Andrew Neiderman: Deficiency

"I saw a lot of scurvy in infants while I was stationed in the Philippines." He shook his head. "Such an unnecessary thing and the poor little things -- you know," he said lifting his long right hand with its puffy fingers, "angular enlargements of the costochondral junctions of the ribs, swelling of the extremities over the ends of the long bones, swollen hemorrhagic gums surrounding erupting teeth..." His body shook as if an ice cube had been dropped down the back of his neck.

"You know there are things that deplete vitamins -- alcohol, of course, antibiotics, anticonvulsants, antihistamines, even aspirin -- but can you imagine the intake of one or more of these substances one would have to undergo to achieve this serious a condition?" he muttered.

She shook her head.

"In any case, what I really don't understand," Terri said, "is she not realizing she was this sick. Manifest scorbutic symptoms are almost always preceded by weakness, irritability, muscle aches and pains, and weight loss." Hyman shrugged.

"She might have attributed all that to her fad diet," he suggested.

"Um. But you would think bleeding gums, gingivitis, loose teeth would have frightened her into stopping it."

Hyman shook his head.

"I've seen a lot of craziness lately. Just last week, they rushed Mrs. Menkos in with a palpitating heart. She had been living on celery stalks and diet pills. She was losing hair, too. What about anorexia?" Hyman asked.

"That's the thing, Hyman. Paige Thorndyke didn't look anorexic to me. She was undernourished, but not really underweight."

He shook his head and then looked at his watch.

"Let's call," he said. "If Julie's on duty, he'll skip the protocol and give us the findings."

He leaned forward and lifted the receiver of the brass phone. Terri remembered sitting in this office nearly ten years ago to talk to Hyman Templeman about her ambitions. He still had that wonderful painting hanging behind his desk. It was a picture of a doctor making a house call and putting the stethoscope on his own chest to show the frightened child it was nothing. Terri had accompanied her grandmother, who had to have a routine examination, and while they waited for the nurse to help her get dressed, Hyman had invited her in to discuss her plans. He knew she wanted to be a doctor. In Centerville, everyone knew everyone else's business; sometimes before he or she knew it. Of course, Terri's parents had been bragging about her and, on more than one occasion, had told Hyman about her ambitions.

Funny, she thought, how everything looked so much bigger to her in those days. Hyman's dark oak desk had seemed enormous, as well as the office itself. Even the examination rooms were bigger in her eyes. Or was it that she was so much smaller? Regardless of her accomplishments and her association with Hyman Templeman, he still loomed larger than life in so many ways. The family doctor remained an icon in America, she thought, whether he or she deserved the reverence or not. She wondered, especially at this moment, if that veneration wasn't as much a liability as it was an asset. They expect miracles, and all we can offer is scientific knowledge and some medical skill. There certainly wasn't very much she could do for Paige Thorndyke last night, she concluded sadly.

"Julie," Hyman said when he had reached the morgue, "Hyman." Only someone with Hyman Templeman's standing in the medical community could slip past the hospital bureaucracy so smoothly, Terri thought enviously.

"My young assistant was on duty last night when they brought in Paige Thorndyke. Yes, yes, tragic. Have you had an opportunity for any preliminary findings?" He listened. "Really?" he said after one point, his eyebrows rising.

"That's amazing. Negligible, you say? I know, I know." He listened some more.

"It sounds like someone kept in solitary confinement for months." He listened and then looked at Terri while he asked the next question. "Any chemical substances, antibiotics, barbiturates...

"Okay. Appreciate it. Talk to you soon," he added and returned the receiver to its cradle slowly. Then he lifted his eyes toward Terri again.

"Normal plasma ascorbic acid level, as you know, is about 1.5 mg. per 100 cc. He couldn't get any reading... nothing."

"Low levels may sometimes be found in nonscorbutic patients," Terri said softly. "But nothing?"

"Right, and she had no reading in the white cell-platelet layer. She had epistaxis, conjunctival, retinal, cerebral, gastrointestinal, and genitourinary bleeding... all of it," he emphasized. "There's no doubt; this was a severe case of scurvy. It's actually one for the record books."

"What a freaky death for a young, affluent woman in the twenty-first century," Terri said, more to herself than to Hyman.

"She had sexual intercourse right before she was brought in," he added. Terri raised her eyebrows just as Hyman's intercom buzzed.

"Yes, Elaine?"

"Mr. and Mrs. Thorndyke are here to see Dr. Barnard," the receptionist said, her voice cracking with emotion. Elaine Wolf had been with Dr. Templeman nearly as long as he had been practicing. Some older patients considered her evaluation of their condition as good as a preliminary examination. She was a fountain of information when it came to knowledge about families in the community. She asked questions with the forcefulness of a homicide detective and knew if someone came in with bad bronchitis, there were good chances this or that close relative wouldn't be far behind.

"Show them in," Hyman said. He sat back.

"What am I going to tell them?" Terri asked, not disguising the panic in her voice.

"All you know. What else?"

There was a knock at the office door, and Terri rose reluctantly to greet the Thorndykes.

Bradley Thorndyke was still in his pilot's uniform. He was a tall, handsome man in his early fifties with light brown hair and a light complexion that usually gave him a youthful appearance. Now, the weight of mourning and the personal tragedy had added years quickly. His eyes were dark; his skin pale, his shoulders slumped.

Geena Thorndyke was nearly her husband's height. She was an attractive, longlegged, slim woman with ebony hair and dark brown eyes. She clung to her husband for veritable support, her eyes bloodshot, her lips trembling.

"Bradley... Geena," Hyman Templeman said, rising. He went to them quickly and shook Bradley's hand and then put his arm around Geena Thorndyke's shoulders and guided her to the brown leather settee. "I'm so sorry," he said.

"Can you believe this?" Bradley asked. "It makes no sense to us and we couldn't sit at home and wait for something sensible, so we decided to come see the doctor who examined her," he said looking at Terri.

"We were just discussing it," Hyman said stepping back. "Needless to say, it's one of the most unusual things I've seen or heard since I began practicing medicine."

Bradley Thorndyke's gaze swung quickly to Terri again. She felt his sorrow, but she also felt his anger. There was accusation in those eyes. She quickly realized that in their need to understand what had happened to their daughter, the Thorndyke's were searching for a scapegoat, someone to blame so it would make some sense.

"You were on duty when they brought her into the emergency room, right?" he said in an accusing tone.

"Yes. I was with a patient and I heard the STAT and rushed right down. I had just gotten my stethoscope on her chest when she expired," Terri explained. Geena Thorndyke groaned and began to sob.

"They're telling us it looks like she died of acute scurvy," Bradley said, his disdain and disbelief quite evident in his voice.

"Yes, Mr. Thorndyke. It's just about certain that will be the diagnosis."

"That's just ridiculous. She was found unconscious on the floor of a cheap, onenight motel room. She must have been drugged," Bradley insisted. "Someone picked her up and slipped her one of those Ecstasy things or something, an overdose, right?"