Mercy (20 page)

The lawsuit filed by William Colchester attracted massive media attention because it was the representative’s son at the center. The suit was ultimately dismissed due to a lack of evidence. However, William Colchester remained unconvinced. He took matters into his own hands and rigged his son’s hospital room with a microphone to record conversations. He wanted to hear a doctor or nurse denying some treatment because of cost. What he heard instead was Brandon Stahl agreeing to help his son die.

“Donald Colchester begged me to kill him every single day. That’s on the recording, too, if you give it a listen.”

Julie felt a stab of pain as she recalled Sam begging the same of her.

Kill me, Julie … Please help me die.

“How long after Donald’s death did that recording surface?”

“Weeks,” Brandon said. “The media would have you think it was William Colchester banging the drum to get better care for his kid, but that’s a load of crap. It was the mother, Pamela Colchester, behind it all. She was always on our case about giving her son the very best care. The dad was always pretty detached. I bet you anything bugging the room was her doing and not the father’s.

“It was the mother who gave the recording a listen, no surprise there. The surprise came when she heard my promise, and I got arrested for murder. By then, Donald was already in the ground.”

“What happened next?”

“My lawyers fought to get the evidence tossed. The Massachusetts wiretapping statue basically says it’s illegal to record someone without a person’s knowledge. They won. The evidence was thrown out, and the Colchesters were fined and given probation for the illegal wiretap. The case should have been dismissed.”

“Except there was a witness,” Julie said.

“Except there was a witness,” Brandon repeated. “I knew the nurse who testified that she heard me make that promise to kill Donald.”

“Sherri Platt,” Julie said.

Sherri Platt had been big news during the trial years ago, and big news once again because of Brandon’s failed appeal. Brandon’s lawyers had argued during appeal that Sherri’s testimony was improperly introduced during trial. The appeals judge did not agree.

“Why do you think Sherri waited to come forward during the trial?”

“She said she felt compelled to tell the truth when news broke that the wiretap evidence was ruled inadmissible.”

“And you don’t deny saying it?”

“I said it, all right. But I didn’t mean it. Like I told you, I was trying to ease this guy’s suffering. Placate him, you know? It’s like a kid begging you to go somewhere. Sometimes you just make a promise without meaning it just to get them to stop asking. It was a stupid thing to say. Obviously, I regret it.”

“As I recall, that wasn’t the only bit of evidence against you,” Julie said.

Brandon gave a nod. “Yeah, police found morphine in my apartment.”

“Morphine stolen from White. Can you explain that?”

“No,” Brandon said. “But I didn’t take any drugs.”

“No autopsy,” Julie said.

“For a guy with end-stage ALS? Why bother?”

“And the court wouldn’t exhume the body?” Julie said. “Cause of death could still be determined, I would think.”

“My lawyer filed a request and the prosecution didn’t object. Things were moving forward when BAM! The prosecution files a motion to deny the request. Suddenly Daddy Colchester is all upset about the idea of digging up his boy. The judge sides with Colchester, something about not revealing significant exculpatory evidence.”

“Who was the judge?” Julie asked.

“The Honorable Robert Josephson, who, by the way, became a superior court judge a year after my trial. And guess which legislator was on the committee that appoints the judges to state court?”

“Um, William Colchester?”

Brandon broke into a lopsided smile. “That’s right. You ask me, I’d say Judge Josephson got some favorable treatment for putting the kibosh on our motion to exhume the body.”

“Why?”

Brandon shrugged. “No idea. I don’t know how the morphine got in my apartment, either. Maybe William Colchester got cold feet about seeing his boy dug up. Or maybe someone made it worth Colchester’s while to flex some political muscle.”

“What does your secret admirer say about all this?”

Brandon opened the manila envelope he’d carried in with him. “I received this in the mail during the initial trial.”

He held a piece of paper up against the window so that Julie could read the typewritten note for herself.

Your defense team is focused on the wrong issue. Forget about the wiretap evidence. Look closely at the enclosed EKG of Donald Colchester. Note the ST elevation and fairly short QT interval. Other ST-T abnormalities and QT prolongation with large negative T waves occurring in succession. This readout indicates a rare heart anomaly called takotsubo cardiomyopathy. The enclosed cardiac echo shows apical ballooning consistent with takotsubo. This is a stress-based condition and the likely cause of death. Morphine did not kill him. This did.

