The Blistering: Chapter IX

To read this serial novel from the beginning, go here. 

Filler on Flight 249

"Ah, elevator music. My favorite," Cardinal said.

"It's impossible for you to make an unironic statement, isn't it?" Marsha said.

"What can I say, I enjoy annoying people."

The were on a moving walkway in the Dallas Airport. Marsha was dressed in a smart but officious business suit. Her back was squarely to him. Cardinal, right behind her, kept looking at the her neck to see if she was making any effort to look back at him. She wasn't, not even a peek.

He was in his standard traveling attire -- dark blazer, red tie. He was not much for wearing ties, but in the airport, you got better service if you looked like a business traveler. Cardinal was all about efficiency, even if it meant playing the phony to achieve it.

At the end of the walkway, they stepped off and headed to the security gate. "Now, John," Marsha was saying, and she still would not look at him, "don't try anything. I mean it. "

"All right, stop it. You aren't traveling with a Neanderthal. I want to get Des Moines just as much as you do, though I can't believe I just said I want to get to anyplace in Iowa. I'm smart enough to play the game."

"Okay, I'm sorry." She glanced at him for the first time.

"First time you've been on a real mission, eh? There's a first time for everything, you know."

"Now it's your turn to stop it."

They got on the plane, enplaned, Cardinal guessed, since the stewardesses always call getting off deplaning. He caught the eye of one of the attendants, a barely-of-age blonde, and thought to clarify the issue. Touching her elbow, he began: "Brittney -- that's your name, right? -- Brittney, I was hoping you could clear something up for me. When you get off a plane, the flight attendants always call it deplaning. So when you get on, is it em-planing, en-planing, or re-planing? Re-planing doesn't make much sense, of course, since you would have to deplane before replaning. But then, you're the expert. What do you call it when you mount an aircraft?" 

The stewardess must have been accustomed to being hit on, because she smiled brightly, and came back with a prompt answer. "Call it what you like," she said. There was a faint streak of lipstick on an upper incisor. "Just mount it gently."

"That's enough," Marsha said, digging her nails into his sleeve. Then in his ear, in a hiss: "I told you, don't do anything to call attention to us."

He followed her down the aisle. They were halfway when he leaned forward to Marsha and said, "Something's not right here." He reached for his belt, the spot where his grenade usually hung, then remembered he had to take it off to get into the airport.

Marsha stiffened. "Cardinal, are you going to behave, or am I going to have to do this alone?"

"Marsha, I know a thing or two about thugs. Something is not right here." She slid into a window seat, and Cardinal sat down next to her.

"What, worried about the guy with the shumagg?" Marsha was annoyed.

"No, those folks are fine," Cardinal said, distractedly. "It's the four guys in suits, right over there." He inclined his head.

"Look John, relax. The plane is headed out to the runway. I won't have you stopping this flight."

His voice was rising. "Marsha, I don't think you're going to have to worry about that -- "

"Everybody freeze," a deep voice snarled from the back. "This plane has been hijacked!"

Next week: The Embryonic Express 

Dr. Anna Pou: A Final Word

As most of my readers are already aware, this past week a grand jury in New Orleans refused to indict Dr. Anna Pou for murder. The response to the news in the medical blogging world has been characteristically divided: While most medical people are saying justice was served, a few are saying a murderer has slipped the noose. I have posted about this topic several times before, but would like to make a final comment before this topic passes out of our collective memory.

First a quick refresher: Anna Pou, MD, is an otolaryngologist (ears, nose, and throat specialist) who was working at Memorial Hospital in New Orleans when Hurricane Katrina struck. An affidavit issued by the Louisiana State Attorney General just over a year ago accused Dr. Pou and two nurses, Cheri Landry and Lisa Budo, of murdering four patients five days after the storm hit with lethal doses of morphine and benzodiazapines. Since that time, the New Orleans District Attorney's office has been preparing the case for prosecution. A grand jury was impaneled in March and had been hearing witness testimony for the past 4 months. A few months ago, the two nurses were granted immunity in the case, presumably in exchange for testimony. This was widely assumed to be a move on the part of prosecutors to isolate Dr. Pou. Now that the grand jury has chosen not to indict, all charges are dropped and the case is essentially dead.

