Robert Vernon Delacroix was a fifty-three-year-old black custodian who had gotten a bad case of the flu and an even worse case of congestive heart failure during one of his coughing fits.
That was the extent of the rather terse autopsy report that Olive had clipped to the file. It did not shine any light on the Mr. D's potential motives for dancing with my pop-eyed vampire. The fact of the autopsy, itself—removal of vital organs, including the brain—made the old man's behavior even more unlikely as opposed to someone who was "merely dead."
Olive had also attached a printout of Mr. Delacroix's credit report and had typed in a variety of forms to gather additional information should I choose to do so: an MV198G requesting a copy of his driver's license, an MV15 for obtaining a copy of his license registration, a UCC-11 for listing such financial information as loans taken out by or liens against Mr. Delacroix, and a list of internet websites for short-cuts to credit reports, tax assessments, and government databases. Each lead might not tell me much but put them together and I would find bits of information connecting to other bits of information that could tell me where to look next.
Normally, that is.
Unfortunately, this was no find-the-hidden-bank-account/trace-the-stolen-property/locate-the-missing-person kind of investigation; it was more of a figure-out-why-the-dead-guy-saved-my-ass-and-what-protecting-his-daughter-was-all-about kind of case.
Complicating everything was the fact that there were vampires in town—emphasis on the plural.
A year and a whole lifetime ago I didn't believe in vampires. Or ghosts. Or a whole raft of night-creatures that had heretofore been relegated to fairytale stories and B-minus cinema. That was before a detour through Weir, Kansas resulted in an episode of "lost time" and the onset of a peculiar wasting disease that dulled my appetite and sharpened my sensitivity to sunlight. Although it seemed to be stealing my life, it also made me highly resistant to death. The automobile accident that killed my wife and daughter landed me on the morgue's autopsy table where I woke up and proceeded to scare the bejezus out of the coroner and a hospital janitor.
Not to mention myself.
Maybe I didn't really die in the crash: my heart still beat, though with a vastly different rhythm, and I still required air—but having one foot in the grave and the other in the land of the living made these distinctions moot. If the necrotic virus from Dracula's transfusion didn't actually kill me someday, it still seemed destined to drive me mad. Half-believing that Jennifer's spirit remained behind to "haunt" me was just the earliest stage of its effect on my cerebral cortex. What would come later? Would I become another soulless vampire predator? Or would I become something more monstrous? More evil?
More like my ancient forebear?
Generations of inbreeding certainly set the stage for the madness to come at the close of the sixteenth century. Erzsébet Báthory's neurological problems manifested at an early age with seizures and blackouts when she was just four or five. A sadistic, bisexual aunt and a schizophrenic uncle provided perverse tutelage at an impressionable age. And then there was Lord Acton's axiom: spoiled, wealthy child of privilege raised by a series of governesses employed to cater to her every need—it would have been a miracle if her relationships hadn't been dysfunctional to some degree.
And what's easier to forget in this kinder, gentler world that we oh-so-civilized folk now inhabit is that she was very much a child of her time. Hungary was experiencing a turbulent period in its already tempestuous history. It had served as a battleground between the Turkish forces of the Ottoman Empire and the Hapsburg armies of Austria and there were continuous and mostly ineffectual efforts to send the Turks back home—or at least keep them at bay. War, battle, death, and retribution unfolded all around her on a regular basis. Life was harsh and the administration of justice—or, rather, rule—was even harsher.
As a young girl Erzsébet witnessed numerous punishments and executions, including numerous whippings, floggings, hangings, forced cannibalism, and burnings at the stake. Three peasant boys were accused of trying to rape her when she was eight years old. She had a front row seat when they were publicly castrated.
A fanatical Lutheran called Preacher Hebler was one of her childhood tutors. He tried impressing upon his young charge the importance of piety with vivid and heartfelt stories of the horrors of Hell and the tortures of the damned. As gruesome as the churchman's imaginative parables were they proved no match for the every day brutality that was up close and impersonal. In later years these stories may have actually provided inspiration for her own appalling "hobbies."
