But perhaps the most disturbing finding came in the medical examiner's report, which found a small hole in Mrs. Malitz's larynx, consistent with a needle puncture from a syringe that would have been used to inject lidocaine. Doctors and toxicologists speculated that if a large amount of lidocaine was mistakenly injected into the windpipe, rather than simply into the fatty tissue in the neck, it might have been taken up rapidly into Mrs. Malitz's bloodstream through her lungs, and had a toxic effect. In the end, the medical examiner found that Mrs. Malitz had four times as much lidocaine in her bloodstream as it would take to kill her, though much of it might have come during the frantic attempts to resuscitate her. (Lidocaine can be used to steady an irregular heartbeat.) The lidocaine injection was administered not by the anesthesiologist, Dr. Mellen, nor by Dr. Aston, the surgeon, but by Dr. Spero Theodorou, a fellow in the plastic surgery training program at the hospital, according to doctors familiar with the case. Dr. Theodorou did not reply to a message left for him at the hospital.
