Blood On The Table

by Colin Evans

  Less than twenty-four hours later Nancy was dead. The end came at 8:15 A.M. on March 21. It seemed inexplicable. An autopsy could shed no light and the stated cause of death was “undetermined physiological reaction.” All surgeons have either experienced or have heard of such isolated tragedies, but Harris was shaken to his core. His only hope was to put the disaster behind him and move on.

  Except that one month later it happened again.

  On April 22, Margaret Henderson, age twenty-six, had also been admitted with abdominal pain, but an exploratory incision, carried out by Harris, had revealed no abnormalities. After a comfortable night, Mrs. Henderson was seen by a nurse at 6:30 A.M. the following day and found to be “tense and apprehensive.” At 7:30 A.M. she was given a bath. Half an hour later, according to the chart, she was unable to swallow and complained of pain in her legs and chest. Another doctor, not Harris, put Mrs. Henderson on an IV drip. At some time during the next forty-five minutes, a third doctor also examined Mrs. Henderson. Despite all this attention, at 8:45 A.M. she died. This time an autopsy was able to disclose a viable cause of death: acute hepatic necrosis, a severe and rapid form of liver failure. Harris was shattered. Twice in a month he had lost patients unexpectedly. And he wasn’t alone.

  When Dr. Robert J. Briski joined Riverdell as a surgeon in May 1965, he had brought with him a lengthy list of loyal patients, one expected to generate handsome revenues for the hospital. An unwritten assumption on Briski’s part was that his appointment would include unrestricted surgical privileges, but within a month he was called in by the hospital’s board of directors and told that his surgical performance had been downgraded to level B, which meant that, for major operations, he would require the supervision of an A-rated surgeon. Briski had bridled under this slight but continued without comment.

  In May 1966, and again another three months later, Briski lost patients on whom he had operated. Neither procedure was especially difficult and both patients were expected to make full recoveries. But it hadn’t worked out that way. Briski, like Harris, was stunned, and over the course of that summer, the problems for both doctors only multiplied, as their patients continued dying for no apparent reason, to the point where some began wondering if Riverdell was jinxed.

  Harris had no time for any of this voodoo nonsense. These unexplained deaths, he was certain, owed nothing to ill fortune and everything to human intervention. And there wasn’t a shred of doubt in his mind as to who that person might be. On October 25, 1966, unable to bottle up his suspicions any longer, Harris went to see his bosses. What he had to say would shake the hospital board to its foundations.

  Six days later, Harris was in full gumshoe mode, secretly breaking into the suspect’s locker. Inside he found eighteen ampoules, either empty or partially filled, of curare, and “a large syringe loaded with a needle on it.” Although Harris shuddered at the discovery, part of him heaved a huge sigh of relief. Vindication had never tasted so sweet. Here was rock-solid evidence—to his way of thinking, at least—that Riverdell’s top surgeon was a mass murderer.

  It is a curious fact that doctors probably account for more serial killers than all the other white-collar professions combined. From Edward Pritchard and William Palmer in Victorian England, to San Francisco’s J. Milton Bowers in the 1880s, and his contemporary Neil Cream who poisoned victims on both sides of the Atlantic, to the businesslike Marcel Petiot who gassed Parisian refugees during World War II after stripping them of their valuables, right through to recent times when a young intern, Michael Swango, poisoned his way across America first and then Africa, doctors feature in the serial killer statistics with startling frequency. The pinnacle of this medical mayhem, as far as we know, was reached with the quite extraordinarily lethal Dr. Harold Shipman, who over several decades murdered an estimated 254 patients (some put the death toll much higher) who attended his surgery in Manchester, England. Shipman’s longevity as a killer can be attributed to one very basic human quality: trust. It would never occur to most patients that the person treating them might be more interested in extinguishing their life than in saving it. The almost mythic bond that can exist between doctor and patient offered Shipman a deadly immunity. Most of his victims were elderly women whom he had been treating for years. All were dispatched with a single overdose of morphine, with no more thought or concern than if he had been killing a fly. Eventually the sheer scale and frequency of Shipman’s patient mortality rate did cause some colleagues to harbor suspicions about the avuncular doctor, but for most it was a fleeting doubt, rejected as quickly as it had occurred, pushed away to a dark corner of the mind. After all, doctors don’t go around killing people for no reason…do they? Dr. Stanley Harris certainly thought so. Only evil intent, he felt, could explain the presence of so much curare in the suspect’s locker.