In my view, the grand jury did the right thing -- the only thing it could do given the weakness of the case. No one saw the fatal doses given other than the accused individuals, and there was no clear evidence in the medical record that any medication was given with the intent to kill. The original affidavit quotes several witnesses who said Dr. Pou indicated that she intended to deliver fatal doses of pain medication to patients, but Dr. Pou has vehemently denied she has said any such thing. Although the witnesses had some credibility, their testimony amounts to hearsay. Dr. Pou could have said any number of things in advance, but saying something in advance only suggests intention, not proof that the action was carried out.

But the real weakness of the case was the lack of physical evidence. The substance of the charges were based on autopsy reports, but the bodies of the patients were not removed from the hospital for three weeks after the storm. In those three weeks the bodies decomposed significantly, and there is no way under these conditions that toxicology reports could prove that the medication dose was high enough to have been intentionally fatal. Toxicology reports can be difficult to interpret mere hours after an overdose. A lapse of weeks made this impossible. Frank Minyard, the Orleans Parish Coroner, underscored this problem when he issued a report in February 2007 stating that the cause of death of all four patients, based on autopsy evidence, was "indeterminate."

The outcome of this case has not satisfied everyone. After all, four patients died under heavy sedation shortly after their doctor suggested to several witnesses that she intended to euthanize them. This temporal association is hard to ignore. On the other hand, it is undisputed that all four patients were very near death, and could easily have died from natural processes.

It is very possible that the morphine in the patients' blood was administered for therapeutic reasons. Pain relief is a necessary and very important part of medical care. Commonly accepted medical guidelines clearly permit doctors to use large amounts of pain medication for dying patients when necessary, even in quantities that could hasten the dying process. Intent is the key. If the doctor is giving the medication to relieve pain, then giving painkilllers is ethical; if the intent is to kill, then it is not.

If this assertion sounds foreign, consider a more familiar example. It is permissible for a doctor to give highly toxic chemotherapy to a cancer patient even though the treatment could kill. As with pain medication, the act is ethical as long as the intent is to help the patient. If the treatment, which is intended to help, inadvertently kills the patient, this does not mean the doctor has done anything wrong.

All that being said, I have some sympathy with the people who feel that dropping the case for lack of evidence is not as satisfying as proving it one way or another. I don't want to know that wrongdoing cannot be proven; I want to know that wrongdoing did not happen. I also wholeheartedly agree that even given the extremity of the situation (100 degree heat, no running water, no electricity, no antibiotics, no IV fluids, 10 feet of standing water in the street, and no help coming) it remains illegal to kill patients, even if the intent is to relieve suffering.  A law does not become less of a law because conditions make it harder to obey. I don't get to kill someone just because I am seriously aggrieved and I don't get to steal simply because I am broke. It is true that in extreme situations physical and emotional pressures distort judgment, and courts of law must account for this. In the event of a guilty verdict, a judge should weigh the matters of distorted judgment and extreme situations before sentencing. But before that time, only the facts should rule. It is regrettable that there are not enough facts available to allow the facts to rule.

I want to make a final point. This case is a very poor example of a euthanasia, and has no place in ethical discussions about euthanasia. Right-to-die activists who think the Anna Pou case is a milestone for their cause need to rethink their positions. Personally, I am strongly opposed to euthanasia in any form, but, for or against, if we are going to argue about it we need to avoid sloppiness. The term euthanasia, as it is used in medical ethics, refers to the voluntary killing of a patient for the purposes of alleviating pain. The operative word here is voluntary. Even right-to-die advocates (at least the sensible ones) would agree that a patient should never be euthanized against his will. In countries like the Netherlands where euthanasia is practiced, a patient who requests euthanasia goes through a careful multi-step process to determine if he is sound of mind, has a terminal condition, and truly wishes to die. Only if all three of these criteria are strictly met is the final act carried out.

Even in the case of Dr. Jack Kevorkian, there was never any question that the patients who died were willing to die, asked to die, and assisted in carrying out the administration of the fatal dose.

In the Pou case, there is no documentation that the patients wished to die. No proof that they were of sound mind. In fact, given the circumstances, at an abandoned hospital without fresh food or running water, without medication, in 100 degree heat, it is unlikely that any of the patients were fit to consent to euthanasia.

