IT IS STILL raining, a special East Coast November kind of cold rain, as we drive away from Vision-Aide. Charlotte, seated in the front passenger seat, says, in an elevated tone to override the rainfall and the windshield wipers, “Another of our residents–you met her, Freda, the outspoken one–suffers from fibromyalgia. I researched it online when she told me. That was a few months ago, but I remembered a good deal of it.”

“Like what?” I ask, leaning forward from the back seat as much as the seatbelt will allow.

“Fibromyalgia is an incurable affliction that causes chronic pain. Because of all the medications that are tried on them, folks suffering from it are at particular risk to develop a rare but increasingly common condition called serotonin syndrome.”

“Serotonin?” Meredith asks. “Isn’t that the natural hormone produced in the brain to regulate a person’s mood?”

“It’s a chemical messenger,” Charlotte says. “Folks with pain or depression often take prescribed drugs that help release serotonin into the bloodstream.”

“So, what is this syndrome?” I ask.

“Serotonin syndrome appears to result from combining two or more drugs designed to release thehormone, or when a medication is used that inhibits the liver’s ability to cleanse the bloodstream. When the bloodstream can’t be cleansed, excess serotonin builds up.”

“Then what?” Meredith asks. “Too much serotonin can be dangerous?”

Charlotte takes a deep breath and says, “This adds one other possibility to Claire’s death, and we really do need to get an autopsy report. Yes, symptoms of serotonin syndrome often appear when one additional medication is added to a person’s regimen, causing an overload. It can result in dizziness, disorientation, sweating, or shivering. It can become severe, and can bring on complications like high blood pressure, loss of consciousness, or stroke. It can lead to death.”

“Jesus!” I say. “This Cumberland woman would know all about that. And we have her own admission that  she  was with Claire just days before Claire’s death.”

“We do, but we do not know if she is snooty or indecent, or that she did anything malicious to Claire. At this point, it is simply one other option to consider.”

“Let’s not forget,” Meredith says, “that Freda would also know all about the syndrome. Kind of puts her on the hook as well.”

Charlotte smiles. “I know Freda pretty well, and I wouldn’t put anything past her. She marches to a different drummer, likes to think she has her own value system, and can do whatever she pleases.”

“Freedom.” I say. “Freedom for Freda!”

“True,” Charlotte responds. “But freedom has an awesome twin: responsibility.”

There is silence in the car, the dominant sound is the relentless cadence of the windshield wipers, like an overwrought pulsebeat. I like it, but Meredith continues to labor at the wheel, and is thankfully cautious and slow paced.

At last she says, “I can’t believe Grandmother is dead. In her way, she was more alive than people half her age.”

In the momentary quiet that follows, the three of us seem deep in thought. Charlotte then says, “It kind of attacks the smugness so many of us get about our lives. The most learned and the most famous all face the remorseless indifference of death.”

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