Royal Pains : Sick Rich (9781101559536) (8 page)

Chapter 10

Divya and I found ourselves back at the Sag Harbor home of Felicia Hecht. We had intended to head over to the high school, but Felicia had called as we left the costume shop. Her headaches had worsened. We dropped Evan at Shadow Pond and drove up.

“What's going on?” I asked as she directed us into her living room.

“Last night was a tough one. I was up and down all night.”

“With the headaches?”

She nodded. “But they're a little different now.”

Felicia sat on the sofa and I settled next to her, automatically reaching for her wrist to check her pulse. Steady but fast.

“In what way?”

“This is going to sound odd.”

“It's okay,” Divya said as she sat in the chair across from the sofa. “We hear odd all the time.”

“My tongue felt like it was on fire.” She took a deep breath and let it out slowly. “Isn't that crazy?”

“Unusual but not crazy,” I said. “Was this with the headaches or at some other time?”

“With. As I said, the headaches were worse last night. I took the pills you gave me and they helped some, but the headaches always came back. Then this morning I felt better. Tired but pain free.”

“And then?” I anticipated there was more to the story.

“A couple of hours ago the pain came back. I tried to ride it out, but when my tongue, neck, and right ear started burning, I got worried.”

“Only on the right side?” Divya asked.

She nodded.

“What were you doing when it started?” I asked.

“I was talking on the phone with a friend.”

“Stressful?”

“Not at all. We were talking about a dinner party we're going to this weekend.”

“Let me check things again,” I said.

I twisted to face her and again did a brief neurological exam and again felt along the right side of her face and jaw. Nothing. Her neuro exam was still normal and I found no tender areas.

“And I almost fainted,” Felicia said.

“When?”

“Just after I called you. I was eating some peanut butter and crackers. I thought maybe my blood sugar was low or something.”

“Did it help? The crackers?”

She shook her head. “Then I felt light-headed. I left the kitchen and headed in here to lie down, but I almost didn't make it. My legs felt rubbery and things looked dim.”

“Did you fall?” Divya asked

“No. I made it to the sofa. Once I lay down for a couple of minutes I felt fine.”

“Is this the only time that's happened?”

She gave me a sheepish look. “A couple of other times. Last week.”

“You didn't tell me that yesterday.”

“I know. I'm sorry.”

“You have to tell me everything. Okay?”

She nodded. “I promise.”

Withholding things from your doctor is not as unusual as most people think. Might not sound logical, but it's not uncommon. Some are afraid the doctor will find something terrible if they reveal all their symptoms. Some simply want to cut things short. Get out of the doctor's office and home as soon as possible. Where it's safe. Where bad things can't be uncovered. Some are simply embarrassed by certain symptoms.

“Have you had any chest pain or shortness of breath?” Divya asked.

“No.” She looked at me. “What is all this?”

“The labs we drew yesterday are normal. We had them e-mailed to us as we drove over. The best bet is still a migraine syndrome, but there are a couple of other things we have to consider.”

“Like?”

“Unusual coronary symptoms.”

“By ‘coronary' do you mean heart attack or angina or something like that?”

“Yes. Coronary problems don't always cause chest pain. Sometimes it's just shortness of breath, or dizziness, or neck pain.”

She sighed. “That's what took my Charles.” She nodded toward the photos on the mantel. “Two years ago.”

“It's unlikely that that's what's going on,” I said. “But we can quickly rule it out.”

“How?”

“A stress test.”

“So I have to go to the hospital?”

“No. We can do it right here. We have our stress echo equipment outside in the van.”

“I'm impressed. Of course, Ellie said I would be.”

“We pay her to say nice things.” I smiled. “We can set it up right here in the living room if that's okay.”

“Sure.”

“While we get things ready why don't you change into something more comfortable and put on your walking shoes if you have any.”

“I walk almost every day, so I have plenty of that stuff.”

