Murder and Mayhem (25 page)

A: Selenium is a nonmetallic element in the same chemical family as sulfur, oxygen, polonium, and tellurium. It is an essential element for life, and its deficiency can lead to various medical problems, the most important being cardiomyopathy (a weakening of the heart muscle). Interestingly, Marco Polo may have discovered the first cases of selenium poisoning when he described a disease called "hoof rot," which occurred in horses in the Nan Shan and Tien Shan Mountains of Turkestan. The soil in that area is rich in selenium.

Selenium poisoning is rare, although it does occur in industrial situations. Its principal applications are in the manufacture of glass, ceramics, photoelectric cells, semiconductors, steel, and vulcanized rubber. The most toxic forms are selenium dioxide (Se0
₂
) and selenious acid (H
₂
Se0
₄
).

Acute poisoning is most often lethal. The ingestion or inhalation of selenium dioxide or selenious acid (found in gun bluing solutions) can cause a dramatic drop in blood pressure, due to its toxic effects on the heart muscle, and a dilation (opening up) of the blood vessels throughout the body, which can lead to cardiac arrest and death. It can cause severe burns to the skin and the lining of the mouth as well as the lungs, where bleeding and pulmonary edema (lungs filling with water) may result. A reddish pigmentation of the teeth, hair, and nails coupled with a garlic-like odor on the breath are typical of acute poisoning.

Chronic poisoning occurs with long-term, low-level exposure. The victim's skin may develop a reddish hue, and a pruritic (itchy) scalp rash may appear. The hair becomes brittle and breaks easily or falls out. The nails become brittle and display red or yellowish white transverse or longitudinal lines. The breath smells of garlic, and the victim may complain of a metallic taste in the mouth. Nausea, vomiting, fatigue, irritability, emotional lability, depression, tremors, and muscle tenderness may also occur.

The diagnosis of selenium poisoning, either in the living or at autopsy, is made by testing the victim's blood and urine for increased selenium levels. At autopsy, findings would likely include congestion in the lungs and kidneys, patchy scarring and enlargement of the heart, edema and swelling of the brain, and a orange-brown discoloration of the skin and internal organs.

For those who survive, treatment consists of stopping any chronic exposure and using intramuscular doses of dimercaprol (also called BAL, or British Anti-Lewisite). BAL acts as a chelating agent by binding the selenium and removing it from the body via the kidneys. The usual schedule is the injection of 3 to 5 milligrams per kilogram of body weight every four hours for two days, every six hours on the third day, and then every twelve hours thereafter for ten days.

For your purposes, either an acute or a chronic poisoning could work, depending on whether you want the character to die right away or slowly over a month or so. Gun bluing solutions contain lethal amounts of selenious acid, and a couple of tablespoons added to food or drink could kill the person in a couple of hours. Adding a little here and there day by day would accomplish a chronic poisoning. The victim would gradually become sicker. His appetite would disappear, his weight would drop, and nausea and vomiting would occur. His hair would fall out, and he would become weak, short of breath, and irritable. His hands would develop a tremor, and he might develop heart failure and pulmonary edema. His doctor might diagnose heart disease or gastroenteritis or even the flu. Selenium poisoning would never enter his mind. He would treat him with digitalis and diuretics or suggest fluids, aspirin, and rest. As the condition progressed, the victim might be hospitalized and then die of progressive heart failure. Since death from heart failure is a common occurrence, the death would likely be written

off to plain old heart failure—that is, until your protagonist became suspicious and tracked down the true cause of the victim's demise.

How Quickly Would Someone Die After Drinking Alcohol Laced with Xanax?

Q: One of my characters crushes Xanax tabs and then adds the powder to another's Scotch. Both men have been drinking. Would the Xanax interact quickly with the alcohol to depress the central nervous system? How much should be used to achieve the desired effect? Would there be any immediate reaction to the mix (that is, vomiting)? What would the specific symptoms be as the character slips into unconsciousness, and how soon would death occur?

A: Xanax (alprazolam) is a short-acting sedative in the benzodiazepine family (along with Valium, Halcion, Restoril, Ativan, and others). It is a relatively safe sedative, but when mixed with alcohol, it can be deadly. Of course, it depends on the dosage of both the Xanax and the alcohol as well as the underlying health, size, and age of the victim. People with chronic lung or heart disease are more susceptible, as are the young and the old.

Xanax comes in white oval tablets of .25 milligram (mg), 0.5 mg (peach), and 1 mg (light blue). It also comes in a white oblong 2 mg tablet. It dissolves easily and is well absorbed by the GI tract. It reaches its peak effect about one to two hours after ingestion, but its effects would begin to appear in less than half an hour.

Now to your specific questions:

Yes, it would begin to act quickly—a half hour or perhaps less if the victim consumed a large amount of alcohol beforehand. The victim would become lethargic and have slurred speech, poor coordination, and confusion. He might stagger and even fall. He would

speak slowly with a thick tongue, and his words may not make sense. In short, he would appear very intoxicated. He would soon lose consciousness, after which his respirations would decline and finally cease. Death would then follow in a few minutes.

The rapidity with which this process unfolds would depend on many factors, but if you give him an hour, you'll be okay. More is better, but as little as thirty minutes would also work.

One problem with Xanax is that it requires several tablets to do the trick. This depends, of course, on how much alcohol the victim downed. If he is intoxicated before the loaded drink is given, less Xanax is required. If your killer crushes ten of the 2 mg tablets, that should do it. If the victim is already intoxicated, he likely won't notice any alteration in the taste of his drink. This is particularly true if you use some flavored concoction rather than Scotch.

