“Don’t know,” Danny said. He was sick of burning days leaving messages, nobody calling back. “Why don’t we go find out?”
The New Jersey Department of Poison Control was only a few months away from moving out of Newark. Until then, the center’s old offices were locked deep within a monolithic institutional building with endless corridors and the haunted smell of a damp library. The main entrance was chained off; broken furniture and rolls of gum-stained carpets littered the halls. Poison Control seemed to be the last tenants left in the building.
Exactly what Tim and Danny expected to find here, they couldn’t say. All they knew was that Somerset Medical Center had contacted the poison experts in relation to the ODs. Tim imagined a laboratory full of bubbling beakers. He hoped that the guys in white coats would be as useful as ballistic experts were in normal homicide cases—maybe they could even trace the poison, if Tim could get a sample.
They found Dr. Marcus up a flight of stairs and at the end of a linoleum hall. There was no lab, none of the Frankenstein stuff the detectives were expecting, only an open door and an office piled with books and papers, the usual desktop golf novelties doctors always seem to get, plus a collection of poison-related knickknacks, stuffed rattlesnakes, and some sort of tribal art. Tim had seen places that looked better after police had turned over a house during a search warrant.
Steven Marcus, Poison Control’s sixty-something white-haired director, had a reputation in the toxicology field for both his extensive experience and startling direct manner, and was considered either a troublemaker or a straight shooter, depending on which side of the argument you were on. Marcus spotted the two hulking men in mustaches and suits lurking by his door, and marked them instantly as detectives. Tim introduced themselves as being from Somerset County. Marcus began shuffling the piles around his desk into a white squall of paper, finally revealing a short stack of cassette tapes and a portable recorder. “You’re late!” he said. “I was expecting you five months ago.”
Danny hit Rewind, hit Play, settled back on his perch on Tim’s office radiator to listen to the scribble of tape head hitting dial tone.
Surreptitious calls were the best. Better than wires. Without visual clues, blind to the subtle semaphore of gesture and expression, phone callers were forced into articulate communication. You want people to tell the truth, Danny found, it was best not to give them a chance to lie—break down the door, serve the search warrant in the shower, catch them cold. Tapes and wires were even easier, and often more revealing.
The Marcus tapes presented a very different picture of Somerset Medical Center’s unexplained incidents and internal investigation than the one presented to Tim and Danny. SMC administrators had never mentioned their interaction with Poison Control, or the results of their calculations. Or the fact that they’d been instructed by NJPC to call the police nearly four months ago. And they certainly hadn’t mentioned that it had all been on tape.
God forgive them, Danny thought, for anything that happened in between, because he sure wouldn’t.
37
Danny watched the spinning cogs of the tape, hearing the familiar female voice1 of Mary Lund introducing herself over the phone to NJPC pharmacist Bruce Ruck. He heard Marcus get loud with Dr. Cors and Lund, telling them he was alerting the DOH. Telling them the evidence suggested that someone was poisoning their patients, telling them they had a police matter.
“So it was Marcus, not Somerset, who first got in touch with the DOH,” Danny said. “Somerset said they weren’t going to go to anybody until they’d done their own investigation.” Danny had to assume that was the reason nobody at SMC ever mentioned the conversations.
“You know, those are the guys we should be going after.” Tim stabbed the tape recorder with his pen. “Those assholes right there.”
At the squad meeting that afternoon, Tim had an important new directive for the detectives working the Somerset Medical Center case. From now on, whenever dealing with Somerset, or any of the hospitals they contacted, the information flow was to be strictly a one-way street. “We take information, but we don’t give them shit,” Tim said. “Play dumb if you have to, whatever it takes, but do not share what we have, or where we’re going—period.” Tim had no idea what Somerset knew or didn’t know, only that he couldn’t trust them. After all the runarounds, Tim figured that telling the suits what he was looking for was the surest way never to find it.
“What kills me, this guy is working, right now,” Tim told Danny afterward. Sixteen years and nine different hospitals, but always the same pattern.
“If that’s going to change, we’re going to have to start leaning harder on the hospitals.”
