Family Practice (28 page)

“Core samples,” she said. “Find out what Vicky meant by that. Who's collecting core samples, of what, and why.”

“Yes, ma'am.”

The clock in the living room chimed eight times. She suddenly realized she could hear it. At some point the rain had stopped. The sky outside the window had gone from gray to blue-gray.

“Go home.” With a thud, she dropped her feet to the floor and pushed herself upright. “Get some sleep before you go in.”

He stood, drained the mug, and set it on the counter. He looked at her, paused, then said, “You might do the same.”

23

T
WO HOURS LATER
Susan viewed the world with dark mutterings, staggered her way into the bathroom, and stood comatose in the shower. She managed to find all the belt loops on the beige pants and line up the buttons in the right order on the white blouse. As she drooped over extra-strength coffee, she glanced at the
Herald.
“Storm Leaves Trail of Destruction.” Winds reported at eighty-five mph. A tornado touched down between the Hampstead Municipal Airport and the Kaw River, and remained on the ground for less than a minute; no report of injuries. Hail ranging in size from pea to golf ball did all kinds of damage. Trees were down, power lines were down. Forecast: more rain.

She rinsed the cup, put it on the cabinet, found her linen blazer, and headed for the hospital.

The sky was a vivid blue, but banks of sinister clouds hung around the edges. At the moment, the sun was bright enough to make itself known even through dark glasses. Streets were flooded with rushing water that fountained over leaves and tree limbs. She avoided State, which was impassable due to water and a fallen tree, and turned up Kentucky. City crews were out in force, trying to cope with overloaded drains, downed power lines, and stalled motorists.

At ten-thirty, it was already hot and muggy; the air felt too thick to breathe. She was sticky, blouse clinging to her back where she leaned against the seat.

Officer White, looking bored, was sitting on a chair outside Jen's cubicle. When he saw her, he shot to his feet. The youngest and newest of her officers, he was blond-haired, apple-cheeked, and had the misfortune of blushing when flustered.

“Anybody been in this morning?” she asked.

“No, ma'am. Just Dr. Sheffield and the nurses. Oh, and her mother's here now.”

Terry Bryant was standing at her daughter's bedside, leaning over and caressing Jen's hair. She looked up, spotted Susan, and came out. “I hope you're not going to bother Jen. She needs to rest.”

“I know.”

Terry dug through her straw handbag for a tissue to pat at her nose. Her makeup intact, she looked tearily attractive, with brown hair tumbling in curls to her shoulders, a bright-yellow full skirt, and a yellow blouse with ruffles down the front. She threw the tissue back in the bag and snapped it shut.

“She's a sturdy little girl. She's doing very well.”

Terry gave her a look that said, no thanks to you. “They let me stay for only five minutes.”

Terry turned and clicked off down the corridor in her high heels, skirt swirling.

Jen was lying on her back, eyes closed.

“Hi, Jen,” Susan said softly.

Jen's eyes opened.

“How are you feeling?”

“Okay.” The word was toneless. Jen closed her eyes

“I need to go do some work. I just wanted to see how you were. I'll be back later.”

Jen opened her eyes, said, “Okay,” in the same flat voice, and closed her eyes again.

Susan's throat closed; she patted Jen's hand and made her way to the elevator.

Any lightness and charm the hospital might have was relegated to the upper floors. The basement was strictly utilitarian—scarred and scuffed white walls, brown-tiled floors—and housed all the functions for keeping the system going: housekeeping, laundry, heat and air-conditioning, lab, and Dr. Fisher's domain.

She could have sent Parkhurst or Osey, but she wanted to be here herself. Being too personally involved—the voice in her head had the cadence of Captain Reardon's—leads to errors in judgment.

An officer needed to be present for autopsies of homicide victims, she justified. Any possible evidence could be obtained directly, to shorten the chain of custody. The officer on hand can receive information immediately, not have to wait for the official autopsy report. And as far as she was concerned, the most important reason was the opportunity to ask questions. Sometimes information resulted that didn't get included in the formal report, information that could be extremely important.

