Deficiency Page 4

  "The autopsy doesn't show that, Bradley," Hyman said softly. "There was some alcohol in her blood stream, but no chemical substances."

  "Well let them do another autopsy, for Christ sakes! My daughter had to have been murdered. Murdered!"

  Hyman Templeman shifted his gaze quickly to Terri and then nodded sympathetically at Bradley Thorndyke.

  "I can understand why you would feel this way, Bradley. We're stumped."

  "Someone had to have at least hit her or..." He turned to Terri, his hands out,

  "Or done something violent to her."

  "Every hemorrhage on her body appears to have been caused by fragile capillaries, a classic symptom of scurvy. The autopsy reveals large muscle hemorrhages and petechial and purpuric skin manifestations," Hyman explained, when Terri hesitated.

  Bradley shook his head.

  "It's not the sort of thing that happens overnight," Terri added. "Not this severe, this quickly. Did either of you notice her becoming weak, irritable? Did she become black and blue at the slightest touch? And her gums... rapidly developing gingival hemorrhages give the appearance of bags of blood," Terri continued. Wide-eyed, both Bradley and Geena looked at her. It was as if she were from another planet.

  Geena finally shook her head.

  "No, nothing like that," she muttered.

  "She wasn't being treated for peptic ulcers, was she?" Hyman asked.

  "Ulcers? No," Bradley said. "Besides, you would know. You were her doctor, Hyman."

  Doctor Templeman nodded.

  "It's been a while since I've seen her," he remarked softly.

  "That's because she was as healthy as a horse. You know she was into all that aerobics and exercise. Christ, she ate like someone in training. She was always complaining about our fatty diets, the chemicals in our food. We never ate the right cereals and she would go into tirades over the cholesterol we consumed, right, Geena?"

  "What? Oh, yes, yes," she said smiling and wiping her cheeks. "She made me promise to buy this butter substitute because Bradley eats so badly when he's traveling." Her voice trailed off. She caught herself as if she realized she was adding the most inane details to the discussion.

  "When did you see your daughter last, Mrs. Thorndyke?" Terri asked softly.

  "Two days ago... we had lunch." She started to bury her face in her hands again.

  "So what were Paige's dietary habits?" Terri pursued. "I mean, was she following any fads? I know that some people get caught up in these meditation cults and make radical changes in their food habits."

  "Meditation cults?" Bradley cried. "This is ridiculous," he said turning back to Hyman. "Scurvy? That comes from a lack of vitamin C, right? A sailor's disease before they knew about vitamins, right?" he insisted. "It has to be a stupid mistake."

  "The lab findings are pretty accurate, Bradley. What we were also wondering was had Paige gone on any sort of fad diet to lose weight," Hyman said.

  "Absolutely not. I told you. She was into exercise. She didn't have to diet to lose weight. She was in great condition. I know I couldn't keep up with her on the jogging track," Bradley replied. Then he looked down at his wife. "Unless there's something I don't know about," he added. Geena shook her head.

  "She wasn't dieting," she said.

  "You say you had lunch with her two days ago, Geena?" Hyman asked softly. Geena Thorndyke looked up.

  "Yes, but nothing made me sick," she added quickly.

  "No, that's not what we're looking for. Do you recall what you ate?"

  "We had a salad... chicken salad."

  "Paige was in the habit of taking a daily vitamin anyway," Bradley said sharply.

  "I know that for a fact because she was always criticizing me for not."

  "Uh huh. What did you drink with your salad, Geena?"

  "We had... cranberry juice," she said and shook her head so vigorously, Terri thought she was going into a convulsion.

  "Well, that's a source of vitamin C," Henry muttered. "And if she was in the habit of taking vitamins daily, she would get the minimum requirements of vitamin C and none of these symptoms would have been precipitated."

  "So she couldn't die of scurvy. Right?" Bradley Thorndyke cried with frustration. He turned from Hyman to Terri. They simply stared at each other.

