Intensive Therapy Part 26

"I knew it," Robin said, patting Victoria's shoulder. There Melinda lay, asleep in a big chair she'd dragged over to Gregory's bedside, clasping his hand.

48.

Within ten days of his operation, Gregory was stable enough to be moved farther away from the nursing station. Victoria noticed a gradual decline in the nurses' attention, but the neurosurgical team rounded on Gregory every morning and evening. Although the doctors were pleased that the brain swelling had gone way down, they still wanted to wait before replacing the skull. Concerned that Gregory hadn't awakened, they were forever running the b.u.t.ts of their reflex hammers across the soles of his feet and mentioning the Glasgow Coma Scale.

Dr. Meninas finished his pediatric ICU rotation the last day in November. The new fellow, Dr. Narissa Hyung, circled the bedsides of the most seriously ill patients like a hawk.

Several children had head injuries, but none as bad as Gregory's. One had epilepsy the doctors couldn't control. Another was in liver failure after drinking a bottle of liquid Tylenol. But the worst cases were the bald preteens and adolescents with cancer. One sixteen-year-old boy had his leg amputated because of a bone tumor. His father looked like he'd had his own leg ripped off.

When Drs. Hyung and Bell disconnected Gregory's respirator for brief periods to see if he would breathe on his own, he did.

"This is good," Dr. Breckenridge said to Victoria. "It means the brain stem is working properly, but we won't remove the breathing tube until we're certain Gregory can maintain his oxygen level. Brain cells are exquisitely sensitive to oxygen deficiency, especially the part of the brain called the hippocampus, which is the seat of working memory. It's like RAM in your computer. Without it you can't function."

"Gregory's the one who speaks computer. I don't," Victoria said. "I can e-mail and type doc.u.ments, but that's it. As far as I'm concerned, rams belong on a farm."

The first week Melinda was in the psychiatric ward, Dr. Milroy called to say she was adjusting well and that the medicine was taking hold.

"She doesn't mind taking it?" Victoria said.

"On the contrary, she says it makes her feel better. We'll start family sessions sometime around the two-week mark; the medicine will help her become stable enough that the sessions won't disrupt her progress. Here's some good news: Melinda has bonded nicely with a girl who's a couple of weeks ahead of her recovery-wise. They're looking forward to seeing each other in group."

Visiting hours at Children's Hospital began at 10:00 AM. Victoria was always the first person to sign in at the visitor's desk. Her presence on Gregory's floor was so regular it looked like she had become a permanent addition to the house staff. Someone even suggested getting her a security badge.

Gregory's bedside became a monotonous, malaise-filled blur. Something about the colors: everyone in uniforms, like the army. Victoria learned to tell people's jobs from their outfits. LPNs wore blue bouffant scrub caps and speckled tunics. RN's wore white jackets and green blouses.

The doctors had distinguishing outfits as well. Pediatric interns and residents had their names embroidered in blue script on their white coats. Surgical residents always wore hospital scrubs beneath their lab coats but, instead of mingling, they hung together, and the alpha males played up to their female counterparts like GIs parading through Paris.

The neurosurgeons were at the top of the food chain. Victoria saw it in the way they moved: They didn't just walk, they didn't swagger-they strode. The respect they commanded upon entering a patient's room was palpable. Hundreds upon hundreds of students and surgical fellows applied for neurosurgery training at Penn, but the program accepted only two per year. Their lives were their work, and everyone knew it.

It surprised Victoria to learn that Dr. Breckenridge was thirty-five years old, and had already completed seven years of neurosurgical residency before entering pediatric neurosurgery. She looked much younger. It comforted Victoria immensely to see Drs. Liddle, Bell, and Breckenridge hovering over Gregory as if he was their prize pupil. Convinced Gregory was stable for the time being and that Melinda was safe, Victoria traveled to New York to see Jonas.

He said, "You look better than the last time I saw you."

"So do you," she said.

"How's it going?"

"I'm reading Harry Potter to Gregory. I want him to hear my voice; I get the feeling he knows it's me. We're in the middle of The Goblet of Fire."

"And how's it going in there?" He pointed to Victoria's head. "Your mind-racing? And your sleep?"

"The medicine helps, but the nights are hard. Thank G.o.d I can sleep. Otherwise they'd need to admit me. I'm not sure why, but I'm dreading family therapy. Dr. Milroy thinks Melinda'll be ready next week."

"Can you focus? Concentrate on reading?"

