Compulsion (22 page)

I got to Mass General at 5:50
P.M.
and headed to the Pediatric Intensive Care Unit — PICU, for short.

Few places could inspire more reflection.  The space looks like a miniature mall from hell, with tiny glass storefronts along all four walls.  Each room holds a child at risk of death or awaiting certain death.  The nurses’ station sits at the center, a kiosk of pathos, with monitors beeping out the weak rhythms of hearts meant to beat strong for the next seventy or eighty years.  Below the monitors, a row of looseleaf charts holds a collection of short stories detailing God’s limitations, with the first names of patients written on white tape along the bindings.

I found Tess’s name and matched the number above her chart with one posted outside the furthest room to my right.  Just as I did, I noticed John Karlstein, the pediatrician in charge of the intensive care unit, walking toward the nurses’ station from one of the other rooms.  He spotted me, too, and headed over.

Karlstein was a huge man, with a full beard, who stands six feet four in his trademark black alligator cowboy boots.  He had been hired when the previous PICU director refused to dance to the tune of managed care companies and was eased into a full-time teaching position.  Since then, the PICU had become a cash cow.  "How are you, Frank?" he said in his bass voice.  "It’s been a while."

"Okay.  You?"

"Can’t complain," he said.  "We’re full.  That’s the good news.  The bad new is that everybody’s length of stay keeps getting shorter and shorter."

I nodded.  "I guess it depends on how you look at it — from our side of the bed, or the patients’."

He smiled, not seeming to take any offense.  "I look at it the end of every month to make sure we’re meeting our projections.  We’re on life support ourselves."  He slapped my shoulder.  "Someone file a psych consult?"

"Not this time.  I’m involved in the Bishop case — forensically," I said.

"I didn’t know you were back in that game."

"I’m not.  A friend of mine with the Nantucket Police called me in.  I took this one case."

"I can see why," Karlstein said.  "What a story, huh?  First one twin, now the other.  And this guy Bishop is a billionaire.  Brilliant, they say.  A financial genius."

"That’s the word," I said.  I nodded toward Tess’s room.  "How’s she doing?"

"The baby?"

"Right."

Karlstein’s face turned serious.  His left eye closed halfway, a reflex that seemed to kick in whenever his intellect engaged.  As much as John Karlstein watched the bottom line, and as much as that could get under my skin, he was still one of the best pediatric intensivists in the world.  Maybe
the
best.  "Here’s the deal," he said.  "The Nortriptyline is a cagey sonofabitch, especially in children.  After overdose, you can still see fatal cardiac arrhythmias crop up days later.  Tess’s QRS interval was point fourteen seconds, which you know is too long.  The electrical impulses traveling through her heart are still sluggish.  That means she’s still very much at risk.  We’ve done what we can — meaning large-volume gastric lavage, followed by charcoal to really go after any pill fragments or trace medicine still in her gut.  I don’t think they were aggressive enough with that down on the island."

"It’s a small hospital," I said.

"No crying over spilt milk."  He winked.  "the only other thing that worries me is whether there could be another toxin in her system that wouldn’t show up on the blood and urine screens."

Plenty of substances don’t turn up on toxic screens unless you go looking for them, with precise chemical probes.  "Do her symptoms suggest another poison?" I said.

"No, but I don’t want to be blindsided by anything."  He glanced over at Tess’s room.  "We’ve got her monitored, on all the right IVs, crash cart one foot from the bed."  He looked at me with the kind of brash confidence everyone should pray for in a doctor.  "No fucking way I’m letting this kid go, Frank.  Period."

Doctors don’t pat each other on the back much, but I was moved by Karlstein’s determination.  "She couldn’t be in better hands," I said.  "Not for all the money in the world."

Karlstein wasn’t a man to take a compliment.  "She’s where the chopper dropped her off."  He turned serious again.  "I don’t want to mix metaphors here.  I know you’re working on the investigation.  But you might consider taking a quick look at the mother for us.  She’s not dealing well."

"Tell me what you mean."

