Perfect Poison (12 page)

By February 2, 1996, the Northeast had all but finished digging out of what was being billed as “the Blizzard of '96,” a mid-January winter storm that had dumped nearly two feet of snow in the Northampton region, and about three feet just to the south, in New York and New Jersey. It had been one of the worst winter storms the East Coast had seen in some seventy years, claiming twenty-three lives by the time it had done its damage and whipped out to sea.

But weather records, storm-related deaths and snowfall amounts were far from the minds of nurses John Wall, Kathy Rix and Renee Walsh. For months now, they had been watching and questioning Gilbert's every move. But with Rix still away on vacation, nothing had been said or done. And Renee Walsh, although highly suspicious, was still keeping her thoughts to herself.

The death rate on Ward C had risen so sharply within the past few months that for anyone who had even glanced at the data in passing, it would have been impossible to deny that something highly irregular was going on. In the past twenty-four months, there had been more than one hundred deaths on Ward C alone, which, by itself, should have been enough to spark someone's interest.

But no one in management noticed.

Broken down even further, the available data were even more shocking. During the past two years, there had been twenty-three deaths during the midnight to 8:00
A.M.
shifts, and twenty-two deaths during the 8:00
A.M.
to 4:00
P.M.
shifts, which was not out of the ordinary for a hospital the size of the VAMC. But during the hours of 4:00
P.M.
and midnight—Gilbert's shift—there had been
fifty
deaths, more than double. In fact, since 1991, when the “angel of death” moniker became attached to Gilbert, there had been approximately one hundred and sixty-one deaths on Gilbert's shift alone, not even close to the one hundred and twenty-one deaths recorded on
both
the first and third shifts throughout that same period.

As for codes, the numbers were even more stunning. During that same two-year period—1995-96—there bad been forty-five codes on Ward C. Gilbert, however, had found thirty of them herself. In what should have further inspired suspicion, since she'd starting working at the VAMC back in 1989, Gilbert had found seventy-two codes herself, whereas during all other shifts—all the nurses combined—her colleagues had found only seventy.

Finally, between August 1995 and February 1996, employees in the VAMC pharmacy had delivered approximately one hundred and fifteen ampoules of 1:1000 strength epinephrine to Ward C, yet not one doctor or nurse had administered the drug. Further, the pharmacy did not maintain any type of record to keep track of its deliveries; it simply restocked the drug whenever the satellite pharmacy, medicine cabinet or anywhere else the drug was stored ran low.

Apparently, the dead were speaking from their graves; the only problem, however, was that no one in VAMC management or quality control was listening.

 

 

Throughout the day on February 2, Kenny Cutting's condition had somewhat improved, with the exception of a high fever. There was no mistaking that Kenny was ill. But he had been down this road before and pulled out of it without any major problems. His daytime RN, Corrine Rourke, later said that Kenny “was quite sick [on February 2] . . . but . . . he was going to pull through.” Assessing him later on that same day, Rourke added that he was “just beginning to turn the corner and he had a good chance of getting back to, partially, his normal life.” Rourke had cared for Kenny many times in the past while he had suffered from the same set of problems, and he always, she later said, “pulled through.”

During the early morning hours of February 2, Kenny's blood pressure remained at 120 over 80.

Nearly perfect.

Around 5:00
A.M.
, Kenny's 103-degree temperature went down to 101, and his blood pressure dropped to 103 over 76, then to 100 over 64. But his heart rate remained a bit high.

The antibiotics were beginning to work.

At 6:50, RN Rourke noticed that Kenny's heart rate had increased into the 130s, but there was no “ectopy,” extra beats. This was a bit high, of course. But Kenny's fever had gone back up, too—and when a fever rises, the heart rate is generally not too far behind.

By ten o'clock, Kenny's temperature had dropped a few degrees, and his heart rate soon followed, dropping back down into the 110s. Sometime later, his temperature rose again, and his heart rate was right behind.

In terms of mechanics, the body is like a machine. Doctors call it “radiational cooling.” The blood and arteries work like the coolant and hoses in a car engine: the hotter the engine gets, the harder the system works to cool it off. The fact that Kenny Cutting's heart rate increased during the duration of his fever indicated that his cardiovascular system was doing the job it was designed to do.

 

 

At about 3:30
P.M.
, the night shift began filing in. When John Wall arrived, he learned he had been designated Team Leader, instead of charge nurse. His colleague and friend, David Rejniak, who lived down the street from Gilbert when she lived in Florence with Glenn, had been elected charge nurse for the night. Rejniak knew Gilbert pretty well, and some said he'd even had a crush on her.

It was a slow night on Ward C. Usually, the census was about twenty to twenty-five patients, but tonight there were only eleven beds filled. Carole Osman and Lori Naumowitz were assigned to work the floor, while Gilbert was told to report to the ICU, where her only patient of the night was Kenny Cutting.

