Chapter 9.1

"Doctor, something from Tajima National Health Institute's arrived, were you waiting on something?"

At Towada's voice, Toshio looked up from the document he was reading. It was the written report on Giichi's death from somebody he knew at the National hospital. As expected Giichi had pneumonia. The cause of death was gram positive cocci, and arrhythmia caused by heart failure.

"It's come? Sorry, but could you fish out just Megumi-chan's results for me?"

"Megumi---Shimizu-chan, you mean?"

"Right," Toshio said, as Towada nodded knowledgeably and turned back. Soon there was the sound of someone hurrying, and Mutou rather than Towada came back with a single sheet of paper.

"Sorry about that, Mutou-san."

Toshio took the test results and looked to the main entries. Her total red blood cell count, white blood cell count, and platelet count were down, and her hemoglobin concentration and hematocrit were reduced as well. In contrast, her reticlocyte count was high, and her serum iron levels, TIBC, and serum ferritin levels were normal.

Toshio's brows furrowed. ---These were not happy results.

"How is it?"

Being spoken to, Toshio finally realized that Mutou was still standing in front of his desk, trying to peek, himself. He felt like telling him to let it go but Mutou was close to Shimizu. Never mind that Toshio was the one to say it was anemia, Megumi did suddenly die. Regardless of the difference in degree of sentiment, Mutou may have been the same in feeling some kind of guilt or something towards Shimizu.

"Ah--- yeah."

"Anemia after all?"

Toshio took a breath. "There was anemia. But, while it was anemia---it wasn't iron deficiency anemia. I misdiagnosed."

That can't be! Mutou made a grievous face.

"Serum iron levels, TBIC and serum ferritin, all of them are entirely within the normal range. If it were iron deficiency anemia, then their levels not being low is strange."

"But the results only came back today," Mutou said, dismayed. "That's right, that's, you shouldn't, you couldn't have made an accurate diagnosis until the results came in, you aren't a fortune teller after all. The reason the results came back late was because it was the Bon holiday----"

"It's nothing for you to get that worked up over," Toshio said with a strained smile. "Anemia is usually iron deficiency anemia. Especially since she was a young girl, any doctor would suspect that first. Certainly saying that there was nothing to worry about without due consideration was my mistake, but," the inside of his mouth was bitter but once he'd spit the words out and acknowledged it it felt better. "it might have been better to hurry the results. If I'd done that then at least the worst case scenario might've been avoided. ----That's what I was thinking but somehow or another it looks like that's not how it was."

"Ha?"

Toshio took a calculator out from the desk drawer.

"Mean corpuscular volume, mean corpuscular hemoglobin concentration." He tried to calculate them roughly based off of the red blood cell count, hemoglobin concentration, and the hematocrit. "and the reticlocyte count are high. That'd mean normocytic normochromic anemia, then."

Mutou blinked. "What does that..."

"There are three general classifications of anemia. If it was iron deficiency anemia, it would be microcytic hypochromic anemia. With macrocytic hypochromic anema, that's three. Normocytic normochromic anemia occurs with acute bleeding, or possibly hemolysis, and if not that than aplastic anemia, or secondary anemia. But, in Megumi-chan's case, there weren't any particular external wounds and there were no signs of heavy internal bleeding. Total bilirubin, direct reacting bilirubin, LDH, haptoglobin--each of them are within normal parameters. That means the odds of hemolysis are low. With her high reticlocyte count, the odds of aplastic anemia are low. No problems with her other biochemical results, either."

"Haa," Mutou blinked, tilting his head. "...So, what does that mean that it was?"

"I don't know." Toshio toyed with the exam results in his hand. "I don't really know the cause. But at least what is confirmed is that it was secondary anemia. Besides sudden death, there was something wrong with some part of her body. And, that it was a big problem that couldn't be discerned from a glance. It was that problem that lead to the anemia showing."

"And so.... an example would be?"

"Like I know? Even if these results came out the day I examined her, all I'd have been able to do is a reexamination. The most I could have done is look if there was something wrong somewhere somehow with a thorough analysis but, there wasn't enough time for me to have done that and gotten any results. ---That's what it means."

Ah, Mutou said seeming slightly relieved. "Is that so?"

"This wouldn't likely have gotten any different result if I'd sent her straight to the university hospital or to a large hospital with the appropriate equipment for one of their top physicians to examine her. I mean, there were only three days until it was all over. That's why even if I were a fortune teller it wouldn't have worked. Of course, even if a fortune teller could nail the cause, they wouldn't be able to provide treatment, but."

"Then it was," Mutou said, sounding as if it were complicated. "bad luck, wasn't it."

Toshio gave an all the more bitter smile. "It's possible there were symptoms besides anemia, though. If there were, they wouldn't have been something that just started that day or the day before, though. And that little lady had a habit of kicking up a fuss any time anything felt the slightest bit off. So the people around her thought it was the usual too, took it lightly and forgot about it, probably, I'd bet. ----Well, no matter what, it's nothing but speculation, now."

Megumi was already dead. The corpse was in the ground. In the heat that had become the norm, the decay was probably already fairly far along. He didn't think Shimizu would agree to a pathological autopsy now, and literally digging up old buried bones at this point wouldn't have a point.

"This must be what they mean by a natural life span," Mutou said, shaking his head as he spoke with deep emotion. "All too short, all too out of our hands."

Toshio nodded.

"---You said it."