Small Great Things(123)
“How is it transported to the state lab?”
“By courier,” Dr. Atkins says.
“When was Davis Bauer’s blood taken for the screening?”
“At two-thirty P.M., on Friday, October third.”
“Did you ever receive the results of the newborn screening test from the Connecticut state lab?”
Dr. Atkins frowns, considering this. “Actually, I don’t remember seeing them. But of course by then it was a moot point.”
“What is the purpose of the test?”
She lists a series of rare diseases. Some are caused by genetic mutation. Some are issues with not having enough of an enzyme or protein in the body. Others result from not being able to break down enzymes or proteins. “Most of you have never heard of these conditions,” Dr. Atkins says, “because most babies don’t have them. But the ones that do—well, some of the disorders are treatable if caught early. If we make accommodations through diet or medicine or hormone therapy, we can often prevent significant growth delays and cognitive impairment by starting immediate treatment.”
“Are any of these conditions fatal?”
“Some, if they’re left untreated.”
“You did not have the benefit of the results of this test when Davis Bauer had a seizure, did you?” Kennedy asks.
“No. The state lab is closed on weekends. We usually don’t get Friday’s results back until Tuesday.”
“What you’re saying,” Kennedy mulls, “is that it takes almost twice as long to get the test results back if the baby has the misfortune to be born at the end of the workweek.”
“That’s true, unfortunately.”
I can see the jury perking up, writing down notes, listening intently. Behind me, Edison shifts. Maybe Kennedy is right. Maybe all they need is science.
“Are you aware of a disorder called MCADD?” Kennedy asks.
“Yes. It’s a fatty acid oxidation disorder. Basically, an infant who has it will have trouble breaking down fats, and that means the blood sugar drops to dangerously low levels. It can be managed with early detection—a careful diet, frequent feedings.”
“Let’s say it isn’t detected. What happens?”
“Well, infants who have MCADD have a significant risk of death during the first clinical episode of hypoglycemia—when that blood sugar goes south.”
“What would that look like?”
“They’d be sleepy, logy. Irritable. They wouldn’t nurse well.”
“Let’s say, hypothetically, a baby with undiagnosed, untreated MCADD was about to be circumcised. Is there anything about that procedure that might have exacerbated the disease?”
The pediatrician nods. “Normally there would be fasting after six A.M., because of the upcoming surgery. For a baby with MCADD, that would lead to low blood sugar—a potential episode of hypoglycemia. Instead, ten percent dextrose would have been given to the baby prior and afterward.”
“You drew blood from Davis Bauer during the code, didn’t you?”
“Yes.”
“Can you tell the jury the results of his blood sugar at that time?” Kennedy asks.
“Twenty.”
“At what level is a newborn considered hypoglycemic?”
“Forty.”
“So Davis Bauer’s blood sugar was dangerously low?”
“Yes.”
“Would it have been enough to cause a child with untreated, undiagnosed MCADD to go into respiratory failure?”
“I can’t say for sure. But it’s possible.”
Kennedy lifts a file. “I’d like to enter this as exhibit forty-two,” she says. “It’s the newborn screening result of Davis Bauer, which was subpoenaed by the defense.”
Odette stands like a shot. “Your Honor, what is this stunt? Defense hasn’t shared this with the prosecution—”
“That’s because I received these results just days ago. They were conveniently missing from the discovery, however, for months,” Kennedy replies. “Which I could claim as obstruction of justice…”
“Approach.” The judge calls both lawyers to the bench. A machine is turned on so that I cannot hear what they’re saying, and neither can the jury. When they finish, though, it’s after much hand waving and a dark flush on Kennedy’s face. But the record is handed to the clerk to be entered as evidence.
“Dr. Atkins, can you tell us what you’re looking at?” Kennedy asks.
“It’s a newborn screening test result,” the pediatrician says, sifting through the pages. Then she stops. “Oh, my God.”
“Is there any particular finding of interest in the results, Dr. Atkins? The results that didn’t get processed because the state lab was closed all weekend? The results you didn’t receive until after the death of Davis Bauer?”
The pediatrician looks up. “Yes. Davis Bauer screened positive for MCADD.”
—
KENNEDY IS HIGH on herself when court is dismissed that first day. She’s talking fast, like she’s had four big cups of coffee, and she seems to feel like we won our case, even though the prosecution has only just begun and we haven’t started the defense. She tells me I should drink a big glass of wine to celebrate a phenomenal day of testimony, but honestly, all I want to do is go home and crawl into bed.