Around six, Rejniak reported to the ICU to relieve Gilbert, who was getting ready to go on her dinner break. With Rix on vacation and Wall now working the desk for Rejniak, Gilbert and Rejniak were the only nurses qualified to stay with Kenny Cutting.

When Rejniak showed up, Gilbert filled him in. “He's doing the same now as . . . before,” she said before walking out of the room.

As she sat and ate her lunch, John Wall came into the break room.

“Kenny isn't looking so good tonight, John,” Gilbert said nonchalantly. “If he dies, can I use some of my comp time and leave early?”

Protocol among the nurses dictated which nurse could leave early on any given night. If a nurse wanted to leave early, he or she would first have to clear it with the others. Gilbert, who had been working part-time for the past few months, had lost her seniority to ask if she could leave early. Full-timers had the opportunity to use any accrued comp time before part-timers did.

After thinking about it for a moment, Wall said, “I don't care, Kristen.”

At first, he had been taken aback by her request. He knew Kenny was sick, but for crying out loud, was the man suddenly on his deathbed? But seeing that Gilbert had spent the past two hours with him, maybe she knew something Wall didn't.

According to Gilbert's own assessment, however, which she had just written in Kenny's chart before she sat down to eat, he was “stable” when she had left him. His doctor, Theodore King, even checked in on him earlier that night and made the same assessment.

After finishing her dinner at about 6:25, Gilbert returned to the ICU and relieved Rejniak.

“How's he doing?”

“The same,” Rejniak said.

While Rejniak had been with him, Kenny's heart rate had remained between 110 and 130.

Fifteen minutes later, Gilbert called Rejniak at the nurse's station.

“Kenny's taken a turn for the worse,” she said.

“I'll be right there.”

When Rejniak arrived, Kenny's heart rate, at 75, was considerably lower that it had previously been.

“He just didn't look good,” Rejniak later recalled.

About twenty minutes after returning to the nurse's station, Rejniak decided to go back and check on Kenny again. When he arrived, he was amazed to find that his heart rate had dropped even lower.

It was now down into the 50s and 60s.

But at 7:00, Gilbert documented that Cutting's heart rate had jumped back up to the “120s–130s.” His telemetry monitor, however, just moments before, had recorded it at 107—and in Gilbert's check of his vital signs back at 6:00, right before she left for her break, it was in the low 100s.

Only minutes after Rejniak left the room, Gilbert claimed Kenny's heart rate tripled, and then went into v-fib, a state in which the heart loses its capability to function as a pump . . . and, then, asystole . . . and, finally, flatline.

Because Kenny Cutting had been on a DNR status, there was nothing anyone could do except watch him die.

Within seconds, he couldn't breathe. Then he had no pulse. A minute later, at 7:15, Kenny Cutting was dead.

 

 

When a patient at the VAMC dies, post mortem care must be administered immediately by his nurse: clean up the body, place it in a black body bag, and transport it to the morgue in the basement.

At 8:10, Gilbert and Rejniak wheeled Kenny's body down to the morgue; then Gilbert went back upstairs, put on her coat, and sat down to write her final note of the night.

“Transferred to ICU for treatment of seizure . . . and fever.... Since admission, patient never regained consciousness, and continued to spike fevers . . . 103 temperatures, despite antibiotic therapy.... Tonight,” she wrote, “Kenny's heart rate [went up to the] 140s.”

All of it was lies.

Nowhere in her note had Gilbert written that Kenny's heart rate had, as Rejniak had witnessed, dropped down into the 70s and 80s and then the 50s and 60s. Further, Cutting had been transferred to the ICU because he had developed a fever due to his bowel obstruction. Seizures were never part of the equation. On top of that, he wasn't unconscious for his entire stay in the ICU. One of the third-shift nurses noted at one point that he was trying to say something but just couldn't get the words out. Nancy, Kenny's son, Jeffrey, and his mother-in-law had spoken to him only a few days before his death. And Kenny's fever had decreased several times during the past several days, at one point dropping down as low as 99 degrees.

Gilbert never mentioned any of it.

Finally, there was no evidence of his heart rate ever being in the 140s. On the previous night's note, Gilbert had written that the “monitor shows [heart rate]” of “120s to 130s,” but the telemetry monitor again disagreed—because the one strip Gilbert chose to include in Kenny's chart indicated his heart rate was 107.

 

 

After she finished writing up Kenny's final report, Gilbert went down to the nurse's station and dialed up Nancy Cutting at her home.

“I'm a nurse from the Veterans Affairs Medical Center,” she said.

“Yes . . . okay.”

“Your husband has passed away!”

Nancy dropped the phone.

After Gilbert hung up, she went looking for David Rejniak. It was approaching nine.

“David,” she said, “can I take sick leave from now until midnight?”

“I guess so . . .”

