“There goes the neighborhood?” said Spironi.
“Unfortunately, Doctor, the neighborhood has already gone.”
“So what do you suggest?” said Elaine, the ponytailed woman. “Closing down?”
Plumb shifted his gaze to her sharply. Lifting his foot from the chair, he straightened and sighed.
“What I suggest, Dr. Eubanks, is that we all remain painfully aware of the realities that, for all intents and purposes, imprison us. Institution-specific problems that augment the already difficult state of health care in this city, county, state, and to some extent, the entire country. I suggest that all of us work within a realistic framework in order to keep this institution going at some level.”
“Some level?” said Kornblatt. “That sounds like more cuts a-comin’, George. What’s next, another pogrom, like Psychiatry? Or radical surgery on every division, like the rumors we’ve been hearing?”
“I really don’t think,” said Plumb, “that this is the right time to get into that kind of detail.”
“Why not? It’s an open forum.”
“Because the facts simply aren’t available at present.”
“So you’re not denying there will be cuts, soon?”
“No, Daniel,” said Plumb, straightening and placing his hands behind his back. “I couldn’t be honest and deny it. I’m neither denying nor confirming, because to do either would be to perform a disservice to you as well as to the institution. My reason for attending this meeting was to pay respect to Dr. Ashmore and to express solidarity — personal and institutional — with your well-intentioned memorial for him. The political nature of the meeting was never made clear to me and had I known I was intruding, I would have steered clear. So please excuse that intrusion, right now — though if I’m not mistaken, I do spot a few other Ph.D.’s out there.” He looked at me briefly. “Good day.”
He gave a small wave and headed up the stairs.
Afro said, “George — Dr. Plumb?”
Plumb stopped and turned. “Yes, Dr. Runge?”
“We do — I’m sure I speak for all of us in saying this — we do appreciate your presence.”
“Thank you, John.”
“Perhaps if this leads to greater communication between administration and the professional staff, Dr. Ashmore’s death will have acquired a tiny bit of meaning.”
“God willing, John,” said Plumb. “God willing.”
12
After Plumb left, the meeting lost its steam. Some of the doctors stayed behind, clustering in small discussion groups, but most disappeared. As I exited the auditorium I saw Stephanie coming down the hall.
“Is it over?” she said, walking faster. “I got hung up.”
“Over and done. But you didn’t miss much. No one seemed to have much to say about Ashmore. It started to evolve into a gripe session against the administration. Then Plumb showed up and took the wind out of the staffs sails by offering to do everything they were demanding.”
“Like what?”
“Better security.” I told her the details, then recounted Plumb’s exchange with Dan Kornblatt.
“On a brighter note,” she said, “we seem finally to have found something physical on Cassie. Look here.”
She reached into her pocket and drew out a piece of paper. Cassie’s name and hospital registration number were at the top. Below was a column of numbers.
“Fresh from this morning’s labs.”
She pointed to a number.
“Low sugar — hypoglycemia. Which could easily explain the grand mal, Alex. There were no focal sites on the EEG and very little if any wave abnormality — Bogner says it’s one of those profiles that’s open to interpretation. I’m sure you know that happens all the time in kids. So if we hadn’t found low sugar, we would have really been stumped.”
She pocketed the paper.
I said, “Hypoglycemia never showed up in her tests before, did it?”
“No, and I checked for it each time. When you see seizures in a kid you always look at sugar and calcium imbalance. The layman thinks of hypoglycemia as something minor but in babies it can really trash their nervous systems. Both times after her seizures, Cassie had normal sugar, but I asked Cindy if she’d given her anything to drink before she brought her into the E.R. and she said she had — juice or soda. Reasonable thing to do — kid looks dehydrated, get some fluids in her. But that, plus the time lag getting over here, could very well have messed up the other labs. So in some sense it’s good she seized here in the hospital and we were able to check her out right away.”
“Any idea why her sugar’s low?”
She gave a grim look. “That’s the question, Alex. Severe hypoglycemia with seizures is usually more common in infants than in 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 glycogen-storage 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.
I said, “Would hypoglycemia explain the other problems — breathing 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.