"Because the facts simply aren"t available at present."
"So you"re not denying there will be cuts, soon?"
"No, Daniel," said Plumb, straightening and placing his hands behind his back. "I couldn"t be honest and deny it. I"m neither denying nor confirming, because to do either would be to perform a disservice to you as well as to the inst.i.tution. My reason for attending this meeting was to pay respect to Dr. Ashmore and to express solidarity-personal and inst.i.tutional-with your well-intentioned memorial for him. The political nature of the meeting was never made clear to me and had I known I was intruding, I would have steered clear. So please excuse that intrusion, right now-though if I"m not mistaken, I do spot a few other Ph.D."s out there." He looked at me briefly. "Good day."
He gave a small wave and headed up the stairs.
Afro said, "George-Dr. Plumb?"
Plumb stopped and turned. "Yes, Dr. Runge?"
"We do-I"m sure I speak for all of us in saying this-we do appreciate your presence."
"Thank you, John."
"Perhaps if this leads to greater communication between administration and the professional staff, Dr. Ashmore"s death will have acquired a tiny bit of meaning."
"G.o.d willing, John," said Plumb. "G.o.d willing."
12.
After Plumb left, the meeting lost its steam. Some of the doctors stayed behind, cl.u.s.tering in small discussion groups, but most disappeared. As I exited the auditorium I saw Stephanie coming down the hall.
"Is it over?" she said, walking faster. "I got hung up."
"Over and done. But you didn"t miss much. No one seemed to have much to say about Ashmore. It started to evolve into a gripe session against the administration. Then Plumb showed up and took the wind out of the staff"s sails by offering to do everything they were demanding."
"Like what?"
"Better security." I told her the details, then recounted Plumb"s exchange with Dan Kornblatt.
"On a brighter note," she said, "we seem finally to have found something physical on Ca.s.sie. Look here."
She reached into her pocket and drew out a piece of paper. Ca.s.sie"s name and hospital registration number were at the top. Below was a column of numbers.
"Fresh from this morning"s labs."
She pointed to a number.
"Low sugar-hypoglycemia. Which could easily explain the grand mal, Alex. There were no focal sites on the EEG and very little if any wave abnormality-Bogner says it"s one of those profiles that"s open to interpretation. I"m sure you know that happens all the time in kids. So if we hadn"t found low sugar, we would have really been stumped."
She pocketed the paper.
I said, "Hypoglycemia never showed up in her tests before, did it?"
"No, and I checked for it each time. When you see seizures in a kid you always look at sugar and calcium imbalance. The layman thinks of hypoglycemia as something minor but in babies it can really trash their nervous systems. Both times after her seizures, Ca.s.sie had normal sugar, but I asked Cindy if she"d given her anything to drink before she brought her into the E.R. and she said she had-juice or soda. Reasonable thing to do-kid looks dehydrated, get some fluids in her. But that, plus the time lag getting over here, could very well have messed up the other labs. So in some sense it"s good she seized here in the hospital and we were able to check her out right away."
"Any idea why her sugar"s low?"
She gave a grim look. "That"s the question, Alex. Severe hypoglycemia with seizures is usually more common in infants than in toddlers. Preemies, babies of diabetic mothers, perinatal problems-anything that messes up the pancreas. In older kids, you tend to think more in terms of infection. Ca.s.sie"s white count is normal, but maybe what we"re seeing are residual effects. Gradual damage to the pancreas brought about by an old infection. I can"t rule out metabolic disorders either, even though we checked for that back when she had breathing problems. She could have some sort of rare glycogen-storage problem that we don"t have an a.s.say for."
She looked up the hall and blew out air. "The other possibility"s an insulin-secreting pancreatic tumor. Which is not good news."
"None of them sound like good news," I said.
"No, but at least we"ll know what we"re dealing with."
"Have you told Cindy and Chip?"
"I told them Ca.s.sie"s sugar was low and she probably doesn"t have cla.s.sical epilepsy. I can"t see any reason to go into any more detail while we"re still groping for a diagnosis."
"How"d they react?"
"They were both kind of pa.s.sive-wiped out. Like, "Give me one more punch in the face." Neither of them got much sleep last night. He just left to go to work and she"s bunked out on the couch."
"What about Ca.s.sie?"
"Still drowsy. We"re working on getting her sugar stabilized. She should be okay soon."
"What"s in store for her, procedure-wise?"
"More blood tests, a tomographic scan of her gut. It may be necessary, eventually, to open her up surgically-get an actual look at her pancreas. But that"s a ways off. Got to get back to Torgeson. He"s reviewing the chart in my office. Turned out to be a nice guy, really casual."
"Is he reviewing Chad"s chart too?"
"I called for it but they couldn"t find it."
"I know," I said. "I was looking for it, too-for background. Someone named D. Kent Herbert pulled it-he worked for Ashmore."
"Herbert?" she said. "Never heard of him. Why would Ashmore be wanting the chart when he wasn"t even interested the first time?"
"Good question."
"I"ll put a tracer on it. Meantime, let"s concentrate on Ms. Ca.s.sie"s metabolic system."
We headed for the stairs.
I said, "Would hypoglycemia explain the other problems-breathing difficulties, b.l.o.o.d.y stools?"
