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Shelly Martin was bone tired from the countless hours she spent at the bedside of her sick friend, but she figured she had better return to the hospital, and fast. For the last 10 days, Mike Scarcella had been in the intensive care unit at Presbyterian Hospital of Plano. Now Martin had learned that his doctors were planning to transfer him to some psych ward, even though his jaw was wired shut and he was being treated for pneumonia and a staph infection. Worse, he was still going through withdrawal from gamma hydroxybutyrate (GHB). Although lucid at times, he would grow restless and agitated, suffering from nightmarish hallucinations aggravated by days without sleep. In terms of withdrawal, heroin had nothing on GHB.

When he came to the emergency room on August 15, Scarcella told the nursing staff he was a GHB addict. He knew that it would be only a matter of hours before he started to feel the anxiety and tremors of early withdrawal. It would take longer than that to fix his broken jaw, which was hanging sideways from the beating he had taken outside a Carrollton bar. He was always a stand-up guy, but that night he stood up to the wrong men. After he was cold-cocked from behind, three others joined the fray, kicking him in the head while he was down.

After she arrived at the hospital, Martin went on her own rampage: He wasn't some destitute druggie who needed to be dispatched to a detox center without so much as an explanation. He was Mike Scarcella, a competitive bodybuilder, a former Mr. America, a personal trainer, a dad. She was one of four devoted friends who took shifts and maintained a round-the-clock hospital vigil, caring for him because nurses were afraid of him. At 39, Scarcella was still a massive wall of buffed and bulging muscle.

Since so little is known about GHB withdrawal, even among emergency room physicians, Scarcella put nurses in touch with Project GHB Inc., a clearinghouse for information about the dangers of the drug. While GHB gained its notoriety as a club drug, used by date rapists preying on unsuspecting women, bodybuilders had been the first to fall victim to the "supplement," which was originally sold in nutrition stores and promised them more muscle mass, less body fat, sound sleep and great sex. Its "good for what ails you" claims were bolstered by its clinical use in Europe and medical research, some of it junk science, that found it nontoxic, nonaddictive and a treatment for certain types of narcolepsy. Government conspiracy theorists furthered its cause on the Internet, finding it scandalous that a substance that occurs naturally in the body could be scheduled as an illegal narcotic. With some science and many Web sites promoting its safety and efficacy, it became easier for the casual user to abuse. That is, until they showed up at emergency rooms, incomprehensible and sweating, their bodies trembling with anxiety, their hearts racing toward stroke.

"It's the worst withdrawal there is," says Trinka Porrata, president of Project GHB. "Most detox takes four to five days. GHB can mean 10 to 14 days of really bizarre and psychotic behavior. The withdrawal itself can be lethal."

Project GHB sent Presbyterian Hospital a withdrawal protocol, which its doctors had followed, at least at first. But when a frantic Martin went to Scarcella's hospital room on the morning of August 25, her friend seemed to be getting worse. A strap crisscrossed his formidable chest and shoulders, harnessing him to the bed. "He was pissed. He wanted to leave and kept struggling to get out of bed," Martin says. "His dementia was so severe, he thought he was driving his car, shifting gears and going home."

The day before, Martin recalls, a doctor told her that another week would pass before Scarcella was released. His staph infection had to first resolve itself. But this morning he was being moved to the psychiatric unit at North Central Medical Center in McKinney. His doctors had signed a medical certificate that authorized taking him into protective custody and committing him to a chemical-dependency facility. "They told me he was outside their scope of treatment," Martin says. "But it was clear they were pushing him out the door."

Three Plano police officers handcuffed Scarcella, placed him in a wheelchair and escorted him to a squad car. Martin says she began to "freak," turning to a nurse and shouting, "No, no, don't let them do this! How can they take him?" Jim Cardenas, another bedside-vigil friend, tried to calm her down: The doctors said it was for the best; they had to trust them. Presbyterian Hospital of Plano declined to comment, citing patient privacy concerns.

But Martin was inconsolable: She and Scarcella had different plans. A nationally renowned expert in GHB withdrawal worked at Southwestern Medical School. If they could get Scarcella to Parkland hospital, the expert would be brought in for consultation. After detox, Scarcella would live with Martin until he got back on his feet. "Just let him come home with me," she pleaded with the police. But they had their orders, and she wasn't even family.

