The Near Death Experience (Thaddeus Murfee Legal Thriller Series Book 10)

by John Ellsworth

  The Clerk swore her in and she took a seat.

  Sanders stood and strode up to the lectern, a red file in one hand, his reading glasses and ballpoint in the other. He settled the reading glasses on the end of his long nose and began searching his notes. The jury saw his finger come to rest at the top of the page and they sat forward, anxious to get the testimony underway.

  “State your name.”

  “Eleanor M. Hemenway.”

  “Your occupation?”

  “Detective, Flagstaff Police Department.”

  “Have you been involved in the investigation into the death of one Nadia Turkenov?”

  “I have.”

  “Tell us about your role in that case.”

  The witness leaned back in her chair. She took her time, coolly assembling her thoughts.

  “I was assigned to the case by our Chief of Detectives. My partner is Herbert Constance and he worked the case with me. Actually, he’s the lead detective on the case but he isn’t here. His mother is very ill in Ohio.”

  “All right. What was the first thing you and Mr. Constance did regarding investigating this case?”

  “We were told there had been an incident at the Flagstaff Medical Center. A death had occurred and certain statements had been made to hospital security personnel and nursing staff. So we proceeded to the hospital to begin our investigation. Upon arriving there, we contacted Francis C. Hickenlooper, the head of security services for the hospital. She told us that two members of the security staff had been in the room of Nadia Turkenov when the defendant Dr. Sewell made several statements about the patient’s death.”

  “What did you do upon learning these things?”

  “We made contact with C.S. Adamson, a security officer on the afternoon shift and Elin Montanez, another security officer on the afternoon shift.”

  “Where did this contact take place?”

  “In the security conference room at the hospital.”

  “Did you speak to both officers at the same time?”

  “We did.”

  “What did you learn?”

  “Objection!” said Thaddeus. “Calls for hearsay.”

  “Your Honor,” said Sanders, “I’m not offering any such statements to prove the truth of the matter asserted, but only that certain things were said. The veracity of those statements will be addressed through later witnesses.”

  Judge Hoover rubbed his chin with the back of his hand. “Well, it is preliminary. You may proceed. Objection overruled.”

  “Again,” said Sanders, “when you spoke to the security personnel, what did you learn?”

  “We learned that Nadia Turkenov had died shortly after her life support was withdrawn. We learned that Dr. Sewell had admitted he withdrew the life support.”

  “He admitted doing it?”

  “Evidently so. Both security officers presented their separate incident report and the words were identical in each report.”

  “What did the words say?”

  “Charlotte Mendoza was the duty nurse. She came into the patient’s room after the monitor activated. She talked to the defendant and accused him of turning off the life support. At that time, he is reported to have said, ‘I did. But she’s free now. She asked me to set her free! You’ll just have to trust me.’”

  “So he admitted to shutting off the life support?”

  “He did.”

  “Did you speak to the defendant doctor yourselves?”

  “By the time we received the file, he was already lodged in the Coconino County Jail. The jailers made clear to us that his attorney had gagged him. No interviews allowed. So we didn’t go there.”

  “Your Honor, that’s all I have at this time. However, I reserve the right to recall the witness.”

  “Very well. Mr. Murfee, you may cross-examine.”

  Thaddeus waited while Sanders took his place at counsel table and finally stopped rattling papers. Then he turned to the witness and addressed her.

  “Ms. Hemenway, did you review the circumstances surrounding Ms. Turkenov’s death with anyone besides your partner Mr. Constance?”

  “Did I what?”

  “You know, have you discussed this case with anyone besides your partner?”

  “I might have—wait, I spoke with the medical examiner. And I spoke with Nancy Stoudemire, the physician who spoke with Dr. Sewell at the jail.”

  “Did Dr. Stoudemire discuss with you any comments made by my client, Dr. Sewell?”

  “No. She said she was serving him in a physician-patient manner and whatever he said to her was confidential.”

  “So you have no statements my client made at the jail?”

  “No, sir.”

  “Did the medical examiner ever speak to my client, Dr. Sewell?”

  “I don’t know that I asked him that.”

  “Would it be important if he had?”

  “I don’t know. Depends on what was said, I suppose.”

  “What was the time of the death of Ms. Turkenov?”

  “You’d have to ask the medical examiner for that.”

  “Please refer to your police report. The chronology pages.”

  Thaddeus handed the witness a copy of her own report. She began turning pages.

  The witness nodded. “Okay. We talked to the medical examiner. He put the time of death at between noon and two p.m.”

  “Do you have any reason to think that might not be true?”

  “No.”

  “Here’s what our jury needs to know: Did turning off the life support kill Nadia Turkenov? Or was she already dead before Dr. Sewell did that?”

  The witness came upright in her chair. She drummed her fingers against the file folder containing her report. She looked at Sanders, who was busying himself with a yellow legal pad.

  “All I know is what the medical examiner told me.”

  “So you’re putting the time of death between noon and two because the medical examiner told you that?”

  “Yes.”

  “Did you ever talk to Ms. Turkenov’s doctor?”

