The Good Nurse: A True Story of Medicine, Madness, and Murder (27 page)

“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

E
d 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

O
n 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.

T
im 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 guy on the backhoe was pretty good, working the hydraulic joysticks on the big machine without crushing anything with the bucket. A few digs and dumps and he was done. Another worker crawled into the hole, taking a handhold on the grave stone and lowering himself down before pulling in the shovel. Tim and Danny watched the guy gopher out a few shovelfuls before the spade hit concrete, the hard, hollow sound reflexively triggering the thought of pirate-movie treasure. An hour later the digger had the vault exposed at the bottom of a neat, rectangular hole, the dimensions having been figured just right to allow the guy to work a chain around the vault sides. All the newer graves had one; concrete didn’t break down or crush like a coffin might under the pounds of dirt piled up, the reason older cemeteries were often too uneven to mow. The men set up another tripod, this one maybe ten feet tall, and centered on the casket. Then they fitted it with a block and tackle and hand-cranked the whole vault, a thing which must have weighed seven hundred pounds easy, up out of the ground like a septic-system version of King Tut’s tomb. The wood still looked new, the brass still polished as the coffin was loaded into the back of a Chevy Suburban and driven back to the turnpike and the regional medical examiner’s office.

Danny met the casket at Mambo’s office, accompanied by one of the young detective sergeants in the unit, Brian Hoey. As it happened, Gall had been Hoey’s pastor. Hoey was there to testify, before God and the regional
ME, that the body was his priest, or had been. Danny handed Brian a camera and some extra film while the Medical Examiner popped the casket lock and recorded the contents.

1. One black Bible.
   
2. One pair of gray glasses.
   
3. One white pillow with ribbons and flowers.
   
4. One pair of black shoes.
   
5. One religious robe, tan.
   
6. One pair of black pants.
   
7. One white religious robe.
   
8. One pair of black dress socks.
   
9. One tan religious scarf.
   
10. One black belt.
    
11. One black shirt.
    
12. Three color photographs.
    
13. One white neck-collar.
    
14. One DNA card.
    
15. One set of fingerprints.
    

Mambo was fastidious and professional. He wasted little movement as he changed gloves and moved back to the recorder, describing the body as he found it: The exhumed and embalmed remains of a 69-inch, 155-pound, well-nourished and slightly thin white male, appearance consistent with the stated age of sixty-eight.

The man’s scalp was bald, and his forehead was unremarkable. The conjunctivae of the eyeballs and eyelids were pale, the irises were light gray, the pupils equal, round, and of intermediate size. His face was undamaged by the excavation. A light green mold covered Gall’s lower nose and most of the cheeks. Nothing was coming out of the body’s ears.

Mambo removed the religious garments, finding a tracheostomy opening filled with gel. Three roughly sutured incisions on the right upper chest were covered in thick glops of white granular gel—the result of the embalming, as were the white plastic trocar buttons dotting his abdomen. Moving down the chest he found more mold, greenish-gray to black. No mold on the arms, plenty on the fingers, thick furry colonies between the webbing, black, then green, ending at the knees like furry short pants. The
molds on the shins were yellowish, the feet were covered in mold as thick as slippers. The name tag on the toe was marked Somerville Medical Center. Mambo wrote it down, and prepared to go inside.

Following the Y-shaped thoracoabdominal incision, Mambo worked along the trachea into the lungs—dark red, firm, and filled with a granular embalming gel. The reverend’s heart weighed out at 660 grams and showed signs of wear and repair. Mambo then set to work collecting samples for the toxicologist. He scooped gel from the right neck, gauze from a bedsore on the sacrum, and mold from the body, placing each sample carefully in a small labeled tube. He clipped samples from the nails of each hand and removed the whole nail from the left big toe, siphoned up fluid from the abdomen and spleen, clipped body hair and small sections of the lungs and kidneys, the liver and small bowel, both testes, a rib, the diaphragm, the spleen, brain, spine, and heart. Mambo bagged the contents of the reverend’s stomach, pulled a syringe of viscous fluid from Gall’s eye, and, dust to dust, filled a small tube with soil from the grave itself.
³
Mambo’s night was over. But over in Somerset, the night shift was just getting started.

41

T
he night before Halloween, Charlie was heading for work at the hour most everyone else headed home. He steered through the working-class suburb along with other cars like his own, late-model compacts with hummingbird engines and bumper-sticker personalities, tailgating one then another as they merged into the stream, Honor Student, Earth Mother, Marine, together but separate, each alone along the river of tar. He had been this alone all his life, never understood, always judged by the bumper sticker and hood ornament of first meetings until he had found another way to get what he needed from the wasteland. The drive was deadening, just car wash and dead Chinese takeout, dead auto parts store, dead tan center. Signage had been stripped to individual letters and eyebolts, frames hanging naked as gibbets. Price Choice, Child Care, Nail One. Stonewashed men in cigarette-brand hats crossed the empty tar expanses from Quik-Mart to Quik-Mart, men without professions or uniforms, men unlike Charlie. In the empty lots, quick weedy growth, fibrous sappers woody as fingernails.