She watched them stuff him into the backseat of a squad car, all 240 pounds of him. He looked like a sad child who had lost his way. "Why are you letting them take me?" he asked her. But it was out of her hands now. Exhausted, she went home, took a sleeping pill and tried not to think about how things had gone so terribly wrong.

Scarcella had dedicated his life to health and fitness--dieting, weight and cardio training, posing--measuring every aspect of his existence like some sort of body chemist. But somewhere along the way, from West Virginia farm boy to admired Mr. America to high-priced personal trainer, he lost the discipline that made his life make sense. Whether that was caused by GHB, steroids or a fundamental insecurity that made him overcompensate on the outside for what was missing on the inside, his story was far too common in the world of bodybuilding. "I knew guys who would take horse piss and inject it into their bodies if they thought it could make them bigger," says one former bodybuilder.

It took 14 hours of sleep and the repeated ringing of her phone to stir Martin. Chad Marr, Scarcella's favorite training partner, was on the line. "Are you OK?" he asked.

"Just tired."

"Oh, then you don't know."

"Know what?"

"Mike passed away last night."

Scarcella used to woo his women, of whom there were many, with tales of his childhood and the timidity that drove him to become a bodybuilder. Raised by adoring grandparents on a farm in West Virginia, Scarcella hardly knew his mother, a model intoxicated by barbiturates and the limelight of Hollywood. Overdosing on downers, she died when Scarcella was 5. He never met his father, whose identity remained a mystery and "the source of much of his mental anguish," says his uncle John Scarcella, who recalls his nephew as "a skinny little runt of a kid." But after being hoisted on a flagpole by some schoolyard bullies, Scarcella decided to do something about it.

Never much of a student, perhaps even dyslexic, there was one book that he read when he was 13 that became his bible: Education of a Bodybuilder by Arnold Schwarzenegger. "Somehow it struck a nerve with him and changed his life," his uncle says. His grandfather bought him a set of weights, and he worked out in the barn. Some nights it was so cold, his hands would stick to the bar, but within a year, his body put on bulk. In high school, he became a success at looking good, enjoying the narcissistic rush that came from girls taking second glances and boys acting envious. He was still a humble guy, but even at that age, what he wanted most in life was to become Mr. America.

Eventually he joined a gym in a nearby town and began to work out every day after school. He never cared about going to college; training with power lifters and several Mr. West Virginias was all the education he needed. At 19, he was thrilled when he bench-pressed 405 pounds. Bodybuilding became his addiction, getting bigger the reason for his existence.

Although Scarcella never thought he was tall enough--he was 5-foot-7--or his legs big enough, he was a natural for the sport. "He was genetically gifted," says Bob Gruskin, president of the National Amateur Bodybuilders Association. "He had good bone structure, good muscle density and a magnificent chest. He was phenomenally symmetrical and structurally balanced, which are the sorts of things judges look for."

But the world of competitive bodybuilding was fraught with hazards. There are more than 15 bodybuilding organizations in this country putting on shows and tendering titles. Steroid use is rampant in many of them; politics abound in all. Judges are influenced by sponsors and promoters who have a financial stake in seeing their bodybuilders win. Scoring is subjective; close calls are seldom given to newcomers. The sport has bred only a handful of superstars such as Schwarzenegger and Lou Ferrigno (The Incredible Hulk). Their competition, documented in the movie Pumping Iron, marked the apex of bodybuilding, which would decline despite its cult following because it lacked broad spectator appeal. Even those who gain professional status may while away in obscurity, picking up endorsements from nutritional companies and appearance fees from shows, but unable to give up their day jobs.

"There are only 10 or 12 pros in the country who can actually make a living from the sport," says Ricky Gates, a former Dallas bodybuilder who trains other bodybuilders for competition. "The rest are bouncers or personal trainers or live off women or a person of the same sex."