One night, while still in the formative years of her childhood, Erzsébet was taken from her bedchamber to witness a special execution. A gypsy had been accused of selling children to the Turks and his sentence was offered as public entertainment. Who knows what emotions filled her young breast as she watched? A horse was brought forward and pulled to the ground where its belly was sliced open. Did the dying beast scream more pitifully? Or the accused while he was stuffed, struggling and shrieking amid the steaming entrails? Did she clutch at the arms of her velvet chair in dismay as the equine guts were closed and sewn shut? Or in excitement during the delayed and drawn out suffocation that followed such a gory entombment.
One might guess at her emotional bent by now but the intellectual lesson was unavoidable: if you were noble-born, commoners might be abused or disposed of with impunity and without fear of retribution. Could I depend upon my civilized upbringing, the lateness of my infection, to make me a more civilized monster? Or did the same dark blood that burned in her savage breast lie dormant in our shared genetic codes? Would that viral key eventually unlock my own murderous id and send it rampaging through the twisted convolution of sulci, gyri and fissures in my cerebellum to mirror her dark acts? How would I know until it was too late?
Maybe it already was.
The phone rang, interrupting my mental detour-de-force.
I picked up the receiver and announced: "After Dark Investigations."
"I would like to speak with Mr. Haim." The voice was familiar. As were the subvocal stressors.
"Speaking."
"Mr. Haim? This is Susan Sinor."
Ah. "Yes, Mrs. Sinor. How is your husband?"
A pause. "He's dead, Mr. Haim."
My turn to pause. "I'm terribly sorry, Mrs. Sinor. Is there anything I can do?"
"Yes." She drew a deep and ragged breath. "The police told me he died at the scene."
So much for my assurances that he would call from the hospital. "I didn't realize that his injuries were so serious."
"They were serious, Mr. Haim. He died in the crash."
"Excuse me?"
"The Medical Examiner thinks it might have been a heart attack. We will have to wait for the autopsy to be sure but he's sure that my husband was already dead when the impact threw him out of the car."
"I—I don't know what to say."
"Well, say something, Mr. Haim. Tell me how my dead husband got up and walked all the way up to your house, called me from your telephone, and then ended up back down at accident scene when the police arrived! Can you explain that?"
I couldn't, of course. Other than to suggest that the M.E. must be mistaken. It wasn't a satisfactory explanation but it was better than the alternative.
She was sobbing when I finally hung up and I cursed myself for picking up the office phone during the day. I had a secretary for that at night and an answering machine for during the day. Another good reason I shouldn't even be here (or anywhere) during the day.
The phone rang again. I sat and stared at it, rethinking my communications strategy: e-mail, I thought; sever all relations with Ma Bell and only deal with people on-line.
The answering machine picked up. "After Dark Investigations," it announced in Olive's chipper tones, "Samuel Haim, licensed private detective, and associates. Our office hours are eight p.m. to two a.m. You may call back or leave a message at the beep."
Please, I thought, be anything but a divorce case.
It was.
Not a divorce case, that is.
My secretary's voice continued to come over the machine's speaker but it was no longer a recording: "Sam, this is Olive. I've left a message on your machine at home but, just in case you miss it, I'm leaving one here at the office, as well. My sister is at the hospital and needs me to sit with her. I don't know how long we'll be there so—"
I picked up the receiver. "Olive? Sam here."
"What are you doing in so early, boss?"
What was I doing here? Oh, yeah . . . "Meeting with a client."
"Must be some client."
"Must be," I agreed. "Is everything all right?"
The barest of hesitations for my ebullient secretary spoke volumes. "It's my sister's boy. . . ."
"Jamal?" I had used Olive's nephew on several cases involving daytime surveillance, including the Snow Queen's "alienation of affliction."
"Is he all right?" I asked.
"It's the flu." She said it as if the boy had been diagnosed with cancer.
"They had to hospitalize him?"
"Maybe you haven't heard but there's a particularly virulent strain going around."
I remembered that Robert Delacroix's fatal coronary was occasioned by the flu. Of course, Jamal was young and healthy and whoever heard of a nineteen-year-old dying from the flu in these early years of the twenty-first century?
"Anyway, I wanted you to know that I may be late or even absent tonight. If that's all right with you."
It didn't matter whether it was all right with me or not. It was family and that mattered more than showing up to sit by a drowsy telephone for my little fly-by-night detective agency-cum-hobby. Olive was just being polite and I completed the formalities by saying "that's all right" and "take all the time that you need."
"Thanks, Sam. I'd better get going."
