by C. J. Lyons
“Admitted to Lucas Stone’s service, workup negative,” Nora continued. “He tried chelation therapy when a urine screen came back borderline positive for mercury.”
“Mercury? Could she have been poisoned?” Gina said, interested enough to reach for the case file and begin to riffle through it.
“Further testing said no. And the chelation didn’t work,” Nora said. “She showed improvement for approximately twenty-four hours, then died of sudden cardiac arrest. Autopsy negative. Also no past medical history, no meds, no history of drug use, no family history.”
Gina tossed the chart to Amanda, who was sitting closer to her than Nora was. It fell open and Amanda found herself staring at a familiar face. She froze, her finger covering the patient’s name: Michelle Halliday was Shelly. Shelly, the assistant manager of the boathouse. Shelly, who had died a few weeks ago from some unknown illness.
“Mercury, that would be environmental exposure, right?” she asked.
“Almost always,” Lydia answered. “Is there a place all three patients have in common?”
“But Lucas ruled out mercury poisoning,” Nora said just as Gina also sat up to protest. “Besides, mercury might explain some of their symptoms but it wouldn’t kill them.”
“You’re right, it wouldn’t explain their deaths.” Lydia rearranged herself, not quite fidgeting but also not standing still.
“Becky and Shelly—er, Michelle—both used the Washington’s Landing boathouse,” Amanda said, her voice low, her gaze still focused on Shelly’s chart. She wanted to be wrong, hoped she was wrong.
“They did?” Nora asked, leafing through the chart.
“Becky was on CMU’s crew team and Shelly worked there.”
“What about Tracey?” Lydia asked.
Amanda remembered Jared lamenting that his girlfriend was a runner, strictly a landlubber, hated the water. “She didn’t row, but her boyfriend works at the boathouse.”
“Well, now we’re getting someplace,” Gina said. “The boyfriend is playing Bluebeard, slipping them all mercury cocktails.”
“Gina, be serious.” Lydia bent to rub No Name’s belly. “You’re right, mercury couldn’t have killed them, but maybe there’s another link. Tracey and Michelle both presented after exercise. What was Becky doing when she presented?”
“Not exercising,” Amanda said. “It was three in the morning. Her roommate said she was pulling an all-nighter, studying for a test.” She thought for a moment; her own symptoms were often worse when she was stressed out or tired. But of course she didn’t have anything like what these three patients had. Definitely not. “Maybe it’s not exertion but fatigue that brought on their symptoms?”
“Maybe,” Lydia allowed.
“Everyone gets tired. They don’t go all spastic and drop dead from it,” Gina put in, always the life of the party.
“She’s right,” Nora said. “There has to be something else these girls had in common, something that made them vulnerable.”
“Vulnerable to what?” Gina asked. “How can you figure out what triggered their symptoms when you don’t even know what killed them? You’re chasing in circles.”
“Let’s look at the symptoms,” Lydia suggested. “What’s our differential?”
“Parkinson’s, multiple sclerosis, Guillain-Barré,” Nora said.
“Huntington’s, myasthenia, rabies, stroke,” Amanda volunteered. “Also botulism, maybe West Nile virus?”
“No, Parkinson’s isn’t fatal, and myasthenia wouldn’t kill this fast,” Gina argued.
“Forget the timetable for now; just concentrate on the symptoms,” Lydia said.
Gina leaned forward, finally getting into the spirit of things. “Okay, then, you’d better add the mercury thing. And how about ciguatera poisoning?”
“Only if they all ate exotic fish a few hours before their symptoms.”
“Still, the symptoms fit.”
Lydia nodded as Amanda added it to her list. “Don’t forget neuroleptic malignant syndrome, progressive multifocal leukoencephalopathy, thalamic lesions, and shattered nerve syndrome.”
Trust Lydia to come up with diseases Amanda never even heard of. She was going to have a lot of research to do. Gina frowned at Lydia’s list as well. “You made that last one up.”
“Nope. Shattered nerve syndrome is real. It’s a form of spinocerebellar ataxia where the beta spectrin proteins degenerate and form deposits. It’s what Abe Lincoln had, why he walked so funny.”
