Last Dance, Last Chance

was anemic. She suffered from leukopenia—a very low white cell count, usually caused because new cells weren’t being formed. Although her muscle tone was normal, she did have that lack of strength and the strange tingling and numbness in her hands and feet, more on the right side than the left. There were no deep tendon reflexes in her knees or ankles. The reflexes in her feet were normal enough to assure them that she hadn’t suffered brain damage.
    And yet, she staggered almost drunkenly when she tried to walk.
    At this point, there were any number of diseases and conditions that had to be considered. In New York State, she could have been bitten by a deer tick and have developed Lyme disease, but she said she hadn’t been out in the woods for months. She hadn’t traveled to any other area where she might have contracted some disease. They had to rule out Guillain-Barré syndrome, a disease that can come on suddenly and completely paralyze a formerly healthy person—a malady that usually reverses itself in time.
    The lab tests took longer than the questions and answers and the observation of skilled doctors. When the results came back, more possibilities were eliminated. A spinal tap produced crystal clear fluid. No meningitis.
    There remained that one diagnosis that Dr. Snyderman didn’t want to be right about: the diagnosis that most doctors don’t turn to until all other options have been considered. They approached it gradually, asking Debbie if she was a gardener. When she said “Yes,” they wondered if she had used toxic chemicals to kill weeds. She had, but she was stunned when they asked her if she had swallowed any. Of course not. And she hadn’t ingested any rat poison, insect killers, or preservatives, either.
    Had she ever worked where someone used heavy metal poisons, or had she ever been exposed to them, to her knowledge? No.
    But the blood tests and the urinalysis came back with a shocking result. Debbie Pignataro’s 24-hour collection of urine showed that it contained arsenic at an almost unheard-of level: 29,580 micrograms per liter.
    To put that in context, it’s necessary to know that we all have some percentage of arsenic in our systems, normally deposited through the environment. Soil has small amounts, and most seafoods—especially clams and oysters—have minute concentrations of the poison. Fuel oils and coal emit arsenic into the air when burned, and of course many weed killers and insecticides have arsenic as a component. Most humans have between 5 and 20 micrograms per liter of arsenic in their entire blood supply. It’s nothing to worry about.
    In 1998, according to the American Association of Poison Control Centers’ (AAPCC) Toxic Exposure Surveillance System, there were 956 non–pesticide-related arsenic exposures with four fatalities, and 399 arsenic-containing pesticide exposures with no fatalities reported. Mystery writers often use arsenic as a way to kill characters; in real life, it is rare.
    Blood arsenic concentrations should not exceed 50 micrograms per liter. In patients with arsenic poisoning, the blood arsenic concentrations usually range from several hundred to several thousand. But Debbie had 29,580 micrograms per liter of arsenic in her body, considerably more than even “several thousand.” Indeed, that was far more than any of her doctors had ever seen—or heard of. She was alive, and she didn’t seem to be in severe pain as long as she lay very, very quietly in her bed.
    Every one of her symptoms made sense now. The numbness of her hands and feet was classic for chronic exposure to arsenic: it was glove or stocking paresthesia, in which the deadening of sensation perfectly fits the area where a person wears gloves or stockings. Her vomiting, diarrhea, and pain were signs of acute exposure. She apparently had swallowed both large and small doses of arsenic.
    The rule of thumb for causes of arsenic exposure is almost always homicidal, occupational, or suicidal. Debbie had been horrified when her doctors asked her if she had taken poison deliberately. How could they even think she would do something like that? She would never, never leave her children. No, she was not suicidal. There was absolutely no occupational or avocational link between her and arsenic.
    That left only the possibility that someone was trying to kill her. Nobody pointed that out to her. She was too sick and too upset for them to even think of bringing such a subject