Intensive Therapy Page 17

  “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 massively 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 eggshell 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 assessing 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 assure 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.”

  On the waiting room wall, a painting of flowers reminded Victoria of her rooftop garden where Gregory sat on her lap while she read him Dr. Seuss. The idea that Gregory might never see her flowers bloom in the coming spring was so overwhelming, she could barely speak.

  “Dr. Breckenridge looks so young,” Victoria said. “She reminds me of a friend who studied here twenty years ago; she worked on brain imaging. Leslie teaches at the medical school now.”

  “You don’t mean Leslie Kilway, do you?”

  “Yes. She’s one of my dearest friends.”

  “Everyone knows Leslie Kilway. Without her research, we wouldn’t have the procedure we use to evaluate brain tumors.”

  “I’ve known her since college.”

  “Talk about small world. Image that … two degrees of separation,” Dr. Liddle smiled. “I’m going back to check on how Anna and the rest of the team are doing. We’ll get back to you when we know more.” He walked toward the operating room, but after two strides, he turned back abruptly and stared at Victoria.

  “What is it?” she said.

  “You’re part of the Schone and Braun I read about in Philadelphia Magazine, aren’t you?”

  Her mind flashed back to the article, which mentioned how much fear her law firm struck into the hearts of adversaries. “That’s just media hype, Dr. Liddle. I’m here as a mother. Don’t think for a minute I would ever—” Victoria knew the damage had been done. “Please. Please, Dr. Liddle, just save my little boy. He’s so special. He’s so smart and compassionate. My doctor already explained how pressure damages the brain. Please do what you can to give him back to me. I won’t blame you if—”

  “Let’s hope it turns out well. The body is resilient, especially in young boys and girls.”

  “I know. My doctor told me.”

  “Your doctor? Your neurologist? Or your GP?”

  “No. My psychiatrist.”

  “Your psychiatrist knows about brain swelling and closed head trauma?”

  “Of course he knows. He’s teaches at Mount Sinai in New York,” Victoria said proudly. “He also lectures on how brain circuitry interfaces with psychiatric disorders. He’s been an expert witness in head trauma cases.”

  “That’s impressive. What’s his name?”

  “Dr. Jonas Speller. He trained at HUP back in the early eighties. I was an undergraduate and he was chief resident in the outpatient department.”

  Dr. Liddle rolled his sleeves up and sat down closer to Victoria than before. “What a coincidence,” he said.

  “What is?”

  “In 1986, Dr. Speller saved my own son’s life. Jock nearly died from a heroin overdose at Cornell. We brought him back to Philadelphia, and Dr. Speller treated both his substance abuse and psychiatric disorders. It’s so ironic, isn’t it? I felt the same then as you do now. I remember looking at Dr. Speller and saying to myself, ‘Look at this fellow; he’s just out of residency. How can I put my boy’s life in his hands?’”

  Dr. Liddle stretched his shoulders. “It’s as it should be, Mrs. Braun. Each new generation supplants its elders. Anna’s got more natural ability than I ever did. She’s a sculptress, you know. For her, neurosurgery is more than a profession; it’s a calling. Twenty years from now, Anna will be sitting here with a parent who loves her child as much as we do. I hope I live to see it.

  “I’ll never forget what Dr. Speller did for my family,” Dr. Liddle added. “Even though Jock was over twenty-one, Dr. Speller insisted our whole family be involved in the treatment, which forced me to look at my life and my relationships. I owe Dr. Speller a lot. He was a very special person.”

  “He still is. He’s on his way here right now.”

  “Maybe I’ll get to see him, then. You’re very fortunate to have him on your team. I don’t know many psychiatrists who would drive all the way from New York on a night like this to be at their patient’s side. He must care for you a great deal.”

  “His support means the world to me,” Victoria sai
d.

  “We’ll do everything possible for Gregory, Mrs. Braun. I’m going back to the OR. One of us will come out to see you once we’re done.”

  39

  Alone for the next hour, Victoria kept picturing Gregory hooked to a respirator in a permanent vegetative state. She seesawed between helplessness and dissociation until her cell phone rang at midnight.

  “Who is it?”

  “It’s me,” Jonas said.

