The Doctor and Mr. Dylan (26 page)

“To convict Dr. Nicolai Antone of murder, the prosecution must show… must show… beyond reasonable doubt, that Dr. Nicolai Antone injected that insulin into Alexandra Antone. As you hear testimony in the ensuing days, you will not hear any testimony that establishes that fact. This is a simple case. A tragic insulin overdose killed Alexandra Antone. No one knows where the insulin overdose came from. No one… no one… will prove to you that Dr. Nicolai Antone gave Alexandra Antone that insulin.”

I listened to Martinovich’s powerful delivery, and marveled at his brevity. He’d framed the key issue in terms the blue-collar jury could well comprehend. No one was going to prove that I’d injected an insulin overdose into my wife. No one.

Would the jurors buy Martinovich’s argument after they heard the witnesses testify? I squirmed in my chair. The waistband on my trousers was already drenched with sweat, twenty minutes into day one. As Martinovich sat down next to me, a wide bead of perspiration cascaded off my forehead onto the table in front of us. Martinovich pulled a pushed a box of tissues across the tabletop in my direction. He flipped his legal pad to a blank yellow page, and wrote, “Relax. You look like there’s a torpedo up your ass.”

“Nervous,” I wrote, as I wiped the moisture off my face.

Martinovich patted my hand, and winked at me. “We will win,” he wrote, and then he underlined the word win.

The first witness for the prosecution was Gina Littlefoot, the nurse who’d worked Alexandra’s appendectomy case. I hadn’t seen Gina since that day. She looked a decade older—grayer, more wizened, and very serious. She sat bolt upright in the witness chair. Gina wore a royal blue dress with a silver heart-shaped necklace across her slender neck—her look sleek and professional. Perhaps she’d made a special shopping trip to Minneapolis or Duluth to pick out her outfit. In Gina’s world, this was her brush with celebrity.

James Hamilton said, “Ms. Littlefoot, you were the nurse in the operating room when Dr. Antone put his wife into her final coma, is that true?”

“Objection. Unfairly prejudicial,” Ed Martinovich said.

“Let me rephrase,” Hamilton said. “You were the nurse in the operating room when Dr. Antone anesthetized his wife, is that true?”

“Yes.”

“How would you describe the interaction between them before she went to sleep?”

Gina didn’t hesitate. “The interaction was cold and impersonal. I couldn’t believe they were married to each other, from the way they acted. I tried to chat with Mrs. Antone, to help her relax. Dr. Antone did none of that. He ignored her at first. He looked through her medical chart, and spent time preparing his anesthesia equipment and his medications. After that, Dr. Antone talked to her for maybe two minutes about the risks of the anesthesia. Then he put her to sleep. You had no inkling that they were a couple. There… there was no affection between them.”

I didn’t look over at the jury, but I knew they must be studying me, curious about my reaction to these accusations. What kind of man could put his wife to sleep for surgery without any sign of affection? Was this the sort of man who could take marriage vows to a woman and later anesthetize her into eternal sleep? Was Dr. Nico Antone the sort of monster that could premeditate his wife’s murder?

“Did you witness Dr. Antone injecting drugs into the patient’s IV?” Hamilton said.

“I did,” Gina said.

“Did you know what he was injecting?”

“No. No one ever does. Only the anesthetist knows what he’s injecting. I mean, people can read the chart later to see what was injected, but in real time I had no idea what drugs he was using.”

“Did you witness anyone else inject any drug into the patient?”

“Absolutely not. No way. No one else had an opportunity to do that.”

“How many individuals were in the operating room during the surgery?”

“There was Dr. Perpich, Dr. Antone, myself, and Heidi the scrub nurse. Four. That’s all.”

“Did anyone else approach Alexandra Antone during the time she was asleep?”

“No. No one.”

“Thank you. I have no further questions.”

Hamilton sat down, and Edward Martinovich approached the podium for his cross-examination. “Ms. Littlefoot,” he said. “How many times have you worked with Dr. Antone as the anesthesiologist?”

