“And yet,” Kendall pointed out, “earlier this morning, you wanted to be a robot.”
Susan bobbed her head pointedly, “Perhaps that’s exactly why I wanted to be a robot.”
The point apparently bothered Kendall, who shivered and flopped back into his sprawled-teen posture. “All right. I’m still waiting for the mental-status exam explanation.”
Susan appreciated leaving the discussion of her personal strengths and weaknesses to focus on helping Thomas Heaton. “The self-conducting scene responses were the most revealing to me. He was able to examine the picture and integrate its parts into a cohesive interpretation, thus ruling out visual simultanagnosia.”
“Visual simultaneousnesseses.” Kendall deliberately mangled the long Latin term. “How the hell did you remember how to pronounce that, let alone what it means?”
Susan ignored the question, not wanting to go off on another tangent. “Thomas was able to easily and properly name a baton, which ruled out both apperceptive and associative agnosia.”
“The difference between those being?”
Susan was not sure whether Kendall did not know or if he tested her, but this time, she deigned to answer. “In associative agnosia, the ability to draw or point to objects named by someone else is preserved, while both forms of agnosia inhibit the patient from naming even the most common objects. It’s usually tested with keys. You have the patient try to name them by sight, then by sound or touch.” She paused a moment for further questions before continuing. “He corrected my false colors of the baton, which means he hasn’t developed either color-blindness or color anomia, which would keep him from naming colors even though he could still perceive them.”
Clearly entertained, Kendall gestured for Susan to continue.
“Having him identify Mozart and the like tested for prosopagnosia, or inability to recognize faces. He could write beautifully, so he doesn’t have agraphia. Or, for that matter, optic ataxia, because it’s tough to write actual words when you’ve lost hand-eye coordination.”
Kendall had clearly been paying attention. “It sounds like you’ve completely ruled out a posterior cerebral artery stroke.”
“Actually, just the opposite. He definitely suffered a stroke. I think with a little research, we could figure out the exact location of the damage.”
Kendall leaned forward, intrigued. “How so? What did you note on testing that I missed?”
“Thomas Heaton has pure alexia, Kendall.”
Kendall heaved an enormous sigh and plumped his chin on the back of the chair. “For those of us who truly are doctors but don’t remember every esoteric Latin word for situations we haven’t actually seen, can you translate into medical English, please?”
Susan said simply, “He can’t read.”
“What?” Kendall’s eyes narrowed as he considered the information that had brought her to the conclusion. “You mean, he’s illiterate?”
“I mean, he used to be able to read, but now he can’t. I mean, English words now look like Chinese pictographs to him.”
“No wonder he’s depressed.” Kendall’s eyes remained slitted. “Are you sure? He didn’t seem to have any trouble pronouncing composer’s names when you spelled them out to him.”
Susan bobbed her head. “That’s not unusual. Patients with pure alexia often retain the ability to formulate a word and its meaning if spelled out to them verbally or traced, letter by letter, on their hands.”
“Weird.” Kendall had surely seen weirder, or would in the future.
“It’s actually a positive prognostic sign, because it bodes well for his ability to learn to read again, though laboriously and slowly, letter by letter.” Susan continued, “The symphonies were tests of this, too. He didn’t seem to notice they had titles at the top. He had to hum them aloud to identify them.”
“That’s true,” Kendall said carefully, apparently lost in his own thoughts. “Calvin,” he started, then stopped in consideration. “Do you think being enmeshed in music might help him? That the proper therapist could use his thorough knowledge of music as a segue to learning how to read again?”
Susan honored the idea with lengthy contemplation. “I would imagine it’s quite possible. Usually, people with pure alexia either never learn to read again or do so with great difficulty. Obviously, a straight substitution wouldn’t work, especially since musical notes only go up to G.”
Kendall ran with the idea. “If he can instantly name a mouthful of symphony by humming the first few bars, imagine what he might do by associating sound with word by blending chords or stringing passages.” A brilliant thought followed. “He clearly kept his ability to absorb music as a whole entity, rather than as a string of individual notes. If we could rechannel reading through that particular mechanism, one most people never develop to his extent, he might actually learn to read again as fluently as in the past.”
