Lawless - Episode 5.5: Brain Trust

Audio sources and additional resources listed at the bottom of the transcript.

LYNN VINCENT, HOST: The Irish playwright Oscar Wilde was a quotable man. One of his most famous quotes is, “Life imitates art far more than art imitates life.”

In Lawless Season 1, you’ve heard a lot of 9-1-1 calls. Ambulance sirens. Paramedics working. So far, they’ve all been for Terri Schiavo. But on May 5, the day our last episode aired, the paramedics came for me. Seriously, they came for me.

It started a couple of weeks ago. I felt dizzy. Lightheaded. I tracked my blood pressure, which was normal. Was it vertigo? An inner ear virus? I’d had one of those before. This time, when I felt lightheaded, I’d lie down. Put my feet up. And soon enough, the feeling passed. Finally, though, on May 5, I felt dizzy enough to call 911.

In the ER, tests and more tests. Lab work—all normal. CT scan—clear. But then life did imitate art.

TONY FAM: So, first coming into the hospital, we want to rule out a hemorrhagic stroke, like a bleeding type stroke. And so you had a CT scan. CT scan, luckily was normal. So it very quickly tells us not a bleeding type…

Dr. Tony Fam is an internist at one of the largest hospitals in the San Diego region. He’s also the doctor who admitted me to that hospital.

FAM: So after that you underwent an MRI…

The MRI showed…a glitch. In my brain. A tiny dot. Think of it as a pixel. It was a stroke. An ischemic one. I didn’t even know I’d had it. In the United States, someone suffers a stroke every 40 seconds. Many don’t know it until years down the line.

Turns out, my dizziness wasn’t a sign of stroke, per se—it was a sign of where I’d had it.

FAM: So yours was located inside the pons, which is about a two and a half centimeters—about a one inch diameter— structure. So it's very small, it's a part of the brainstem.

Dr. Fam calls the pons “Manhattan real estate”—tiny, but valuable. The pons relays critical data to other parts of the brain. It regulates things we do without thinking. Like breathing. Sensing pain. And equilibrium…which explains those dizzy spells.

Ironic isn’t it? I’m in the middle of investigating the story of Terri Schiavo, a brain-injured woman…when I suffer a brain injury myself. No comparison, of course. Not only was Terri’s brain injury severe and life-altering, but there’s a very good chance that her entire state of consciousness was misdiagnosed.

LAWLESS THEME: INSTRUMENTAL BARS

From WORLD Radio, and the creative team that brings you The World and Everything in It: This is Lawless.

I’m New York Times bestselling author and WORLD Magazine senior writer Lynn Vincent.

Lawless is a new true crime podcast that examines a frightening fact of American life: That not every crime is against the law. In America, the essential value of being human has eroded to the point that what once would have been prosecuted as a crime is now unexceptional. Even celebrated.

In Season 1 of Lawless, we’re investigating the Terri Schiavo story, a case that in 2005 shocked the world. This is Episode Five Point Five: Brain Trust.

SPONSORSHIP MESSAGE: Lawless is made possible by listeners like you. Additional support comes from Samaritan Ministries, a Biblical solution to health care, connecting Christians across the nation who care for one another spiritually and financially when a medical need arises. More at samaritanministries.org/worldpodcast.

So far, you’ve heard a lot of nitty gritty details. A lot of pieces to this 15-year puzzle. In this Point Five episode, we’ll take a step back to look at some of the main threads that run through the whole story. We’ll tug on some of those threads…The questions we’ve raised…and haven’t answered yet.

In our first Point-Five episode, you met Lillian Hamman—the Sound Queen. This week, my co-writer Anna Johansen Brown is taking point. Anna is a deep thinker and…a new mom. An intellectual who is also hilarious.

Anna’s been with me from the start of this podcast reporting adventure. Last May, when I went to Florida to do on-site interviews with people close to the case, she traveled with me.

ANNA JOHANSEN BROWN: I'm Anna. I am carrying the mics and doing some of the sound stuff...

Anna was there when we drove around St. Pete’s in a rental car with no air conditioning. In Florida. In the summer.

LYNN: That’s just blowing hot air.