“That,” said Danny, “and start pulling bodies out of the ground.”
The case needed a definite homicide victim. First Danny made the trip to the Norfolk Street office of Dr. Mambo, the regional medical examiner. They handed the ME copies of the medical paperwork Somerset had forwarded from their six unexplained incidents. Mambo consulted with Dr. Jackson from the State Toxicology Lab. Of the six, they both liked Gall best. His outrageously high dig levels were the most likely to constitute a smoking gun. But the SCPO couldn’t build a case on paperwork alone.
They’d need to check Gall’s fluids themselves. Luckily, Gall was what homicide detectives call a “fresh kill.”2 His body was the closest thing they would ever have to a crime scene.
Danny called down to Tim Van Hise, to help him nail the legal language for the sworn affidavit, then walked the paperwork to the Superior Court judge’s chambers so the Hon. Roger Mahon might put his name on it. Danny asked His Honor if he would also be willing to put the whole thing—both order and affidavit—under seal. If this were going to work, he needed to keep it as quiet as possible.
38
Danny had been required to deliver hundreds of notifications to murder victims throughout his career, and he’d hated every one. The first time Danny told a mother that her son had been killed over a pair of sneakers he cried more than she did. Nobody wanted to hear that their loved one was dead, that was bad enough. The word murder only amplified the hurt. It was one piece of the job he never looked forward to, but over the years he’d gotten used to it, gotten good at it even. His visit to Lucille Gall was something new.
Danny had to be careful—he didn’t want to just walk in and blurt it out all at once. Or to give her the case from the perspective of a homicide detective. Mrs. Gall was a nurse, so she would understand the lingo, but it was still important to lay it out slowly, allowing her the opportunity to absorb the background before he hit her with the specific bad news, and the request. Danny ran through the scenario, reminding himself, Break it into small pieces. Tell it straight and steady, without hedging or flinching. And, no matter what, make sure the woman is sitting down.
The address in Danny’s notebook was for an older development within a manicured suburb, older residents, not renters but owners, Halloween decorations whittled down to a single long-stemmed deli pumpkin, uncarved, no muss. Danny parked the unmarked car on the street, avoiding the driveway, glad to have arrived in daylight. He had this part planned. First, he straddled out of the car and stopped, taking a moment to smooth his tie, gathering himself in full view of every window on the street. Then he pulled the badge from his inside pocket and held it, shield out, in his right hand, and placed the business card between the fingers of his left as he slowly walked toward the Gall home. He always went through this routine, especially when he was responding by himself. Being African-American, it didn’t matter that he’d just stepped out of a new cop car in a $500 suit. One unit he worked, the homeowner saw him and called the police on the police.
Danny could feel the eye on him through the peephole. The woman who answered the door was white, thin, and what Danny1 generally read as “older,” with short blonde hair.
They stepped inside a neat room, filled with ceramic tchotchkes and baroque furniture. Danny thought it looked Catholic. He starte
d at the beginning, as Lucille Gall was sitting down.
Lucille’s initial reaction was shock. Her jaw physically dropped, as if the idea was expanding so rapidly that her mouth unhinged like a snake eating a rabbit. She was devastated. Then she got angry.
Accepting her brother’s death had been difficult, particularly after investing so much energy and prayer in keeping him alive. Her brother had been an especially difficult patient at Somerset. He was suspicious of the hospital and more so of its staff. He disliked one nurse especially. The reverend didn’t know his name, but he didn’t trust him. Her reverend brother had asked her to keep a constant vigil during his hospital stay, and as a dutiful sister and obedient Catholic she had, staying at his bedside sometimes twelve hours a day.
When Reverend Gall was first hospitalized, Lucille had made peace with the possibility of her brother’s imminent death, and placed him on Do Not Resuscitate status. If medicine could not help him and God did not, at least she could spare him the indignity of lingering. But her brother did get better. By his second week at Somerset, Gall had stabilized enough that Lucille rescinded his DNR and allowed herself a break from her bedside vigil. But then Gall had suddenly crashed. And so, after the tears, Lucille was required to make a new peace, reminding herself that this was God’s plan, God’s hand, and not hers to question. That was what her brother would have preached in Sunday Mass—God calls, you answer. But now that peace was shattered, and Lucille Gall was livid.
