Perfect Poison (11 page)

An overdose of the drug causes the heart to beat faster and faster until it cannot sustain the rate, thus collapsing it into
v-fib,
where it quivers without beating.

Epinephrine is extremely hard to detect in the human body. Not because the body produces it naturally, but that it is the first drug given when a person goes into cardiac arrest.

If one were in the business of killing people, it could be said that EPI is the
perfect poison.

 

 

A thought occurred to Rix as she looked at the broken vials in disbelief. In over twelve years on the job, she had never known anyone to use the drug in that form.

Quickly, Rix opened up the medicine cabinet to see if there were any other drugs stocked that, in appearance, even remotely resembled the three broken vials of epinephrine she had just seen. Maybe there was another answer?

There were none.

After the initial shock set in, Rix grabbed a piece of paper and jotted down how many unused ampoules of EPI were in the medicine cabinet.

Eighteen,
she wrote as her hand trembled.

From that point on, Rix decided she was going to keep track of the EPI inventory herself. With a drug like EPI, which was rarely ever used, it wouldn't be hard to figure out if Gilbert was, as Rix and Wall now highly suspected, using it to poison patients.

“I can't believe it,” Rix said to Wall in a whisper after she realized what could be happening. “I just can't believe it . . .”

John Wall and Kathy Rix didn't need much more convincing. Patients at the VAMC were dying at alarming rates, and medical emergencies were being called just about every other day on what seemed to be only during the second shift—and Kristen Gilbert's signature was all over them. The questions plaguing Rix and Wall, however, were a bit more difficult: What should they do about the spent epinephrine ampoules they had found in Callahan's room? Whom should they go to? Was it even proof of anything?

Rix was scheduled to leave for vacation on January 26. So whatever she and John Wall were going to do would have to wait until she got back a week or so later. Wall, of course, wasn't going to act on anything alone. If this thing went as far as he and Rix thought it would, once it became known, Wall himself would have some explaining to do. He was addicted to heroin, he had been using the drug for years, and he had been lying about it to everyone around him. The last thing he wanted was to draw attention to himself.

The day before Rix left, she removed all the disposal needle buckets and replaced them with new ones.

“If I find any spent ampoules of EPI when I return,” she told herself, “I'll know they aren't from the Callahan incident.”

It seemed like a good plan.

Then she took out her pad and counted the ampoules in the medicine cabinet.

 

 

Bonnie Bledsoe, on January 28, 1996, was working in Ward D, which, being in another building altogether, was a considerable distance to walk from Ward C. Gilbert was alone in the ICU with one patient, Michael Cascone, a seventy-five-year-old World War II vet who, like Callahan, had been admitted to the VAMC with a severe case of pneumonia. Cascone, a big man, had spent twenty-eight years in the Army, reaching the rank of master sergeant, and was well respected by anyone who wore camouflage green.

Because she was the only respiratory therapist on duty that night, Bledsoe would be responsible to show up for any codes called on Ward C.

At 7:00, Gilbert called a code on Cascone, and Bledsoe rushed over from Building Two. No sooner had she made it back to her post in Building Two after she helped Gilbert get Cascone out of trouble, than Gilbert called a second code.

When Bledsoe made it back to her post in Building Two after the second resuscitation effort on Cascone had been successful, her pager went off again—sure enough, for a third time, Michael Cascone was fighting for his life.

After things calmed down and Cascone was out of trouble for the third time, Bledsoe walked toward the door in the ICU to leave, but stopped for a moment.

She had something to say.

“If I have to run over here one more time, Krissy, I'm going to start wheezing.”

Bledsoe was an asthmatic. She and Gilbert had been out with their significant others on a number of occasions, and because she knew Gilbert was so knowledgeable in medicines, Bledsoe brought up her asthma all the time.

Standing about ten feet away from Gilbert in the ICU, Bledsoe explained how all the running back and forth was making her asthma act up. When she finished talking, Gilbert reached into the front pocket of her smock and pulled out a small vial of some type of medication.

Gilbert flashed the vial. “Do you need some EPI, Bonnie?” she asked. Then, quickly, put it back into her pocket.

“No,
thank you,” Bledsoe snapped and walked away.

 

 

As for Michael Cascone, his heart wasn't as strong as Francis Marier's. After a fourth code was called later that same night, he died.