ANNA: Yes it is…

And she was there when we wandered the beach with Bobby Schindler, exploring one of Terri’s old haunts.

ANNA JOHANSEN BROWN: The ocean at St. Pete’s looks like a postcard. A long sweep of translucent green-blue waves. Boardwalks running out across the dunes. Black eyed susans. Seagulls. Sailboats.

BOBBY SCHINDLER: This is the Pass-a-Grille. It's one of our favorite beaches while we lived here.

Across the street is a tall Victorian style house painted mint green. It’s a restaurant called the Hurricane. A fixture in this area.

SCHINDLER: When we moved here they were known for having the best grouper sandwiches, if not in Florida, at least in this area.

It’s a beautiful beach. But being here is strangely melancholy.

LYNN: So I'm having the most interesting experience. And I don't know if I'm just imagining things, but I just keep having these images of Terri, just laughing and just, you know, having fun on this beach.

Bobby and Terri spent boatloads of spare time here…back before her sudden, unforeseen, abrupt, out-of-the-blue brain injury. Back before everything changed.

Before Terri got the diagnosis: Persistent Vegetative State. It’s one of the most crucial pieces of this story. So it’s the first big question we’ll talk about today.

That diagnosis would become the lynchpin of years of litigation. Which is ironic. Because in the 1990s, PVS was still a brand-new field of study. Lots of “figuring it out as we go along.” Even to this day, it’s a slippery, controversial thing. Here’s Village Voice journalist, the late Nat Hentoff.

NAT HENTOFF: Persistent vegetative state is one of the hardest things to diagnose. The last big survey in England, there's a 43% error rate. So this is very, very amorphous.

Experts didn’t hammer out a protocol for clinical diagnoses until 1994…four years after a doctor labeled Terri as PVS. Here are the key metrics: No awareness of self or environment. No voluntary, reproducible responses. And no evidence of language comprehension.

But…just days before Terri’s PVS diagnosis, a doctor noted the progress she had made.

CLIP FROM EPISODE 3: Dr. Barras gives Terri a physical exam. She closes her eyes to mock threats around her face and blinks appropriately. Terri responds to pain by moaning and moving her arms and legs. She makes eye contact with family members. And by this point, she says the word, “no.”

Several months after Terri’s injury, Michael took her to California for an experimental treatment. Doctors implanted a brain stimulator to try to jumpstart Terri’s cognition.

Throughout the first month of stimulation, Dr. Eugene Alcazaran reported that Terri had “increased alertness.” He said she turned her head toward voices and could track things with her eyes. Speech therapists noted that Terri could follow commands like sticking out her tongue, nodding, and blinking.

Michael would later say that was all just wishful thinking. Here’s one of Michael’s lawyers, George Felos.

GEORGE FELOS: Michael in the first few years of Terri after Terri’s cardiac arrest believed the same as the parents. He misinterpreted the involuntary actions of Terri as, as consciousness and he said, she's there, and I can. I know she's there. And I know she understands me. And I know she can get better. And so it was that took a long time for him.

By the early 2000’s, doctors had begun to identify a different state of cognitive awareness in severely brain-injured patients. They had more awareness than some people in PVS. Patients in this newly recognized condition drifted between a reflexive state with random movements…and conscious, purposeful responses. That describes Terri to a T.

WESLEY SMITH: Her brain was consistent with either the minimally conscious, which is what the Schindlers said she was, and what the videos that they posted up on the internet said, would make it appear…

This is lawyer and author Wesley Smith.

SMITH: …where someone comes in the room and says, Terri, will you lift up your eyebrows, eventually she says she raises her eyebrows, and she raises them so high, her forehead wrinkles. I mean, that is a really humanizing moment for Terri, or when she comes in and her mother says, Hi, Terri, it's mommy. And Terri looks over and gets a big smile on her face. Now you know, you're not dealing with quote, a vegetable, close quote, you're dealing with a human being.

By 2002, even before Terri’s case arrived on most people’s radar, research had advanced enough to give this condition a name—the minimally conscious state, or MCS. But by then, Terri had already been slapped with the PVS label.