At her first autopsy, she'd wedged herself in a corner, afraid if she moved, she'd fall on her face. The sight, grim as it was, wasn't the problem. The smell. Like no other. It got deep in the throat and stayed there for days. Once smelled, never forgotten.

Dr. Fisher, in scrub greens, glanced at her briefly as he snapped on a pair of latex gloves and spoke into the tiny microphone clipped to his chest. He recited the case number and name: “Victoria Barrington … body that of well-developed, well-nourished, thirty-one-year-old Caucasian female. Blond hair, blue eyes. Body sixty-three inches long, weight 112 pounds.”

With deliberate attention, he examined the hands and fingernails for skin or blood or fibers that could provide evidence of an assailant. Hands and fingernails were clean.

Vicky lay on her back on the stainless-steel table, the bright overhead light harsh on her blue-gray skin.

Picking up a scalpel, he made a deep Y incision, starting at a shoulder, to a point midway in the chest, then the other shoulder, and a straight line to the pubic area. He examined the chest, lifted out the block of organs, weighed each, sliced sections for lab evaluation, moved methodically to the pelvis, then grunted and muttered, “Gravid.”

“She was pregnant?”

“Five to six weeks gestation. Embryo ten millimeters.”

Slightly larger than a bb shot. Had Vicky known she was pregnant? Five to six weeks, only just begun. A fetus weighing less than 500 grams—usually five to six months—didn't require a separate death certificate, but two lives had been taken here. Licks of anger like small flames flared in Susan's chest.

Fisher removed the bladder. Any urine would be carefully removed and sent, as would the dregs of hot chocolate from the mug in Vicky's living room and the vial labeled codeine, to the KBI lab in Topeka for toxicology. Many drugs, including barbiturates and sedatives, were excreted by the kidneys. Urine was the way to find them.

Dr. Fisher peeled off the latex gloves. “Not much to help you with.” He turned on a spigot in the deep sink and washed his hands. His hands were actually quite beautiful. They fascinated her. Even working on somebody long past caring, they were gentle. His touch on a body was almost a caress, as though knowledge was absorbed through the fingertips.

“What can you tell me about porphyria?” she asked.

“She didn't have it.”

“It's a disease,” Susan said to get him started.

“Not one. A constellation of seven different inheritable diseases.” He shook water from his hands and reached for a towel. “Some forms are more debilitating than others, some life-threatening.”

Dr. Fisher was a man happy in his work, enthusiastic about the job, with the attitude “Oh, boy, I'm fortunate to be given this opportunity” and “Well, well, what do we have here?” whenever he pulled on latex gloves. Sometimes his enthusiasm spilled over and he had to share it with whomever was at hand. Like the time when he'd sliced open the heart of a young man and traced the flow of blood through the chambers. In great detail. There might have been some purpose if the kid had had heart disease, but he was a healthy young male who'd died of a head injury sustained in a motorcycle accident. For a long time after that she'd been aware of her every heartbeat.

Questions never irritated him, no matter how irrelevant. Information about the human body came pouring out, like turning on a tap.

“Extremely rare.” He tossed the towel at a hamper and leaned back against a stainless-steel cabinet. “A group of inborn errors of metabolism caused by mutations in genes that code for various enzymes of the heme biosynthetic pathway.”

Right. One difficulty with all this information that poured out was she usually needed a medical dictionary to interpret it.

“The rarity makes it hard to diagnose. Each form has its own symptomology. Appropriate lab tests give an unequivocal diagnosis, but the symptoms simulate a multitude of illnesses, even including mental illness.”

“What are the symptoms?”

He drew his heavy, dark eyebrows together and peered at her from under them. “Seven different kinds.” He held out the index finger of his left hand, tapped it with the index finger of his right hand, and recited, “Congenital erythropoietic porphyria. Characterized by severe cutaneous lesions, hemolytic anemia, large amounts of uroporphyrin 1 in the urine. Onset of symptoms usually in the first year of life. Treatment here, often blood transfusions. The photosensitivity can lead to scarring to the point of mutilation affecting nose and fingers. Teeth can get pointed and red. Increased hair growth sometimes.”

