Perfect Poison (15 page)

Late in the day on February 13, Renee Walsh and Kathy Rix got together to talk about their next move.

As they spoke, it became obvious that talking at work about such sensitive issues was probably not a good idea. The last thing Walsh and Rix wanted was for a rumor to start floating around that they were getting ready to turn Gilbert in.

So after a few moments, they decided to table the discussion for a later time. Walsh, however, had been treading water now for weeks, losing sleep, not eating. She suggested that whatever they decided to do had to be done quickly.

“Okay,” Rix said. “Don't worry. I'll call you at home later.”

The following day, Rix once again counted the epinephrine ampoules in the ICU and satellite pharmacy. In the ICU there were three; the satellite pharmacy still had twenty-two. Since she'd returned from vacation a week ago, there had not been a drop in the count. But that made little difference to her and John Wall. Because during the past week, while the epinephrine count in the ICU and satellite pharmacy stayed the same, there had been only one medical emergency, on February 11, and Gilbert was nowhere in sight when it occurred.

That, however, was all about to change.

Ed Skwira was born in Holyoke, Massachusetts, on May 25, 1927. Eighteen years later, he entered the U.S. Army, became a truck driver, and, after being discharged from the Army in early 1947, joined the local chapter of the Teamsters Union.

Not long after that, Skwira married a local gal, Stacia, and started a family, having three kids right off the bat.

Pushing six feet, two hundred and fifty pounds, with his greased back, jet-black hair, “Big Ed,” as the family called him, became known around the house years later as “The King.”

For whatever reason, ever since he had been discharged from the Army, Skwira had developed a hearty taste for hard liquor. And by February 1996, at sixty-eight years old, when he was admitted to AdCare Hospital in Worcester, Massachusetts, for alcohol abuse, Skwira admitted that he had been drinking scotch on a daily basis for fifty years.

His chief complaint when he arrived at AdCare on February 6, 1996, was alcohol dependence. But he was also suffering from diabetes, along with several other problems either directly or indirectly related to his years of abusing alcohol. Overindulging in hard liquor for five decades doesn't come without a price, both physically and socially. Yet despite the health problems he had, Skwira's alcohol abuse, remarkably, had little effect on his home life. At the time he was admitted to AdCare, he and Stacia had been married for forty-eight years, having celebrated their twenty-fifth and fortieth wedding anniversaries with extravagant parties.

Skwira had detoxed himself once before, two years earlier, and managed to stay sober for about six months, but then began drinking again.

After a quick assessment at AdCare, save for his drunkenness, Skwira checked out pretty well. He showed no signs of jaundice. His vision was good. He had no hearing problems. No chest pain. No shortness of breath. No palpations. No wheezing. And no diarrhea or constipation. He had no memory loss and, answering questions at will, could concentrate suitably. His vitals checked out incredibly well: his blood pressure was 150 over 90; temperature 96.8; pulse 100; and his heart had a regular rhythm and rate, with no rubs or murmurs. He wasn't experiencing hallucinations, nor had he any thoughts of killing himself.

If he could beat his addiction to alcohol, everything else might just fall into place.

Within a few hours, however, Skwira would learn just how severe an alcoholic he was, and, because of that, his doctors planned on detoxing him “in a safe environment to prevent [any] medical or psychiatric complications.”

There was no getting around it: The next few days in Ed Skwira's life would be hell.

For the next week, doctors kept him heavily medicated, trying to ward off the multitude of complications associated with withdrawal. But it being a seven-day program, by the end of the week, Skwira's time had run out at AdCare, and the hospital couldn't keep him any longer.

As a veteran of the U.S. military, however, Skwira was entitled to long-term care for his alcohol abuse, and on February 15, 1996, was transferred to the Leeds VAMC to begin what everyone had told him would be the fight of his life.

A quaint little Southern belle, Renee Walsh believed things in life happened for a reason. Being a devout Episcopalian, she had always turned to God for comfort and guidance during times of uncertainty. The Lord gave a person only what they could handle—no more, no less. Lent was right around the corner. Perhaps more than any other year, it was time for Walsh to cleanse herself of the demons that had been haunting her now for weeks.