  “Yes.”

  “Did you ever think to ask him whether Ms. Turkenov was alive at the moment Dr. Sewell withdrew her life support?”

  “No. The medical examiner already told me—”

  “I know what the M.E. told you. I want to know what the treating physician told you”

  “I didn’t ask whether she was alive. Of course not. Why else would she be hooked up?”

  Thaddeus smiled and pointed at the witness. “That is exactly what we’re here to find out. Why was she hooked up? Especially if she was already medically dead?”

  “Objection!” cried Sanders, coming to his feet. “We’re not here to find out when she was medically dead. We’re here to find out whether the defendant contributed to her death!”

  “Your Honor,” said Thaddeus, “the jury has a right to know whether she was medically dead when the ventilator was turned off. That’s the whole case for them to decide.”

  “Mr. Murfee, please refrain from instructing on what the jury has a right to know. That is my role. But for the record, I will overrule the objection as it’s cross-examination and I don’t want to limit you needlessly.”

  “Thank you, Judge.”

  Thaddeus paused and thumbed through his papers.

  “So you didn’t ask her doctor whether she was alive when the life support was turned off?”

  “No.”

  “That is all. Thank you.”

  Sanders then attempted to rehabilitate on the issue of living versus already dead, but, without the expertise of a physician to fall back on, there was little he could do. The witness left the witness stand on a decided note of counter-climax, and, more important, left the jury wondering whether Dr. Sewell had actually killed Nadia Turkenov. Their faces were perplexed and their body language unsettled. What had seemed at first to be open and shut had taken on a sudden turn. When did the patient die? They asked themselves.

  D.A. Sander
s called his next witness.

  Angus Wainwright, M.D., next took the witness stand. He was a mid-sized lanky man with a full beard and light-sensitive eyeglasses that still hadn’t cleared up from the bright sunshine outside, which blocked any eye contact he might have attempted to have with the jury. He testified that he had served as the Medical Examiner of Coconino County for twelve years, that he was supported by a full laboratory staff and two other physicians who shared on-calls with him, and that he was married, had two sons at NAU, and had attended forensics training both in the U.S. and in Switzerland.

  “She died between noon and two p.m.”

  “What time did you make this judgment,” Sanders asked the doctor on direct.

  “I arrived at the scene just after five o’clock that same day. The room was taped off with yellow police tape and nobody was being allowed in and out. The body remained on the bed as it had been when the patient died. I took her temperature, examined her, and wrote in my notes that the time of death was sometime between noon and two.”

  “Was there anything remarkable about the body?”

  “A trachea wound in her throat where the ventilator had been inserted. Various IV tubes and telemetry wires still in place. I instructed the police photographers on certain additional photographs I wanted and they complied. Then I spoke with the decedent’s treating physician.”

  “What did he tell you?”

  The M.E.’s busy eyebrows closed together and he said, “He told me she had been in that same state as that afternoon when she died for about a month. There had been no change.”

  “But she was alive?”

  The doctor chewed his lip. “Yes, she was alive. The machine was breathing for her and she had a pulse. I checked all of her vitals on the monitor later that evening.”

  “So she was alive?”

  “Definitely, she was alive.”

  Sanders then proceeded through the autopsy, which had actually been performed by an associate physician. Photographs were entered into evidence, the autopsy report was entered, and Thaddeus made his notes. There was nothing remarkable in any of the exhibits so he would ignore those on cross-examination. Finally, his turn with the witness came.

  “Dr. Wainwright, you’ve told the jury she was alive when Dr. Sewell removed her life support?”

  “I did. She was.”

  “Tell us what indicated to you that she had been alive.”

  “Well, according to the monitor, her heart was beating, her body temperature was well within normal limits, her respiration ready was steady—”

  “She was breathing?”

  “She was breathing.”

  “But?”

  “Well, the machine was doing her breathing for her. She was alive, however, no doubt about that.”

  “What about her brain activity?”

  “The brain activity was difficult to assess.”

  “Well, are you a neurologist trained in the medicine of neurology?”

  “No, I’m a trained forensic pathologist.”

  “You’re a death expert?”

  “Yes.”

  “Was there brain stem activity in the patient?”

  “Yes and no.”

  “What does that mean, ‘yes and no.’?”

  “There were artifacts but I’m not the one to interpret their meaning for you. Again, I am not a neurologist or neurosurgeon.”

  Thaddeus nodded, then said slowly, “So on the issue of brain stem activity, you would defer to the neurologists and neurosurgeons for their expertise?”

  “Yes, it would be inappropriate for me to offer expert testimony on brain stem monitoring.”

  “Thank you, Doctor.”

  The medical examiner stepped down from the witness stand and Judge Hoover recessed for the day.

  Next up, Sanders told the court and jury, Nadia’s own physician.

