Jonathan Kellerman - Devil's Waltz

“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.’ ”