Deficiency

EIGHT

Terri overslept.

She had not set her alarm clock either. It was the phone that woke her and thankfully so, she thought when she opened her eyes and saw the clock. She threw off her blanket and sprung up like a jack in the box.

"Dr. Barnard," she said swinging her legs over the bed after she had seized the receiver.

"Terri, forgive me for calling so early," she heard Will Dennis say. She knew it was he before he added, "It's Will Dennis." He had that distinct a voice.

"Oh. No, it's fine. Actually, I'm glad you called. I forgot to set my alarm." Will Dennis laughed.

"Even doctors oversleep, huh?"

"Especially doctors. How can I help you?" she followed, trying not to sound impatient. She would have to shower and dress in twenty minutes and like a character on a television commercial, grab some breakfast bar on her way out and to the office. Grandma Gussie's single-story Queen Anne-style house was just outside Centerville, so fortunately there wasn't that long a commute to the office. When she was little, she called it the Gingerbread House because of the color of the shingles and the shutters.

"One of my ADA's was summoned to a situation regarding a Kristin Martin from Loch Sheldrake last night. The on-the-scene officer's report has your name on it. How did you come to be the one attending to the victim?" The sheer coincidence of it was obviously not lost on Will Dennis, whose voice sounded full of wild suspicions.

"I was on my way home from dinner when I saw the patrol car and the vehicle. The officer asked me to look at her when I told him I was a physician."

"So you had time to examine her?"

"Barely. She went into a convulsion quickly. I can't tell you what happened to her except to say it was probably heart failure. What caused it is another..."

"Well, there is evidence of sexual intercourse," he said quickly, "so considering the condition she was in when she was discovered, we would have to consider an assault, but the report from the autopsy I was just given over the phone has thrown me for a loop, as they say."

"Oh. What was it?"

"The official diagnosis is going to be an extreme case of wet beriberi." She could feel herself holding her breath involuntarily. That diagnosis had lingered like a persistent itch she refused to scratch or acknowledge.

"Wet beriberi," she repeated as though she had to say it to confirm that she had heard it.

"Correct me if I'm wrong, Doctor, but isn't that caused by a vitamin deficiency?"

"B1, thiamine," she said.

"The report claims not a trace of it in her body," Will Dennis said. "Isn't that very unusual?"

"Not a trace? Yes. A very low level would be common in the Third World, a chronic alcoholic, breast-fed babies, but not a trace?"

"That's what they're telling me, which was basically what was on Paige Thorndyke's autopsy report, not a trace of vitamin C in that case. Can you offer any sort of explanation, Doctor?"

"I'm not any sort of expert for this, Mr. Dennis. I just know what any family physician would know."

"I realize that. I'm calling you solely because of the coincidence of your being an attending physician on both these bizarre cases. I wanted you to know about it, first, and then, maybe later, we can talk."

For a second or two, she couldn't speak and then her voice returned.

"Yes, of course. I'm on until five today and then I'm going to the hospital to do rounds," she said.

"You have a worse schedule than I have," he kidded. He was silent a moment. "I really don't know what to make of all this. That's why I'm reaching everywhere. I mean, if someone dies because of malnutrition, I don't see how I can indict anyone unless it was a child and a parent situation involving criminal neglect. And yet, as you pointed out, this sort of phenomenon is too unusual in a highly developed country. We're out here a ways and some people think we're still hicks, but two otherwise healthy young women dying of vitamin deficiencies within a week's time...."

"I understand your concern," she said. "If I were you, I'd have the same and start to bring in some real medical experts," she said. It sounded too much like she was trying to get him off her back, however. "Of course, I'll be glad to add anything I can to any investigation."

"Thank you. What time do you actually begin at the hospital?"

"As I said, I'll leave the office about five and grab a quick bite in the hospital cafeteria before starting my rounds about seven."

"Okay, I'll stop by the hospital and catch you at dinner. The way this is going it might be my only chance to grab dinner tonight, too. Even hospital food has some nutrition in it, right?" he added.

"Right. Although I'm beginning to wonder if it matters all that much where we eat," she quipped.

He grunted.

"If you have a quiet moment, give some thought to what you saw last night, what if anything the girl managed to say, that sort of thing."

"She didn't say..."