Some
thing had to be done. It couldn't wait any longer.

She was scheduled to leave work early on Thursday, February 15. Before gathering her things and signing out, Walsh pulled Kathy Rix into the locker room, took a quick look to see if anyone else was around and laid it on the line.

“It can't go on any longer,” Walsh urged. “The longer we sit on this, the more it's going to happen. I've made up my mind, Kathy. I think the best thing we can do, in order to be safe, since we're government employees, is to go to see Melodie.”

For the past few days, the entire ordeal had caused Walsh a considerable amount of anxiety. She was still second-guessing what they were about to do. “What if I'm wrong?” she would ask herself while staring at the ceiling trying to fall asleep. “What if I'm so far off base . . . what if there's some other explanation?”

Part of it was not wanting to believe it was possible. Northampton was akin to Mayberry, the fictional town where television's
The Andy Griffith Show
was set in. Almost everyone knew one another. People stopped you at the gas station and asked how your kids were. Locals hung around the coffee shops and talked about taxes, Little League and upcoming elections. Who wanted to believe they had been living in the same community—or, worse, working side by side—with a serial killer?

What was more, what if they
were
wrong? Walsh worried the entire incident would end up in the newspapers if they went to the police. Anyway, the VA had always insisted that if a nurse had suspected some type of negligence, or had a complaint about another employee, the right thing to do was to go to one's immediate supervisor and report it. If one didn't get any satisfaction there, keep going up the chain of command.

“Yes,” Rix agreed, “we need to do something—
soon.”

“I'm going to Melodie,” Walsh said. “That's it! If you and John don't want to take it any further, I'll understand.”

“Don't go alone, Renee,” Rix advised. “I'll go with you. And call John. I'm sure he'll go, too. You shouldn't have to do this by yourself.”

“I'll call Melodie tonight.”

 

 

When Ed Skwira arrived at the VAMC on February 15, he wasn't feeling all that well. Inside the VA van during the ride over, he had been experiencing some mild chest pain. But chest pain—or “angina”—was something he had suffered from for decades. He'd even been taking nitroglycerin pills for quite a few years now to ease the pain.

Admitted shortly after 2:00
P.M.
, Skwira was mentally confused and “appeared . . . hypotensive,” meaning his blood pressure was low. This was Skwira's first time at the VAMC. Maybe the thought of what was ahead scared him?

Upon a further check of his medical history, doctors learned that Skwira had developed some serious cardiovascular problems throughout the years. Maybe it wasn't anxiety and stress causing his chest pain after all; perhaps it
was
a heart attack.

Ed Skwira had suffered from hypertension for many years; coronary artery disease; peripheral vascular disease; and carotid artery disease with hypercholesterolemia. In the late 1980s, he'd undergone abdominal aortic aneurysm repair surgery. Common in patients with hypertension, the large blood vessel going through the diaphragm to the abdomen becomes engorged, like a backed-up garden hose, and has to be relieved. Although he went through the surgery without any complications, the continuing angina pain Skwira suffered from was an indication he still had some blockages, which limited blood flow.

The admitting doctor, after examining him, noted there was a “slight change on his EKG.” With Skwira now acting confused and restless, this worried the doctor.

Maybe he
is
having a heart attack?

But heart attacks don't, normally, come on as suddenly as they did to people on television or in the movies. Often, a heart attack was days in the making, and sometimes people didn't even know they had one.

Not taking any chances, the doctor ordered some fluids, got Skwira stabilized, and sent him up to the ICU in Ward C to be monitored more closely.

It was about 2:30.

When Gilbert came in at four, she was assigned to the ICU, where now, mildly sedated, Skwira rested comfortably.

Placing him in the ICU was a precautionary measure. His EKG readings were normal, but the admitting doctor wanted to be sure there was nothing else wrong. By this point, Skwira had even stopped complaining about the chest pain he'd had, yet the doctor still wanted to rule out the possibility, he later said, of a heart attack.

Shortly after four, Dr. Nabil Raheb, the attending physician, came in and ordered Gilbert to give Skwira a chest X-ray and full body CAT-scan. There was a slight chance, Raheb contended, that Skwira's aorta had a tear in it.

