Perfect Poison by M. William Phelps Page A

one to associate with the other patients, isolated himself in his room.
    Getting the cellutitus under control was the only reason Marier admitted himself to the VAMC, and his dosage of insulin upon admission reflected that. Because he wasn’t being treated for diabetes during this particular visit, Marier’s meds had been adjusted to counteract the fact that he was on a restricted diet and antibiotics for the ulcers. What was more, low or high blood sugar was not one of his problems. Nor was anything having to do with his heart.
    In fact, a doctor later calculated the risk factor percentage for Marier’s having sudden cardiac arrest—as so many of the Ward C patients around him were seemingly having—as being “less than one percent.” Diabetics don’t generally go into cardiac arrest, no matter how low their blood sugar is. Even if a hypoglycemic event occurs, where the BSL dips to dangerous levels, cardiac arrest is unlikely. There has never been a correlation between cardiac arrest and low blood sugar. “One does not cause the other, period,” a doctor who later assessed Marier’s condition said.
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    As the charge nurse, John Wall worked the 2:00 to 10:00 P.M. “T shift” on December 20, 1995, while Gilbert, who handled the med cart, and Kathy Rix, who spent the night working in ICU, were scheduled for four to midnight. As usual, Bonnie Bledsoe, a respiratory therapist who had been dating and living with John Wall at the time, April Gougeon and Lisa Baronas were also on board. Renee Walsh, who had been scheduled to leave at four, was still there. Since Ward C was understaffed, Wall had asked Walsh to hang around and help out where she could.
    The nurses were split into teams. Since Marier was in the room directly next to the nurse’s station, he was on Gilbert’s team. She would be responsible for giving him his meds for the night. Wall, seeing they were shorthanded, also volunteered to give out meds and look after a few patients. Since Marier was in the room across from the nurse’s station, Wall decided to take him on as a patient.
    During the day, Marier had been seen by several nurses. One of them, Frank Bertrand, a burly man about the same size as Marier, had befriended Buck. Bertrand called him “a woodsman—a guy who played hard and perhaps lived hard, too.”
    Before he left for the day, Bertrand had taken Marier’s vital signs. With a temperature of 97.9, a heart rate of 85, and his blood pressure at a near perfect 126 over 80, Bertrand noted he was fine.
    Between four and six o’clock, Marier’s vital signs were checked again. He was “stable,” “normal,” one nurse recorded. His mental status was “alert and orientated.” Francis Marier was, by all accounts, recuperating from the ulcers on his left leg. On top of that, Marier wasn’t shy when it came to ringing the call bell. With a deep, thunderous voice, if something was bothering him, he would gladly let the nurses know about it.
    At 8:00, Wall looked in on Marier for about the eighth time that night, and noted that although he “denied any change in the sensation of his leg where the infection was, his appetite was one hundred percent.”
    Furthermore, Wall reported, Marier showed no signs of hypoglycemia, a common illness among diabetics. When hypoglycemia sets in, diabetic patients almost instantly become weak, drowsy, confused and hungry. Turning pale, they get dizzy and develop headaches. They become irritable. They sweat, tremble, and their heart beats rapidly.
    To the contrary, Francis Marier was calm and relaxed, getting ready to go to bed. He’d even shaved himself.
    Around 8:15, Wall checked his BSL and found it to be within normal limits. Again, Wall noted that he was “alert and orientated.”
    After Wall finished up in Marier’s room, he returned to the nurse’s station and continued to catch up on