Intensive Therapy Part 37

CHOP's physical and occupational therapy departments were very different from the drab surroundings in which Victoria had felt quarantined at Gregory's bedside. Children of all ages and colors, some in wheelchairs, most in slings and casts, cavorted busily under the watchful eyes of a legion of therapists encouraging their charges like the Dallas Cowboy Cheerleaders. Thank G.o.d he'll see colors, Victoria told herself, thinking of all the birthday pizza parties they had attended when Gregory was four, five, and six.

An athletic man with a crew cut met the threesome at the sign-in station. After introducing himself as Mark, he spent half an hour testing Gregory's muscle strength, then turned Gregory over to a pear-shaped speech therapist.

His right side was considerably weaker than his left. Because he had trouble with his tongue, Gregory had problems forming sibilants, as well as Ls and Rs. The p.r.o.nounced lisp and lack of mental acuity intensified Victoria's worries.

Mark retrieved Gregory from the speech therapist and wheeled him over to a set of parallel bars. "Okay, let's see what we've got to work with."

"Hold on a second. Let's do this first," said a familiar voice from behind. Dr. Jonathan Bell, still in his scrubs, placed a blood-pressure cuff around Gregory's arm. "Oh," said Dr. Bell, noticing Victoria. "I'm glad you're here."

"I didn't expect to see anyone from the team. How did you know where we were?"

"We keep track of everything. You don't think we'd miss a moment like this, do you?"

Victoria had never looked so closely at Dr. Bell's boyish face. His dark brown eyes seemed older than the rest of him.

"Percy's in the OR with Dr. Liddle. I volunteered to come to PT to make sure they were taking good care of our young skateboarder." Dr. Bell gave the stubble on Gregory's head a playful tousle.

"That's very considerate."

"Thanks, but Dr. Breckenridge would be one angry neurosurgeon if she came back from vacation and found Gregory with his head cracked open after fainting in PT, and rightly so. For your information, she's not as demure as you might think. Let me tell you, you don't want to make that woman mad."

"I never pictured her that way."

"Gregory's recovery will look like watching a baby grow, only speeded up like in a time-lapse movie. You don't see it as much as we do, because you're with him every moment, but the change the past week is phenomenal. Once Gregory can feed himself and get around, we'll send him to a rehabilitation unit for the next phase. Keep this in mind: Don't be spooked if he's very concrete at first, the way young children are."

"Concrete?"

"Concrete as in literal. If you asked him about an operating system, it wouldn't surprise me if, instead of computers, he talked about the saw we used on his skull. Abstract thinking comes later in development or, in other words, his recovery.

"How long are we talking about?"

"I can't say for sure, but even Dr. Liddle is amazed at Gregory's progress this week. I don't know if anyone told you, Mrs. Braun, but even though Gregory ruptured an artery when his head hit the ground, he was actually lucky because the way he landed concentrated the damage to one area, as opposed to shearing the ascending and descending nerve-cell pathways, the brain's version of a spinal cord transection."

"You could have sent one of the pediatric residents to check on Gregory, couldn't you?"

"We don't operate that way, Mrs. Braun. We take care of our own." Dr. Bell checked Gregory's blood pressure, and said, "That's one hundred over seventy-five. Not bad. Okay, let's see what happens."

Two women grasped Gregory under his arms, while another stabilized his wheelchair and steadied him from behind. They hoisted him up slowly, stopping every few degrees to give him time to acclimate.

Halfway to vertical, Dr. Bell halted the crew and took the second reading. "Ninety-five over seventy. Let's go nice and slow."

Mark said, "That's it, Gregory. You're doing great. Now try and get your arms over the bars. That's it. Just like this. Here, we'll help you." The women draped Gregory's arms across the metal beams.

Dr. Bell took the third measurement. "One-ten over eighty. That's some ticker you've got there, young fella. Gregory must have been in fine shape to begin with."

Not quite as limp as spaghetti, more like a garden hose, Gregory's arms sagged and his knees buckled, but even before the group could brace him, Gregory locked his knees. As if awakening from a deep sleep, he said, "Who aw awl deeze peepawl?"

Everyone laughed except Victoria.

"Let me introduce myself. I'm Dr. Jonathan Bell from the neurosurgery department, and these are the physical and speech therapists who are going to help you regain your strength. I thought this might happen. I bet everyone five bucks that when we got Gregory's heart pumping, he would wake up like Rip Van Winkle."

"I hate that thory," Gregory said. He looked around the room until he caught his mother's eye. "Witthen to me, I thound wike an idiot."

"That's what this woman is for," Dr. Bell said, nodding at the speech therapist. "Her name is Jolanda, but we all call her Jolly. She's the best in the business. She'll have you doing tongue twisters inside of a week."

"Ith obviuth I cud ooth thum help with that," Gregory said.

Victoria was overjoyed that Gregory still had his sense of humor. She hugged him so tightly that she had to be restrained, tears smudging the mascara and eyeliner she had applied carefully to look her best for Martin.

Gregory scanned the rest of the crowd. "Wheaw ith Mawtun? I wanna thee Mawtun."

Thank G.o.d he still thinks of his father the same way. "He'll be here soon, Gregory," she said.

Mark said, "That's plenty for today. Great job, Gregory. I'm sure you and Jolly are going to be best of pals. Thanks for coming," he said to Dr. Bell, who gave Gregory's good hand a parting high five.

When the elevator stopped to return Victoria and Gregory to his hospital room, who should be there but Martin and Melinda. Melinda, who hadn't seen Gregory in over a month, turned pale when she saw her brother in a wheelchair and with most of his hair shaved off.

"Oh my G.o.d! I can't believe I did this to you, Gregory!" she said.

