Compulsion (23 page)

"That’s always up to you," I said.  "But if you choose to confront the thoughts, they may not sneak up on you anymore.  You may find you can turn them on and off, without using a needle."

She looked as if she was on the fence about trying.

"Try it for ten seconds.  No more," I said.

She looked at me to see if I were serious, then rolled her eyes and shook her head.

"Would he have been angry with you?" I led.

"No," she said.  "He was an understanding man."

"Embarrassed?"

She shook her head.

"Shocked?"

She blushed, giggled.  "God, I honestly don’t know how he would have responded."

Those words, taken literally, sounded like they came directly from the heart of the problem.  Lilly couldn’t predict whether her grandfather would have taken her as a lover, had she asked him.

Healthy psychosexual development unfolds in an atmosphere in which children know the adults around them would never take them up on their sexual feelings.  When a little girl asks her father whether he will marry her, a good answer is, “I’m married to your mother.  I love her.  Someday I know you’ll meet someone who loves you that way.”  The father (or grandfather) should not respond with a suggestive wink or a playful pat on the backside — or with silence.

Unconsciously fearing that an offer of romance would be accepted by her grandfather, Lilly reacted by burying her sexuality.  When it emerged on her honeymoon, it emerged with all the guilt and anxiety of a little girl trying to steal away the man of the house.  Her sexual impulses were taboo.  Worthy of punishment.  Dirty.

"Did he have other women?" I asked.

"Oh, I would think so," she said.  "Almost certainly."

"Why do you say that?"

"They argued about it — he and my grandmother.  He worked late a lot.  Some nights he didn’t come home at all.  There was a real scene over a woman he had hired as his secretary."

"Did he ever mention these women to you?" I asked.

"I don’t think so," she said.  "At least not directly.  But I knew he was unhappy with my grandmother."

"How did you know that?"

"He used to talk about old girlfriends he dated before he got married.  One, in particular.  A woman named Hazel.  She was Jewish, and my grandfather was Irish Catholic, and that ended that.  The times were different.  But he told me she was the one he was meant for."

"How old were you when he shared that with you?" I asked.

"Probably eight.  Maybe nine."  She paused.  "Weird, how I remember that."

People often cling to single, vivid childhood memories as symbols of larger psychological issues.  By age nine, after all, Lilly knew plenty of toxic facts about Grandpa.  He wasn’t completely in love with his wife.  He was available to other women.  Most important, he was willing to share intensely personal, very adult information with her.  Perhaps, nine-year-old Lilly might have reasoned, she could one day replace her grandmother and make her grandfather complete.  Keeping him content was important, after all, since she had already lost her father.

"It sounds like you don’t know what your grandfather would have done, had you offered yourself to him," I told Lilly.  "That means he seduced you, without ever laying a hand on you."

"That’s so hard for me to believe," she said.  "He wasn’t mean or predatory.  He was... loving."

"I doubt he set out to do you any harm," I said.  "But he was empty emotionally and looking everywhere to be filled up — even by the romantic fantasies of his granddaughter.  You played along, because that’s what little girls do at eight or nine or ten."  I let that sink in a couple seconds.

"And that’s why I feel so guilty?" she said.

"Yes," I said.  "That guilt may have been protective, for a time.  When you were little, it may have kept you from getting yourself deeper into a relationship that was bad for you."  I leaned closer to the bed.  "Now that emotion — the guilt — has outlived its purpose.  It’s time to let it go."

She glanced at her leg.  "What do I do when these images come up, and the feelings come back?  Is there something I can take?"

"My opinion might be a little different from what other psychiatrists would tell you," I said.

"Why?  What would they say?"

"I think most would tell you to take an antianxiety medication, like Klonopin, or a combination antidepressant/antianxiety medication, like Zoloft.  Or both.  And you could do that.  Your symptoms would decrease or even disappear, at least for a while."

"What would you recommend?" she asked.

"I say, run into the images, not away from them.  Find a psychiatrist to help you watch the scenes as they unfold in your mind.  My guess is that your guilt will turn pretty quickly to anger.  And that’s a much easier emotion to deal with."

"Can’t I do that work with you?" she asked.

