True Intent
Page 19
“What do you mean we have to leave?” said Bre clear enough for me, and the jury, to hear.
Victoria whispered.
Bre turned her head and stared daggers at me. “But I want to hear what the coroner has to say!”
Victoria whispered again.
I wasn't watching Bre Phillips anymore. I was watching the jury. I hoped this tantrum lasted a little longer.
“Well, you best call us next then,” Bre said as she stood. Andrew stood with her and the two of them filed out of the court room. Judge French waited until they were gone before he said, “Do you intend to call the same witness, Ms. Lance?”
“Yes, Your Honor. The prosecution calls coroner Ray Gerchuk.”
32
One of the young attorneys went out to the hallway and, a moment later, the coroner for Carrefour, Ohio, Ray Gerchuk, strolled in.
Ray Gerchuk was the antithesis of what you thought a coroner should look like. He was in his early sixties but still fit, tall and slightly tan, even though we were barely past Memorial Day. He had blonde hair that was almost imperceptibly white at the fringes and a perpetually cheerful disposition that seemed out of line with his chosen vocation.
Victoria let him get settled in the witness chair before she said, “Could you introduce yourself to the jury please, Doctor?”
“My name is Ray Gerchuk.”
“And what do you do, Dr. Gerchuk?”
“I’m the coroner for Carrefour, Ohio.”
“You are a medical doctor?”
“I am. I went to undergrad and medical school at the University of Michigan and then went down to Ohio State for my residency where I trained in pathology.”
“Given that background, Dr. Gerchuk, I think it’s very important for all of us to know just who you root for in the big game?”
Dr. Gerchuck smiled. “I played for Michigan, so no matter how many years I trained down in Columbus, I'll always root for the Wolverines.”
“Dr. Gerchuk, I'm afraid you just alienated half of the jury.”
Two of the jurors smiled and gave exaggerated nods.
Ray Gerchuck smiled back. “My apologies.”
Victoria smiled then put on her serious face. “Now Doctor, please explain to the jury what you do as a coroner.”
“I examine the bodies of people who have passed away in order to determine a cause of death.”
“And have you done a number of autopsies?”
“I have.”
“About how many would you estimate?”
“I'm not certain but probably more than fifteen thousand.”
“And how do you determine the cause of death?”
“I examine the exterior of the body and I examine the organs. If that’s not sufficient, I also perform a microscopic examination of any relevant tissues and perform toxicology or chemical testing on the blood and organs.”
“Dr. Gerchuk did you perform an autopsy on Richard Phillips?”
“I did.”
“Tell us about it.”
“May I refer to the autopsy report?”
“Of course.”
Ray Gerchuk slipped on a pair of reading glasses and picked up the autopsy report that was a joint exhibit in the case. “Mr. Phillips was a fifty-nine-year-old man in reasonably good shape for his age. His external examination was unremarkable.”
“Was that a surprise?”
“No. It was consistent with my understanding that he had collapsed and died at a wedding reception.”
“What did you do next?”
“I moved on to an internal investigation. Because of the way Mr. Phillips died, I was most interested in his heart and vascular system.”
“And what did you find?”
“I found that Mr. Phillips had an enlarged heart. Specifically, he had left ventricular hypertrophy.”
Victoria smiled. “What does that mean for us lay people, Doctor?”
“It means that Mr. Phillips’ heart was bigger and heavier and thicker than it should have been.”
“And what causes that to happen?”
“It's a common finding in someone with high blood pressure. When someone has had years of high blood pressure, the heart tends to get larger because of the effort it takes to pump. I confirmed this fact when I dissected the walls of the heart and found that they were thicker than normal.”
“Did you also examine the blood vessels leading into and out of the heart?”
“I did.”
“And what did you find?”
“One of the first things I looked for was atherosclerosis. That's when you get a buildup of plaque in the blood vessels.”
“And did you find any plaque?”
“I did not. Mr. Phillips appeared to have clean vessels for his age.”
“What did you do next?”
“I examined the tissue of Mr. Phillips’ heart. With a traditional heart attack, what’s called a myocardial infarction, the blood supply to a portion of the heart is cut-off and that section of heart muscle dies. Here, Mr. Phillips’ heart muscle was intact.”
“So he did not have what we would think of as a traditional heart attack?”
“He did not.”
“What do you think happened to him then?”
“Because there was no evidence of tissue death in the heart, and because we know that his heart rhythm was disturbed, I believe that Mr. Phillips died of an arrhythmia.”
“Now what does that mean?”
Dr. Gerchuck leaned forward like an enthusiastic teacher. “Your heart runs on an electrical system. That's what makes it beat regularly. When you have an arrhythmia, those beats become irregular, and when the arrhythmia is severe, the beats are so irregular that the heart can no longer pump blood.”
“And the person dies?”
“And the person dies.”
“And do you believe that is what happened to Mr. Phillips?”
“I do.”
“What's the basis for that opinion?”
