Deficiency (5 page)

"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, one-night 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?"

"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 tête-à-têtes. "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 fiancé 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.