Radiology was on the same floor as Ward C, but with Skwira being as heavy as he was, there was no way Gilbert was going to lift him up on the gurney herself. So she called nursing assistant Lisa Baronas in for some help.

When they got down to Radiology, Lisa helped Gilbert lift the overweight vet off the stretcher and onto the table.

“Call me when you're done, Kristen. I'll come back and help you.”

“Thanks.”

It was now 4:15.

Within the hour, Lisa Baronas was summoned back to the CAT-SCAN room, where she helped Gilbert return Skwira to his room in the ICU and, when they finished, left the room and continued preparing the supper trays she was getting ready to distribute.

Dr. Raheb learned quickly what all the fuss had been about. Ed Skwira, Raheb diagnosed, had a “bulge in [his] aorta.” Medically speaking, it was called a “thoracic aortic aneurysm.”

After studying Skwira's X-rays and CAT-scans, Dr. Raheb thought there was a possibility he also had a tear in his aorta, which meant disaster. Blood can leak into the chest cavity and cause all kinds of problems, resulting in a drastic drop in blood pressure and, ultimately, death.

Dr. Raheb saw the bubble in Skwira's chest, put that together with his low blood pressure and confusion, and thought,
Dissection! This patient has a dissecting aortic aneurysm.

The VAMC wasn't equipped for emergency open-heart surgery. So a decision had to be made right away.

At the same time, however, a tear in the aorta was extremely painful. And Skwira hadn't complained of any chest pain in a number of hours. In fact, since his admission, he'd been seen by several doctors and nurses and his condition hadn't changed one bit.

A decision was soon made to have Skwira transferred to Baystate Medical Center, a full-facility hospital more equipped to deal with a patient in his condition. If nothing else, doctors at Baystate could make a more calculated diagnosis and take things from there.

 

 

Alone now, while Lisa Baronas handed out dinner trays, Gilbert monitored Skwira's status in the ICU.

It was pushing five o'clock.

The charge nurse, David Rejniak, was down at the nurse's station doing some paperwork when Gilbert called him from the ICU.

“Call Dr. Raheb,” Gilbert said. “Ed is having chest pain.”

She sounded excited and anxious. So Rejniak called Dr. Raheb right away.

Moments later, at 5:07, Gilbert called a code, and efforts began to resuscitate Skwira immediately afterward.

Soon, the room filled with all sorts of medical personnel and, of course, the one guy who seemed to be on duty whenever a code was called: Gilbert's lover, security guard James Perrault.

In her notes, Gilbert wrote that Skwira had gone into “sudden cardiac arrest” for no apparent reason. Nowhere in the note had she written that he had been experiencing chest pain right before he coded, as she had told David Rejniak. Nor had Dr. Raheb reported it. This was odd, because with all the confusion surrounding his condition for the past several hours, knowing that he was going to be transferred to Baystate, Skwira's nurses would want to document anything—and everything—that happened so his doctors at Baystate could have a clear picture of what had been going on.

But Gilbert didn't see fit to add any information above and beyond the fact that he had coded.

Down at the other end of the ward, Kathy Rix had been going about her normal nightly duties when the team pager she was wearing went off.

Looking down at the blinking light, Rix shook her head.

Shortly after she arrived for work at four, Rix had, without telling anyone, gone directly into the ICU medicine cabinet and, once again, counted the ampoules of epinephrine.

There were three—same as there had been for the past week.

As Rix entered Skwira's room shortly after his code, she was told the situation was under control. But before leaving the room, Rix took a look in the medicine cabinet to see if the three ampoules of epinephrine she had counted an hour or so ago were still there.

As she approached, she hoped her suspicions were off base. But here she was now, faced with the prospect of Gilbert calling yet another code.

She had to find out.

Please be in there, please, please,
Rix kept thinking as she went for the drawer.

But it was empty.

Her knees buckled, and she felt sick to her stomach.

“I was useless,” Rix later recalled. “I was sure I couldn't function anymore. To me, that made it positive that there was something going on.”