Dr. Fisher broke off his discourse and rubbed a finger down his forehead between his heavy eyebrows. “Matter of fact, some scientist somewhere hypothesized that vampires might have been porphyria victims.”

“Vampires.”

“They go out only at night. The teeth get pointed and look larger because mouth and gums are tight. The need for blood. He even brought in the bit about garlic. Theory being garlic was dialkyl disulfide, which destroys heme and increases the severity of an attack.”

“Heme.”

“Porphyria's a metabolic disorder, comes from a deficiency of an enzyme involved in the synthesis of heme. Bunch of nonsense, this vampire stuff. All it did was cause people suffering from an incurable disease a whole lot more suffering by making them the victims of nasty jokes.”

He held out his middle finger and tapped it. “Protoporphyria. Characterized by acute photosensitivity, no urine abnormalities, often serious liver disease.”

He held out his third finger. “Acute intermittent porphyria. Can exist in latent form. No cutaneous manifestations, but acute attacks of neurologic dysfunction—”

“Never mind.”

“—chronic pain, muscle paralysis in arms and legs, seizures, blindness, tachycardia. Purple urine. Then there's porphyria cutanea tarda. Excess iron in the blood, needs to be periodically removed by phlebotomy.”

“Never mind.” The problem with turning on Fisher's flow of information was that it was hard to turn off. “Was Dorothy Barrington likely to see a patient with porphyria?”

“Not likely, no. I told you, it's extremely rare.”

“Tests can be done to find out if a patient is suffering from this illness?”

“Didn't I just say that? But because of its rarity, it's not considered until other things are ruled out.”

Had Dorothy thought she might have a patient with porphyria? Had she been reading about it to see if she might be right? Which patient? Susan had never had the need to get a court order to look at patient files, but she knew there was no way a judge would sign an order on the basis of her vague speculations. Fishing expedition. She didn't even have a name, would have to go through all the patient files. The possibility—if it even was a possibility—of a patient having porphyria could have no bearing on the murders anyway. Probably didn't. A bookmark inserted in a different spot probably meant, as Parkhurst had suggested, someone used the book and put the bookmark back at random. Maybe.

“Have you ever seen a patient with porphyria?”

“By the time I see them, it wouldn't matter. I haven't seen any evidence that might indicate porphyria. Unless I missed it.”

“You ever know of anyone who had it?”

“No. I told you it's rare.” He massaged his chin. “One interesting particular. Sometimes a genetically affected individual is asymptomatic. Raises some questions concerning the simple, Mendelian, dominant mode of transmission, doesn't it?”

Is that what it raised? In her mind, it simply raised confusion.

24

S
USAN NO LONGER
needed sunglasses when she left the hospital; the clouds had taken over. She turned right on Railroad Street—passable, but with standing water in the gutters—and drove past Bobcat Canyon Park, which was a big lake with trees rising from it, wooden benches covered with water, the old railroad locomotive in water up over its wheels.

Outside of town, the farm road was passable, but the fields on both sides held standing water. In one, nine mahogany-colored cows stood in a line, water up to their knees. They all had their rears turned toward the road, except one white-faced freethinker in the center who blandly watched the pickup drive by.

At the crossroads, she went left. Ellen Barrington's land lay to the right. Not much was getting accomplished in the way of plumbing repairs, most likely. Susan slowed at a row of six mailboxes. Two redwing blackbirds perched forlornly on one, surveying the flooded fields like leftovers from the ark.

She made a left to the Dietz farm and pulled up behind the house. A large walnut tree, uprooted by high wind, lay across the ground, limbs split and broken.

Heat and mugginess made the air seem like something you had to push through. Her white blouse stuck to her back, her beige pants clung to the back of her legs. Shrugging off the linen jacket, she tossed it on the seat beside her.

The Lab, the collie, and the hairy mutt eyed her from inside the kitchen. As watchdogs, these three were a washout. Not even a mild growl until she rapped on the screen door, then they gave excited little yips and whipped their tails so hard their rear ends wiggled.

Holly came into the kitchen. There was no surprise on her face at seeing Susan. The corners of Holly's mouth twitched as she was deciding whether or not to smile; she opted for a smile. The dogs crowded in front of her, prancing and yelping.