Tess Gerritsen - Bloodstream

“What does that mean?”

“It doesn’t pinpoint any particular drug. But there is a peak, which indicates something out of the ordinary is circulating in his blood. It could be completely innocuous-an herbal supplement, for instance.”

“How do we find out what it is?”

“We’d need more extensive analysis. The Bangor lab isn’t equipped to do that. We have to draw more blood and send it to our reference lab in Boston. They can simultaneously screen for hundreds of different drugs.”

“Then let’s do it.”

“Well, here’s the problem. It’s the other reason I paged you. I just got an order to cancel any and all remaining drug tests. It’s signed by Dr. DeIRay.”

“What?” She shook her head in disbelief. “I’m Taylor’s doctor.”

“But DelRay’s writing orders, and his are contradictory to yours. So I’m not sure what to do.”

“Look, let me talk to the mother and I’ll clear this up right now” She hung up and returned to the chapel.

Even before she opened the door, she could hear a man’s voice, raised in anger. never exerted any control! Completely useless, that’s what you are. No wonder he’s so screwed up!”

Claire pushed into the chapel. “Is there a problem here, Wanda?”

The man turned to her. “I’m Taylor’s father.”

Personal crises bring out the worst in people, but Paul Darnell was probably not likable even at his best. A partner in the largest accounting firm in Two Hills, he was far more stylishly garbed than his wife, who seemed to shrink to inconsequential size in her ill-fitting suit. The brief interaction Claire had witnessed between these two ex-spouses told her what this marriage must have been like: Paul the aggressor, full of demands and complaints. Wanda always appeasing, retreating.

“What is this about my son taking illegal drugs?” he asked.

“I’m trying to find a reason for what happened today, Mr. Darnell. I was just asking your wife-”

“Taylor hasn’t been taking any drugs. Not since you stopped the Ritalin.” He paused. “And he was fine on the Ritalin. I never understood why you took him off it.”

“It’s been two months since I discontinued it. This personality change is more recent.”

“Two months ago, he was fine.”

“No he wasn’t. He was tired and listless. And that diagnosis of ADD was never really established. it’s not the same as diagnosing hypertension, where there are definite parameters to go by.”

“Dr. Pomeroy was certain of the diagnosis.”

“ADD has turned into a catchall for all childhood misbehavior. When a student’s failing in class, or he gets into mischief, parents want to find a reason. I didn’t agree with Pomeroy’s diagnosis. When in doubt, I prefer not to push pills on children.”

“And look what’s happened. He’s out of control. He’s been out of control for weeks?’

“How would you know, Paul?” said Wanda. “How long has it been since you actually spent time with your own son?”

Paul turned to his ex-wife with such a look of hatred, Wanda shrank back.

“You’re the one who’s supposed to be in charge,” he said. “I knew you couldn’t handle him. You screwed it up as usual, and now our son’s going to end up in jail!”

“At least I didn’t provide him with the gun,” she said softly.

“What?”

“It was your gun he brought to school. Did you ever notice it was missing?”

He stared at her. “The little shit! How did he get-”

“This isn’t helping!” Claire cut in. “We need to focus on Taylor. On how to explain his behavior.”

Paul turned to his wife. “I’ve asked Adam DelRay to take over. He’s upstairs looking at Taylor now.”

Paul’s blunt announcement left Claire speechless. So this was why DelRay had written orders; he was the new attending. She’d just been fired from the case.

“But Dr. Elliot’s his doctor!” Wanda protested.

“I know Adam, and I trust his judgment.”

Meaning he doesn’t trust mine?

“I don’t even like Adam DelRay,” said Wanda. “He’s your friend, not mine.”

“You don’t have to like him.”

“If he’s taking care of my son, I do.”

Paul’s laughter was grating. “Is that how you choose a doctor, Wanda? Pick whoever gives you the most warm fuzzies?”

“I’m doing what’s best for Taylor!”

“And that’s exactly why he ended up here.”

Claire’s temper at last burst through. “Mr. Darnell,” she said, “this is not the time to be attacking your wife!”

He turned to Claire, and his contempt was clearly meant for her as well.

“Ex-wife,” he corrected. And he turned and walked out of the chapel.

She found Adam DelRay sitting at the nurses’ station, writing in Taylor's chart.

Although it was late in the evening, his white coat was starched and fresh, and Claire felt rumpled by comparison. Whatever embarrassment he’d suffered earlier that day during the crisis with Katie Youmans had been conveniently forgotten, and he regarded Claire with his usual irritating self-confidence.

“I was about to page you,” he said. “Paul Darnell just decided-”

“I’ve already spoken to him.”

“Oh. So you know.” He gave an apologetic shrug. “I hope you don’t take it personally.”

“It’s the parents’ decision. They have a right to make it,” she acknowledged grudgingly. “But since you’re taking over, I thought you should know the boy has an abnormal peak on gas chromatography. I suggest you order a comprehensive drug screen.”

“I don’t think that’s necessary.” He set the chart down and stood up. “The most likely drugs have been ruled out.”

“That peak needs to be identified.”

“Paul doesn’t want any more drug tests.”

She shook her head, puzzled. “I don’t understand his objections.”

“I believe he reached that decision after speaking with his attorney.” She waited for him to walk away before picking up the chart. She flipped to the progress notes and with growing dismay read DeiRay’s entry.

History and physical dictated.

Assessment.

1. Acute psychosis secondary to abrupt Ritalin withdrawal.

2. Attention Deficit Disorder.

Claire dropped into the nearest chair, her legs suddenly unsteady, her stomach queasy. So this was their criminal defense strategy. That the boy was not responsible for his actions. That Claire should be blamed, because she took him off the Ritalin, triggering a psychotic break. That she was the one who should be blamed. I’m going to end up in court.

This was why Paul didn’t want to find any drug in the boy’s bloodstream. It would shift the blame away from Claire.

Agitated, she flipped to the front of the chart and read DelRay’s orders.

Cancel comprehensive drug/tox screen.

Refer all future questions and lab reports to me. Dr. Elliot is no longer the attending physician.

She slapped the chart shut and felt her nausea intensify. Now it was no longer just Taylor’s life on the line; it was her practice, and her reputation as well.

She thought of the first rule of defensive medicine: cover your ass. You can’t get sued if you can prove you didn’t make a mistake. if you can back up your diagnosis with lab tests.

She had to get a sample of Taylor’s blood. This was her last chance to draw the specimen; by tomorrow, any drug would be cleared from his system, and there’d be nothing left to detect.

She crossed the nurses’ station to the supply room, pulled open a drawer, and collected a Vacutainer syringe, alcohol swabs, and three red-top blood tubes.

Her heart was racing as she walked up the hall to Taylor’s room. The boy was no longer her patient, and she had no right to be doing this, but she needed to know what drug, if any, was circulating in his bloodstream.