  "I'm sorry but we can't explain this, Bradley," Hyman said. "The autopsy report doesn't show a reading of ascorbic acid at all." He sighed. "Dr. Barnard can describe her symptoms when she was first brought into the emergency room. She never had an opportunity to begin any therapy. You will see a copy of the autopsy report, of course, and you will see that all the findings point to scurvy."

  "But what was she doing in that cheap motel?" Geena Thorndyke asked, staring down at the floor. She was really asking herself.

  No one spoke; only Geena's sobbing broke the heavy silence. She realized it and stopped crying to look up at Terri. Bradley Thorndyke turned to her too, as if he expected she had the answer to Geena's question as well as all the others. Terri felt like she was shrinking under their demanding gazes, and for the first time in her long journey to become a physician, she wanted to run away from the profession.

  Nearly eight hours later, Terri emerged from the first examination room where she had seen her final patient for the day and handed Elaine the patients file. She had had little time during the remainder of the workday to dwell on Paige Thorndyke. Before visiting hours had ended, she had seen twenty-five patients. The rapid change in weather characteristic of the Catskill mountain climate engendered the usual minor epidemic of coughs and colds. Many residents stubbornly clung to the remnants of summer, dressing lightly for the daytime and forgetting that the temperatures plummeted in the late afternoon and evening as the sun settled below the peaks and treetops. Shadows grew longer, deeper, darker.

  But Terri loved the Catskill fall mornings. They had that wonderfully invigorating crispness to them. Immediately after stepping out, she enjoyed inhaling deeply and feeling the rush of air fill her lungs and wash away the cobwebs woven during another restless night. Her spiders were hatched out of every diagnosis and prognosis. She had an understandable anxiety, a fear of missing something significant, making the wrong diagnosis and therefore causing the unnecessary death of a patient.

  "A good doctor is never completely free of that anxiety," Hyman told her when she confessed it to him during one of their frequent tete-a-tetes. "The trick is to recognize the gray areas and be modest enough to ask for a second opinion. Unfortunately, there are some pretty arrogant bastards in our profession. Even when they make a mistake, they refuse to recognize it's their mistake. They blame it on the symptoms being too ambiguous or something. Many even blame the patients, claiming they didn't tell them everything. They see and hear what they want. I suppose there's nothing as dangerous as an arrogant doctor.

  "But mind you," he added quickly, fully cognizant of her relationship with Curt,

  "I'm not happy with all this malpractice crap. All you've done, in most cases," he interjected, lowering his bifocals, "is substituted one type of parasite for another. In the end the patients will suffer."

  Of course, Curt had another view. "If it weren't for the malpractice suits," he claimed, "many unscrupulous and incompetent doctors would have free rein and woe-be-gone the unsuspecting clod who wandered into their waiting rooms." Curt had already successfully represented clients in two malpractice suits. One was a clear case of negligence that Terri couldn't deny. A doctor had rushed a patient through a routine D and C in order to make a golfing date and had neglected to check her blood count. She hemorrhaged and died on the table in the hallway.

  Nevertheless, she saw that Curt had been smitten, and like a shark with the taste of blood on his lips, he swam eagerly in the waters of the medical world searching for a new opportunity or, as Hyman would say, a new victim. It wasn't hard to foresee that this would be an area of argument between her and Curt. Her fiance was a strong-minded, firm man, proud of his self-assurance and the old-fashioned
grit he believed he had inherited from his father and grandfather. Curt was willing to make the necessary compromises when he had to, but he was always like a combatant dragged kicking and screaming to the negotiating table. He relented; he gave in and made sacrifices, but he didn't do so with a full heart. Even when his opponents won a point, they left the office feeling they had lost.

  "There's a policeman here to see you," Elaine whispered sharply, taking her out of her reverie. The gray-haired little woman who always reminded Terri of Gracie Allen shifted her eyes to the left.

