year's Eve.

Of course, alcohol is involved on New Year's Eve.

I have had car accidents, drunk driving, and, of course,

you know, partying.

People like to use dr*gs, and so I've had a lot of overdoses.

NARRATOR But Dr. G. notices that one of the six bodies

doesn't fit the profile of a New Year's partier.

DR. JAN GARAVAGLIA This woman in particular was sad.

She just looked like a sweet, grandmotherly type.

We need to figure out why she d*ed on New Year's.

[suspenseful music]

NARRATOR Dr. G. learns that Virginia [inaudible]

was in Orlando on vacation with her son, Dennis,

and her grandson, Nathan.

It was a nice break from the winter in Michigan.

We went to Florida for the warm weather and sunshine.

And she loved the [inaudible]

NARRATOR After a day of sightseeing,

Virginia and her family sit down for dinner

at a seafood restaurant.

It was just basically a perfect dinner,

perfect vacation so far.

And then, you know, she started complaining

about something in her throat.

[ominous music]

I gave her water and, you know,

I thought it would probably work it's

way out because catfish bones aren't too treacherous,

that I know of.

NARRATOR The water seems to help,

and the family finishes dinner and returns to the hotel.

DENNIS FRIEND We were relaxing and getting ready for bed

and going to watch the ball drop for New Year's Eve.

And me and Nathan were screwing around down the hall.

Actually, I think we were running

down the hallway at full speed to see who was faster.

NARRATOR But then Dennis hears something

coming from his mother's room.

She was making like a coughing, choking sound.

NATHAN FRIEND And it sounded like she

wasn't breathing in, like gasping for air, or something.

And he started trying to get, you know, shake her and then

started doing like CPR.

The paramedics came.

They tried to resuscitate her for several minutes

and took her to the hospital.

[ominous music]

I sat in the waiting room till the doctor came out.

It seemed like hours, and the doctor came out and told me
[ … ]

that she had passed away.

Well, I was devastated.

I didn't know what to do.

It was definitely one of the most devastating things I've

ever heard because she's been there for me

and my whole family, my entire life.

DENNIS FRIEND I mean, I lost the most important person

in my life, someone who had been there for me

for anything, good and bad.

NARRATOR What's more, Dennis and Nathan's grief

is compounded by guilt.

Well, I felt like, what could I have done differently,

you know?

And if she had choked on a bone, or whatever,

I could be personally responsible because I didn't

take her to see a doctor.

I kind of felt like it was my fault.

NARRATOR Now, they're hoping that Dr.

G. can ease their guilt and give them some sense of closure.

When a loved one dies, when the is here

on vacation during the holidays, it's

just a little more shocking.

I mean, it's not what you expect to happen.

And it's-- it's just a sad time for them.

So we at least have to give the family an answer.

[ominous music]

NARRATOR It's New Year's Day at the District

morgue in Orlando.

Dr. G. is reviewing the case of -year-old

Virginia [inaudible],, who d*ed suddenly last night.

It was sad because she was here with her grandchild

and her son.

And they were really enjoying the time together.

NARRATOR According to the investigators report,

the family believes Virginia might have choked to death.

She had fish for dinner.

And at the hotel, she started coughing.

So her son feels like she's choking

on some of the fish bones.

But I don't understand how the fish

bones are connected to, you know,

multiple hours after she ate.

Honestly, truly, I didn't think she was choking on fish bones.

It didn't make sense.

So I really didn't know what I was going to find with her.

But you have to keep an open mind when you do an autopsy.

I have to find out what the facts are.

NARRATOR In the meantime, Dr. G.

looked deeper into Virginia's medical history

for other clues.

We know she's got here from Michigan.

That's a long trip.

That really made me think possible a pulmonary embolism.

One of the risk factors for emboli

is immobility, being cramped in one place

for one long period of time.

You are much more prone to get blood

clots in your leg that then break off and go to your lung.

And if they're massive, it causes sudden death.

--times.

NARRATOR But Dr. G. then sees other red flags

in Virginia's medical history.

Oh my god.

We know she's obese.

And we know that she's got high blood pressure.

She's got high cholesterol.

Unfortunately, she's does have type diabetes,

and that's going to put her at risk for other diseases.

You're very much at risk for strokes,

heart att*cks, kidney disease--

NARRATOR And according to the records,

she's already had a stroke.

And this along with her high blood pressure

could have been a deadly combination.

A hypertensive stroke could k*ll you very fast

if it's in the right location.

So that is a possibility.

We find out she's on a medication

to lower her blood pressure.

It seemed to be pretty well under control

with the medications her doctor was giving her.

