She withdrew the needle and applied a bandage to the puncture site. Everyone in the room seemed to give a simultaneous sigh of relief; the procedure was over.
But the answer was no closer.
Later that evening, she found Taylor’s mother downstairs in the tiny hospital chapel, gazing numbly at the altar. They had spoken earlier, when Claire had requested the mother’s consent for the lumbar puncture. At the time, Wanda Darnell had been a bundle of nerves, all jittery hands and trembling lips. She had been on the road all day, first the two-hundred mile drive to Portland to visit her divorce attorney, and then the harrowing drive back, after the police had contacted her with the terrible news.
Now Wanda seemed exhausted, all her adrenaline depleted. She was a small woman, dressed in an ill-fitting skirt suit that made her look like a child playing grown-up in her mother’s clothes. She looked up as Claire came into the chapel and barely managed a nod of greeting.
Claire sat down and gently placed her hand on Wanda’s. “The lab results have come back on the spinal tap, and they’re completely normal. Taylor doesn’t have meningitis.”
Wanda Darnell released a deep sigh, her shoulders slumping forward in the oversize suit jacket. “That’s good, then?”
“Yes. And judging by the CT scan, he has no tumors or signs of hemorrhage in his brain. So that’s good, too.”
“Then what’s wrong with him? Why did he do it?”
“I don’t know, Wanda. Do you?”
She sat very still, as though struggling to come up with an answer. “He hasn’t been … right. For almost a week.”
“What do you mean?”
“He’s been out of control, angry at everyone. Cursing and slamming doors. I thought it was because of the divorce. He’s had such a hard time of it …”
Claire was reluctant to bring up the next subject, but it had to be addressed. “What about drugs, Wanda? That could change a child’s personality. Do you think he’s been experimenting with anything?”
Wanda hesitated. “No.”
“You don’t sound sure.”
“It’s just that …” She swallowed, tears flashing in her eyes. “I feel like I hardly know him anymore. He’s my son, and I don’t even recognize him.”
“Have you seen any warning signs?”
“He’s always been a little difficult. That’s why Dr. Pomeroy thought he might have attention deficit disorder. Lately, it seems he’s gotten worse. Especially since he started hanging out with those awful boys.”
“Which boys?”
“They live up the road from us. J.D. and Eddie Reid. And then there’s that Scotty Braxton. All four of them got into trouble with the police back in March. Last week, I told Taylor he had to stay away from the Reid brothers. That’s when we got into our first really big fight. That’s when he slapped me.”
“Taylor did?”
Wanda’s head drooped, the victim ashamed she’d been abused. “We’ve hardly spoken to each other since then. And when we do talk, it’s so obvious that …” Her voice slid to a whisper. “That we hate each other.”
Gently Claire touched Wanda’s arm. “Believe it or not, disliking your own teenager isn’t all that abnormal.”
“But I’m also afraid of him! That’s what makes it even worse. I dislike him and I’m scared of him. When he hit me, it was like having his father back in the house.” She touched her fingers to her mouth, as though remembering some long-faded bruise. “Paul and I are still in a custody fight. Two of us battling over a boy who doesn’t like either of us.”
Claire’s beeper went off. She glanced at the digital readout and saw the lab was paging her. “Excuse me,” she said, and left the chapel to make the call from the hospital lobby.
Anthony, the lab supervisor, answered the phone. “The Bangor lab just called with more of Taylor’s results, Dr. Elliot.”
“Did anything turn up positive on the specific screens?”
“I’m afraid not. There’s no alcohol, cannabis, opioids, or amphetamines in his blood. That’s a negative for every drug you wanted screened.”
“I was so sure,” she said in bewilderment. “I don’t know what else could cause this behavior. There must be some drug I’ve forgotten to test for.”
“There may be something. I ran his blood through our hospital gas chromatography machine, and an abnormal peak showed up at one minute, ten seconds’ retention time.”