"Do you need anything? Is there anything I can do?"
Again there was that quarter-beat hesitation, imperceptible to anyone else.
"What?" I pounced. "Tell me, Olive." And knowing she was too proud to ask any favors, I pushed. Mental Domination is not a simple process in face-to-face encounters and I had only tried "pushing" over the telephone once before. It hadn't proved effectual in getting my cable installed any quicker.
"My car's in the shop," she finally admitted. "I need to call a cab."
"Cancel the cab," I said, "I'll drive you."
Despite Olive's protestations that it was a sunny day and I should stay inside, I picked her up forty-five minutes later.
She was fully signed on to my explanation about extreme susceptibility to skin cancer. It was certainly true that I had developed a few epidural carcinomas before I figured out that my stopover in Weir had effectively cancelled my membership at the tanning salon and necessitated a career move to the nightshift. But what she didn't know was that cancer was only a secondary issue.
Sunlight made me sick. It sapped my strength, clouded my mind, and made me itchy and jittery, and downright nauseated. Wearing hats and long-sleeved shirts and wraparound shades and slathering on a ton of SPF100 sun block served as talismans against the tumors.
But there was always that nagging apprehension that, one of these days—just like the undead whose blood I shared—I was going to spontaneously combust.
Olive didn't know anything about my preternatural biology but she kept apologizing as if she knew the gamble I took to chauffeur her across town. The Merc's heavily tinted windows made the trip bearable but I was on the verge of developing a nervous tic as we approached the hospital.
"Forget it," I said for the fifth time. Obviously five had not proved sufficient so I added: "I actually have business at Greenwood so it's no inconvenience at all." That seemed to help but now I would have to park the car and go inside for a little while, wander around as if I actually did have someplace to be.
At least it beat tailing Hyrum Cummings to evening City Council meetings.
The closest available parking slot was a good two-block walk from the visitors' entrance but I smiled, crossed my fingers, and trusted my fate to Coppertone. Outside the car the solar radiation staggered me, the light bearing down with a palpable weight on my back and shoulders. I immediately slapped a straw fedora on my head—a Dobbs' Palmer with a moderate brim—but my scalp itched and tingled throughout the long walk to hospital's entryway.
A double-set pair of sliding doors formed an airlock that kept the lobby cool and soothed my buzzing nerves and twitching skin. It didn't do anything for the fresh migraine simmering at the back of my brainpan like the embers of a banked fire. I took my sunglasses off before my eyes had time to recover and nearly ran into a potted plant and then a trashcan on the way to the elevators.
Olive—at least I assumed it was Olive—laid a hand on my arm. "Are you okay, Boss?"
I tried a grin and attempted to put reassurance in the middle of it. "Well, if I'm not, I'm certainly in the right place."
"Maybe you better let me drive you home."
"Seriously, Olive, how are you getting home?"
"My sister will drop me off."
"I can wait."
"I won't leave while she's here. If necessary, I'll be her excuse to go home before she's totally exhausted."
I reached out, located her shoulder, squeezed gently. "How bad is it?"
I think she shook her head. "It's killing black people."
"What?"
"Mr. Haim!" A new voice derailed the conversation before I could make sense of what I thought I had just heard.
"What do you mean—" I was saying when another dim blob emerged from the haze. As my hand left Olive's shoulder, it was enveloped by another and shaken vigorously.
"Lou Rollins, Mr. Haim; I sent you a letter last week!"
"I'm afraid I don't—"
"BioWeb Industries," the voice continued, filling the emptiness of the corridor like an auditory tidal wave. "My people are very keen on joining your client list!"
"Client list," I repeated.
"Sam, I'd better get upstairs," Olive said, excusing herself.
Lou Rollins maintained a firm grip on my hand. He added another to my upper arm. "I'll check in on you before I leave," I called after her retreating form.
"Say, this is perfect!" Lou-from-BioWeb exclaimed. In fact, every sentence from Lou's lips had sounded exclamatory so far. "I'm on my way up to Pedes to work another handshake deal and this way I get to kill two birds with one stone!"
Two birds with one stone. I grew less fond of that old saw with every passing day.
"Let's walk this way . . ." He released my hand but steered me toward the elevators with an arm that hovered dangerously close to my shoulders. "Now, the area hospitals pay you how much per unit of blood?"
