Heat and Light (35 page)

“Fine,” he snaps. “What can you do for me?”

There is a silence.

“I can't help you, Whip.”

“What do you mean, can't? I thought you were the law in those parts.”

“Only in Personal Wealth Group,” says Taffy. “This came from upstairs.”

THE POINT OF DYNAMISM
is a construct, useful only when it is useful.

Fatally undercapitalized.

Facial disfiguration.

The packet of birth control pills at the edge of the sink.

Multiple points of dynamism, darting randomly, fleet as june bugs, their demented trajectories known only to the Creator himself.

Driving, Kip has a realization that nearly makes his brain burst.

The point of dynamism is me.

W
hen Rena pulls up to the house, they're waiting on the porch: Olivia in a plaid jumper, Shelby in a severe navy blue suit like an old-school airline stewardess. Shelby buckles Olivia into the van's backseat, then climbs in beside Rena. There is a chill in the air, a rumor of fall.

“I thought your pastor was coming.”

“She couldn't make it. It's a long story. Oh, can you stop right here? I need to mail this.” Shelby takes an envelope from her purse.

“What about Rich? We have plenty of room.”

Shelby lowers the window and leans out to open the mailbox. “He's not a very good passenger. Anyways, he's on day shift. Oh, wait! I forgot the flag.”

She steps out of the van and hurries back to the mailbox, raising the red flag.

“Where's Dr. Trexler?” she asks when she returns.

“He couldn't make it. Something came up.”

“People are always saying that.” Shelby reaches over the seat and hands Olivia her cell phone. “You look tired.”

“I'm fine.” Objectively, it's true. There's nothing wrong with Rena beyond a kind of psychic hangover from her day with Lorne—a creeping soreness, vaguely muscular, as though she threw out her back while shoveling snow.

The long and complicated day, in all its electrifying strangeness. After the rally he'd left her sitting in the student union for
nearly an hour.
I have to see a colleague in the Geology Department. I won't be long.

In the student union Rena waited and waited, wishing she'd brought
Silent Spring.
In her bag she found a pamphlet folded in thirds. She'd had a vague idea of saving it for Mack.

           
Gender identity is a person's internal sense of being

                     
•
  
a woman,

                     
•
  
a man, or

                     
•
  
a person outside the gender binary.

           
Not all gender-nonconforming people identify as transgender, nor are all transgender people gender-nonconforming.

Rena thought: Sometimes you just meet a person.

She threw the pamphlet in the trash.

Lorne's moodiness on the drive home, the unexpected silence that was somehow nothing like Mack's. How was it possible, that two people could say nothing in entirely different ways? Mack's silence was negative space, an absence of anything. Lorne's was rich and complicated, fraught with unknowable meanings, a pot simmering on the stove.

By the time they crossed over the border—
PENNSYLVANIA WELCOMES YOU
—she understood the depth of her foolishness. She had misread the situation completely. Lorne cared nothing for her.

As they turned into the Days Inn parking lot, he seemed to remember she was there.

I wish I could go with you tomorrow,
he said.
To see Ravi. I'll be thinking of you. Call me, okay?

He leaned over and kissed her cheek.

Now, in the backseat, Olivia plays a game on her mother's phone. She stares at the tiny screen, rapturously absorbed. Shelby is chatty, animated, full of questions: Did Rena grow up on the farm?
Did she have brothers and sisters? Had she always wanted to be a nurse? Does she belong to a church?

No, yes, yes, no. Rena answers the questions at length, with copious details. Why not? She has nothing else to do but drive.

Were Mack and Rena best friends since childhood? What was Mack's real name, actually, and why did she go by Mack?

Rena answers: No. Susan. Nobody remembers why.

Shelby asks, “Have you ever been married?”

There is a simple answer to the question, and a complicated one. Rena opts for simplicity. “No,” she says.

“Has Mack?”

Rena studies her, fascinated. Honestly, how is it possible? What goes on in Shelby's brain is a flat-out mystery. At times it's like talking to a precocious child. At other times, a slow-witted adult.

“No,” she says.

Shelby nods sagely. “I used to be afraid of that. Being—an old maid, or whatever. No offense. But now I think it wouldn't be so bad. Marriage isn't all it's cracked up to be.” She stares out the window. “I think Dr. Trexler likes you.”