"Not directly, but all the problems could have been symptoms of a generalized infectious process or a rare syndrome. New stuff is always coming at us-every time an enzyme is discovered, we find someone who doesn"t have it. Or it could even be an atypical case of something we did test for that just didn"t register in her blood for some G.o.d-knows-why reason."
She talked quickly, animatedly. Pleased to be dueling with familiar enemies.
"Do you still want me involved?" I said.
"Of course. Why do you ask?"
"Sounds like you"ve moved away from Munchausen and think it"s genuine."
"Well," she said, "it would be nice for it to be genuine. And treatable. But even if that is the case, we"re probably talking chronic disease. So they can use the support, if you don"t mind."
"Not at all."
"Thanks much."
Down the stairs. At the next floor I said, "Could Cindy-or anyone else-have somehow caused the hypoglycemia?"
"Sure, if she gave Ca.s.sie a middle-of-the-night shot of insulin. I thought of that right away. But that would have required a lot of expertise with timing and dosage."
"Lots of practice injections?"
"Using Ca.s.sie as a pincushion. Which I can buy, theoretically. Cindy has plenty of time with Ca.s.sie. But given Ca.s.sie"s reaction to needles, if her mom was sticking her, wouldn"t she be freaking out every time she saw her? And I"m the only one she seems to despise. . . . Anyway, I never noticed any unusual injection marks when I did the physical."
"Would they be obvious, given all the other sticks she"s had?"
"Not obvious, but I"m careful when I do my exams, Alex. The kids" bods get gone over pretty thoroughly."
"Could the insulin have been administered other than by injection?"
She shook her head as we continued to descend. "There are oral hypoglycemics, but their metabolites would show up on the tox panel."
Thinking of Cindy"s health discharge from the army, I said, "Any diabetes in the family?"
"Someone sharing their insulin with Ca.s.sie?" She shook her head. "Back at the beginning, when we were looking at Ca.s.sie"s metabolics, we had both Chip and Cindy tested. Normal."
"Okay," I said. "Good luck pinning it down."
She stopped and gave me a light kiss on the cheek. "I appreciate your comments, Alex. I"m so thrilled to be dealing with biochemistry, I run the risk of narrowing my perspective."
Back on the first floor I asked a guard where to find the Personnel office. He looked me over and told me right here, on the first floor.
It turned out to be exactly where I remembered it. Two women sat at typewriters; a third filed papers. The filer came up to me. She was straw-haired and hatchet-faced, in her late fifties. Under her ID was a circular badge that looked homemade, bearing a photo of a big hairy sheepdog. I told her I wanted to send a condolence card to Dr. Laurence Ashmore"s widow and asked for his home address.
She said, "Oh, yes, isn"t it terrible? What"s this place coming to?" in a smoker"s voice, and consulted a folder the size of a small-town phone book. "Here you go, Doctor-North Whittier Drive, over in Beverly Hills." She recited a street address in the 900"s.
North Beverly Hills-prime real estate. The 900 block placed it just above Sunset. Prime of the prime; Ashmore had lived on more than research grants.
The clerk sighed. "Poor man. Just goes to show you, you can"t buy your safety."
I said, "Isn"t that the truth?"
"Isn"t it, though?"
We traded wise smiles.
"Nice dog," I said, indicating the badge.
She beamed. "That"s my honey-my champ. I breed true Old English, for temperament and working ability."
"Sounds like fun."
"It"s more than that. Animals give without expecting anything in return. We could learn a few things from them."
I nodded. "One more thing. Dr. Ashmore had someone working with him-D. Kent Herbert? The medical staff would like him to be informed of the charity fund the hospital"s establishing in Dr. Ashmore"s honor but no one"s been able to locate him. I was appointed to get hold of him but I"m not even sure he"s still working here, so if you have some sort of an address, I"d be much obliged."
"Herbert," she said. "Hmm. So you think he terminated?"
"I don"t know. I think he was still on the payroll in January or February, if that helps."
"It might. Herbert . . . let"s see."
Walking to her desk, she pulled another thick folder from a wall shelf.
"Herbert, Herbert, Herbert . . . Well, I"ve got two here, but neither of them sound like yours. Herbert, Ronald, in Food Services, and Herbert, Dawn, in Toxicology."
"Maybe it"s Dawn. Toxicology was Dr. Ashmore"s specialty."
She screwed up her face. "Dawn"s a girl"s name. Thought you were trying to find a man."
I gave a helpless shrug. "Probably a mixup-the doctor who gave me the name didn"t actually know this person, so both of us a.s.sumed it was a man. Sorry for the s.e.xism."
"Oh, don"t worry about that," she said. "I don"t mess with all that stuff."
"Does this Dawn have a middle initial "K"?"
She looked down. "Yes, she does."
"Then, there you go," I said. "The name I was given was D. Kent. What"s her job description?"
"Um, five thirty-three A-let me see . . ." Thumbing through another book. "That looks like a research a.s.sistant, Level One."
"Did she transfer to another department in the hospital, by any chance?"
Consulting yet another volume, she said, "Nope. Looks like a termination."
"Hmm . . . Do you have an address for her?"
"Nope, nothing. We throw out personal stuff thirty days after they"re gone-got a real s.p.a.ce problem."
"When exactly did she terminate?"
"That I can tell you." She flipped a few pages and pointed to a code that I couldn"t comprehend. "Here we go. You"re right-about her being here in February. But that was her last month-she gave notice on the fifteenth, went officially off payroll on the twenty-eighth."