The only track to turn pro in the United States is through the National Physique Committee (NPC), the amateur organization feeding the professional International Federation of Bodybuilders (IFBB). Win the NPC Nationals, the NPC USA or the NPC North American and your IFBB pro card is guaranteed. Scarcella won his first competition in an NPC-sponsored event, becoming Mr. West Virginia in 1983. By 1986, he felt as though he had outgrown the local competition, and he moved to Fort Worth, where he became manager of the now-defunct Outlaw Gym. But that job didn't last long, not after he met Debbie Muggli, a nationally titled professional bodybuilder from Dallas who would become his fiancee. That didn't stop him from dating, however, and she eventually broke off their engagement.

"Mike always had to have a woman around," Martin says. "He could never survive a week without one."

And women seemed only too happy to accommodate him. He couldn't walk into a bar or restaurant without turning heads. Club owners put him on their no-wait A-list, figuring his impressive presence would attract more women, which would in turn attract more men. "He was just a shy country boy who was bitten by the Dallas bug," says one former girlfriend. "Dallas has lots of flash and beauty and fast-paced people who like to look good. He just got sucked up into that lifestyle."

In 1990, he met Judy Kurtz, then an American Airlines flight attendant, in a popular North Dallas nightclub. Ten months later they were married. "He was a child in a superman's body," she says. "My nature is to want to mother somebody, and he needed a mother."

The only thing that requires more discipline than being a bodybuilder is living with one. "It was my job to go to the grocery store and make sure he was fed every three hours," she recalls. But life could get intense when his obsession made him overly concerned about "retaining water or looking big enough," when he grew irritable because he needed to get down to 4 percent body fat before a show or when he injected himself with steroids because he was willing to do anything to win. He got a job as a baggage handler at American Airlines so he could travel cheaply to competitions. But Kurtz handled the bills, she says, and he seldom felt responsible or in charge of his life. Except, of course, when he was in the gym.

Crowds would gather around Scarcella, watching him wherever he trained. "Once he had 555 pounds on the bench, and the bar looked like it was going to snap," Chad Marr recalls. "He hit it for three reps, and it was effortless. Another time, someone left 315 pounds on an incline bench. He knocked off 20 reps while he was in his street clothes. The guy was strong as a damn ox." When Marr became his training partner, a powerful bond developed between them, forged out of the shared pain of grueling two-a-day workouts. "You push yourself to a place where you feel you can't walk and may black out. You find out what your limits are, and you go beyond them. It was an awesome thing."

Scarcella never lost his focus on the Mr. America title, which at the time was owned by the American Athletic Union (AAU). Although it would not qualify him as a professional, it was the most prestigious amateur bodybuilding title in the country. To get there, he won the South Western Mr. America, the junior Mr. America and Mr. USA.

On September 25, 1992, a ripped and ready Scarcella entered the 53rd annual Mr. America contest held in Cherry Hill, New Jersey. His wife, Judy, was in his corner, coating him with tanning solution and oils so his body would glisten. Bob Gruskin helped out as well, coaching him on his mandatory poses, making certain he "put life into each one." Scarcella won the medium class with a flawless performance. In the overall competition, he out-posed the other bodybuilders, gathering strength and peaking perfectly while the others couldn't hold their poses. The judges' decision was unanimous: The 1992 Mr. America was Mike Scarcella.

"He was so excited when he won the 'America,'" Kurtz recalls. "It was the best thing that ever happened to him. How many other people can say they achieved their life's dream?"

Scarcella posed for several muscle-magazine covers and traveled in Europe making guest appearances, but whatever recognition or revenue he hoped to receive from being Mr. America never materialized. Despite the win, he was still an amateur, an amateur who needed to rest and recover. His plans to turn pro would have to wait. Although he told friends and Muscle Mag International that he couldn't have won without the support of his wife, his womanizing left Kurtz no choice but to leave.

Devastated by her decision, Scarcella hit the club scene harder, becoming a favorite customer at Baby Dolls and The Men's Club. "It didn't matter to him if you were a good person or came from a good family," says one former girlfriend. "What mattered was did your boobs and butt look good in a bikini?"

While competitive bodybuilding began its decline sometime in the '80s, stigmatized by steroids and drug use, there was money to be made in personal training, particularly for someone like Scarcella. At the gym, he had star power, and he developed a high-profile clientele willing to pay up to $100 an hour to train with Mr. America. For serious gym rats and young bodybuilders, his advice was often doled out for free. "He would talk fitness with anyone," Marr says. "He may have had a lot of bravado, but he was never condescending."

