The Chemistry of Alcohol and Love-Dr. Blumenschein Speaks

The Chemistry of Alcohol
and Love

By

Leonard Zwelling

         On September 18, 2014, in Judge Cabaniss’ 248th
District Criminal Court, I had a more thorough lesson in the organic
biochemistry of alcohol in the human body than I had had since I was in medical
school. This is because the first key step in the prosecution’s case against
Dr. Ana Maria Gonzalez-Angulo who is alleged to have poisoned her lover Dr.
George Blumenschein is to determine the cause of the acute renal failure and
intoxication that led to his admission into the MD Anderson ICU on January 27,
2013. He easily could have died from his illness, but did not although his
renal function is severely and permanently impaired.

         The two expert witnesses who acted as teachers for me and
for the jury were a medical toxicologist and one of the most knowledgeable basic
scientists in the country on the subject of ethylene glycol toxicity.

         It is beyond a reasonable doubt that Dr. Blumenschein was
poisoned with ethylene glycol. Both experts agreed that was the case with a
high degree of certainty. In fact, they had no doubts at all. Dr.
Blumenschein’s symptoms, signs and clinical course really have no other
rational explanation. The oxalate crystals in his urine are virtually
diagnostic.

         I
also learned that ethylene glycol is an alcohol metabolized by the body as all
alcohols are by alcohol dehydrogenase to an aldehyde and then on to an acid by
aldehyde dehydrogenase. (I am sure I knew this once, but I have had no use for
this information of late.) It is the final metabolite of antifreeze that can
combine with calcium and raise havoc with the kidneys. These are the oxalate
crystals. This is what has been presumed to have happened to Dr. Blumenschein.

         I also learned that many cases of ethylene glycol poisoning
are caught early in the ER because they result from an alcoholic’s cravings leading
to the ingestion of the wrong kind of alcohol to which the patient admits, a
child being found drinking the stuff by accident, or a suicide attempt with a
note next to the bottle. None of these were in play here. Thus, it took the MD
Anderson staff a little time to figure out the diagnosis and initiate
treatment, but the medical toxicologist found no fault with Dr. Blumenschein’s
care.

         The next question being asked is where and when he ingested
the toxin that almost led to his demise. The prosecution will be making the
case that he was poisoned on the morning of January 27 by the defendant through
her spiking his coffee with ethylene glycol obtained from a laboratory at MD
Anderson. The defense is trying to extend the possible time line of the
offending event back a few days to when the defendant was in Houston and the victim
in San Diego, putatively explaining the 2-day delay in the symptoms exhibited by
Dr. Blumenschein to his having ingested significant quantities of ethanol
(wine, vodka) to compete with the metabolism of the ethylene glycol so as to
delay his illness. Both ethanol and ethylene glycol are similarly metabolized
and so when both are present, the ethanol can delay the metabolism of the
glycol to its toxic acid form. The two experts were quite convincing that this
theory does not pass the smell test in this instance. It turns out that Dr.
Blumenschein would have had to sustain a blood alcohol level beyond the legal
limit for driving by ingesting ethanol throughout the period from Friday to
Sunday for the poisoning to have taken place prior to his return to Houston on
Saturday January 26. Not likely.

         The chemistry doesn’t lie, which is more than I can say for
the principals in this trial who had denied they were having a relationship
when directly asked by a supervisor. With a reasonable degree of certainty, Dr.
Blumenschein was poisoned on Sunday, January 27 and began to exhibit the
characteristic symptoms of ethylene glycol intoxication within hours. The
defense’s attempt to come up with an alternate theory of the crime on the basis
of timing seems like a pretty desperate Hail Mary pass to stir up reasonable
doubt. Of course, that doesn’t mean it won’t work with the jury.

         That’s enough of the chemistry of alcohol for me.  It is reasonably unlikely that the
prosecution is incorrect in its time line or that the victim was not poisoned
in Houston earlier on the same day as the onset of his acute illness and ICU
admission.

         The chemistry of love, however, is a bit harder to describe
with a simple equation, but may have a huge role in this trial. Why?

