Authors: John Hornor Jacobs
Choreoathetosis
, Lucy noted.
Another one
.
They ducked into a waiting room. Robbins locked the door and led the woman to a cushioned examination table. She set her child down and removed the blanket.
“What’s her name?” Robbins asked softly.
“Deborah. We call her Deb.”
“Age?”
“Six months.”
“What’s wrong with her? Fever? Crying?”
The woman nodded.
Robby said, “What made you bring her in?”
“She was shaking. She started crying and her legs and arms just started to . . . I don’t know . . . vibrate.”
“She cough or choke?”
“Coughed, maybe. I think.” She was a short woman, heavyset like most of the folk around White Hall, with originally brown hair done up into a confectioner’s mess, bleached and highlighted. She had French nails with designs applied to them and cheap jewelry, two rings, a necklace, and large, tacky earrings. Tears welled at the corners of her eyes and she wiped them away, smearing mascara. “I don’t know. She spat up her milk.” Her hands shook and she rubbed her face. Not much sleep recently. “What is going on? Why is everyone out there?”
“I don’t know,” Lucy said. “But I intend to find out what’s wrong with your baby.”
The mother showed her teeth to Lucy. Lucy realized it was the woman’s attempt at a smile.
She peeled away the child’s clothes and diaper.
With the baby nude, pink, and splayed upon the paper-wrapped examination table, Lucy felt a twinge of nostalgia for Gus at that age. When he was just a baby, she felt such love suffusing her, she found herself speechless when she held him. And she was content to stay in that speechless state beyond thought or reason. Just pure emotion. But as he grew and took his first steps, his first stabs at speech and then abstract ideas, she had such problems with his ignorance that, to her shame, she let Fred commandeer the child’s
upbringing. After all, she was the breadwinner. Why not have Fred raise Gus?
Without Fred, she’d have been lost. He guided both her and Gus through those rough waters.
This
child was wonderfully plump and apparently healthy, despite being flushed with fever. She had a thick head of amber hair and blue eyes, now narrowed in pain. Her tiny fists waved in the air, angry.
Lucy pulled the diaper tabs to examine the child’s genitalia and take her temperature.
“Hold the phone.” She held up the diaper, heavy and wet. “Robby. You see this?”
“What is it?”
Turning, Lucy moved the diaper into the light.
“Her urine looks orange.”
Robbins washed his hands in the examination room sink, rubbed them with antibacterial foam, and then listened to the baby’s heart and took her pulse.
“Tachycardia. One hundred and thirty beats per minute. And rising. She’s a hummingbird.”
Lucy turned to the mother—her hand covering her mouth in disbelief or pure horror, Lucy couldn’t tell.
“Robby, you going be okay here? I’ve got to take this to the lab. No infant gets gout.”
Robbins nodded absentmindedly and continued examining the infant.
A crash rattled the frosted-glass window. Booming male voices sounded from the waiting room. Then screams.
“Robby, lock the door behind me, okay?”
“Will do.” He didn’t look up from the child.
Lucy removed the white doctor’s coat and unpinned her long brown hair. She wrapped the diaper into a ball and reconnected the tabs, saying, “I hope you have another one.” Immediately afterward she realized how that must sound and hoped the mother knew she meant another diaper, not another child.
Maybe that’s just the way my fucked-up mind works
.
The woman gave a pained nod.
Lucy opened the door as quickly as she could and stepped out into bedlam.
“Oh, shit,” she whispered to no one.
The older man who’d suffered the spine-cracking episode of opisthotonus lay unbowed. But the boy still stood in the fencing position, and it looked as if the girl who’d been thrashing about on the floor had chewed off her lips. Cathy mopped at the child’s face with cotton, a bottle of antiseptic clutched in the opposite fist. Dr. Patel leaned over her, injecting something—most likely benzodiazepine—into the girl’s arm.
Lucy moved across the room to the contortionist. The woman sitting near him continued to curse, staring unblinking at the plastic ficus tree in the corner.
Lucy knelt and searched for a pulse. The loose skin of his neck made it hard to find. It was weak and fluttery. She opened his eyelids.
Pupils nonresponsive.