What made him outgoing and what kept him going was a nutritional supplement that he and other bodybuilders legally purchased at health-food stores: GHB. In powder or liquid form, GHB was marketed to bodybuilders as a natural alternative to steroids that would increase muscle mass by stimulating growth hormones in the deepest stages of sleep. Bodybuilders swore by its results. But what it likely stimulated was euphoria, which enhanced what bodybuilders already enjoyed doing: working out.

Scarcella's story is the same one that is told countless times on GHB Internet message boards: After a day of pumping iron, he would have trouble falling asleep, so he used GHB occasionally to get a good night's rest. It seemed like a miracle drug: made you sleep, made you bulk up, got you high, got you through the day. And if doctors in Europe used it to anesthetize pregnant patients during labor, if it was being used to treat alcohol withdrawal, and it could make you bigger, then how harmful could it be?

"At lower doses, it can energize or relax; at larger doses, it can cause coma and death," says Dr. Deborah Zvosec, a Minnesota GHB researcher. "The consensus in the clinical community is that it is a very dangerous drug."

But that consensus has been a long time coming. The Food and Drug Administration didn't ban the supplement until 1990, and even then it left loopholes, which allowed for GHB analogues (chemical cousins that turn into GHB after ingestion) to continue to be sold over the counter. Although Texas and several other states had made GHB possession illegal in the '90s, the federal government didn't follow suit until 2001. Responding to its pernicious reputation as a date-rape drug, Congress listed GHB and its analogues (if adapted for "human consumption") as Schedule 1 controlled substances on par with heroin and methamphetamine.

Early studies, some of them conducted in Europe, concluded that GHB was neither toxic nor addictive. Some recent emergency medicine journals have reviewed the medical literature and catalogued a variety of therapeutic benefits for the chemical, which is a depressant. But Zvosec believes these studies are based on bad science and are part of "a campaign of misinformation," reinforced by the Internet, which continues to make the drug poorly understood, even within the medical community. "Because GHB has been used in limited cases for medical purposes, some people assume that it is a good thing," she says. "They leap to the profound conclusion that since GHB occurs naturally in the body [believed to be a neurotransmitter], it is nontoxic. And that is just not true." Although there is scant science on the drug's long-term effects, there is a great deal of research (some of it hers) that shows that GHB is a highly addictive drug whose withdrawal can be lethal.

Despite this research, GHB hasn't become a public health priority and hasn't even made it onto the radar screens of many within the rehab or medical communities. "We are battling a lack of public awareness," Zvosec says. "GHB is not as available as heroin, and it hasn't gotten the attention of Ecstasy, which is much less dangerous. But according to the federal drug warning system, the number of ER admissions where GHB is mentioned has grown from 50 a year to nearly 5,000."

In 1996, when GHB was still a nightcap for Scarcella, he again felt the itch to compete, this time at the NPC-sponsored Mr. Lone Star contest. If he won the competition, he would qualify to compete in the nationals, where a win could finally make him a pro. This time, in his corner, he had Crystal Gleisner, who also knew from the moment she met him at a Dallas nightclub in 1995 that she wanted to take care of him. She got her wish, moving in with him and cooking his meals four times a day, exactly the way he wanted them, exactly when he needed to eat them. "His body was like a machine," she recalls. "The minute he would start eating he would start to sweat, instantly metabolizing his food."

She thought his shyness meant they might connect at a deeper level, but bodybuilding kept him shallow and self-absorbed. "What you saw with Mike was all there was: a sweet man who ate, slept, worked out and watched sports. If you wondered where he was, it was either in the kitchen or the bedroom." Gleisner wanted something more. "Do you know how many times a day we heard, 'Say, how much can you bench?'"

Scarcella prepared for the competition the only way he knew how: by over-training. Although he tore a hamstring before the competition, he won the Lone Star Classic easily and felt he was finally on his way to becoming a professional. Just one more win at the NPC Nationals and there might be endorsement deals, special appearances, a shot at some real money. But something happened in the meantime, something that made him look beyond himself: He became a dad.

