Five Quarts: A Personal and Natural History of Blood

by Bill Hayes

Steve and I woke early to make the drive to San Jose for the 8:45 A.M. court date. Mile after mile down Highway 101, traffic to our right was a clogged artery as we zipped by in the diamond lane. We arrived with a couple of minutes to spare, only to find the doors of the third-floor courtroom locked, which caused us some distress but seemed not to worry any of the people seated in the hallway. We sat down on the banquette that stretched the length of the windows. After all the trial delays, it now struck me as silly to have thought the sentencing would start on time.

  I tried to figure out who all these folks were—the solitary older gentleman dressed in khakis and a T-shirt; the two younger men in navy-blue suits down to the right, lawyers presumably; the man and woman across from us, knotted in conversation. The brittle, waiting-room atmosphere changed in a snap when two more besuited lawyers strode from a courtroom down the hall—both wearing the grin of a happy verdict—and paused to talk to the couple opposite us.

  Steve leaned in close. “Do you think that’s her?” he whispered. Beside the doughy man in his midthirties sat an unremarkable silver-haired woman, fifty-something, in a black pantsuit.

  “No, I don’t think so.” Over the yawn of months, I’d constructed a mental image of the phlebotomist, or at least a rough outline. In my head she was tall and fleshy and robust. Her sheer physicality accounted, in part, for her ability to deceive and frighten so many people, to inflict such damage. By contrast, the hunched woman seated a few yards away looked tiny and frail. Her shoulder blades jutted from her suit jacket, as if she’d forgotten to remove the clothes hanger when she’d dressed.

  “It is her,” Steve said, his voice soft but insistent. “She’s with her attorney. Matthews, right? One of those lawyers who just walked up said his name. That’s got to be her.”

  “I . . . I think you’re right.”

  Steve’s face said pure relief and I knew why: He did not recognize her. For three years, he’d been worrying about the two phlebotomists who’d regularly drawn his blood at the San Francisco lab. Though he couldn’t remember their names, he could picture their faces. This lady was neither of them. Which meant that his blood had, in all likelihood, never caused anyone harm. His phew was a lovely sound.

  Just then, a deputy emerged from the courtroom and propped open the door. Joining the queue, we followed Elaine Giorgi, her attorney, and a handful of others into the small courtroom. I sidled into the row behind Giorgi’s. As I reached down to lower the seat, I studied her appearance. The first thing I noticed close up: The silvery hair was a wig. She tugged at it and the whole helmet shifted. Either it had stretched or she had shrunken. With her wire-rimmed glasses, lined face, and that hair, she resembled one of the Golden Girls, Estelle Getty’s character.

  We’d hardly settled into our seats when the deputy approached and told a few of us that the first portion of the hearing would be closed to the public. As quickly as we’d entered, we were headed back out into the hallway. The deputy was very pleasant and said he’d notify us when we could return. The courtroom door shut. I was surprised by how few people had been inside—twelve at most, including the officers of the court. I’d expected many more, given the media attention that had swirled around this case three years earlier. Where were all the reporters? The TV cameras? In fact, we now waited with just one other person, the older gentleman I’d spotted before. “You must be here for the Elaine Giorgi case,” I said.

  “Yes,” he answered, “I’m one of her victims.”

  Jerry Orcoff was a big man, about six feet tall, with a bristly white beard and glasses. He looked like the kind of guy who’d give you a good deal at a flea market. As strangers in the same boat, we naturally began to share our stories. Four years ago, Jerry said, he was diagnosed with hepatitis C. At the time, he’d had no idea how he could have contracted this viral infection that’s most common among IV drug users—which he’d certainly never been. Then came the letter from SmithKline Beecham. Jerry realized that the dates matched up—he’d first fallen sick with the characteristic flu-like symptoms shortly after he’d had his blood drawn, one time only, for some routine medical tests. He’d gone to the Palo Alto branch of the lab. He was certain Elaine Giorgi had been his phlebotomist.

  Jerry was a retired mechanical engineer, seventy years old, married, and the father of two grown children. Sure, he’d expected to slow down a bit as he grew older, but he never—Jerry couldn’t finish the sentence. He just gave me a look like his dog had died, then shook his head.