Ah. A light clicked on at the end of my tunnel vision. "Mr. Rollins—"
"Lou!"
"Lou," I amended; "that is privileged information between my blood bank and my clients. And the client-list is very short because I simply don't do enough volume to service all of the local hospitals. We're really more of a boutique as blood banks go."
"We can help you change that!"
The elevator doors slid shut behind me as I pondered that. My Glock was neatly holstered and zippered and locked in the glove compartment of my car while, for the briefest of moments, I considered the odds of being trapped in this metal box with a homicidal maniac.
"Oh, Sam—may I call you Sam? Your expression!"
I could now see that Lou Rollins had a face like my Uncle Harry: round and capped with a fringe of curly brown hair, large eyes with smile crinkles at the corners, and a wide mouth that perpetually alternated between laughing and grinning.
I never did care much for Uncle Harry.
"I'm talking about a combined fundraiser and blood drive!" he continued. "BioWeb is hosting a big bash at its conference center this weekend and I think you'll find it very profitable to come on board with us!"
"What does your company want with my blood bank?"
"Product, of course! Blood!" The doors slid open and I stepped out, not caring if this was the right floor or not. "We do research, Sam, and we've embarked upon some new trials that require more than double—nearly triple the volume of blood, plasma, and platelets that we utilized last year!"
"Well, Mr. Rollins—"
"Lou!"
"As scarce as my resources are, I would rather my 'product' go to the people who need it the most: the sick, the injured, the dying."
"I respect that, Sam, I really do! But let me tell you a little story . . ."
With some alacrity I suddenly realized that I wasn't so much affecting a retreat from Lou as he was herding me toward his destination.
"Once upon a time there was this town that was situated near a cliff that overlooked the sea. Now, from time to time—on a pretty regular basis—people would get too close to the edge of the cliff and fall off. The fall usually wasn't enough to kill them but it would bang them up pretty good! So the town council held a bunch a' meetings and came up with two plans."
"I think I've heard this," I said.
"The first involved getting a fancy ambulance and parking it at the bottom of the cliff. It would be outfitted with all the trimmings: life-saving gear, specially trained paramedics, the works! And a specially paved road that would get the ambulance up to the hospital in record time! That was Plan A!" Dramatic pause. "And do you know what Plan B was?"
"A wall," I answered.
"A wall!" he continued with no indication of having heard me. "A plain and simple wall to be built so as to keep people from getting too close to the edge at the top!"
"Prevention versus treatment," I observed. "With the town choosing the more expensive and painful back-end solution."
"So, with the estimates running to five-thousand dollars for the wall and five-hundred-thousand for the ambulance and stuff, which do you think the town council decided to fund?" He looked at me expectantly.
"Lou," I said, "I think you're telling me this story to try to make the point that an ounce of prevention is worth a pound of cure and that your research is going to save a lot of lives down the road. Of course, to make the analogy more truthful you'd have to add the stipulations that the ambulance could be in place tomorrow while the wall couldn't be built for another year or two."
"Yeah, the ambulance . . ." He looked at me curiously. "Say, have you heard this one before?"
"I used to belong to an HMO. Look, Mr. Rollins, I'll consider your request if you can send me some info on this research project of yours. Diverting already scarce resources for research is a gamble. A worthy gamble, but a gamble nonetheless. Before I roll the dice on an expectant mother hemorrhaging in the delivery room, I want a sense of the stakes for future lives."
"You think we're playing God, Sam?"
"One way or another, we're all playing God, Lou. Most of us just won't own up to it."
A thin wail pierced the conversation and I noticed that we had ambled into the maternity wing. The neonatal unit was to my left and I caught sight of a dozen tiny beds and four closed incubators beyond a large glass window. Five babies rested or squirmed in their hospital cradles while a sixth shrieked its pain or anger from the back of the room.
"Well, I'm sure I can get the company to send you some information," Lou was saying, "but I gotta warn you—it'll probably be pretty technical."
"That's okay," I said absently, "I've been reading a lot of medical research papers of late."
A nurse was carrying the screaming infant against her shoulder, walking back and forth, trying to soothe it into restfulness. Not anger, I decided, the pitch and tone are pure misery. Acute discomfort, if not actual suffering.
