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. Cassie’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 glycogenstorage problem
that we don’t have an assay 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 Cassie’s sugar was low and she probably doesn’t have
classical 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 passive-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 Cassie?”
“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. Cassie’s
metabolic system.”
We headed for the stairs.
1 said, “Would hypoglycemia explain the other problemsbreathing
difficulties, bloody 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
God-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 Cassie 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 Cassie as a pincushion. Which I can buy, theoretically.
Cindy has plenty of time with Cassie. But given Cassie’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.”
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