"For now, Doctor, I would appreciate it if you would keep what I have told you confidential," he interjected before she could finish. "I have no idea where I'm going with this or what I'm looking for and that makes me a very nervous man," he concluded, thanked her, and hung up.

Makes you nervous, she thought. What do you think it does to me?

She had just backed out of her driveway when her cell phone rang. She had it on speaker and flipped the lid.

"Dr. Barnard," she said.

"Say Doc, you make house calls?" Curt asked.

"Not today," she said dryly. They often had humorous conversations before either of them said anything remotely serious, but she was far from that mood. He heard it in her voice.

"I was hoping to hear from you this morning," he said, a little more irritation in his voice than she expected.

"I overslept. I'm actually rushing to get to the office."

"Oh. Hope it wasn't something I said or did. I did think I would hear from you before you turned in, remember?"

"No. I had a problem last night on the way home, Curt."

"What? What happened?"

"I came upon a woman in trouble. A police car was on the scene and I tried to administer medical aid, but she died shortly after I had arrived."

"Holy shit! What happened to her? Who was she?" he asked rapidly. She thought about Will Dennis's request to keep the information confidential.

"She had heart failure," she replied. That was at least partially the cause. "Her name is Kristin Martin and she's from Loch Sheldrake."

"Loch Sheldrake? Yeah, I know of a Martin family there. They have a tourist house, one of the last remaining old-time borscht belt properties," he said. "A bed and breakfast type."

"Did you know the young woman?"

"No. Dad did something for the family years ago. I think there was a dispute over a submersible well or something. Heart failure. Jesus. Was she very fat or something?"

"No, Curt," she said. "I don't know the exact cause yet," she said, deciding not to tell him what she already knew. It was still too bizarre and inexplicable.

"Will I see you today?" he asked. "I'm in the office all morning and then I'm off to court, but I have time for lunch, I think."

"I have a full day, Curt, and tonight's my night for hospital rounds, remember?"

"No, but I hope I won't have to get sick to see my wife," he quipped.

"And I hope I don't have to sue anyone to see my husband," she fired back. He laughed, but it was forced.

"You should have come home with me," he finally said. She had been counting the seconds.

"If I follow that logic, I shouldn't come out of the house, period," she replied.

"Okay, okay. What about meeting for a quick dinner, then? I'll even eat in the hospital cafeteria with you."

"I have to meet with the district attorney about then. He's coming to the hospital."

"Will Dennis? Why?"

"He wants to talk to me about the situation I confronted last night, Curt," she said. She realized half truths made it all even stranger. Curt was far from dense when it came to things like this, she thought. He was silent for a moment.

"Why?" he demanded. "Were there signs of foul play?"

"The woman was totally naked and probably raped."

"What?" He thought a moment. "I don't like the sound of any of this, and I especially don't like you talking to Will Dennis without my being present," he said.

"Huh?" She smiled and froze a laugh. "Why not?"

"I just don't like it. First, maybe an undercover detective, maybe not, and now this."

"You're sounding a little paranoid, aren't you?" she quipped.

"It's my job to be that way, especially when it comes to law enforcement officers who look for the easiest way out, and," he added before she could comment, "who are political creatures."

She stifled any reply. Was he right?

"I have to speak to him, Curt. It would look worse if I didn't. I'll call you right afterward."

"No, you won't, but I'll call you," he said. "Maybe you should have become a paramedic."

"Maybe you should have become a court stenographer," she retorted.

"Right," he said, his voice full of controlled anger. She flipped the phone closed and concentrated on what she knew she had at the office, hoping she would be able to do just that: focus on her patients, but news of any death in the township traveled fast, even before it made the local radio news.

"Did you hear about Kristin Martin?" Elaine Wolf asked Terri the moment she entered the lobby.

Apparently Elaine Wolf, her one-woman news team, did not have much detail yet and didn't even know Terri's involvement. Will Dennis was keeping the lid tight on this one for as long as he could, she thought, but she knew Elaine would feel betrayed if Terri didn't tell her something.

"I came upon the scene last night and attended her myself," she replied.

"Oh. I didn't hear that. My God, poor you. Well, what happened to her? All I heard was she had a heart attack. A girl that young?"

"We'll have to wait to see," Terri said quickly, trying to make it seem as routine as possible. Before Elaine could ask anything else, Terri continued into the offices. She went directly to Hyman's.

