“But Dr. Cage would have seen that the morphine was not killing his patient, would he not?”
“If he stayed at the scene. Did he stay at the scene?”
“Let me ask the questions, Dr. Phillips. Would it have been to Dr. Cage’s advantage to stay at the scene? If his goal was to murder the patient and not be found out?”
“Well, of course. If he had stayed at the scene, then Mrs. Turner would have died under a doctor’s care. No autopsy would have been required. If he wanted to kill her, or murder her, he’d have been home free. Unless the family raised a stink.”
The question of whether or not Dad was present at Viola’s house during her death comprises the central hole in Shad’s case, and to my knowledge, no evidence proves that he was. The idea that Quentin would let this kind of leading questioning proceed without objecting is simply beyond me.
“How long after the botched morphine injection would it have taken for a doctor at the scene to realize the drug was not killing his patient?”
“That’s hard to say. It depends on a lot of factors, and a patient’s morphine tolerance can’t be determined after death.”
“Can you make an educated guess?”
“Between ten and thirty minutes. With as little morphine as got into her bloodstream, Mrs. Turner might have remained conscious the whole time, or she might have awakened after only a few minutes of sedation.”
“All right. Why would a doctor administer adrenaline after seeing that the morphine was not having its intended effect? Would he do it to resuscitate her? To try to bring her back to life?”
This question is improper on so many grounds that I wouldn’t know where to begin to object. Shad is obviously implying to the jury that Dad injected the adrenaline, when he has presented no evidence that he did so. Yet Quentin does not object!
“A knowledgeable physician would not use adrenaline in that situation, no. He would know that adrenaline does not counteract the effects of an intravenous morphine overdose. For that he would need naloxone. I suppose that if he were desperately trying to save the patient, he might hope it would help keep her alive until paramedics arrived to take her to the hospital. But the evidence shows that a lethal dose of morphine never reached Mrs. Turner’s brain, so why would he try to resuscitate her? She could not have been dying from the morphine.”
What if she were dying of something else? I make a note to ask on cross, as if I will actually get the chance to question this witness.
“Precisely,” says Shad. “And in this case, no paramedics were called, Doctor. Furthermore, we know from the hard drive recording that the doctor was not performing chest compressions on the patient subsequent to the adrenaline injection. What does that suggest to you?”
“Object, Quentin,” I mutter, “you son of a bitch.”
“Medically, I can’t make sense of it. Not if his objective was to save the patient. But then, why would he be trying to save her at all if she had signed a DNR directive? Adrenaline is used to yank patients back from the precipice of death. A DNR order is signed for the specific purpose of preventing the use of such drugs.”
“Think about the facts as they’ve been explained, Doctor. Can you come up with any theory that might explain them, short of Dr. Cage intentionally giving the adrenaline to murder the patient?”
“Well . . . a doctor helping a patient to die might feel some regret in the midst of the act. It’s conceivable that he might try to resuscitate her with adrenaline, and accidentally kill her with it. Due to allergy or simple overdose. The effects of epinephrine can vary widely from patient to patient.”
“Epinephrine and adrenaline are the same drug, correct?”
“I’m sorry, yes. But again, a competent physician would know that adrenaline wouldn’t specifically counter the depressive effects of morphine. And finally, again, the evidence shows that a lethal dose of morphine never reached her brain. Why would anyone try to resuscitate a conscious person? It makes no sense.”
“I suppose he might have tried to resuscitate her in that ten-to thirty-minute window of unconsciousness, if he were suddenly filled with remorse, as you suggested.”
“Yes, but if so, then why didn’t he call paramedics?”
“Oh, yes. Thank you for reminding me. Doctor, given the forensic evidence, let me suggest a hypothetical scenario to you, as a forensic expert.”
At this, I almost throw the kitchen phone onto the floor. Even Judge Elder must have been tempted to step in here, yet the questions roll on, as if Shad is directing this movie as well as acting in it.
“Our physician means to kill his patient with morphine by injection of an overdose. The patient submits voluntarily, as it was her intent to commit suicide. Due to stress and arthritis, the doctor botches the injection. Soon he realizes that the morphine is not killing the patient. He has no more morphine. The doctor is under a time constraint to leave the house. His patient has been partially sedated by the morphine, so he decides to use what he has on hand to finish the job. He decides to inject her with IV adrenaline, which will send her into cardiac arrest. Because of his profession, and his standing in the community, he’s virtually certain that no questions will be asked, so long as he remains at the scene to call the coroner. He can sign the death certificate himself. It will still be a perfect murder, as he’d planned. Are you with me so far?”
“Yes.”
“The problem begins when the adrenaline hits the patient’s system. She does not die quickly. She panics, cries out, flails about. Despite his plan, the doctor is horrified by what he’s done. He might even be afraid that the neighbors or relatives will hear and become alarmed. In his panic he flees the scene, knocking the telephone onto the floor. He knows that by leaving the scene, he is risking an autopsy. But if the adrenaline is detected, he can simply say that he resuscitated the patient and left her alive. That he was in a quandary about what to do. He had to say that, you see? Otherwise he could not explain his failing to report her death.
“Do you see any problems with this scenario so far?”
“Only that adrenaline has limited therapeutic value in counteracting a morphine overdose, if he intended to claim he had resuscitated her with it and left her alive.”
“Might not a general practitioner plead ignorance on that point? Ignorance and desperation?”
“No. But you’re forgetting the DNR order. Why would he say he had tried to resuscitate her, since she was DNR?”
“I’ll ask you to answer your own question.”
“I don’t know.”
“Think about it.”
“Well . . . he might claim that, since the woman was his former nurse, and he had great affection for her, he disobeyed the DNR order and saved her.”
“That would make sense, wouldn’t it?”