'Hey, party hearty, man,' said Macauley, 'just as long as it's sugar-free.'
'Fuck,' said the boy.
'Now, that's' okay, Kev. That you can do to your horny little heart's content, long as you use a condom.'
The boy grinned despite himself.
Macauley slapped him again and said, 'Okay, scram, get, vamoose, clear out of here. I've got sick people to deal with.'
'Yeah, right.' The boy pulled out a pack of cigarettes, stuck a smoke in his mouth, but didn't light it.
Macauley said, 'Hey, turkey, your lungs are someone else's problem.'
The boy laughed and shambled off.
Macauley came over to me. 'Noncompliant adolescents with brittle diabetes. When I die I know I'm going to heaven, cause I've already been to hell.'
He shot a thick arm forward. The hand at the end of it was big but his grip was restrained. His face was basset with a touch of bull terrier: thick nose, full lips, small, drooping dark eyes. The baldness and perpetual five o'clock shadow gave him a middle-aged look, but I guessed he was thirty-five or so.
Al Macauley.'
Alex Delaware.'
'Meeting of the Als,' he said. 'C'mon out of here before the natives grow restless.'
He took me behind swinging doors just like those in Stephanie's clinic, past a similar mix of clerks, nurses, residents, ringing phones, and scratching pens, to an examining room decorated with a sugarcontent chart issued by one of the big fast-food chains. The five food groups with an emphasis on burgers and fries.
'What can I do for you?' he said, sitting on a stool and spinning back and forth in small semicircles.
Any insights on Cassie?' I said.
'Insights? Isn't that your department?'
'In a perfect world it would be, Al. Unfortunately, reality's refusing to cooperate.'
He snorted and ran his hand over his head, smoothing nonexistent hair.
Someone had left a rubber reflex hammer on the examining table. He picked it up and touched the tip to his knee.
'You recommended intensive psych support,' I said, 'and I just wondered-' 'If I was being an especially sensitive guy or ill thought the case was suspicious, right? The answer is b. I read your notes in the chart, asked around about you, and found out you were good. So I figured I'd put in my two cents.'
'Suspicious,' I said. As in Munchausen by proxy?'
'Call it what you want-I'm a gland-hand, not a shrink. But there's nothing wrong with the kid's metabolism, I can tell you that.'
'You're sure of that?'
'Look, this isn't the first time I've been involved in the case-I worked her up months ago, when she supposedly presented with bloody stools. No one ever actually saw the stools except the mom, and red spots on a diaper don't make it in my book. We could be talking diaper rash. And my first go-round was rigorous. Every endocrine test in the book, some that weren't.'
'Someone saw this latest seizure.
'I know that,' he said impatiently. 'The nurse and the U.C.
And low sugar does explain it, physiologically. But what it doesn't explain is why. She's got no genetic or metabolic abnormality of any kind, no glycogen storage disorder, and her pancreas is functioning perfectly. At this point, all I'm doing is plowing old ground and throwing in some experimental assays I borrowed from the med school basic science stuff they're still getting baselines on. We might just have the most tested two-year-old kid in