A proud father, former Navy crewman Walter Cutting watched his son, Kenny, play football for the Lunenburg High School Blue Knights during the early seventies, perhaps dreaming of him one day becoming the next all-star running back for the New England Patriots.

A clean-cut kid with bushy, Groucho Marx-type eyebrows set above his sad brown eyes, Kenny was motivated to succeed at anything he did. Marrying his high school sweetheart on January 26, 1976, Kenny joined the U.S. Army a year later. In a matter of weeks, he was off to Fort Leonard Wood, Missouri, for recruit training. It was a far cry from the Yankee confines of Lunenburg, Massachusetts, but it was what Kenny wanted. On April 11, only months after he left, Jeffrey Cutting, Kenny's son, was born.

After boot camp graduation, Kenny was transferred to the 39th Engineers Station at Fort Devens, which worked out perfectly, because Fort Devens was located in Ayers, a mere stone's throw from the new ranch-style house he and Nancy bought in Leominster.

He was living the life he had only dreamed about. But shortly after Cutting arrived at Fort Devens, tragedy struck.

For the past few years, he had been experiencing stiffness in his legs and his eyesight had been poor. But it never amounted to anything. While in training, only about fifteen months into his military career, Kenny called his father at home with some rather grim news.

“My doctor just informed me that I'll be dead in a few years . . .” Kenny said, not a speck of worry, discontent or concern in his voice.

Kenny wasn't overly emotional or tattered in the slightest by what appeared to be the worst news a married man of twenty could ever imagine hearing from his doctor.

“They say I have multiple sclerosis,” Kenny continued.

At the time Kenny was diagnosed, little was known about the affliction his father would later tag a “horrendous disease.” Many doctors, in the late seventies, had equated MS with a death sentence.

Nonetheless, each day after the initial diagnosis offered a new set of problems for Kenny. His body deteriorated quickly as the disease grew at an extraordinary rate—and within only a couple years after being discharged, Kenny was having trouble walking and seeing.

Like almost everyone who had ever entered Kenny's life, his in-laws adored him. Kenny always had something nice to say and never once complained about having been dealt a deck of cards that might end his life years before he'd planned. He vowed to fight the disease with everything he had.

By 1980, it was obvious to Nancy that caring for Kenny at home was going to be almost impossible. One day, shortly after he first started using a wheelchair, Nancy wheeled him out on the front porch so he could enjoy a promising summer afternoon. Kenny loved just sitting, soaking up the sunshine. After a while, Nancy went out to check on him and found the skin on his feet stuck to the cement, as if they had melted to it like a piece of gum. The roughest part for Nancy was that Kenny was oblivious to what had happened; he couldn't feel his feet.

After that, the Cuttings placed Kenny in a long-term care program at a Jamaica Plain VA hospital. Within days, he began saying how uncomfortable it was. The Cutting family thought that for a man like Kenny Cutting, who was as gentle as a falling leaf, a man who never once complained about
anything,
to begin fretting, the conditions in Jamaica Plain must have been deplorable.

The VAMC in Leeds was a long drive from Leominster, but it had a reputation for being one of the best VA hospitals in the state. Perfect for Kenny's situation, the VAMC had both short-and long-term care units, an acute medical ward, and a staff of doctors that could help make Kenny's life as comfortable as possible.

Before moving him into the VAMC, Nancy had once again tried taking care of him at home, but by this time he was bedridden, his eyesight nearly gone. And one of his main problems brought on by the MS was bowel obstruction, which was usually accompanied by fever and infections.

His muscles just didn't want to work anymore.

Throughout all of it, though, Kenny's spirit never wavered. He stayed focused on the good in his life.

“He never fussed,” Walter later said. “He was always cheerful. He was [a] very happy . . . happy man.”

As he began to get comfortable at the Leeds VAMC, Nancy and Walter soon realized that they had finally found a place where they could feel comfortable about leaving Kenny.

“He could not have had any better care,” Walter later said.

Nurses at the VAMC fell in love with Kenny and his angelic attitude, and he soon became a favorite patient of many nurses.

“Everyone loved Kenny,” Rachel Webber recalled. “He had these big, brown eyes, and he would look at you and [say], ‘You look beautiful tonight . . . you look so beautiful.' ”

A favorite saying of Kenny's to all the female nurses was, “Can I tell you something? You're looking very beautiful today.”

