Bloodstream

‘Who was it?’ said Claire, turning to Lincoln. ‘Who brought the gun to school?’

‘It was Taylor Darnell.’

She stared at him. ‘Oh god. He’s my patient.’

‘That’s what his father told us. Paul Darnell says the boy can’t be held responsible. That he has attention deficit disorder and can’t control his impulses. Is that true?’

‘ADD doesn’t cause violent behavior. And Taylor doesn’t have it, anyway. But I can’t comment on this case, Lincoln. I’m betraying confidentiality.’

‘Well, something’s wrong with the kid. If you’re his doctor, maybe you should take a look at him before he’s moved to the Youth Center.’

‘Where is he now?’

‘We’re holding him in the principal’s office.’ Lincoln paused. ‘Just a word of warning, Claire. Don’t get too close.’

5 (#ulink_a692c739-21de-567f-9858-0b8375b890a5)

Taylor Darnell sat handcuffed to a chair, swinging his foot, bam, bam, bam! against the principal’s desk. He didn’t look up when Claire and Lincoln walked into the room, didn’t even seem to notice they were there. Two Maine state cops were in the room with him. They looked at Lincoln and shook their heads, their thoughts transparent: This one is totally bonkers.

‘We just got a call from the hospital,’ one of the state cops said to Lincoln. ‘The teacher’s dead.’

No one spoke for a moment; both Claire and Lincoln absorbed the terrible news in silence.

Then Claire asked, softly: ‘Where is Taylor’s mother?’

‘She’s still on her way back from Portland. She drove down there on business.’

‘And Mr Darnell?’

‘I think he’s rounding up a lawyer. They’re going to need one.’

Taylor was kicking his foot against the desk again in a ceaseless, accelerating beat.

Claire set her medical bag down on a chair and approached the boy. ‘You remember me, Taylor, don’t you? I’m Dr Elliot.’ He didn’t answer, just kept up that angry banging. Something was very wrong. This was more than adolescent rage she was looking at. It appeared to be some sort of drug-induced psychosis.

Without warning, Taylor’s gaze rose and locked on hers, focusing with predatory intensity. His pupils dilated, irises darkening to ebony pools. His lips curled up, canines gleaming, and from his throat escaped an animal sound, half hiss, half growl.

It happened so fast she had no time to react. He sprang to his feet, dragging the chair up with him, and lunged at her.

The impact of his body slamming into hers sent her toppling backwards to the floor. His teeth sank into her jacket, ripping the fabric, sending goose down and feathers flying in a white cloud. She caught a glimpse of three frantic faces as the cops struggled to separate them. They wrenched Taylor away, dragging him backwards even as he continued to thrash.

Lincoln grasped her arm and lifted her back to her feet. ‘Claire – Jesus –’

‘I’m okay,’ she said, coughing on goose down. ‘Really, I’m fine.’

One of the state cops yelped. ‘He just bit me! Look, I’m bleeding!’

Even cuffed to the chair, the boy was fighting, bucking against his restraints. ‘Let me go!’ he shrieked. ‘I’ll kill you all if you don’t let me go!’

‘He should be locked up in a freaking kennel!’

‘No. No, there’s something seriously wrong here,’ said Claire. ‘It looks like a drug psychosis to me. PCP or amphetamines.’ She turned to Lincoln. ‘I want this boy moved to the hospital. Now.’

‘Too much movement,’ said Dr Chapman, the radiologist. ‘We’re not going to get very clear definition here.’

Claire leaned forward, watching intently as the first cross-section of Taylor Darnell’s brain appeared on the computer screen. Each image was a compilation of pixels formed by thousands of tiny X-ray beams. Aimed at different angles along one plane, the beams distinguished between fluid and solid and air, and the various densities were reproduced in the image on the screen.

‘See that fuzziness there?’ said Chapman, pointing to the movement artifact.

‘We can’t make him hold still unless we put him under anesthesia.’

‘Well, that’s an option.’

Claire shook her head. ‘His mentation’s cloudy enough. I don’t want to risk anesthesia right now. I’m just trying to rule out any mass shifts before I do the lumbar puncture.’

‘You really think encephalitis could explain these symptoms?’ Chapman looked at her, and she saw skepticism in his eyes. In Baltimore, she’d been a respected family practitioner. But here she still had to prove herself. How long would it take before her new colleagues stopped questioning her judgment and learned to trust her?

‘At this point, I have no choice,’ she said. ‘The initial screen for both methamphetamine and PCP came back negative. But Dr Forrest thinks this is clearly an organic psychosis, not psychiatric.’

Chapman was obviously unimpressed by Dr Forrest’s clinical skills. ‘Psychiatry is hardly an exact science.’

‘But I agree with him. The boy’s shown alarming personality changes in just the last few days. We have to rule out infection.’

‘What’s the white cell count?’

‘Thirteen thousand.’

‘A little high, but not all that impressive. What about the differential?’

‘His eosinophil count is high. Way off the scale, in fact, at thirty percent.’

‘But he has a history of asthma, right? That could account for it. It’s some sort of allergic response.’

Claire had to agree. Eosinophils were a type of white blood cell that proliferated most commonly in response to allergic reactions or asthma. High eosinophil counts could also be caused by a variety of other illnesses such as cancer, parasitic infections, and autoimmune diseases. In some patients, no discernible cause was ever found.

‘So what happens now?’ asked the Maine state trooper, who’d been watching the procedure with a look of growing impatience. ‘Can we move him to the Youth Center or not?’

‘We have more tests to run,’ said Claire. ‘The boy could be seriously ill.’

‘Or he could be faking it. That’s what it looks like to me.’

‘And if he’s sick, you could find him dead in his cell. I wouldn’t want to make that mistake, would you?’

Without comment, the trooper turned and stared through the CT viewing window at his prisoner.

Taylor was lying on his back, wrists and ankles restrained. His head was hidden inside the CT cradle, but they could see the movement of his feet, twisting against the restraints. Now comes the hard part, she thought. How do we hold him in position long enough for the lumbar puncture?

‘I can’t afford to miss a CNS infection,’ said Claire. ‘With an elevated white blood count and changes in mental status, I have no choice but to do the spinal tap.’