“I don’t know. Maybe forty cases.”

“Were there any complications during any of those cases?”

“Not that I recall. Not until this one.”

“Very well. Is it your understanding that Alexandra Antone became brain dead due to an extreme low blood sugar concentration?”

“Yes.”

“And is it your understanding that Alexandra Antone had an extreme low blood sugar concentration because she had an overdose of insulin in her system?”

“Yes, I heard that’s what the lab tests showed.”

“Did you witness Dr. Antone inject insulin into Alexandra Antone’s IV that day?”

“Like I said, it’s not standard for me to watch or monitor every drug the anesthesiologist injects. I wasn’t watching everything he did. I mean, I was doing my job as a circulating nurse.”

“Let me repeat the question. Did you see Dr. Antone make an insulin injection during the surgery?”

“I was busy charting and handing sterile supplies to the surgical team. That’s what my job was.”

“Let me repeat the question again. Did you see Dr. Antone make an insulin injection during the surgery? A yes or no answer, please.”

“No.”

“I have no further questions, Your Honor.”

Gina Littlefoot returned to her seat in the gallery. As she walked past me, she looked straight down at the floor tiles in front of her. Gina had shown extraordinary composure on the witness stand, but now that she was done, she looked as if she was about to break into tears. I felt sorry for Gina. She hadn’t done anything wrong. Gina Lightfoot had been dragged into the quagmire of this case by bad luck. She just happened to be in the wrong O.R. on the wrong morning.

Hamilton stood again and said, “The prosecution would like to call its first expert witness, Dr. Thomas Zender.”

An ancient figure, a curled up Yoda of a man, hobbled toward the witness stand with the aid of a cane in each hand. Dr. Thomas Zender wore a coarse tan corduroy jacket over a wine-colored cardigan sweater. He took the oath with his head cocked, as if straining to hear the words.

Hamilton’s first question was, “Dr. Zender, can you describe your training and expertise to us?”

“Certainly,” the old man answered. He turned away from Hamilton, and faced the jury face on. His tone was grandfatherly and sage. “I’m the chairman of the Endocrinology Department at the University of Minnesota Medical School. I’ve been a practicing endocrinologist for 49 years. My research interests are in the field of diabetes medicine.”

Zender continued for twenty minutes, revealing the details of his long and distinguished career—the hundreds of articles he’d written, the textbooks he’d authored, the medical journals he’d edited, and the boards he’d served on. Hamilton made sure the jury knew that Zender was one of the foremost experts in diabetes medicine.

After Dr. Zender stopped his well rehearsed, choreographed script, Hamilton said, “Based on your 49 years of practice and your experience teaching at the University of Minnesota, can you explain to the jury what happened to Mrs. Antone?”

Dr. Zender swiveled to face the jury box again. He licked his lips, and Grandpa Zender became a very hungry and very clever wolf about to feast. “Her lab tests were very specific. She had the lowest blood sugar level I can ever recall. She had a markedly high insulin level and a near-zero level of C-peptide. The triad of a low blood sugar, a high insulin level, and a low level of C-peptide is diagnostic of an injected insulin overdose.”

“Slow down for us here, Doctor. Can you explain again how you know this was an injected insulin overdose?”

“Yes. Insulin causes blood sugar levels to go down. In this case, an extremely high insulin level caused the fatal low blood sugar.” He paused there, to let this simple fact settle in to the jurors’ minds.

“One questions whether the insulin overdose was from the patient’s own body, that is, from her own pancreas, or whether the insulin came from outside her body.” He paused again, until several of the jurors nodded their understanding. “The C-peptide level is how doctors determine where the insulin came from. C-peptide concentration rises with the body’s own insulin production. A high C-peptide level with a high insulin level means the body is manufacturing excess insulin. A low C-peptide level like Mrs. Antone had, with a high insulin level, means the insulin came from outside the body.”

“Tell us what ‘from outside the body’ means.”

