Do No Harm

David stepped outside and pulled the door gently shut behind him. They walked down Barrington, side by side. Diane opened her notebook, a hint of excitement creeping into her voice. "So, get this. When Clyde-or Douglas-worked at the hospital, he had a prescription for lithium carbonate. Eskalith, to be precise."

David readjusted his stethoscope across his shoulders. "Well, the patient in the NPI whom I just interviewed-he said that Clyde tried to steal his medication once. And guess what one of his meds is?"

"Lithium."

"That's right. Evidently Clyde thought it would help control his emerging violent urges."

"But its primary use isn't to control violence. It's for mania."

"I know. But it can help against violence. It's been used to treat aggression in prison inmates and the mentally retarded. But the extent to which lithium actually controls violence isn't important. What's important is Clyde thinks it helps control violence. If he's after lithium, we have a paper trail. Who wrote the prescription?"

"Well, that's just it," Diane said. "Dr. Warren."

"Dr. Warren? An orthopod prescribing lithium?"

"I know. I checked it out with him. He's never heard of Douglas Da-Vella, of course. Clyde must've gotten ahold of his DEA number somehow."

"Well," David said, "Clyde must've made plenty of deliveries to Orthopedics. Horace does a lot of cutting for them. Joints and whatnot. It would have been easy enough to lift a loose prescription off a counter somewhere and copy down a DEA number."

"Why didn't he just go see someone and get drugs prescribed legally?"

"When he came into the ER, I asked him if he was on any drugs, and he became intensely defensive. I'd guess he's ashamed of the fact he needs help. Scared to admit it outright. It's not uncommon, especially for someone presumably uneducated. So he forged a prescription."

Diane added, "And his meds would've all been covered by his employee health plan. Eskalith doesn't come free."

"But he gets fired-"

"-goes off the health plan-"

"-can't afford drugs-"

"-believes that this affects him-"

"-and begins acting drastically," David finished.

Diane whistled. "Holy shit."

"What are the signs of lithium toxicity, Dr. Trace?"

"Upset stomach, difficulty concentrating, clouding of consciousness, hair loss, weight gain… " She paused. "It's as bad as Dilantin."

"What else?"

"Excessive thirst, metallic taste in the mouth, GI distress, acne, frequent urination." She paused, shaking her head, a faint smile crossing her face.

"Slurring of speech, swelling of hands, psoriasis of the fingernails, nystagmus, ataxia, hypothyroidism," David added. "There are many more, of course, but these seem to be the relevant ones."

"But one thing doesn't make sense," Diane said. "If he lost his prescription coverage when he was fired months ago, then why was he displaying signs of lithium toxicity just last week?"

"Because he's still taking it."

"But my friend at the DEA said there have been no prescriptions of any kind filled in the past three months for either Clyde C. Slade or Douglas DaVella. So how's he getting it?"

"Maybe he's been stealing it." David made a mental note to tell Ed about this possibility.

Just south of the post office, they turned into a park composed of two converted baseball fields. Range Rovers and Land Cruisers pulled up and dogs bounded from tailgates-dalmatians and Rhodesian Ridgebacks and Great Danes-and headed for the large lawn ahead. David had forgotten about the dog park, and found himself entertaining the idea of trading in his wife's cockatoo for a Labrador. A golden retriever nuzzled Diane's hand and she laughed, crouching to scratch behind its ears. Its owner, a young Hollywood type in a tight black Kenneth Cole T-shirt that showed off his prodigious biceps, used the opportunity to strike up a conversation with Diane, while David stood by dumbly.

When Muscles finally strode off to join the other dog owners, Diane and David headed for the field. David felt a tug at his sleeve and looked down to see a hand covered with paint, the fingernails and rough cuticles flecked white and green. It belonged to a disheveled kid in his midtwenties with a long, pointed goatee and a pair of glasses with a green thumbprint at the edge of one of the lenses. The kid wore Tevas and a ripped Berkeley T-shirt, also splattered with paint. Even the greyhound dog at his side was speckled with green dots.

"Hey, Dr. S!" the kid said amicably.

"Hello, Shane."

"Hey, man, I'm sorry about Elisabeth. She was one of the good ones."

"Yes. Yes she was."

"If she hadn't come to my opening at that shithole gallery on Cahuenga, I'd still be running the coasters at Magic Mountain."

The greyhound sped off and began furiously humping Hollywood guy's leg. David watched with perverse amusement.

"Oh, shit," Shane said, running over to retrieve his dog. "I'll see you around, man," he called over his shoulder.