Brock Scarcella was his father in miniature. His green eyes, his nose, his facial expressions, the way he carried himself were all like Mike. "Think about being a kid and having this huge, giant muscle man of a dad," says Shelly Martin. "Mike was great with Brock, and Brock worshiped his dad."

Shortly after Brock was born in 1998, Scarcella told Gleisner that he was done with bodybuilding. It was too selfish a sport, and he needed to make money as a personal trainer. He wanted to be there for Brock in a way that his own parents had never been.

With his win at the Lone Star, Scarcella was booked solid, seeing clients at The Gym in Carrollton or in their homes, from 6:30 in the morning until 8:30 at night. That's when the "GHB began to creep into his days," Gleisner says. "He would take a cap of G for a morning pick-me-up, and before he knew it, he was taking it every few hours."

Gleisner found herself craving the drug as well. Whether she was having a good day or bad, a cap of G seemed to make it better. She didn't realize she had a drug problem until she couldn't get any drugs. "One night we ran out, and I began sweating and shaking. I told Mike, 'I think I am addicted to this stuff.' He said, 'I think we both are.'" Anti-depressants would stem their longing for a while, but when a friend would score some G, "we would be back on it again."

The GHB brought even more drama to their relationship, which a friend describes as "kind of Jerry Springer." While Scarcella could somehow function on GHB, at least for a time, Gleisner had a harder time coping--passing out, wrecking her car and eventually getting arrested for DWI. Scarcella had his own legal problems. In May 1999, he was busted for felony possession of steroids and possession with the intent to deliver GHB. Although prosecutors sought to put him in prison for 15 years, numerous character witnesses, three of whom were police officers, convinced a Denton County judge to probate his sentence for 10 years.

Even though they had a son in common, it wasn't enough to salvage Gleisner and Scarcella's relationship. They lived in different worlds and wanted different things. "I wanted to settle down, and he didn't know how to be content with one person," Gleisner says. Their breakup would enable her to confront her addiction, and she managed to recover with the help of Narcotics Anonymous. She and Scarcella continued to be close friends; he was so easy to forgive, and Brock loved him so much. But nothing--not his trouble with the law, not his feelings for his son, not his inner sense of discipline--could curb his GHB habit.

Sometimes he would show up late for sessions, sometimes not at all, and he ran off much of his clientele. "No one wants to train with a fucked-up trainer," says Randy Edwards, a close friend who owns The Gym. Scarcella filed for bankruptcy and had a federal tax lien placed against his house, which he eventually was forced to sell. He slept on the couch of whichever friend was kind enough to have him. With his resources limited, he resorted to selling GHB, again.

"Kitchen GHB" can be made on the cheap, synthesizing it in great batches by adding its analogue, gamma butyrolactone (GBL), commonly found in industrial solvents, to sodium hydroxide. The GHB that Scarcella dealt, however, was pure. "After you took it, you had to drive straight home," says Edwards, who is himself a recovering GHB addict. "It would knock you out for at least four hours."

Scarcella knew he had to get clean, and he tried to self-detox several times, but the withdrawal brought on panic attacks so crippling, he was certain he was going to die. In spring 2002, he broke down crying in front of training partner Chad Marr. "His depression and anxiety were getting out of hand," Marr recalls. "He loved his son and didn't want to die just like his mother had." Marr brought him to Green Oaks Hospital in Dallas, but he was moved to Medical City's intensive care unit after his blood pressure soared. "He went through some badass hallucinations," Marr recalls. "He was standing on a bed, buck naked, swinging at everyone. They sedated the hell out of him, but it still took five security guards to hold him down." He ripped the bed sheets apart and was restrained to his bed, and there was some concern he had suffered a stroke. But after three weeks, he checked himself out of the hospital, convinced he had kicked the habit. A week later, Marr says, it was obvious he hadn't. "He showed up at the gym, and his speech was slurred. He was using again and blamed the hospital for not fixing him."

His downward spiral continued unabated as his drug use grew worse. His few remaining clients were mostly friends trying to help him stave off ruin. He knew GHB had beaten him but was afraid the withdrawal was going to kill him. If he was going to be there for his son, he knew he would have to face rehab again. What was stopping him was his vanity. "He told me that he wanted to keep taking steroids and keep working out," Marr says. "He had lost everything, and the only part of his identity that he had left was the way he looked."