“What does that mean?”
“It doesn’t pinpoint any particular drug. But there is a peak, which indicates something out of the ordinary is circulating in his blood. It could be completely innocuous—an herbal supplement, for instance.”
“How do we find out what it is?”
“We’d need more extensive analysis. The Bangor lab isn’t equipped to do that. We have to draw more blood and send it to our reference lab in Boston. They can simultaneously screen for hundreds of different drugs.”
“Then let’s do it.”
“Well, here’s the problem. It’s the other reason I paged you. I just got an order to cancel any and all remaining drug tests. It’s signed by Dr. DelRay.”
“What?” She shook her head in disbelief. “I’m Taylor’s doctor.”
“But DelRay’s writing orders, and his are contradictory to yours. So I’m not sure what to do.”
“Look, let me talk to the mother and I’ll clear this up right now.” She hung up and returned to the chapel.
Even before she opened the door, she could hear a man’s voice, raised in anger.
“ … never exerted any control! Completely useless, that’s what you are. No wonder he’s so screwed up!”
Claire pushed into the chapel. “Is there a problem here, Wanda?”
The man turned to her. “I’m Taylor’s father.”
Personal crises bring out the worst in people, but Paul Darnell was probably not likable even at his best. A partner in the largest accounting firm in Two Hills, he was far more stylishly garbed than his wife, who seemed to shrink to inconsequential size in her ill-fitting suit. The brief interaction Claire had witnessed between these two ex-spouses told her what this marriage must have been like: Paul the aggressor, full of demands and complaints. Wanda always appeasing, retreating.
“What is this about my son taking illegal drugs?” he asked.
“I’m trying to find a reason for what happened today, Mr. Darnell. I was just asking your wife—”
“Taylor hasn’t been taking any drugs. Not since you stopped the Ritalin.” He paused. “And he was fine on the Ritalin. I never understood why you took him off it.”
“It’s been two months since I discontinued it. This personality change is more recent.”
“Two months ago, he was fine.”
“No he wasn’t. He was tired and listless. And that diagnosis of ADD was never really established. It’s not the same as diagnosing hypertension, where there are definite parameters to go by.”
“Dr. Pomeroy was certain of the diagnosis.”
“ADD has turned into a catchall for all childhood misbehavior. When a student’s failing in class, or he gets into mischief, parents want to find a reason. I didn’t agree with Pomeroy’s diagnosis. When in doubt, I prefer not to push pills on children.”
“And look what’s happened. He’s out of control. He’s been out of control for weeks.”
“How would you know, Paul?” said Wanda. “How long has it been since you actually spent time with your own son?”
Paul turned to his ex-wife with such a look of hatred, Wanda shrank back. “You’re the one who’s supposed to be in charge,” he said. “I knew you couldn’t handle him. You screwed it up as usual, and now our son’s going to end up in jail!”
“At least I didn’t provide him with the gun,” she said softly.
“What?”
“It was your gun he brought to school. Did you ever notice it was missing?”
He stared at her. “The little shit! How did he get”
“T
his isn’t helping!” Claire cut in. “We need to focus on Taylor. On how to explain his behavior.”
Paul turned to his wife. “I’ve asked Adam DelRay to take over. He’s upstairs looking at Taylor now.”
Paul’s blunt announcement left Claire speechless. So this was why DelRay had written orders; he was the new attending. She’d just been fired from the case.
“But Dr. Elliot’s his doctor!” Wanda protested.
“I know Adam, and I trust his judgment.”
Meaning he doesn’t trust mine?
“I don’t even like Adam DelRay,” said Wanda. “He’s your friend, not mine.”
“You don’t have to like him.”
“If he’s taking care of my son, I do.”
Paul’s laughter was grating. “Is that how you choose a doctor, Wanda? Pick whoever gives you the most warm fuzzies?”
“I’m doing what’s best for Taylor!”