The State Attorney General maintained that Dr. Pou murdered the patients, not that she euthanized them. Dr. Pou has always maintained that she did not kill the patients, not that she did and should be excused from doing so. Such a defense would not work under Louisiana law anyway, which prohibits physician-assisted suicide just as well as murder. As far as I know, Dr. Pou is not nor ever has been an advocate of euthanasia.

It would be lunacy for right-to-die advocates to use Dr. Pou's case as an object lesson in their cause, any more than it would make sense for death penalty advocates to use a lynching case as an example of a justified death sentence. If right-to-die advocates consider Dr. Pou's case meaningful than they are a dangerous lot indeed. Extreme circumstances don't justify relaxing the rules, and there is no reasonable person who believes that people should be euthanized without asking them first. If there is anything that supersedes the duty of the doctor to relieve pain, it is the right of the patient to self-determination.

One final question the reader may ask: Do I think Dr. Pou did it?

I don't know Dr. Pou personally, but I do find it difficult to believe that a doctor educated in the United States, knowing the law as all doctors do, would have tried to do something like this. It would have been much easier for her to simply sedate the patients with the aim to relieve pain. She had no obligation to kill them, and, in fact, with sufficient morphine on hand to keep pain at bay, no need to kill them either. She could have managed them to to the point of natural death without having to make such a terrible decision. So on balance, I would have to say probably not.

Of course, only Dr. Pou knows the truth. The rest of us are left, like the grand jury, with nothing more than insufficient evidence.

Update on Monday, July 30, 2007 at 09:34AM by Michael Hebert

This morning when I came into my office, I found a letter on my desk soliciting a political contribution for Charles Foti's opponent in the upcoming State Attorney General election. (Charles Foti is responsible for bringing charges against Anna Pou.) The letter is signed by three medical doctors, and opens this way:

To say that Charles Foti is over his head is kind. To say that he has blundered and stumbled from one disaster to another and failed to take the initiative in protecting our citizens is much more accurate.

The doctors then go on to tell what is really on their minds:

Most illustrative of his ego-centered abuse of the power of his office for personal political gain was his handling of the issues at Memorial Hospital after Hurricane Katrina . . . .

Remember, this time, this election is truly about protecting Louisiana -- from Charles Foti.

It is an understatement to say the doctors in Louisiana are furious about this case.

Foti's behavior in the Pou case was inexcusably bad. He called a press conference to announce the charges -- something the Attorney General almost never does -- and continued to call press conferences each time he made a move in the case. He arrested Pou in the middle of the night instead of allowing her to voluntarily surrender -- and notified the media so they could film it. He repeatedly called the case a murder case, even though the decision to charge Pou with murder was not his, but that of the New Orleans DA's office. And he failed to disclose to the press a serious conflict of interest in this case. Since Anna Pou is a state university employee, her legal defense comes from the state -- the AG office. In other words, Foti was both Pou's accuser and, in theory, her defense attorney.

Needless to say, Foti is not a popular figure in Louisiana these days. I think Foti's hijinks made it easier for the public to sympathize with Dr. Pou. Foti came off as the bad guy, and Dr. Pou as the innocent. I don't know that it would have made a difference in the final outcome, but if Foti had simply filed his report and kept his mouth shut more people would have examined the case on its merits. Instead, once the labels were applied, Dr. Pou was tried and exonerated in the public mind. 

Sometimes, rather than speaking for the facts,  it is better to let the facts speak for themselves. 

The Blistering: Chapter VII

To read this serial suspense novel from the beginning, go here. 

School Daze

There almost wasn’t enough duct tape. But by the time any of the Candy Gang members had regained consciousness, Marsha and Cardinal had the three of them taped together on the mattress.

They waited.  After a few pregnant minutes, Marsha went over to the sink to wash off the sweat and compose what was left of her maid outfit. Cardinal figured he might as well make conversation.

“So how’d you know they were going to kidnap me?”

In the mirror, the reflection of her face looked up at him from the sink basin. A huge crack down the middle of it made it look like she had two cleavage lines. “I didn’t. I was going to the prison to pick up some papers for my memoir. It must have been right after the time they released you.” She splashed some water on her face and toweled it off. “As I was arriving,  I saw the helicopter chasing you. I started chasing the chopper, and then saw the blast. I followed you here.”

Cardinal sniffed. “Everybody is writing a memoir these days.”

