Intensive Therapy Part 20

At the door, Eddie said quietly, "It's her again, isn't it? Miss Abington. I knew you two weren't done with each other."

"Not now," said Jonas, slipping on his coat and gloves. "I don't have time to argue with you. Think what you like. I have to go."

Jonas set out for Philadelphia, glad he had driven the four-wheel-drive SUV to the Bodenheims. On the way, he phoned Rob Milroy's answering service and left his number. Then he called Martin.

"Hold on one second, Dr. Speller," Martin said. "I'm talking with Inspector Ruby Pale. She's in charge of the investigation. This whole nightmare is turning surreal; Melinda might be charged with a.s.sault and battery. G.o.d knows what kind of trouble she'll be in if Gregory doesn't make it." He, too, sounded dissociated.

The stress these people are under with their children, Jonas thought as he drove across the George Washington Bridge. From the middle of the span, he saw New York's skyline to his left; it looked so incongruously peaceful compared to the mayhem occurring only ninety miles to the south.

"I'm back," Martin said. "Inspector Pale has some more questions."

"I'm on my way to Philadelphia," Jonas said. "Hopefully Dr. Milroy will call back soon. Would you mind putting your phone on speaker, so I can hear what you and the inspector are saying?"

Straining to hear every syllable, Jonas heard Martin say, "Inspector Pale, there's a doctor named Jonas Speller on the other end of the line. I want him to listen in. Is that okay?"

"That's fine," the inspector said curtly. "Is your daughter athletic? Is she in good physical condition?"

"She used to ice skate compet.i.tively. Up until this past summer, she played tennis and ran regularly."

"A runner, eh? Were there any favorite routes she'd take?"

"That's very clever, Inspector Pale," Martin said. "Melinda liked to run past the museum onto Kelly Drive. She was wearing sneakers tonight. Do you think that's where she might have gone? She hasn't been there for months."

"People under stress tend to revert to old patterns. The cold won't bother her until her adrenaline wears off."

"That's exactly right," Jonas broke in as he negotiated the maze of ramps connecting the bridge with the Jersey Turnpike.

Inspector Pale continued, "Then she'll feel spent, like a marathoner hitting the wall. She's already desperate. I just don't like her being so close to the water. As her body temperature goes down, she'll become uncoordinated, then lethargic. Especially in these slippery conditions, she could fall in. Does she have any favorite places in the park?"

"She likes the view of the bridges from the river. She knows all their names."

"Good. That's a start. Let's concentrate on Kelly Drive. I'll radio in a description. We'll post squad cars on the bridges."

"On the bridges?" Martin exclaimed.

"They're right to do that," Jonas said. "She could become suicidal."

"How long ago did she take off?" Inspector Pale said.

Martin said, "About an hour, give or take a few minutes."

Jonas's cell phone buzzed. He said, "Martin and Inspector Pale, I have to stop to talk to the doctor who'll be taking care of Melinda. I'll jump back in when he and I are done."

He toggled to Dr. Milroy's call. "Rob, is that you?"

"Yes, Jonas," Milroy said. "I hope this isn't about the Braun girl."

"It is, and unfortunately it couldn't be much worse." Jonas accelerated to seventy-five miles per hour. "Melinda had a meltdown at Thanksgiving dinner. On the way home, she and her brother got into a fight, and the boy wound up cracking his head on the pavement in front of their house. He's in critical condition at CHOP, undergoing surgery to relieve intracranial pressure. There's brain-stem involvement, and his vital signs were deteriorating quickly. I've already spoken to the neurosurgeon who's operating. They're probably going to do a hemicraniectomy. We won't know much for several hours."

"And Melinda?"

"Melinda ran off into the frigid night. The police are searching for her, but the inspector in charge of finding Melinda sounds very sharp. Melinda's in all kinds of trouble, legal and emotional, and I fear the worst unless someone can talk her down before she does something impulsive. Mania and hypothermia are a deadly combination. I know you've only met her through her parents' eyes, but I think you should hook up with her father and the police trying to track her down. You could be instrumental."

"G.o.ddammit!" Rob exclaimed. "G.o.ddammit. What was I thinking? What made me think we could wait until Monday?"

"This isn't the time for hindsight, Rob. You did what you thought was right. Most likely, I would have done the same thing. It doesn't matter now. The girl's missing, and we have to act fast."

"I'll do everything I can. What's the boy's prognosis? When we find Melinda, she's going to want to know how her brother is."

"It's too early to tell, Rob. I'll know more after I talk with the neurosurgeon. I'm in touch with Gregory's mother. He won't be out of surgery for several hours. Right now, I'm on the road to Philadelphia."

"Just so you know, the roads are caked with frozen slush."

"I know. I've got Martin on the other line. He's with the police inspector looking for Melinda. They're concentrating around the Art Museum, along the river where she used to run."

