“Oh,” Gregor said.
“Yes,” Dr. Niazi said. “From what I have here, I would have expected him to show such symptoms. They occur even in people who eliminate caffeine normally if such people drink more than they are used to or drink coffee or tea that is stronger than what they are used to. In someone with a particular sensitivity, the symptoms would be pronounced, and they would extend longer than the few hours they would in people who eliminate normally. A single cup of coffee could cause symptoms for most of a day. I am under the impression that this boy was drinking more than a single cup of coffee a day?”
“He said he was mainlining it,” Gregor said.
Dr. Niazi looked puzzled.
“It means he was practically living on the stuff,” Liz said. “I know just what he means; I was like that in college. I almost didn’t eat. And I couldn’t ever seem to stay awake for the amount of time I needed to work. So I drank tea practically all day, except I used to steep each cup for twenty minutes, so it probably had more caffeine in it than coffee. I mean, that was the idea. I just didn’t like the taste of coffee.”
“In this boy’s case,” Dr. Niazi said, “he liked the taste of coffee. Mr. Demarkian, and Mr. Makepeace, and severalother people have said to us that he was drinking coffee before he began to convulse, so I decided to check. It is not as uncommon as you might think in students, although we do not usually see high school students in this state. It’s more often college students. Especially here. In Greater Boston. And in Boston itself. Because of the universities, and the level of the work required of them.”
“But you said that he couldn’t have had convulsions from drinking coffee,” Liz said, “but he did have convulsions. Mr. Demarkian saw him.”
“Yes,” Dr. Niazi said, “we understand that. However, he did not have convulsions here. The convulsions seem to have come and gone in a very short time, and that in itself would be consistent with caffeine poisoning.”
“Caffeine poisoning,” Liz said. “It’s possible to be poisoned by caffeine. That’s new to me. But you’re still contradicting yourself. You said he couldn’t have gotten convulsions from drinking coffee. Or tea or Coca-Cola, I’d expect.”
“He could not have gotten convulsions from drinking, no,” Dr. Niazi said, “but there are other ways to ingest caffeine. There are caffeine pills.”
Gregor sat up a little straighter. “Tablets,” he said, “caffeine tablets. Like NoDoz. I remember those.”
“So do I,” Liz said. “Was Mark taking NoDoz?”
Dr. Niazi flipped through the folder. “He had most certainly had some kind of caffeine tablet or pill in the last several hours before his convulsions,” he said. “We analyzed the contents of his stomach from the pump, and also some of the matter from the vomit on his clothes. In the vomit on his clothes there were pieces of these tablets. Many pieces. It will be a day or more before we can have an understanding of how many of these tablets he might have ingested during the evening before his trouble. When the attending physician takes over, I will give him a complete report, and I will put him in touch with the laboratory people for the complete analyses. I will tell you what I can. The level of caffeine in his blood when he was admitted here was close to fifty times higher than is considered safe—”
“Fifty times?” Liz said.
Dr. Niazi gave no sign that he’d heard. “That in and of itself could have caused him difficulty and might have brought on convulsions. It is not unknown for elevated levels of caffeine to bring on stroke or heart attack in people susceptible to such things. Your son is young and healthy and without any known family medical history of these illnesses, and he is not considered at risk. Unless the medical records are incomplete? Unless you have something to add?”
“Well, his father’s family had a lot of heart disease,” Liz said, “but they didn’t have it young. And they weren’t like Mark. They were mostly very overweight.”
“As so,” Dr. Niazi said. “The level of caffeine toxicity in the material analyzed from the vomit on his clothes was two hundred and fifty times higher than is considered safe.”
“What?” Liz said.
“Jesus Christ,” Gregor said.
“Precisely,” Dr. Niazi said. “There is no question that the level of caffeine toxicity found could have brought on convulsions. The same is the case for the vomiting. One has to assume the logical result of such ingestion to be at least both and possibly something much worse. It is my opinion that your son will be found to have a particular sensitivity to caffeine, and that that is what saved him. His system could not handle the caffeine he had taken in, and so it got rid of it in vomit. It is a very good thing. If those caffeine tablets had been able to dissolve fully and get into his bloodstream, he would now be dead.”