“Too soon to tell. But it makes her pretty sick.”

“How are you doing with it?”

“Better than last fall, not as good as last summer.”

Diane looked away. She said, “I can see how hard it is for you.”

I said, “Thanks. Lauren’s off to Washington this afternoon.” I looked at my watch. “Couple of hours. It looks like her mother may have had an MI last night.”

“Oh, my. How is she?”

“Stable, apparently. She’s in coronary care. All the kids are rushing home.”

“Lauren doing okay? She doesn’t need this kind of stress, does she?”

“No, she doesn’t need the stress. What can you do? Things are worse for John Trent, right?”

Adrenaline affects my friend Adrienne in the same paradoxical way that Ritalin affects hyperactive kids. It seems to calm her down.

On Saturday morning, as I was pushing my bicycle through the front door after doing ninety hard minutes on the hilly roads of eastern Boulder County, the phone rang. I was tempted to let the machine catch the call; I wanted to get out of my sweaty Lycra, I needed fluids, and I was desperate for a shower. But I answered anyway, hoping it might be Lauren with some news about her mother.

Adrienne said, “Hey, Alan, how you doing? It’s me.” The casualness of her greeting alerted me that something might be up; as often as not she didn’t even bother to say hello when she phoned. “Hey, you doing anything? You busy right now? I have someone I think you should see.”

I paused a second as I greeted my dog, Emily, who was pushing her flank against me forcefully, as though I were a sheep she was planning to herd to a different pasture. My pause was also intended to allow Adrienne an opportunity to explain what she wanted. When she didn’t, I said, “I just got in from a ride. Where are you, at your house? What’s up?”

Adrienne, a urologist, and her young son, Jonas, were our only nearby neighbors. They lived just up the hill from Lauren and me, in a renovated farmhouse that sat on a rise across the gravel and dirt lane.

“No, I’m at the hospital. Been playing Zorro with bladder cancer in the OR since seven. Just when I finished up the operation, Marty Klein found me and asked me to consult on an ER case, an adolescent female overdose. You know Marty, don’t you?”

“Yeah, I know-”

“I’m still here doing the consult, and I think you should see her, too-the kid.”

“Isn’t there a psychiatrist on call for that?” Although I did occasional psychological liaison work at the hospital, I didn’t routinely consult in the hospital ER, probably hadn’t seen a case there in two years.

Impatience crept into Adrienne’s voice. “I didn’t say I think somebody should see her, Alan. I said I think you should see her. Can you hear the difference?” She paused. “Anyway, Levitt’s on call.”

Whenever Adrienne had an impulse to assail the mental health profession-not an infrequent urge on her part-Natt Levitt, M.D., was her incompetent-practice poster child. His name at the top of the ER on-call roster helped explain why I was being drafted to see the adolescent overdose.

I asked, “What’s the kid’s condition?”

“She’s critical. Her vitals are…her vitals are shit. Consciousness is waxing and waning. Her kidney function is way whacked, and she has gross hematuria, which is why Marty wanted me on board. She’s on her way to the ICU soon.”

The severity of the girl’s condition was unnerving. Adolescent suicidal behavior is a crapshoot. Sometimes it’s manipulative and benign, sometimes it’s lethal as hell. Sometimes the kid screws up and actually kills herself when she doesn’t really intend to.

I asked, “Why does she have blood in her urine? She take aspirin?”

“Don’t know what she took. But ultrasound indicates a perinephric hematoma. We’ll confirm with CT.”

“Which means what in English?”

“She has a mild renal contusion, a little rip in her kidney. So she’s bleeding into her bladder.”

“What can cause that?”

“Fifty different things. Little traumas. Falling out of bed, tripping over a cat. Punch in the gut.”

“Any idea about the precipitant? What does the family have to say? Did she just break up with someone? Problem at school? What?”

“We don’t know anything. Family isn’t here. Police say a frantic kid-called herself a girlfriend-found the patient unresponsive, called 911. The friend left the front door of the house open for the ambulance, but she wasn’t there when the paramedics arrived. The kid’s parents are nowhere to be found. The police are trying to find everybody involved. But we’re pretty much in the dark.”

“Has she been oriented enough to say anything since she was brought in?”

“Not to me. Marty said she asked about her sister. Twice, I think he said. She said, ‘Is she all right?’ Something like that.”

“And her sister’s not around?”

“No, I haven’t seen anybody with her, you know, visiting.”

“Has anyone checked the house for the sister? This could have been some kind of suicide pact.”

“I hadn’t thought of that. The police went over to the house after the ambulance picked her up. I’ll phone and make sure that they looked around real well.”

“The kid hasn’t spoken to you, Ren?”

“No, since I’ve been down here she’s been in the ozone.”

“Is she going to make it?”

“She’s just a girl, Alan. She damn well better make it.”

“What did she take?”

“Like I said, we don’t know; it’s polydrug, probably a cocktail. She responded to Narcan, so some narcotics for sure, and it looks like three, four, five other drugs, maybe more. There was a lot of stuff in the house. We’ll be sorting out the toxicology for a while.”

“Why-”

“Because I think you’re the right one to see her. That’s why.”

“That’s not what I was about to ask.” It actually was, but I wasn’t about to admit it. “What about the attending? You said it’s Marty Klein? Is he okay with me seeing his patient? He’s the one who’ll have to absorb the flack when Natt Levitt finds out he wasn’t called first.”

“Done. Marty doesn’t like Natt any more than I do. Does anybody like Natt? What keeps him around? I don’t get it. Since when is having a medical license supposed to provide as much security as having tenure? But Natt’s not your problem, he’s mine. The order is written.”

“Well-”

Adrienne laughed. “Most of the time I’m irresistible, aren’t I?”

Adrienne was a true friend. And she asked few favors, professionally or otherwise. “Yes, Ren, you are.” I glanced at my watch. “I have to shower first. I’ll try and be there by eleven.”

“I’m sure she’ll be in the ICU by then. Look for us upstairs. And Alan, one more thing.”

“Yes.”

“I don’t think it’s too likely you’ll get reimbursed on this.”

So what else is new. “No insurance?”

“Worse, I’m afraid. We’re not totally sure of her identity, but if she’s who we think she is, admission records for a previous ER visit for a finger laceration show that, back then at least, she was MedExcel. Are you a provider?”

“I was. MedExcel and I didn’t see eye to eye.”

“What do you mean?”

“Slight difference in philosophy. They wanted to run the treatment and I sort of thought that was my role. I wanted to be paid and they thought that was pushy of me. Little conflicts like that.”

Her tone was mildly admonishing as she said, “You’re just too sensitive for the current managed care environment. There are worse companies than MedExcel, let me tell you.”

“I don’t want to know about them.”

“But you’ll see her anyway?”

“Sure, I’ll send you the bill, Ren. You’re rich.”

She found my threat amusing, “Go right ahead. If you think insurance companies are hard to deal with, wait till you try to get a dime out of me.”

I took a quick shower and thought about Lauren. She was, I guessed, sitting by her mother’s bedside in a hospital in eastern Washington. Had she been home, I think she might have said something to caution me about what I was doing.