“That was fast,” I said. “I didn’t expect to hear from you so soon.”

“It’s been ten days,” he said. “About par for the course. Case wasn’t complicated. I’ll send you a copy of Dr. Palchek’s notes, but you might as well get the gist of it by phone.”

“Great.”

“I’ll give you the formal version first and then answer any questions you have. Cause of death was hepatic failure due to chronic alcoholism. Thus the jaundice. No big surprise there.”

“Right.”

“He was also suffering from alcoholic ketoacidosis syndrome. AKA for short. Essentially we’re talking about the buildup of ketones in the blood. Ketones are a type of acid that form when the body breaks down fat for energy. Patients typically have a recent history of binge drinking, little or no food intake, and persistent vomiting. This results in a delay and decrease in insulin secretion and excess glucagon secretion. A lot of hokum here that I’ll skip . . .

“Basically, all patients with severe AKA are dehydrated. Several mechanisms might be responsible, including decreased fluid intake and inhibition of antidiuretic hormone secretion by ethanol. Volume depletion is a stimulus to the sympathetic nervous system, which decreases the ability of the kidneys to excrete ketoacids and can culminate in circulatory collapse.

“My guess is if you go back and talk to his pals, they’ll confirm one or more of the following symptoms. You got a pencil and paper handy?”

I picked up a pen and pulled over a scratch pad, jotting down the list as he recited it.

“Abdominal pain, agitation, confusion, an altered level of alertness. Also, let’s see here . . . low blood pressure, fatigue, sometimes dizziness. Fruity breath is one key, so be sure you ask about that. Smells like acetone.”

“You want verification?”

“It might satisfy any questions his cohorts have. His family might be interested as well. The bad news is, if someone had picked up on his condition and had taken him to the ER in time, he might be alive.”

“Oh, man. I think I’ll keep that to myself,” I said. “Anything else?”

“Well, just running down the page here . . .autopsy showed his heart was enlarged and there was also extensive kidney damage.”

“Also associated with chronic alcoholism I’d imagine.”

“Can be. The only thing that struck me as odd was that blood and urine came back negative for opiates and alcohol.”

I was silent. “You’re saying he was sober?”

“Totally.”

“Are you sure? Because two of his homeless pals swear he was drunk to the end. In fact, Pearl was devastated because he swore up and down he’d quit.”