Devil's Waltz

14

When I entered room 505W, Cassie followed me with her eyes but the rest of her didn’t move.

The drapes were drawn, and yellow light came from the half-open door of the bathroom. I saw wet clothes hanging over the shower rod. The bed rails were down and the room had the gluey smell of old bandages.

A metered I.V. line was still attached to Cassie’s left arm. Clear fluid from a hanging bottle slow-dripped through the tubing. The whirr of the I.V. meter seemed louder. LuvBunnies surrounded Cassie. An untouched breakfast tray sat on the table.

I said, “Hi, sweetie.”

She gave a small smile, closed her eyes, and moved her head back and forth the way a blind child might.

Cindy came out of the bathroom and said, “Hi, Dr. Delaware.” Her braid was gathered atop her head and her blouse was untucked.

“Hi. How’re you managing?”

“Okay.”

I sat on the edge of Cassie’s bed. Cindy came over and stood next to me. The pressure of my weight made Cassie’s eyes open again. I smiled at her, touched her fingers. Her stomach rumbled and she shut her eyes once more. Her lips were dry and chapped. A small scrap of dead skin hung from the upper one. Each breath ruffled it.

I took her free hand. She didn’t resist. Her skin was warm and silky, soft as a dolphin’s belly.

I said, “Such a good girl,” and saw her eyes move behind the lids.

“We had a rough night,” said Cindy.

“I know. Sorry to hear it.” I looked down at the hand in mine. No new wounds but plenty of old ones. The thumbnail was tiny, square-edged, in need of cleaning. I exerted gentle pressure and the digit rose, remained extended for a moment, then lowered, tapping the top of my hand. I repeated the pressure and the same thing happened. But her eyes remained shut and her face had grown loose. Within moments she was sleeping, breathing in time with the I.V. drip.

Cindy reached down and stroked her daughter’s cheek. One of the bunnies fell to the floor. She picked it up and placed it next to the breakfast tray. The tray was farther away than she’d estimated and the movement threw her off balance. I caught her elbow and held it. Through the sleeve of her blouse, her arm was thin and pliable. I let go of it but she held on to my hand for a moment.

I noticed worry lines around her eyes and mouth, saw where aging would take her. Our eyes met. Hers were full of wonder and fear. She stepped away from me and went to sit on the sleeper couch.

I said, “What’s been happening?” though I’d read the chart before coming in.

“Sticks and tests,” she said. “All kinds of scans. She didn’t get any dinner until late and couldn’t hold it down.”

“Poor thing.”

She bit her lip. “Dr. Eves says the appetite loss is either anxiety or some sort of reaction to the isotopes they used in the scans.”

“That sometimes happens,” I said. “Especially when there are a lot of tests and the isotopes build up in the system.”

She nodded. “She’s pretty tired. I guess you can’t draw with her today.”

“Guess not.”

“It’s too bad — the way it worked out. You didn’t have time to do your techniques.”

“How’d she tolerate the procedures?”

“Actually, she was so tired — after the grand mal — that she was kind of passive.”

She looked over at the bed, turned away quickly, and put the palms of her hands on the sofa, propping herself up.

Our eyes met again. She stifled a yawn and said, “Excuse me.”

“Anything I can help with?”

“Thanks. Can’t think of any.”

She closed her eyes.

I said, “I’ll let you rest,” and walked to the door.

“Dr. Delaware?”

“Yes?”

“That home visit we spoke about,” she said. “When we finally do get out of here, you’re still planning on doing it, aren’t you?”

“Sure.”

“Good.”

Something in her voice — a stridency I’d never heard before — made me stand there and wait.

But she just said “Good” again, and looked away, resigned. As if a critical moment had come and gone. When she started to play with her braid, I left.

No sign of Vicki Bottomley; the nurse on shift was a stranger. After completing my own notes, I reread Stephanie’s, the neurologist’s, and those of the consulting endocrinologist — someone named Alan Macauley, with strong, large handwriting.

The neurologist had found no abnormality on two successive EEGs and deferred to Macauley, who reported no evidence of any metabolic disorder, though his lab tests were still being analyzed. As far as medical science could tell, Cassie’s pancreas was structurally and biochemically normal. Macauley suggested further genetic tests and scans to rule out some sort of brain tumor, and recommended further “intensive psychological consultation per Dr. Delaware.”

I’d never met the man and was surprised to be referred to by name. Wanting to know what he meant by “intensive,” I looked up his number in a hospital directory and called it.

“Macauley.”

“Dr. Macauley, this is Alex Delaware — the psychologist who’s seeing Cassie Jones.”

“Lucky you. Been to see her recently?”

“About a minute ago.”

“How’s she doing?”

“Wiped out — post-seizural fatigue, I guess.”

“Probably.”

“Her mother said she didn’t hold her dinner down.”

“Her mother, huh?... So, what can I do for you?”

“I read your notes — about psychological support. Wondered if you had any suggestions.”

Long pause.

“Where are you now?” he said.

