Tess Gerritsen - Bloodstream

Without comment, the trooper turned and stared through the CT viewing window at his prisoner.

Taylor was lying on his back, wrists and ankles restrained. His head was hidden inside the CT cradle, but they could see the movement of his feet, twisting against the restraints. Now comes the hard part, she thought. How do we hold him in position long enough for the lumbar puncture?

“I can’t afford to miss a CNS infection,” said Claire. “With an elevated white blood count and changes in mental status, I have no choice but to do the spinal tap.”

Chapman at last seemed to agree. “From what I see here on the scan, it looks safe enough to proceed.”

They wheeled Taylor out of X-ray and into a private room. It took two nurses and a male orderly to transfer the struggling boy to the bed.

“Turn him on his side,” said Claire. “Fetal position.”

“He’s not going to lie still for this.”

“Then you’ll have to sit on him. We need this spinal tap.”

Together they rolled the boy on his side, his back to Claire. The orderly flexed Taylor’s hips, forcibly pushing the knees toward the chest. One nurse pulled the shoulders forward. Taylor snapped at her hand, almost catching her finger in his jaws.

“Watch his teeth!”

“I’m trying to!”

Claire had to work fast; they couldn’t keep the boy immobilized much longer. She lifted the hospital gown, exposing his back. With his body curled into a fetal position, the vertebral spines poked out clearly under the skin. In rapid order she identified the space between the fourth and fifth spinous processes in the lower back, and swabbed the skin with Betadine, then alcohol. She snapped on sterile gloves and picked up the syringe with local anesthetic.

“I’m putting in the Xylocaine now. He’s not going to like this.”

Claire pricked the skin with the twenty-five-gauge needle and gently injected the local anesthetic. At the first sting of the drug, Taylor shrieked with rage.

Claire saw one of the nurses glance up, fear in her eyes. None of them had ever dealt with anything like this, and the violence coursing through this boy’s body was frightening them all.

Claire reached for the spinal needle. It was three inches long, twenty-two-gauge gleaming steel, the hub end open to allow cerebrospinal fluid to drip out.

“Steady him. I’m doing the tap now.”

She pierced the skin. The Xylocaine had numbed the area, so he didn’t feel any pain-not yet. She kept pushing the needle deeper, aiming the tip between the spinous processes, toward the dura mater of the spinal cord. She felt a slight resistance, then a distinct pop as the needle penetrated the protective dura.

Taylor screamed again and began to thrash.

“Hold him! You have to hold him!”

“We’re trying! Can you hurry it up?”

“I’m already in. It’ll just be another minute now.” She held a test tube under the open hub of the needle and caught the first drop of CSF as it slid out. To her surprise, the fluid was crystal clear with no blood, no telltale cloudiness of infection. This was not an obvious case of meningitis. So what am I dealing with? she wondered as she carefully collected CSF in three different test tubes.

The fluid would be sent immediately to the lab, where it would be analyzed for cell count and bacteria, glucose and protein. Just by looking at the fluid in the tubes, she knew that the results would be normal.

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.”