Keith Ablow - Compulsion

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.

"We're going to watch Tess like hawks," Karlstein said. "What I'd advise is for you to take, say, five, ten minutes with her, then go and get some rest. There's a decent hotel across the street. Check in. Nap. She'll be here when you get back."

"I'm not leaving," Julia said, looking to me for support.

I saw Karlstein's left eye close halfway, his mind chewing on something. "Why don't you give Dr. Karlstein and me a minute?" I said to Julia.

She took a deep breath, wiped her tears away. "I'm doing fine," she said. "I won't get in anyone's way. I promise."

I nodded. "One minute," I said. "I'll be right back." I stepped away and headed to a corner of the PICU, with Karlstein lumbering behind me.

"Talk about touch and go in there," I said, nodding toward Tess's room.

"I'm gonna call one of the cardiac boys and have him thread a temporary pacemaker," he said. "I don't like the way she crapped out on us. Ventricular tachycardia, out of nowhere."

"What do you think her chances are?"

"Impossible to predict," he said. "If we can get her out of here okay, she's still at increased risk for a year or more."

"From sudden death," I said.

"You got it. Twenty-five percent of people who make it back after cardiac arrest drop dead during the first year after discharge from a hospital. Take it out four years and you go up to about thirty-one percent. No one knows exactly why."

"That's still better odds than she had about three minutes ago."

Karlstein smiled. "Thanks for reminding me." He shook his head. "This place could get to you, if you were a half-normal person, you know?" He chuckled.

I did know. I also knew Karlstein couldn't think it was all that funny. "You can always give me a call," I half-joked, trying to take the edge off the invitation.

He slapped me on the back. "I'm one of those guys who'd fall apart if I gave myself fifty minutes to think," he said. "Better to keep on chugging."

I didn't respond, which was enough of a response to let Karlstein know I wasn't a big fan of that strategy.

"Two things I do need to tell you," he went on, "seeing as you're involved in the Bishop case-forensically, at least." The way he said "at least" made me wonder whether he intuited that Julia and I were more than professionally involved.

"Shoot," I said.

"I'm gonna go ahead and file that psychiatry consultation on the mother. I've been at this long enough to know she's having a tough time."

"Fair enough," I said. "I'm sure you're right."

"And I'm ordering a sitter, as well," he said.

"A sitter?" I said. "You want the baby on one-to-one observation?"

"One of the nurses suggested it, but I was already batting the idea around in my head." He took a deep breath, glanced at Julia, then looked back at me. "She hovers, you know? She's got that stickiness to her."

Those were code words for parents who seem too close to their kids. "You're not sure she has the baby's best interest at heart," I said. "You want someone to keep an eye on her."

"At heart, that's a good one." He smiled.

"I didn't mean it that way," I said.

"Freudian slip, maybe," he said. His voice turned serious. "Let's face it, Frank, there's been a murder in this family already. If Tess codes again, I damn well want to know it's because of the nortriptyline from last night, not something in Mommy's purse."

"She's lost one daughter," I said. "Another may die. I'm not arguing against the sitter, but I don't think there's any 'normal' way to respond in a situation like this."

"Granted," he said. "I'm being extra-cautious. It's my way."

I swallowed hard at the realization that another person I respected was red-flagging Julia as a suspect. "No. You're doing the right thing," I said. "I'll let her know to expect company."

I walked back to Julia. "Staying here around the clock isn't going to change Tess's prognosis," I said. "There's a hotel across the street. Let me check you in. You can eat, maybe sleep a little. Then you can come right back here."

"I don't trust them to keep Darwin away," she said.

"I'll stay here myself until you're back," I said.

She shook her head. "I'm not leaving."

"Okay…" I wanted to let her know about the one-to-one. "There's going to be someone watching Tess, anyhow," I said. "They're ordering what's called a 'sitter.' "

"What's that?"

"Usually a college kid, or a student nurse," I said. "The person sits by the bedside, twenty-four hours a day."

"What for?" she asked.

I thought about fibbing that the reason was to monitor the baby's breathing, but decided to be straight with her. "With the investigation ongoing, the hospital needs to protect Tess from anyone who may have had access to her before the overdose," I said.

"Including me," she said.

"Right," I said, watching for her reaction.

"Good," she said. "That makes me feel a little better. At least they're taking her safety seriously."

Julia's comment made me feel a little better, too. Typically, a parent who has caused a child's injuries will resist close monitoring by the staff, sometimes insisting on a meeting with the hospital's patient rights advocate, or even calling in an attorney. "Does that mean you'll think about the hotel?" I asked.

"I'll get a room a little later," she said unconvincingly.

"You know, I live ten minutes from here, in Chelsea," I said. "You could always-"

"Thanks." She reached for my hand and held it a few moments. "You've been incredible," she said. "I need you with me to make it through this."

"You've got me," I said.

"Just blind luck, I guess," she said.

I stopped at Cafe Positano for a quick, late dinner. Mario steamed my milk and handed me a cappuccino while I waited for three slices of the best pizza outside of Rome. It felt good to be back in familiar territory. When Carl Rossetti walked in, I actually started to relax for the first time in days.