  Beloved by detective story writers ever since the 1920s—Agatha Christie, a trained nurse, always had a particularly soft spot for this most sinister of toxins—curare’s deadly qualities were first discovered by the indigenous hunters of the Amazon basin. Monkeys might have been a prized delicacy in the village cooking pot, but their dazzling upper tree canopy gymnastics did make them damnably difficult to bring down with a blowgun. Even if the hunter’s aim were true, it didn’t always guarantee a tasty meal. Often the shock of being struck by a dart would induce in the monkey a cadaveric spasm—a kind of instant rigor mortis—causing its fingers to clamp viselike around a branch and enabling the beast to hang on for grim death, as it were. Scores of feet below in the undergrowth, the hungry hunter was left to gnash his teeth in frustration.

  And then one day, some inventive soul realized that by dipping his dart head in a gluey liquid distilled from various local plants, when the monkey was hit, instead of becoming rigidly taut, its muscles would relax as if by magic, causing the stupefied or dead animal to tumble from the tree and into the hunter’s grateful clutches.

  This hunting aid was prepared from the bark scrapings of the Chondodendron and Strychnos toxifera plants. These were boiled for about two days, then strained and evaporated until one was left with a dark, heavy paste with a very bitter taste. Testing the brew’s potency was rudimentary, to say the least: simply count the number of jumps a frog could manage after being pricked. The hunters called this substance variously woorari, woorali, and urari, all local words meaning “poison,” and it is from these that we get the word curare.

  Because curare production represented a source of considerable wealth to the various tribes, it was regarded as far too valuable for use in warfare and was kept solely for hunting. Darts, tipped with curare and fired with astonishing accuracy through blowguns made of hollow bamboo, would strike their target. Then it was a matter of waiting. A bird would ordinarily die in one or two minutes, small mammals might take ten minutes, and large mammals could survive as long as twenty minutes.

  The first outsiders to note this deadly use of curare were invading Spanish conquistadors in the sixteenth century, but hundreds of years would pass before its medical properties were realized. The breakthrough came in 1811, when the pioneering British surgeon Sir Benjamin Brodie noticed a strange phenomenon: during curare poisoning the heart continues to beat, even after breathing stops. He puzzled over what could cause this effect. The answer would not be forthcoming until much later in the nineteenth century when Claud Bernard, a French physiologist, discovered that the main active constituent of curare is tubocurarine. By experiment, Bernard worked out that curare causes paralysis by blocking transmission between nerve and muscle, without affecting nerve conduction or muscle contraction directly. Bernard’s findings intrigued the surgical profession. For years they’d searched for some means to keep patients absolutely still during delicate operations and curare seemed to fit the bill. The injection of curare during anesthesia produces a profound relaxation of the muscles (because the drug also relaxes the respiratory system to the point of standstill, patients administered tubocurarine have to be artificially ventilated). Typically, a
dose of 20 to 30 mg induces a paralysis lasting thirty minutes. The great benefit of tubocurarine is that the patient requires less anesthesia, thus reducing risk and greatly improving the postoperative recovery rate.

  In the right hands, curare is a lifesaver. Used willfully, it’s one of the most efficient killers on the planet. Larger than recommended doses are almost always fatal within forty seconds, with death owing to respiratory failure. What makes curare poisoning so ghastly is that the victim is very much awake and aware of what is happening until the loss of consciousness. Doctors who have volunteered to take curare under supervised conditions have described the ordeal as horrifying, knowing they were suffocating and near death, yet being unable either to call out or gesture. A more horrible death would be hard to imagine.

