Part 1 of 5: What killed Reece Meikle?

Leona Meikle was on her way out the door when she saw her son lay his head down on the dining room table and begin to cry.

Sure, he'd been dragging for a couple of days with a fever and a rash, and he had that awful cough. But Reece overflowed with 15-year-old bravado. His favorite saying was "I'm awesome." Only a few days before, he and his younger brother had been jumping a bonfire on their bikes. This exhausted weeping was just not like him.

Leona paused in the dining room, suspended in the stillness of the morning on that day in late April 2004. She had been in a hurry to get to the airport for a business trip to Washington. But as Reece's quiet sobs penetrated the silence, she felt a sliver of fear slide through her. Something was really wrong.

She grabbed her purse and her keys. Work could wait. Reece needed a doctor.

By the time they got to the clinic in Woodbury, Reece was so exhausted he nearly passed out. The skin on his arms and legs was streaked with purple. The nurse tried to draw blood but gave up in bewilderment. She couldn't get any out of his arm.

The doctor didn't hesitate. Go now, she said. Take him straight to Children's Hospital.

•••

Mom, he said to Leona one day in the car. Do you ever just feel good about being you?

He was so confident, so fearless, that he even half-thought he could fly. One day that spring he and his younger brother, 12-year-old Payne, tied tarps to their backs and leaped, soaring, off their trampoline.

Leona was often the one who egged them on. She let them use swear words, but never on a school night. She drove the getaway car when Reece and his buddies went to T.P. some houses after dark. She turned all the car lights off and kept the engine running. But if she saw the cops, she warned them, she would leave them behind to take the rap.

Reece called her the beautiful brunette behind the wheel.

Reece and Payne used to get lost for hours on the acres of land that surrounded their old farmhouse in Woodbury, coming home with scratches and scrapes they never felt.

Later the why would come to permeate her life. But for now, as the miles hummed by beneath the car, all she wanted was to get Reece into the hands of people who could take care of him. Because she knew that she couldn't.

•••

Reece was so weak when they got to the hospital that she had to put him in a wheelchair. He threw up into a bucket on his lap.

That first afternoon in the hospital, Leona and her husband, Roger, watched doctors and nurses come and go. They would come in, look at the pale, coughing boy and leave. Someone else would come by, ask a few questions and leave.

Lab tech Paul Blackman came in to draw blood from Reece's arm. Leona warned him that it might not be easy. The nurses had had trouble with it.

As he continued to ease back on the plunger, a stream of thick, purplish blood settled in the bottom of the tube.

He hurried back to the lab in the hospital basement, struggling to make sense of what he had seen. To separate red blood cells from plasma, Blackman usually has to spin a tube of blood for five or 10 minutes in a centrifuge machine. But it looked like Reece's blood had separated while it was still in his body.

This boy, Blackman thought, was critical.

As the day wore on, the Meikles realized they were witnessing a collective bewilderment about Reece's blood. And they started to hear a word that would forever after carry a unique meaning for them.

Clumped. His blood clumped.

They laid hot packs on his arm. It clumped. They wrapped the tubes in hot packs. It clumped.

As Leona watched the nurses pull tube after tube of blood from her son, the sliver of fear she had carried since she took Reece to the doctor earlier that day ballooned into near panic. Roger had gone home to take Payne to his baseball game, certain that it was only a matter of time before the doctors figured out what was wrong. Leona was alone. She found a quiet place in the hallway and called her mother in Jamestown, N.D.

Never before had she asked her mother to drop everything and come help, not even when her oldest son, 19-year-old Grant, was hospitalized after a car accident. Now her plea was instinctive: Mom, I need you here.

•••

About 5 p.m. Dr. Yoav Messinger stopped her in the hallway outside Reece's room. They were moving Reece to the pediatric intensive-care unit down the hall, he told her.

Leona listened intently to Messinger, gentle and professorial with his stooped shoulders and wire-rimmed spectacles. She didn't say what she was thinking: He could say "precautionary" all he wanted. She knew Reece was in trouble.

The pediatric ICU is a place for kids who are critically ill. Their rooms are walled with glass so the nurses can see each of them like precious fish floating in individual aquariums.

The littlest ones were just bumps on top of their high white beds. Reece was 6 feet tall -- a giant next to them. His feet dangled off the end of the bed.

Leona waited for her family as Reece coughed and coughed in the antiseptic twilight.

Messinger went home that night still not knowing what was making Reece sick.

All that uncertainty made Messinger anxious. That's why he had moved Reece to the pediatric ICU.

If he waited for certain test results, Reece might die. So Messinger did what doctors are often forced to do: He treated Reece for what he thought he had.

Reece's symptoms -- the rash, the clumping blood, the cough and the low hemoglobin -- were signs that he had an extreme case of an unusual type of anemia. Something, probably one of the antibodies created by his own immune system, was destroying his red cells and bundling them together like elaborate Tinkertoy structures. Those bundles were collecting in the tiny sacs at the base of his lungs and making him cough. Left unchecked, they would clog his liver, kidneys and spleen and damage his brain.

Reece already was getting antibiotics in case an infection had started the immune reaction. And he was getting two different drugs to suppress his immune system.

If that wasn't enough, then they would transfuse him with new, healthy blood from the blood bank -- just as soon as the Red Cross could figure what type of blood to give him.

•••

Dr. Clark Smith, a blood expert who was on call that night, was home when Messinger handed off the case to him. Right away Smith began fielding phone calls from frustrated lab technicians who were struggling to analyze Reece's blood. It wouldn't go through the machine that counted red cells, white cells and platelets -- all the cells that made up human blood. The microbiologist couldn't test it for viruses and bacteria.

Eyes are OK, Smith told the technicians. That is, smear Reece's blood on a slide and find a pathologist to look at it through a microscope.

Later the pathologist called to say that all parts of the blood -- except the red cells -- were fine.

That cinched it. Reece did have anemia, and he was getting the right kind of drugs, Smith thought. Most of the time the condition occurs in adults, but six or seven times a year Smith sees kids or teenagers with the disease.

Smith knew that in such cases the blood clumps when it cools, but not when it was warm. That's why Reece had purple splotches on his arms and legs -- blood is cooler in the extremities. That's why it clumped when it hit the cold needles and the cold collection tubes.

The solution was well known: Warm the patient. Warm the patient's room. Warm the tubes. Warm the equipment, and the blood would flow.

That's what he kept telling the lab technicians as they called him repeatedly through the night. Smith was certain that somehow, somewhere, they were making a mistake in the process and allowing the blood to cool. It was the only possible explanation.

Finally, early in the morning, Smith told the tech to call him at each step in the process and describe what he was doing. The technician got an incubator -- the kind the hospital uses to keep premature babies warm. He took all his equipment, including the machine to analyze the blood, up to Reece's room. He put Reece's arm in the incubator and waited for it to warm up. He warmed the needles and warmed the tubes. He slid a needle into the boy's arm, pulled back on the plunger and immediately ran the blood through the analyzing machine.

Smith's phone rang before dawn.

And Smith's world shifted a little bit. The techs were doing everything right. That meant Reece's blood was clumping at both warm temperatures -- in his body -- and at cooler temperatures outside of his body.

That was deadly.

My God, he thought. We can't control this.