"I just have a bad feeling about her.  She hasn’t said more than a couple words since she arrived, which is understandable — shock or whatever — but she’s glued to the bedside in a way that worries me.  She hasn’t left for more than a minute.  Hasn’t eaten.  No phone calls.  Not a question about her daughter’s care."  He paused.  "I guess none of this is very specific data, but she reads to me like somebody about ready to lose it."

"I came here to talk to her," I said.  "But I can’t do it as an official consult for the hospital — not when I’m involved in the investigation."

"Fair enough," he said.  "We’ll get someone else from psychiatry to see her if she goes downhill."

We agreed on that, and I walked to Tess’s room.  Julia was sitting with her back to the glass wall, staring at the baby, so she didn’t notice me standing there at first.  That gave me a minute to steady myself at the sight of Tess’s three-month-old body with EKG leads stuck to her chest, two IVs running into her tiny arms, and a nasogastric tube snaking into her nose.  Her arms were taped to boards designed to keep them from flexing and dislodging the IV needles.  She was breathing, but mercifully, she was asleep.

I have seen many ugly things in my life, including the grotesqueries that had driven me from forensic work, but Tess’s plight took a backseat to none of it.  I was trying to find words to share with Julia when she turned around and saw me in the doorway.  She looked lost and beyond panicking over it, resigned to wandering aimlessly, like a ghost of herself.  Yet whatever emotional vacuum had stripped her of affect had left her beauty intact.  She looked almost of another world — her shiny black hair even more captivating without her attending to it, her green eyes shimmering even under the fluorescent lights.  Maybe it was the backdrop of sterility and death that made her seem so incredibly vibrant.  Or maybe it was simply that I had fallen in love with her.  I stepped into the room.

She spoke before I could, which was a relief.  "You were right," she said blankly.

"About?" I said.

"Win."

"What do you mean?"

"He did this to Tess."  She turned back toward the baby.

My pulse quickened.  I walked in and stood on the opposite side of the bed, watching Tess breathe.  "Why do you think that?" I asked.

"He asked me where the pills were."

"The Nortriptyline?"

She nodded.

"When?"

"Yesterday."  She closed her eyes.  "Before we left for Brooke’s... funeral."

"Did he say why he wanted them?"

She looked toward one corner of the room, at nothing.  She seemed to be lost in thought.

"Julia," I prompted her.  "Did Darwin say why he wanted the Nortriptyline tablets?"

She took a deep breath.

"Julia?"

"He said he was worried I’d take them.  All of them.  That I’d kill myself."

"Were you thinking about suicide?" I asked.

"I was upset, that’s all," she said.  "I mean, I said good-bye to my daughter.  Shouldn’t I be allowed to show some sadness, shed a tear or two?"

"Of course," I said softly.

"I promised him I wouldn’t hurt myself.  But he still wanted the pills."  Her face moved a few degrees toward sadness.  "The bottle was in the side pocket of a carry-on we had taken with us to Aspen last year," she said.  "I had a bad feeling about the whole thing.  I thought about telling him the pills were lost."  Her voice fell to a whisper.  "But I gave them to him."  She looked at Tess.

"Are you willing to tell North Anderson all this?" I asked.

"Yes," she said.  She stared through me.  "I gave Darwin the medicine he used to poison my baby.  You begged me to keep her safe."

"She’ll make it," I said.

"At the hospital on Nantucket they said she might have brain damage."

I knew Julia’s statement was actually a question, but I didn’t have the answer.  Tess was at risk for neurological complications, but I didn’t know how grave a risk.  "Give her a little time," I said.  "There’s every chance she’ll make a full recovery.  She could look much better in a couple days — or a couple hours."

"I’m not leaving," she said.

"No one’s trying to make you.  You can stay with her as long as you want."  I walked over to her and crouched beside her seat, so that our faces were on the same level.  "You do need to keep yourself well for her."

Julia looked at me directly for the first time.

"She’s going to need a healthy mother more than ever," I said.

"Can you stay with us a little while?" she asked.  She offered me her hand.

I took it.  Her hand was trembling slightly, like a delicate, frightened bird, and holding it made me feel needed and strong.  I thought of North Anderson’s warning about getting too close to see the truth about the Bishop case, but, at that moment, it seemed to me that there were two clear-cut suspects — Billy and Darwin Bishop.  "I’ll stay here a while," I said.  "I have another patient to visit in the hospital a little later, but I can stop back after that."