By the fall of 1995, he was being spoon-fed and had lost total use of his hands and legs. But, as if he had accepted his fate and made peace with the outcome, he never looked back.

In late October, Cutting had been sent back to the Jamaica Plain VA hospital for small bowel obstruction surgery, where he underwent an “exploratory laparotomy.” But after opening him up, doctors found “no mechanical obstruction . . .”

Being cleared for surgery and subsequently undergoing it
without
any cardiovascular problems was significant for someone in Kenny Cutting's condition because coronary artery disease and myocardial infarction—heart disease—are equally the number-one cause of death during general surgery. This was why doctors did extensive research beforehand, profiling patient risks for cardiovascular disease. A quick check of Kenny's medical history showed that he didn't have the disease, and there was no history of it in his family. Many people confuse MS with some of the more common diseases. MS patients, at the end stages of the disease, deteriorate in increments, each organ—liver, pancreas, kidneys, etc.—failing, in succession, like dominoes. After that, respiratory failure slowly develops, and, finally, death.

Although Kenny's organs weren't the same as, say, a healthy forty-one-year-old male's, by all accounts he had a healthy heart—which is one of the only organs unaffected by the onslaught of MS.

On November 1, 1995, Kenny had a complete colonoscopy. It showed no lesions, but did indicate he had multiple infections. So he was then put on antibiotics, eventually recovered, and was transferred back to the VAMC in Leeds—a place that he had literally called home for the past fifteen years.

By November 20, settled back into his room in the long-term care unit of the VAMC, Kenny was assessed as “alert” and in “fair physical condition.” He had no problems with his heart, lungs, or anything else related to his organs. He was having the same mild seizures he'd had for years, but that was it.

Things got a bit more complicated by late January, though. His persistent bowel obstruction was back, and along with it an infection and fever of 104 degrees.

Since 1985, Kenny had been on what is called a “DNR [do not resuscitate] status.” Nancy figured that if it was his time to go, she should let him go, and never winced at making the decision. She knew there was no cure for his MS; why fight the inevitable when it came time?

Back on December 3, 1995, Gilbert, who, like most of the VAMC nurses, knew Kenny pretty well, noted in his chart that his “abdomen remain[ed] distended and firm . . . [But will] continue to monitor bowel sounds . . . [patient was] resting quietly.”

The following day, Kenny's daytime nurse recorded his blood pressure at 160 over 85; his pulse regular at 100; and there was “no report [from the patient] of pain.” With the exception of his bowel obstruction and a slight fever, Kenny was stable.

Running a high fever because of an infection, on January 26, 1996, he was transferred to the Ward C ICU. A few days later, nurses took him off the oxygen he had been on, and he began breathing on his own.

For the next week, his fever seesawed, and with it, his heart rate.

By Thursday, February 1, Gilbert wrote that he “remain[ed] unresponsive to all stimuli”—verbal interaction, prodding, poking—“ [and] opened his eyes spontaneously . . . [but] not as a result of stimuli.”

This change was drastic compared to what Nancy, Kenny's now-grown son and Kenny's mother had witnessed the previous day, January 31. When Nancy first entered the room that day, Kenny said the same thing he had a thousand times before, “You look exquisite, Nancy.”

He was groggy and tired, sure. But he answered all of her questions and talked to everyone in the room.

For the next twenty-four hours, nurses in the ICU monitored Kenny's fever and bowel movements. After hearing faint bowel sounds over the course of the day, it appeared Kenny's system was responding to the antibiotics.

During the early morning hours of February 2, Kenny's fever had gone down, and there was even more movement in his bowels. He had good color. He was alert.

It was an old story where Kenny Cutting was concerned: He would get transferred to the Ward C ICU and do battle with whatever part of his MS decided to act up, and, after fighting it with every ounce of strength he had left, his condition would return to as stable as it would get.

Kenny Cutting was a fighter. No one denied him that.

But no matter how hard he was willing to fight this time around, Kenny's fate was sealed later that same afternoon when Gilbert approached James Perrault with plans for later on that night.

Before leaving for work at half past three, on February 2, 1996, Gilbert told Perrault she would meet him at his house at around 10:00 so they could go out on the town.

This was an odd time—because Gilbert's scheduled shift didn't end until midnight.