No doubt Lilly wanted to win over every male authority figure she came across.  Her grandfather.  All her surgeons.  Why not a psychiatrist?  Her case fascinated me, but I had a chance to demonstrate that I was willing to do the right thing for her, not the gratifying thing for me.  Seeing that I, unlike her grandfather, could draw that distinction might be the first baby step on her long journey to recovery.  "I’d recommend someone older than I am," I said.

She looked away.  "I’m not sure I could open up to anyone else."

"It’s someone I have tremendous respect for," I said.

"You said you’d stay with me through this," she said.

Normally, I wouldn’t have divulged what I was about to tell her, but I felt that Lilly needed a special, continuing connection with me.  Without that, I feared she wouldn’t follow up.  "I’m referring you to a psychiatrist who helped me," I said.  "My own analyst."

She looked at me.  "You own analyst?  You’d share him with me?"

"Yes," I said.  "I will."

"Who is it?" she asked.

"Dr. Theodore James.  He’s your grandfather’s age."

*            *            *

The PICU was in crisis as I walked through its sliding glass doors.  Nurses ran for IV bags, and John Karlstein barked orders from Tess’s glass cubicle.  Someone had pulled the blinds closed.

Julia was standing in a far corner of the central room, crying, as a nurse tried to comfort her.  "Frank!" she yelled when we made eye contact.  She ran to me.  I held her, her chest heaving so hard she was barely able to speak.  "She stopped... breathing.  Tess...  Please, God."

"Hang a tocainide drip," Karlstein ordered.  An alarm sounded on the bank of monitors at the nurses’ station.  I looked over and saw Tess’s tracing had gone flat.  "Hold the drip.  We’re going to shock her again," Karlstein yelled.  "Stand back!"

Julia crumpled in my arms.  "No!" she pleaded.  "Frank, please help."

I eased Julia into a seat by the unit secretary’s desk, with no view of Tess’s room, and motioned for the nurse.  "Stay here," I told Julia, as the nurse arrived.  "I’ll find out what’s happening."

I walked to the edge of five or six figures huddled over Tess.  She had been intubated, and one of the nurses was squeezing a rubber ambu bag to force air in and out of her lungs.  Karlstein looked like a battlefield general, a towering figure amidst a tangle of hanging bags and bottles and rubber tubing, the paddles of the cardioverter still in his hands.

He glanced at me.  "We’ve got a pulse," he said.  "Maybe we got lucky."

Several members of the team nodded to themselves, drinking in that bit of reassurance.  Unlike Karlstein, who still looked crisp, they were sweat-soaked, whether from working feverishly or standing so close to the abyss.

"Let’s start that tocainide now," Karlstein said.

I noticed a full surgical tray had been opened at the bedside.  I knew what that meant:  Karlstein had been prepared to open Tess’s chest and pump her heart by hand.  I felt a surge of admiration for him.

"Try letting her breathe on her own," he said.

The nurse at the head of the bed untapped the breathing tube from Tess’s lips and slowly pulled it out of her throat.  Tess coughed, weakly at first, then more vigorously.  Then she began to cry.

Smiles broke out on the faces of the men and women who had, at least for the moment, beaten back death.

"Strong work," Karlstein said.  "Let’s order in some Chinese.  My treat.  Just make sure we get plenty of those potstickers.  Fried, not steamed."  He walked out of the room and motioned for me to follow him.  I did.  He headed over to Julia, who was standing, wide-eyed, where I had left her.  "Her heart’s beating, and she’s breathing," Karlstein told her.

Julia started to weep again.  "Thank you so much," she managed.  She leaned against me in a way that would have made it natural for me to put my arm around her — something I wanted to do, and would have done, were we somewhere else.  When I didn’t move to hold her, she straightened up.

"We’re going to watch Tess like hawks," Karlstein said.  "What I’d advise is for you to take, say, five, ten minutes with her, then go and get some rest.  There’s a decent hotel across the street.  Check in.  Nap.  She’ll be here when you get back."

"I’m not leaving," Julia said, looking to me for support.

I saw Karlstein’s left eye close halfway, his mind chewing on something.  "Why don’t you give Dr. Karlstein and me a minute," I said to Julia.

She took a deep breath, wiped her tears away.  "I’m doing fine," she said.  "I won’t get in anyone’s way.  I promise."

