A Mother's Trial Read Free Page B

slumped at the nurses’ station on the fifth floor of the hospital, Five West, the pediatric ward.
    Sara could see that Mindy had suffered through a bad afternoon just by reading her chart. Suddenly at four o’clock, after more than twelve hours of no stool, the diarrhea had started again. Within two hours the baby had put out 274 cubic centimeters of liquid stool in a total of six different stooling episodes, and she was fussy and irritable. Her output far exceeded her intake and this was a potentially dangerous situation, especially in view of her poor veins. It might become impossible to rehydrate her fast enough.
    For the second time, Sara restlessly checked the four pages of notes she had written in the chart. First she had summarized the patient’s course since her admission on February sixteenth, listing the intake and output for each day. Then she had made another note:
     
     
    This patient is not a typical case of gastroenteritis and is falling into the category of chronic diarrhea. Her course seems to follow one compatible with secretory diarrhea, i.e., not necessarily affected by p.o. intake. I have checked her several times for evidence of osmotic diarrhea secondary to carbohydrate malabsorption by checking stool Ph and reducing substances. This patient has had greater than 6-7 Ph and negative reducing substances and I will continue checking the stool Ph—and reducing substances—daily. She is not receiving enough calories yet to allow for weight gain. Patient’s weight = 6.5 kg X 75-100 cal/kg = 500-650 cal per day. Patient just had another 270 gm stool output after a 12-hour period of no dietary change today and patient has been on Cho-free + 5% polycose x 36 hrs.
     
     
    It was beginning to sink in. No matter what they put into this child, the state of her gastrointestinal tract did not, as it should, reflect her diet. This was not a case of gastroenteritis. Whether it was a case of secretory diarrhea, or something different—and more ominous—was now the question, Sara realized.
    She still planned more tests for Mindy, although the workup was essentially complete. The normal blood tests indicated no immunodeficiencies that might cause diarrhea, but Sara needed to check with an endocrinologist the possibility that Mindy might be suffering from an unusual case of Bartter’s Syndrome. There were some other possibilities, too—rare, but not impossible—to rule out. They were all things she had once investigated with Tia. She noted down her plan to increase Mindy’s diet to allow for weight gain, her decision to try some rice cereal, and her plan to keep the IV running for as long as the cut-down appeared clean. She had decided to treat Mindy for the parasite giardia, despite the negative stool sample, because sometimes that parasite could be elusive. She had hesitated over it but finally concluded that it wouldn’t hurt to treat her.
    Sara lifted herself to her feet and stretched, one hand bracing her back, her dark eyes closed against the fluorescent glare. She had one more note to add, and she made it, finally. Once written on the copybook-style lined paper they issued for the progress notes, it did not look so dramatic:
     
     
    Consider that some type of toxin may be responsible. Urine sent for heavy metal analysis.
     
     
    The heavy metal test for mercury, lead, and arsenic had been run once before, on February sixteenth, and it had been negative. Janet Specht had ordered that test. Perhaps the result would be different this time.
    There, it was done. And tomorrow was her day off. By Monday she would have some more answers, one way or another. And on Monday she would talk to the San Francisco coroner. It could all wait until then.

6
     
    By the early hours of Friday, February twenty-fourth, Mindy had deteriorated sharply. She lay pale and flaccid in Priscilla’s lap, her eyes black and dull. Since ten-thirty Thursday night, Mindy’s stooling had been explosive, and she had been