Five Quarts: A Personal and Natural History of Blood (17 page)

“So what’s with the hair?” I said, sotto voce, sitting in between Steve and Jerry a few rows behind and to the left of Giorgi. Among the three of us, two theories quickly emerged: Wiglessness was either a ploy on her attorney’s part to make her look as pitiful as possible before the judge, or it merely served a practical consideration—if she were taken straight off to jail, her personal possessions, silver helmet included, would be confiscated, and perhaps in her thinking the day would bring indignities enough. Steve pointed out that her tailored pantsuit was gone, too. The ex-phlebotomist, now a felon, wore informal slacks and a sweater, clothes I doubted she’d have given a second thought to bundling up and using as a pillow.

At Judge Mullin’s entrance, the courtroom clockwork instantly wound down. With his small build, full ruddy cheeks, and clipped mustache, he looked like the tycoon from the game Monopoly, except for his expression, which was, already, one of profound irritation. Giorgi’s attorney, Brian Matthews, wasted no time and called to the stand forensic psychologist Rahn Minigawa. Minigawa had spent seven hours interviewing Giorgi and administering personality assessment tests. From TV courtroom dramas, I suppose, I was primed to think that a photogenic authority such as he would provide a lucid, penetrating explanation of the deep-rooted cause of Giorgi’s behavior. But in this instance, I experienced no eureka-like
aha!
as Minigawa ticked off the phlebotomist’s laundry list of personal problems, from childhood physical abuse to a more recent history of depression, panic attacks, and compulsiveness. A recovering alcoholic, the fifty-five-year-old Giorgi had had other legal problems stemming from two DUIs as well as a host of financial troubles, he testified. What’s more, “She’s also menopausal.” It was the doctor’s belief that the debilitating side effects of menopause, such as the insomnia and mood swings, together with the aforementioned problems—
Okay, here comes his conclusion,
I thought at the time,
the distillation of seven hours of psychological analysis, the meat of her defense
—“All affected her ability to make good decisions.”

Throughout all this, Jerry reacted with a steady emission of sighs and
harrumphs,
which I believe is the straight man’s way of saying,
Oh please.
Steve turned his notepad to me and pointed to where he’d doodled a bewigged stick figure wearing a T-shirt that read
MENOPAUSE MADE ME DO IT.
But I quickly returned to watching Judge Mullin, who, chin propped on fist, continually re-aimed his gaze at Giorgi.

Next up was Dale Sanderson, whose every word and manner in his cross of Minigawa said,
Gimme a break.
The prosecutor did not hide his disdain for this paid defense witness, this “expert.” Pressed by Sanderson to dispense with the DSM jargon and to provide the court with genuine insight into why she’d done what she’d done, the doctor hesitated, obviously uncomfortable, then replied, “Well . . . she said she didn’t have a clear recollection of her actions . . . she said she was stupid.”

Sanderson, who throughout the proceedings was never granted the opportunity to interview Giorgi, wanted to make sure he had heard Minigawa correctly. Okay, he recapped: You administered two personality tests. You spent several hours with her. You’re an expert who’s testified in more than fifty trials. And the best assessment you can provide the court of her motivation is that she said she was “stupid.” With an expression I found vicariously satisfying, Sanderson looked at Minigawa as if the doctor were something he’d poked with a pencil from the bottom of his shoe.

Finished with the psychologist, the prosecutor laid out his own theory of what had occurred. Elaine Giorgi’s actions were calculated, he contended, and were motivated by the desire “to curry favor with SmithKline Beecham and make patients happy.” Giorgi, who’d once been fired from the company for her inefficiency, sought to make the most of this second chance. The problem was, she wasn’t a very good phlebotomist. She had to perform thirty to fifty blood draws per day and, despite her training and experience, had a hard time using the standard needles. She found the small, light butterfly needles easier to use. Patients also found them less painful; hence fewer patients made complaints. Just one drawback, though: Butterflies were expensive—eighty cents apiece as opposed to five cents for a standard needle—and they were intended for use with only a small number of patients, mainly pediatric and geriatric. Giorgi reused the pricier butterflies because, if she ordered them in mass quantities, her bosses would notice.

There was my
aha.

Sanderson said in closing, “It is inexcusable that she’d value a human life at seventy-five cents.”

Matthews spoke next—a candle to Sanderson’s fireworks—and meekly summed up with, “I don’t think society needs to be protected from her.”

Finally, Elaine Giorgi read a prewritten statement. Her quavering, peeping voice obscured each syllable before it reached my ears, but the judge nodded at her when she’d finished.

