North Anderson was interviewed at the end of the piece and said the department was "still investigating," but had identified a lead suspect. He explained that the individual's name was being withheld because he was a minor.
I got to Mass General at 5:50 p.m. and headed to the Pediatric Intensive Care Unit-PICU, for short.
Few places could inspire more reflection. The space looks like a miniature mall from hell, with tiny glass storefronts along all four walls. Each room holds a child at risk of death or awaiting certain death. The nurses' station sits at the center, a kiosk of pathos, with monitors beeping out the weak rhythms of hearts meant to beat strong for the next seventy or eighty years. Below the monitors, a row of looseleaf charts holds a collection of short stories detailing God's limitations, with the first names of patients written on white tape along the bindings.
I found Tess's name and matched the number above her chart with one posted outside the furthest room to my right. Just as I did, I noticed John Karlstein, the pediatrician in charge of the intensive care unit, walking toward the nurses' station from one of the other rooms. He spotted me, too, and headed over.
Karlstein is a huge man, with a full beard, who stands six foot four in his trademark black alligator cowboy boots. He had been hired when the previous PICU director refused to dance to the tune of managed care companies and was eased into a full-time teaching position. Since then, the PICU had become a cash cow. "How are you, Frank?" he said in his bass voice. "It's been a while."
"Okay. You?"
"Can't complain," he said. "We're full. That's the good news. The bad news is that everybody's length of stay keeps getting shorter and shorter."
I nodded. "I guess it depends how you look at it-from our side of the bed, or the patients'."
He smiled, not seeming to take any offense. "I look at it the end of every month to make sure we're meeting our projections. We're on life support ourselves." He slapped my shoulder. "Someone file a psych consult?"
"Not this time. I'm involved in the Bishop case-forensically," I said.
"I didn't know you were back in that game."
"I'm not. A friend of mine with the Nantucket Police called me in. I took this one case."
"I can see why," Karlstein said. "What a story, huh? First one twin, now the other. And this guy Bishop is a billionaire. Brilliant, they say. A financial genius."
"That's the word," I said. I nodded toward Tess's room. "How's she doing?"
"The baby?"
"Right."
Karlstein's face turned serious. His left eye closed halfway, a reflex that seemed to kick in whenever his intellect engaged. As much as John Karlstein watched the bottom line, and as much as that could get under my skin, he was still one of the best pediatric intensivists in the world. Maybe the best.
"Here's the deal," he said. "The nortriptyline is a cagey sonofabitch, especially in children. After overdose, you can still see fatal cardiac arrhythmias crop up days later. Tess's QRS interval was point fourteen seconds, which you know is too long. The electrical impulses traveling through her heart are still sluggish. That means she's still very much at risk. We've done what we can-meaning large-volume gastric lavage, followed by charcoal to really go after any pill fragments or trace medicine still in her gut. I don't think they were aggressive enough with that down on the island."
"It's a small hospital," I said.
"No crying over spilt milk." He winked. "The only other thing that worries me is whether there could be another toxin in her system that wouldn't show on the blood and urine screens."
Plenty of substances don't turn up on toxic screens unless you go looking for them, with precise chemical probes.
"Do her symptoms suggest another poison?" I said.
"No, but I don't want to be blindsided by anything." He glanced over at Tess's room. "We've got her monitored, on all the right IVs, crash cart one foot from the bed." He looked at me with the kind of brash confidence everyone should pray for in a doctor. "No fucking way I'm letting this kid go, Frank. Period."
Doctors don't pat each other on the back much, but I was moved by Karlstein's determination. "She couldn't be in better hands," I said. "Not for all the money in the world."
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.