Perfect Poison (16 page)

When Renee Walsh got home on February 15, she picked up the phone, dialed John Wall and explained the conversation she'd had with Kathy Rix earlier that day.

“Okay,” Wall said. “I'm with you guys.”

After that, Walsh phoned Melodie Turner.

“Melodie . . .” Walsh said apprehensively, pausing for a moment. “Okay, here it is. John and Kathy and I . . . we need to talk to you professionally about something very serious, and it's very important that we do it as soon as possible.”

“What's wrong, Renee? What is it?” Turner, wild with curiosity, asked.

“I'd rather wait until we're all together, Melodie. We need to have absolute confidentiality with this. No one can know that we're meeting with you, or even talking right now. We have to meet in a secure place—
not on the ward, though.
We can't been seen coming and going.”

“Just tell me, Renee. What's so important that the three of you need to speak to me? I need to know
now.”

Walsh knew Turner hated being left in the dark about things. But as much as she would have liked to, she couldn't tell her.

“You'll have to wait!”

A few minutes after they hung up, Turner called back. She was even more anxious and impatient. Walsh had never heard her act like this before.

“What is it that could be
so
serious? Just tell me, Renee.”

“No!” Renee said. “Wait until we can all get together.”

The following day, February 16, wasn't going to work. It would have to be the day after. It was the only day Wall, Rix and Walsh could meet together.

On the morning of the sixteenth, Turner called Walsh again.

“Can't we push this meeting up . . . maybe have it today?”

“No,” Walsh said. “We're busy, Melodie. It'll have to wait.”

“What about tonight?”

“No.”

For the next twenty-four hours, Turner called half a dozen more times, demanding to know what the problem was. But Walsh repeatedly told her no.

“Well, I guess if you're going to talk to me about something so serious,” Turner finally said in defeat, “I can't think of three finer people to come and talk to me besides you and Kathy and John. I'm sure you have something very important and worthwhile to say, but can't we do it any sooner?”

“Absolutely not.”

Any anxiety and fear Walsh had been dealing with now seemed to be doubled. She kept thinking about Gilbert, Glenn, and their kids. She had known Gilbert as a friend, colleague. It wasn't every day someone accused a coworker of murder.

But ultimately, it came down to the patients: as a nurse, Walsh had a responsibility, both professionally and ethically, to do something. As a person, she had a moral obligation. How, she wondered, could she look at herself in the mirror every day if she didn't do something?

On the other hand, if Gilbert was indeed a cold-blooded murderer, what would she do to Walsh and her family if she ever found out what Walsh was planning? Walsh knew it was possible that Gilbert had tried to “do something” to Glenn. If she was capable of trying to kill her husband, Walsh thought, what wasn't she capable of?

 

 

The entire situation scared the hell out of all three nurses. But underneath the apprehension and fear was a layer of suppressed anger that had compressed over time. They were upset that they were the ones who had to come forward. Where was upper management in all of this? Why didn't Melodie Turner see it? Why didn't Turner's boss, Priscilla McDonald, notice the increasing number of codes, deaths and medical emergencies? What about Quincy Garfield, the Chief of Nurses? The Medical Emergency Committee? The Chief of Medicine? The Chief of Staff?

Where in God's name was Quality Management?

After unsuccessfully intubating Ed Skwira for a fifth time, Dr. Raheb decided they couldn't wait any longer for his transfer to Baystate Medical Center. He had to go now. Something was dreadfully wrong. He wasn't responding to treatment.

By this point, Skwira's family had been notified about his code and were en route to Baystate. While awaiting his transfer, Skwira coded again and underwent CPR. Within moments, the team at the VAMC got his heart to beat at a normal rhythm. He was then sedated, where his blood pressure remained at 141 over 91, his heart rate at 100.

Shortly after six o'clock, Phillip Skwira, Skwira's youngest son, showed up at the VAMC and followed his father's ambulance to Baystate.

Meanwhile, Dr. Raheb had made the diagnoses that Skwira had suffered a “dissecting descending aortic aneurysm”—a fatal condition.

But the doctor was wrong.

As it would later be proved, Ed Skwira had been showing all the classic signs of epinephrine poisoning—and now his killer, undoubtedly worried sick that he was still alive, was riding with him in the ambulance to Baystate.

After Skwira was gone, Kathy Rix went back into his room.

While putting the medical equipment away, Rix grabbed the needle-disposal bucket near his bed and looked inside to see what she could find out about his code. Being a nurse for almost two decades, Rix knew that during codes doctors ordered 1:10,000 bristo-jet plunges of epinephrine, not the 1:1,000 ampoules she had been counting.

Rix couldn't believe it, but when she opened the bucket, there were three broken ampoules of 1:1000 epinephrine in the bottom of it.

Her legs went numb.

Before she finished cleaning up, Rix went around and picked up the various portions of heart rhythm strips that, like a fax machine, had spit out of Skwira's telemetry monitor during and after his code. It was a detailed account of what had happened to his heart as it spiraled out of control.