Up to this point Judge Mullin had said little beyond requesting the occasional clarification from one of the attorneys. Now he took aim at Giorgi and said in a voice of seven thunders, “What you did was as dangerous as holding a loaded gun to your victims’ heads.” He then paused, whether to wring the disgust from his voice or to let it build up, I couldn’t tell. And those patients, he resumed, “were as vulnerable as you can get.” She was lucky beyond words that no one had died of AIDS or another fatal disease due to her actions, a comment that was powerful but, it struck me, inaccurate—HIV rarely progresses that quickly. Still, obviously, the judge wasn’t out to educate the crowd. Under this barrage, I don’t know how Giorgi was able to remain standing.

A butterfly needle, the item at the heart of the Elaine Giorgi trial

Judge Mullin then broke from addressing the defendant and spoke more broadly to the court: Had someone died, he declared, she’d be facing a long stretch in state prison. “In this case, prison would—” He stopped and shuffled through some papers. “—do absolutely no good. Except as punishment.”

Wha—?
I’d been right there with him up to that point, but . . . Was she going to go free?

“But I
am
going to punish her. To a year in county jail, plus four years probation.”

For the next couple of minutes, while the various fines that Giorgi would have to pay were entered into the record and the details of her future parole were clarified, my brain kind of zoned out. I found myself with that surreal sensation one has after enduring a long flight—your plane’s landed but it’s still taxiing—that contradictory feeling that you’ve reached your destination though you’re not quite there yet. Around us people started standing and we fell in line, following the folks in front of us toward the exit.

I took a deep breath of sidewalk air and realized I’d arrived at a moment I’d never thought beyond. Jerry, who’d steered us out of the Hall of Justice, seemed to have already placed the day into a healthy perspective. Yes, he agreed with Steve, he was disappointed by how short a sentence she received but, in the long run, he was glad that she would never be permitted to draw another person’s blood.

Behind us, on the opposite side of the courtyard, reporters had congregated. “Are you a victim? Will you speak for the camera?” they called out to passersby in English and Spanish.
“¿Es usted una víctima?”

At the same time, Giorgi emerged, clutching the arm of her attorney. For reasons unclear to me, she was being allowed to walk herself to jail, which was located half a block away. The reporters swarmed but she didn’t say a word. Her attorney held up a hand,
No comment,
and the two kept moving. With that, Jerry headed to his car. Steve and I stood and watched as Elaine Giorgi climbed the last few steps that led to the Santa Clara County Jail.

N
INE

Exsanguinate

Blood makes noise
It’s a ringing in my ear
And I can’t really hear you
In the thickening of fear
Blood makes noise

—S
UZANNE
V
EGA
, 1992

FOR A PERIOD OF SEVERAL HUNDRED YEARS UP THROUGH the nineteenth century, the earthly punishment meted out to British criminals sentenced to death did not end with execution. Worse than imagining the tightening of the noose or the plunge of the guillotine’s blade, according to writings of the time, was a felon’s fear of ending up on the wrong side of an anatomist’s knife. The idea of your body being sliced apart piece by piece—regardless that this was done to instruct medical students or in the name of science—could tap into every private horror, whether humiliation or desecration or something grislier. For this, the condemned had England’s Henry VIII to thank. In 1542, by royal decree, the Guild of Barbers and Surgeons—the bloodletting specialists who sidelined in haircuts and minor surgeries—was granted a maximum of four executed “malefactors” per annum for use in public dissections. This was the only legal source of cadavers. By no miracle of accounting did four per year come close to meeting demand, however, and the shortage led to a thriving black market in stolen bodies.

The Reward of Cruelty
by William Hogarth, 1751

In 1752 the king’s law was amended to allow a judge to send any executed convict’s body to the Surgeons’ Hall. A felon had just cause to worry. An engraving titled
The Reward of Cruelty
(1751), by the British artist William Hogarth, depicts a dissection-in-progress at Surgeons’ Hall. The naked body of a freshly executed murderer is splayed in a crowded auditorium of onlookers, and the lead anatomist directs the activity with a long stick:
Cut here and gouge there, if you please.
One surgeon pries loose an eyeball, another slices open the foot, while a third man seems to have slid his entire hand up into the deceased’s chest cavity, perhaps reaching for the heart. A final man kneels to the side collecting in a bucket the long sausage of the intestines. While Hogarth’s engraving is a work of satire—the noose is still affixed to the felon’s neck, for instance, and a small dog is about to make off with what looks like the liver—it nevertheless captures the graphic nature of the butchering.

