considerably, but she was drenched in perspiration, and the bleeding from her nose and her original intravenous site was intensifying. Her fingernail and toenail beds were at least as dark as Lisa's had been. Still, as Sarah conducted her examination, she could not shake the feeling that the two cases were different in some basic way. First there was the fever. Neither Lisa nor the other hospitalized case had experienced a rise in temperature, although it certainly could accompany DIC. Then there was the frightening speed with which Annalee's symptoms were developing. And finally, there were unsettling weaknesses in her acupuncture pulses. Sarah tried to attribute the strange pattern she was feeling to altered blood flow. But her instincts told her she was picking up on something significant. Whatever it was-possibly some sort of systemic toxin-seemed to be affecting every organ in the woman's body.
She returned to the two department chiefs and shrugged.
'Have you anything to offer her?' Snyder asked.
'I don't know. I can try some of the things I did with Lisa. But no guarantees.'
Snyder glanced over at the fetal monitor. 'Eli, I've got the anesthesiologist and the pediatrician standing by. But I want to exhaust every possibility before we go ahead with a section.'
A unit clerk raced in and handed Eli a computer printout.
'These clotting studies look remarkably like Lisa Summer's did,' he said. 'They make DIC pretty much a certainty. We've got to get her on heparin. Sarah, if you want, I'll give you ten minutes-fifteen if she gets no worse.'
'I can't promise anything, but I'll do what I can,' Sarah said. 'Someone please talk to her father and tell him what's going on.'
Her thoughts swirling, she raced past Peter, and off the labor and delivery floor. For months she had hoped Rosa was wrong about their seeing just the tip of the iceberg; prayed that they had encountered the last tragedy from the macabre, malignant complication of childbirth. Now the lives of Annalee Ettinger and her daughter were on the line. But having studied the previous cases so intensively, Sarah had questions. Why the high fever? Why the unusual pattern in her twelve acupuncture pulses? Why the rapid evolution of symptoms?
She took the tunnel to the Thayer Building, bypassed the elevator, and raced up the five flights to her locker.
'Two spins to the right, then stop at three… left to forty…'
As always, Sarah murmured the combination to herself as she dialed it. Halfway to the forty, the dial caught momentarily. In freeing it, Sarah spun well past the number. She cursed out loud. Even in the most trying OR situations, her hands had always been her most supple, dependable allies. Now, with Annalee in such trouble, they were stiff as cold taffy. She was about to spin through the combination again when she noticed the scratches in the metal door, just beside the lock. Instead of redoing the combination, she tugged on the dial. Her pulse was throbbing in her ears as the door swung open. Her lacquered mahogany box of acupuncture needles was gone, as was the electrostimulator she occasionally attached to them. In their place was an unopened Federal Express box addressed to her care of MCB. On top of the box was a small brown paper bag.
Her hands trembling, Sarah reached into the bag and withdrew a glass vial and a receipt. The vial was empty, but its label made all too clear what was going on. It also answered the gnawing questions about Annalee's clinical picture.
CROTALID (M IXED R ATTLESNAKE) VENOM FOR RESEARCH PURPOSES ONLY
CAUTION: HIGHLY POISONOUS
HAVE ANTIVENIN AVAILABLE, AND REVIEW USAGE
The receipt, from a mail order laboratory supply house in Houston, was made out to her. Sarah dropped the vial into her clinic coat pocket and carefully tore open the FedEx package. There was no doubt in her mind what it contained. Polyvalent Crotaline Antivenin-twenty vials in all.
Badly shaken, Sarah stood alone by her open locker on the dimly lit fourth-floor corridor of the Thayer Building. In her pocket was quite likely the cause of Annalee's hellish, imminently lethal situation. In her hands was the cure. No one was likely to believe her story that both the empty poison vial and the packaged antidote had been placed in her locker by whoever had actually administered the venom to Annalee.
If her account of Andrew's death had strained her credibility around MCB, this latest tale would snap it.
It made much more sense to believe that Sarah had infused the rattlesnake poison in order to create a case of labor-induced DIC that was unrelated to her herbal supplement. That Annalee was supposedly her friend would impress no one-especially after Peter got through telling whatever version of their history he concocted. Why, then, had Sarah produced the antidote? Perhaps, some people would reason, she had intended to create a dramatic though sublethal condition, but had missed. Only when things were clearly on a downhill slide for Annalee had she come up with the antivenin-and the farfetched explanation that it had just shown up in her locker. Perhaps, others would claim, she had not initially cared whether the case was sublethal or lethal. But seeing Annalee's extreme distress had brought about a sudden change of heart.
The two groups might argue over nuances. But clearly, there was one and only one logical explanation for Sarah's miraculous, eleventh-hour discovery of both the cause and cure of Annalee's DIC. Sarah herself had to have administered the toxin in the first place. No one with half a brain would believe otherwise.
For a moment, the notion flickered through her mind simply to dispose of the empty vial and the antivenin. She could say that her locker had been pried open and her acupuncture needles stolen. No one except the person who had set her up would ever be the wiser. With luck and aggressive treatment, Annalee and her child-or at least one of them-might possibly survive. And as Randall Snyder had said, with a case of DIC unrelated to Sarah's herbal supplements, she would at last be off the hook. By the time Sarah was even aware of having that notion, she was bounding, three at a time, down the stairs to the tunnel, the precious FedEx box tucked beneath her arm like a football.
The scene in Annalee's room was much as it had been when Sarah sprinted off, except that hematologist Helen Stoddard was now conferring with Eli and Randall Snyder. Sarah groaned at the sight of her. Since their conflict over Lisa Grayson, they had passed in the halls and sat near each other at conferences, and not one word had been exchanged between them.
Well, Dr. Stoddard, Sarah thought as she approached the three treating physicians, if you thought I was a quack before, you're going to think I'm a positive lunatic now. And a homicidal lunatic at that!
'I need to speak with you all over here,' Sarah whispered, motioning toward the only unoccupied corner of the room. 'It's very important.'
'Not again.' Helen Stoddard moaned. 'Eli, I thought you promised-'
'Helen, either shut up or leave,' Eli snapped with uncharacteristic impatience. 'This girl is in big trouble. We've got to do whatever we can to save her.'
'What's going on?' Snyder asked. 'Are you all going to give her the heparin or not?'
'Yes,' Helen Stoddard said, quickly and definitively.
'I think you'd best hear what I have to say first,' Sarah countered.
She briefly described what she found at her locker and showed the three physicians the contents of the FedEx package.
'I was concerned about Annalee's high temperature, the speed with which her symptoms were developing, and also the pattern of her twelve acupuncture pulses. Crotalid poisoning would explain all that.'
'You're absolutely mad,' Helen Stoddard said. 'Someone purposely placed this in your locker? How on earth can you possibly expect us to swallow-'
'Dammit, Helen,' Eli cut her off. 'Would you just listen for once?'
The woman glared at him, then at Sarah. Then she whirled and stormed from the room. A moment later Peter Ettinger stormed in.
'What in the hell is going on here? Why did the hematologist leave that way?' he demanded.
Eli moved to confront him, but Sarah stopped the professor with a raised hand.
'Wait, Dr. Blankenship,' she said. 'Please. I know how important Annalee is to Peter, and I know how worried he is about what's going on. Let me talk to her for a second.' She whispered a few words in Annalee's ear and then returned to the group. 'Annalee says it's all right with her if he stays.'
'Okay,' Blankenship growled. 'But one disruptive word, Ettinger, and you're out.'
'Peter, Annalee has been poisoned,' Sarah said. 'Someone has injected crotalid venom either into her IV line