  Viral hepatitis, as I knew, has six different strains, all represented with letters. A, B, and C are the most prevalent. Hepatitis A is spread through water or food contaminated with fecal matter (every school year seems to come with a news story about kids who’ve been exposed through improperly washed fruit; frozen strawberries are a common culprit). Hepatitis B, like HIV, is most often transmitted through unprotected sex. By contrast, the hepatitis C virus—HCV for short—is exclusively blood-borne and spread primarily through shared dirty needles; less frequently through accidental needle sticks in health care settings and from mother to newborn during childbirth; and, in a small number of well-publicized cases, through shared or unsterilized tattooing equipment. Whatever its initial cause or strain, viral hepatitis can destroy the liver’s ability to perform life-preserving functions, including filtering toxins from the bloodstream and converting blood sugar into usable energy. The most visible sign of advanced disease is jaundice. This yellowing of the skin and eyes indicates that the liver is failing to clear the blood of what are called bile pigments, the yellow-colored by-products of dead red cells. Vaccines now exist to prevent hepatitis A and B, but not C.

  HCV, the most common chronic viral infection in the United States, has been labeled “the silent epidemic.” It’s difficult to treat, has no definite cure, and in most cases lingers for years without expressing symptoms. In fact, the virus’s progression can be so slow that an infected person is more likely to die of other causes. But in 15 to 20 percent of cases it quickly brings on cirrhosis, liver cancer, or related illnesses. HCV is the leading cause of liver transplants in the United States.

  Jerry, who’s still in a relatively early stage of chronic HCV, is plagued by fatigue, he told us, but not by worse health problems—knock on wood. His disease, which began with a single blood draw, has led to many draws since, he explained, as his progress is monitored through tests of liver enzymes and other markers. “I’m fighting a dragon,” he said, and I first thought he’d chosen an apt metaphor for illness. Then I realized he meant his lawsuit. Like other former patients of Elaine Giorgi, Jerry had filed a civil suit against her former employer, SmithKline Beecham, which is part of one of the largest pharmaceutical companies in the world. A few weeks back they’d offered him a settlement of a few thousand dollars, which he refused. He told us he was hoping his case would go to trial within the year, though he wasn’t betting on it. Dragons are so good at dragging their feet. Regardless, today Jerry Orcoff’s stake in this whole awful mess was not financial but emotional. Today he wanted to see Elaine Giorgi brought to justice. He would have to wait for that, however, as would Steve and I. Right then, the deputy reemerged and explained that, due to some paperwork missing from a probation report, her sentencing had been postponed until August 15.

  With a wave, Jerry said, “See you next month,” and strolled off.

  The Santa Clara county prosecutor in charge of the case, Dale Sanderson, explained to me that Elaine Giorgi’s bizarre behavior—his words, not mine—went way beyond her boneheaded reuse of needles—my words, not his. For instance, he elaborated, a co-worker had caught her deliberately putting the wrong patient’s name on a vial of blood. Evidently Giorgi hadn’t taken enough blood from someone who’d already left the lab, which isn’t an uncommon mistake. It happens. But rather than calling the patient back in for another draw, Giorgi made up the difference using someone else’s blood. Although I was speaking with Sanderson on the phone, clearly he heard my jaw hit the floor. He was just as agh
ast. “I mean, can you imagine?” he exclaimed. “Can you imagine going in for your blood results and being told you have a disease that’s not even in your blood?” Or, say, your wife going out partying with friends because she’d been told she wasn’t pregnant when, come to find out, she was?

  Giorgi then tried to cover up her mistake by changing the blood work requisition form that the second patient had brought in, so she could take the extra vial. Under the law, these actions, along with other violations she’d committed, were misdemeanors. But Deputy District Attorney Sanderson wanted a felony conviction and its stiffer penalty. Looking back three years to when he’d first received her case, he recalled, “I figured it would be very easy to show that someone who reused a needle puts the entire world at risk.” But that’s not how it turned out. Unable to find a corresponding law on the books, Sanderson thought back to a murder case he’d prosecuted in the late 1980s, “the first pit bull killing case,” in which the dog’s owner was charged with using a violent animal to commit assault. Sanderson believed this case showed a promising parallel to Giorgi’s reuse of potentially deadly needles. In addition, he “dusted off” a statute in the California Health and Safety Code regarding the illegal treatment or disposal of medical waste. Although no health care provider in California, to Sanderson’s knowledge, had ever been prosecuted under this statute, he felt sure he could use it to argue Giorgi’s culpability on multiple felony counts—that in reusing needles she was unlawfully “treating” biohazardous waste.