Rix collected them, rolled them into a scroll, and left them near his chart. This way, she thought, when Gilbert returned from Baystate, she could go through and cut out certain sections that best depicted the codes.

It never occurred to Rix that Gilbert might want to dispose of what would ultimately be incriminating evidence against her: the rhythm strips. Rix was confused, scared. After seeing a second round of spent epinephrine ampoules, she had a hard time concentrating on anything else. Plus, she had no idea if Gilbert was falsifying medical records and failing to follow policy on top of everything else.

Between the time Gilbert returned to the VAMC after escorting Skwira to Baystate and the next morning, those heart telemetry strips Rix had collected had disappeared—and Gilbert had not even cut and pasted one section to Skwira's chart.

 

 

At 6:30, on February 15, 1996, Ed Skwira was admitted to Baystate Medical Center and, oddly enough, doctors quickly ruled out the possibility that he'd had a heart attack. Moreover, after only a few tests they concluded that he, in fact, had a normal functioning heart.

Yet on learning of his sudden cardiac event back at the VAMC, doctors believed that he had developed a “possible tear in his aorta,” a condition that, added to his thoracic aortic aneurysm, was a recipe for death. Then, upon further evaluation, they suspected that he also had a “perforated viscus.”

Bad news all around.

A perforated viscus is a tear in the wall of the stomach, which results in germ- and bacteria-laden air bleeding into the abdominal cavity. It was likely due to Skwira's first code and the arduous time the VAMC staff had intubating him.

For a person who had just suffered sudden cardiac arrest and now had a possible tear in his stomach, an operation to repair it carried a one hundred percent mortality rate—and Ed Skwira's doctors were totally against doing it.

But now they had to break the bad news to Skwira and his family, who were waiting patiently in his room for a status report.

As Stacia and Phillip stood by, Skwira's doctor came into the room and gave it to them straight.

“Mr. Skwira, I'm sorry, but you're going to die. There's not much we can do for you.”

Skwira began to cry. Stacia took his hand and kissed him on top of his head. Phillip, having trouble digesting it all, just stood there, stone-faced, waiting for someone to tell him it was all a joke.

Under the misbelief that he had a swollen thoracic aortic aneurysm, doctors convinced Skwira and his family that the cardiac medication he was on should be stopped right away. It wasn't doing him any good.

This was a crucial decision, because the meds Skwira had been on were basically keeping his heart stable.

Next, doctors suggested that he begin morphine treatment right away to make him more comfortable as he passed on.

Skwira and his family agreed it was probably a good idea.

Unfortunately, this type of painkiller actually suppresses respiration and “makes the heart muscle more irritable.” The morphine would, undoubtedly, put Skwira in another world and allow him to be comfortable as he died, but coupled with everything else that had happened, it would also help in killing him.

The next day, Phillip went to see his father early in the morning. Skwira appeared to be well-rested when Phillip arrived, but was still showing signs of discomfort and, strangely, had developed a new set of symptoms.

Every once in a while, Skwira would begin to have hallucinations and become fidgety, sitting up and lying down in his bed.

His doctors had already decided to have him transferred back to the VAMC, where he would be more comfortable during his final days.

Later that night, Skwira's entire family visited. Time was short. It seemed like just weeks ago he was out in his garden tending to his vegetables and flowers, walking around the house watering his plants and cracking jokes.

Now he was waiting to die.

 

 

Some years ago, Skwira had asked someone in the family to take a picture of him standing at the base of a favorite maple tree he'd planted in the front yard. An avid bird-watcher, he had placed a bird feeder next to the tree that he wanted in the picture too.

“Why?” his family asked when he said he wanted the picture taken.

“Because . . . I just want a nice picture for all of you to remember me by.”

 

 

As the others went out to get some coffee, or just take a break from the emotion of being in Skwira's room, Phillip watched as his father forced himself up in bed, looked straight up at the ceiling, and said, “I don't want to die,” before falling back into bed, as if he had just taken his last breath.

Skwira had suffered a tremendous amount of pain the entire day. He would sit up, lie down, and move around. No matter what he did, he just couldn't seem to get comfortable. And the hallucinations continued.

“He was agitated,” Phillip recalled later. “He was in a lot of agony . . . a lot of pain.”

Two days later, on February 18, 1996, Edward Skwira died early in the morning, shortly before his family, who were planning on visiting him, had a chance to make it to the hospital.

 

 

A year later, toxicology tests determined that Ed Skwira's system was loaded with the drug ketamine. Ketamine is an anesthetic used therapeutically for children and adult asthma patients. On the street, it's commonly referred to as “Special K,” and kids take it mainly for its hallucinatory side effects. Given to someone improperly, ketamine can cause hallucinations, which Skwira clearly suffered from during his final days.

More of a concern to investigators, however, was that the VAMC had never purchased or stocked ketamine, and not a single doctor or nurse—from AdCare, in Worcester, where Skwira had been detoxed, to Baystate—had prescribed or authorized the drug.