Perfect Poison (9 page)

About forty-five minutes after Henry Hudon had first coded, Gilbert got online and e-mailed Perrault an answer to his previous question. In her terse note, Gilbert mentioned nothing about the dramatic cardiac arrest that had just taken place in her presence less than an hour ago. Instead, she wanted to make sure she had the correct directions to the Christmas party, which she suspected Perrault had mixed up.

Gilbert had a patient in ICU who had literally been dead for about twenty minutes before being brought back to life, and she still hadn't taken any of his vital signs since she'd started her shift nearly three hours ago. It was odd that she would remember to e-mail her lover but forget her duties as a nurse, especially since Hudon had been through so much.

Nurses in ICU were required to record vital signs every hour on the hour and include strips of the patient's telemetry heart monitor that best described the condition of the patient's heart during the course of the night. If a patient went into cardiac arrest, most nurses included three, four or even a half-dozen strips. But here was Gilbert, three hours into her shift, and she hadn't recorded
any
vital signs whatsoever, and had cut and pasted only one small section of Henry's heart strip to his chart.

A few moments after she finished sending Perrault an e-mail, Gilbert called a second code on Henry.

As the same team worked to resuscitate him, Dr. Blackman, with Gilbert right beside him, reached into his medical tool box and took out a drug he rarely—if ever—used: bretylium.

Bretylium is not a first-line drug used to shock a patient's heart into beating again. It is a last-resort drug used only after everything else—including epinephrine—has failed.

When Gilbert saw him pull it out, she said, admiringly, “I've never seen ‘bret' used before, doctor.”

“How 'bout that?” Blackman shot back.

The bretylium worked. Hudon was brought back to life for a second time.

Blackman ordered him to be put on Valium for comfort. If anything—
anything
—went wrong, Blackman said, he wanted to be notified right away.

At 7:21, Perrault responded to Gilbert's e-mail: “Oops. You're right as always,” he wrote, regarding his mix-up with the directions.

By this time, Dr. Blackman had gotten Henry's definitive test results back from the lab. It was confirmed that there were no barbiturates in his system when he had been admitted seven hours ago. The entire scope of his blood work was negative.

At 7:30, Gilbert called a third code on Henry.

Shocking everyone in the room, Dr. Blackman once again brought him back to life—but this time Henry remained unconscious. His body, because of all the fighting it had done, was beginning to shut down.

Dr. Blackman again ordered Henry to be kept on a heart monitor, but he also wanted him placed on a blood pressure machine.

Twenty minutes later, Gilbert wrote back to Perrault. She wanted to know what time she should meet him and what she should wear.

By 7:58, Perrault responded. Between 12:00 and 12:30, he wrote. “I'll be in jeans and a T-shirt.”

A minute later, at 7:59, Gilbert wanted to know how late they were staying.

Perrault must have been away from his desk, because he didn't respond until 8:10. “Who knows?” he wrote. “Why, do you have to be home at a certain time?”

Gilbert didn't respond immediately. She must have been away from her computer doing something else. So Perrault wrote back at 8:18 trying to get a response. He said he really “needed that kiss.” Then, “I love you.” He added that the kiss “felt so right.” He wanted to know if they could go out later that night.

By 8:43, Gilbert was back online. She said she would love to go out. “You're welcome for the kiss.”

By 9:00, when she hadn't heard from Perrault, Gilbert wrote back asking if they were going out. “Should I meet you?” She seemed to be worried that he wasn't answering right away.

Between each e-mail, Perrault and Gilbert had seen each other during Henry Hudon's three codes. Perrault had been the one cop to respond. But Gilbert hadn't seen nor heard from Perrault for quite some time now, and she was likely wondering what was going on, where he was, and why he wasn't responding.

At 9:35, she called one more code on Henry Hudon. But within moments, Dr. Blackman made the sullen determination to call off resuscitation efforts. Henry wasn't responding . . . he was totally unconscious . . . the telemetry showed a flatline.

Still, for the next twenty-five minutes, Dr. Blackman and his team tried everything they could to revive him.