"When I'm with Gregory, I can stay on track. I try to get some work done. Thank G.o.d the judge recessed our big case indefinitely. My colleagues have been great. I was worried I'd be blackballed by the legal community."

"You worry so much," Jonas said. "How is it when we talk by phone?"

"Not the same, but better than nothing. Being in your presence has such a calming effect. I remember our conversation in therapy when we first talked about Leslie Kilway. Do you remember her?"

"Sure. She was your biology tutor."

"Leslie teaches at the medical school. She looks in on Gregory every day. I hadn't thought about that conversation in years. You think memories are gone when bang, they're there, like yesterday. It amazes me."

"Speaking about yesterday," Jonas said, "did the doctors say anything new?"

"Didn't I tell you? They're using a new kind of bed that turns Gregory to keep him from getting bed sores."

"That's good."

"Other than that, everything's the same. The doctors come early each morning and before they leave for the day. They say the brain swelling is gone, but I think they're concerned that Gregory hasn't woken up. They say to be patient, but I get the feeling they're talking to themselves as much as to me."

"Anything else?"

"They're still concerned that the pressure inside Gregory's head might increase. They mentioned it on rounds. They were talking about hydrocephalus and something that sounded like 'NIH.' They're not thinking of medevac-ing Gregory to D.C., are they?"

"No. The term is NPH, not NIH: Normal Pressure Hydrocephalus; that's more common in adults."

"Whatever it is, they need to be sure about it before reattaching the skull."

"Did they say when they're going to do that?"

"Somewhere around the three-week mark; which should be pretty soon. They may need to use plates and screws, but if they do, Dr. Liddle says they're made of t.i.tanium, so Gregory can still get MRIs and won't set off metal detectors."

"Amazing," Jonas said. "They think of everything."

"What's this NPH thing?"

"The brain has four fluid-filled cavities called ventricles," Jonas explained. "If the filter becomes plugged, like it can after a head injury, the pressure can rise. I'm sure they've been monitoring the pressure in Gregory's head very carefully since they operated. Speaking of which, I bet if you look at Gregory's heart rate and blood pressure, the numbers go down when you read to him."

"I hope so. But if they put the sensors on me, the machine would go haywire when Lorraine visits."

"How are you and Lorraine doing with each other?"

"We coexist; that's all. She blames me. I can tell."

"And how do you feel about her?"

"I go back and forth between hating her and feeling sorry for her. Most of her friends deserted her after the divorce. I guess they didn't want her flirting with their husbands. It's awkward when Morris visits while she's there."

"What happened to Morris?"

"He's been in AA for years. He sponsors newcomers, and he married a woman he met there. Her name's Carolyn; I like her. It's wonderful to see the way they touch each other. I can tell she cares about Gregory, too, but she won't visit when Lorraine is there."

"We still haven't talked about Martin."

"I know, I know," Victoria said testily.

"I know this isn't a good time, Victoria. But something's going on with you and Martin. Something's not right."

"It's not him. It's me. My feelings about him are so complicated, I don't know if I'll ever be ready to deal with them."

"We have to get to it sometime, Victoria," Jonas said. "You can't keep putting it off."

"Don't push me, Jonas," Victoria flared. "I'm doing the best I can! I'll deal with it when I'm ready."

Jonas sighed. "The way you say that worries me, Victoria. Something's going to blow; I see it coming. And when it does, it could be ugly. Very ugly."

49.

As Gregory's coma dragged on and on, so did Victoria's anomie. Between shuttling back and forth from Gregory's bedside to Melinda's family therapy at Pennsylvania Hospital, Victoria had not seen Jonas in person for two weeks. Phone sessions were the best they could manage.

"I haven't told you what's happening with Melinda," she told him in mid-December. "Dr. Milroy wants to keep her in the psych unit until after New Year's. I think he's afraid of another debacle like Thanksgiving. Melinda likes talking with him. I get the sense she's confiding in him. Has he said anything to you?"

"No, there's nothing to tell," Jonas said. "From the beginning, I told Rob not to tell me anything about Melinda that I couldn't tell you."

"Do you have any idea what's she talking about with him?"

"Anything I say is pure conjecture, nothing more. Understand, Victoria?"

"I understand."

"Melinda might have experimented with drugs, or with s.e.x. Either one might have pushed her over the edge."

