diabetes. When I die I know I’m going to heaven, cause I’ve already
been to hell.”
He shot a thick arm forward. The hand at the end of it was big but his
grip was restrained. His face was basset with a touch of bull terrier:
thick nose, full lips, small, drooping dark eyes. The baldness and
perpetual five o’clock shadow gave him a middle-aged look, but I
guessed he was thirty-five or so.
Al Macauley.”
Alex Delaware.”
“Meeting of the Als,” he said. “C’mon out of here before the natives
grow restless.”
He took me behind swinging doors just like those in Stephanie’s clinic,
past a similar mix of clerks, nurses, residents, ringing phones, and
scratching pens, to an examining room decorated with a sugarcontent
chart issued by one of the big fast-food chains. The five food groups
with an emphasis on burgers and fries.
“What can I do for you?” he said, sitting on a stool and spinning back
and forth in small semicircles.
Any insights on Cassie?” I said.
“Insights? Isn’t that your department?”
“In a perfect world it would be, Al. Unfortunately, reality’s refusing
to cooperate.”
He snorted and ran his hand over his head, smoothing nonexistent
hair.
Someone had left a rubber reflex hammer on the examining table. He
picked it up and touched the tip to his knee.
“You recommended intensive psych support,” I said, “and I just
wondered-” “If I was being an especially sensitive guy or ill thought
the case was suspicious, right? The answer is b. I read your notes in
the chart, asked around about you, and found out you were good. So I
figured I’d put in my two cents.”
“Suspicious,” I said. As in Munchausen by proxy?”
“Call it what you want-I’m a gland-hand, not a shrink. But there’s
nothing wrong with the kid’s metabolism, I can tell you that.”
“You’re sure of that?”
“Look, this isn’t the first time I’ve been involved in the case-I
worked her up months ago, when she supposedly presented with bloody
stools. No one ever actually saw the stools except the mom, and red
spots on a diaper don’t make it in my book. We could be talking diaper
rash. And my first go-round was rigorous. Every endocrine test in the
book, some that weren’t.”
“Someone saw this latest seizure.
“I know that,” he said impatiently. “The nurse and the U.C.
And low sugar does explain it, physiologically. But what it doesn’t
explain is why. She’s got no genetic or metabolic abnormality of any
kind, no glycogen storage disorder, and her pancreas is functioning
perfectly. At this point, all I’m doing is plowing old ground and
throwing in some experimental assays I borrowed from the med school
basic science stuff they’re still getting baselines on. We might just
have the most tested two-year-old kid in the Western Hemisphere. Wanna
call Guinness?”
“What about something idiopathic a rare variant of a known disease?”
He looked at me, passed the hammer from hand to hand.
Anything’s possible.”
“But you don’t think so.”
“What I don’t think is that there’s anything wrong with her glands.
This is a healthy kid, presenting with hypoglycemia because of
something else.”
“Something someone gave her?”
He tossed the hammer up in the air and snagged it with two fingers.
Repeated the exercise a couple more times, then said, “What do you
think?” He smiled. Always wanted to do that with one of you guys.
Seriously, though, yeah, that’s what I think. It’s logical, isn’t it,
considering the history? And that sib who died.”
Did you consult on his “No, why would I? That was respiratory. And
I’m not saying that was necessarily ominous-babies do die of SIDS. But
in this case it makes you think, doesn’t it?”
I nodded. “When I heard about the hypoglycemia, one of the first
things I thought about was insulin poisoning. But Stephanie said there
were no fresh injection marks on Cassie’s body.”
He shrugged. “Could be. I didn’t do a complete physical. But there
are ways to stick someone and be subtle: Use a really small needle-a
newborn spike. Pick a site that’s easy to miss-the folds of the
buttocks, knee folds, between the toes, right under the scalp. My