It didn't make sense.

So I really didn't know what I was going to find with her.

We'll see.

I'm anxious to see what the external has.

OK, how's it going over here?

[ominous music]

DR. JAN GARAVAGLIA Clearly you can see that she's obese,

but she looks like a grandmother.

And she looked like a sweet old lady.

I look in her nose and her mouth.

Her last dying statement, her last declaration was,

I am choking on fish bones.

I'm hoping whatever was in her airway causing

the choke would still be there.

I don't see anything coming up.

I certainly don't see anything that obstructed

her oral airway in her mouth.

NARRATOR Though Dr. G. is fairly confident that Virginia

didn't choke on a fish bone, she won't know for sure until she
[ … ]

completes the full autopsy.

I need to look on the inside.

Well, we know she's had a stroke before.

We know she has high blood pressure.

So I think what we'll do first is go ahead to the cranium.

[ominous music]

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

reflects Virginia's scalp and opens the skull,

revealing the brain.

The first thing you do is look at it before you take it out,

see if there's any hemorrhage over it,

any swelling, edema that can kind

of give you a hint of anything's going on in the inside.

There really wasn't any of that.

Then Dr. G. lifts the brain from the skull.

It's not long before she does spot evidence of a past stroke.

You see the loss of tissue.

You just see kind of a little cavity of where

brain tissue would have been.

It's d*ed and gone away.

Yeah, previously.

NARRATOR However, Dr. G. finds no evidence of any new strokes

and rules this out as the cause of death.

I'm going to turn my attention now to the rest of her body,

because I really don't think the answer's in the brain.

All right.

So let's see.

[ominous music]

[Kn*fe SHARPENING MACHINE BUZZING]

So we'll do the Y incision and extend that in the abdomen.

Oh, my god, look at this, a lot of fat surrounding her organs.

That's bad.

That's what's associated with type diabetes.

NARRATOR Dr. G. knows that diabetes can cause

damage to the abdominal organs.

She starts with the liver.

I look at the liver.

It's very congested, a little fatty,

probably from her obesity.

I look at her spleen, and I look and move the bowels

around to see if there's any hemorrhage

behind all those bowels.

She didn't have any of that.

OK, so nothing.

Her kidneys though-- not so good.

[ominous music]

Her kidneys show very devastating effects

from the high blood pressure and from the diabetes.

But you don't necessarily die that suddenly from that.

So I'm not finding anything that really

tells me what's going on.

But we still have a few things to look at.

And the one important thing, which is high on my list,

is those lungs because this could be a pulmonary embolism.

Blood clots develop in your vessels

in your leg that can break free and get into your lungs.

So I really think that, you know,

that would have fit some of her symptoms.

She was coughing a lot, right before she went down suddenly.

Let me take out her lungs, [inaudible]

NARRATOR Dr. G. removes and weighs each lung,

then examines them carefully.

But after a thorough inspection, she

comes up empty handed again.

We can't find anything wrong with her.

I don't know.

They're just very congested, like we'd

normally see with somebody who's resuscitated.

But her lungs do not show any pulmonary emboli.

No pulmonary embolus.

It's just hard.

I can't really figure out what's going on.

Hopefully, I'll have the answer by the end of the autopsy

because her family would like to know what happened.

[ominous music]

NARRATOR Dr. G. is performing the autopsy of -year-old

Virginia [inaudible] and hoping to find an answer

for her grieving family.

I really needed to know what happened and how it happened.

I wanted to know exactly why she d*ed,

so I just wanted closure.

NARRATOR Now, with pulmonary embolism and stroke

off the table, Dr. G. has one more organ left to examine,

and that's the heart.

It's important to look at a heart,

particularly in this case.

We know she's diabetic, and we know that she's got high blood

pressure, which increases your chance

of atherosclerotic plaque in your heart.

Certainly coronary artery disease

could be a reason why somebody would die suddenly

and unexpectedly.

All right.

Let's get this off.

NARRATOR Dr. G's first glimpse of the heart

confirms her suspicion that there

was something wrong there.

There's clearly a lot of fat on the outside

of her pericardial sac, which you

don't see very often, except when really obese people.
[ … ]

NARRATOR Since Virginia was obese, this isn't a surprise.

But what she finds next is.

As soon as I open up her heart sac, oh, oh.

There's a problem.

Oh, boy.

NARRATOR The thin membrane that surrounds

the heart, the pericardial sac, is filled with blood.

She slices it open and ladles out ounces, enough to fill

a whole soda can.

DR. JAN GARAVAGLIA We've got a lot of blood.