I nodded.  "One minute," I said.  "I’ll be right back."  I stepped away and headed to a corner of the PICU, with Karlstein lumbering behind me.

"Talk about touch and go in there," I said, nodding toward Tess’s room.

"I’m gonna call one of the cardiac boys and have him thread a temporary pacemaker," he said.  "I don’t like the way she crapped out on us.  Ventricular tachycardia, out of nowhere."

"What do you think her chances are?"

"Impossible to predict," he said.  "If we can get her out of here, okay, she’s still at increased risk for a year or more."

"From sudden death," I said.

"You got it.  Twenty-five percent of people who make it back after cardiac arrest drop dead during the first year after discharge from the hospital.  Take it out four years and you go up to about thirty-one percent.  No one knows exactly why."

"That’s still better odds than she had about three minutes ago."

Karlstein smiled.  "Thanks for reminding me."  He shook his head.  "This place could get to you, if you were a half-normal person, you know?"  He chuckled.

I did know.  I also knew Karlstein couldn’t think it was all that funny.  "You can always give me a call," I half-joked, trying to take the edge off the invitation."

He slapped me on the back.  "I’m one of those guys who’d fall apart if I gave myself fifty minutes to think," he said.  "Better to keep on chugging."

I didn’t respond, which was enough of a response to let Karlstein know I wasn’t a big fan of that strategy.

"Two things I do need to tell you," he went on, "seeing as you’re involved in the Bishop case — forensically, at least."  The way he said ‘
at least
’ made me wonder whether he intuited that Julia and I were more than professionally involved.

"Shoot," I said.

"I’m gonna go ahead and file that psychiatry consultation on the mother.  I’ve been at this long enough to know she’s having a tough time."

"Fair enough," I said.  "I’m sure you’re right."

"And I’m ordering a sitter, as well," he said.

"A sitter?" I said.  "You want the baby on one-to-one observation?"

"One of the nurses suggested it, but I was already batting the idea around in my head."  He took a deep breath, glanced at Julia, then looked back at me.  "She hovers, you know?  She’s got that stickiness to her."

Those were code words for parents who seem
too
close to their kids.  "You’re not sure she has the baby’s best interest at heart," I said.  "You want someone to keep an eye on her."

"
At heart
, that’s a good one."  He smiled.

"I didn’t mean it that way," I said.

"Freudian slip, maybe," he said.  His voice turned serious.  "Let’s face it, Frank, there’s been a murder in this family already.  If Tess codes again, I damn well want to know it’s because of the Nortriptyline from last night, not something in mommy’s purse."

"She’s lost one daughter," I said.  "Another may die.  I’m not arguing against the sitter, but I don’t think there’s any ‘normal’ way to respond in a situation like this."

"Granted," he said.  "I’m being extra-cautious.  It’s my way."

I swallowed hard at the realization that another person I respected was red-flagging Julia as a suspect.  "No.  You’re doing the right thing," I said.  "I’ll let her know to expect company."

I walked back to Julia.  "Staying here around the clock isn’t going to change Tess’s prognosis," I said.  "There’s a hotel across the street.  Let me check you in.  You can eat, maybe sleep a little.  Then you can come right back here."

"I don’t trust them to keep Darwin away," she said.

"I’ll stay here myself until you’re back," I said.

She shook her head.  "I’m not leaving."

"Okay..."  I wanted to let her know about the one-to-one.  "There’s going to be someone watching Tess, anyhow," I said.  "They’re ordering what’s called a ‘sitter.’

"What’s that?"

"Usually a college kid, or a student nurse," I said.  "The person sits by the bedside, twenty-four hours a day."

"What for?" she asked.

I thought about fibbing that the reason was to monitor the baby’s breathing, but decided to be straight with her.  "With the investigation ongoing, the hospital needs to protect Tess from anyone who may have had access to her before the overdose," I said.

"Including me," she said.

"Right," I said, watching for her reaction.

"Good," she said.  "That makes me feel a little better.  At least they’re taking her safety seriously."

Julia’s comment made me feel a little better, too.  Typically, a parent who has caused a child’s injuries will resist close monitoring by the staff, sometimes insisting on a meeting with the hospital’s patient rights advocate, or even calling in an attorney.  "Does that mean you’ll think about the hotel?" I asked.