Blackman decided at 10:05 to stop efforts. Henry Hudon, at thirty-five, was dead.

Julia Hudon had not been notified once that her son, for approximately five hours, was fighting for his life. As far as she knew, Henry was sleeping off the terrible effects of the flu.

Julia Hudon was used to getting phone calls from the VAMC at all hours of the night. Henry would go out for a smoke, hop on a bus near the hospital's entrance—as he had done on December 5—and never return. The VAMC would call Julia and explain what had happened.

“I'll go get him,” she'd say.

A little after 10:00, on December 8, Julia Hudon's phone rang, startling her awake.

“Mrs. Hudon. It's Dr. Gregory Blackman.”

“Yes?” Julia Hudon said. She was still half asleep.

“Your son is gone,” Blackman said matter-of-factly.

“Fine. I'll go and get him more food,” Julia said, and hung up.

She wasn't the least bit alarmed by Blackman's words. She figured Henry had just walked out of the hospital again. She had gotten calls like this for the past ten years and was at a point in her life where she almost expected them whenever Henry was in the hospital.

After hanging up with Dr. Blackman, Julia prepared to take her second trip of the day to Henry's apartment. But no sooner had she hung up the phone than it rang again.

“Mrs. Hudon . . . don't hang up,” Dr. Blackman said in a panic. “What about food?” he asked. “I told you he's gone!”

“I heard that. I'll get him food or whatever he needs,” she said. “And I'll try to get him back to you as soon as I can.”

“No, Mrs. Hudon. I mean Henry's gone.” He spelled it out: “Like D-E-A-D . . . dead!”

 

 

The following day, after allowing the blow of Henry's death to sink in, Julia phoned the VAMC and asked for Ritchie, the orderly she and Henry had come to know throughout the years. She said she wanted all the records from the time her son had been admitted to the time of death.

“Who was with him, Ritchie?” Julia wanted to know. “I can't believe he's gone.” She was hysterical. “Who can I talk to? I need to speak to someone . . .
anyone.”

“If you call back later,” Ritchie said, “ask for his nurse, Kristen Gilbert.”

Ritchie gave her the direct phone number to Ward C.

Though the horror of her son's death still hadn't sunk in, Julia Hudon suspected foul play from the start. If nothing else, she at least wanted some answers.

So she called the number Ritchie had given.

“Hello?” Gilbert said.

“This is Mrs. Hudon, Henry's mother. Can you tell me anything about my son . . . please, please, what were his last words?”

“It was fast. I have just come on duty and have to go,” Gilbert snapped before hanging up.

 

 

Part of Gilbert's job, as the ICU nurse that night, was to file the heart monitor recordings of Henry Hudon's four cardiac arrests. These papers, no doubt, would have shed light on what had happened to his otherwise healthy heart as it beat wildly out of control.

To no one's surprise, those records were never found.

Years later, after she learned the details of Henry's fateful night, regarding Gilbert and Perrault's e-mail correspondence throughout the night, Julia Hudon told the
Hampshire Gazette
newspaper that Gilbert “was e-mailing her lover while my son was dying.”

Like many of his comrades, seventy-two-year-old Army veteran Francis Marier never claimed to be a war hero—just one of the lucky ones. On D-Day, June 6, 1944, when soldiers were being killed on the beaches of Normandy as if they were skeet targets, Marier escaped without a blemish.

As the decades after the war passed, Marier developed problems one might assume were a manifestation of his days in combat. He became obsessed with food. For the past several years, the six-foot-one, two-hundred-and-ninety-pound Marier would sit down with his brother and knock off ten pounds of corned beef in a weekend. His doctors warned him about overeating and placed him on an 1800-calorie-a-day diet, punctuated by extensive exercise, but Marier rarely adhered to it. Adding to his problems, “Buck,” as he liked to be called, lived on the second floor of a small efficiency apartment that didn't have a kitchen. This forced him to eat at local restaurants for the better part of his life.