“Chappy Ward nursing station.”

“Okay, listen, I’ve got Diabetes Clinic in about twenty minutes. I can get there a little early — say in five. Why don’t you catch me? Three East.”

He waved when he saw me coming and I realized I’d seen him the day before at Ashmore’s memorial. The husky, dark, bald man who’d talked about Texas and guns, a Smith & Wesson in every black bag.

Standing, he looked even bigger, with thick sloping shoulders and stevedore arms. He had on a white polo shirt over pressed jeans and western ostrich boots. His badge was pinned just above the jockey-and-horse logo. His stethoscope was in one hand. The other hand made aeronautic movements — nosedives and fast climbs — as he talked to a gangly boy of around seventeen.

Fifteen minutes before clinic was scheduled to start and the Endocrinology waiting room was filling up. Nutritional posters hung on the walls. Children’s books and battered magazines were stacked on the table, along with brochures and packets of artificial sweetener.

Macauley slapped the boy’s back and I heard him say, “You’re doing great — keep it up. I know sticking yourself sucks the big hairy one, but depending on Mommy to stick you sucks even worse, doesn’t it? So keep her the heck out of your life and go have some fun.”

“Yeah, right,” said the boy. He had a big chin and big nose. Big jug ears, each pierced with three gold wire loops. Well over six feet, but Macauley made him look small. His skin was oily-looking and sallow, spotted with pimples on cheeks and brow. His hair had been mowed in a new-wave do with more levels and angles than an architect’s wet dream. “Party on,” he said glumly.

“Hey, party hearty, man,” said Macauley, “just as long as it’s sugar-free.”

“Fuck,” said the boy.

“Now, that’s okay, Kev. That you can do to your horny little heart’s content, long as you use a condom.”

The boy grinned despite himself.

Macauley slapped him again and said, “Okay, scram, get, vamoose, clear out of here. I’ve got sick people to deal with.”

“Yeah, right.” The boy pulled out a pack of cigarettes, stuck a smoke in his mouth, but didn’t light it.

Macauley said, “Hey, turkey, your lungs are someone else’s problem.”

The boy laughed and shambled off.

Macauley came over to me. “Noncompliant adolescents with brittle 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 sugar-content 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 if I 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 case?”

“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 doper patients get creative all the time, and insulin goes right into the skin. Little pinprick like that can heal really quickly.”

“Have you mentioned your suspicions to Stephanie?”

He nodded. “Sure I did, but she’s still hopped up on something esoteric. Between you and me, I didn’t get the feeling she wanted to hear it. Not that it matters to me personally. I’m off the case — quits, vamoose. Out of here, as a matter of fact.”

“Leaving the hospital?”

“You bet. One more month, then off for quieter pastures. I need the time I have left to wrap up my own cases. It’s gonna be a mess — lots of angry families. So the last thing I want to do is muck around in Chuck Jones’s family affairs when there’s nothing I can do about it anyway.”

“Because it’s his family?”

He shook his head. “It would be nice to say yup, that’s it, the whole thing’s politics. But actually, it’s the case itself. She could be anyone’s granddaughter and we’d still be spitting into the wind because we have no facts. Just look at you and me, right here. You know what’s going on; I know what’s going on; Stephanie used to know what was going on until she got all horny about the hypoglycemia. But knowing doesn’t mean a thing, legally, does it? ’Cause we can’t do anything. That’s what I hate about abuse cases — someone accuses parents; they deny it, walk away or just ask for another doc. And even if you could prove something was going on, you’d get into a circus of lawyers, paperwork, years in court, dragging our reputations through the mud. Meantime the kid’s a basket case and you couldn’t even get a restraining order.”

“Sounds like you’ve had experience.”

“My wife’s a county social worker. The system’s so overloaded, even kids with broken bones aren’t considered a priority anymore. But it’s the same all over — I had a case back in Texas, diabetic kid. The mother was witholding insulin and we still had a hell of a time keeping the kid safe. And she was a nurse. Top O.R. gal.”

“Speaking of nurses,” I said, “what do you think of Cassie’s primary R.N.?”

“Who’s that? Oh, yeah, Vicki. I think Vicki’s a cranky bitch but generally real good at what she does—” The droopy eyes perked. “Her? Shit, I never thought about that, but that doesn’t make sense, does it? Till this last seizure, the problems started at home.”

“Vicki visited the home, but only a couple of times. Not enough to do all the damage.”

“Besides,” he said, “it’s always the mother, isn’t it, these Munchausens? And this one’s strange — at least in my uneducated opinion.”

“How so?”

“I don’t know. She’s just too damned nice. Especially considering how inept we’ve been diagnosing her kid. That were me, I’d be pissed, demanding action. But she keeps smiling. Smiles too much for my taste. ‘Hi, Doctor, how are you, Doctor?’ Never trust a smiler, Al. I was married to one the first time. Those white teeth were always hiding something — you can probably give me all the psychodynamics behind it, right?”

I shrugged and said, “Perfect world.”