She clearly has a heart sac, or a pericardial sac,

filled with blood, pressing on her heart.

When that happens, her heart can't pump.

It can expand to get blood in it.

So there's forces on the outside of the heart

keeping it from expanding.

So you go down very quickly.

That's a cardiac tamponade.

Those are incompatible with life.

And there is nothing else that's going to Tr*mp that.

I had my cause of death, but I don't know why.

So I have to look very carefully to see if I can find where

that blood is coming from.

NARRATOR Dr. G. removes the heart and weighs it.

Her heart looks like it's pretty good shape.

It's only about grams.

That's not so bad.

You know we see hearts from high blood pressure, / grams.

NARRATOR Baffled, Dr. G. holds the heart in her hands

and explores it inch by inch.

I'm moving it around, and then I see it.

Hmm, what's that?

It's about a half an inch tear through the muscle,

causing the blood to come out the left ventricle

and into the pericardial sac.

She literally has a hole in her heart.

Why does she have a hole?

NARRATOR Dr. G. Dissects the vessels of the heart to find

out what caused the hole.

As I cut that coronary artery about every--

about five millimeters, there it is, a blood clot that's

totally clogged up the artery.

So no blood can get there.

And then that heart muscle doesn't have oxygen going

to it, and it starts to die.

And because there's constant stress on that dying,

softened part of the heart, it eventually gives out and tears

a hole right through it.

Now I see why she d*ed.

NARRATOR But there was one thing that puzzles Dr. G.

DR. JAN GARAVAGLIA I can't tie this one

up with a little bow for you.

I don't know.

We know she's on medication to lower her blood pressure.

She's on to oral medications for type diabetes.

She's on a medication to lower her cholesterol,

and she's also on blood thinners.

NARRATOR Virginia's combined medications should have helped

prevent this from happening.

Why didn't they work?

Something is not quite right.

NARRATOR Hoping to shed some light on this final mystery,

she decides to make a call to Virginia's son, Dennis.

What she learns finally helps her piece of the puzzle

together.

Oh, my god.

[ominous music]

This story actually begins years ago.

Because of her putting on weight,

causing type diabetes and high blood pressure,

plaque starts building up inside of her coronary arteries.

And that decreases the space for the blood to go.

NARRATOR Her doctors prescribed medication

to control her cholesterol and blood pressure.

But Dennis reveals to Dr. G. startling new information

about the medication.

I, um, kind of was cleaning up her room

and opened up one of her dresser drawers,

and it was just full of pills.

But I was astounded that she hadn't been taking them.

NARRATOR There's no way to know for sure

if Virginia's medication would have prevented this.

But without it, she develops a thick layer

of plaque in a coronary artery.

This plaque eventually ruptures, or breaks open.

The body responds by forming a clot

over the ruptured plaque, which then

blocks the artery completely.

That clot then cuts off blood to that heart muscle

and then doesn't have oxygen going to it.

And it starts to die.

That's an acute heart att*ck.

This heart att*ck happened several days earlier,

most likely five days ago.

But she didn't feel it.

She had a silent heart att*ck.

NARRATOR The dying heart muscle grows weaker and weaker

until finally, it tears.

That pressure of the heart pumping causes it to tear.

And then blood sh**t out the heart
[ … ]

and it starts filling up and filling up and filling up

the sac where the heart sits.

That's a cardiac tamponade.

The heart is being suffocated by its own blood.

It compresses the heart, so it can't b*at.

NARRATOR With her heart unable to b*at, Virginia d*ed.

Dr. G. Is finally able to give her family the answers

they've been waiting for.

I don't know why she said she was choking on fish bones,

but I do know why she d*ed. [music]

(SINGING) Forget--

NARRATOR For Dennis, knowing the truth

is a double-edged sword.

(SINGING) --standing alone--

DENNIS FRIEND It was kind of a relief.

But in another way--

(SINGING) --yourself--

--um it kind of made me wonder if I

had monitored her medicine better,

she would have lived longer.

NARRATOR To Dr. G, the lesson is that Virginia wasn't

k*lled by any one thing, but by a lifetime

of unhealthy choices.

This is a sad case.

This is a Western civilization kind of death.

[music]

(SINGING) --to hear--

You know, clearly, our Western diet, our junk food,

our refined carbohydrates--

they aren't good for us.

And this is what's going to happen.

[music]

(SINGING) Away--

DENNIS FRIEND I miss everything about her.

I mean, she was my best friend, the person

I could talk to about anything, um, there when I needed her.

If I could say one last thing to her, I'd say, Mom, I love you,

and I miss you.