  Terri was so tired she hadn't noticed the tall, blond-haired man in a dark-blue sports jacket, tie, and slacks standing by the window. He had beautiful blue eyes that fixed on her with remarkable intensity. Broad-shouldered, at least six feet two or three, he stood with a firm demeanor that suggested strength and purpose. Her clinical eyes concluded from the rich sheen of his hair and the robust color of his complexion that he was a healthy, vigorous man. He had a small cleft in his chin and a set of teeth that belonged in toothpaste advertisements.

  "Oh," she said. "Thank you, Elaine."

  She opened the door and stepped into the waiting room.

  "Dr. Barnard, I assume," he said smiling. The twinkle in his eyes made him seem years younger than she imagined he was. He extended his hand and when she placed hers in it, he didn't hesitate to give hers a firm shake. No timidity here, she thought quickly.

  "Yes."

  "I'm here to talk to you about Paige Thorndyke."

  He displayed his badge and card identifying him as a New York State Bureau of Criminal Investigations agent.

  "Clark Kent?" she asked, smiling and reading.

  "I know, I know," he said putting his identification away quickly. "You can imagine the kind of kidding I have been enduring my entire life. Every time my friends and I approached a telephone booth, they pushed me into it. What can I say, I had parents with a sense of humor."

  Terri laughed.

  "Let's sit down," she said indicating the waiting room sofa on her right.

  "Thank you."

  "Why is there an investigation like this? Was something criminal discovered in relation to her death?" she quickly asked, actually hopefully asked.

  "It's routine basically. I won't be long. Just tying up loose ends on the Thorndyke woman's death for the district attorney. You were the doctor on duty when they brought her in, right?" he asked sitting back, his long arm along the rear of the sofa.

  "Yes, but there wasn't much for me to do. She died within moments of arrival."

  "I understand. Did she say anything, anything at all that would lead you to believe someone had done something harmful to her? Perhaps she gave you a name, a description."

  "No. I don't believe she had even the strength to speak. She was too far gone." He nodded.

  "The traumas you observed are characteristic of those caused by a vitamin deficiency?" he asked.

  "As far as I know, yes, but Dr. Templeman and I both think this is going to take a far more expert opinion than ours. It's too bizarre."

  "There was nothing that looked like a blow to the face or head?"

  "I didn't see anything like that. I examined her face because she was missing some teeth, but except for the hemorrhaging in the gums, there wasn't anything, no contusions about the lips, no bruise on the jaw or cheeks. The autopsy has apparently revealed nothing of the kind either, but you would probably know that."

  "Uh huh."

  "So? Do you have reason for some suspicion of foul play?" she inquired again.

  "She did check into that motel with someone, right?"

  "Well, yes, but he was gone by the time she was discovered."

  "But can't you track him down? He signed in, paid for the room..."

  "He signed a fictitious name and address and he paid in cash, no credit card." Terri sighed deeply, the frustration coming over her like a chill.

  "Didn't anyone see him with her earlier? Do we know how she met him at least?"

  "Well, she was at this dance club, the Underground, in Monticello earlier that evening. As I understand it, she went there to meet a friend, but her friend never showed. I questioned some of the people who were at the club and they remember her leaving with the man with whom she had been dancing. The bartender said they met at the bar, and from what he had overheard, met for the first time. No one knows anything about the guy. I've got a description," he said, looking at his small notepad. "But not that concise. Some said he had light hair, some thought dark brown. The bartender claims he was in shadows most of the time.

  "I was hoping she had said something to you. No matter how insignificant it might seem, it could be important," he emphasized.

  "No, as I said, she was too far gone to speak. She didn't know where she was anymore."

  Terri looked up at him.

  "How was she discovered? In the state she was in when I saw her, I can't imagine her even calling out for help."

  "The manager was walking by her room and noticed the door was wide open. When he looked in, she was sprawled on the floor. What about the nurse at the ER or the paramedics... did any of them hear her say anything?"

  "Not that I know," she replied and wondered why he didn't just go directly to them.

  He anticipated the question.