"Well, let me set you up with a tour of the BioWeb facilities," Lou was saying as he pressed some cardstock into my hands. "And here's a couple of free passes for our 'Death Sucks' blood drive and Halloween dance! Bring a friend. Hell, here's two more: bring friends!"
I nodded absently as if I had friends. Instead, I concentrated on the baby's wails, trying to clarify the pattern. Obvious—blatant even—once I figured it out but Rollins had distracted me, preventing me from seeing it sooner. Every time the nurse brought the child in close proximity to the window on the far side of the nursery, it cried all the harder. It might not be obvious to the untrained human ear or a nurse nearing the end of a thirty-six-hour rotation but Lupé says I have the ears of a wolf.
And she should know.
"Excuse me, Lou; did you say you had a meeting in Pediatrics?"
Startled and derailed, it took him a moment to shuffle through his mental scripts. "Actually, I've arranged a sit-down with the neonatal supervisor. . . ."
"Great! Can I get an introduction?"
"You want to sit in on the meeting?" Caught between company pitches, he hadn't regained his balance. Or maybe he didn't fancy any third parties at the next deal cutting.
"No. I just need a few minutes of whoever's in charge here's time."
"That would be me." The voice belonged to a short, round woman in pale blue scrubs, cap, and booties. "I imagine one of you is Mr. Rollins."
"That's me!" Outstretched hand and thousand-watt smile, Lou Rollins was back on track. "And you must be Anita!"
"Nurse Jensen," she said with a mild smile. "You'll forgive me if I don't shake your hand. I just scrubbed and I have to get back to my babies in a few minutes."
"Ma'am, what's the matter with the baby that's crying in there?" I asked politely. I learned early on that it never pays to be rude to those in authority.
She frowned at me anyway. "I'm a nurse, not a 'ma'am.' Are you family?"
"Maybe," I said. And gave her a mental nudge.
The frown lines deepened but she nodded and answered anyway. "We don't know, yet."
"What do you know?" I pushed a little harder.
"Baby Helen has an enlarged liver and spleen. She's anemic and her bilirubin is elevated." Her frown deepened. "Doctor suspects EB."
"EB?" I asked, trying to blend a "please tell me more" tone with a subvocal command to nevermind my stranger status and keep talking.
"Epidermolysis bullosa. It's an inherited disorder that causes blisters to form on the skin at sites of trauma to the body."
"The child has trauma injuries?"
"She has blisters," Jensen snapped, eyes narrowing as she shifted her attention away from the what of my question and more toward the why. "Infants with EB are sometimes born with blisters."
"Sounds as if you need a genetics consult," I suggested, preparing to mentally cram that request down her throat if necessary. I was spared having to mind-wrestle Nurse Jensen into placing the call by the arrival of a familiar face.
"Mr. Haim?"
I turned and looked at my newest client. "Ms. Delacroix?"
"Dr. Chalice," Nurse Jensen said, "I was just explaining the infant's symptoms to this gentleman."
"Really?" Chalice Delacroix nodded briefly to Lou Rollins who nodded back. "Why? Is he family?"
Jensen looked a little confused; her frown lines squirmed.
"In a manner of speaking," I answered. "I think this baby and I have something in common."
"Oh my," my client said with a good-natured smile, "I don't know how I can resist passing up such a wonderful set-up line, Mr. Haim." She turned and nodded at Lou. "Mr. Rollins. What brings you to neonatal?"
He smiled but leaned forward and lowered his voice to answer: "Umbilical cords."
I mentally grabbed my eyebrows before they could rise.
"What's that?" Nurse Jensen's frown deepened.
Rollins turned back to her and upped the wattage on his smile. "Is there someplace we can sit down and talk?"
"Let me just collect those blood samples and I'll be on my way," Delacroix said, placing an insulated carrier on the counter of the nurses' station. "Then you can palaver to your heart's content."
Jensen turned to the small refrigerator at the back of the station and stooped to open the door.
"What makes you think EB?" I asked Chalice.
"I don't think EB. Doctor thinks EB. I run the samples on the parents and child and screen for a variety of genetic disorders and see what pops up."
"I thought you worked the night shift."
"Ditto."
"An emergency came up," I answered.
"Ditto," she repeated with a smile. "Here's mine. Where's yours?"
"Downstairs." I was spared a longer answer by Nurse Jensen's return with four vials of blood.
"I should have an answer in forty-eight to seventy-two hours," Delacroix told her.