Through the doorway, Susan caught sight of a man striding purposefully toward Jessica Aberdeen’s room. A stab of discomfort lanced her stomach, accompanied by an imminent feeling of dread she could not wholly explain. “That’s an amazing idea. In fact, I think you should work out a detailed plan with his occupational therapist when you discharge him…today. I’ve never heard of such a thing being tried, and this might well turn out to be a reportable case.”
Kendall’s response came from behind her. “I’d appreciate you looking at me, preferably with adoring eyes, while you’re calling me a genius.”
Susan suddenly realized she had her attention fully on the passing man and had craned her neck to watch him turn the corner. “Excuse me, Kendall. I think Jessica Aberdeen’s father just arrived, and I’d better go talk to him.”
“Good luck,” Kendall said, and Susan did not think she imagined the trepidation in his voice. For the first time all day, he did not offer to accompany her.
Chapter 9
Chase Aberdeen was a swift walker, and Susan did not catch up to the man until he had stepped into Jessica’s room. A tall man, in clear and vivid contrast to his tiny daughter, he had a bony face that reminded Susan of a ferret. He was lanky and slender, though not emaciated, and his skin had a grayish cast, suggesting low blood-oxygen saturation and probably anemia. As he entered the room, he flung his long arms about like one accustomed to people taking notice of him at all times. Despite his bold manner, his voice emerged tinny, thin. “Good morning, Jessica. How are you feeling today?”
Farrah looked up from the IV infuser, and Jessica turned to her father with a weak smile. “Much better, Dad. Thanks for asking.”
Chase seemed to grow taller in that moment. “So glad to hear it, darling. We’ll have you home in no time.”
Susan stepped into the doorway. “Another week, at least. Most likely two.”
Chase whirled on his heel, a motion that nearly uprooted him. He fixed his eyes on Susan, green with golden flecks that seemed to flicker in the low light of the dementia room. “And who is this young woman who seeks to countermand me?”
Susan took an instant disliking to the man and appreciated that Farrah spoke before she could say something she might regret. “This is Jessica’s doctor, Mr. Aberdeen. Dr. Calvin, this is Jessica’s father.”
Susan did not waste time with small talk. “Mr. Aberdeen, your daughter was suffering from severe vitamin B12 and calcium malnutrition.”
Chase Aberdeen nodded, though a frown scored his features. He clearly took Susan’s words as a direct assault. “She’s not a fan of raw nori, and the tempeh clearly wasn’t enough. I knew it was only a matter a time before the combination finally worked.”
Susan shook her head. She kept her tone level, her timbre conversational. She needed to enlighten without confrontation. “What worked, Mr. Aberdeen, was the intravenous addition of vitamin B12 and calcium to her system.”
His grin was predatory. “Let’s agree to call it a combined effect.” He turned back to tend Jessica.
Susan would have loved to do so. It would make thin
gs so much easier, so much smoother. Though it incorporated ignorance, it was a compromise she could live with. Unfortunately, Jessica Aberdeen could not. “With all due respect, Mr. Aberdeen, I can’t agree to that. Nori and tempeh do contain B12 analogues, perhaps even active B12, but it’s not in a bioavailable version.”
Chase jerked his attention to Susan. Color eased onto his face. And while it probably indicated the raw stirrings of anger, it gave his face a rosy, more friendly, hue. “Are you a vegan, Dr. Calvin?”
“No,” Susan admitted. “But, like most people, I explored vegetarianism for a few years. It did not suit me.”
Chase snorted in clear derision. “So you’re a fizzer. I should have known.”
Susan allowed her brows to inch gradually upward as the silence became heavier between them.
At first, Chase Aberdeen met her gaze, but he soon turned his attention back to his daughter. He spoke loudly. “Don’t worry, darling. I’ll have you out of this terrible place.” He emphasized, “Today.”
Susan did not allow herself to speak until she could keep all of the irritation from her voice. “So, is this the famed vegan compassion I’ve heard so much about? Apparently, compassion for animals doesn’t extend to people.”