What Substance Can Be Added to a Fire-Eater's "Fuel" to Cause a Sudden and Dramatic Death?

Q: I want to kill off a street performer, a fire-eater in Madrid, by substituting or adding a substance to the clear liquid these people swish in their mouth and then blow out to be ignited. Since they don't actually swallow the liquid, I need something that is very deadly, won't alter the clear nature of the liquid, and hopefully won't be immediately detected when the liquid enters the mouth. Also, I'd like the death to be relatively quick and dramatic.

A: Cyanide is quick, nasty, and very effective. It kills instantly. The person will suddenly become short of breath, may clutch his chest as if having a heart attack, may suffer a seizure, may foam at the mouth, and will definitely fall over dead. Since cyanide is a metabolic poison, which means it poisons the body's cells so that they

cannot use oxygen, even if some bystander began CPR or other life-saving measure, the victim would die anyway. Effective CPR would supply blood and oxygen to the tissues, but the cyanide would prevent the tissues from using the oxygen, so death would be the result regardless.

Cyanide comes as a powder in the form of potassium cyanide (KCN) and sodium cyanide (NaCN). It dissolves easily in most liquids and requires only a tiny amount to be deadly. It has a slight bitter almond smell and taste, which would be undetectable in the flammable liquid.

In your scenario the fire-eater would take a mouthful of the liquid and within a few seconds clutch his throat or chest, spit out the liquid, gasp for breath, cry out for help, collapse to the ground (with or without a seizure), and die quickly.

One caveat: The person handling the cyanide should not let it contact his skin since it is readily absorbed through the skin. The use of rubber gloves would be safest.

Cyanide is used in metal plating and tanning and can be obtained from many chemical supply houses or stolen by your villain from any place that plates jewelry or uses it in other ways.

MEDICAL MURDER

How Can Someone Who Is Undergoing Heart Surgery Be Murdered?

Q: I need help with a hospital scene. The bad guys decide to execute a very successful and powerful enemy while he is in the hospital undergoing a heart bypass operation. The plan is a strike against the hospital's primary and redundant power sources, effectively imperiling all patients in the hospital or wing, not just the intended. Now the questions: How does one take down the hospital power grid and its backup systems? Where is the most ticklish point of the bypass surgery to have a power loss?

A: Most hospitals have backup generators that switch on automatically when the power supply is interrupted. I suspect that most of these systems are computer controlled, so your villain can approach the problem in several ways.

He could attack the computers and effectively shut down both the main power and the backup generator at will. A good hacker could tamper with the control program, and then they could be shut off on command—maybe by remote control with a wireless modem.

Or he could disengage or disable the backup and then cut the main power supply by severing the hospital's incoming power line or knocking out the local power station. That would deal with the power supply to the entire hospital but would not completely resolve your problem.

In cardiac surgery the patient is typically placed on a heart-lung machine, which acts as his heart and lungs by circulating and oxygenating the blood while the operation is being performed. The pump is dependent on a power supply to function, but these gadgets have both an internal backup battery supply as well as a hand-crank system for just such power loss situations. This means that your bad guys would have to tamper with the heart-lung pump itself. They would need to damage or disconnect the battery or its cables, or mangle the gears and pulleys that are part of the hand-crank system.

These heart-lung machines are typically kept within the surgical suites (operating rooms) of the hospital, an area that has restricted access. Still, someone with knowledge of the layout could sneak in, especially at night when fewer staff members are on duty.

Or an insider could be involved. The best person for this would be either someone in the bioengineering department (called biotechs for short) or one of the technicians who run the heart-lung machine (called pump techs).

The biotechs maintain and repair most of the medical gadgetry in the hospital. Some techs can fix anything, while others have to call in repairmen from the various manufacturers or independent biomedical repair companies more frequently. Your tech could be the insider, or the accomplice could be the outside tech he called in. Either would work.

Most major medical centers have pump techs on staff, while smaller hospitals contract to outside companies for techs who come in and work on a case-by-case basis. The in-house techs have easy access to the machines any time they aren't in use. For the contracted tech, things would be more difficult. Since he goes into the OR only when a case is scheduled and since there are always several nurses and operating room technicians around preparing for surgery, he would have to be fairly slick to tamper with the backup systems. It's possible, just more difficult.

The best time to attack the power supply would be during the operation. That is when the patient/victim would be most vulnerable. If your villains could accomplish their tampering after the patient/victim is "on bypass," on the heart-lung machine, a loss of power would be potentially fatal. During the surgery, the heart is stopped by a combination of cooling the blood and delivering a large dose of potassium. (We call this "cold cardioplegia.") After the operation, the heart-lung machine rewarms the blood and washes out the potassium; then the heart resumes beating on its own. This takes ten to fifteen minutes or more to accomplish.

If the power and the backup systems failed, the surgeon would be left with only internal cardiac massage to maintain blood flow and keep the patient alive. Internal cardiac massage is simply squeezing the heart rhythmically with your hand. The surgeon would then begin giving the patient warmed blood and intravenous fluids in an attempt to rewarm the patient and wash out the potassium. This would be difficult and could take as much as half an hour to an hour without the aid of a functioning heart-lung machine. But this is what they get the big bucks for. Failure to do so would certainly result in the patient's death, which is what you want.