Lee was still processing his meeting with the first lady when noon rolled around. He had arranged with Paul to have the time off, but with his camping trip canceled, Lee decided to take a shift at the MDC supervising medical residents. It was good in a way to get back to business as usual, and the extra pay did not hurt. But it was hardly a return to normal.
He was supposed to form some sort of alliance with a man who might be intentionally harming the first family’s son for personal gain. Either the man was so egotistical he would risk medical malpractice just to be right, or he was devious, trying everything possible to keep Lee from discovering what was making Cam Hilliard sick.
Lee headed straight to the coffee station in the MDC lounge to fuel up for his afternoon rounds. He poured himself a cup of coffee thick as mud and chuckled, thinking Paul would never suffer such a beverage. He had called to see if Josh wanted to meet up for lunch, but he was already out with friends. Dinner remained a possibility, though Josh had made plans to eat with his mother.
On his walk to a nearby empty chair, Lee noticed his knee acting up again. It was a nagging little pain, right where the patella connects to the ligament. His nightly run was suddenly in question. Someday those runs would turn into walks. After walks, maybe downshift into a stroll. The next phase after that got a little grim.
Lee took his seat, sipped at his coffee, and pondered ways to get Gleason on his side. His focus wandered when he overheard a snippet of conversation between two nearby doctors he did not know. Both were young, with full heads of hair (one blond and curly, the other straight and dark). They probably had good knees.
“We’ve weaned her off fosphenytoin,” the curly-haired doc said. “But she’s still on a pretty aggressive course of diazepam.”
“No more seizures?” the darker-haired of the two asked.
“No, but I was hoping the diazepam might bring her myoclonus under control. It hasn’t. She’s had episodes even when we had her sedated. Her arms keep snapping like whips without warning.”
“What did the CT scan show?”
“Slightly enlarged spleen and liver, but nothing else.”
Lee’s ears perked up like a dog hearing a whistle. He was standing in a flash, knee pain be damned. The two doctors watched him approach.
“I’m sorry to bother you, but I couldn’t help but overhear,” Lee said. “Your case sounds similar to a patient of mine. Have you figured out what’s causing her symptoms?”
“No, she’s a young girl who came in the other day with CO poisoning,” the dark-haired doctor said. “She lost her parents. It’s a real tragedy.”
Lee had heard about the fatal gas leak on the news, but yesterday it seemed like a sad headline and nothing more.
“Say, if you come up with something on your patient that can help ours, let us know.”
The curly-haired doc fished a business card out from a leather wallet and handed it to Lee. The doc was a hospitalist, a physician who cares for patients while they are hospitalized—the same profession helping to put Lee out of business.
“Will do,” said Lee, shaking hands good-bye. He had no intention of involving them in his case, because they could not know his patient was Cam Hilliard. But still, seizures and an enlarged spleen and liver? Even though he was not her doctor, there were enough symptoms overlapping for Lee to investigate. Using his phone to check the news, he quickly found the girl’s name, Susie Banks, and decided to pay her a visit.
Locating the patient was a matter of locating a hospital computer. He entered his log-in credentials into the terminal and was soon directed to the ICU on the sixth floor of the main building. While Lee was not responsible for Susie’s care, he was at least dressed for the part in a white lab coat, striped cotton shirt, blue tie, and the slacks from the Brooks Brothers suit he had worn to his meeting with Ellen.
He marched over to the nurses’ desk, taking confident strides, acting like he was in a hurry, but pretending not to know exactly where he was headed.
“I’m looking for Susie Banks’s room,” Lee said to a dour-faced nurse with dyed black hair. She peered out from behind her expansive monitor and appraised Lee with some skepticism.
“And you are?”
“Dr. Lee Blackwood. I’m a member of the internal medicine practice. I’m consulting on the case for Dr. Sarah Anderson. I thought you were informed.”
He used a name of a doctor who he knew worked on this floor. The tone Lee had taken implied any lack of cooperation might result in a ding on this nurse’s next performance review.
“Of course, Dr. Blackwood,” the nurse said, feigning awareness as convincingly as a Broadway actress. “She’s in 601.”
Lee thanked her and moved on. The scene inside Susie’s ICU cubicle was a familiar one. Sick person, lying on a bed, hooked to an array of machinery. The sweet-faced girl with long brown hair was on high-flow oxygen therapy delivered via a nasal cannula. Her eyes were closed, but only because she was sleeping, not sedated. He was glad to see she was not on ventilation, which was far more invasive and would leave her prone to infection.
The telemetry monitor showed good vitals. Steady sinus rhythm, though her oxygen saturation was a low ninety-two percent: safe, but far from normal.