More gruesome still were twin dissections performed the following century, as recounted by medical historian Gustav Eckstein in his book
The Body Has a Head
(1970). Eckstein’s tale is thin on personal details but rich in methodology. Two criminals, sentenced to decapitation, would be used to answer once and for all the nagging question,
How much blood does the human body contain?
Of course, many times throughout history best guesses had been made, but this latest effort would be as exacting as humanly possible. First, each man had blood drawn—a predetermined amount, which was diluted precisely one hundred times. These samples were set aside to serve later as a color standard. With no further ceremony, the two men were relieved of their heads, and all spillage was collected. The heads and trunks were drained, then squeezed. Once no more color would bleed, the bodies were carved into smaller and smaller pieces, eventually down to human chum, and washed, soaked, and wrung. All excess water added to the process was tallied and saved. Finally, in a process that to me seems fraught with the potential for error, the total liquid remains of each criminal were color-compared to his original sample, dilutions were made until they matched, mathematics were applied, and both weight and volume proportions were calculated. The results, consistent in both men, were presumed representative of all people—not inaccurately, as it turned out. The exsanguinations “proved our blood to be one-thirteenth of us,” to borrow Gustav Eckstein’s summation. This is roughly 7.5 percent of our total body weight. Likewise, every thirty pounds of us has about a quart of blood. For the average 150-pound man such as myself, that’s 11.25 pounds of blood in circulation, or, echoing Eckstein, “Five quarts go the round-and-round.”

Now, trading horror for horror, the coolness of science for the seduction of literature: Set in the same century, this next story revolves around the same unsavory deed—the taking of blood—yet to an altogether different end and employing a more sensual methodology. The basic plot should be familiar, even if you’ve yet to read the tale in its original form. Within a handful of pages, our protagonist stands in the gloom of a desolate night, in a foreign land, on the doorstep of an enormous stone castle. He finds no bell or knocker and is unsure how to signal his arrival after the arduous journey from London. Just then, a noise from within: rattling chains followed by the clanking of massive bolts, a key thrust into the lock. At last the door swings open. Centered in the entryway stands a tall older gentleman dressed in black, clean-shaven but for a long white mustache. His pale, pale skin picks up none of the warmth cast by the flickering lamp he carries. “Welcome to my house!” he says in peculiarly inflected English. “Enter freely and of your own will!”

The weary traveler shakes an ice-cold hand, and the elder man makes it official: “I am Dracula.”

If you, too, are still puzzling over that
long white mustache,
I’m right there with you. The Dracula in Bram Stoker’s
Dracula,
the template for bloodsucking horror since its publication in 1897, does not resemble Bela Lugosi; nor does sunlight destroy him. The story of the Transylvanian vampire has been retold and reimagined in such varied contexts—from early Hollywood flicks to adult films, a soap opera to video games, and a breakfast cereal to the number-obsessed Count von Count from
Sesame Street
—that it’s fascinating to discover elements in the original source that, more than a century later, feel new. How creepy, for instance, is Dracula’s lizard-like way of scaling walls. And how clever is his strategy of concealing fifty coffins throughout the greater London area so that, after prowling, he has a wide variety of places to rest during the daytime. And, oh yes, the way the heroes use Communion wafers to render these coffins unsleepable. At the same time, it’s great to find all those familiar trappings of vampire lore: the mirrors that don’t reflect, the fangs, the turning into a bat, the garlic, the stake through the heart. And sure enough, the greedy mouthfuls of blood. Save for the Bible, no other work in the English language has had, I’d wager, a stronger impact on how people of the modern Western world think and feel about blood. Blood as dangerous and profane as opposed to sacred and profound.

Stoker’s novel, originally titled
The Un-Dead,
a term the Dubliner coined, is more ambitious than I had remembered, technically as well as psychologically. But
Dracula
is also very much a dusty product of its era. Abraham (Bram) Stoker (1847–1912) wrote a conventional Gothic novel, the type of romantic fiction that first appeared in England in the mid-eighteenth century, a forerunner of the bodice ripper and the modern mystery novel. True to the form,
Dracula
features a damsel in distress (two, actually); a good guy (in this case, a quintet of good guys); and a tall, dark villain, although here, obviously, Stoker created a new standard of darkness. As was typical of Gothic fiction, the action takes place in ominous locations, shadowy and perilous, the most archetypal of which is the count’s home, Castle Dracula.