Turning his head, she noticed an orange smear on the man’s earlobe. Without anything to take a sample with, she reached into her pocket and found her house keys. She dug
into the man’s ear, scraping away some of the orange substance.
“What’re you doing
, bitch
?” A deep voice, close, behind her.
Lucy turned. Another elderly man stood over her. Liver spots ran up his arms and disappeared into the sleeves of a plaid shirt. He had the look of a withered eagle chick, bulbous head with wispy white hair perched precariously atop a thin, wattled neck. He was rangy and lean, if doddering, with oversized joints due either to arthritis or to unfortunate genetics. His lips drew back from dentures; his hands were balled into knobby, furious fists.
This isn’t going to go well
.
Still crouching, Lucy lurched forward, putting her shoulder into the man’s groin. Knocked off balance, he howled and fell down hard on his ass. His hands jittered.
“Cunt! Rip your tits off!” His body shuddered and then he emitted a strange sound.
“Eurppp!”
She rose, leaping forward, and dashed to the pneumatic doors.
She swiped her key card across the sensor plate, waited breathlessly while the doors swung open, and sprinted through.
In her office, she locked the door and felt intense relief that there were no glass windows, frosted or otherwise, in her workspace. Just a solid-core door with the placard Pathology to its right.
She set the diaper and her keys down next to the microscope. Hastily, she popped open a case of slides and, taking a
swab from a glass container, began preparing them. No time to formalin fix the specimens.
She slipped the infant’s specimen into the scope, centered it in the viewfinder, and adjusted the ocular and focus.
Bright orange crystals filled her vision, like an airburst over a crowd on the Fourth of July. An explosion of light and color.
Hyperuricemia. Too much urea for the body to handle. She’s sloughing off the excess through her urine
.
She prepared another slide, this time from the old man’s sample on her keys.
Another bright explosion of color against her retina. A field of orange crystals.
Urea coming from his ears? That’s bizarre
.
She turned to the computer, to the diagnostic database, and placed her cursor in the search form field.
She thought for a moment, then began to type.
Hyperuricemia
, for the uric residue in the diaper and around the ears.
Coprolalia
, for the involuntary cursing.
Choreoathetosis
, for the spastic movements.
Opisthotonus
, for the spine-cracker.
Dystonia
, for the boy in the fencing position.
She jabbed at the return key. The search results filtered onto her screen.
Three hits: progressive supranuclear palsy, drug-induced acute dystonia reaction, or Lesch-Nyhan syndrome.
What the hell is Lesch-Nyhan syndrome? I’ve never heard of it
.
She clicked through, and, as she read, her stomach began to twist and ball into a painful knot. She turned, dug through her purse, and found a flat package of Marlboro Lights. A
secret shame, smoking. She knew if her colleagues found out, she’d be ridden about it for months. She fished out a cigarette and lit it with a match from a book tucked into the pack’s cellophane.
Lucy took her time, drawing the hot cigarette smoke into her lungs and expelling it toward the ceiling in a blue cloud as she reread everything. The nicotine calmed her. She’d be good for the next few hours or so. And now, knowing what she did, it might be a long time before she’d get another smoke.
When she was through, she dropped the cigarette to the tile floor and ground it out.
She wiped off her house keys and pushed them deep into her pocket.
Then she turned to the cabinets and rifled through them. She withdrew swabs, ethyl alcohol. She found gauze and tape and cotton and swept them all into her purse. She considered trying to break into the drug storage but realized she’d need a chainsaw to get through the door. No drugs. She’d have to make do.
With her purse full, she slung it over her shoulder and then opened the drawer holding her needle gun. The big one for aspirating tissue. She took the package of extra needles, placed them in her purse, and held the gun by the handle, form fitted to her hand. She held a five-inch sliver of steel in her fist that could easily be used in self-defense.
She turned and headed back to Robbins.
The waiting room was quieter now, which made Lucy nervous.
The woman had stopped cursing and the belligerent old
coot who’d called her a cunt was nowhere to be seen. Cathy and Melissa handed out bottles of water. A woman nursed her baby, frowning.
The man who’d suffered from opisthotonus was still on the floor.
Lucy went to him and knelt. His lips were gone, along with his fingertips. He must’ve come to while she’d been in Pathology and begun eating himself. She shivered.