Julie knew an echo was not routine in chest pain protocols, but Colchester’s high profile ensured that when in distress he got the full workup.

“If you can cast doubt on the morphine theory—”

“I’m probably a free man,” Brandon said.

“Show me the EKG and echo, please,” Julie said.

Her pulse ticked up as Brandon fished out the images enclosed with the letter. Who was his secret admirer? Julie wondered.

Julie could not believe an inmate had access to Colchester’s private files. What she could believe was that the data existed. White Memorial had a state-of-the-art EMR—electronic medical records—system that uploaded patient data to the cloud. Years of data were collected and kept on permanent record. What Brandon showed her matched what Julie had seen in Colchester’s electronic medical record. It was convincing, but she would want a cardiologist to have a look.

“What did your defense team do with this evidence?”

“ST-T abnormalities? QT prolongation? What do you think they did? They ignored it,” Brandon said.

“Ignored?”

“Look, my parents are dead, I’m a bachelor. I didn’t have a lot of cash on hand to begin with. I spent my entire life savings on my defense, which wasn’t much. Sure, my team brought it up. Even hired a medical expert, some internist who couldn’t explain how to tie a shoe. The prosecution’s pathologists and medical experts argued pretty convincingly that the EKG and echo didn’t show anything significant enough to have caused Donald’s death. Heck, I believed them.”

Julie understood. Ninety-five percent of takotsubo cases resolved with a complete recovery. An old adage in medicine went:
Common things occur commonly
. Combine the low probability of a fatal takotsubo event with an eyewitness who heard Brandon offer to kill Donald Colchester and morphine in Brandon’s apartment, and the result was a life sentence with no possibility for parole.

“What do you want me to do?” Julie said. “Why did you call?”

“Help me prove that Donald Colchester died of the same thing that killed your husband.”

Julie stiffened. “He was my fiancé.”

“I’m sorry, my mistake,” Brandon said. “And I’m deeply sorry for your loss. But listen, Doc, I’m going to spend the rest of my life in prison for a crime I didn’t commit. Somebody thinks you’re the only person who can help prove my innocence. I don’t know you very well, but I’m willing to believe whoever sent me this information knows what the hell they’re talking about.”

CHAPTER 25

The day after her meeting with Brandon Stahl, Julie made the short three-block walk from the ICU in the Tsing Pavilion to the Barstow Building, home to White Memorial’s famed Center for Cardiac Angiography, Angioplasty, and Arrhythmias, known as the C2A3. It was also where the director of C2A3, Dr. Gerald Coffey, kept a private office.

Dr. Coffey had been with White Memorial since the Pleistocene era, some staffers joked, but back in his day he had been at the forefront of new technical advancements in the field. He was a pioneer of acute myocardial infarction angioplasty, and had helped to perfect the procedure a decade before it became routine. He had completed his clinical training in cardiology at Harvard Medical School, his residency at Mass General Hospital, and a fellowship in cardiac medicine at Johns Hopkins, all best of the best.

The other cardiologists Julie had spoken with about Sam’s case suggested she direct her inquiry to Dr. Coffey, but he had been unavailable until now. It was good fortune that his schedule cleared at a time when she had new and perhaps startling information to share.

Julie’s legs ached as she hurried to make her appointment on time. She had spent the past five hours on her feet and desperately wanted to decompress in the hospital cafeteria with a cup of mud-colored coffee and
The Boston Globe
. Rare was the morning Julie had time to read the paper, and today was no exception.

Her Wednesday workday had begun just after sunrise, when she met with her ICU nursing staff and respiratory therapists before morning rounds. She was now on an extended lunch break. So far it had been a typically atypical day, with a variety of administrative issues and unpredictable patient ailments.

Julie took the elevator up to the third floor and proceeded down a quiet, carpeted corridor, dimly lit as any casino. She found Dr. Coffey’s office, fourth on the left, and checked the time. One minute before the hour. Good start. She knocked twice, and a voice softened with age told her to enter.