“And that’s exactly why he ended up here.”
Claire’s temper at last burst through. “Mr. Darnell,” she said, “this is not the time to be attacking your wife!”
He turned to Claire, and his contempt was clearly meant for her as well. “Ex-wife,” he corrected. And he turned and walked out of the chapel.
She found Adam DelRay sitting at the nurses’ station, writing in Taylor’s chart. Although it was late in the evening, his white coat was starched and fresh, and Claire felt rumpled by comparison. Whatever embarrassment he’d suffered earlier that day during the crisis with Katie Youmans had been conveniently forgotten, and he regarded Claire with his usual irritating self-confidence.
“I was about to page you,” he said. “Paul Darnell just decided—”
“I’ve already spoken to him.”
“Oh. So you know.” He gave an apologetic shrug. “I hope you don’t take it personally.”
“It’s the parents’ decision. They have a right to make it,” she acknowledged grudgingly. “But since you’re taking over, I thought you should know the boy has an abnormal peak on gas chromatography. I suggest you order a comprehensive drug screen.”
“I don’t think that’s necessary.” He set the chart down and stood up. “The most likely drugs have been ruled out.”
“That peak needs to be identified.”
“Paul doesn’t want any more drug tests.”
She shook her head, puzzled. “I don’t understand his objections.”
“I believe he reached that decision after speaking with his attorney.”
She waited for him to walk away before picking up the chart. She flipped to the progress notes and with growing dismay read DelRay’s entry.
History and physical dictated.
Assessment:
1. Acute psychosis secondary to abrupt Ritalin withdrawal.
2. Attention Deficit Disorder.
Claire dropped into the nearest chair, her legs suddenly unsteady, her stomach queasy. So this was their criminal defense strategy. That the boy was not responsible for his actions. That Claire should be blamed, because she took him off the Ritalin, triggering a psychotic break. That she was the one who should be blamed. I’m going to end up in court.
This was why Paul didn’t want to find any drug in the boy’s bloodstream. It would shift the blame away from Claire.
Agitated, she flipped to the front of the chart and read DelRay’s orders.
Cancel comprehensive drug/tox screen.
Refer all future questions and lab reports to me.
Dr. Elliot is no longer the attending physician.
She slapped the chart shut and felt her nausea intensify. Now it was no longer just Taylor’s life on the line; it was her practice, and her reputation as well.
She thought of the first rule of defensive medicine: cover your ass. You can’t get sued if you can prove you didn’t make a mistake. If you can back up your diagnosis with lab tests.
She had to get a sample of Taylor’s blood. This was her last chance to draw the specimen; by tomorrow, any drug would be cleared from his system, and there’d be nothing left to detect.
She crossed the nurses’ station to the supply room, pulled open a drawer, and collected a Vacutainer syringe, alcohol swabs, and three red-top blood tubes. Her heart was racing as she walked up the hall to Taylor’s room. The boy was no longer her patient, and she had no right to be doing this, but she needed to know what drug, if any, was circulating in his bloodstream.
The state trooper gave her a nod of greeting as she approached.
“I need to draw blood,” she said. “Would you mind holding down his arm for me?”
He didn’t look happy about it, but he followed her into the room.
Draw it quick and get out of here. With shaking hands she snapped on the tourniquet and twisted off the needle cap. Get out of here before someone finds out what you’re doing. She swabbed Taylor’s arm with alcohol and he gave a shout of rage, twisting against the trooper’s restraining grip. Claire’s pulse accelerated as she pierced the skin and felt that subtle and satisfying pop as the needle penetrated the vein. Hurry. Hurry. She filled one tube, slipped it into her lab coat pocket, then squeezed another into the Vacutainer. Dark blood streamed out.
“I can’t hold him still,” said the trooper, wrestling for control as the boy bucked and cursed.
“I’m almost done.”
“He’s trying to bite me!”