By the late summer of 2003, Scarcella convinced himself that if the rehab didn't kill him, the drug would. So he allowed Shelly Martin and Crystal Gleisner to intervene on his behalf, researching Web sites to find an affordable facility capable of treating his GHB addiction. Martin received several local referrals from Project GHB's president, Trinka Porrata, who believed that once in recovery, a former Mr. America would be the perfect national spokesman for her nascent organization. "Mike was so excited," Martin recalls. "Finally, he had found a venue where he could be celebrated again, where he could be in the limelight again. He wanted to do something that would make his son proud."

McKinney, August 25, 2003, about 9:30 p.m.

"McKinney 911," answered the voice of the female dispatcher. "What is the address of your emergency?"

A nurse mumbled that she was calling from the psychiatric unit of North Central Medical Center. "I have a code blue [cardiac arrest] in progress, and I need help immediately..."

"How old is the person?"

"I don't know," she said frankly.

"...I am sending the paramedics right now," assured the dispatcher. "Ma'am, I have some questions for you."

The nurse searched for Mike Scarcella's chart but couldn't seem to find it.

The dispatcher sounded annoyed. "Ma'am, is he having breathing difficulties?"

"He has stopped breathing, and they have started to...hold on." She paused to speak to another nurse. "Are you sure this is the right Mike?"

"...OK, is he conscious at all?"

"No, he's not conscious right now."

"And he's still not breathing?"

"They're doing CPR, and we're looking for his chart," said the nurse. "Do you have his chart over there?"

"...Is he able to talk to you at all?"

"No, no."

"Is he changing color at all?"

"Yes, yes," she said. "That's when we noticed he went down on the floor, and he was banging his head on the floor."

"...Does he have a history of heart problems?"

"That I don't know. Actually I don't know anything about the patient."

"Do you have an AED there?"

The nurse repeated the letters, acting as if she had no idea what they meant.

"An automatic electronic defibrillator," instructed the dispatcher.

"Oh, no. Well, they might have one on the fourth floor..."

"Do you want me to send an officer with an AED?"

"Yeah, I guess it couldn't hurt..."

Precious seconds were passing. "Do you know anything about this man?" asked the dispatcher.

A second nurse answered, ostensibly more knowledgeable than the first. "I don't know that much about the man except that he's very psychotic. And the last thing that I saw was that he threw himself down on the ground and banged his head on the ground."

"Did he choke on anything first?" the dispatcher asked.

"...He didn't appear to be choking," she said.

"Does he have a history of seizures?"

"That I don't know."

Seven minutes into the 911 call, medical personnel found his chart. "He has been having withdrawal from GHB," she informed the dispatcher. "Hallucinating and inaudible. He was apparently on a medical floor."

She was referring to the intensive care unit of Plano Presbyterian Hospital, where Scarcella had been a patient for 10 days after suffering the broken jaw. Despite his mouth being wired shut, despite his being treated for pneumonia, despite his being in the throes of psychosis induced by GHB withdrawal, the Plano hospital had him involuntarily committed to North Central Medical Center's psych unit. This was not what he and his friends had envisioned when they planned his rehab.

"My fire department is on location," said the dispatcher. "I am going to disconnect. Thank you so much."

At 10:12 p.m., less than six hours after leaving intensive care, Mike Scarcella was pronounced dead.

For those friends who had maintained a hospital vigil for Scarcella, his sudden death seemed impossible to comprehend. For Scarcella to get his jaw busted in a bar fight was so out of character; his physical presence was enough to intimidate the drunkest of challengers. No police report was filed, and no witnesses were interviewed, so rumors filled the void. His criminal attorney, Mike Bragg, attempted to get the police involved, but the Dallas, Plano and Carrollton (where the bar was located) police departments each claimed it wasn't their case. "It really pissed me off," says Bragg, who did his own cursory investigation. "The four guys who beat him up were known GHB drug dealers. I heard they hit him with a lead pipe. But what the fight was over, I don't know."

