Alone by Lisa Gardner

anything at first. He was eyeing Bobby up and down. Wondering where Bobby got the gall to show his face in public? Preparing to cite doctor-patient confidentiality? Dr. Rocco finally glanced up again and Bobby saw something unexpected in the man's gaze: fear.
    “Have a seat,” the pediatrician said at last. He gestured to a file-covered chair, then belatedly grabbed the stack of papers. “How can I help you?”
    “I understand you're in charge of Nathan Gagnon's care,” Bobby said.
    “For the past year, yes. Nathan was referred to me by another pediatrician, Dr. Wagner, when she failed to make progress on his care.”
    “Nathan has an illness?”
    “Officially, he's listed as FTT.”
    “FTT?” Bobby asked. He took out a small spiral notebook and a pen.
    “Failure to thrive. Basically, from birth, Nathan's been behind the curve in size, weight, and key developmental benchmarks. He's not developing in a ‘normal' manner.”
    Bobby frowned, not sure he was getting it. “The boy's too small?”
    “Well, that's one element. Nathan's height of thirty-four inches puts him in the lowest one percent for a four-year-old boy, and his weight—twenty-six pounds—doesn't make the curve at all. His condition, however, has to do with more than just size.”
    “Explain.”
    “From birth, Nathan has struggled with vomiting, diarrhea, and spiking fevers. He seems constantly malnourished—he's had rickets, his blood phosphate levels are too low, same with blood glucose levels. As I said before, he's lagged behind almost all traditional benchmarks for development—he didn't sit up until he was eleven months old, he didn't cut teeth until he was eighteen months old, and didn't walk until he was twenty-six months old. None of that is considered good. And then, in the past year, his condition appears to have worsened. He's had several attacks of acute pancreatitis as well as two bone fractures. He's failed to thrive.”
    Bobby flipped a page in his notebook. “Let's talk about the bone fractures. Isn't it unusual for a four-year-old to have two broken bones in one year?”
    “Not for a patient such as Nathan.”
    “What do you mean?”
    “Nathan suffers from hypophosphatemia—low phosphate. Combined with the rickets, his bones are unusually brittle and prone to fracture. For the record, he also bruises quite easily.”
    Bobby looked up sharply. “Why do you say that?”
    “That's why you're here, isn't it? To find out if Nathan was being abused. To prove to yourself you killed the right man.” Dr. Rocco added quietly, “For the record, I think you aimed just fine.”
    Bobby scowled. He hadn't expected this turn in the conversation, to be called head-on. He felt overexposed and it pissed him off.
    “Do you think Nathan was being abused?” Bobby asked tightly.
    “There are a lot of ways to harm a child,” Dr. Rocco replied.
    “Did someone break Nathan's bones?”
    “No. Rickets broke Nathan Gagnon's bones. I can tell from the X-rays.”
    Bobby sat back. Dr. Rocco's assessment didn't please him. In fact, it left him more confused than ever. “So what's wrong with this kid? Why does he have all these problems?”
    “I don't know.”
    “You don't know ?”
    “That's essentially what a diagnosis of FTT tells you—we don't know. We can't pinpoint an exact cause, so the boy remains under the catchall umbrella of ‘failure to thrive.'”
    “Well, Doc, you must have explored some options?”
    “Sure. We conducted initial tests—complete blood count, lead levels, urinalysis, and a set of electrolyte values. We've tested him for diabetes, reflux, malabsorption, and cystic fibrosis. One of the best endocrinologists in the country has examined Nathan for thyroid diseases, metabolic disorders, and hormonal imbalances. Then a nephrologist studied Nathan's kidneys and did more tests related to electrolytes, diabetes, and anemia. I've tested Nathan, I've studied Nathan, and I've sent him to the best experts I know. And I