“Just keep him still!” she snapped, her ears ringing with the boy’s shrieks. She slipped the third tube into place and watched as a fresh stream of blood shot out. Just one more. Come on, come on.
“What the hell is going on in here?”
Claire looked up, so startled she let the needle slip out of the vein. Blood dribbled from the puncture wound and dripped onto the sheets. Quickly she snapped off the tourniquet and applied gauze to the boy’s arm. Cheeks burning with shame, she turned to face Paul Darnell and Adam DelRay, who were staring at her incredulously from the doorway. Two nurses peered over their shoulders.
The trooper said, “She was just drawing some blood. The boy got a little noisy.”
“Dr. Elliot isn’t supposed to be in here,” said Paul. “Didn’t you hear about the new orders?”
“What orders?”
“I’m the boy’s physician now,” snapped DelRay. “Dr. Elliot has no authority. She shouldn’t even be in here.”
The trooper stared at Claire, and his anger was unmistakable. You used me.
Paul thrust out his hand. “Give me the blood tubes, Dr. Elliot.”
She shook her head. “I’m following up an abnormal test. It could affect your son’s treatment.”
“You’re no longer his doctor! Give me the tubes.”
She swallowed hard. “I’m sorry, Mr. Darnell. But I can’t.”
“This is assault!” Paul turned to the others in the room, and his face was florid with outrage. “That’s what this is, you know! She assaulted my son with that needle, and she knows she has no authority!” He looked at Claire. “You’ll be hearing from my attorney.”
“Paul,” interjected DelRay, playing the role of diplomat to the hilt. “I’m sure Dr. Elliot doesn’t want this kind of complication in her life.” He turned to her and spoke with the smug voice of reason. “Come on, Claire. This is turning into a circus. Just give me the tubes.”
She looked down at the two tubes she was holding, weighing their value against a charge of assault. Against the probable loss of her hospital privileges. She felt the gaze of everyone in the room watching, even enjoying, her humiliation.
In silence she handed over the blood tubes.
DelRay took them with a look of triumph. Then he turned to the Maine state trooper. “The boy is my patient. Is that clear?”
“Perfectly clear, Dr. DelRay.”
No one said a word to Claire as she walked out of the ward, but she knew they were staring at her. She kept her gaze focused straight ahead as she turned the corner and punched the down button. Only when she’d stepped into the
elevator and the door slid shut did she finally allow her hand to slip into her coat pocket.
The third blood tube was still there.
She rode the elevator to the basement lab and found Anthony sitting at his lab bench, surrounded by racks of test tubes.
“I’ve got a sample of the boy’s blood,” she told him.
“For the drug screen?”
“Yes. I’ll fill out the requisition myself.”
“The forms are on that shelf over there.”
She took one off the stack and frowned at the letterhead, Anson Biologicals. “Are we using a new reference lab? I’ve never seen one of these forms before.”
He glanced up from a whirring centrifuge. “We just switched over to Anson a few weeks ago. The hospital signed a new contract with them for our complex chem and radioimmunoassay work.”
“Why?”
“I think it was a cost issue.”
She scanned the form, then checked off the box for gas chromatography/mass spectrometry; comprehensive drug and tox screen. In the space for comments at the bottom of the page, she wrote: “Fourteen-year-old boy with apparent drug-induced psychosis and aggression. This lab test is for my personal research only. Report results directly to me.” And she signed her name.
Noah answered the knock on his front door and found Amelia standing outside in the dark. She was wearing a bandage, a bright slash of white across her temple, and he could tell it hurt her to smile. In her discomfort, the best she could muster was a crooked lifting of one side of her mouth.
He was so surprised by her unexpected visit, he couldn’t think of a single intelligent thing to say, so he just gaped at her, as dazzled as a peasant who suddenly finds himself in the presence of royalty.
“This is for you,” she said, and she held out a small brown package. “I’m sorry I couldn’t find anything nice to wrap it in.”
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