Farrah’s eyes widened. The man stiffened in every part before stating coldly, “‘Fizzer’ is merely a descriptive term, not an insult.”
Susan did not point out the preceding snort nor the venom that had dripped out with the term. “I wasn’t talking about what you said to me. I was talking about what you said to your daughter.”
Chase lost it. “I love my daughter. That’s why I want her away from this”—he gesticulated wildly—“this…” He did not seem to have a functional term that would not prove Susan’s point about compassion. If he used her word, “garden,” he would denigrate all of the inhabitants and his own chosen diet simultaneously.
“Hospital?” Farrah supplied helpfully, hiding a grin of her own.
Chase added pointedly, “And what does a fizz…a failed vegetarian know about nori and tempeh?”
Susan had done her homework. “Nori is an edible seaweed, a species of red algae from the genus Porphyra. It’s usually used as a wrap for sushi or onigiri. Tempeh is a fermented whole soybean product that originated in Indonesia. The fermentation starter contains bacteria known to produce active B12.”
Chase frowned. “Okay, so you know—”
“Unfortunately,” Susan finished, “it is not bioavailable cobalamin when consumed by human beings such as Jessica. There are only two sources of useful vitamin B12: animal products and supplements.”
Chase stood his ground. “You’re wrong, Doctor. There are at least two million practicing vegans in America alone, and they aren’t demented. If the whole world practiced raw veganism, we’d double our lifespans, quadruple our food supplies, and end war entirely.”
Susan could not think of a single military conflict that had arisen from a disagreement over recipes or the contents of a dinner plate. Nor could she name a two-hundred-year-old human, vegan or otherwise. Anecdotally, if raw, plant-based diets made people more docile, she was not seeing that espoused in the hostile person of Chase Aberdeen. However, that particular line of argument was not harming anyone, so she did not bother to refute it.
“Mr. Aberdeen, I’m not condemning vegetarians in general or vegans in particular. Many of my friends and colleagues choose not to consume animal flesh or products for a variety of legitimate reasons. As I’ve said, I’ve tried it myself.” She sighed deeply, seeking a careful way to assuage a man whose emotional and philosophical identity was so intricately intertwined with his diet.
“Unfortunately,” she continued, “facts do not conform to desire or faith. The great majority of vegans obtain vitamin B12, and other necessary nutrients, from supplemented soy milk. As you produce your own soy milk, it lacks this supplementation. Thus, Jessica’s diet, and your own, is deficient in vitamin B12. Probably for very similar reasons, Jessica is also deficient in calcium, which explains the deplorable state of her teeth.”
Chase Aberdeen’s face obtained even more color, a vast improvement, though probably, once again, for negative reasons. “Bad teeth run in my family.”
Unnecessarily. Susan did not argue the point. “Heredity can be a strong factor in many illness and conditions. In some cases, we can escape our genetic fate; in others, we can’t.”
“Exactly,” Chase trumpeted. “Which is why, despite the near-perfection of Jessica’s lifelong diet, we could only delay the dementia.”
Susan worked hard to make absolutely certain she caught Chase’s full gaze with her own. “Mr. Aberdeen, there isn’t one shred of evidence Jessica is suffering from early-onset Alzheimer’s.”
Chase allowed her to hold his gaze, though, as he tipped his head, Susan found her own moving with his. “So…her previous doctors are wrong.”
“All wrong,” Susan said. “At least anyone who diagnosed her as having early-onset Alzheimer’s.”
“And heredity?”
“Is what it is, but it has nothing to do with Jessica’s current problems.” Susan finally glanced toward Jessica, who seemed to be watching the exchange with an expression mingling interest with horror. Clearly, she had never heard anyone stand up to her father.
“So, you know better than everyone else in the world, young Dr. Calvin?”
Susan had tired of hearing it. “It’s not a matter of knowing better. It’s a matter of performing the right tests, Mr. Aberdeen. And tests don’t lie.” She leaned in carefully, lowering her voice. “Jessica is deficient in cobalamin and calcium. And probably in other micronutrients as well.”