  48

  Dr. Sylvan Glissandos kept the jury waiting thirty minutes while she finished up with an emergency admit at the Medical Center. When she finally arrived, she flounced furiously down the aisle, her long dress flowing, stethoscope still firmly around her neck where she had left it and forgotten to remove it, white lab coat buttoned down the front, and her granny glasses looking at the jury as she came, clearly interested in her surroundings and the players involved. It was quite evident to Thaddeus that the woman was a pure scientist and gave little thought—or less of a damn—how she dressed and looked. As Detective Hemenway had been all-business, so was Dr. Glissandos.

  She had been to court many times and waited for no one to tell her to climb up on the witness stand and be sworn. She breezed across the floor in front of the judge and stepped up the one small step, turning abruptly and raising her hand while she waited for the anointment of the magical witness words so she could launch into why she was there.

  Sworn and smoothing her dress as she sat, the doctor looked from Shep to Sanders. She had recently spoken to both lawyers and wasn’t clear which one had wanted her there.

  But Sanders wasted no time.

  “Dr. Glissandos, what was your admitting diagnosis for Nadia Turkenov?”

  “Drug overdose. She was loaded on pain killers.”

  “What treatment was undertaken on admission?”

  “Two things, initially. First there we did a gastric lavage. What you would call stomach pumping. This mechanically removes unabsorbed drugs from the stomach. Secondary was the administration of activated charcoal. This was forced into the stomach to help bind the drugs and keep them in the stomach and intestines to reduce the amount absorbed into the blood. Followed up with a cathartic to quickly evacuate stool from her bowels.”

  “Was she conscious?”

  “Never was conscious. She had thrown up in her throat and her air supply was cut off. We cleaned that out in the ER but I think the damage was done. She had been without oxygen and her brain had shut down.”

  “Was she alive when she came in? Or was she shocked back to life?”

  “I don’t quite follow you.”

  “Did you have to give her shocks to get her heart started?”

  “No, her heart never stopped beating. Not at any time.”

  “So she was alive?”

  “She was what you would probably call alive.”

  “What would you call it?”

  “Well, I would say she was alive or we wouldn’t have taken such extraordinary measures as we took. Upon admission, it remained to be seen whether brain function would be restored.”

  “Did she have brain function on admission?”

  “You know, we weren’t doing EEGs on admission. We were too busy passing tubes, opening an airway, and getting her hooked up to a ventilator. The EEGs came later, on a consult with a staff neurologist.”

  “Who would that be?”

  “Jacqueline Childs. She was in the hospital that night on an accident case. So she looked in on my patient, Ms. Turkenov.”

  “She ordered the EEG?”

  “I ordered it. She recommended, of course, after we talked for a few minutes.”

  “Did she read the EEG?”

  “She examined the patient. I don’t know if she ever read the EEG. But I did. I am board certified in neurology as well as emergency medicine.”

  “What were your findings?”

  “Abnormal.”

  “There has been talk of brain death in this courtroom and I want to set that issue to rest. Was she brain dead?”

  The doctor drew a deep breath. “Brain death is referred to as the complete, irreversible, and permanent loss of all brain and brainstem functions. Brain death implies the termination of a human’s life; correspondingly, the diagnosis of brain death is very important. Was she brain dead? We ran certain tests.”

  “What tests did you do?”

  “Typically, isoelectric EEG recording is required at least thirty minutes and may last three to twenty-four hours. I thought three hours sufficient with this patient. The positive response of EEG tests suggests functionin
g of the brain. Consequently, the patient in deep coma might show some EEG electroactivity, while the brain-dead patient will not.”

  “Did she show electroactivity?”

  “Yes and no. Let me answer that by explaining how I broadened the scope of my inquiry just a little bit. Nowadays, the standard diagnosis procedure depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. These were the three features I was investigating.”

  “We will want to hear about how these were investigated. But first tell us what you’re talking about in terms we can understand.”

  “Well, brainstem is the lower portion of the brain between the cerebrum and the spinal cord. The brainstem controls breathing, swallowing, seeing, hearing, and other vital functions. The examination of brainstem functions in clinical practice and in my approach included pupillary response to light, fixed or variation pupils, corneal reflex, gag reflex, cough reflex, irrigating the ears with cold water, presenting painful stimuli, and I think that was it. The examination of the absence of spinal reflexes included the test of ocular movement, facial sensation and facial motor response, pharyngeal and tracheal reflexes. These tests were corroborated, over time, by the several EEGs I ran.”

  “And your findings.”

  “You should know that I’m a little slow to pronounce brain death, maybe, compared to some physicians.”

  “You are a little slow, why?”

  The doctor shrugged and her face lit up momentarily. “Because I have seen my share of miracles.”

  “You have seen brain dead patients revive?”

  “I have. Remember, however, that medicine, particularly this area of medicine, is more art than science. We’re talking here about physical tests, many of which are subjectively analyzed. Dilation, reflex, sensation—all of these are measured by the physician’s five senses. They are not measured on a machine that gives numerical readings. So it is an art. When I say I have seen, as you put it, the brain dead revive, I am saying that based on my many subjective tests I have seen such phenomena. Now. What about this patient’s case? It finally became evident to me, after several weeks of observing her vegetative state, that she wasn’t going to revive. She wasn’t coming back.”