'Like what?'
'Better security.' I told her the details, then recounted Plumb's exchange with Dan Kornblatt.
'On a brighter note,' she said, 'we seem finally to have found something physical on Cassie. Look here.'
She reached into her pocket and drew out a piece of paper.
Cassie's name and hospital registration n'mber were at the top.
Below was a column of numbers.
'Fresh from this morning's labs.'
She pointed to a number.
'Low sugar-hypoglycemia. Which could easily explain the grand mal, Alex. There were no focal sites on the E.E.G and very little if any wave abnormality-Bogner says it's one of those profiles that's open to interpretation. I'm sure you know that happens all the time in kids.
So if we hadn't found low sugar, we would have really been stumped.'
She pocketed the paper.
I said, 'Hypoglycemia never showed up in her tests before did it?'
'No, and I checked for it each time. When you see seizures in a kid you always look at sugar and calcium imbalance. The layman thinks of hypoglycemia as something minor but in babies it can really trash their nervous systems. Both times after her seizures, Cassie had normal sugar, but I asked Cindy if she'd given her anything to drink before she brought her into the E. R. and she said she had-juice or soda.
Reasonable thing to do-kid looks dehydrated, get some fluids in her.
But that, plus the time lag getting over here, could very well have messed up the other labs. So in some sense it's good she seized here in the hospital and we were able to check her out right away.'
Any idea why her sugar's low?'
She gave a grim look. 'That's' the question, Alex. Severe hypoglycemia with seizures is usually more common in infants than in toddlers.
Preemies, babies of diabetic mothers, perinatal problems anything that messes up the pancreas. In older kids, you tend to think more in terms of infection. Cassie's white count is normal, but maybe what we're seeing are residual effects. Gradual damage to the pancreas brought about by an old infection. I can't rule out metabolic disorders either, even though we checked for that back when she had breathing problems. She could have some sort of rare glycogenstorage problem that we don't have an assay for.'
She looked up the hall and blew out air. 'The other possibility's an insulin-secreting pancreatic tumor. Which is not good news.
'None of them sound like good news,' I said.
'No, but at least we'll know what we're dealing with.'
'Have you told Cindy and Chip?'
'I told them Cassie's sugar was low and she probably doesn't have classical epilepsy. I can't see any reason to go into any more detail while we're still groping for a diagnosis.'
'How'd they react?'
'They were both kind of passive-wiped out. Like, Give me one more punch in the face.' Neither of them got much sleep last night. He just left to go to work and she's bunked out on the couch.'
'What about Cassie?'
'Still drowsy. We're working on getting her sugar stabilized.
She should be okay soon.'