  “I’m falling apart. I can’t stop these awful thoughts. Where are you?”

  “I’m in your house, changing into some boots Martin left for me.”

  “How was the drive?” Victoria asked.

  “The last thirty miles took forever. I got stuck behind every salt truck between Exit 4 and the Ben Franklin Bridge.”

  “Where’s Martin?”

  “Martin’s with the police searching for Melinda. They’re meeting up with his father and Dr. Milroy.”

  “Charles? What does he have to do with this?”

  “Inspector Pale—she’s directing the search for Melinda—told us to find someone Melinda trusts. It could be useful when the time comes.”

  “When what time comes?”

  “We’re afraid Melinda might act impulsively. It’s extremely cold. As her body temperature goes down, her thinking will deteriorate. She’ll get clumsy, maybe even stutter. The more people she trusts, the better. I’m coming to the hospital now.”

  “Dr. Liddle gave me a progress report an hour ago,” Victoria said. “He’s the senior neurosurgeon. He remembers you, Jonas. He said you saved his son’s life. He wants to save Gregory’s, too. I could lose him, my Gregory; he might never wake up. Dr. Liddle said as much.” The line went silent. “Are you still there?”

  “Yes.” Jonas sounded shaken. “I’m leaving for CHOP in two minutes. I’ll be there as soon as I can.”

  As Jonas sat on the foyer steps putting on the boots Martin had left for him, he noticed the hall closet was open. A multi-colored skateboard stood on end, its bottom indented with black streaks, probably from sliding down outdoor handrails; the edges were scratched, no doubt by half-pipes like the ones Jonas had seen on television. A helmet and knee- and elbow pads rested on the top shelf. Gregory’s, he surmised.

  Next to the skateboard were two pairs of well-worn ice skates: figure and speed skates. A tennis racket and two sealed containers of tennis balls sat on the shelf beside the helmet. Melinda’s, no doubt. A vivid image of Victoria’s children playing sprang to mind. How vulnerable these children are, Jonas thought, followed by an idea he never expected: Could they have been my children? Victoria’s and mine? Locking the front door behind him, the frozen night jarred him back into the present.

  Slowly, Victoria became aware of the pain in her wrist, and her head-spinning sensation recurred. At 12:15, Jonas stepped off the elevator. They looked at each other, whereupon she flung her arms around him and buried her head on his shoulder and sobbed. Jonas patted her back tentatively, as if he were comforting someone else’s child.

  “Someone should have prevented this,” Victoria exclaimed. “You weren’t there to see my beautiful Gregory lying on the pavement with his skull bashed in. I’ll never be able to forget that. Ever.”

  “We’ll deal with it.” Jonas looked at Victoria’s disheveled hair and terror-stricken eyes, then her broken wrist and cyanotic fingers. “Oh my God, Victoria. What happened to your hand?”

  “I think I broke my wrist when I fell. I heard something snap.”

  “Well, we’ve got to get this taken care of. Now.”

  “I can’t leave him. I can’t.”

  “You’re not leaving him. You said he’s in good hands. Dr. Liddle must have said something about getting your wrist taken care of.”

  “Yes. So what?”

  “So what? You have to listen to him. Swelling is preventing the blood from getting to your fingers. Do you want to lose them?”

  “It doesn’t matter.”

  “Don’t talk that way.”

  “What way?”

  “Like you’re giving up. Like you don’t care. Not now. They need you.”

  “Need me?” Victoria said. “My son needs brain surgery. God knows what my daughter needs.”

  “Well, before anything, your wrist has to be set. That’s what you need.”

  “I’m not leaving here.”

  “Then, we’ll go to the emergency room. If you’re lucky, it’ll turn out to be a simple Colle’s fracture. It happens to kids all the time. The ER doctors probably see hundreds a year. If it’s not complicated, they can fix it in no time.”

  “How poetic, a Colle’s fracture. I’ve become a dog. Lassie, come here, girl. Come home.”

  “That’s the Victoria I know. As for Melinda, she needs you. The night’s far from over. We’re going to the emergency room now. Don’t argue.”

  “You have to make them understand they cannot put me under.”

  “Suppose you need an operation to save your hand? Be reasonable, Victoria. Please.”

  “Don’t yell at me.”