Rena says, “I like him, too.”

IN THE WAITING ROOM
Rena flips through a magazine, trying to picture where Lorne is at this moment. She thinks, I am lovelorn. An old-fashioned word she hasn't heard in years.

She leaves a message on his cell phone: “Shelby and Olivia are in with Dr. Ghosh. They've been in there awhile.” For half an hour she's kept her eyes on the door next to the reception desk. Somewhere behind it, Shelby and Olivia are sitting in an exam room.

At that moment the door opens. Shelby, red-faced, leads Olivia by the hand. Behind them, a nurse signals to Rena.

“Call me later, okay?” she tells the voice mail. “I have to go.” She
hangs up and gets to her feet. “Shelby, what happened? Are you all right?”

Shelby shakes her head mutely, her eyes welling.

The nurse asks, “Are you Rena Koval? Dr. Ghosh would like to see you.”

“Sit tight, Shelby. I'll be right back.”

The nurse leads her down a long corridor to an exam room. Dr. Ghosh—a tiny wizened man, hairless, ageless—offers his hand. “Lorne has told me a lot about you. Please have a seat. Have you spoken with Mrs. Devlin?”

“Not yet. She seemed upset, though. What happened?”

Ghosh closes the door. “I examined Olivia and looked at her labs, and I'm afraid I can't help her.”

“You mean it's not the water?”

“No.”

“But you've seen the lab reports, right? Two different labs said there was methane migration.”

“I have no doubt the well is contaminated. But as I told Mrs. Devlin, it's extremely unlikely that has anything to do with Olivia's GI symptoms.”

“I was afraid of that,” says Rena. “Poor Shelby!”

“Is she always so volatile?”

“No. Well, sort of.” How to explain Shelby Devlin? “It's just that she was hoping for answers. She was convinced—we all were—that the water was the problem. Lorne, especially. He was absolutely sure.”

“Lorne is an activist, not a doctor.”

“That's true. But, you know,
something
is making her sick. And I'm worried about Shelby. This is taking a toll on her.”

The doctor seems to hesitate. “How well do you know Mrs. Devlin?”

“Not very. Why?”

“Something else occurred to me. It's only a theory. Less than a theory; let's call it a possibility. I have absolutely no proof.”

IT'S NEARLY DUSK
when Rena drives into Bakerton. She drops Shelby and Olivia at their house and immediately dials Lorne's number.

“Hey, it's Rena. Can you please pick up?”

She remembers, then, that he can't hear her: she's talking to a cell phone, not an answering machine. Does anybody have an answering machine anymore?

She deletes the message and tries again.

“So, hi there, it's Rena calling. I know you're busy, but this is
important.
” She is surprised by the tremor in her voice. “I talked to Dr. Ghosh and—”

Words fail her.

“Can you please call me, please?”

UNSPEAKABLE.

In Melbourne, Australia, a toddler was brought to the Emergency Room with projectile vomiting, fever, diarrhea. He weighed no more than a year-old infant. He was diagnosed with failure to thrive.

The term “factitious” describes symptoms that are artificially produced rather than the result of a natural process. GI symptoms can be produced with emetics, laxatives, and many common substances.

The Australian boy was put on an elimination diet. For six weeks he ate only boiled chicken.

The deliberate production or feigning of symptoms in another person who is under the individual's care.

The Australian boy was fitted with an NG tube.

The mean number of symptoms per victim is 3.25.

By the time of his death, at age four, the Australian boy had been seen by a pediatrician nearly three hundred times. His autopsy showed profound deterioration of the heart muscle.

“Come to bed,” says Mack. “You've been on that thing for three hours.”

“In a minute,” Rena says.

The mother in North Carolina caught on videotape, injecting salt water into her son's IV.

The British mother who contaminated her baby's urine sample with drops of her own blood.

The daily disasters of the ER, the heart attacks and car accidents, seem benign in comparison. Nursing in the Information Age: a catalog of horrors at your fingertips.

THAT NIGHT LORNE DOESN'T CALL.
Again and again Rena tries his cell phone.

Hey, it's Lorne. You know what to do.

He's wrong, of course. She has no idea what to do.