Hospital lab tests had found elevated levels of the drug digoxin in her brother’s blood. Danny started to explain what that meant, but Lucille stopped him—she knew dig; she was an RN and had worked with dig for decades. She understood exactly what Danny was saying. It wasn’t God Who had called. “Someone killed him,” Lucille said.
Danny had numbers for her. Lucille immediately recognized that those dig levels demanded an autopsy.2 But Somerset had not autopsied Reverend Gall. They had recorded his passing as “a natural death.” Lucille’s rage was logical and inquisitive, and moved forward along the same path Danny and Tim had walked for weeks. She had been there day after day, 9 a.m. to 9 p.m. She was known to the staff, both as a family member and a fellow professional. At the very least, she should have been notified as a professional courtesy. Lucille would have understood exactly what the high dig levels meant. And she would have demanded an autopsy. Was that why they didn’t tell her?
Danny decided that, in terms of winning Lucille Gall as an ally to the investigation, pissed off wasn’t such a bad place for her to be.
“Your reverend brother spent his life in the service of God, helping others,” Danny said. “And he can still help people, even now.”
Lucille was watching him now.
“We need his help,” Danny told her. “We need your help.”
Danny said that with Lucille’s signed permission, they could stop her brother’s murderer from killing anyone else.
But Danny was wrong.
39
October 21, 2003
Ed Zizik was six years into his retirement as an electrical engineer for Automatic Switch in Edison, and he still hadn’t grasped the allure of idle time. His volunteer job at Somerset Medical Center gave his days structure and meaning, and his wife of half a century appreciated that it got him out of the house.
Zizik was a cheery and familiar man, always nattily dressed for his job at the gift shop register or manning the information desk, and he’d become a popular character at Somerset. When the ambulance arrived at the Zizik house on October 16, there was no question which hospital he’d go to.
Charlie only had two patients that night, and he shot up both with 8 mgs of Xanax. Mr. Zizik received his at 8:30 and was calm throughout the night. Charlie tended the lines, studied the telemetry, and, sometime after midnight, set about his ritual task of stripping the unconscious Mr. Zizik for a sponge bath before starting with the Keri lotion. Together, he and Amy made quick work of it. It was a good shift, if uneventful.
The next day Charlie was assigned to different patients, for whom he logged only one drug request. He returned home at daybreak to find Cathy in her bathrobe, angrily clearing her kids’ breakfast dishes.
Their time in the apartment together was filled with argument, walking now familiar battle lines, Cathy wanting Charlie to move out, Charlie not refusing, but not packing either. Work was his only true home.
Charlie was already in the nurses’ station when Amy Loughren arrived, but he barely acknowledged her. She had seen this version of her friend, his mood screwed down, his mouth like a paper cut, and she knew not to take it personally. Amy tended to her patients, occasionally spotting Charlie with the Cerner cart and stationed in the doorjamb of his patient’s room like a dog jealously guarding a bone. He was bent to the Cerner all night, typing, scanning, a Rachmaninoff on the keyboard. He would leave his post only to approach the nurses’ station to pull drugs from the Pyxis, and he did that only when the station was empty. He was back and forth all shift; that night, Charlie withdrew perhaps forty times more drugs than any other nurse on the unit. Rather than bunching his orders, Charlie made a separate entry for each.
These drug orders would make little sense to a knowledgeable nurse. The administration had been watching his Pyxis entries all summer—but were they watching now? Charlie assumed they were. He felt his Pyxis orders were like an open letter, addressed chiefly to himself, but available to anyone who read it.
Part of the game lay in Charlie’s habit of using the Pyxis machine to order staples more easily accessed from the supply closet. He was the only nurse who would take the time to enter his passcode and the patient’s name to request hydrogen peroxide or aspirin or ointment. He did it just to see the big drawer swing open. That night, he ordered all of those things, each requiring a separate and laborious entry, each opening one or another drug drawer. He ordered heparin, then thought about it—were they watching heparin? The lawyer had talked to him about canceling dig. He hit Cancel for the heparin. It was a new trick, one of many.