  Sanderson’s strategy withstood the numerous legal hurdles of the preliminary hearings, he explained to me, but, just days before Giorgi’s trial was to begin, the California Supreme Court pulled a significant patch of rug out from under his feet. In its ruling on an unrelated case, the court narrowed the legal definition of the word likely (in the charge of “assault with a deadly weapon likely to cause great bodily injury”). This narrowing made it unlikely that Sanderson would get a conviction on Giorgi’s assault charges. In exchange for dropping these, she agreed to plead guilty to the remaining “less egregious” felonies, as Sanderson called them, as well as a single misdemeanor.

  The woman who awaited sentencing on the afternoon of August 15 looked different from the one Steve and I had seen in court four weeks earlier. Elaine Giorgi’s silver wig was gone, revealing dyed rusty hair in a ratty cut. If possible, she appeared even thinner and more exhausted, as if she were also suffering the full weight of Jerry Orcoff’s fatigue. While the courtroom of superior court judge Hugh F. Mullin III was electric with last-minute activity as the legal teams prepared to begin, she sat frozen.

  “So what’s with the hair?” I said, sotto voce, sitting in between Steve and Jerry a few rows behind and to the left of Giorgi. Among the three of us, two theories quickly emerged: Wiglessness was either a ploy on her attorney’s part to make her look as pitiful as possible before the judge, or it merely served a practical consideration—if she were taken straight off to jail, her personal possessions, silver helmet included, would be confiscated, and perhaps in her thinking the day would bring indignities enough. Steve pointed out that her tailored pantsuit was gone, too. The ex-phlebotomist, now a felon, wore informal slacks and a sweater, clothes I doubted she’d have given a second thought to bundling up and using as a pillow.

  At Judge Mullin’s entrance, the courtroom clockwork instantly wound down. With his small build, full ruddy cheeks, and clipped mustache, he looked like the tycoon from the game Monopoly, except for his expression, which was, already, one of profound irritation. Giorgi’s attorney, Brian Matthews, wasted no time and called to the stand forensic psychologist Rahn Minigawa. Minigawa had spent seven hours interviewing Giorgi and administering personality assessment tests. From TV courtroom dramas, I suppose, I was primed to think that a photogenic authority such as he would provide a lucid, penetrating explanation of the deep-rooted cause of Giorgi’s behavior. But in this instance, I experienced no eureka-like aha! as Minigawa ticked off the phlebotomist’s laundry list of personal problems, from childhood physical abuse to a more recent history of depression, panic attacks, and compulsiveness. A recovering alcoholic, the fifty-five-year-old Giorgi had had other legal problems stemming from two DUIs as well as a host of financial troubles, he testified. What’s more, “She’s also menopausal.” It was the doctor’s belief that the debilitating side effects of menopause, such as the insomnia and mood swings, together with the aforementioned problems—Okay, here comes his conclusion, I thought at the time, the distillation of seven hours of psychological analysis, the meat of her defense—“All affected her ability to make good decisions.”

  Throughout all this, Jerry reacted with a steady emission of sighs and harrumphs, which I believe is the straight man’s way of saying, Oh please. Steve turned his notepad to me and pointed to where he’d doodled a bewigged stick figure wearing a T-shirt that read MENOPAUSE MADE ME DO IT. But I quickly returned to watching Judge Mullin, who, chin propped on fist, continually re-aimed his gaze at Giorgi.

  Next up was Dale Sanderson, whose every word and manner in his cross of Minigawa said, Gimme a break. The prosecutor did not hide his disdain for this paid defense witness, this “expert.” Pressed by Sanderson to dispense with the DSM jargon and to provide the court with genuine insight into why she’d done what she’d done, the doctor hesitated, obviously uncomfortable, then replied, “Well . . . she said she didn’t have a clear recollection of her actions . . . she said she was stupid.”