THE NEXT DAY SHE ARRIVES EARLY
for her shift and corners Dr. Stusick in the hallway. “I need to talk to you about Olivia Devlin.”

“I only have a minute.”

Rena thinks, What else is new?

She leads him into an exam room and closes the door. Sometimes there's no way to say a thing, except to say it.

“You think she's poisoning her own child?” Dr. Stusick stares at her as though Rena—not Shelby—were the monster. As though she's grown claws and scales.

“It's not just me. I took them to Pittsburgh yesterday, so Olivia could see Dr. Ghosh.” Rena's heart beats loudly. “I didn't believe him at first. Then I thought about the last time Olivia was admitted. Shelby didn't want her to be discharged. She was really upset about it. I left them alone for maybe ten minutes. As soon as Shelby left, Olivia was vomiting again.” She pauses for a breath. “She could have given her something.”

Dr. Stusick frowns. “Even if she were capable of it—and I'm not
prepared to believe she is—I don't see how it's possible. With all the labs we've done, something would have come back hinky.”

“Not necessarily. Not if she used an emetic. Ipecac, maybe?”

Dr. Stusick blinks, a look she's seen before: the mute amazement of a doctor confronted with evidence that nurses actually think.

“There was a case in Australia,” she says. “I did some research.”

He seems to consider this. “Ipecac is undetectable, as far as I know. So even if it
were
true—”

“We couldn't prove it. Dr. Ghosh said the same thing.”

There is a silence.

“I've read about these cases,” says Dr. Stusick. “From what I understand, parents do it to get attention from medical staff. And Mrs. Devlin has never seemed terribly interested in what I have to say.”

“I had the same thought,” says Rena. “But, you know, what if we're not the ones she cares about?”

Somewhere a clock is ticking.

“This guy in Pittsburgh,” says Dr. Stusick. “Ghosh. Did he confront her?”

“No. He just wasn't sure. Neither am I,” she adds quickly. “But if I suspect a child is being hurt, I'm legally obligated to report it.”
So are you,
she thinks but does not say.

She doesn't have to; Dr. Stusick grasps the subtext. “Let's be clear, Rena: these are
your
suspicions, not mine. If you want to report it to ChildLine, I'm not stopping you. This is your call.”

There is a knock at the door.

“Two seconds, Agnes! I'll be right there.” Dr. Stusick eyes her intently. “Reasonable cause, Rena. That's the standard. Do you have reasonable cause to believe Mrs. Devlin is harming her child?”

(Dr. Ghosh:
It's only a theory. Less than a theory; let's call it a possibility. I have absolutely no proof
.
)

“No,” she admits. “Well, maybe. I honestly don't know.”

“That doesn't inspire confidence.” He goes to the sink and turns on the water. “These are very serious allegations. Have you thought about what happens if you're wrong?”

In the past twenty-four hours she has thought of little else.

He literally washes his hands.

RENA IS DRIVING BACK
to the farm when, at last, her cell phone rings.

She signals and pulls off the highway. Hand over one ear, she lets Lorne complain about the dullards in his Intro course, his ongoing feud with the registrar's office, the gas-guzzling rental car, his wounded Prius still in the shop. She lets him talk, knowing that once she says it, there will be no unsaying it. That nothing, ever, will be the way it was.

“Listen,” he says finally. “I want to apologize for the other night. I had a lot on my mind.”

It takes her a moment to remember what he's talking about. The long, awkward drive back from New York seems very long ago.

“Remember that girl I told you about? The consultant? Well, I saw her. I gotta say, it messed with my head. I don't know if I told you, but we were lovers. A long, long time ago.”

“You didn't mention that.” Only yesterday she would have been sick with jealousy. Now his words wash over her like water. None of it matters anymore.

“Lorne, we have a problem. It's Shelby.”

He listens without comment as she explains about the boy in Australia, the mother in North Carolina. “There's a name for it. Munchausen syndrome by proxy. You can Google it.”

Finally he speaks: “Are you sure?”

“Well,
no.
That's my whole point. Ipecac, if that's what she's using, is untraceable. It has kind of a weird smell, like grape candy, but I've never smelled that on Olivia.”

“So we can't prove it.”

“No,” Rena says.

He exhales audibly. “All right, then. It's still
possible
the water is to blame. For our purposes, that possibility is enough.”