Twenty minutes later Felicia had changed clothes and Divya had finished the resting echocardiogram. Felicia then climbed on the treadmill belt and we began the exercise portion of the test. While she walked, I asked more questions.

“These dizzy spells? Did they only happen while you were having the headaches?”

“Yes.” She hesitated for a beat. “Actually the dizziness seems to happen only when the pain is in my jaw and tongue.”

“I thought those symptoms were new. Just today.”

“Maybe a few times in the last week. But never before that.”

The treadmill kicked up its speed and elevation as she entered the second stage of the Bruce Protocol.

“How long do I have to do this?” Felicia asked.

“Until we get your heart rate up to about one-seventy or until you can't do any more, whichever comes first.”

“I'd bet on the latter.”

She was wrong. She got her heart rate up to one-eighty before I ended the test. Divya completed the postexercise echocardiogram. I then loaded the images onto my laptop and angled the screen slightly toward Felicia so she could see the images.

“These are ultrasound movies of your heart,” I said.

“That's it moving there?”

“Sure is.”

“Fascinating. What do you see?”

“A completely normal heart.”

“Really?”

“Scout's honor.”

“Thank goodness.”

“Now that we know it's not your heart, you can relax a bit while we finish what we need to do.”

“So you still don't know what it is?”

“Patience.” I smiled. “We now know what it isn't and that's important. It isn't your heart, so whatever it is, it'll be less sinister than that.”

“Sinister?”

“Maybe not the best word. Let's say less threatening.”

She nodded. “That's comforting.”

“I think it might be a problem with one of the nerves that come from the base of your brain. But like I told you earlier, let's not get too far down that road until we know exactly what we're dealing with.”

“What's next? A surgeon to open my head and look around?”

I laughed. “I don't think we have to go quite that far. I'm going to arrange a brain MRI for you over at Hamptons Heritage. Later today. While you're there they'll place a Holter monitor on you. It's a device that records all your heartbeats for twenty-four hours.”

“I thought you said my heart was normal.”

“It is. But if what I suspect is indeed the problem, slow heart rates and dizziness, even passing out, can be part of it.”

“You guys are just full of good news, aren't you?”

I smiled. “We try.”

It's not every day that you get a call from the medical examiner. Actually the call didn't come from him. It was from Sergeant McCutcheon. But the medical examiner was sitting right there in McCutcheon's office. McCutcheon wondered if I was available to drop by for a chat. When I asked what it was about he said they would tell me when I got there.

If a call like that doesn't tweak your curiosity you must be in a coma.

I told him I'd be right over.

We still had two follow-up visits scheduled, so Divya dropped me by Shadow Pond to pick up my trusty Saab and she took the HankMed van. We arranged to meet over at the high school after we were finished.

When I entered McCutcheon's office I was greeted by two somber faces. McCutcheon and Suffolk County's medical examiner, Dr. James Hawkins. I had met Hawkins a few months earlier during the StellarCare/Julian Morelli investigation.

Hawkins stood and shook my hand. “Thanks for coming over.”

“Good to see you again.”

“Have a seat,” McCutcheon said from behind his desk.

Curiosity faded to dread as I sat in one of the two chairs that faced his desk. Hawkins took the other.

“What's this about?” I asked.

McCutcheon nodded to Hawkins.

Hawkins twisted slightly in his chair to face me, one elbow resting on the arm. “Those pills that you got from Kevin Moxley.”

I hate it when that little electric current goes up the back of your neck. The one that makes the hair stand on end and drops your body temperature a couple of degrees. The one that says the light at the end of the tunnel is a train. A large, fast-moving train with no brakes.

“Crystal meth?” I asked.

Hawkins nodded. “Yes. They did contain crystal meth. But they also contained another amphetamine. Methylenedioxymethamphetamine. MDMA.”

I stared at him for a beat. “Ecstasy?” I glanced at McCutcheon and then back to Hawkins. “They had both crystal meth and ecstasy?”

