Paula Reed Ward - Death by Cyanide: The Murder of Dr. Autumn Klein

acknowledgments

I would like to thank all those who helped in the conception and execution of this projectfrom providing even the most mundane of details to sharing huge parts of their lives with me. It could not have happened without each one of them.

This book is a culmination of the work of many, including Lillian Thomas, who is a superb editor and friend; the Post-Gazette, which gave me the gift of time to do research and reporting in the early stages; my dear friend Patti Hippler, who can copyedit with the best of them; my best friend, Pamela Walck, who knows how to calm my madness; my sister Janet Sardon, who unfailingly makes me laugh and supports me; my sister Lisa Ford, who sent words of encouragement every day; and my agent, Jane Dystel, of Dystel and Goderich, who took a chance on me sight unseen.

Among those who deserve individual thanks are Neil and Suzanne Alexander for the amazing work they do through their Live Like Lou foundation, and Mike Manko from the Allegheny County District Attorneys office, who really is a very patient man.

To the Klein family, I think about you often and wish you peace and happiness in your lives.

And of course, my most immense gratitude goes to Jim, Logan, and Gavin for not only tolerating me throughout this ordealJim is inevitably rightbut for encouraging me, too. I could not imagine a world without you, your love, and fun.

All of the information in this book was obtained through interviews, court documents, medical records, e-mails, and trial testimony.

1

saving one of their own

THEY HAD NO IDEA what was wrong.

Their patient, a forty-one-year-old female, was lying on the kitchen floor unresponsive, after, her husband said, shed collapsed suddenly while complaining of a headache. Immediately, they began their assessment. She was breathing and had a pulse.

Steve Mason got a quick summary from Bob and asked him about a big ziplock bag of white powder on the counter. It was creatine, he said, that his wife was taking for infertility. As they spoke, Masons partner, Jerad Albaugh, got his attention.

Their patient was crashingher pressure and pulse were dropping fast.

Shes not responding, Albaugh said.

The men loaded her on a gurney and rushed her to their ambulance parked in front of the home. They called ahead to the hospital and raced the half mile there, with Albaugh unable to do anything other than start an IV during the short trip.

They pulled up to the emergency entrance of UPMC Presbyterian (Presby) at 12:21 a.m., an hour and three minutes after Autumn had walked out. She lay prone on the gurney, her arms contorted and her face twisted up and over her left shoulder.

Emergency department (ED) resident Dr. Andrew Farkas met the stretcher in the hallway. The patients eyes were open and glassy, and her breaths were shallowshe was struggling to breathe. There was a vacant look on her face.

They rushed her to curtain area thirty-two in the ED, where her heart rate was measured in the low forties, and her blood pressure was barely moving at forty-eight over thirty-six. Although her pupils were reactive to light, the patientwhom they now knew was a Presby neurologistwas unresponsive.

The team of nurses and technicians assisting Farkas put in another IV to push fluids to try to boost Autumns blood pressure. Her respirations were starting to slowas low as four per minuteand Farkas knew immediately she needed to be put on a ventilator to help her breathe. He inserted the breathing tube into her mouth and down her trachea, then ran to get his ED attending physician, Dr. Thomas Martin.

Just two minutes after Farkas checked his patients pupils, Martin checked them again. They were no longer reacting to light.

Farkas had ordered a broad panel of blood tests, gases, and chemistries be sent out to check Autumns organ function. The problem, though, was that because she was so slim, the staff was having trouble getting a blood draw from her arm. Using a larger needle, they moved to the femoral artery in her leg, but still couldnt successfully take her blood.

As the staff continued to work on Autumn, her husband arrived with his friend and colleague, Dr. Robert Friedlander, who had driven him there. Farkas pulled back the curtain surrounding the bed where Autumn lay, the vent pushing air in and out of her lungs.

Bob took a long look and then screamed, No!

Farkas continued his assessment while he listened to Bob describe what had happened at the house. Autumn had been complaining of headaches in recent weeks, and when she arrived home from work that night she said she wasnt feeling well. Her husband described her grasping her head in her hands and dropping to the floor.

Farkas and Martin suspected she was having a brain hemorrhage. They needed to get a CT scan of her head immediately, so they momentarily scrapped their plans for the blood draw to move her to the 3-D imaging machine.

It was only one hundred feet from her bed, but Autumns pressure was below sixty, and her pulse was in the thirties. Just putting her in the scanner was too risky. Ignoring protocol, Martin went in with her. Draped in a protective vest, he pushed epinephrine every one to two minutes to keep her heart pumping.

As the scan ran, the images immediately appeared on a computer monitor in the control room.

They were normal.

It looks completely clear, Farkas said. Theres no explanation for her symptoms. Theres no evidence of any disease state whatsoever.

The emergency team then switched focus, trying to think of what else could cause such a dramatic decline so fast. They ordered additional CT scans of Autumns chest, abdomen, and pelvis. Her EKG showed no abnormalities in her hearts electrical activity. There was no aneurysm in her abdomen. She had no aortic tear that could have caused blood to spill into her chest cavity. There was no blood clot in her lungs.

The treatment team had no idea what was wrong.

At 1:20 a.m., Martin paged the hospitals on-call intensivista doctor who works exclusively with intensive-care patients. Dr. Lori Shutter returned the page.

This is Tom Martin. Im one of the ED docs.

Yeah, Shutter answered. What do you need?

I have a patient down here. You may have heard of her: Autumn Klein. Shes one of our neurology attendings.

Autumn? Shutter responded. Autumn was her colleague, neighbor, and friend.

Yeah. She got here around midnight. Ive been working on her since then, and I just need help. I dont know whats going on.

Shutter hung up the phone, thinking to herself, What the fuck would have happened to Autumn? Shes younger than me. What could have happened? The critical-care physician told the fellow she was working with that she was needed in the ED and rushed to the elevators to make the trip down the nine floors to the ground level of the hospital.

She quickly walked around the corner to the trauma room where Autumn lay, a huge team of nurses, technicians, and doctors working on her. Bob, Friedlanderthe chair of neurosurgeryand Autumns neurology chair, Dr. Lawrence Wechsler, were there, as well.

Bob, whats going on? Shutter asked.

He said Autumn had collapsed at home.

Martin was at the bedside, still pushing syringes full of epinephrine to try to sustain Autumns blood pressure. He told Shutter about her condition, the need to intubate her, and the puzzling fact that all the CT scans were clear.

I cant figure out whats happening.

The nurses were still having difficulty getting blood from Autumn, who at nearly five foot seven weighed only 107 pounds. Everyone agreed she needed to have a central line placed in her chest so that they could more quickly administer medications and draw blood.