  Sanderson, who throughout the proceedings was never granted the opportunity to interview Giorgi, wanted to make sure he had heard Minigawa correctly. Okay, he recapped: You administered two personality tests. You spent several hours with her. You’re an expert who’s testified in more than fifty trials. And the best assessment you can provide the court of her motivation is that she said she was “stupid.” With an expression I found vicariously satisfying, Sanderson looked at Minigawa as if the doctor were something he’d poked with a pencil from the bottom of his shoe.

  Finished with the psychologist, the prosecutor laid out his own theory of what had occurred. Elaine Giorgi’s actions were calculated, he contended, and were motivated by the desire “to curry favor with SmithKline Beecham and make patients happy.” Giorgi, who’d once been fired from the company for her inefficiency, sought to make the most of this second chance. The problem was, she wasn’t a very good phlebotomist. She had to perform thirty to fifty blood draws per day and, despite her training and experience, had a hard time using the standard needles. She found the small, light butterfly needles easier to use. Patients also found them less painful; hence fewer patients made complaints. Just one drawback, though: Butterflies were expensive—eighty cents apiece as opposed to five cents for a standard needle—and they were intended for use with only a small number of patients, mainly pediatric and geriatric. Giorgi reused the pricier butterflies because, if she ordered them in mass quantities, her bosses would notice.

  There was my aha.

  Sanderson said in closing, “It is inexcusable that she’d value a human life at seventy-five cents.”

  Matthews spoke next—a candle to Sanderson’s fireworks—and meekly summed up with, “I don’t think society needs to be protected from her.”

  Finally, Elaine Giorgi read a prewritten statement. Her quavering, peeping voice obscured each syllable before it reached my ears, but the judge nodded at her when she’d finished.

  Up to this point Judge Mullin had said little beyond requesting the occasional clarification from one of the attorneys. Now he took aim at Giorgi and said in a voice of seven thunders, “What you did was as dangerous as holding a loaded gun to your victims’ heads.” He then paused, whether to wring the disgust from his voice or to let it build up, I couldn’t tell. And those patients, he resumed, “were as vulnerable as you can get.” She was lucky beyond words that no one had died of AIDS or another fatal disease due to her actions, a comment that was powerful but, it struck me, inaccurate—HIV rarely progresses that
quickly. Still, obviously, the judge wasn’t out to educate the crowd. Under this barrage, I don’t know how Giorgi was able to remain standing.

  A butterfly needle, the item at the heart of the Elaine Giorgi trial

  Judge Mullin then broke from addressing the defendant and spoke more broadly to the court: Had someone died, he declared, she’d be facing a long stretch in state prison. “In this case, prison would—” He stopped and shuffled through some papers. “—do absolutely no good. Except as punishment.”

  Wha—? I’d been right there with him up to that point, but . . . Was she going to go free?

  “But I am going to punish her. To a year in county jail, plus four years probation.”

  For the next couple of minutes, while the various fines that Giorgi would have to pay were entered into the record and the details of her future parole were clarified, my brain kind of zoned out. I found myself with that surreal sensation one has after enduring a long flight—your plane’s landed but it’s still taxiing—that contradictory feeling that you’ve reached your destination though you’re not quite there yet. Around us people started standing and we fell in line, following the folks in front of us toward the exit.

  I took a deep breath of sidewalk air and realized I’d arrived at a moment I’d never thought beyond. Jerry, who’d steered us out of the Hall of Justice, seemed to have already placed the day into a healthy perspective. Yes, he agreed with Steve, he was disappointed by how short a sentence she received but, in the long run, he was glad that she would never be permitted to draw another person’s blood.

  Behind us, on the opposite side of the courtyard, reporters had congregated. “Are you a victim? Will you speak for the camera?” they called out to passersby in English and Spanish. “¿Es usted una víctima?”

  At the same time, Giorgi emerged, clutching the arm of her attorney. For reasons unclear to me, she was being allowed to walk herself to jail, which was located half a block away. The reporters swarmed but she didn’t say a word. Her attorney held up a hand, No comment, and the two kept moving. With that, Jerry headed to his car. Steve and I stood and watched as Elaine Giorgi climbed the last few steps that led to the Santa Clara County Jail.