When he was admitted to the VAMC during the fall of 1995, Buck Marier was suffering from “a history of adult onset diabetes mellitus maintained on insulin,” along with Chronic Obstructive Pulmonary Disease (COPD), a respiratory illness brought on by smoking that generally evolves into emphysema. Patients with COPD have trouble breathing. They wheeze. And a deep recurring cough hampers their daily life.

By December 5, 1995, the VAMC had Marier's diabetes under control and discharged him a few days later. Knowing he was unable to care for himself, Marier planned on going to live with his nephew, Raymond Marier, in Chicopee. His right foot had been amputated at the ankle some time ago, and he had trouble maneuvering the stairs where he lived.

One of the primary problems that landed Marier back at the VAMC had nothing directly to do with his blood sugar, COPD or heart. It was his repeated bouts with cellutitus. Diabetics fight a constant battle with circulation. Cellutitus is a byproduct of the disease. Ulcers develop on the surface of the skin and can get out of control if not contained.

After just a few weeks of being home, on December 19, Marier once again admitted himself to the VAMC, after developing an acute ulcer on the lower extremity of his left leg—a hole about the size of a pea. If it wasn't treated immediately, Marier was smart enough to know he could lose the entire leg.

As with all diabetics, Marier's blood sugar level (BSL) was checked and monitored upon his admission. Even though it came in at 155, which was somewhat higher than normal, his doctors agreed it wasn't that big of an issue because Marier had a strong heart and no history of heart problems.

It became apparent from that same initial examination that Marier had, at least for the past two weeks, taken heed to his doctor's orders and had been watching his diet. For he now weighed two hundred and seventy-seven pounds, almost fifteen pounds less than his previous admission.

Nevertheless, Marier's condition was unusual. Many of the vets admitted to the VAMC with similar problems weren't so lucky. What separated Buck from most others was that he was not totally dependent upon the care of the Ward C nurses. He could shave himself, eat on his own, move around fluidly in a wheelchair, and get dressed by himself.

RN John Wall was Marier's nurse on the night of December 19, and even Wall noticed how well he was doing.

“He was on bed rest . . .” Wall later remembered, “[he] had a snack after dinner—as most diabetics do—and had even wheeled himself into the restroom to shave.”

The following day, Marier woke up, ate breakfast and, not being one to associate with the other patients, isolated himself in his room.

Getting the cellutitus under control was the only reason Marier admitted himself to the VAMC, and his dosage of insulin upon admission reflected that. Because he wasn't being treated for diabetes during this particular visit, Marier's meds had been adjusted to counteract the fact that he was on a restricted diet and antibiotics for the ulcers. What was more, low
or
high blood sugar was not one of his problems. Nor was anything having to do with his heart.

In fact, a doctor later calculated the risk factor percentage for Marier's having sudden cardiac arrest—as so many of the Ward C patients around him were seemingly having—as being “less than one percent.” Diabetics don't generally go into cardiac arrest, no matter how low their blood sugar is. Even if a hypoglycemic event occurs, where the BSL dips to dangerous levels, cardiac arrest is unlikely. There has never been a correlation between cardiac arrest and low blood sugar. “One does not cause the other, period,” a doctor who later assessed Marier's condition said.

 

 

As the charge nurse, John Wall worked the 2:00 to 10:00
P.M.
“T shift” on December 20, 1995, while Gilbert, who handled the med cart, and Kathy Rix, who spent the night working in ICU, were scheduled for four to midnight. As usual, Bonnie Bledsoe, a respiratory therapist who had been dating and living with John Wall at the time, April Gougeon and Lisa Baronas were also on board. Renee Walsh, who had been scheduled to leave at four, was still there. Since Ward C was understaffed, Wall had asked Walsh to hang around and help out where she could.

The nurses were split into teams. Since Marier was in the room directly next to the nurse's station, he was on Gilbert's team. She would be responsible for giving him his meds for the night. Wall, seeing they were shorthanded, also volunteered to give out meds and look after a few patients. Since Marier was in the room across from the nurse's station, Wall decided to take him on as a patient.

During the day, Marier had been seen by several nurses. One of them, Frank Bertrand, a burly man about the same size as Marier, had befriended Buck. Bertrand called him “a woodsman—a guy who played hard and perhaps lived hard, too.”