Early for her date with James Perrault, Gilbert showed up at his Parsons Street apartment a few minutes before ten o'clock.

Since the Francis Marier episode back on December 20, Renee Walsh had been looking for some solid evidence that Gilbert was up to no good. She had a feeling that something was amiss where Gilbert and medical emergencies were concerned. The coincidences were just too many.

By the end of the day on February 3, Walsh had all the proof she needed. First, when she came in that morning, Walsh couldn't believe Kenny Cutting had died.

“Who was Kenny's nurse last night?” she asked a colleague. But before the nurse could even answer, Walsh chimed in, “No, don't tell me . . . Kristen, right?”

Then, later that morning, Walsh ran into one of her favorite patients, a middle-aged Hispanic man,
José Velasquez,
she had come to know throughout the years. Velasquez would come into the VAMC once a month for an IV antibiotic treatment the hospital was giving at the time to its AIDS patients.

The previous night, Walsh had bumped into Velasquez downstairs in the triage room. He would show up during the day and get the treatment down in the outpatient clinic, but for whatever reason, he had come in late, just as Walsh was leaving.

The treatment itself was a snap. A nurse would insert an IV into his forearm, hang a bag of the antibiotic, and Velasquez would sit and read a magazine while the medication worked its way into his system. The entire procedure took about an hour. After that, Velasquez would sign out and leave. It was a painless procedure that, besides having an IV hanging, a patient wouldn't even know was taking place.

For some reason, Velasquez couldn't make it in for his normal time on February 3. The outpatient clinic closed at four, and by the time he had shown up it was about 5:30. The Admissions nurse, after checking, told Velasquez that someone in Ward C would take him, and sent him on his way.

At six, preparing to leave, Walsh stopped in the ICU to pick up a book she had forgotten. Once there, she bumped into Gilbert as she was making her way to dinner.

“Hi, Kristen, anything going on?”

“Not much, Renee.”

Out of the corner of her eye, Walsh spotted Velasquez; he was sitting, an IV in his arm, reading a magazine.

“What's
he
doing up here?”

“Oh,” Gilbert said, “José . . . Well, Admissions sent him up. The clinic was closed when he came in. I only have one patient, Kenny Cutting. I told them it wouldn't be any trouble.”

It seemed like a logical explanation.

After Walsh and Gilbert discussed work-related issues, Walsh went home.

The next morning, shortly after hearing about Kenny Cutting's untimely death, Walsh bumped into Velasquez, who was wandering aimlessly in a daze out in the hallway near Ward C.

She couldn't understand if he had spent the night at the hospital, or if he had come back for something he might have forgotten.

So she asked him.

“Hello, Miss Walsh,” Velasquez said. He was a bit nervous and fidgety. He looked pale and weak. “Boy,” he added, “did I ever have a strange experience last night.”

“Excuse me?”

“Yeah, I'm still not feeling too good from what happened.”

“Really,” Walsh said.

“I was just sitting there, you know, getting my treatment and reading my magazine. Well, I finished the treatment and that nurse, Kristen—”

“—Gilbert,” Walsh said.

“Yeah. Well, she came over, flushed my IV and, all of a sudden, well . . . I . . . I . . . I can't really tell you what happened next, Miss Walsh . . . I felt hot . . . sick, like I was going to pass out—”

“Relax, José. Take your time.”

“Well, I
did
pass out!”

Whenever an IV treatment like the one Velasquez had received ends, the attending nurse has to flush the line. With a catheter sticking out of a patient's forearm, a syringe filled with saline solution is inserted and, with one plunge, the port of the IV is cleared to insure that every last bit of the medicine makes it into the patient's body. It's a routine procedure, one nurses do thousands of times throughout their careers.

“Continue, José,” Walsh urged. She was horrified.

“I don't know, Miss Walsh. I felt sick. I must have passed out. But a few minutes later, I must have come back around and, after picking myself up off the ground . . . the weirdest thing happened.”

“Go ahead.”

“She's just standing there staring at me. You know, looking down at me.”

“What?”

“She looked at me and said that I must have had some type of allergic reaction to the treatment.”

Walsh knew it was impossible. The drug Velasquez had been receiving had been dripping into his body for about an hour at the time he had passed out. An allergic reaction would have taken place within minutes of its first being administered. But more important to Walsh was that Velasquez had gotten the treatment more times than she could count and had never had an adverse reaction to it. She'd given him the treatment herself just last month, and the month before that, and the . . .

As Walsh listened, her mind began to race.
That's it,
she thought,
I
have
to do something.

“What else happened, José? What did you do then?”

“Well, I felt better, you know, after a while. So she took the IV out, and I went home.”

Walsh put her arm around Velasquez, gave him a hug, and told him to take it easy.

You can't let this go on any longer. Something has
got
to be done,
Walsh said to herself as she left the building