“It means that insulin was injected into the patient.”

“Dr. Z
ender, can insulin be inhaled?”

“Yes. Recently the Food and Drug Administration approved an inhaled insulin, but only metered doses of 4 to 8 units of insulin
can be delivered via the lungs. These small doses of inhaled insulin could never cause the extreme hypoglycemia found in Alexandra Antone’s bloodstream.”

“So it is your expert opinion that the
insulin overdose was injected?”

“Yes.”

Hamilton nodded in assent. He surveyed the jury. There were no looks of confusion. Dr. Zender had explained the topic in language anyone could understand. Now it was time to turn the discussion toward causation.

“How does low blood sugar produce brain death?” Hamilton said.

“Brain cells need oxygen to survive, and brain cells need glucose to survive. Deficient in oxygen, or deficient in glucose, brain cells will die.”

“And after they die, can they be replaced?”

“No. When brain cells die, there is no back up. The brain dies.”

“Were there any other abnormal laboratory values in Mrs. Antone’s blood?”

“No.”

“Any low oxygen levels?”

“No.”

“Could anything else have caused her brain death?”

“No. There was no other explanation for her brain death.”

I covered my eyes with my left hand as the ping-pong game of easy questions and damning answers continued between Hamilton and Zender. I wanted to shrink into a puddle of primordial slime on the floor under the table. The pen in my right hand had a mind of its own, as it doodled concentric swirls on the blank yellow legal pad in front of me. If only Dr. Zender would acquire a sudden case of Alzheimer’s or perhaps die of natural causes before he nailed me any higher up the wall.

Hamilton concluded his dance with Zender, and turned the podium over to Martinovich for cross-examination. My attorney’s first question, the key question in this trial, forced me to drop my pen and stop doodling. “Dr. Zender,” he said, “In your expert opinion, when was the insulin administered to Alexandra Antone?”

“By all accounts, the patient’s brain function was normal prior to her general anesthetic. Following the surgery she was hypoglycemic and brain dead. The insulin had to be administered after she went to sleep.”

“Do you have a theory as to how it was administered?”

Zender pushed his lower lip skyward, almost touching the tip of his nose. “I can’t be certain, but to push her blood glucose level as low as 2 mg/dL, it had to be a very large dose of insulin. In all probability it was injected intravenously.”

Martinovich raised the amplitude of his voice into a shout, a resounding call that rivaled any Baptist preacher calling to the Good Lord on Sunday morning. “Is it possible, Dr. Zender, that the insulin could have already been present in the patient’s IV prior to the time she was asleep?”

Zender blinked, unfazed by the question. “I’m doubtful of that.”

Martinovich dropped the volume in his voice, and adopted the sternness of a high school principal interrogating a truant. “Let me rephrase my question. If someone injected a lethal dose of insulin into Alexandra Antone’s IV bag before Dr. Antone arrived, is it possible that the patient could have been normal and awake prior to the anesthetic, but be brain-damaged once the insulin was infused during the anesthetic?”

“In my opinion, no,” Zender said.

“I have no further questions at this time, Your Honor,” Martinovich said. He sat down next to me and wrote, “The man is a bold-faced liar.”

I was dismayed. The possibility that the insulin was present in Alexandra’s IV before I arrived that morning was the central thesis in our defense strategy. Zender had pooh-poohed the notion as untenable, and Martinovich had let him get away with it.

Zender stepped down. Mr. Hamilton said, “For the next witness, the prosecution would like to call Dr. Jillian Ayers.”

Dr. Ayers strode to the front of the courtroom. She was a thin woman dressed in a baggy cream-colored suit that hung on her bony frame like a slack sail from a yardarm. I knew her by her reputation as a professor of anesthesiology at the Mayo Clinic. I’d read dozens of papers she’d authored in the medical literature. Dr. Ayers was a well-trained academic and a formidable foe. Today she appeared cheery and self-assured. For her it was just another day answering questions in a courtroom—just another day collecting her expert witness fee of $700 per hour.