Twenty seconds after the heparin, he ordered more ointment. Another twenty seconds and he ordered the ointment again. Then he ordered Tylenol, acetaminophen. Then potassium chloride. Furosemide. Two more Tylenol. A few seconds later, two more Tylenol.
He drove home, parking, sleeping, not sleeping, Three Stooges, History Channel, another fight with Cathy, and then back in the little Ford, still thinking, still curious, and ordering, right away, Tylenol. It was a new night, but still the same night in his head. The whiteboard listed different patients, but he had the same patients in his head. He made as many trips as possible. He ordered nitroglycerine, then, eight minutes later, more nitroglycerine. Then nitroprusside, but just two units—and two units of nitroprusside didn’t even constitute a full dose—every nurse knew that.
Metoprolol, ondansetron, Xanax, potassium chloride, magnesium sulfate, metoprolol, metoprolol and nitroprusside again, one dose. The sun came and went and Charlie on shift with it, back on the unit, doing the same. The next night, the same. The next night also.
Charlie’s Pyxis records for the night of October 20 said he pulled furosemide, furosemide, insulin, Tylenol, hydrogen peroxide, propofol, propofol, heparin, heparin, ointment, haloperidol, magnesium sulfate, ointment, heparin, insulin, norepinephrine, dobutamine, heparin, dobutamine. The charts said Mr. Zizik’s heart stopped on October 21st at approximately 2:30 a.m. from an overdose of digoxin. But dig appeared nowhere on Mr. Zizik’s chart. Nor was it in Charlie’s Pyxis.
40
On October 27, Danny drove up to Newark with the first assistant prosecutor, Robert Land, and Assistant Prosecutor Tim Van Hise. The meet was at Saint Michael’s Hospital—Danny’s call. He needed an outside medical authority to read the charts on Somerset’s six suspicious lab values, and he wanted someone other than Somerset to do it.
The group from the Somerset County Prosecutor’s Office was met in the lobby by Paul Nittoly and his private detective, Rocco. Danny gave a cool hello
and made introductions. He didn’t say anything more until he got his results.
Dr. Leon Smith was Saint Michael’s chief of medicine. He had reviewed the charts of all six patients Somerset had presented to the detectives, and didn’t find them quite as “unexplained” as Somerset had. Dr. Smith presented the group with a very different interpretation of the charts than the one Dr. Cors and Nittoly had first handed to the detectives back on October 7.
Dr. Smith had focused on the four most abnormal and suspicious patient lab values;1 these were, as it happened, the only four that had occurred more than thirty days before the detectives were called, and whose Pyxis records were thus apparently unavailable.2 Dr. Smith could not offer any medical explanations for what had happened to the four patients. It was his professional medical opinion that all four appeared to have been given an overdose by an outside source.
Paul Nittoly turned to Danny for a reaction, but Danny had already cut from his group and was out the door, running through the rain to his car.
Tim drove past the courthouse, classic rock on his radio, windshield wipers beating against a cold October rain. On either side of the road the houses with yards worth raking had leaves gathered into those happy-colored recycling bags for the chipper, some orange and decorated with jack-o’-lantern faces so you could keep them as a display. Front yards sported fake cemeteries, machine-made cobweb spun over talking tombstones from the CVS. Twenty minutes later, he turned off the interstate, stuck doing twenty miles an hour behind an Accord with a joke rubber leg bobbing from the trunk as he crossed Woodbridge Township to Perth Amboy, where Florida Grove Road turned off toward the Holy Trinity Cemetery.
Danny was waiting for him under an oversized umbrella, watching a backhoe manned by workers in yellow rubber suits. The guys were on time. Tim had called the Gustav Novak Funeral Home the day before, gotten the number of the outfit they usually used in the Trinity Cemetery and told them to be there at noon. He’d warned them, “This time, you’ve gotta take someone out instead of putting them in,” expecting a reaction, but finding that, pretty much, it was all the same to the grave diggers.
The Good Nurse: A True Story of Medicine, Madness, and Murder Page 17
