Kim let go of David. David smoothed his jacket. Each man glared at the other.

"What would you expect to see in the culture?" Tracy asked, hoping to defuse the situation and get the conversation back on track. "What kind of bacteria do you think is involved'?"

"Mainly salmonella, shigella. and some of the newer strains of E. coli," Claude said. "But it could be a lot of other things as well."

"The blood scared me," Tracy said. "I guess it looked like more than it was. Will she be admitted?"

Claude looked at David. "It's not a bad idea," he said. "But it's not my call."

"I think it is a good idea," David said. "She needs fluids. Then we can evaluate the possibility of anemia and make sure there's no more bleeding."

"What about antibiotics?" Tracy asked.

"I wouldn't recommend it," Claude said. "Not at this juncture. Not until we have a definitive diagnosis."

"Which is why the goddamn culture should have been done last night!" Kim growled.

"Please, Kim!" Tracy urged. "We have to deal with the current situation. It would be nice if you'd try to be helpful."

"All right," Kim said resignedly. "If we don't have a culture, why not use a broad-spectrum antibiotic. It can always be changed once the organism and its sensitivities are known."

"It would not be my recommendation," Claude repeated. "If the offending agent turns out to be one of the aberrant strains of E. coli. antibiotics can make the situation worse."

"Now, how can that be?" Kim said. "That's ridiculous."

"I'm afraid not," Claude said. "Antibiotics can decimate the normal flora and give the renegade E. coli more room to flourish."

"Will she be admitted to your care?" Tracy asked Claude.

"No, that's not possible," Claude said. "AmeriCare requires a gatekeeper. But I'll be happy to look in on her, especially if whoever handles the case requests an infectious-disease consult."

"Since Becky does not have a staff pediatrician, she'll be admitted under the care of Claire Stevens," David said. "It's her rotation. I can give her a call."

"You can't do much better than Claire," Claude remarked.

"You know her?" Tracy asked.

"Very well," Claude said. "You're lucky it's her rotation. She takes care of my kids."

"Finally something seems to be going right," Kim said.

EIGHT

Wednesday, January 21st

Kim turned into the hospital parking lot a little after six in the morning. He'd skipped stopping at his office, as he normally did. He was eager to look in on Becky and make sure everything was okay.

The previous night things had gone well after the unpleasant episode with David Washington. Dr. Claire Stevens had come into the ER within a half hour of being paged. In the interim, Kim had phoned George Turner for the second time that evening. This gave him a chance to ask George's opinion about the pediatrician. George had echoed Claude's sentiments, and both Kim and Tracy had felt relieved.

Claire was a tall, thin woman – nearly Kim's height. Her features were sharp but they were belied by her gentle, reassuring manner. Kim's personal impressions of her added to the professional testimonials. She was about his age, which suggested years of clinical experience under her belt. What's more, her competence was immediately apparent and reassuring. Of equal importance, she established immediate rapport with Becky.

Kim pushed into Becky's room. There was a night-light near the floor that reflected off the ceiling, casting a gentle glow over the entire room. Kim advanced silently to the bedside and looked down at his sleeping daughter. Her halo of dark hair made her face appear the color of ivory. Its translucency gave her a fragile look as if she were made of porcelain.

Kim knew that under the circumstances it was appropriate for Becky to be in the hospital. At the same time her being there gave him great anxiety. His vast experiences in hospitals reminded him that it was an environment where horror could lurk.

Becky's breathing was regular and deep. Her IV was running slowly. Happy to see her resting so well, Kim quietly backed out. He did not want to disturb her.

Back at the nurses' station, Kim withdrew Becky's chart. He glanced through the admitting notes that Claire had dictated, then turned to the nurses' notes. He noticed Becky had been up twice during the night with continued diarrhea. There had been some blood reported but only by Becky. None of the nurses had seen it.

Kim then turned to the order sheet and was pleased to see that Claire had followed up on her word: she'd requested a pediatric gastroenterology consult for that day.

"Now, that's one delightful child." a lilting voice said.

Kim looked up. Glancing over his shoulder was a plump nurse with a face red from exertion. Her blond hair was permed into a multitude of tight ringlets. Her cheeks were dimpled. Her name tag indicated she was Janet Emery.

"Have you been looking in on her?" Kim asked.

"Yup," Janet said. "Her room's in my area. Cute as a button, that one."

"How has she been doing?" Kim asked.

"Okay, I guess," Janet said without a lot of conviction.

"That doesn't sound too positive," Kim said. A minute sliver of fear eked its way up his spine, giving him an involuntary shiver.

"The last time she was up, she seemed weak," Janet said. "Of course, it might have been because she was sleeping. She rang for me to come help her back to bed."

"I understand from the chart that you didn't get to see how much blood she might have passed," Kim said.

"That's right," Janet said. "The poor thing is embarrassed to beat the band. I tried to tell her not to flush after she uses the toilet, but she does anyway. What can you do?"

Kim made a mental note to talk to Claire about that problem and to Becky as well. It would be important to know if the blood was mere spotting or worse.

"Are you a consult on the case?" Janet asked.

"No," Kim said. "I'm Dr. Reggis, Becky's father."

"Oh my goodness," Janet said. "I thought you were a consult. I hope I didn't say anything out of line."

"Not at all," Kim said. "I certainly got the feeling you care for her."

"Absolutely," Janet said. "I just adore children. That's why I work this floor."

Kim went off to see his inpatients and then attend the series of hospital conferences scheduled for that morning. Like Mondays, Wednesdays were particularly busy with respect to his administrative responsibilities. Consequently, he didn't get back to Becky's floor until almost ten. When he did, the ward clerk informed him that Becky was off to X-ray. He was also told that Tracy had come in and was with her.

"Can you tell me about the status of the gastroenterology consult?" Kim asked.

"It's been ordered," the clerk said. "If that's what you mean.

"Any idea when it will be?" Kim asked.

"Sometime this afternoon, I'd guess," the clerk said.

"Would you mind giving me a call when it does happen?" Kim asked. He handed the clerk one of his cards.

"Not at all," the clerk said.

Kim thanked him and hurried off to his office. He would have preferred to see Becky and talk to her, even if for a moment, but he didn't have the time. He was already behind schedule, a fact that he was philosophical about, since it tended to happen more often than not.

'Well, Mr. Amendola," Kim said, "do you have any questions?"

Mr. Amendola was a heavyset plumber in his early sixties. He was intimidated by modern medicine and horrified by Kim's verdict: he needed a valve in his heart replaced. A few weeks earlier, he'd been blissfully unaware he even had valves in his heart. Now, after experiencing some scary symptoms, he knew that one of them was bad and had the potential to kill him.