"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."
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. "Your 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 the group 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 into 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 untaped 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 onto 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 pot-stickers. 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 a 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."