In addition, she said that if the plaintiff’s attorney was truly interested in the truth, he should have no objection to her motion. Betty Wu asked for an expedited decision, stating that the longer the body remained in the ground with further decomposition, the less chance there would be that the medical examiner would be able to find the actual cause of death.
In ten days the judge rendered his decision ruling that the exhumation should proceed without delay and requesting an immediate autopsy from the medical examiner’s office. Veteran court watchers had accurately predicted the decision but were surprised at the speed with which it was rendered. For once, the leisurely pace of the Cook County courts had been accelerated. The quick action was attributed to the prominence of the parties involved. Betty Wu told Cliff that under normal circumstances, the decision would not have been rendered for months. Cliff’s sarcastic response was, “I’ll have to remember in the future to make sure only corporate big shots die on me.”
Just as quickly, Barbutti filed a motion to appeal the judge’s verdict. Betty Wu’s counter filing differed in no significant aspects from her initial pleading. Once again, she appealed to the court for an expedited decision. Once again the decision was quickly rendered. Thirty days after oral arguments, the appeals court upheld the hearing judge’s ruling and Victor Wallberg was ordered to be exhumed and autopsied.
Dr. Jacob Epstein of the Cook Count Medical Examiner’s Office performed the autopsy. He was an experienced and competent pathologist in whom both sides had confidence. The results indicated that the union of the two sections of resected bowel was intact and the surgery performed was sound. There were no cut blood vessels. Cliff was in Betty Wu’s office going over the autopsy findings with her and was gratified to read that part of the report. He breathed a sigh of relief; it would be difficult for Barbutti now to claim surgical negligence in the death of Victor Wallberg.
The autopsy report further disclosed that not only had there been an abdominal cavity bleed, but there was also blood in the chest cavity, the urinary tract, and the brain. This was all grossly consistent with DIC, but when the microscopic and blood analysis was performed it was determined that DIC was not the cause of death! Cliff shook his head in puzzlement. What the hell had killed this guy? The next paragraph provided the answer. Cliff’s eyebrows rose in shock as he read further.
The pathologist concluded that Victor Wallberg died from a massive injection of heparin, which caused his uncontrollable bleeding and subsequent death. Heparin, as Cliff well knew, was a naturally produced substance that thins blood and is used with cardiac, pulmonary, and surgical patients to help prevent or treat blood clots. The presence of large amounts of heparin in Wallberg’s blood was confirmed by coagulation studies and the presence of microvascular white clots, formed by platelet aggregation alone and seen only as a consequence of a heparin overdose, not DIC.
Cliff turned to his attorney, “Betty, there is no way Sanjay could have injected this amount of heparin into Wallberg.”
“Are you sure?” Betty asked, her features showing her bewilderment. “Perhaps he made a mistake and gave too large a dose.”
Cliff shook his head, “I just can’t see it. Sanjay would have had to empty an entire vial of heparin to produce this result.”
Betty was not convinced. “Did you watch him inject the heparin?”
“Of course not. I was too busy trying to keep Wallberg alive.”
“Then how do you know he didn’t make a mistake?”
“It would be almost impossible. The normal dose is one-tenth or less of a full vial. How could a competent anesthesiologist make a mistake like that?”
Wu was insistent, “How else could the heparin have gotten into Wallberg’s blood stream?”
Again Cliff shook his head. “I don’t know. That’s what’s so crazy here. This just doesn’t make sense.”
Wu probed further, “Could one of the nurses in the operating room have taken it upon herself to administer the heparin while you were shouting at Madhava?”
“Not a chance. First, I don’t think it could have happened that way without someone seeing what was going on. Second, if a nurse did that, she would be instantly terminated and probably not allowed to work in a hospital again. I can’t tell you what a serious violation of operating room procedures that would be!”
Wu was exasperated. “Cliff, so far all you’ve done is tell me how a massive dose of heparin could not have been injected into Wallberg, yet the autopsy says that is exactly what happened. How can you explain that?”
In a confused voice, Cliff said, “Betty, I can’t explain it. This is just inconceivable. If the autopsy weren’t so conclusive, I would assume that a mistake had been made. All I can tell you is that a large amount of heparin was administered to Wallberg but there is no way it could have happened.” He uttered a small laugh of disbelief at his own words.
”This is ridiculous!” Wu cried out in frustration. “If you didn’t administer the heparin, and Madhava didn’t, and the nurses couldn’t, then how the hell did it get into the man?”
Equally frustrated, Cliff said, “I don’t know, Betty. I just don’t know.”
With an effort, Betty Wu regained her composure. “All right. Let’s settle down. We’re not getting anywhere like this. Let me think for a minute.” She closed her eyes, mentally reviewing the case.
After a minute or two she opened her eyes and smiled at Cliff. “Well, there’s one thing for certain here. There’s no basis for a negligence suit against you. On the basis of the autopsy report I am going to ask the court to remove you from the list of defendants.”
Cliff brightened, “Will the judge do that?”
“Why not? The cause of death is a massive dose of heparin and no one is claiming that you could have done that. The way I see it, the hospital is on the hook because there had to be negligence somewhere for this to happen. And Madhava is not in the clear. You say it’s impossible for him to administer an overdose but I guarantee you that Barbutti won’t see it that way.”
“Betty, I don’t know if Sanjay made a mistake or not. But I am not going to rest until I find out how that much heparin got into Wallberg’s bloodstream.”
Wu was skeptical. “How do you propose to do that?”
“I don’t know. All I do know is that I can’t just close the book on this and not know how a patient died while under my care.”
Wu thought for a moment and said, “Let me ask this, how long would it take for a dose of heparin this large to manifest itself?”
Cliff thought for a few seconds and said, “There’s no way to be sure but it could be anywhere from fifteen minutes to half an hour.”
“Why the difference?”
“It depends on the patient’s speed of circulation of blood and where in the IV line the port is located into which the heparin is injected. There may be a high port that goes right into the IV bottle and if you inject into that one the heparin would eventually go into the lower part of the IV bottle after dilution. Then it would take longer to fully get into the blood stream as it has to travel down the IV tubing before it gets into the patient’s body. There is a lower port where the needle or the cannula goes directly into the vein. That’s the port we use when