When Gleisner received a phone call from North Central Medical Center informing her of Scarcella's death, "the hospital said he died in transit to the emergency room," she says. But two days after he died, Gleisner's fiance, Jim Cardenas, received an anonymous phone call from a nurse at North Central Medical Center, who told him "that a grave injustice had been done." In a later call, the nurse revealed his name was Robert Meskunas and that he helped admit Scarcella to the McKinney hospital, although he was off-duty when he died. Meskunas' knowledge was secondhand, a compilation of what others had observed, but he was convinced Scarcella was too unstable to be in a psych unit. "He said they should have stepped him down from critical care to regular care for three or four days," recalls Cardenas, who took notes on the conversation. Meskunas told him there was a concerted effort on the part of North Central Medical Center officials to say that Scarcella died while paramedics were transferring him to the emergency room, but that just wasn't the case. He was dead before they arrived, and the nurses charged with his care improperly responded to the code blue. He and another nurse had filed complaints about the incident with the Texas Department of Health. Meskunas told the same story to the McKinney Courier-Gazette, as did a second nurse, who wished to remain anonymous but gave the newspaper a copy of her complaint. Meskunas was removed from the "nurses schedule" and no longer works at North Central Medical Center. Meskunas has not returned phone calls seeking comment, but the Dallas Observer has obtained the findings of those complaints, which fault North Central Medical Center for violating three federal regulations, including the "failure to supervise and regulate the nursing care [of Scarcella]." "The hospital's Cardiac Arrest/Code Blue policy was not followed," says a statement of deficiency prepared by the Department of Health and Human Resources. "No cardiac monitor was attached to determine the rhythm...no IV access was obtained, and the suction was not set up and prepared to intubate."

A spokesman for the hospital expressed "our condolences to Mr. Scarcella's family and friends" and cited the Collin County medical examiner's report, which "makes it clear that Mr. Scarcella's death from natural causes was not the result of the care he received during the short time he was our patient." Referencing patient privacy laws, the hospital specifically declined to comment on whether the violation of its own code blue policy might have contributed to Scarcella's death.

Cardenas and Gleisner weren't the only ones contacted by whistle-blowing nurses. Upon hearing about Scarcella's death, Shelly Martin says she "flipped out," phoning the hospital and demanding to know what had happened. She spoke with an ICU nurse, whose anonymity she is protecting, who felt that Scarcella was in no condition to be transferred in the first place. "She said doctors thought he was difficult, and they had a heart patient who needed the bed," Martin recalls. The nurse was later fired, Martin says, on grounds she had breached a "confidential relationship." The nurse also spoke with attorney Rachel Montes, who was hired by Gleisner to investigate the circumstances surrounding Scarcella's death. "The information I have gathered comes from an informant [the same nurse] who wishes to remain anonymous and says Mike wasn't stable enough to be released and was dumped because he didn't have insurance."

Before filing a lawsuit, Montes had to wait on the autopsy report, whose preliminary findings revealed that Scarcella suffered from an undiagnosed subdural hematoma (blood clot in the brain), which resulted from the blow he took to his head. Gleisner and Cardenas say they saw hospital charts, which recommended a CAT scan that was never performed. But the quality of his care became less relevant after the medical examiner ruled that Scarcella suffered "sudden cardiac death" because of a "hypertensive enlargement of the heart" and withdrawal from GHB--making litigation, at least against Plano Presbyterian, less attractive unless an expert can be found to say that Scarcella wouldn't have died if he hadn't been transferred in the first place.

More relevant were the deep feelings of loss suffered by the 150 people who attended Mike Scarcella's funeral on August 29. "I can't explain to you how much my heart hurts," says Martin, who gave one of five eulogies. All eyes were fixed on 5-year-old Brock, who did his best to remain seated, fidgeting anxiously and looking uncomfortable in an oversized tie. Finally, Brock couldn't contain himself. He marched toward his father's coffin and lingered in front of a large portrait of a younger, formally clad Mike Scarcella. Brock traced his fingers over the photograph, placing his hand over his father's heart and bringing it back to touch his own. Huge strongmen and everyday gym rats broke into tears. It seemed the perfect moment to preach about the dangers of GHB and the havoc of getting hooked, just as Scarcella had. Gleisner had laid out a stack of Narcotics Anonymous literature, which all but disappeared. Nearly a dozen people thanked her for saying what they needed to hear.

"Mike just wanted his story told," Gleisner says. "We just hoped for a different ending."

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