He laughed. “Lot of good you are.”

I said, “Any impressions of the father?”

“Never met him. Why? Is he strange too?”

“I wouldn’t say strange. He’s just not what you’d expect of Chuck Jones’s son. Beard, earring. Doesn’t seem to have much affection for the hospital.”

“Well, at least he and Chuck have something in common... Far as I’m concerned the case is a loser and I’m tired of losing. That’s why I punted to you. And now you’re telling me you’ve got squat. Too bad.”

He retrieved the hammer, tossed it, caught it, used it to drum the top of the table.

I said, “Would hypoglycemia explain any of Cassie’s earlier symptoms?”

“Maybe the diarrhea. But she also had fevers, so there was probably some kind of infectious process going on. In terms of the breathing problems, it’s also possible. Mess with the metabolism, anything’s possible.”

He picked up his stethoscope and looked at his watch. “Got work to do. Some of the kids out there, this’ll be the last time I see them.”

I got up and thanked him.

“For what? I’ve accomplished squat on this one.”

I laughed. “Same way I feel, Al.”

“Consultancy blues. You know the story of the oversexed rooster who was bothering the hens in the henhouse? Sneaking up behind ’em and jumping their bones, just generally making a nuisance of himself? So the farmer had him castrated and turned him into a consultant. Now he just sits on the fence, watching and giving advice to the other roosters. Trying to remember what it felt like.”

I laughed again. We left the exam room and returned to the waiting room. A nurse came up to Macauley and handed him a pile of charts without comment. She looked angry as she walked away.

“Good morning to you, too, darling,” he said. To me: “I’m a rotten deserter. Next few weeks are gonna be my punishment.”

He looked out at the turmoil and his hound face sagged.

“Does quieter pastures mean private practice?” I said.

“Group practice. Small town in Colorado, not far from Vail. Ski in the winter, fish in the summer, find new modes of mischief for the rest of the year.”

“Doesn’t sound too bad.”

“Shouldn’t be. No one else in the group does endocrinology, so maybe I’ll even have a chance to use my training once in a while.”

“How long have you been at Western Peds?”

“Two years. One and a half too long.”

“The financial situation?”

“That’s a big part of it but not all of it. I was no Pollyanna when I came here, knew an inner-city hospital would always be struggling to balance the books. It’s the attitude that bugs me.”

“Grandpa Chuck?”

“And his boys. They’re trying to run this place like just another company. We could be manufacturing widgets for all they’re concerned. That’s what grinds — their not understanding. Even the gypsies know things are bad — you know about our Hollywood gypsies?”

“Sure,” I said. “Big white Cadillacs, twelve to a car, camp-outs in the hallways, the barter system.”

He grinned. “I’ve been paid with food, spare parts for my MG, an old mandolin. Actually, it’s a better reimbursement rate than I get from the government. Anyway, one of my diabetics is one of them. Nine years old, in line to be king of the tribe. His mother’s this good-looking woman, educated, about a hundred years of living behind her. Usually when she comes in she’s full of laughs, buttering me up, telling me I’m God’s answer to medical science. This time she was really quiet, as if she was upset about something. And it was just a routine exam — the boy’s doing well, medically. So I asked her what the matter was and she said, ‘This place, Dr. Al. Bad vibrations.’ She was narrowing her eyes at me like some storefront fortuneteller. I said, what do you mean? But she wouldn’t explain, just touched my hand and said, ‘I like you, Dr. Al, and Anton likes you. But we won’t be coming back here. Bad vibrations.’ ”

He hefted the charts and transferred them to one hand. “Pretty dicey, huh?”

I said, “Maybe we should consult her on Cassie.”

He smiled. Patients continued to stream in, even though there was no room for them. Some of them greeted him and he responded with winks.

I thanked him again for his time.

He said, “Sorry we won’t have a chance to work together.”

“Good luck in Colorado.”

“Yup,” he said. “You ski?”

“No.”

“Me neither...” He looked back at the waiting room, shook his head. “What a place... Originally, I was gonna be a surgeon, slice and dice. Then, when I was a second-year med student, I came down with diabetes. No dramatic symptoms, just some weight loss that I didn’t think much about because I wasn’t eating properly. I went into shock in the middle of gross anatomy lab, collapsed on top of my cadaver. It was just before Christmas. I got home and my family handled it by passing the honey-baked ham right by me, no one saying anything. I handled that by rolling my pants up, hoisting my leg up on the table and jabbing it, in front of everyone. Eventually, I figured it was time to forget about scalpels and think about people. That’s what appealed to me about this place — working with kids and families. But when I got here I found out that was all gone. Bad vibes is right. That gypsy lady could tell the moment she walked in the door. It might sound nuts to you, but she crystallized what had been going on in my head for a while. Sure, Colorado’s gonna be boring — sniffles and sneezes and diaper rash. And I haven’t been here long enough to collect any pension, so financially the two years have been a wash. But at least I won’t be sitting on the fence. Cock-a-doodle-doo.”