Last Dance, Last Chance

The only response he got was a slight reaction to the closed chest compressions. He heard Pignataro shouting for a clothes hanger.
    Koehler recalled that Pignataro was begging to no one in particular, “We can’t lose this one!”
    Firefighters Lou Gimbrone, Rich Cramer, and Paul Bernardi rushed in, followed by David Willman, the second assistant fire chief. When the Rural/Metro Team arrived a few minutes later, Koehler heard the doctor ask them for their intubation equipment. Koehler looked to see if there was a crash cart in the surgery and saw none. What he saw was Pignataro and Janie trying to work the yellow wire clothes hanger into the victim’s throat so he could get an oxygen tube into her lungs.
    Jim Cavanaugh had been the last paramedic to arrive. The emergency medical personnel were attempting to get oxygen into the silent woman on the operating table. Like the rest of them, Cavanaugh was shocked to see that she was so young. They had expected an older person.
    Pignataro was frantic, and he was getting in their way more than helping them. However, he left the room once “to get a cup of coffee,” and then returned and pointed at his EKG machine. “Look at my EKG,” he shouted. “Mine’s better. Can’t you guys shock her? We’ve got to save this one!”
    Anthony Pignataro had then grabbed the Rural/Metro team’s defibrillator and moved toward his patient as if he were going to use it, but the paramedics stopped him. Whatever his reason, he hadn’t used his own defibrillator. They didn’t know if it even worked.
    Paul Bernardi wished mightily that someone would get Pignataro out of the operating room. He was so out of control that he wasn’t helping the patient. He was hindering the rescue workers, attempting to remove some tube from the woman’s chest area, fighting clumsily to intubate her airway. Bernardi and the other emergency medics carried Sarah Smith on a gurney to the rescue rig, where they were able to get oxygen going and shock her heart into beating. As they prepared to race to Buffalo Mercy Hospital, Pignataro attempted to jump into the back of the rig.
    He was too agitated for them to deal with, and Dave Koehler volunteered to drive Pignataro in his vehicle and follow the ambulance.
    It had been nineteen or twenty minutes since Sarah Smith received any oxygen—far too long for a human brain to survive without profound damage.
    Debbie was left behind. It would be up to her to explain to Dan Smith why he couldn’t pick his wife up and take her home for the few days of rest that Anthony had assured Sarah was all she would need to recover from his miraculous surgical procedure.
    And, of course, there had been no easy way to tell Dan Smith that his beloved wife was in such critical condition. His loss was something that would come to him in a series of searing revelations over the next seven days—and indeed for the rest of his life.
     
    A postmortem examination of Sarah Smith’s body was performed at 9:45 on September 7, 1997, by Dr. Fazlollah Loghmanee, associate chief of the Erie County Medical Examiner’s Office. If, as Anthony claimed, Sarah had a preexisting medical condition that had killed her, Dr. Loghmanee would find that out.
    The term “autopsy,” roughly translated, means “to see for one’s self.”
    Dr. Loghmanee dictated into a tape recorder at the beginning of the postmortem examination. Sarah was five feet, five and a half inches tall and weighed 124 pounds. She had very little fatty tissue on her body. Her breasts were small.
    The forensic pathologist could see the beginning of an operation: the semicircular incision around her navel and an odd “tunnel” above her muscles but through the soft tissue from her navel to her right breast. A bag containing less than 20 cubic centimeters of blood-tinged fluid rested within the breast. The left breast was normal; her surgery had stopped before the second half had begun.
    All the signs in the organs of her body were normal. She had a sound heart, lungs, kidneys, arteries, liver; all were normal save for changes that had occurred after she was deprived of oxygen for twenty minutes. The only trauma had come from the breast augmentation surgery.
    Dr. Loghmanee’s final notation read: Cause of Death: Asphyxia due to Inadequate Ventilation Under Anesthesia.
    As always, it would take several weeks before the results of a toxicology screen were available. When the results came in, Sarah Smith’s blood and urine had