Intensive Therapy

by Jeffrey Deitz

  “I’ll call my doctor first.”

  “Fine,” she said, as she left waiting room.

  Victoria called Jonas, who picked up immediately. “Victoria?” he said.

  “I don’t believe this, Jonas. They want to operate. Gregory was just riding the banister with his cousins. He just stuck up for his sister. It was only an hour ago, and now they’re talking about taking out part of Gregory’s skull. Can this really be happening?”

  “The operation is the best option for acute traumatic brain injury,” Jonas said. “We’ve been doing the same procedure at Mount Sinai. It’s particularly effective in children. There’s been a flurry of case studies from all over the world, and every patient got better. Every patient. Dr. Breckinridge assures me it’s done routinely at Children’s Hospital. She doesn’t strike me as scalpel-happy. Listen to her.”

  “Are you sure?”

  “As sure as anyone can be. The older, more conservative therapies don’t work well, especially when there’s a lot of swelling. It’s the pressure, Victoria. Remember that. The operation reduces the pressure immediately. The earlier that happens, the better the results.”

  “Jesus, Jonas. You want me to put Gregory’s life in the hands of this doctor? She looks like a kid.”

  “Victoria, opening up the skull is something neurosurgeons do all the time. She’s had plenty of experience, and it’s the only chance for Gregory to come out unscathed. You’ve got to give your consent to the operation, Victoria.”

  “You mean he could wind up …?”

  “Permanently brain-damaged. That’s right.”

  “Like those children who spend their lives in wheelchairs with horrible impairments?”

  “That’s right,” Jonas said.

  “My God, you’re telling me this could happen to my Gregory?”

  “Yes, Victoria. It’s what we’re fighting against.”

  “No. Not my Gregory. Not my Gregory,” she cried.

  “Trust this doctor, Victoria. We don’t have much time. Now, I have to get back to Martin about Melinda. I have to get hold of Milroy, too. We’ll need him to deal with her.”

  Victoria’s hair stood on end. “Melinda. What about her?”

  “She’s missing. The last I heard, the police were mobilizing a search. As soon as Melinda is located, if exposure hasn’t lowered her body temperature, I want her brought to wherever Milroy can get her a bed. I’m leaving for Philadelphia now.”

  “You’re coming here? Why?”

  “I’m not sure why, but something tells me you might need me.”

  “What should I do until then?”

  “Trust the doctor. Give her permission to operate. It’s the right thing. I’m going to hang up now and get going. I’ll try and call from the road. I’ll see you as soon as I can. Okay?”

  The line went quiet.

  “Okay?” Jonas repeated

  Victoria could hardly speak.

  “Victoria? Are you still there?” Jonas asked.

  “Yes,” she managed weakly before saying good-bye.

  Dr. Breckenridge returned to the waiting room with a white-jacketed young man who handed Victoria a manila folder.

  She said, “I know this is hard for you, Mrs. Braun, but I need you to sign this consent form so we can operate. I also need to know when Gregory last ate and if he has any medical problems or bleeding problems. We also need to know if he takes any medications. It makes a difference in the anesthesia.”

  Victoria looked at her watch. “He had dessert at my in-laws’ two hours ago. Are you sure about this …?”

  Dr. Breckenridge looked Victoria in the eyes and said, “If we don’t operate now, your son’s heart will surely stop within the next half hour.”

  “Do you have any children?”

  “No. But I hope to someday.”

  “Do you have family?”

  “I have two younger brothers. I always looked out for them when I was younger. I still do.”

  “Can you save my son’s life?” Victoria asked, tears streaming from her eyes.

  “I’ll try. I promise you, I’ll do everything in my power to keep Gregory alive.”

  “Where do I sign?” Victoria said. Dr. Breckenridge indicated where to sign and initial.

  Dr. Breckenridge said, “I wish we had more time, Mrs. Braun, but I have to get to the OR and scrub up.” Pointing to the young man at her side, she said, “This is Dr. Jonathan Bell. He’s a first-year resident; he’ll explain everything.”

  “Please. Please save my son.”

  Dr. Breckenridge touched Victoria’s good arm lightly. “Someone will talk with you as soon as we know anything,” she said.

  Dr. Breckenridge left hastily, then reappeared with the trauma team, who whisked Gregory’s gurney past Victoria on the way to the elevator.

  Victoria barely had time to squeeze Gregory’s hand and kiss his pale cheek.

  “Is anesthesia ready?” Dr. Breckenridge asked someone.

  “They’ll be waiting when the elevator opens on the fourth floor,” an intern replied.

  “I want four pints typed and cross-matched, in case there’s rebleeding once I remove the clot.”

  “Already done.”

  “Good. Let’s go, let’s go,” the doctor commanded, as they wheeled Gregory into the elevator.

  Once inside, Dr. Breckenridge turned to Dr. Bell, “As soon as you’re done with the consent form, get to the OR and scrub in. I’m going to need you.”

  As the elevator doors closed, the bottom fell out of her stomach. Victoria wondered if she would ever see her Gregory again.

  37

  Jonas apologized to the Bodenheims for departing abruptly. He hugged his wife and children tightly after Eddie reassured him that he and Margo would transport everyone home safely.

  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 assault and battery. God 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 competitively. 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.”

  “Goddammit!” Rob exclaimed. “Goddammit. 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 circumstances 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 hell 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 fuck 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 r
ink. 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 décor 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. Larsen 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 impassable. 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.”