“Well, we know from the paramedic records that he was having an irregular rhythm. The defibrillator machine that they used to shock him registered the heartbeat first and we can see from that record that Mr. Phillips’ heart was not in sinus rhythm. When you combine that with my examination of his heart, which showed that there was no tissue death, the only alternative is that he had an arrhythmia.”
“As part of your examination and investigation, did you check any of Mr. Phillips’ medical records?”
“I did.”
“And did those records support your opinion?”
“They did.”
“How so?”
“I found that Mr. Phillips had been treating for high blood pressure for some years, probably close to ten, and that he had been treated for episodes of an irregular heartbeat. He was receiving a medication for both of those conditions.”
“How do you know that he was receiving medication for an irregular heartbeat?”
“Two ways. His medical records state that he was being prescribed Lopressor and, in the toxicology tests I performed, I found the presence of trace amounts of a beta blocker in his system.”
Victoria raised a hand and glanced at the jury. “I'm going to have to slow you down a little bit there, Doctor. What is a beta blocker?”
“A beta blocker is a type of medication that's used to treat high blood pressure and heart arrhythmias. Basically, it causes your heart to beat more slowly and with less force which in turn lowers your blood pressure.”
“And you said Mr. Phillips was being prescribed a beta blocker?”
Dr. Gerchuk nodded. “He was. According to his records, Mr. Phillips had been taking one for about four years. It was a drug called metoprolol. The brand name was Lopressor.”
“Is that medication a common treatment for high blood pressure?”
“It's not usually the first line of treatment but it is fairly common.”
“Are beta blockers strong drugs, Doctor?”
Dr. Gerchuk looked
over his glasses. “I'm not sure what you mean by that.”
“You shouldn't stop taking beta blockers abruptly, should you?”
“No, you should not.”
“Why is that?”
“Because you can have an irregular rhythm or a heart attack.”
“Dr. Gerchuk, in the course of your practice, do you also study the interaction of drugs with each other?”
“Sometimes.”
“You evaluate certain drug interactions when you're determining someone’s cause of death?”
“If necessary.”
“Do you also examine the interaction of over-the-counter medications or supplements with prescription drugs?”
“I do.”
“Dr. Gerchuk, are you familiar with the herbal supplement St. John's wort?”
“I am.”
“What is it?”
“St. John's wort is a common herbal supplement that people take. It's often used to treat depression, anxiety, or sleep disorders.”
“Do you know how St. John's wort is taken?”
“It can be taken as a pill. It's also a yellow flower that can be dried and mixed as a tea.”
“Dr. Gerchuk, does St. John's wort interact at all with beta blockers?”
“It does.”
“How so?”
“Basically, St. John's wort speeds up the metabolism of your liver which speeds the elimination of beta blockers from your system.”
“Could you explain that a little more please, Doctor?”
“Sure. Your liver processes the medications you take and removes them from your system. When you take St. John's wort, it speeds up the rate at which your liver gets rid of the beta blocker. For that reason, our current thinking is that you shouldn’t take St. John's wort if you're taking a beta blocker because it speeds the beta blocker out of your system.”
Victoria nodded and looked at the jury. “And when the beta blocker is out of a patient’s system, the patient could be susceptible to high blood pressure or a heart arrhythmia, true?”
“That’s true.”
“So if a patient is taking a beta-blocker, he should not take St. John's wort, is that right?”
“That's the standard recommendation.”
Victoria walked away from Dr. Gerchuck and glanced at the jury again. “Now Doctor, St. John's wort can also interact with other things besides beta blockers, can’t it?”
“What do you mean, Ms. Lance?”
“For example, are there certain foods you shouldn’t eat when you're taking St. John's wort?”
“Oh, yes, right. People taking St. John’s wort shouldn’t eat foods that are high in tyramine.”
“Could you explain to the jury what tyramine is, Doctor?”
“It’s an ingredient that’s related to an amino acid.”
“What are some example of foods that have tyramine?”
“Aged meats like prosciutto, aged cheeses like brie or blue cheese, and red wine are the big ones.”
“And why shouldn’t a person who’s taking St. John’s wort eat those kinds of foods?”
“Because the interaction between the St. John’s wort and the tyramine can cause a person’s blood pressure to skyrocket to life-threatening levels.”
“And that effect of St. John’s wort is totally separate from the beta blocker effect?”
“It is.”
“So are you saying that, even if someone has a perfectly healthy heart or has normal blood pressure, he shouldn't eat aged meats or drink red wine if he’s taking St. John's wort?”
“That’s right.”
“Because he would run the risk of experiencing life-threatening blood pressure levels?”
“Right.”
“And that risk would be even higher for someone with a pre-existing blood pressure problem, true?”
“That's also true.”
“That person would have the double risk of eliminating the effectiveness of his blood pressure medication and ingesting a chemical that could spike his blood pressure, right?”
“That's right.”
“So giving someone St. John's wort who is taking a beta blocker and eating prosciutto would be like putting a gun to his head, wouldn’t it?”