"You know, I didn't make much of it at the time, but during the summer, Melinda hung around with a friend-of-a-friend of someone at school. The text messages cost us a fortune. She was obsessed with him for two weeks; then he vanished. When I asked her about it, Melinda made out like it was no big deal, but she hasn't been the same since."

"It wouldn't be the first time a guy sweet-talked a girl, then ditched her after he got what he wanted. She's so young."

"You don't think he got her pregnant? Or gave her a disease?"

"I hope not."

"Martin and I visit her every evening. A social worker named Pamela Blount is a.s.signed to us for family therapy."

"Blount? I know that name. If it's who I think it is, her husband was an a.n.a.lyst in town. He was a big mahaf back when I was training."

"'Mahaf!' n.o.body who isn't from Philadelphia knows that word."

"I spent my psychological adolescence in West Philadelphia and Center City, Victoria," Jonas said. "It's in my blood. So tell me about this Blount woman."

"Well, whoever she is, this lady has wrung out every drop of contentiousness that ever existed between Melinda and me. As far as she's concerned, my emotional life is her property. She must know there's no way we'll follow up with her after Melinda's discharge, so for now, she's like a jackal gnawing on a carca.s.s. She makes a big deal that she studied family therapy with someone whose name sounds like Munchkin. She drops his name all the time, like he's some kind of guru."

"The name is Salvador Minuchin. He's a family therapist from South America. According to him, children's psychological issues come from dysfunctional families."

"Do you agree?"

"Not completely. The mind is much more complicated. Biological predisposition to mood disorders plays too huge a role to be discounted. Minuchin's followers want the therapist to become part of the family; then the therapist riles things up, telling people to leave the room, or to sit in a corner, or not to talk. I understand the rationale, but that invites the therapist to become a dictator. Like most therapies, there's good and bad. Minuchin's work gave me the idea of using a one-way mirror in therapy with adolescents. In my practice, instead of forcing families to look at themselves, which makes people defensive, I get permission to record other families' sessions; having parents look at the behavior of people they don't know makes it easier to identify maladaptive patterns in their own families.

"In my experience, a Family Systems approach can help once you get past the totalitarianism, but the therapists have to watch themselves, or else they can become tyrannical and rationalize it as good for the therapy."

Victoria's wrist, still in its cast, began to itch. "Oh, this is just wonderful. Mrs. Blount must think she's doing a good job when she makes me feel horrible. You should see her in action."

"What does she look like?"

"She's painfully thin; I can see her bones. Her skin sags like it's melting off her face and arms, and she wears shapeless dresses that hang off her shoulders. Her voice is so caustic it could penetrate a missile silo. She has no chest or rear end." Victoria laughed. "She looks like she's wearing a Halloween costume."

Jonas laughed, too. "Good Lord, she sounds like a character from The Night of the Living Dead."

"She harps on what she calls Melinda's a.s.signed role in our family. That Gregory is the golden child who can do no wrong, while I over-identify with Melinda's faults and devalue all her strengths."

"There is some truth to that, wouldn't you agree?"

"I accept the concept, I do. But Mrs. Blount's formulation is too black and white. I've always acknowledged Melinda's accomplishments. People play more than one role, don't you think?"

"Of course they do. Did you tell her that?"

"Yes. But when I did, she accused me of being confrontational, which she a.s.sumes is how I treat Melinda. She does nothing but criticize my parenting. One night, she made Melinda role-play Gregory with me, which Martin and I understood and found helpful, but then Mrs. Blount attacked me like a pit bull. Even Melinda told her it wasn't fair. If the goal of family therapy is getting us to bond, Mrs. Blount's doing a fine job of turning Melinda and me into trench buddies, united against a common enemy. I remember you once saying something about changing therapists, didn't you?"

"I was just thinking about that. Your family therapy reminds me of how I felt trapped with my former a.n.a.lyst. It took guts, but I extricated myself. It was one of the best things I ever did."

"I just realized something. Mrs. Blount makes me feel like I did growing up with Lorraine."

"You stood up to Lorraine on graduation day. You were so proud of that. Remember that Mrs. Blount works for you, not the other way around."

"But what will Dr. Milroy say if I tell him we want someone else?"

"Rob's a pro. Things like this happen all the time. He's interested in results. How's Melinda doing?"

"Better. She's not so infuriated with me. But I have to watch myself; when Melinda gets irritated it's hard not to take it personally. I'm glad we talked about Mrs. Blount. It gives me something to work on."

"About Martin ...?"