He was on the phone talking to the radiologist at the hospital about Marvin Kaplan's fractured femur. The sixty-year-old plumber had fallen from a ladder in his own home, screaming how he could crawl through sewers, swing on rafters, and lug two hundred pound pipes and not get hurt, but do something for himself.... Hyman had his hands full with him when he was brought to the office and then sent on to the hospital.

"We'll have to chain him to the bed," he concluded after hearing the full report.

"That man hasn't taken a day off for forty-five years. Weekends to him just mean time and a half."

Hyman nodded at Terri and held up his hand for her to wait.

"Thanks, Fred. I'll see you at two thirty."

He hung up and turned his chair around.

"One of my spies at the hospital called me ten minutes ago and told me something on the Q.T. It seems we have another very bizarre fatality in the county."

She sank into the chair in front of his desk.

"You don't know that I was the attending physician on the scene last night?" He sat back, his mouth slightly open, his eyebrows raised.

"You're kidding."

"Believe me, I wish I was," she said and reviewed what she had discovered and what she had done. "It all happened so fast," she concluded. "You know how rapid and dramatic the response to flooding doses of thiamine hydrochloride in patients suffering with wet beriberi can be. A diuresis starts between 4 and 48

hours with visible resolution of most of the edema within four to eight hours. It's all gone in two days!" she added with frustration turning her eyes into PingPong balls.

"I'm beginning to sound like a broken record, but I've never seen this serious a case of wet beriberi, even during my internship. No trace of thiamine in the blood!" He paused and considered her. "No one could possibly blame you in any way."

She shook her head.

"I'm not even thinking about that," she said. "We didn't have time to get her to the hospital for blood tests so we could start a protocol." He nodded and leaned forward, putting his elbows on the desk and pressing his two forefingers into the bottom of his jaw, a habitual posture for him.

"It's a maddening sort of deja vu."

He nodded.

"Yes, but I would even go as far as saying there are some diseases so rare in the modern world, many physicians wouldn't recognize them or consider their possibility when they confronted the symptoms," he said. She knew he was just trying to help her feel better about it.

"I really considered that diagnosis, Hyman, but I shook it out of my head. I was concentrating on an allergy," she said, hating the sound of her voice, the whining. "The policeman got me thinking about a bee sting."

"Logical. You had the hyperventilating, the racing heartbeat, edema."

"I also smelled alcohol on her breath and a whole series of other possibilities flew by."

"A-huh," Hyman said. "Well, I can't tell you any of it makes sense to me."

"The district attorney feels the same way."

"Oh? How do you know that?"

"He was my first call this morning. He wants to see me so much he's coming to the hospital to meet me in the cafeteria before I begin my rounds."

"Oh." Hyman's forehead went into folds. "Why? He has his own medical experts to call upon. No offense, but I would think he would contact an expert on nutrition, not a family physician still green around the gills."

"I agree, and I think Curt does too, although I didn't tell Curt about Kristin's beriberi. Will Dennis wants it kept as quiet as possible for now."

"Oh?"

"Dennis's request to see me confused Curt or worried him. He was upset about it and chided me for agreeing to talk to Dennis like this, but I was the attending physician on both cases, Hyman, and for some reason Will Dennis thinks I might know something or help him understand the deaths of these two women. Kristin Martin, like Paige Thorndyke, was in no condition to provide valuable details. She mouthed something, but I made no sense of it." He stared at her for a moment and then sat back shaking his head.

"I admit Curt has me feeling a little paranoid," she confessed.

"This is all just coincidence," Hyman said. "We live in a small town. There's no reason to make any more of it."

"I hope so," she replied. "I hope that's the way the district attorney sees it, too."

"Well," he said starting to laugh, "what else could it be? You're not some sort of medical serial killer, are you?"

It was on the tip of her tongue to tell him it was some mystical or fated force at work, a dark force that had decided to attach itself to her, something her grandmother would believe as strongly as she believed in the Evil Eye, but Hyman would call that a bubbe meise, an old-wives' tale. He was reading it in her eyes.

"You're not going to go all funny on me now, are you, Terri?" he asked, halfjesting, "and talk about Fate and some curse or something. Are you?"

"No," she said rising. "But please, give me colds, allergies, even diabetes today and leave the bizarre outside our door."

He laughed and she went to set up for her first patient of the day.