Dead Certain

only difference is that what I do smells worse and is much more interesting.”
    “How can you be so sure that it’s more interesting? „
    “Because every life, no matter how tragic or mundane, is a story, and I’m the person who gets to tell the end.”
    “I guess that’s what I wanted to ask you about— hypothetically, of course.”
    “You and I both know that there’s no such thing as a hypothetical question,” she replied sweetly, “only people who want to put some distance between themselves and what they want to know.”
    “In that case I hope you’ll wait before you start leaping to any conclusions,” I replied, suddenly wondering if this was such a good idea. “I wanted to ask you how you might go about killing off hospital patients.” Dr. Gordon raised her eyebrows and shot me an appraising look. “Assuming you don’t want to get caught?” she asked.
    “Yes.”
    “Well, I don’t know what I would do, because it’s not a question I’ve ever really considered, but I can tell you what’s been done in the past. For example, there was a fairly recent case where a male nurse in Oregon was convicted of killing seventeen patients by injecting them with potassium chloride.”
    “Is that a poison?”
    “No, it’s a drug that’s commonly used in low concentration to control irregular heartbeat. At higher doses it’s fatal.”
    “Why did he do it?”
    “I don’t think they ever found out. As I recall, there were several witnesses for the defense who all testified that he was a particularly conscientious and devoted caregiver. I believe the theory the prosecution presented to the jury was that his actions were an extreme form of burnout. The defense tried to make the case that the nurse was driven to madness by the escalating demands of managed care.”
    “What about the others?”
    “Well, by far the most famous case was at the Veteran’s Hospital in Ann Arbor, Michigan, mostly because the number of patients involved was huge. There were something like forty patients—practically an epidemic— who experienced episodes of cardiopulmonary arrest. I don’t know if you are familiar with it, but cardiopulmonary arrest is almost always fatal unless artificial respiration is begun immediately. Fortunately, there was a pair of Filipino nurses who seemed not only particularly vigilant, but highly skilled at the technique. Due to their efforts, out of the forty cases only seven of the patients died.”
    “So what happened?” I asked, thinking about the sixteen folders in the trunk of my car.
    “Well, naturally the sheer number of incidents involved raised suspicions that something abnormal was going on. An investigation was eventually launched, which led to four of the bodies being exhumed and autopsied.”
    “What did they find?”
    “Absolutely nothing.”
    “You’re kidding.”
    “No, but because the deaths occurred on federal property, the medical examiner was able to send tissue samples to the FBI crime lab.”
    “Did they find anything?”
    “Yes. In every one of the patients they found a drug called pancuronium. It’s a neuromuscular blocking agent that’s actually a synthetic form of curare. It’s most commonly known by its brand name, Pavulon.”
    “I thought curare was a poison.”
    “If by that you mean that it can be used to kill people, then half the drugs that are commonly prescribed are poisons. Pavulon acts by inducing temporary muscle paralysis. In high enough doses it stops your heart from beating and your lungs from breathing. It’s used in the operating room during anesthesia as part of a mixture of different anesthesia drugs.”
    “What does it look like?”
    “It’s a colorless, odorless liquid that resembles water. It’s very fast acting, but conversely its effects disappear quickly. That’s why the nurses were able to both induce arrest in their patients and then reverse it.”
    “You mean it was the two nurses who were killing off the patients?” I demanded.
    “Yes.”
    “But again, why?”
    “Again, nobody knows for sure. Some people believe that the two women did it to draw attention to what they felt was an acute shortage of nurses. Several psychiatrists were called in to interview them both, and their conclusion was that both women were mentally ill and craved the attention they received whenever they successfully resuscitated a patient.”
    “What I want to know is why it took forty cases before they launched an