Okay. Today is officially fucked up
.
She felt for a pulse. None. His eyes stared unblinking at the buzzing fluorescent tube above.
“Cathy!” The nurse looked up and trotted over on white, cushy shoes. She knelt beside Lucy, smelling of Mentholatum.
“This man is dead, Cath.”
Cathy covered her mouth with a trembling hand. “Oh, no. This is—”
“Listen to me, will you? Just listen.” She cleared her throat. “I’m not exactly sure, but I’ve analyzed some samples from this man and an infant, and I think they both have the same thing. There’s no way for me to be absolutely positive without a genetic test, but that isn’t going to happen in the next couple of hours. I need you to lock the entrance doors—now. Send someone to check the other exits.”
“What? Lock the doors?”
“Yes. Lock them. This might get worse; it looks infectious, and we’ve got to take care of the people here. If I’m right—”
“Right about what?”
Lucy wanted another cigarette. “I don’t know yet,” she said. “But clearly, it’s infectious, and those that—” She thought
about the withered geezer who called her a cunt. “Those that contract it are dangerous. We’ve got to go on lockdown.”
Cathy put her hand to her mouth again, as if to stifle some exclamation. She had soft white palms and each plump finger ended in a pink, shiny nail. Kind hands. A healer’s hands.
“Just do it, will you? Lock the doors.” She stopped. Tried to smile. Failed, maybe. Maybe not.
The nurse nodded. “Okay.”
Lucy stood and walked to the examination room. As she entered, she saw the mother huddled in the corner, crying. Robbins sat in a plastic chair with an unfocused look. He stared up at the fluorescent lights, pushing his lips in and out while rubbing his chin. The baby lay on the table, unmoving, tinged blue gray.
“Oh no.”
The mother drew her knees to her chin and moaned.
“My baby. My baby . . .”
Lucy set down the tissue-aspirating needle and seated herself on the physician’s stool in front of Robbins.
“Robby,” she said in a low voice. “Whatever this is . . . It’s totally bizarre. I analyzed the orange crystals from . . .” Lucy glanced at the mother.
He wasn’t listening. Lucy touched his knee; he blinked and looked at her.
“This is not a good situation, Luce.” He tilted his head at the woman grieving for her child.
“What these people have could be Lesch-Nyhan syndrome. It’s very rare and triggers on the Y chromosome.”
“Lesch-Nyhan? I’ve . . . that sounds familiar. But it’s almost
unheard of. And . . . let’s see . . .” His eyes unfocused as he looked at the wall, his gaze moving back and forth between two invisible points, searching. “It only occurs prenatally.”
“Yes. Caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase activity. An inborn error of purine metabolism associated with uric acid overproduction and a continuum spectrum of neurological manifestations depending on the degree of the enzymatic deficiency.” Almost like being in med school again, the recitation of symptoms. She’d always been strong in school.
She took a long breath, opened her eyes, and looked at Robby, ticking off symptoms on her fingers. “Lithiasis and gout. Neurological manifestations, including severe action dystonia, choreoathetosis, ballismus, cognitive and attention deficit, and self-injurious behavior—everything we’ve witnessed. All you’ve got to do is peek out in the waiting room to see it all. But what I can’t figure out is
why
. Or how.” She balled her hand into a fist and ground it into her thigh. Lucy felt infected by the mystery of the thing. It was a puzzle, and it needed to be solved.
“Wait. Did you say Y chromosome? Then . . . then how could this child have had it? She was female.”
Hearing the past-tense usage, the mother wailed again and began pulling her hair and shaking her head. Robbins winced at the sound. Lucy found it hard to concentrate, and for a moment, despite full knowledge of the woman’s terrible loss, Lucy just wished she’d shut up so she could think. So she could figure out the problem. Followed swiftly by an intense flush of shame for feeling that way.
“Do you have anything for her, Robby? The mother?”
Sedatives
.
“No. These examination rooms are bare. And it can’t be Lesch-Nyhan. That only occurs in boys.”
Lucy shook her head, irritated. She threw up her hands and said, “Shit. I don’t know.”
“I’ve read about knockout gene therapy where you can take a viral vector, like adenovirus, and carry a ‘suicide gene’ to a target, render it inert, and induce a disease.”