"Will you screen for Xeroderma pigmentosum?" I asked.
"What?" Jensen asked.
"Why?" Delacroix seconded.
I nodded toward the nursery. "The child shows signs of increasing distress every time she's carried close to the window." Another thought occurred and I turned to Jensen. "You said her bilirubin was elevated. Has she had photo-therapy?"
"I don't know," Jensen replied, "I just came on duty. Let me check."
As she went off in search of the chart I looked back at Rollins and Delacroix.
"Billy who?" Rollins asked with a half-smile.
"Bilirubin is a byproduct of red blood cell destruction," Delacroix explained before I could open my mouth. "Hemoglobin is broken down to heme and globin. Heme is then converted to bilirubin and carried to the liver by albumin in the bloodstream where it's further processed and then excreted in the bile."
The expression on Rollins' face wavered between "huh?" and "so?"
"The problem," I said, continuing the explanation, "is that a newborn's liver isn't as efficient as an adult's—it's just started working for one thing. It takes a few days for an infant's system to gear up the entire process for breaking down red blood cells and eliminating the byproducts. Sometimes there's a brief period where the bilirubin builds up in their systems, causing their skin and the whites of their eyes to appear jaundiced."
I noticed that Chalice Delacroix eyed me with the same look that most zoo-goers gave the duck-billed platypus.
"Most of the time this is a temporary condition but there are occasions when the bilirubin levels can get dangerously high. If too much accumulates for too long, it can find its way into the central nervous system and cause brain damage."
"Kericterus," Chalice said, nodding.
"So I'm wondering if the hospital has tried photo-therapy."
"Photo-therapy," Rollins repeated. If he had been following me up to this point I'd clearly lost him now.
"It's the most common treatment for reducing bilirubin levels in infants," Chalice explained. "By positioning special fluorescent lights over a newborn, a chemical reaction can be stimulated that speeds up bilirubin breakdown in the bloodstream."
"So," Rollins pondered, "you think they ought to try it on the baby in there?"
"No," I said a little too sharply. I softened my tone. "If this baby is photo-sensitive, it would be harmful—possibly fatal—if she's exposed to excessive light!"
"What makes you think the child is photo-sensitive?" Chalice wanted to know.
Nurse Jensen returned with the chart and spared me the necessity for elaboration. "Yes. She's had photo-therapy. In fact we have two blood samples on her, one taken before and the other after, to see if there's been any changes in the blood chemistry."
"We need to see the baby," I said.
"What?" Jensen shook her head. "No. I'm afraid that's out of the question."
Chalice glanced at me before giving the charge nurse her full attention. "I really think it might be a good idea, Nurse," she said.
Jensen's mouth was set in a tight line. "You have no jurisdiction here, Dr. Delacroix."
"Let us take a quick look," I said reasonably. You won't regret it! "You won't regret it."
"I—I shouldn't—"
"It's all right," I said. Really! "Please?"
"Perhaps . . ." Jensen was wavering. Rollins just stared at us, bug-eyed.
"Think of it as getting a second opinion." Let us in! I pushed, finally out of patience as the infant continued to squall in the next room.
Jensen opened the half door that permitted egress into the nurse's station and led us into the adjoining nursery. The nurse who had been carrying Baby Helen had placed her back in her isolette and was tending to another infant now. She looked up at our approach. "I couldn't get her to stop crying, Anita."
"It's all right," Jensen said. "We'll—I'll take over for now."
"I think her blisters are worse," the other nurse said as she made notations on another chart. "When is our consult coming?"
"I'm here," Chalice answered. "I've already logged the tests as high priority but I'll camp in the lab and try to push to the front of the line if I can."
While they were talking I reached into the isolette and retrieved Baby Helen. "Oh dear God!" I whispered as I drew her close to me. The child was covered with vesicles or bullae—quarter-sized blisters. I touched one and, as it gave under the light pressure of my finger, it oozed clear fluid. It could still be XP but I had another idea. "I need a Wood's lamp."
"Put that child down," Jensen said, reaching for Baby Helen.
"Get me a Wood's lamp now!" I barked, applying enough pressure to jumpstart my own headache.
Pain and confusion in her eyes, Jensen turned and hurried away.