Amanda wrote as fast as she could, trying to keep up.
“Okay, then,” Gina countered. “How about idiopathic generalized dystonia?”
“Now, you made that one up,” Nora protested. “That name translates to ‘muscle problems anywhere in the body from unknown causes.’ ”
“No, Gina’s right,” Lydia said. “It is a disease category. Mostly older folks, but there’s an early-onset variant.”
Gina smirked and swung her legs over the arm of the chair. “Anyone else got one?”
They all shook their heads. Amanda glanced at the list she had scribbled onto the back of a HIPAA form. Most of the diseases had no common origin: some infectious, some inflammatory, some genetic; some were side effects of medication, others idiopathic.
“Now,” Lydia continued, “what have we already ruled out?”
“Lucas did a pretty comprehensive workup,” Nora said, thumbing through the charts. “And it looks like he thought of everything we did, plus a few things I’ve never heard of.” She went through the diagnostic evaluations each patient had, all with negative results.
Amanda crossed off each diagnosis in turn. They were left with a handful of rare diseases, including Gina’s ciguatera poisoning and Lydia’s shattered nerve syndrome. And mercury toxicity.
“Did he test anyone besides Shelly for mercury?” Lydia asked.
“No, not Becky,” Nora said, shuffling through the pages of Becky’s chart.
“He did send a urine mercury level on Tracey,” Amanda said. “I remember wondering why. It won’t be back for a day or more.”
“And the autopsy tests on Shelly’s tissue won’t be back for weeks.”
“Besides,” Gina said, “if it was this boathouse, there’d be tons of young women showing symptoms. How many women go there, Amanda?”
Amanda shrugged, uncomfortable as everyone turned to stare at her. “Gina gave me a membership two Christmases ago,” she muttered. “All the colleges use the boathouse for their crew teams, some of the local high schools as well. And there are tons of rowing clubs …”
“See? We’re talking hundreds of people—but only two with symptoms and a third whose only connection is through her boyfriend? It doesn’t add up.”
“Okay,” Lydia conceded. “What else, besides mercury?”
“Lucas wants to do a Tensilon challenge tomorrow,” Amanda said, circling myasthenia gravis. It was an autoimmune disease where the body attacked the nerve endings secreting the chemicals needed to stimulate muscles. If the patient did have myasthenia, the Tensilon would jump-start those nerve endings by flooding the body with the needed chemical.
“I still say the timing isn’t right. And the symptoms are too extreme for myasthenia,” Gina argued.
“Sudden-onset generalized myasthenia does occur. It’s rare, though,” Lydia conceded. “And for three women to all present that way?” She shook her head. “You’d have better odds hitting the lottery without buying a ticket.”
“Other than being women, young, and living within thirty miles of Pittsburgh, they don’t seem to have anything in common,” Gina said, standing and pacing behind her chair, zigzagging between the numerous plants Lydia kept near the window, “except the kinda-sorta-quasi connection to the boathouse. Becky was originally from Ohio. Tracey was born and raised in Millvale. Michelle was married and from Wheeling, West Virginia. Becky was a student, Tracey works at Westinghouse.”
“Maybe the slides from Becky’s tissues will show something,” Amanda said.<
br />
Lydia didn’t look satisfied with that answer. “Let’s hope so. A trip out to that boathouse to investigate any environmental factors would be worthwhile.”
Gina stopped abruptly, swinging back around to stare at the other women. “Wait. They do all have something in common. They all had Lucas Stone as their doctor.”
EIGHTEEN
Thursday, 10:51 P.M.
FOR SOME REASON THE OTHERS DIDN’T WARM up to Gina’s announcement of the obvious: that all the women who had died were patients of Lucas Stone.
Nora had grown downright surly, grudgingly dividing up the patient charts so that Lydia and Amanda could do more research tomorrow. Though Lydia said nothing, Gina had the feeling that she’d been thinking along the same lines as Gina—or had at least entertained the thought.
Amanda had surprised her, vehemently defending Dr. Stone. “You can’t go around saying things like that,” she’d told Gina as they walked out to Gina’s car. “What would people think?”