Before he left for the day, Bertrand had taken Marier's vital signs. With a temperature of 97.9, a heart rate of 85, and his blood pressure at a near perfect 126 over 80, Bertrand noted he was fine.

Between four and six o'clock, Marier's vital signs were checked again. He was “stable,” “normal,” one nurse recorded. His mental status was “alert and orientated.” Francis Marier was, by all accounts, recuperating from the ulcers on his left leg. On top of that, Marier wasn't shy when it came to ringing the call bell. With a deep, thunderous voice, if something was bothering him, he would gladly let the nurses know about it.

At 8:00, Wall looked in on Marier for about the eighth time that night, and noted that although he “denied any change in the sensation of his leg where the infection was, his appetite was one hundred percent.”

Furthermore, Wall reported, Marier showed no signs of hypoglycemia, a common illness among diabetics. When hypoglycemia sets in, diabetic patients almost instantly become weak, drowsy, confused and hungry. Turning pale, they get dizzy and develop headaches. They become irritable. They sweat, tremble, and their heart beats rapidly.

To the contrary, Francis Marier was calm and relaxed, getting ready to go to bed. He'd even shaved himself.

Around 8:15, Wall checked his BSL and found it to be within normal limits. Again, Wall noted that he was “alert and orientated.”

After Wall finished up in Marier's room, he returned to the nurse's station and continued to catch up on his clerical work for the night.

Gilbert, walking toward Marier's room, stopped by the nurse's station for a moment.

“John, you got a second?”

“Shoot, Kristen.”

“Can I leave early?”

“No,” Wall said. “Absolutely not.”

They were short on staff as it was. If Gilbert left, Wall would have to go back out on the floor and help the other nurses. It was the same old story with Gilbert lately. All she wanted to do was leave early so she could go see James Perrault.

At a few minutes before 10:00, Gilbert once again approached Wall, who was himself preparing to go home.

“John, I really need to leave early . . . can I go?”

“No, Kristen. We're shorthanded. I'm on my way out the door myself, anyway.”

Gilbert became enraged and stormed off down the hall.

What Gilbert didn't realize was that Wall wasn't going home early. He had come in at 2:00; by 10:00 he'd already logged his eight hours.

After checking in on Marier once more, Wall left. If for some reason Marier had shown any disturbing signs, Wall would have never gone home, he later said.

Only minutes later, Gilbert walked into Marier's room and found him to be “lethargic and mumbling incoherently,” she later wrote. She then checked his BSL and said it was at an unprecedented 44. Even for diabetics, this was unheard of. A 44-count is well below the scale many nurses usually see. Plus, Marier had been fine only moments ago when Wall checked him. How could his BSL drop nearly one hundred points in the span of just a few minutes? A person with a 44-count would literally be in a comatose state.

It was almost impossible.

Gilbert later said that after she pricked his finger and found his BSL that low, she decided to administer an ampoule of D-50, which is a concentrated, syrupy form of sugar that can be pushed directly into the vein. Nurses give D-50 to diabetics who are in a diabetic coma. It generally perks them right up.

When Gilbert pumped the D-50 into Marier's arm, she said he went into “full cardiopulmonary arrest.”

Another improbability.

Because of its thick consistency, and the fact that it comes in such a large syringe—one slightly smaller than a tube of caulking—it takes two hands to administer D-50. Even under the most perfect conditions, nurses say, it takes about two minutes, sometimes even longer, to push the entire ampoule into the vein. One needs strong arms. For a nurse to ascertain that a patient had suffered a cardiopulmonary arrest during the push of a syringe of D-50, she would have to be taking his pulse at the same time. The only other way to know would be if the patient had been hooked up to a heart monitor. And because Francis Marier hadn't had any problems with his heart, he wasn't on a monitor.

At 10:17, Gilbert called a code on Marier, and resuscitation efforts began.

Many later agreed that the only way a person could end up with a BSL of 44, in the short time frame that had occurred in Marier's case, was if someone had given him an overdose of insulin.