Chase Aberdeen leaned in even closer. “Then we will have to put more bok choy, broccoli, and okra on her plate. More nori and barley grass.”
Susan knew the vegetables he named did contain adequate amounts of calcium, but the nori and barley grass would not help the situation. “Mr. Aberdeen, you can solve the entire problem by using commercial, supplemented soy milk in the future. And it wouldn’t interfere with your veganism whatsoever.”
Chase rolled his eyes, as if he found Susan singularly uninformed. Apparently, her knowledge of tempeh and nori had not convinced him one iota. “I’m not going to stoop to commercial preparations. They add artificial preservatives. Sugar, salt, starch. Colorings and supplements.” He shook his head with obvious disgust. “The food manufacturers process all the positive nutrients out of our food, add all kinds of poisons, then they expect us to cheer when they supplement it with a bit of what they squeezed out in the so-called refining process.” He shook his head harder. “No way I’m feeding that toxic waste to my only child.”
Susan stifled a sigh. She had seen a case like this before: A woman pathologically afraid of her own weight gain had literally starved her toddler nearly to death. The doctor had taken custody of the child, who had subsequently bounced between home and foster care multiple times until she became old enough to feed herself. By then, she had developed an unhealthy relationship with food that left her in a constant struggle with obesity, all of which could have been avoided had her mother just taken a more evenhanded and casual attitude toward food.
Susan knew what she had to do. She raised her head to hold Chase’s green gaze again. The golden flecks seemed to shimmer and snap in the lighting. “Mr. Aberdeen, you don’t understand. Jessica is frail, fragile, with severe neurologic damage due to chronic vitamin B12 deficiency.”
“She’s always been frail and fragile,” Chase insisted, disengaging from Susan’s stare. “That’s why she needs this special diet. It’s the only thing that’s kept her alive this long.”
Susan walked all the way around Jessica’s bed to reassert her position. She would not allow the man to look away. “Mr. Aberdeen, Jessica is not frail and fragile despite your ministrations. She is frail and fragile because of them.”
Chase’s jaw clenched. The flecks in his eyes became positively hyperactive. His words boomed, echoi
ng through the room and spilling out into the hallway. “Are you saying I’ve neglected my daughter? That I’ve abused her?” His fists knotted, and he tensed as if to pounce.
“Not deliberately.” As Susan now fully held the man’s gaze, she shifted left to readjust the position she had taken. She wanted the bed between her and Chase Aberdeen and the door at her back. “The road to hell is paved with good intentions, Mr. Aberdeen, but consequences don’t evolve from what we want or feel to be right. No matter how much we desire it, dirty diapers will never smell like roses.”
Chase’s brows rose farther, until his eyes seemed as wide as golf balls. “So now you’re saying I stink.”
Farrah rose suddenly. “That’s not what Dr. Calvin said, Mr. Aberdeen. I know you could have a rational discussion, if you’d just calm down—”
Susan cringed, but only inwardly. She could think of few worse things to say to an angry person. No matter how heartfelt or carefully worded, suggesting to someone in the pique of emotion that he was behaving irrationally always sounded patronizing. Still, Susan could hardly blame the nurse for stoking a fire she, herself, had kindled and nurtured.
Chase’s features purpled, and he gesticulated so wildly that, had Farrah not scrambled out of the way, he would have struck her. “No person in the history of the universe has loved a human being as much as I do my daughter. And no one eats a healthier diet than Jessica.”
Susan was not at all sure the near-miss was accidental. “I’m just saying it’s possible to get too much of a good thing. To a man with a blood sugar of five hundred, insulin is lifesaving. But too much will drive him into a hypoglycemic coma.”
Chase scoffed. “You can’t overdose on natural substances any more than you can on clean air.”
“Insulin is a natural substance,” Susan pointed out. “And you can overdose on clean air. In addition to the explosive potential, exposure to excessive amounts of oxygen is known to cause oxidative damage to cells, collapse air sacs in the lungs, constrict blood flow to critical areas of the brain, induce seizures, and cause blindness, especially to infants.”
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