         First, the prosecution is obviously convinced of the
defendant’s guilt as a woman scorned. Her sexual relationship with the victim
is usually described in the press as casual and his more permanent relationship
was with his live-in girlfriend with whom he was putatively trying to have a
child. I suspect we will hear more about this from all three of them and that
the defense will undoubtedly cast the shadow of guilt on the girlfriend.

         Dr. Blumenschein has a reputation as a ladies’ man so I am
not sure he should have been surprised that someone tried to poison him. He
sounds like he was rolling the dice with each roll in the hay. He actually
testified this afternoon when I could not attend the trial, but admitted to the
casual nature of his sexual relationship with the defendant and to his
suspicions about the source of his injuries once their cause had been ascertained.

http://www.chron.com/news/houston-texas/houston/article/MD-Anderson-doctor-takes-the-stand-in-poisoning-5767395.php

         But even this admission by the victim does not get us any
closer to knowing exactly what transpired and, more critically, did Dr.
Gonzalez-Angulo poison her lover and business colleague and, if so, why.

         There are still many unknowns in the ether:

1.  During testimony today the lead detective from the
University of Texas Police Department who undertook the unenviable task of
pursuing this case alluded to lies he was told by the defendant. We are waiting
to hear what those were and how the detective discovered the prevarication.

2.  He also related an incident in which the defendant
self-reported being mugged outside her condominium (about 5 weeks before the
alleged poisoning). This crime was initially examined by the local police in
the province of her home 4 days after its putative occurrence as this is when the
defendant made her local constabulary aware of the incident. The UTPD
detective’s subsequent review cast doubt on whether this incident ever occurred.
He testified that the photographed bruises that were given as evidence of the
attack do not match with one another as being from a single episode of trauma
that occurred when the defendant said it did, about 8:30 PM on December 17,
2012. The bruises on different parts of her body appeared to be healing in a
fashion that suggested they did not occur co-temporally with one another.

3.  Quite run of the mill emails were discovered from the
defendant that are time stamped as having been sent right after the alleged
attack that left the bruises, which makes no sense. Even most teens wouldn’t be
emailing within an hour of being beaten up.

4.  The prosecution, whose witness the UTPD detective was,
was holding back on asking him certain questions and he showed some reluctance to answer certain defense queries in a yes or no fashion. Of course, the presumption is
that some pretrial decisions by the judge are precluding some avenues of inquiry
by the prosecution. Does the defendant have a prior record? Can her testimony
that is alleged to have been false only come in if she testifies?

We
still have a long way to go. There was an issue of conflict of interest alluded
to today that will probably come up on Monday. Audio tapes of phone calls from
the defendant to Dr. Blumenschein are scheduled to be admitted into evidence
next week. He has said he made them because he feared for his own safety and
that of his live-in girlfriend.

There’s
a lot of chemistry left in the pathway to a verdict, but little of it has to do
with alcohol. Pheromones and hormones, maybe.

It
appears on first pass, that Dr. Blumenschein’s testimony was successful in
painting him as a typical susceptible male who melted in the hands of a wily
and persistent female with both jealousy and vengeance in her heart. I cannot
say if that was the jury’s conclusion, but it won’t be surprising if this is
the case.

I
suspect that the defendant will have to testify though to counteract today’s
story, for it appears that she had means (ethylene glycol was in her lab),
motive (jealousy) and opportunity (Sunday morning coffee). 

    

I
just cannot accept the MD Anderson institutional position that this trial has
nothing to do with the business of the cancer center and that it only reflects
on the two principals.

Lots
of people knew about the affair and public displays of affection in the work
place. MD Anderson mandates sexual harassment sensitivity training for all employees. No one alerted the leadership that they were feeling the interactions at work between the two principals were creating an uncomfortable work environment.

Lots
of people knew that Dr. Blumenschein had additional lovers.

Lots
of people knew that they were being lied to.

Lots
of people knew lots of stuff, but no one did anything or the few who tried were
not taken seriously enough. Now one faculty member has permanent renal damage
and another is on trial for her freedom. And over a dozen have had a
life-changing event occur–testifying in open court about their professional
and in some cases private lives. And it’s all on tape!

     And my guess is that Al Jolsen deserves
some props about now as well for “wait a minute, wait a minute, you ain’t heard
nothin’yet.”

     I suspect next week will bring some
additional surprises and probably none will reflect well on MD Anderson.

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