  "I'm just getting into this. I haven't even had an opportunity to speak with her parents yet."

  She nodded, imagining how hard that was going to be now.

  "It's never easy to understand the death of a child, but something like this especially so. This sort of acute scurvy would have revealed itself through symptoms far earlier. Her parents were here this morning," Terri continued.

  "Understandably, they don't believe the cause of death was scurvy. I can't believe it myself, or can Dr. Templeman, but the medical evidence is quite convincing.

  "I can't believe that whoever brought her to the motel would not have noticed something," Terri continued. "To begin with her teeth... she would have had bleeding in her mouth, black and blue marks... been tired.... Who would do such a thing, bring a woman that sick to a motel or keep her there once he saw that? Why not get her to a hospital? The therapy was simple and would have saved her life."

  "I know. That's what I'd like to know."

  "If someone kept a person from getting life-saving medical attention, he would as much as murdered her," Terri concluded.

  "Exactly."

  "Oh. I see why you would be investigating," she said nodding. "As I understand it, she looked well the day before. At least, that's what her parents say." Terri shook her head. "Everything I know about the disease would make that impossible. The whole thing seems impossible. I can't think of any medical explanation for a practically instantaneous case of acute scurvy. People don't develop something like that overnight, even if they neglect vitamin C for days."

  "Maybe drugs caused it," he suggested.

  "Haven't you seen a copy of the autopsy report?" she asked.

  "Oh yes, but I just wondered. Maybe they missed something," he said quickly.

  "There are many drugs that deplete vitamins, but nothing would work this fast and everything I know would show up in an analysis. I'm not going to pass myself off as any world-renowned expert on the subject, however. I'm just a family physician, you understand."

  "Of course," he said smiling, "but I can appreciate your frustration."

  "I mean her parents told me that she was an exercise fanatic. What can I say? It's a real medical mystery. You don't have any other situations like this, do you?" she asked.

  "I don't know yet. I'll have to contact the FBI. I hope not," he said.

  "Oh, I would have thought you would have done that already," she said.

  "Not enough time. This is my first case on a new position and I get this," he said smirking.

  "Oh?"

  "I moved out of New York City because my wife wanted a quieter, safer environment for our children."

  "How old are they?"

  "We don
't have any yet," he replied, "but my wife's pregnant."

  "Do you live here?"

  "No. We moved to the Albany area, a small community just outside the city. It's actually more rural than I had expected, but we like the stressless life, a world without all this urban turmoil."

  "Normally this is a safe place to live," Terri said. "I grew up here."

  "Really? And you returned to practice medicine here. I guess you do like it." She smiled.

  "My fiance lives here. He has a successful law practice."

  "Oh." He looked impressed.

  She thought a moment.

  "You're absolutely sure no one noticed anything unusual about her at the club?" Terri asked, still struggling with the effort to understand and free herself of this terrible frustration.

  "The bartender claims she was dancing up a storm." Terri shook her head.

  "That would just seem to be impossible. I wish I could tell you something that would clear it all up, but I'm more confused than anyone right now."

  "I understand. Well, Doctor, thank you," Kent said rising. "I'm certain we'll reach some satisfactory conclusion."

  "Well," she said, "nothing is for certain in this world, but people don't die like this."

  "No," he said, "they don't."

  He said it as if he knew just as much about medicine as she did. He nodded, thanked her again, and left.

  She turned slowly and saw Elaine Wolf seated behind the counter. Of course, she had been listening in. Only now she looked sorry about her curiosity. Her eyes were filled with terror.

  It gave Terri a chill that she knew she wouldn't shake off until she had made herself a cocktail at home.

  THREE

  He hadn't slept late this morning because he was fully energized and his every sense was heightened, sharp and clear. Maybe he imagined it, but he thought he had been able to hear the movement of the birds on the branches, their tiny steps on the thin twigs of the birch trees just outside the motel window. All he had to do was concentrate and he homed in so quickly and completely, it was as if he were right beside the birds, his ear against the twig.