  Much the most insidious side effect of curare, though, is the way it disappears from the human body after it does its deadly work. And it is this quality, more than any other, that has enhanced curare’s reputation as the perfect poison, virtually impossible to detect, even with an autopsy and sophisticated toxicological analysis.

  Given this background, Dr. Stanley Harris’s shocked reaction when he found the half-empty ampoules of curare was entirely understandable. Surely now, the hospital board would have to investigate his suspicions and look into the meteoric career of Riverdell’s head of surgery, Dr. Mario Enrique Jascalevich?

  The slight and bespectacled man from Argentina had been born in Buenos Aires, on August 27, 1927, the son of Italian-Yugoslav parents. After graduating from medical school, he traveled to the United States to take up an internship at Passaic General Hospital, and in 1956 began a four-year surgical residency at New York’s Polyclinic Medical School. With his residency complete, he joined the surgeons’ staff of Christ Hospital in Jersey City. On July 12, 1961, three months after becoming an American citizen, he received his full medical license. In January of the following year, he married Nora Caperan, also from Argentina, and a talented pianist who studied at the world-renowned Juilliard School of Music in New York City.

  Jascalevich’s connection with Riverdell began in November 1962, when he joined the staff as the sole general surgeon. At the time Riverdell was a small, privately run hospital overlooking the Oradell Reservoir in northern New Jersey. In its short existence—it had only been founded three years earlier—the hospital had gained an enviable reputation for providing top-quality medical care. When Jascalevich joined the staff, Riverdell had about fifty beds and plans to expand rapidly.

  No one doubted Jascalevich’s technical excellence. In the operating room he was fast, superbly efficient, and imaginative (in the early 1960s he had invented a stapler, used to suppress bleeding during operations, that still bears his name). The problem was that nobody liked him. He had an abrasive, hackle-raising personality. Junior doctors who came to him for guidance and consultation on various surgical problems all too often found themselves swatted away like unwelcome flies. They soon learned that Jascalevich was brutally proprietorial with his expertise and begrudged sharing it with those whom he regarded as his inferiors. As the only surgeon at Riverdell with full operating privileges, he was much the biggest fish in a very small pond. That was how he liked it, and that was how he wanted it to remain.

  But Riverdell was expanding fast, and all that explosive growth put an intolerable strain on the staff. In the summer of 1965, the hospital board decided to boost the surgical team, and to this end, appointed Dr. Robert J. Briski. Warm and outgoing, Briski was the complete antithesis of Jascalevich, popular with other staff members, prepared to share his knowledge, always available should an emergency crop up. He was also an excellent surgeon. At first all went well. The hospital board was delighted with Briski, especially with the handsome difference that his prodigious patient list made to the hospital’s bottom line, but it soon became clear that his arrival hadn’t pleased everyone. Jascalevich was icily furious and made no attempt to mask his anger. Personality clashes exist in all walks of life, nowhere more so than among the kind of high-octane egos that populate the operating room, so Briski just shrugged, decided it was one of those things, and got on with his job.

  Continued expansion—by now Riverdell had eighty-one beds—meant that in April of the following year the hospital board hired another general surgeon, Dr. Stanley Harris. Jascalevich, who had lobbied hard against this appointment, only to be outvoted, was forced to sit and smart as his two junior surgeons began taking on more of the operations.

  Shortly thereafter, the patients began dying unexpectedly. The autopsy results were vague and inconclusive, usually attributing the deaths to postoperative complications, but for young doctors trained to save lives, that summer of 1966 was a savage time. Briski’s confidence plunged, bottoming out in August when he lost two patients in the space of a week. Harris, tougher minded, though no less traumatized, decided that if the pathologists couldn’t find what was killing his patients, then he would.