Dr. Coffey’s spacious office had a window and a view of the quad. Julie tried to contain her envy; her office was a refurbished maintenance closet, a quarter the size of this one, without any natural light. Dr. Coffey rose from his chair behind an expansive oak desk, giving Julie a look at his thin frame. He extended his hand. His grip was firm as Julie introduced herself. They had never met, but with so many physicians at White, that was no great surprise.

Everything in the office was impeccably neat, from Dr. Coffey’s desk to the bookshelves, to the fine mane of silver hair that topped a strong, square-shaped face. He wore black plastic glasses with thick lenses that magnified brown eyes set close to a snub nose. Underneath a white lab coat he wore a rose-colored shirt adorned by a solid red tie. The office walls were plastered with framed diplomas and certificates, as well as a large photograph of Dr. Coffey playing golf with the mayor of Boston. Another photo showed him inside the cockpit of a plane he piloted.

“Please have a seat,” Dr. Coffey said. “Can I offer you something to drink? Lemon water, perhaps?”

He has lemon water in his office?

“No, thank you,” Julie said.

Dr. Coffey went to a small refrigerator (he had a refrigerator, too), poured two glasses, and gave one to Julie.

“In case you change your mind,” he said. “Now, what can I do for you?”

“I want you to have a look at this EKG, if you wouldn’t mind.”

Julie produced several printouts from her purse and handed them to Dr. Coffey.

“The patient died,” she said. “These were recorded shortly before death.”

“You pulled this from an electronic medical record, I assume.”

“Yes,” Julie said. “The cloud-based system stores everything now.”

“Cloud-based.” Dr. Coffey said it with contempt. “To me a cloud is something puffy in the sky that one flies through.”

“It’s just a way of storing data,” Julie said, though she did not fully understand the cloud herself. Her son Trevor could explain it to them both.

“Have you ever flown a plane?”

“Can’t say that I have.”

He pointed to the picture on the wall of him in the cockpit of one. “No feeling like it,” Dr. Coffey said. “The only thing that makes me consider retirement is more time in the sky. That’s why I’m very protective of my schedule. Got to make the most of every minute.”

In her mind, Julie rolled her eyes. This was his not so subtle way of telling her to make it quick.

“I hope this won’t take up much of your time,” Julie said.

Dr. Coffey adjusted his glasses and cleared his throat, then took a sip of his lemon water.

“Very well,” he said. “Let me have a look.” He held the eight-by-ten printouts to his face, but did not study any image for long.

“Yes, I see the AVR elevated here, along with the anterior leads V2, V3, V4. Was the patient male or female?”

“Male.”

“Over forty?”

“That’s correct,” Julie said.

“So it’s atherosclerosis disease, buildup of plaque in the arteries.”

“But there’s no evidence of heart disease in the medical record,” Julie said.

“Please,” Dr. Coffey said dismissively. “Ten percent of patients have plaque we can’t see.”

“Can’t see? Really?”

“Think of a Twinkie,” Dr. Coffey said.

Julie looked baffled. “A Twinkie?”

“Yes. I use this analogy with my Harvard students every year. It connects with them. Now, imagine a large tube that has this Twinkie inside it, such that when you bend the tube where the Twinkie is, it cracks open, causing the white filling that represents free cholesterol to pour into the tube. That stimulates the clotting cascade and an acute thrombus forms. The body naturally produces elements like tissue plasminogen activator, which causes the clot to dissolve, and others that break the residual Twinkie plaque down like Pac-Man-gobbling ghosts. When you come back to the tube at the time of doing an angiogram, you find it clear of the filling and the Twinkie. But that’s only temporary. The Twinkie comes back, cracks open again, and gets gobbled up again.

“Now, and I’m just thinking out loud because the EKG is very nonspecific, this could be a coronary artery vasospasm.”

“And that is?”

“Smooth muscle constriction of the coronary artery,” Dr. Coffey explained. “You can have nonexertional chest pain with ST-segment elevation. Patients may perform normally on the stress test, but constricted blood flow could result in ventricular fibrillation.”

“Very well, but have a look at this. It’s the patient’s echo.”

Dr. Coffey reached across his desk and took the printout from Julie’s hand.