From a plastic pouch affixed to the end of the bed, Lee removed Susie’s medical chart and began to give it a careful read while keeping an eye out for one of Susie’s doctors or a nurse. They would be harder to fool than the duty nurse. It was all clear for the moment. The only person nearby was a maintenance worker, standing on a ladder, with his head and shoulders hidden inside the drop ceiling.
Lee resumed his evaluation. Susie’s medical history was sparse. There was no primary care physician listed, and with her parents gone, nobody could fill in the blanks. The line for next of kin was also a blank. Lee felt heartbroken for this girl. Her parents were dead and either she did not have, or could not provide, the name of her closest living relative.
She was alone, and had to be terribly frightened.
A CAT scan confirmed what the doctors in the lounge had said—both the spleen and liver were enlarged. Lee could think of no reason why CO gas would have affected her organs in such a way. She’d been given urine myoglobin in the ER to combat rhabdomyolysis, but that would not cause organ enlargement, either.
Lee felt a jolt, a tingle telling him to read on. After suffering a grand-mal seizure in the ER, she had briefly slipped into a coma before regaining consciousness. Later, she began experiencing myoclonic jerks, another type of seizure, unrelated to her acute carbon monoxide poisoning. Neurological issues, liver and spleen enlargement—indeed, her case was sounding a lot like Cam’s.
When Lee read Susie’s labs, his eyes went wide. The liver enzymes were elevated, only slightly, again similar to Cam. Susie’s doctor noted something else: a very unusual cherry-red spot in the retina of both eyes, a rounded red dot surrounded by a halo of pallor, like a target’s bull’s-eye right where the macula was, that part of the retina where rays of light are directly focused. There were multiple comments about it in the record, the consensus being it was most likely a rare manifestation of carbon monoxide poisoning. But Lee wondered: If CO gas could produce a red spot in the eye, could a different toxin also do the same?
Lee called Paul’s cell, but after several rings got patched through to his voice mail.
“Paul, it’s Lee. There’s a patient at the MDC with a possible connection to Cam Hilliard. Could you do some research for me on cherry-red spots in the macula? Curious to know if you can find any connections to these red spots in the eyes and various toxins like we discussed. Thanks much, and I’ll see you soon.”
Lee put his phone away and went back to flipping through pages of Susie’s medical chart when he noticed her eyes flutter open. He could see her struggle to focus her vision. When she spoke her voice was whispered, soft as a breeze.
“Are you my doctor?”
Lee returned a friendly smile, slipped the chart back into its pouch, and came around to the side of the bed. He poured water into a plastic cup and gave her a drink.
“I’m a doctor,” Lee said. He set the water cup on the side table after Susie finished taking a sip. “How are you feeling?”
Tears flooded Susie’s big round eyes. Answer enough.
“I’m okay,” she said without any conviction.
Lee gave her hand a squeeze. “You stay strong, Susie Banks. I promise, I’m going to check up on you again very soon.”
Lee did not tell her his checkup would happen after he dilated Cam’s pupils and used an ophthalmoscope to look for a cherry-red spot on his macula.
* * *
WITH HIS tools and ladder, Mauser was dressed for the part. He had come to the ICU to decide how and when to take care of Susie Banks permanently. This was Rainmaker’s order, and Mauser could lose his supply if the deed was not done. The miracle of Susie’s survival confounded and infuriated them both, perhaps Mauser more than Rainmaker. He was not accustomed to failure. Susie should be dead like her parents, but no, she had to go and complicate things. No matter. Mauser had other ways to eliminate her. Other tools at his disposal.
Now was not the time to take care of business. Too many people were on the floor. He would come back later—perhaps after dinner, when things quieted down. He’d show up with some complicated piece of machinery he’d say was needed to complete a job he was pretending to do. Being an actual heating and cooling repairman made this a relatively easy ruse. Nobody at the front desk had asked questions when Mauser presented a bogus work order. Nobody wondered what he was doing moving ceiling tiles about. Nobody asked why he was peering into dark spaces with his flashlight.
At first Mauser thought nothing of the doctor who had come to see Susie. His perspective changed dramatically when he overheard him talking on the phone. If the acoustics up in the ceiling had not amplified the call, Mauser would have missed the conversation entirely. He knew from Rainmaker there was a connection between Susie Banks and the president’s kid. Now he knew the doctor was connected as well.
He could inject Susie easily later tonight, but the doc was another story. Perhaps Mauser would inject him as well. Or maybe it would happen during a mugging gone wrong. Could be something else entirely. He would check with Rainmaker, and together they would decide this doctor’s fate.