Chalice eased her hands between mine. "May I?" she asked carefully. Just as carefully she eased the infant up and over just enough to get a good look at her back. "See the bullae here? The vesicles are smaller and more newly formed."
"The blisters on her front are probably from the bili-lights," I reasoned. "Her back would have picked up indirect sunlight while she was being carried close to the window."
Chalice nodded. "A difference in time and light intensity. Let's check the diaper."
I laid the baby down on the changing table. Jensen returned with a Wood's light as we unfastened the diaper and folded it down. Stains, as though someone had spilled a small amount of red wine, marked the inner layer. Also telling was the absence of blisters on the skin that had been shielded by the diapers.
"See this?" I said to the group as they gathered around closely. "The reddish color in the urine? Someone douse the lights and plug in that lamp."
While Chalice plugged in the Wood's lamp and positioned it, Jensen turned off the room's lights and the other nurse lowered the shades over the observation windows to block the light from the hallways.
As the Wood's lamp flickered into an eerie purplish fluorescence the stained area of the diaper began to glow an unearthly pink.
"What you're seeing now," I continued, "are the abnormal proteins that have been excreted through Baby Helen's renal system."
"Porphyrins," said Chalice.
"Right. And I think the proper tests will confirm one of the porphyries—probably CEP."
"CEP?" Jensen's licorice frown was even scarier in the violet murk of the Wood's light.
I nodded. "Congenital erythropoietic porphyria."
"It's pretty rare," Chalice observed. "Even among the known porphyrias."
"Less than a couple of hundred known cases worldwide," I agreed. I looked over at the head nurse. "You're going to need a serious genetics consult. I can give you a list of experts in the field of porphyrias and photo-sensitive disorders such as XP if the hospital doesn't have ready access." I switched off the Wood's lamp, and the purple and pink luminescences faded. Now immersed in darkness, the room's only illumination came from a Christmas-y constellation of red and green LEDs on the natal monitors.
"They'll recommend more specific treatments but, starting right now, you've got to keep this infant away from direct light sources. No windows. No bili-lights. In fact, she will be safer around incandescent bulbs than fluorescent lamps as they emit less porphyrin-exciting wavelengths. But any light at all is a hazard. Keep her in the dark as much as possible until you've got a doctor on the case that knows CEP!"
"How serious is it?" Jensen asked as she picked up a blanket and began to drape Baby Helen's isolette.
"Very serious. Although a lot better now than once upon a time." I explained as best I could how the absence of the enzyme uroporphyrin in the body's cells created two serious problems. First there was the issue of heme, an essential ingredient of hemoglobin that victims of CEP couldn't manufacture. Transfusions and bone-marrow transplants could help, assuming the right genetic donors could be found but that was a trickier business than one might assume. The second problem echoed the bilirubin issue: the uroporphyrin enzyme deficiency prevented the breakdown of heme's toxic protein precursors—porphyrins. The buildup of toxic levels of these porphyrins in the bloodstream and urine produced a number of unpleasant side effects. The photosensitivity not only produced blisters on the epidural surfaces but also caused scarring and even patches of hair to sprout where it might not normally grow. Porphyrin deposits on teeth and bones produced a reddish discoloration and made them brittle. Even so, with proper treatment and careful avoidance of sunlight, most patients with CEP could now anticipate a life expectancy of forty to sixty years.
"Once upon a time they would have lived short, painful lives," I concluded. "Shorter, if the locals decided they were vampires."
The other nurse gasped as she turned on a small lamp at the far end of the room. "Vampires?"
"Receding gums giving the teeth an elongated appearance, already stained red from the porphyrin deposits . . . reddish urine . . . extreme pallor and a nocturnal lifestyle." I omitted the fact that garlic was also a no-no, due to the fact that it painfully stimulated heme production.
Jensen made a call as we left, demanding an immediate genetics consult and would someone please page the attending Pedes physician. Stat!
"You're extremely well-read on the porphyrias," Chalice said as we rode down on the elevator together, "for a private investigator."
"I have a wide range of interests."
"You work the night-shift, wear a hat, sunglasses, protective clothing . . ." her nostrils flared, " . . . sunscreen . . . pardon my nosiness, Mr. Haim, but do you have something like CEP?"
"No," I said as the doors slid open on the second floor. "Nothing like, at all."
Unfortunately.
I stepped out and walked away as the doors closed behind me.