“I don’t know, that it’s the truth?”
“But still—”
“A fact is a fact, Amanda. There’s no arguing that Lucas Stone is a common denominator between these women.”
“After they had symptoms.”
“Before they died,” Gina reminded her. Amanda slammed the passenger door and slouched in her seat. Gina continued, “Before they died of unknown causes.”
Amanda maintained an uncharacteristic silence as Gina drove them to the Angels employee garage where Amanda had left her VW parked.
“I’ll see you at home,” Gina said as Amanda got out. “Jerry will be working all night, I’m sure.”
Amanda nodded, twisted the keys in her hand, then shoved them back in her pocket. “I think I’ll spend the night here. Make sure my patients are okay.”
“You’re on elective, Amanda, you don’t have to take call.” Gina really, really did not want to go home to an empty house. Not after her visit to Homewood today. And Jerry’s place was out of the question—when she’d talked to him earlier, he’d made it clear that he’d probably be at the station all night, working those dead bodies he’d dug up out of some yard in East Liberty. She’d be lucky if she saw him for days. “What good are you going to do running yourself ragged?”
“Tracey’s all alone. At least if she does wake up again, even if she can’t move, she’ll know there’s someone there for her.”
“Sometimes you sound more like a nurse than a doctor.” Gina pulled out her Gitanes and shook one free of the pack. She’d been dying to light up for ages but knew better than to smoke around Lydia. “Look, I’m sorry about what I said about Lucas Stone.”
Amanda didn’t answer. Gina lit the cigarette and took a deep drag. Ahhh, that was the ticket. “Oh, come off it. Grow up, Amanda. Tracey’s not going to even know you’re there, and all the compassion in the world isn’t going to help your grade on this rotation. Who are you really showing off for?”
Amanda flushed, opened her mouth, closed it again, then stomped off toward the stairwell. Gina gunned the engine, tires leaving rubber behind as she sped down the ramp. Seemed like nobody gave a shit about what was going on with her. Nobody except maybe the half-gallon of Cold Stone she’d stashed in the freezer.
She left the top down, but despite the AC on high, the night air hit her like a warm, wet wall of humidity. Heat lightning and thunder rumbled in the distance, echoing like the sound of gunshots. She clenched the wheel, pushed the car, skirting yellow lights and dodging traffic, ignoring the curses and honking of other drivers.
Let her get arrested. Wouldn’t that just be the icing on the cake? Being forced to choose between pulling Jerry off his precious homicide investigation and waking the great and mighty Moses Freeman from his prescribed eight hours of slumber.
The dreadful thought for some reason filled her with a rush of anticipation. Awful, yet tempting. Like standing on a cliff and stepping out to the edge, looking down and wondering what it would feel like to jump.
Who would she call to bail her out?
She let off the accelerator, her stomach sinking, the lingering taste of Yuengling turning rancid in her mouth. Would either of them care enough to come for her?
AMANDA ENTERED THE MEDICAL ICU AND wasn’t too surprised to find Lucas asleep in the visitor’s chair beside Tracey’s bed, a nursing chart facedown on his lap, perilously close to sliding off. She’d been working so hard to avoid him ever since their encounter down in pathology that he was basically all she’d been thinking about.
Better than thinking about where she was going to come up with another two hundred dollars a month now that she was out of the study, or what her labs might show, or how she had no time to take off if she was sick—which she wasn’t—or Gina and her tantrums, or even the mysterious ailment that had taken Becky Sanborn and maybe Michelle Halliday and now Tracey … the ailment that Amanda most definitely, absolutely did not have.
She blew her breath out in a frustrated sigh, too soft to disturb Lucas. His glasses had slid halfway down his nose. He had thick and wavy hair, the kind that got curlier as it grew, and he was definitely past due for a trim. She opened and closed her hand, stretching her fingers, knowing just how good it would feel to run her fingers through his hair …
Stop it, Amanda. Not the time or place.