  Jonas drew a deep breath. “How about this, then? Let them examine you and tell you what they think. We’ll deal with the rest later.”

  Victoria acquiesced reluctantly. Unsteady on her feet, Jonas supported her on his arm as they walked down the hallway.

  The Childrens Hospital emergency department waiting room—a cross between Sesame Street and MASH—overflowed with a horde of West Philadelphia’s and Center City’s children who had fallen on the jagged ice. On one side of the room, a chorus of overtired toddlers with broken bones, lacerations, and abrasions screamed continuously. Once one howl ceased, two others took its place. The other side looked as if the Sharks and Jets had called a truce. Bloody bandages, splints, and ice packs appeared everywhere.

  Victoria was too dazed and shaken to speak for herself. Jonas explained her situation to an understanding triage nurse, who prevailed on the overworked staff to treat her promptly. After studying the X-ray, the on-call orthopedist diagnosed displaced fractures of Victoria’s ulna and radius bones.

  “That’s what’s restricting blood flow to her fingers,” the orthopedist explained. “I can try to reset the bones with a closed reduction. The circulation should improve immediately.”

  “There’s no way she will allow you to put her under,” Jonas told him.

  “That’s fine. I’ll give you a nerve block, Mrs. Braun, then put you in a cast,” the doctor said. “You won’t feel anything for an hour or so. Just make sure to see an orthopedist for a follow-up.”

  While a technician applied Victoria’s cast, Jonas returned to the waiting room, where a steady stream of adults were shepherding their young from the treatment area—every child on crutches or in a sling, most wearing fresh casts.

  Parents and their children, Jonas mused—a thought that disappeared abruptly when his cell phone rang.

  40

  “We need to leave now,” Jonas said when Victoria rejoined him in the waiting room. “Let’s get going.”

  “Where are we going?”

  “I’ll explain on the way.”

  “On the way? On the way to where? I told you I’m not leaving Gregory.”

  “This is more important. Here, take my arm.” Jonas draped the parka he had brought from the Braun house over Victoria’s shoulders, and led her firmly through the ER door.

  “What is it?” Victoria said. “Where are you taking me?”

  A plump secretary ran into the frigid night after Victoria. Sliding to a halt on the icy pavement, she handed Victoria a CD case and said, “You’ll need this, Mrs. Braun. It’s your X-rays. Your orthopedist will want to see them.”

  “Thank you,” Jonas said to the woman, who retreated backwards into the biting wind. “I’ll make sure Martin gets it,” he told Victoria. By then, they had reached Jonas’s car. “Get in, please.”

  Jonas revved the engine and put the car in reverse. He said, “Martin called while they were setting your wri
st. The inspector was right; Melinda did head for the park. Police dogs found fresh blood where she must have fallen on some ice past Boathouse Row. Fifteen minutes ago, a squad car spotted her on the Strawberry Mansion Bridge. She’s perched on top of an observation post overlooking the river. She’s convinced Gregory is dead, and she’s terrified of what you and the police will do to her. Martin said that when he and Charles approached, Melinda threatened to jump. She believes you’ll never forgive her for murdering Gregory. No one can reason with her except you. You have to go to her, Victoria. You’re the one person who might get her to change her mind.”

  “Me? I want to tear her apart! Look what she did to her brother, her own flesh and blood. I could choke her to death with my own bare hands. We should have sent her away to boarding school when we had the chance. Goddamn Martin; he talked me out of it.”

  Jonas felt like a battlefield surgeon operating on a patient hemorrhaging to death. He put the car in park and said quietly, “Look at me, Victoria. Look at me and focus. How long have we known each other?”

  “What are you talking about?”

  “How far back do we go?”

  “What does that have to do with anything?”

  “We knew each other back when we were kids; before we had children. I remember how much you wanted a daughter to love and cherish. Remember that?”

  Victoria grimaced. “That was then. I gave birth to a monster.” Victoria’s eyes darted from Jonas’s face to her broken wrist and back. “I should have known better. I hated my mother; now my daughter hates me.”

  “This is about more than your daughter. This is about your whole family.”

  “It’s falling apart, like me.”

  “What about Gregory? You love mothering him. Gregory is easy.”