Gregg Hurwitz - Do No Harm

David touched Alberto's forehead-hot-then walked his fingertips up along the back of Alberto's jaw, feeling for swollen glands. "Why would that make you gay?"

Alberto pulled away. "Well, I like girls. I'm dying to get laid, even. I don't want to be gay." His eyes pooled with concern. "But, I mean, I almost had a dick in my mouth."

David inhaled deeply and held it for a moment. "Well," he began, in a textbook voice, "gender roles are a complicated and… " He paused, then rubbed his eyes with a thumb and forefinger. "No, Alberto, it doesn't make you gay."

The relief in Alberto's eyes was palpable.

"Now can we focus on your sore throat?" David felt again for Alberto's glands, and Alberto winced slightly when David found them. David grabbed a tongue depressor from a Pyrex beaker. "Open up. Open." Alberto refused, and David squeezed his cheeks gently until he complied. Red beefy throat, enlarged tonsils with exudate mucus-what David's mother would have called "angry throat." "Oh boy, kiddo. We have some activity going on in here. Does it hurt?"

"I had to spit into a bag last night because it hurt too much to swallow."

"Why didn't you come in?"

Alberto looked down. One of his untied shoelaces trailed along the tiled floor. "We don't got insurance no more. My dad got laid off, and I didn't want to cost him nothing more."

David crouched, resting his hands on Alberto's knees. "Alberto, listen to me. If you ever feel sick, you come in here. Don't worry about money. Okay? Now say aah."

Alberto opened his mouth, and before he realized what was going on, David had already swabbed him with the elongated Q-tip. He handed it to Jill outside. "Let's get a Rapid Strep on this."

He ducked into the doctors' lounge and called Carson but got the machine. Someone had taped Clyde's police composite to the wall, and David studied it as he left a message. "Carson, it's Dr. Spier. I hope you're doing all right. I'm going to stop by around six-thirty, and I hope we'll be able to talk then."

Jill met him in the hall on his way back to Alberto's exam room and walked alongside him. "It's positive," she said. "First strep of the day."

"All right. The patient has a penicillin allergy. He's also got no insurance, but I just met with a rep from Biaxin, and I stowed a bunch of samples in the locked drawer in Three. Would you mind grabbing them for me?"

David swung into the exam room and faced Alberto with a resigned smile. "You have group A betahemolytic streptococci, aka strep throat. I'm going to get you some antibiotics. You'll take one in the morning, one at night, for ten days. Now, this particular drug has a side effect. It'll give you a dry metallic taste in your mouth, so you'll want to get some Altoids or strong suckers so you can- " He froze.

Two minutes later, having paged Ed three times consecutively from the doctors' lounge, he had him on the phone. "I have something," he said.

"L' Ermitage. Twenty minutes."

A man impeccably dressed in a charcoal suit with a shimmering blue tie, his gray hair coifed, paused in front of David. Still dressed in his scrubs and white medical coat, David slumped on a leather couch in the elegant cocktail lounge of the modern, upscale hotel. A fire flickered beneath the screen to his right, though it was August. Before him, on a simple glass table, sat a tray containing jars of wasabi peas, Parmesan twists, and herb-cured olives.

"Nice outfit, Spier," the man said. "I appreciate your not calling attention to us."

David literally did a double take as Ed shook his hand roughly and slid into the love seat opposite the couch, slightly favoring his left side. "Don't say anything loud," Ed said softly. "Don't raise your voice, don't act surprised. Just start talking."

David swallowed hard, finding his train of thought. "The orange zinc lozenges that Clyde was sucking-I think he uses them because he's taking meds that can cause a dry or metallic mouth as a side effect. Doctors usually recommend Altoids or zinc lozenges to cover it." David's voice was high and shaky; he could feel his heart hammering.

"Slow down. Calm down. Can't you use anything to cover the taste? Like gum?"

"You can, but generally something stronger is more effective."

The waitress came over, and Ed ordered a Sapphire martini, up, chilled, with three olives. David ordered cranberry juice.

"And guess which drugs most commonly have that side effect?" David said, as soon as she departed. "Psychiatric drugs. Sure, now and then an antihistamine like Claritin will dry you out, but classically it's antipyschotics-clozapine, Mellaril, Haldol, Prolixin, risperidone, Zyprexa-or antidepressants, like Paxil or Prozac."

David pulled a sheet of paper from his pocket and smoothed it on the cocktail table between them. "I made a list of Clyde's symptoms. Jerking pupils, headaches, difficulty concentrating, clouding of consciousness, slurred speech, restlessness, and drunken walking. These all pointed me to nervous system diseases and conditions."

"But you think these traits are actually drug side effects, not symptoms of a disease?"

"Exactly. I was so focused on the nervous system presentation, I neglected to write down other relevant traits. So I went back in my mind and tried to think of what I might have missed." Pulling a pen from his scrub top, David added dry or metallic-tasting mouth to the list. "Remember I told you he had swollen hands? Well, I recalled his neck was a bit swollen as well, which could indicate hypothyroidism. He left hair behind on the pillow when he fled, so it could be falling out. Acne and pitted fingernails should be on the list as well." He wrote down swollen hands-hypothyroidism?; alopecia-loss of hair; acne; pitted fingernails.

David glanced down at the potential diagnoses he'd written beneath. The new symptoms did not fit the symptom clusters for most of the diagnoses on the list. He drew a line through them all except drug toxicity and insecticide poisoning. But insecticide poisoning generally causes excessive salivation, the opposite of a dry or metallic-tasting mouth, so he crossed that one out as well. "We're probably dealing with a drug toxicity issue here. Whatever he's taking, he's taking too much of it and it's poisoning him."

David looked at Ed with sudden irritation. "And you-where have you been? What happened with the print? When did you tip off the police? Did you know Clyde's not even Clyde anymore? He's Douglas DaVella. He used to work at the hospital."

"No," Ed said. "Douglas DaVella died three years ago Sunday of colon cancer. He was a sixty-seven-year-old veteran of the Korean War. I ran the print, and the results came back this morning." Before David could say anything, Ed held up his hand. "I got the print results over to the police, as I promised I would. Our boy is indeed Clyde. Clyde C. Slade, to be precise. DOB January 2, 1963." He adjusted his wig with a subtle gesture that looked as if he were straightening his hair in the front.

"Holy shit," David said. "So he really is named Clyde. But how did he…?"

"Clyde took Douglas DaVella over. Someone's social security number isn't placed on the social security death index when they die, it gets put there when their death benefit gets claimed. As far as the records go, no claimed death benefit, no dead guy."

"Don't registrars cross-index birth and death certificates?"

"Only by county, sometimes state. California does it statewide, but our boy Doug was from Virginia. He didn't move out here till after his tour in Korea. When he died, Clyde stole his social security number so he could apply for a job at the hospital under a false name. One might argue that showed premeditation, were one prone to legal arguing."

"How did you find out about DaVella?"

"Public Utilities Commission records. The cops always go the DMV route, which takes longer and is easier for criminals to deceive. But no one thinks to lie to the gas company. My scanner gave me a heads-up they were going after a Douglas DaVella, and my intelligence showed that Clyde C. Slade had changed his name on a gas bill to Douglas DaVella three years back, right after DaVella kicked. Unfortunately, he's not at that address anymore, and there's no new utilities listing for either name. So either he's living in some economy shithole where utilities are provided or he's got a new fake name. Back to square one."