She caught her lip between her teeth in a sad and seductive, little girl way.  "I meant, will you stay with us when we leave here?  I’m not going home."

"What’s your plan?" I asked, sidestepping the original question.

"I’ll take Garret and Tess to my mother’s," she said.

I nodded.

"I want you to come with us," she said.  "Just until I feel safe."  She shrugged.  "Who knows?  Maybe we’ll both end up feeling safer together."

Looking back , I heard those words with a part of myself injured in childhood and unhealed as an adult, despite the good work of Dr. James in trying to piece my psyche back together.  Because the pull toward rescuing an unhappy woman — a wife and mother — who would simultaneously rescue me was nearly overpowering.  It was a dream I had stored away in my unconscious for forty years.  And it was all I could do to remind myself that Julia had had equal access to Tess — and to the Nortriptyline — as Darwin.  "I promise not to leave you in danger," I said, leaving the door open for any and every possibility.

*            *            *

I called North Anderson and told him about Julia’s suspicions.  He said he would have a detective from the Boston police force take her statement.  "I got to tell you I’m being shoved toward the sidelines," he said.  "I guess you got to be careful what you ask for.  The state’s pulling out all the stops to find Billy, but the resources come along with a State Police captain named Brian O’Donnell.  He’s hot to run the whole show."

"What sort of guy is he?"

"Nobody we’d want to have a beer..." Anderson said, stopping himself.

"It’s okay," I said.  "I can take a joke, without taking a drink."

"Let’s just say he’s by the book.  Very focused.  Very serious."  He paused.  "Megalomania is probably the right diagnosis, if that’s a diagnosis at all."

"It’s been replaced with Narcissistic Personality Disorder," I said.

"Sounds about right," Anderson said.  "When are you back?"

"Early tomorrow.  I’ll check in with Claire and Garret, like you suggested."

"I’d do it as soon as you can.  O’Donnell has the Governor’s ear.  He could pull the plug on both of us."

"Understood."

"Call me when you hit the island."

*            *            *

I headed to Lilly Cunningham’s room and was surprised to find her sitting up in bed, reading the
Boston Herald
.  Her leg was still packed with gauze, but it was out of traction.  I walked closer and saw that the Bishop story had made it onto the front page of the late edition, under a massive headline that read  "
TWIN TERROR
."  A photograph accompanying the story showed Julia and Darwin at a black-tie event.  A smaller inset showed the Bishop estate.  I tried to focus on Lilly.  "You seem to be on the mend," I said.

She lowered the paper and smiled at me.  "They finally found the right antibiotic," she said.

I glanced at the IV pole.  It had been pruned down to one hanging plastic bag.  "I guess so."

"I’m glad you came back," she said.

"I told you I would."  I sat down.

"I’ve been thinking about my grandfather."

The way those words rolled off Lilly’s tongue made me wonder whether the antibiotics had done all the good work on her leg, or whether her mind had opened up enough to let some of the toxins drain.  "What about him?"

"These thoughts I have," she said.  "I don’t think they’re flashbacks — or some sort of delayed recall.  I don’t think Grandpa ever touched me."

"Okay," I encouraged her, "where do you think the thoughts are coming from?"

"My imagination," she said.  "They’re things I’ve dreamt up — nightmares during the day.  Don’t all little girls have funny feelings for their dads?"

Freud did believe that all young girls have unconscious sexual feelings toward the men in their families.  But those feelings generally evaporate by adulthood and never fuel serious psychiatric symptoms.  I wondered why Lilly’s impulses had survived childhood and adolescence intact.  Why did they surface on her honeymoon?  And why were they so threatening that she had to resist them by doing something as distracting and destructive as injecting herself with dirt?

"
Because she couldn’t count on anyone else to resist them
," the voice at the back of my mind said.

That seemed like the right path to journey down.  "How would your grandfather have responded," I asked her, "if you had made the first move?"

"The first move?" she said.

"If you asked him for sex," I said.

A hint of a smile played across her lips.  "I don’t want to think about it," she said.