After long stretches without rehab, Terri’s progress slowed. But even years later, witnesses like Tom Broderson still reported a shocking level of awareness.

TOM BRODERSON: At some point I said, Terri, I'd like you to do this. I'd like you to moan. But hold it like a note if you were singing. And it'll sound like this. Aaaaah. And I probably said it again. I had no idea of, of what intellectual level she was operating at. So I was trying to be as clear as I could be. But after I asked her to do it, she went ahhhhhh. And I was blown away.

We were blown away, too, Lynn and I. Broderson’s interview was stunning. I’m pretty sure my mouth was hanging open for most of it. You’ll hear more of what he had to say in Episode 8 and also on a future edition of The Point Five.

Broderson visited Terri in 2002—one year before the media began characterizing her as “comatose.” Some even called her a “vegetable.”

NEWSCAST MONTAGE:

But Terri definitely wasn’t in a coma. And if Broderson was right…if Terri could communicate…she wasn’t in PVS either. And if she wasn’t in PVS, then it’s not likely that Michael could remove her feeding tube…even if that was what Terri would have wanted.

But before anyone started wondering about Terri’s wishes, they were asking another question. A question that should have had a simple answer: What happened that night, back in February of 1990?

CLIP FROM EPISODE 2: Experts say that in times of extreme trauma, events often burn into the human memory with sudden and unalterable clarity…

We’ve talked a lot about what happened in those early morning hours. Or…what may have happened. The trouble is, no one seems to know for sure.

CLIP FROM EPISODE 2: …but somehow, that burning clarity of memory would become blurry. The timeline of events. Who called whom, and when. Even the position of Terri’s body. And details that should have been easy to remember would change.

When the homicide detectives talked to Michael that morning at the hospital, his account was straightforward. He woke that morning, heard a thud, found Terri, called 911.

But that simple retelling would soon become more detailed…and more confused.

Terry Beckstrom is an investigator and security expert. He spent 25 years as a special agent with the US Department of Justice.

TERRY BECKSTROM: There were timing inconsistencies with I guess in the different interview that he did. He would articulate different times that he arrived home, and that he woke up. And there were also timing consistencies, or with what, what time he actually called paramedics.

When Michael wrote his book in 2005 chronicling the case, he says he woke up “sometime after 5:30.” That’s when he heard a thud, went out to the hall, and found Terri unconscious. But in a 1992 deposition leading up to the malpractice trial, he says he woke at 5:00. When Larry King interviews him in 2003, he says he woke up at 4:30.

The 911 call came in at 5:40am.

BECKSTROM: The problem I have with that is usually if someone is telling the truth. They're going to remember that first time articulated. And they're going to keep repeating that same time, it's not a difficult thing to remember.

Years into the case, what time Michael woke up that morning would become a crucial, yet bitterly disputed fact. At first, Michael says he found Terri on her back. That’s what he told lawyers in that 1992 deposition. But in 2000, on the witness stand once more, he says he found Terri on her front and turned her over.

By the time he wrote his book in 2005, his story had shifted again. He says he found Terri on her left side, one arm down by her side, the other flung up over her head. “I got down on my knees,” he writes, “rolled her over so she was facing me, and scooped her into my arms.”

Michael says he cradled Terri three different times. But that doesn’t fit with what Bobby remembers. Or what the paramedics reported.

CLIP FROM EPISODE 2: The paramedic tells the cop that they found Terri facedown on the floor, half in and half out of the bathroom.

LYNN: And how did you find her?

BOBBY: On the floor, on her stomach, and her hands are underneath her torso. And her face was to the side.

Once the paramedics arrived on site, it’s all pretty clear and documented. But before that? What caused Terri’s brain injury in the first place? We’ve covered one theory so far…the theory that convinced a jury.

DAN GRIECO: Her nutritional levels were totally off. And that's what caused it, it was the eating disorder. And it was bulimia.

But that diagnosis was based on a single piece of key data: Terri’s potassium level. The problem is…there’s more to it than that. Let’s rewind.

SCHINDLER: I knew something was, something wasn't right. Because you could tell they were very, very concerned. And I think it wasn't. It was shortly thereafter, they hit her for the first time with the defibrillators.