"I don't know how anyone could run given what's on the ground tonight. It's bitter cold outside, and the wind is howling."

"That's why we have to get to her soon. Her thinking will only deteriorate as she gets hypothermic. Right now, I've got to get back to Martin. I'll probably see you in a couple of hours. I wish the circ.u.mstances were different."

"Me, too. Look out for black ice as you get closer, okay?"

"I promise," Jonas said. He switched back to Martin and Inspector Pale.

He heard Martin telling her, "My father, Charles, calmed her down during dinner. She feels he likes her."

The inspector said, "Good. Please call him and see if he'll join us. It'll be good to have someone along who Melinda trusts."

"Of course."

"Have you heard about your son?" Inspector Pale said.

Martin said, "Nothing yet, but Dr. Speller said the doctors at CHOP are operating now. He's in very critical condition."

The word "critical" made Jonas's stomach heave; he pictured Dr. Breckenridge opening Gregory's skull with a rotary power saw.

"Children's Hospital's is as good as it gets. I'm sure they're doing everything they can," the inspector said. "Let's get on with finding Melinda."

"Hold on just a minute, Dr. Speller." Martin said. "I'm going inside to put on warmer clothes."

Jonas heard Martin's footsteps on a wooden floor. After a few seconds, Martin said, "I'm back. Are you still there?"

"I'm here. You just reminded me of something," Jonas said to Martin. "Can you find me some warm things for Victoria? She might need them. Maybe something for my feet? I left right from dinner and didn't have time to get warm clothes."

"I'll put them inside our vestibule, and I'll leave a key under the vase on the top step." Martin gave him the address.

Jonas said, "Dr. Milroy's coming to join the search. I gave him your number. I'll get into warm clothes at your place and then drive to CHOP to see Victoria before joining the search for Melinda."

An hour later, Jonas's phone rang. The caller ID read Edward Speller. Jonas said, "Eddie, are Jennie and the children okay?"

"Yes, I dropped them off back home. It was crowded, but we all made it. What the h.e.l.l are you doing, Jonas?"

"You wouldn't understand," Jonas said, sipping sludgy cold coffee from a travel mug. "So don't pull your stern father routine on me. I have no choice. She could lose both her children on the same night. One's at death's door in the operating room; the other ran off into the night and is probably suicidal."

"You don't get this involved with any other patient or their family. I hear the roads are treacherous. Jesus, Jonas! Think of your wife. Think of your family."

Jonas gripped the steering wheel, scanning the roadway for black ice.

"Don't tell me what I should or shouldn't feel for Jennie and our children, Eddie. I could list fifteen reasons why I'm on the road right now, but I don't need to justify myself to you or anyone. It's about what I feel. And where I belong right now. It's about who I am."

"What is that supposed to mean?"

"I'm her doctor, for Christ's sake."

"We both know you're more than that."

"So what? I'm doing what I have to do. Let's leave it at that. Okay?"

"You're not being objective."

"You're wrong, Eddie. I am. She needs me. They both do. Her and her husband; I haven't lost sight of him. Besides, you don't know the half of it. There's a young neurosurgeon in the operating room right this minute battling to save their ten-year-old boy's life. Their daughter's gone AWOL into this frigid night, and we're all scared to death she'll become hypothermic and frostbitten, that is unless she kills herself first. So, let's postpone the lecture about right and wrong until next semester."

"Why do you feel so responsible?"

Jonas decelerated as the three lanes of the turnpike merged into two, past the exit for the Pennsylvania Turnpike. "I'm not responsible for what happened. But I might have a say in what's going to happen. My instinct says they need me, and I learned a long time ago to trust my instinct. It's the same instinct that serves you well when I'm on the stand under pressure. Stop and think about that."

"You said she came back into your life on Monday. Are you having an aff-?"

"What the f.u.c.k is that supposed to mean?" Jonas said. "Since when is that your business? And the answer is No with a capital N."

"All right, all right. Just drive safely. You're driving into an ice rink. The black ice could sneak up on you any second."

"The psychiatrist working with the family said the same thing."

"Don't break Jennie's heart. You hear me? She'd never get over it. And neither would I."

"Why do you always have to get in the last word. Eddie? Can't you just leave it alone? Why not say you're proud of me for doing the right thing?"

"Okay, I'm sorry, but please be careful tonight. Call me when you know anything. I don't care what time it is. Do you want me to call Jennie?"

"I'll call her when I can."

Jonas drove on. The northbound lanes of the turnpike were eerily empty. Thirty miles from Camden, ice crystals began sprinkling the windshield, lighting up in the headlights like swarms of moths. He slowed down instinctively. Wanting the solace of familiar music, he inserted the remastered Arthur Rubenstein edition of Chopin's Mazurkas and Polonaises into the CD player. He felt himself sinking back in time and place, beckoned by some ill-defined sense of unfinished business.