Stoker wrote the novel during a seven-year period that neatly falls between two major advances in the understanding of blood: the identification in the 1880s of platelets, the circulating blood cells that aid in clotting, and the discovery of human blood groups in 1901. This precarious in-between stage is reflected in the scene describing the character Lucy’s blood transfusion, a procedure necessitated by Dracula’s secret nightly feedings. When choosing a compatible blood donor, the two doctors treating Lucy never mention blood type. A, B, and O are a few years off. This being Gothic fiction, the desired sex of the donor is also never questioned. “It is a man we want,” Dr. Van Helsing states, implying in these six syllables all sorts of manly virtues, such as vigor. A spirited game of scissors-paper-rock, I imagine, is waylaid by the arrival of the ideal donor, Arthur. The youngest, strongest, and “calmest” of the three men, Arthur is also madly in love with Lucy, a quality that seals the deal.

Next, Stoker makes a little stumble. He has Van Helsing happily point out that Arthur is “of blood so pure that we need not defibrinate it.” Only in a work of fiction would this be considered an advantage. Blood that does not produce fibrin is blood that doesn’t clot. A real-life Arthur would’ve been suffering from a disorder analogous to hemophilia and clearly would not have been a doctor’s first choice when selecting whose vein to slice open. In the story, however, the physicians are glad to avoid the sticky problem of coagulation, which I can certainly appreciate. Upon exposure to air, blood at the site of an injury immediately begins to clot, or congeal. The body is trying to self-seal. Platelets (so named for looking like tiny plates) converge on the site, clumping together and simultaneously secreting chemicals that turn the blood-borne protein fibrinogen into long, sticky threads. Red and white cells get caught in the webbing, and the clump becomes a clot. At a wound site, clots are lifesaving. But within the circulatory system, a clot may lodge in a blood vessel (this is called an embolism) and cause stroke or death. While anticoagulants prevent clots from forming during transfusions today, such agents did not exist during the era portrayed in
Dracula
—hence the need to defibrinate.

Defibrination was a crude but clever process developed in the 1820s and used up through the introduction of anticoagulants in the 1920s. Wildly varying methods arose, but each took time, so I can see why Bram Stoker, if only to keep the scene moving, had Dr. Van Helsing skip this step. One method involved collecting the donor’s blood in a bowl, whipping it with a wire eggbeater, then filtering out the clots through a stretch of gauze. Even simpler was allowing the collected blood to settle for several minutes and then scooping out what congealed. Sometimes, too, the blood was twirled in a flask containing glass beads around which clots would form. These methods were not foolproof—bacteria entered the process, and clots slipped through—but transfusions had become safer, if only just. (To be fair, they did represent a vast improvement over the previous treatment for blood loss, bloodletting. Up until the 1820s, for example, a woman with uterine hemorrhaging following childbirth was commonly bled. Now, there’s a horror story.)

Once Lucy is drugged up, Van Helsing proceeds. Arthur lies next to his fiancée while the doctor removes from his bag the necessary instruments—what he calls the “ghastly paraphernalia of our beneficial trade.” Although Stoker doesn’t linger long on the procedure, details suggest that his fictional doctor may be performing an actual type of transfusion that, at the time
Dracula
was written, would have been highly experimental, a direct artery-to-vein transfer. This method, considered promising in animals, made a short-lived leap into human use in the late 1890s. You’ll soon see why it so quickly came and went. Typically, the blood donor’s radial artery (one of the two main arteries in the forearm) was exposed, distended, tied off or clamped, sliced open, and then either sewn directly to the recipient’s similarly exposed vein or connected to it via a small metal pipe. Bodies had to be aligned just so. Once the clamps were removed, the donor’s heart literally served as a blood pump. But, like gassing up the SUV without benefit of a meter, the transfer was difficult to measure. Too much blood? Too little? In some cases, the blood donor was simply weighed before and after “the operation,” to borrow Stoker’s apt phrase, and the difference used to estimate the volume taken. (A bit late, no?) In
Dracula,
Van Helsing demonstrates an alternate method. For several tense minutes, his gaze darts among Lucy, Arthur, and his pocket watch, used to time the flow. Once some unexplained threshold is reached, he announces, “It is enough.”

It
is
enough. A bloom returns to Lucy’s cheek, and the possibility of her heart being overwhelmed by too much blood has passed. Arthur, who could’ve suffered excessive blood loss, is shaky but also fine. While the medical dangers have been avoided, however, a supernatural one remains. Dracula, unbeknownst to all, continues to feed on Lucy. Over the next ten days she receives three more transfusions, each helping her less. The heroic efforts fail to save Lucy’s life. Dracula drinks her to death, and Arthur’s dream of marrying the beautiful young woman is dashed. Heartbroken, he consoles himself with the fact that a consummation of sorts had taken place: “The transfusion of his blood to her veins had made her truly his bride.”