The brown-haired girl woke up first.

“So, are you going to tell us who sent you?” Marsha leaned very close.

“Do I look like a snitch to you?”

Marsha stood up and walked across the room, taking her swaying hips along for the ride. “Fine, “ she said. “Do you know what I did before I worked as a public defender? I worked for the Vice President’s anti-terrorism office. Helped write the Gitmo handbook.” She found her purse, slung some time ago into a corner, and pulled out a soft cover manual with Dick Cheney’s face on it. Dick was dressed in a sharp pinstripe suit with a lethal red tie, arms crossing his chest; he had a .38 in one hand, a pair of nunchucks in the other. “We’ll be working through this sucker cover to cover. Could be an all-nighter.”

She carries around a torture manual, Cardinal thought, impressed. Perhaps the Kama Sutra’s in there too.

Candy’s eyes opened wide. “All right, all right. I don’t get paid enough to put up with this.”

“So?”

“We work for the Department of Education, as you seem to have figured out. We are part of the Pornstar Rehabilitiation and Improvement Commission, or PRIC. It’s a faith-based initiative. The idea is to gradually rehab porn stars by getting them gainful employment.”

PRIC, eh? Now that she mentioned it, Cardinal seemed to recall the face of the redhead from Harry’s Putter and the Socket of Fire.

“You rehab from a porn career as scantily clad waitress at Chester’s?”

“It’s a graduated program. You start out at a strip club, them move up to Chester’s, then the weekend weather girl,  then,  if you do well,  it’s on to become eithera TV news analyst or a spokesperson for the Justice Department.”

“And what does this have to do with John Cardinal? Why did you pick him up?”

“Our program director from Iowa told us to do it. He gives us missions like this every once in a while. He likes to call himself Deep Throat, but we know his name is Lawton Stone.”

Cardinal finally spoke up. “Lawton Stone? Sounds like a porn name to me.”

“No, I found his name in the Republican Party donor rolls. He’s a real guy.”

A real guy who gets paid to recruit porn actresses to serve as federal operatives. Cardinal clenched his jaw in disgust. Republican slugs. When he did that for the Clinton administration, no one paid him a dime.

Marsha stuck to the program. “What were you supposed to do with John once you got him?”

“Deliver him to the office in Des Moines.”

Marsha turned and looked at Cardinal. “Well, Johnny C, it looks like we need to pay Mr. Stone a visit.”

“I’m up for it.”

They started for the door, when Candy spoke again. “So what are you going to do, leave us here to die?”

Marsha paused. Without answering, she opened up her purse and fished out an old piece of beef jerky. She took the wrapper off and shoved it between  the layers of duct tape that bound the Candy Gang together. The she kicked the wall hard near one of the holes that had been kicked out in the fight. A large gray rat jumped out.

“The rat will eat through the tape to get to the jerky. Just don’t talk or move around too much or he might chew through your face too.”

They headed out the door and back to Marsha’s car. As soon as they were in the car, Cardinal cleared his throat. “Oh, uh, by the way, I was wondering if you could spot me the cash for a plane ticket. I emptied my bank account paying your legal fees.”

Next Chapter: Filler on Flight 249 

Here We Go Again

Attorney General Roberto Gonzales is back in Congress today, testifying before the Judicial Committee. His last performance in Congress may have been the most embarrassing performance in the history of his office. He answered questions with "I don't know" or "I don't recall" at least 70 times in that notorious session, demonstrating a cringingly blissful willingness to appear ignorant in public. The Attorney General is the number one lawyer in America. Though lawyers take a sometimes-deserved beating for their behavior in this country, no one denies that lawyers, as a group, are a pretty smart lot. The number one lawyer in America should be an impressive intellect, a skilled communicator, and deft in law. Gonzales looks like a fool every time he opens his mouth. He may be the dumbest public official since DanQuayle. And at least Quayle had the common sense to keep his mouth shut and be thought a fool, rather than opening it and erasing the doubt.

I do not understand why Congress won't impeach him. He clearly lacks the brain power to do his job. He oversaw a group firing of U.S. Attorneys that was obviously less than proper, and has publicly admitted he had no control or understanding of the situation. That is a public admission of incompetence if there ever was one. He also refuses to help Congress in its investigation, which is a violation of public trust. Political appointees aren't called public servants for nothing. Every public appointee has a responsibility to account for his actions to the public when asked. I understand that Gonzales is asserting executive privilege (the right of the president to keep personal advice private), but the President's right to privacy is superseded by the public's right to bring wrongdoing to light, unless national security is at stake. In this situation, it clearly is not.

