Drug of Choice

Sandra shrugged. “The police brought him into the emergency ward. They figured he’d had an accident, so they took him up to X-ray and checked him over. No broken bones, nothing. All the enzymes and electrolytes came back normal. The EW couldn’t figure it out, so they shipped him up here. It’s all very mysterious. He was going a hundred before the accident, but the police think he slowed way down before it happened. The policeman who found him said it was just as if he had suddenly fallen asleep.”

“Ummm,” Clark said. He bit his lip. “What about his urine?”

“What about it?”

“Has it always been blue?”

Sandra frowned and left the desk. She went into the ward and looked at the bottle, then returned. “I’ve never seen anything like that,” she said.

“Neither have I.”

“What turns urine blue?”

“I was just wondering the same thing,” Clark said. “Why don’t you call down to neurology and say the guy is still in a coma, but urinating blue. Maybe that’ll bring them up.”

Ten minutes later, Harley Spence, Chief of Neurology, appeared on the seventh floor, panting slightly. He was a white-haired man in his middle fifties, very proper in a three-piece suit.

His first words to Clark were: “Urinating blue?”

“That’s right, sir.”

“How long has this been going on?”

“Apparently it just started, within the last few minutes.”

“Fascinating,” Spence said. “Perhaps a new kind of porphyria. Or some idiosyncratic drug reaction. Whatever it is, it’s definitely reportable.”

Clark nodded. In his mind, he saw the journal article: “H.A. Spence: Unusual Urinary Pigment in a Comatose Man. Report of a Case.”

They walked to the patient’s bed. Clark ran through the story while Spence began his examination. Arthur Lewis, twenty-four, unemployed, first admission through the EW in a coma after a motorcycle accident…

“Motorcycle accident?” Spence said.

“Apparently.”

“He’s unmarked. Not a scratch on him. Would you say that’s likely?”

“No sir, but that’s the police story.”

“Ummm.”

Muttering to himself, Spence conducted his neurological examination. He worked briskly at first, and then more slowly. Finally he scratched his head.

“Remarkable,” he said. “Quite remarkable. And this urine — bright blue.”

Spence stared at the bottle, hesitated, then turned to Clark. “What makes urine blue?”

Clark shrugged.

Spence shook his head, put the bottle down. He stepped back from the patient and looked at him.

“Jesus Christ, blue piss,” he said. “What a patient.”

And he walked off.

The metabolic boys came around an hour later; they collected several samples for analysis, amid a lot of vague talk about tubular secretory rates and refractile indices; Clark listened to them until he was sure they had no idea what was going on. Then, as he was leaving, one of them said, “Listen, Rog, what do you make of this?”

“I don’t make anything of it,” Clark said.

“Do you think it’s a drug thing? You’re the local expert.”

Clark smiled. “Hardly.” He had done two years of drug testing at Bethesda, but it had been boring work, measuring excretion and metabolism of experimental drugs in animals and, occasionally, in human subjects. He had only done it because it got him out of the army.

“Well, could it be a bizarre drug reaction?”

Clark shrugged. “It could. Of course it could. Even a common drug like aspirin can produce strange reactions in certain people.”

Someone else said, “What about an entirely new drug?”

“Like what?”

“I don’t know. But these Angels will take anything in a capsule. Remember the guy we got who had swallowed a hundred birth control pills?”

“I don’t think that birth control pills would turn—”

“No, no, of course not. But what if this is some entirely new drug, some new thing like STP or THC or ASD?”

“Possible,” Clark said. “Anything’s possible.” On that note, the metabolic boys went back to the labs, clutching their urine samples, and Clark went back to work.

Word of the Angel quickly spread through the hospital. A constant stream of doctors, residents, interns, students, nurses, and orderlies appeared on the floor to look at Arthur Lewis and his urine bottle. During all this time, the patient continued to sleep peacefully. Repeated attempts to rouse him by calling his name, shaking him, or pinching him were unsuccessful.

At midnight, everything on the floor seemed quiet, and Clark went to bed. He stretched out on the cot in the resident’s room, fully dressed, and fell asleep almost immediately.

At five in the morning, he got a call from Sandra. She needed him on the seventh floor; she couldn’t say more. She sounded frightened, so he went right up.

When he arrived, he found Sandra talking to an immense, bearded man in black leather. Though all the lights on the floor had been turned off except the nightlights, the man wore sunglasses. He had a huge naked angel painted on the back of his leather jacket, and on his hand was a tattoo of a heart pierced by an arrow. Underneath, in gold lettering, it said “Twat.”

Clark walked up to him. “I’m Dr. Clark. Can I help you?”