The paramedics are desperately trying to revive Terri, trying everything they know.

SCHINDLER: They seemed to be adamant that it was an overdose.

They hit her with Narcan, a drug that reverses the effects of narcotics. And five doses of adrenaline. Adrenaline is a hormone the body produces in response to stress. Here’s Gavin Perkins, an expert in critical care.

GAVIN PERKINS: Adrenaline is exciting. Can you feel the rush? I mean, it's exhilarating. It gets your heart pumping.

…literally. Adrenaline increases your heart rate and strengthens the force of its beating. That’s why doctors use it to jumpstart a struggling heart. But adrenaline doesn’t just affect your heartbeat.

In 2018, Perkins led a group of researchers studying the effect of adrenaline on people who suffered cardiac arrest. People like Terri. Here’s what the researchers found: Adrenaline helped buy time to get patients to the hospital.

PERKINS: There were 36 more survivors overall.

But it increased the likelihood of severe brain damage. In fact, it doubled it.

PERKINS: There were 27 patients, more patients that had moderate or severe disability in the adrenaline treated group.

Patients who received adrenaline were twice as likely to have severe brain damage. Why? Because adrenaline reduces blood flow to other organs…like the brain. Terri’s brain was already oxygen-deprived. It’s possible that adrenaline made it worse.

Adrenaline also messes with other systems in the body.

Jon Thogmartin is the medical examiner in Pinellas County, Florida. He conducted an autopsy on Terri’s body in 2005. We’ll go through it more in a later episode. But part of what he said is relevant here. He notes Terri’s severely low potassium level. That was what originally prompted Dr. Shah to wonder if Terri had an eating disorder. But Thogmartin says that’s unlikely. Instead, he points to another cause.

During that hour the paramedics worked on Terri, they gave her “dextrose solution, five 1 mg doses of epinephrine…lidocaine, Narcan, dopamine and seven defibrillations.”

Thogmartin points out that epinephrine and defibrillation are known to cause changes in electrolytes. Drastic swings in potassium levels. He says flat out that Terri’s potassium levels were probably low because of all the stuff the paramedics gave her…not because of any secret eating disorder.

“Thus,” he writes, “the main piece of evidence supporting a diagnosis of Bulimia Nervosa is suspect, or at least, can be explained by her clinical condition at the time of blood draw.”

Here’s what’s important: if the bulimia theory is dismantled, a huge question remains:

What happened to Terri?

But that’s a question for a future episode. Lawless is taking a short break so that Lynn can get her…equilibrium back. We’ll be back with Episode 6 in a couple of weeks. Meanwhile, we’ve raised a lot of questions so far this season. Now, we’d like to hear your questions. The rest of season one is mapped out, but not set in stone. We’ve left space for last minute interviews or new developments. So if there are topics you want us to address, email us at editor@wng.org.

Next time on Lawless:

MICHAEL VITODAMO: I just remember somebody coming up with the idea that, you know, we need to record Terry. I did it without hesitation...just walking into Terry's room…and then starting to record.

Lawless is a production of WORLD Radio. Our executive producer and sound engineer for this episode is Paul Butler. Our production assistant is Lillian Hamman. Music by Will Shehan. Audio support from Creative Genius Productions. Lawless is reported and written by Lynn Vincent, Bonnie Pritchett, and me, Anna Johansen Brown. For a list of additional audio sources in this episode, visit LawlessPodcast.com. Thank you for joining us.

AUDIO SOURCES:
(in order of appearance)

Democracy Now, Nat Hentoff: Terri Schiavo Suffered From “Longest Public Execution in American History.”

Youtube video, Shortcut of Terri Schiavo story by koliberek89

Vimeo video, Between Life & Death - the Terri Schiavo Story by beanfieldproductions

Youtube video, Terri Schiavo: A Look Back 10 Years After Her Death by ABC News

Youtube video, Michael Schiavo weighs in on Jeb Bush's potential bid for president by ABC Action News

Youtube video, Adrenaline in cardiac arrest is dead, what next? by Coda Change

CSPAN video, Experiences on the Terri Schiavo Case, January 9, 2006

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.