“Afraid so.” He slipped off his glasses, rubbed one eye with a knuckle, and then pinched the bridge of his nose. He looked as if a headache might be brewing. He settled his glasses back in place with a sigh. “Sometimes I don't understand this planet. Why on earth would someone cook up this concoction?”

“Money,” McCutcheon said. “It always comes down to the money.”

“When I saw Kevin Moxley he certainly behaved and looked as if he was on amphetamines,” I said. “I know that ecstasy is an amphetamine, but its major effects are more psychedelic. I didn't see that. Kevin seemed oriented and he certainly understood everything that I said to him.”

“That likely has to do with the dosing,” Hawkins said. “Those little pink pills were mostly fillers and crystal meth, but there was a very tiny amount of the MDMA.”

I thought about that for a minute. “Just enough to add a little euphoria to the speed? Something like that?”

“That's how I see it,” Hawkins said.

Methamphetamine alone can create euphoria and hyperactivity. It can also drive your blood pressure and heart rate through the roof and kill you. Happens every day. Toss in a little ecstasy and your brain can get really freaky. Delusions, hallucinations, emotional instability, even seizures. Whoever figured out this combination was trying to get a leg up on the competition by selling a product that had a little more effect. A little more euphoria. And unfortunately, the potential for a little more death.

“Have you ever seen anything like this before?” I asked.

“No,” Hawkins said. “I called a couple of my colleagues and neither had they.”

I looked at McCutcheon. “What's the plan from here?”

He leaned forward and rested his thick forearms on the edge of his desk. His biceps and shoulders looked as if they might rip the seams of his shirt. “I've issued a department-wide bulletin on the couple Kevin Moxley described. A BOLO. Means ‘Be on the Lookout.' I wish we had more to go on, but his description is all we have.”

“And their names,” I said.

“Probably bogus.”

That made sense. If you lived and worked in the shadows you probably wouldn't use the name on your driver's license.

“How did Kevin hook up with them?” I asked. “I mean, was it random or did he know how to reach them?”

“I asked him the same thing. Seems he actually had a phone number for them.”

“That should help.”

“Not really. I called the number. Tried to act like a buyer. It didn't go well.”

“What happened?”

“The dude asked me how old I was. I told him fifteen. He asked what grade I was in. I told him I was a sophomore. He asked me who my teacher was. I guessed wrong. I only know a handful of teachers over at the high school and apparently the one I chose taught senior classes.”

“What happened?”

“He said that I should have a nice day and hung up.”

“Can't you trace the phone or something?” I asked.

“I did. It's a prepaid. No way to track it back. He'll toss it, if he hasn't already, and crack open another one. Probably has a glove box full of them.” He opened his huge palms toward me. “And life goes on.”

“So I guess you're telling me that these people aren't stupid.”

“Not by a long shot.” He leaned back in his chair and stuffed the four fingers of his right hand beneath his belt. “I just had a chat with Jerry Hyatt, the principal over at the high school. He says that in the past few months he's seen an uptick in kids showing up intoxicated or stoned. Not a lot, but some.” McCutcheon scratched an ear. “Not sure how he'd notice. I don't think stoned kids are all that uncommon in high schools anymore.”

“From what I hear, Hyatt's a hands-on guy,” I said. “He takes student issues very seriously. If a trend was to be seen he'd be the guy to see it.”

“True. He's definitely hands-on. Unfortunately his hands are also full. I don't see how the guy could do half of what he does and still keep tabs on all his stoned students.”

As sad as that was, it was very true. To my mind there were many reasons for it, not the least of which was the ready availability of drugs. Couple that with the fact the classes were usually too big and teachers were overworked and the school system had too little money and the mountain of new rules and regulations and paperwork tied everything in a knot. You mix all that in the blender and you get stoned kids walking the hallways.

Hawkins slipped his glasses off again. “Now you can see why I insisted on us talking face-to-face. I wanted to be sure you understood what we're dealing with.”