Compulsion

by Keith Ablow

  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 the 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 goodbye 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 going to try 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 Cuningham'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 Lily'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.

  "That's always up to you," I said. "But if you choose to confront the thoughts, they may not sneak up on you anymore. You may find you can turn them on and off, without using a needle."

  She looked as if she was on the fence about trying.

  "Try it for ten seconds. No more," I said.

  She looked at me to see if I was serious, then rolled her eyes and shook her head.

  "Would he have been angry with you?" I led.

  "No," she said. "He was an understanding man."

  "Embarrassed?"

  She shook her head.

  "Shocked?"

  She blushed, giggled. "God, I honestly don't know how he would have responded."

  Those words, taken literally, sounded like they came directly from the heart of the problem. Lilly couldn't predict whether her grandfather would have taken her as a lover, had she asked him.

  Healthy psychosexual development unfolds in an atmosphere in which children know the adults around them would never take them up on their sexual feelings. When a little girl asks her father whether he will marry her, a good answer is, "I'm married to your mother. I love her. Someday I know you'll meet someone who loves you that way." The father (or grandfather) should not respond with a suggestive wink or a playful pat on the backside-or with silence.

  Unconsciously fearing that an offer of romance would be accepted by her grandfather, Lilly reacted by burying her sexuality. When it emerged on her honeymoon, it emerged with all the guilt and anxiety of a little girl trying to steal away the man of the house. Her sexual impulses were taboo. Worthy of punishment. Dirty.

  "Did he have other women?" I asked.

  "Oh, I would think so," she said. "Almost certainly."

  "Why do you say that?"

  "They argued about it-he and my grandmother. He worked late a lot. Some nights he didn't come home at all. There was a real scene over a woman he had hired as his secretary."

  "Did he ever mention these women to you?" I asked.

  "I don't think so," she said. "At least not directly. But I knew he was unhappy with my grandmother."

  "How did you know that?"

  "He used to talk about old girlfriends he dated before he got married. One, in particular. A woman named Hazel. She was Jewish, and my grandfather was Irish Catholic, and that ended that. The times were different. But he told me she was the one he was meant for."

  "How old were you when he shared that with you?" I asked.

  "Probably eight. Maybe nine." She paused. "Weird, how I remember that."

  People often cling to single, vivid childhood memories as symbols of larger psychological issues. By age nine, after all, Lilly knew plenty of toxic facts about Grandpa. He wasn't completely in love with his wife. He was available to other women. Most important, he was willing to share intensely personal, very adult information with her. Perhaps, nine-year-old Lilly might have reasoned, she could one day replace her grandmother and make her grandfather complete. Keeping him content was important, after all, since she had already lost her father.

  "It sounds like you don't know what your grandfather would have done, had you offered yourself to him," I told Lilly. "That means he seduced you, without ever laying a hand on you."

  "That's so hard for me to believe," she said. "He wasn't mean or predatory. He was… loving."

  "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 orde
red. 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.