Bloodstream

‘I believe he reached that decision after speaking with his attorney.’

She waited for him to walk away before picking up the chart. She flipped to the progress notes and with growing dismay read DelRay’s entry.

History and physical dictated.

Assessment:

1. Acute psychosis secondary to abrupt Ritalin withdrawal.

2. Attention Deficit Disorder.

Claire dropped into the nearest chair, her legs suddenly unsteady, her stomach queasy. So this was their criminal defense strategy. That the boy was not responsible for his actions. That Claire should be blamed, because she took him off the Ritalin, triggering a psychotic break. That she was the one who should be blamed. I’m going to end up in court.

This was why Paul didn’t want to find any drug in the boy’s bloodstream. It would shift the blame away from Claire.

Agitated, she flipped to the front of the chart and read DelRay’s orders.

Cancel comprehensive drug/tox screen.

Refer all future questions and lab reports to me.

Dr Elliot is no longer the attending physician.

She slapped the chart shut and felt her nausea intensify. Now it was no longer just Taylor’s life on the line; it was her practice, and her reputation as well.

She thought of the first rule of defensive medicine: cover your ass. You can’t get sued if you can prove you didn’t make a mistake. If you can back up your diagnosis with lab tests.

She had to get a sample of Taylor’s blood. This was her last chance to draw the specimen; by tomorrow, any drug would be cleared from his system, and there’d be nothing left to detect.

She crossed the nurses’ station to the supply room, pulled open a drawer, and collected a Vacutainer syringe, alcohol swabs, and three redtop blood tubes. Her heart was racing as she walked up the hall to Taylor’s room. The boy was no longer her patient, and she had no right to be doing this, but she needed to know what drug, if any, was circulating in his bloodstream.

The state trooper gave her a nod of greeting as she approached.

‘I need to draw blood,’ she said. ‘Would you mind holding down his arm for me?’

He didn’t look happy about it, but he followed her into the room.

Draw it quick and get out of here. With shaking hands she snapped on the tourniquet and twisted off the needle cap. Get out of here before someone finds out what you’re doing. She swabbed Taylor’s arm with alcohol and he gave a shout of rage, twisting against the trooper’s restraining grip. Claire’s pulse accelerated as she pierced the skin and felt that subtle and satisfying pop as the needle penetrated the vein. Hurry. Hurry. She filled one tube, slipped it into her lab coat pocket, then squeezed another into the Vacutainer. Dark blood streamed out.

‘I can’t hold him still,’ said the trooper, wrestling for control as the boy bucked and cursed.

‘I’m almost done.’

‘He’s trying to bite me!’

‘Just keep him still!’ she snapped, her ears ringing with the boy’s shrieks. She slipped the third tube into place and watched as a fresh stream of blood shot out. Just one more. Come on, come on.

‘What the hell is going on in here?’

Claire looked up, so startled she let the needle slip out of the vein. Blood dribbled from the puncture wound and dripped onto the sheets. Quickly she snapped off the tourniquet and applied gauze to the boy’s arm. Cheeks burning with shame, she turned to face Paul Darnell and Adam DelRay, who were staring at her incredulously from the doorway. Two nurses peered over their shoulders.

The trooper said, ‘She was just drawing some blood. The boy got a little noisy.’

‘Dr Elliot isn’t supposed to be in here,’ said Paul. ‘Didn’t you hear about the new orders?’

‘What orders?’

‘I’m the boy’s physician now,’ snapped DelRay. ‘Dr Elliot has no authority. She shouldn’t even be in here.’

The trooper stared at Claire, and his anger was unmistakable. You used me.

Paul thrust out his hand. ‘Give me the blood tubes, Dr Elliot.’

She shook her head. ‘I’m following up an abnormal test. It could affect your son’s treatment.’

‘You’re no longer his doctor! Give me the tubes.’

She swallowed hard. ‘I’m sorry, Mr Darnell. But I can’t.’

‘This is assault!’ Paul turned to the others in the room, and his face was florid with outrage. ‘That’s what this is, you know! She assaulted my son with that needle, and she knows she has no authority!’ He looked at Claire. ‘You’ll be hearing from my attorney.’

‘Paul,’ interjected DelRay, playing the role of diplomat to the hilt. ‘I’m sure Dr Elliot doesn’t want this kind of complication in her life.’ He turned to her and spoke with the smug voice of reason. ‘Come on, Claire. This is turning into a circus. Just give me the tubes.’

She looked down at the two tubes she was holding, weighing their value against a charge of assault. Against the probable loss of her hospital privileges. She felt the gaze of everyone in the room watching, even enjoying, her humiliation.

In silence she handed over the blood tubes.

DelRay took them with a look of triumph. Then he turned to the Maine state trooper. ‘The boy is my patient. Is that clear?’

‘Perfectly clear, Dr DelRay.’

No one said a word to Claire as she walked out of the ward, but she knew they were staring at her. She kept her gaze focused straight ahead as she turned the corner and punched the down button. Only when she’d stepped into the elevator and the door slid shut did she finally allow her hand to slip into her coat pocket.

The third blood tube was still there.

She rode the elevator to the basement lab and found Anthony sitting at his lab bench, surrounded by racks of test tubes.

‘I’ve got a sample of the boy’s blood,’ she told him.

‘For the drug screen?’

‘Yes. I’ll fill out the requisition myself.’

‘The forms are on that shelf over there.’

She took one off the stack and frowned at the letterhead, Anson Biologicals. ‘Are we using a new reference lab? I’ve never seen one of these forms before.’

He glanced up from a whirring centrifuge. ‘We just switched over to Anson a few weeks ago. The hospital signed a new contract with them for our complex chem and radioimmunoassay work.’