38.

Victoria had been pacing the waiting room for two hours; its characterless decor reminded her of a motel lobby. The nauseating pungency of hospital disinfectant permeated the entire floor. Just after 11:00 PM, an older gentleman in a white coat over hospital scrubs glided gracefully toward her. He had long, perfectly manicured fingers. He reached for Victoria's hand, then winced when he saw her contorted wrist.

"Look at your wrist," he said with alarm. "You should have this taken care of right away. Your fingers are turning blue."

Victoria looked at her discolored hand as if it belonged to someone else. "I'll get to it when I can."

"Please don't wait much longer." He motioned her to sit down.

"You must be the boy's, I mean Gregory's, mother." He sat down a comfortable distance away. "Mrs ...?"

"Mrs. Braun. Victoria Schone-Braun. You are-?"

"Dr. Liddle. La.r.s.en Liddle, chairman of the Children's Hospital of Philadelphia's Division of Pediatric Neurosurgery. Anna Breckenridge is my fellow. She called me when Gregory arrived at the hospital. I agreed with her decision to operate without delay. I'd have gotten here sooner, but the roads were impa.s.sable. I had to wait for the highway department to send a salt truck. I've been in the OR with Dr. Breckenridge for an hour."

"What's going on in there? Is he still alive?" Victoria was terrified that the doctor was going to ask permission to donate her son's organs.

"Given the seriousness of Gregory's injury, it's gone as well as it could. Dr. Breckenridge explained the procedure, didn't she?"

"Yes, she did."

"Gregory's brain is ma.s.sively swollen, Mrs. Braun. He developed a subdural hematoma-a leakage of blood, which we've evacuated-caused by a depressed skull fracture that ruptured a small artery. Removing the skull gives the swollen tissue room to expand, like opening an eggsh.e.l.l whose contents are about to explode. The good news is that Dr. Breckenridge reduced the pressure and stopped the bleeding as soon as possible. There's no way we could have treated Gregory without surgery. Thankfully, Gregory's vital signs have improved, but there is a long, long way to go before we'll know the outcome."

"How long are you talking about?"

"Weeks. It could even be months."

"What's happening now?"

"The technically challenging part of the operation is over. No one could have done better than Dr. Breckenridge, and it's a good thing she didn't wait. She reduced the pressure before I got there. There is one thing, however." Dr. Liddle's lips moved silently as if he was rehearsing his next line.

"What's that?"

"We had to remove more skull than we usually do, because the swelling was so extensive. We're sewing the scalp over Gregory's brain to protect against infection. When the swelling goes down, we'll replace the skull and reattach the scalp; somewhere around three weeks from now depending on how things go. The skull was dented and cracked, but not fragmented. The rest of the operation is quite straightforward."

The elevator doors opened, and a maintenance man sporting a tool holster headed down the hall. Hospital business was proceeding as usual. Victoria went from terror to dissociation and back again. "What will happen to Gregory now?" she asked.

"We wait; once he's settled in the pediatric ICU we'll attach an EEG machine to monitor the electrical activity of his brain. We'll know more when we get an MRI, which is better for a.s.sessing damage to fine brain tissue; the CT scan we used when he arrived is better when looking for blood or skull fractures. We'll repeat it after the surgery's done. The good news is that Gregory is only ten years old. Young brains are much more resilient than adult brains; youngsters Gregory's age heal better and faster. We've seen children who were in coma for months make remarkable recoveries.

"When Gregory gets out of the OR he'll be taken directly to the intensive care unit on the seventh floor. Now that the clot is out and the bone is off, the pressure is lower. It'll take vigilance, but my team will work diligently with the ICU doctors to manage the pressure. Be prepared, Mrs. Braun. The swelling hasn't peaked yet; that won't be for another two to four days. His face may swell so much that you don't recognize him, but that's to be expected and it will resolve quickly. Over the coming days and weeks we need to watch for infection, hydrocephalus, seizures, and stroke.

"Keep this in mind though, Mrs. Schone. Even though Gregory did great with surgery, he's still critical. He'll be attached to a breathing machine and he will have a drain coming out of his scalp. He's receiving anti-seizure medication as well as concentrated intravenous fluids to keep his minerals in balance and decrease brain swelling. He'll be sedated to keep him from thrashing, but," Dr. Liddle added solemnly, "it remains to be seen when, and even if, he wakes up. Until then, I can a.s.sure you he won't be in pain. Once we get the MRI, we'll know more."

"When and if?" Victoria said. "You make it sound like a death sentence."

"I'm sorry. I didn't mean to do that. Anna Breckenridge is the most talented and humane fellow I've had in the last twenty years. She sees three-dimensionally and she has great hands. She really needed them tonight. If Gregory were my child, I'd have wanted her on the case."