I stood. “Objection, Your Honor.”
Judge French didn't even look up from the brief he was reading. “Sustained.”
Victoria nodded. “Let's go about this another way, Doctor. Someone who's taking a beta blocker shouldn't take St. John's wort, should he?”
“It's not recommended.”
“Because it could spike his blood pressure?”
“That's correct.”
“Or cause a heart arrhythmia?”
“True.”
“And someone who is taking St. John's wort should not eat aged meats?”
“That’s right.”
“Or eat aged cheeses?”
“Correct.”
“Or drink red wine?”
“Right.”
“Or drink coffee?”
“They should avoid caffeine.”
“All those things can cause a serious spike in blood pressure, right?”
“Right.”
“All those things can cause a fatal heart arrhythmia?”
“Yes.”
“Doctor, do you have an opinion as to what caused Richard Phillips’ heart arrhythmia?”
“I do.”
“What is that opinion?”
“Richard Phillips had an enlarged heart from years of high blood pressure and was taking a beta blocker to treat it. I originally thought that he just had a heart arrhythmia over the course of the long weekend. However, I was subsequently provided with evidence that he was drinking tea that contained St. John's wort. The St. John’s wort would have eliminated the effectiveness of his beta blocker. I also understand that Mr. Phillips was drinking and eating foods high in tyramine. All those things together were a volatile cocktail which caused his arrhythmia.”
“Doctor, do you hold that opinion to a reasonable degree of medical certainty?”
“I do.”
“Doctor, would you say that, given the events of that weekend, Mr. Phillips’ arrythmia was inevitable?”
I stood. “Objection. Calls for speculation.”
“He can offer his opinion if he has one, Your Honor,” said Victoria.
Judge French looked at me and then looked at Dr. Gerchuk. “Doctor, you may offer an opinion if you hold that opinion to a reasonable degree of medical probability.”
Dr. Gerchuck tilted his head back for a moment as if thinking before he said, “I think that the combination of taking St. John's wort, eating high tyramine foods, drinking wine and caffeine, and physical exertion made a heart arrhythmia likely to occur in a man with a history of that condition.”
“Could that result have been anticipated?”
“If you knew of all these factors, sure.”
“You mentioned physical exertion. Do you consider dancing to be physical exertion?”
Dr. Gerchuk smiled. “Have you seen the way people sweat on the dance floor?”
Victoria smiled back. “I have.”
“Then you know that, yes, dancing is physical exertion.”
Victoria crossed her arms, acted as if she were thinking and stepped forward so that she was standing right in front of the jury box. “Now Doctor, to be fair, most people probably don't know all of these things about St. John’s wort, do they?”
“I don't know what most people know, Ms. Lance.”
Victoria smiled. “Fair enough. Doctor, would you be surprised if people didn’t know about these interactions with St. John’s wort?”
“I would not be surprised.”
“However, people with a scientific background might know about them, right?”
“I don't know what other people know.”
“You wouldn’t be surprised if a biologist knew these facts about St. John’s wort, would you?”
I stayed in my seat. An objecti
on would only serve as an exclamation point to the answer we all knew was coming.
“No, Ms. Lance, I would not be surprised if a biologist knew those facts about St. John’s wort.”
“That's all I have, Dr. Gerchuk. Thank you for your time.”
As I started to stand, Judge French raised his hand. “Counsel, we’ve been going at it for a while. I think we’ll take our afternoon break now.”
Victoria looked over her shoulder at the door. “Your Honor, if Mr. Shepherd isn't going to take too long—”
“Ms. Lance, I don't know if he needs a break but I certainly do. We will reconvene in fifteen minutes.”
“Of course, Your Honor,” she said. The jury was ushered out and Victoria hurried out the door as soon as they left.
I looked over to Liselle. “How are you holding up?” I said.
Her face was neutral. “Fine. For a murderer.”
“Like I said, the beginning’s the worst part. You did fine.”
“Nate, I didn't know about it.”
I nodded. “I know, Liselle. I'll bring it out.”
“I didn't even know he was taking the blood pressure medication.”
“There's no reason you would. I'll be right back.” She nodded.
As I left the courtroom, I saw Victoria holed up with Bre and Andrew Phillips on the far side of the hallway. Bre was facing Victoria, standing straight, fists clenched. “I did not pay all this money to be sent to the hallway like some girl in detention.”
“This is typical in a trial like this,” said Victoria.
“Don't tell me about typical. We are not typical.”
Victoria's eyes flashed at me, then she put a hand on Bre’s arm and whispered.
“And I will not be shushed either!” Bre said.
I kept walking. When I hit the corner, I pulled out my phone and called Olivia Brickson.
“Hey Nate? How's Gerchuck going?”
“No big surprises. Got time for some research?”
“Always.”
“I think that the Phillips family or their company or a charity is donating money up here in some way to help pay for the trial. Can you see what you can find out?”
“On it. I'll get back to you.”
“Text me if you find something and I’ll call you after we get out.”