“Some tears, but basically she stayed composed. Able to comfort the
baby, cuddling her when it was over. I made sure she never was
involved in holding the baby down-integrity of the mother-child bond.
See, your lectures stuck, Alex. Of course the rest of us felt like
Nazis.”
She wiped her brow again. Anyway, the blood tests kept coming back
normal but I held off discharge until she’d had no fever for four days
running.
Sighing, she burrowed her fingers through her hair and flipped through
her chart.
“Next fever spike: the kid’s fifteen months old, mother claims a
hundred and six.”
“Dangerous.”
“You bet. E.R. doc records a hundred and four and a half, bathes and
doses it down to a hundred and one and a half. And mom reports new
symptoms: retching, projectile vomiting, diarrhea. And black
stools.”
“Internal bleeding?”
“Sounds like it. That made everyone sit up. The diaper she had on did
show some evidence of diarrhea, but no blood. Mom said she threw the
bloody one out, would try to retrieve it. On exam, the kid’s rectal
area was a little red, some irritation at the external edges of the
sphincter. But no bowel distension that I can palpate-her belly’s nice
and soft, maybe a bit tender to the touch. But that’s hard to gauge
cause she’s freaking out, nonstop, at being examined.”
“Raw rectum,” I said. Any scarring?”
“No, no, nothing like that. Just mild irritation, consistent with
diarrhea. Obstruction or appendicitis needed to be ruled out. I
called in a surgeon, Joe Leibowitz-you know how thorough he is. He
examined her, said there was nothing that justified cutting her open
but we should admit her and watch her for a while. We put an I.V
In-great fun-did a complete panel, and this time there was a slightly
elevated white count. But still within normal limits, nothing that
would jibe with a hundred and four and a half Next day she was down to
one hundred. Day after that, ninety-nine point two, and her tummy
didn’t seem to hurt. Joe said definitely no appendicitis, call in
GI.
I got a consult from Tony Franks and he evaluated her for early signs
of irritable bowel syndrome, Crohn’s disease, liver problems.
Negative. Another tox panel, a careful diet history. I called in
Allergy and Immunology again, to test her for some weird
hypersensitivity to something.”
“Was she on formula?”
“Nope, a breast-fed baby, though by that time she was totally on
solids. Alter a week she was looking perfect. Thank God we didn’t cut
her open.”
“Fifteen months old,” I said. “Just past the high-risk period for
SIDS. So the respiratory system quiets and the gut starts acting
up?”
Stephanie gave me a long, searching look. “Want to hazard a
diagnosis?”
“Is that all of it?”
“Un-uh. There were two other GI crises. At sixteen monthsfour days
after an appointment with Tony in Gastro clinic-and a month and a half
latet, following his final appointment with them.”
“Same symptoms?”
“Right. But both those times, mom actually brought in bloody diapers
and we worked them over for every possible pathogen-I mean we’re
talking typhoid, cholera, tropical maladies that have never been seen
on this continent. Some sort of environmental toxin-lead, heavy
metals, you name it. But all we found was a little healthy blood.”
Are the parents in some sort of work that would expose the child to
weird pollutants?”
“Hardly. She’s a full-time mom and he’s a college professor.”
“Biology?”
“Sociology. But before we get off on the family structure, there’s
more. Another type of crisis. Six weeks ago. Bye-bye gut, hello new
organ system. Want to take a guess which one?”
I thought for a moment. “Neurological?”
“Bingo.” She reached over and touched my arm. “I feel so vindicated
calling you in.”
“Seizures?”
“Middle of the night. Grand mal, according to the parents, right down
to the frothing at the mouth. The E.E.G showed no abnormal wave
activity and the kid had all her reflexes, but we put her through a CAT
scan, another spinal, and all the high-tech neuroradiology video games,
on the chance she had some kind of brain tumor. That really scared me,