  He began by reviewing his cases. In July he had operated on Ira Holster for a diseased gallbladder. Within twenty-four hours Holster was dead. Acute coronary occlusion, said the death certificate. Then came a hiatus for the remainder of the summer. Relieved but still racking his brains to find the cause—after all, his career was on the line; many more unexplained “losses” such as these and no insurance company would touch him—Harris pored over the patients’ records and charts. Suddenly, a glaring fact leapt off the page at him. Throughout August and September, during which time none of Harris’s patients had died in peculiar circumstances, one person was conspicuously absent from the hospital: Dr. Mario Jascalevich. It might, of course, be nothing more than coincidence, except that Harris uncovered yet another warning flag. Just days after Jascalevich returned from vacation, one of Harris’s patients had died suddenly, and the chart showed that Jascalevich had visited him shortly beforehand. Harris frowned. There was no sound medical reason for Jascalevich to be there, his presence had not been requested, and such a visit was a clear violation of protocol. Then Harris’s eyes grew wider. By cross-referencing the records, he saw that all the patients who had died in mysterious circumstances had received a visit from Jascalevich shortly before their death. Coincidence could not explain such a bizarre chain of events; all Harris could conclude was that Riverdell’s senior surgeon was deliberately killing patients. Harris took his concerns to Dr. Allan Lans, a member of the hospital’s board of directors. Shortly after this came the dramatic opening of Jascalevich’s locker.

  Discovery of the curare prompted the board to immediately pass its suspicions to Guy Calissi, the Bergen County district attorney. This was a remarkable step. In the ordinary course of events, most members of the medical profession would rather walk barefoot over hot coals than accuse colleagues of malpractice. Their readiness to turn a blind eye is largely a matter of self-preservation. No one wants to jeopardize a hard-won career by being branded as a troublemaker or whistle-blower. After all, the reasoning goes, the next time it might be your name under the microscope. For instance, in the 1960s plenty of coworkers knew that Charles Friedgood was a lousy doctor who butchered patients, long before he got round to pumping his wife full of Demerol, but not one was prepared to pass their concerns to the relevant medical boards. As a result, despite being discreetly fired from a string of hospitals, the Long Island MD still kept finding jobs, fueling the egomania and sense of omnipotence that would eventually turn him from bungling physician to cold-blooded killer.

  For the Riverdell board to act so decisively meant that it had to be very sure of Jascalevich’s guilt. And after reading the report, the district attorney’s office agreed. Calissi and his assistant, Fred Galda, seized the contents of Jascalevich’s locker and hauled him in for questioning. The surgeon, bland and confident, offered a perfectly plausible explanation for the curare. In 1963–64, while a lecturer at Seton Hall Medical School, he had received a five-hundred-dollar grant to develop a new type of stomach feeding tube. About three hundred dollars of the funds were used
to purchase twelve dogs for experimentation. Although curare was not used in this research, he claimed that he had retained his interest in dog experimentation. When the grant money ran out, the fifty-thousand-dollar-a-year doctor protested he was unable to afford to buy more dogs in the conventional way, and that this led him to obtain animals in an “unofficial” way. (He claimed that by tipping attendants after hours at the medical school, he could obtain “dying dogs” left strapped down on tables by other researchers who had completed their experiments.) For this new round of experiments, which included biopsies, Jascalevich said he required curare.

  Calissi discovered that between September 21, 1965, and September 28, 1966, Jascalevich bought twenty-four 10 cc vials of purified curare from the General Surgical Supply Company of West New York. (As little as 5 cc’s of the standard solution of purified curare can be lethal without artificial respiration.) When questioned about the highly unusual string of deaths at Riverdell, Jascalevich empathized with Briski and Harris, because such tragedies were an inevitable corollary of surgical life; any doctor could lose patients in such a way. He attributed it to a dreadful run of coincidences.