The Doctor and Mr. Dylan (27 page)

“Dr. Ayers, can you please tell the jury about your qualifications as an expert in anesthesia,” Hamilton said.

“I attended college and medical school at Johns Hopkins in Baltimore. I did my anesthesia residency training and subspecialty training in neurosurgical anesthesia at the University of Chicago. I joined the staff at the Mayo Clinic 18 years ago, and I’ve been on the faculty there since that time.” Like Dr. Zender, Dr. Ayers spent twenty minutes recounting her considerable professional accolades for the jury, and droned on and on until it seemed as if she was God’s advisor during the Creation.

At the conclusion of her speech, Hamilton said, “Very well. You’ve had time to review this case and form an expert opinion?”

“I have.”

“Can you explain to the jury what happened to Alexandra Antone?”

“Before the surgery, the patient had a normal mental status and a normal blood sugar level of 88 mg/dL. Per the chart, the patient received 9 different injectable medications in the operating room before, during, and after the surgery. All the drugs were standard agents used during general anesthetics. All the drugs were given in standard concentrations.”

“Could any of these drugs affect the blood sugar concentration?”

“No.”

“Based on the anesthetic record of medications that were administered, when would you have expected the patient to awaken after the surgery?”

“There is variability among individual patients, but I would expected the patient to regain consciousness within 10 minutes.”

“And based on your medical expertise and your review of the records on this case, why did the patient not regain consciousness?”

“Her blood glucose level was severely low. The lowest I’ve ever seen, in fact.”

“We’ve already heard testimony from endocrinologist Dr. Zender that the low blood glucose level was the probable cause of her brain death. In your opinion, when did the patient receive this overdose of insulin?”

Dr. Ayers sniffed and nodded three quick times in succession, as if this was an elementary question that any first grader could answer. “It had to be sometime after the induction of general anesthesia and before the end of surgery.”

“And how could the insulin have entered her body?”

“Insulin can be administered either subcutaneously or intravenously.”

“Please explain to the jury what those terms mean.”

“Subcutaneously means the injecting needle is inserted just under the surface of the skin. This is the way most diabetics introduce insulin into their own bodies. Intravenously means the injecting needle is inserted directly into a vein. Doctors in intensive care medicine sometimes use this method to treat diabetes.”

“And what is a typical dose of insulin used to treat diabetes or hyperglycemia?”

“A typical dose would be from five to fifty units of insulin subcutaneously, or five to ten units intravenously.”

“From your review of Mrs. Antone’s chart, was there any mention of insulin being administered to her on that day?”

“No.”

“Was there any medical reason to administer insulin in that operating room on that day?”

“No. Mrs. Antone was not diabetic, and she did not have an elevated blood sugar.”

“Dr. Ayers, how is insulin packaged?”

“The most common package is a 10-milliliter vial.”

“How many units of insulin are in such a vial?”

“The typical concentration of insulin is U-100, which means that there are 100 units of insulin per milliliter. A 10-milliliter vial would hold 1000 units of insulin.”

“Dr. Ayers, you testified that a typical dose of insulin is five to fifty units, correct?”

“Yes.”

“Have you ever administered 1000 units of insulin, an entire vial of insulin, as a single dose to one patient?”

“No. Never. No one would. One thousand units would be a massive overdose.”

“And if 1000 units of insulin were injected into Mrs. Antone as a bolus, could that explain Mrs. Antone’s low blood sugar of 2 mg/dL?”

“Yes.”

“Would the patient show any signs of hypoglycemia if she was under general anesthesia?”

“No. The typical symptoms of hunger, shakiness, lightheadedness, sweating, confusion, or weakness would be masked by general anesthesia.”

“You’ve read the coroner’s report and the police report on Mrs. Antone’s death?”

“I have.”

“Then you’re aware that no empty insulin vial was found anywhere in the operating room following the case.”

“Correct.”

“Do you have an opinion as to where the insulin came from?”

“Insulin is a standard medicine in every hospital. It’s not a controlled substance like morphine or Valium that has to be locked up. Dozens of doctors and nurses have access to insulin.”

“Do anesthesiologists have access to insulin?”

“Yes. Of course.”

“Do you have an opinion as to where the empty vial of insulin went?”

“Objection,” Martinovich said. “Speculation. Calls for conjecture.”

“Overruled,” the judge said. “You may answer the question.”

“Anesthesiologists throw used vials into the pharmaceutical waste container in the operating room.”

“But no insulin vial, empty or full, was discovered anywhere in the operating room after the case that day.”

“Correct.”

“Do you have an opinion as to why there was no empty insulin vial anywhere in Mrs. Antone’s operating room?”

“I do have an opinion. Whoever gave the injection was trying to hide the evidence, hoping it would never be discovered.”

“And where could you hide such an empty vial?”

“Anywhere. An insulin vial is small, no bigger than the cork from a wine bottle. The empty vial could have been hidden in the pocket of a scrub shirt and flushed down a toilet after the surgery. You’ll never find that empty vial.”

“We heard Dr. Zender describe how insulin overdose and hypoglycemia caused Alexandra Antone’s brain death. From Nurse Littlefoot’s testimony, we heard that no one other than Dr. Antone injected any drugs into Mrs. Antone in that operating room.”

At this point Hamilton stopped and tapped his index finger to his temple, as if he had just put all this information together for the first time. “One man doing the injecting. A low blood sugar causing brain death. With a reasonable degree of medical certainty, can you conclude that the defendant injected the insulin?”

“Objection,” Martinovich said. “Leading the witness.”

“Overruled,” the judge said. “You may answer the question.”

Dr. Ayers looked over at me, and her face contorted into a smirk of superiority. She answered, “Yes.”

