Chapter 9: Three Years of Grams

"I'm his ex-wife," I said. "And I'm a metabolic physician. I trained here."

The attending looked at the hairnet.

Then at the letter in his other hand, in my handwriting.

"You wrote this?"

"Two days ago."

"Then tell me what you want."

I pulled off the hairnet and told him.

Stop all protein.

Ten percent dextrose and lipids through the IV, so his body stopped eating its own muscle.

A loading dose of the ammonia scavenger, sodium benzoate and phenylacetate, and IV arginine.

Ammonia every two hours.

Call nephrology now, so dialysis was ready if the number didn't fall.

"And call metabolic genetics," I said. "Tell them it's OTC until proven otherwise."

He wrote it all down.

Then he picked up the phone.

The scavenger came up from pharmacy at midnight in a bag the size of my hand.

I watched the nurse hang it.

I watched the drip chamber, one drop at a time.

At twelve forty Emerson started to seize.

It was short.

It was the longest minute of my life.

We turned him, protected his head, pushed the drug, and I said his name over and over in a voice I didn't recognize.

Then he was still and breathing, and the monitor beeped on, and the nurse squeezed my shoulder.

"You're good at this," she said.

"I used to be."

"You still are."

The metabolic team arrived at one fifteen.

The attending on call was a man I'd trained under, with a gray beard and a bow tie under his coat.

He took one look at me and shook his head.

"Mayhew. Where the hell have you been?"

"Rittenhouse."

"Well, come back," he said, and reached for the chart.

At two the second ammonia came back lower.

Not low.

Lower.

Nephrology stood down.

At two thirty a hospital administrator came through the curtain.

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