The last guy she’d dated seriously had been right before leaving for med school—her brother Andy’s best friend, Justin. They’d known each other for ages, practically grew up together, so she hadn’t been too worried when things turned more serious. But Justin had other ideas, taking her out on the boat one day, proposing to her—only to return to the marina to find her mother and both their families, all their friends, the entire town practically waiting to celebrate. But she had turned down Justin’s proposal, to the everlasting shame of her mother.
No one seemed to understand that she didn’t want to settle down and have kids—at least not right away. She wanted to do something with her life, see the world, meet people. Learn things.
She thought she had everything figured out. Until now. Lucas Stone confused her—compelling and infuriating all at once. Add to that a silly-schoolgirl-falling-in-lust feeling and it was a recipe for bad juju. Right now she had more of that than she could handle.
Okay, this was a huge mistake, coming here. Especially after two glasses of wine and a bottle of beer—more than she usually drank in an entire month.
She turned and crept away. Until the shrill tones of “Free Bird” sounded from her pocket. Damn it. She snatched at the phone, answering it without looking to see who Gina had programmed the ring tone for. Skynyrd—it could only be the other “free bird” of the Mason clan, her middle older brother, Anthony. The one brother she might enjoy hearing from, Tony had been her defender against Adam’s tyranny and Andy’s tormenting.
“Hey, sweetie pie,” he said by way of greeting. “How’s my favorite Baby Girl?” You could hear his smile in his voice, even a thousand miles from home. Tony was always smiling. So laid back that she often had to resist the urge to poke him with a stick just to see if he was still breathing. Andy used to torture him mercilessly, trying to get a rise from his big brother and always failing.
She edged farther away from Tracey’s bedside, darting a glance over her shoulder. Too late. Lucas was awake, glasses back into position, rescuing Tracey’s chart and climbing to his feet to follow her as she crossed through the ICU.
“Hey, Tony. I’m just fine, thank you. How’s it going? Everything okay with Becca and the baby?”
Tony wasn’t fooled by her lilting voice or lies. She could tell by the pause before he answered. “Everything’s fine down here—no matter what Mama told you. Don’t let her guilt you into doing something that’s going to hurt your schoolwork.”
At least Tony saw what she did as some kind of work rather than a childish fit of pique. Even her father didn’t understand why she’d been driven to leave South Carolina and the family.
“How’
s the Love Bug? It getting you around okay up there in the snow and all?”
Coming from a family of mechanics had its benefits—Tony had rallied her brothers and father to restore a pink 1972 VW Bug and give it to her as a going-away present when she left for Pittsburgh over three years ago. “It was eighty-five degrees here today, Tony. Not a snowflake in sight.”
Footsteps approached from behind, and a hand brushed against her arm. Lucas. She shivered and pulled away— not sure whether the heat slip-sliding from her belly up her chest was embarrassment or anticipation.
“You still there, Baby Girl?” Tony’s voice reached out to her.
“I have to go now, Tony. Give Becca and the baby a kiss and hug for me.”
“I will. Love ya—don’t you forget that.”
She folded the phone closed and tucked it back into her pocket before turning to face Lucas. “I was just on my way home.”
He said nothing, but merely nodded toward the small conference room the nurses used for report. Amanda held her ground. He finally broke the silence. “We need to talk. Now.”
How dare he treat her like he had any right to order her around? “No. I don’t want to talk about it. I’m fine, and Dr. Nelson’s taking care of everything. There’s no need for you to get involved.”
She remembered what Nora had told her about Lucas and Dr. Nelson and regretted her words. But she didn’t back down, staring at him, meeting his gaze even though she had to tilt her head back to do it.
“You made that perfectly clear, Ms. Mason,” he said, his words clipped with annoyance. “It may be difficult for you to believe, but the topic I wanted to discuss was our patient, Tracey Parker. Not you.”
He stalked past her down the back hall to the conference room. As he stood there, holding the door open, waiting for her to join him, she realized that all the nurses were staring at her. At them. Embarrassment flooded over her, burning her cheeks.
Damn it, why couldn’t she and Lucas Stone have a rational, adult discussion? She walked down the hall, following in Lucas’s footsteps, trying to keep her chin high, dignity intact.