“Is it probable, Dr. Ayers, that anyone other than Dr. Antone injected a large dose of insulin into Alexandra Antone’s IV at any time?”

She rolled her eyes. “In a word, no. When you hear hoofbeats, you look for horses. You don’t look for zebras. Mrs. Antone had a normal brain prior to her anesthetic, and she was comatose afterwards. I believe in Occam’s razor, the scientific principle that the simplest of competing theories is preferred to the more complex. Occam’s razor tells me that the man who injected multiple anesthetics into that woman also injected the insulin. Blaming the disastrous outcome on anyone else is absurd. There are no data indicating that anyone else can be blamed for the patient’s death. None.”

Hamilton nodded and raised one eyebrow, as if the whole case were being explained to him for the very first time. He seemed pleased. “Thank you, Dr. Ayers. I have no further questions.”

Edward Martinovich stood, his hands splayed wide on the table before him. He boomed out, “Dr. Ayers, you have examined the medical records from Hibbing General Hospital. Correct?”

“Yes.”

“Can you point out any specific evidence in the medical record that documents that Dr. Antone injected insulin into this patient?”

“As I just said, one can infer…”

“I’m not asking for inference here, Doctor. I asked you a specific question. Is there a page in the medical record that documents that Dr. Antone injected insulin?”

“No.”

“Is it possible that someone other than Nico Antone injected insulin into Alexandra Antone’s body?”

Dr. Ayers scowled in contempt. She furrowed her brow, and a frown blossomed across her angular face. “Anything is possible. In my expert opinion, to a reasonable degree of medical probability, the anesthesiologist is the only one who could do this.”

“Dr. Ayers, were you there in the operating room in Hibbing, Minnesota the day of Mrs. Antone’s final surgery?”

“No, I was not.”

“Then you are cannot be certain who injected that insulin, can you?”

Even from across the room, I could see her pulse bounding in the temporal artery bordering her forehead. Her heart was rocketing at 160 beats-per-minute or more. Dr. Ayers looked like she was ready to explode like a Roman candle on the Fourth of July. Still she did not answer.

“You cannot be certain who injected that insulin, can you?” Martinovich boomed once more.

“With a reasonable degree of medical certainty, my opinion is that Dr. Antone injected the insulin.”

Martinovich glared back at her. He’d asked the question twice. He chose not to ask it a third time.

“I have no further questions at this time, Your Honor,” he said.

A wave of nausea overtook me. Martinovich had made both Dr. Zender and Dr. Ayers uncomfortable, but he’d failed to discredit the testimony of either expert. I checked the jury for their reaction at this point in the trial, and my heart sank. Of the twelve jurors, one was yawning, another was looking at his watch, a third had her eyes closed, and the rest of them were staring at the opposite wall in various states of boredom. These twelve men and women held my future in their hands, and they looked like they couldn’t wait to leave the room for a cup of coffee and a smoke.

Hamilton took the stage again, to stack the next brick in the prosecution’s wall. In a circus hawker’s voice, he announced, “I call the prosecution’s next witness, Mr. Frank Demitree.”

The Neanderthal-like hulk that was Beard Man lurched across the courtroom toward the witness stand. He’d cleaned up his act. His beard was trimmed to a twelve o’clock shadow. His hair was cropped short, accentuating prominent elephant ears. He held up one substantial hand and took the oath. When he sat down he shot me a glower of disdain.

“In what capacity did you know Alexandra Antone?” Hamilton said.

“I’m the managing partner at Demitree, Greenberg, and Hawking, a law firm in Palo Alto, California. Alexandra Antone owned a major realty company in town, and I was her attorney in business matters.” He sniffed and tipped his chin skyward. I could see the nose hairs inside his wide nostrils, and it made my stomach roil.

“What was your relationship with Alexandra Antone?”

“We were dating. After she and her husband separated, we began dating.”

“Did Mrs. Antone ever mention her husband?”

“Not often. They were estranged, and they rarely talked. He lived here in Minnesota, and she lived in California. The only reason they were still married is that they had a child together.”

“Was Dr. Antone aware that his wife was dating you?”

“He was.”

“Describe how he knew that fact.”

“One night last summer Dr. Antone made an unannounced and uninvited return to Mrs. Antone’s California residence. He entered her home in the middle of the night and marched into her bedroom. Dr. Antone discovered Alexandra and me in bed together.”

“How would you describe his reaction?”

“Insane rage. Jealousy. The man has a titanic temper. He held a fireplace poker over our heads and threatened to kill us.”

“Dr. Antone threatened you?”

“He did. He said, ‘For two cents I’d kill both of you right now, and no jury would convict me.’ Then he smashed the bedside lamp with the poker, and stomped out the door.”

I wrote on the legal pad, “That’s a lie. She threw that lamp at me. I said nothing like that.”

Martinovich scrolled back, “It’s his word against yours. Impossible to refute what he claims. Damage is done. He’s planted the idea in the minds of the jurors that you are a violent person.”

Hamilton continued the questioning. “Why did Mrs. Antone come to Minnesota during the last days of her life?”

“Her son Johnny got his girlfriend pregnant. Alexandra loved her son very much. She wanted to be there for him. She was very scared and protective of her son’s emotions about this pregnancy. Alexandra was worried that Johnny’s dad was going to disown his son over it.”

I’d heard enough. I blurted out, “You’re a liar!”

Judge Satrum slammed down his gavel and said, “Dr. Antone, you will remain silent or I will remove you from the courtroom.”

Martinovich put his lips against my ear and said, “Control yourself. You’re hurting us big time. You need to be quiet as a totem pole.”

I bit my lip and said, “I’m sorry, Your Honor.”

The judge said, “Please continue, Mr. Hamilton.”