Michael Crichton: Drug of Choice

THE COP, POSITIONED AT the intersection of the Santa Ana Freeway and U.S. 85, saw it all. At three in the afternoon an Angel went past him, hunched over his bike, doing a hundred and ten. The cop later remembered that the Angel had a maniacal grin on his face as he raced forward, weaving among the passenger cars.

The policeman gave chase, light flashing and siren wailing, but traffic was heavy and the Angel managed to keep his distance. He left the freeway in the foothills, and headed north into the mountains, still going more than a hundred miles an hour. The cop followed, but the bike was taking chances, and managed to pull further ahead.

After twenty minutes, the police car came around a bend and the cop saw the bike at the side of the road, lying on its side. The motor was still on, spinning the rear wheel.

The Angel lay sprawled on the ground a short distance away. He had apparently been moving slowly at the time of the accident, because he was unmarked—no cuts, no bruises, no scrapes. He was, however, comatose, and could not be roused. The policeman checked the pulse, which was strong and regular. He tried for several minutes to awaken the Angel, and then returned to his car to call an ambulance.

Roger Clark, resident in internal medicine, went on duty at the Los Angeles Memorial Hospital at six. When he arrived on the floor, he went to see Baker, the day resident. Baker was in the dressing room, changing from his whites to street clothes. He looked tired.

“How’re things?” Clark said, stripping off his sportcoat and putting on a white jacket.

“Okay. Not much excitement, except for Mrs. Leaver. She still pulls out her intravenous lines when she thinks nobody’s looking.”

Clark nodded, stepping to the mirror and straightening his tie.

“And then Henry,” Baker said. “He had the DT’s this morning, and sat in the corner arguing with the little green men.”

“How is he now?”

“We gave him some librium, but watch him. One of the nurses said he felt her up last night.”

“Who’s that?”

“Alice.”

“Alice? He must really be hallucinating if he felt her up.”

“Well, just don’t mention it to Alice. She’s very sensitive.”

Baker finished dressing, lit a cigarette, and rapidly went through the status of the other patients. Nothing much had changed since Clark had gone off duty twenty-four hours before.

“Oh,” Baker said. “Almost forgot a new admission. One of those Hell’s Angels. The cops brought him in after he had a motorcycle accident. He was comatose and he hasn’t come out yet.”

“You ask for a neurological consult?”

“Yeah, but they probably won’t get around to it until morning.”

“What’s his status now?”

“We did the usual stuff. Skull films negative, CSF normal, chest films okay, EEG vaguely abnormal, but nothing specific. All his reflexes are there.”

“Cardiorespiratory depression?”

“Nope. He’s just fine. To look at him, you’d think he was asleep.”

“You treating?”

“No, we’re waiting for the consult. Let the neuro boys play around with him for a while.”

“Okay. Anything else?”

“No. That’s it.” Baker smiled. “See you tomorrow.”

When he was alone, Clark made a quick round of the wards, checking on the patients. Everyone seemed in pretty good shape. When he came to the comatose Angel, he paused.

The patient was young, in his early twenties. Nobody had washed him since admission; his hair was greasy, his face was unshaven and streaked with grit, and his fingernails were rimmed with black. He lay quietly in bed, not moving, breathing slowly and easily. Clark checked him over, listening to the heart, tapping out the reflexes. He could find nothing wrong. They had put an intravenous line into him, and had catheterized him in case of urinary retention. The catheter tube led to a bottle on the floor. He looked at it.

The urine was bright blue.

Frowning, he held the bottle up to the light and looked closely. It was an odd, vivid blue, almost fluorescent.

What turned urine blue?

He went back to the desk, hoping to catch Baker and ask about the urine, but Baker was gone. Sandra, the night nurse, was there.

“Were you on duty when they brought that Angel in?”

“Arthur Lewis? Yes.”

“What happened?”

Sandra shrugged. “The police brought him into the emergency ward. They figured he’d had an accident, so they took him up to X-ray and checked him over. No broken bones, nothing. All the enzymes and electrolytes came back normal. The EW couldn’t figure it out, so they shipped him up here. It’s all very mysterious. He was going a hundred before the accident, but the police think he slowed way down before it happened. The policeman who found him said it was just as if he had suddenly fallen asleep.”

“Ummm,” Clark said. He bit his lip. “What about his urine?”

“What about it?”

“Has it always been blue?”

Sandra frowned and left the desk. She went into the ward and looked at the bottle, then returned. “I’ve never seen anything like that,” she said.

“Neither have I.”

“What turns urine blue?”

“I was just wondering the same thing,” Clark said. “Why don’t you call down to neurology and say the guy is still in a coma, but urinating blue. Maybe that’ll bring them up.”

Ten minutes later, Harley Spence, Chief of Neurology, appeared on the seventh floor, panting slightly. He was a white-haired man in his middle fifties, very proper in a three-piece suit.

His first words to Clark were: “Urinating blue?”

“That’s right, sir.”

“How long has this been going on?”

“Apparently it just started, within the last few minutes.”

“Fascinating,” Spence said. “Perhaps a new kind of porphyria. Or some idiosyncratic drug reaction. Whatever it is, it’s definitely reportable.”

Clark nodded. In his mind, he saw the journal article: “H.A. Spence: Unusual Urinary Pigment in a Comatose Man. Report of a Case.”

They walked to the patient’s bed. Clark ran through the story while Spence began his examination. Arthur Lewis, twenty-four, unemployed, first admission through the EW in a coma after a motorcycle accident…

“Motorcycle accident?” Spence said.

“Apparently.”

“He’s unmarked. Not a scratch on him. Would you say that’s likely?”

“No sir, but that’s the police story.”

“Ummm.”

Muttering to himself, Spence conducted his neurological examination. He worked briskly at first, and then more slowly. Finally he scratched his head.

“Remarkable,” he said. “Quite remarkable. And this urine—bright blue.”

Spence stared at the bottle, hesitated, then turned to Clark. “What makes urine blue?”

Clark shrugged.

Spence shook his head, put the bottle down. He stepped back from the patient and looked at him.

“Jesus Christ, blue piss,” he said. “What a patient.”

And he walked off.

The metabolic boys came around an hour later; they collected several samples for analysis, amid a lot of vague talk about tubular secretory rates and refractile indices; Clark listened to them until he was sure they had no idea what was going on. Then, as he was leaving, one of them said, “Listen, Rog, what do you make of this?”