The Attorney General has maintained repeatedly that the government has the right to violate the privacy of citizens for the public good. Why would the President's right to privacy be any different than yours or mine? If Gonzales has a legal right to listen in on your phone conversations, why don't you, as a citizen, have the right to know if he recommended firing 8 U.S. Attorneys for pure political reasons? Today Gonzales will ask Congress to renew  FISA, the Federal Intelligence Security Act,  a law that allows the Executive Branch broad powers of search and seizure without the usual search warrant. Would you call it hypocrisy to argue that the White House should be allowed to secretly snoop on private citizens while asserting that Congress has no right to ask questions about illegalities in the Department of Justice? I wouldn't.  It is plain stupidity.

The House of Representatives needs to pull out a copy of the impeachment form, write "Incompetent" under reason for impeachment, and vote to impeach the Attorney General. At that point, Gonzales would be tried in the Senate on grounds of incompetence. If, during the trial, he continued to defend himself with his pitiful  "I don't know" and "I don't recall,"  the Senate would have to remove him. If he tells the truth, he could save himself but would likely bring down the entire Bush administration, since it is clear that Bush and Cheney are directing him to keep quiet.

The Blistering: Chapter VII

To read this serial suspense novel from the beginning, go here. 

 

Feminine Fisticuffs

There were freshly shaved legs flying everywhere. Cardinal hadn’t seen so much flesh in motion since he took a front seat at Radio City Music Hall as a teenager.  Before long all four women were glistening with sweat, fabric adhering transparently to skin, and at that point it might as well have been a porn movie.

One of the girls got a good lick in on Marsha and she went crashing into the table right next to him. As she got up moisture and heat flowed from her, and she slowly spread her feet apart, lowering her center of gravity in anticipation of an offensive move. Her muscles flexed rhythmically, thighs, shoulders, neck, and even a part of her torso now visible though a tear in the maid’s outfit. Her fall, disappointingly, had toppled his glass of bourbon and water. He had been looking forward to sharing what was left of it, rohypnol and all, with the winner.

Despite a three-to-one disadvantage, as the fight progressed Marsha began to gain the upper hand. All those months of lifting his capital crime file had really built her stamina. Perhaps more relevantly, Marsha had brass knuckles, and was using them with great skill. After the four of them had smashed both lamps, most of the furniture, and left half a dozen cranium-sized holes in the drywall, Marsha picked up what was left of the table top and smashed it on the heads of two of the girls. Then she pivoted in one Rockette motion and got the third in the face with both brass knucks. In three efficient seconds, all three were knocked unconscious.

Oh, well, Cardinal thought. He wouldn’t have wanted any of those three women now, not after the job Marsha had done to their faces.

Marsha’s momentum carried her into the corner of the room, and in exhaustion she stumbled down to her hands and knees. There wasn’t a lot left of that maid’s outfit now. Slowly, perspirationally, she rose to her feet. John stood up out of his chair.

“Fine work. Couldn’t have done better myself.”

Her eyes widened. “You mean to tell me you weren’t duct taped to the chair all that time?”

“Oh, I was at first, but I have a cutting device in my watch. I had the tape cut away by your fourth karate kick.”

“You bastard. Why did you let me go through all that if you could have helped me?”

“You kidding? And miss a show like that?”

“I repeat myself. You bastard.” Her second rebuke trailed off with indifference, her mind already working on the next problem. She scanned the detritus that remained of the room, finally spotting a purse. Picking it up, she began going though it, casting out its contents piece by piece.

She pulled out a pistol. “I guess they were confident in their abilities in martial arts. They would have been better off drawing the gun on me.”

"Who would have gotten them off on the murder one charges with you in the cemetary?"

She pulled out a wallet, opened it up and looked at the ID. “Care to know what Candy’s last name is?”

“Not really. Let's just keep it as a one night stand.”

“Fine. But this ID here," she flipped over the wallet, "is quite interesting. Candy is an undercover agent.”

“FBI?”

“Department of Education.”

Next Episode: School Daze