"Hewwo Mewinda," Gregory said. "Whea haf you been? I miffed you."

"It's a long story. I think about you all the time. You don't remember what happened, do you?

Pointing at his head, Gregory said, "Oh thith? m.u.t.h.a thaid I fell down the theps. I don't wemembah a thing. The doctahs had to opawate on my bwain. Ith a good thing they found thomething in thewe. I hope you'we feewing better. You hawen't been yowthef for a wong time."

"Oh Gregory, I love you," Melinda cried. "Thank G.o.d you're getting better."

When everyone had settled into Gregory's room, Victoria tried to seize the moment. "Martin, he's back; Gregory's back. I heard it in physical therapy. It just happened again when he joked about his brain. Isn't that good news, Martin?"

"It is," Martin said to Gregory as if Victoria weren't in the room. She went to hug Martin, but he moved away and stared past her.

"Welcome back, Gregory," he said tearfully, extending a hand to caress Gregory's cheek. "Welcome back."

66.

Sat.u.r.day, February 5, 2005

"I'd like a word with you," Dr. Frantz told Jonas at the early February meeting of the American Academy of Psychoa.n.a.lysis. "We need help with something."

Jonas had just conducted a seminar on the pros and cons of the therapist's self-disclosure in psychotherapy. He felt pleased that his former a.n.a.lyst wanted his opinion. "Who is we?" he asked.

"Me, Sid Pulver, and Phil Escoll. Remember them from the Inst.i.tute?"

"Of course." The men came over and shook hands warmly.

Jonas had seen Dr. Frantz occasionally over the years, but not since Frantz's wife, the cellist, had died. The cheekbones of his once-stout face protruded like a scaffold, and he had lost a good twenty pounds since his wife succ.u.mbed to pancreatic cancer.

Dr. Frantz said, "Here's the situation, Jonas. Phil Fowler has been deteriorating. We've heard that he gets his patients confused, and his mind wanders so much that he forgets his point. Either he stops practicing and gets treatment, or the Inst.i.tute will suspend, possibly revoke, his privileges. He doesn't seem depressed; he's convinced we want to steal his ideas."

"Sounds manic to me," Jonas said. "It could be neurological, you know. Was he ill? He didn't fall or have a mini-stroke, did he? People Fowler's age don't just suddenly become manic."

"Now that you mention it, he complained of dizziness after a tennis match a few months ago," Dr. Escoll said.

Dr. Pulver said, "He thinks he's completing Freud's Project for a Scientific Psychology. His notes are pure gibberish, scribbled in the margins of science journals and on the backs of envelopes. Between his crumpled clothes and the key ring full of flash drives attached to his belt loop, he looks like a janitor. According to his wife, one time when he couldn't find a file he was working on, he hurled his laptop against a wall and accused her of conspiring with us. Maybe you can get through to him."

"Me? We haven't spoken in more than twenty years. Why would he listen to me?"

"Because he respects you," said Dr. Frantz.

"Respects me? After what happened when I dumped him and went to you?"

Dr. Frantz said, "A lot happened to Phil after that. The bottom line is that you were the one who got him to stop and think about what he was doing. You must have really sobered him up, because he became a lot less doctrinaire. At first, we didn't know if it was because we had a policeman at his shoulder or if he had a true change of heart, but over time, he convinced us he'd learned to keep an open mind. People change. You have to respect him for that. Will you try to help out?"

Jonas had hoped to discuss his feelings about Victoria with Dr. Frantz, but his former a.n.a.lyst looked too frail to be up to it. Reluctantly Jonas agreed to meet with Fowler, but his major motivation in going to Philadelphia was to talk things over with Stan.

Two days later, southbound on the Jersey Turnpike, a string of jetliners on final approach to Newark Airport caught Jonas's eye; they looked like fireflies. One after another, they descended. As soon as one plane pa.s.sed, another followed in a line extending to the horizon. Appearing to head toward them were planes taking off from LaGuardia Airport. For an instant Jonas wondered how the air-traffic controllers could put them on a crash course. Then, he realized that his collision fantasy reverberated with long-forgotten airplane dreams from his final days on Dr. Fowler's couch.

Jonas drove directly to Marta and Stan's.

"How about a cigar?" Stan asked when Jonas said he needed to talk something through.

"Sure, it'll help us a.n.a.lyze better." Both men smiled as they shared the same flame to light up.

"So what's up, Jo?" Stan asked.

"I don't even know if I should be talking about this with you, Stan."

"Talk to me, Jonas. There's nothing you could say that would surprise me."

"It's about Victoria. You remember I was talking about her in Puerto Rico?"

"Sure."

"Well, it got worse. A lot worse. Now, I'm not sure what to do. She stopped therapy a few weeks ago; disappeared just like that. In all the time I've known her, she's never done that. It's just not her."

"Did you say anything or do anything unusual?"

"I don't think so. When I got back from Puerto Rico, she told me how she lit into her husband Martin. I drew the parallel between the way she treated him and the way her mother treated her father. She seemed to accept the interpretation at the time, but now that I think about it, my timing might have been off. Maybe she wasn't ready to hear it."

"She could have easily dissociated her emotional reactions."

"G.o.ddammit, I should have thought of that before I opened my mouth. Come to think of it, that's when things began to change. Can't you just picture her? Seething on the inside while yessing me to my face. The last few times we talked, she sounded like she was in another world."

"In person?"

"No, she made several appointments to meet me in New York, but she called at the last minute to cancel, saying something had come up and the best she could manage were phone sessions. She sounded burnt out and disconnected."

Both men puffed away thoughtfully. "It's resistance," Stan said.

"I was thinking that, too. What do you think it's about?"

"Let's put our heads together. What would you tell a supervisee?"

"That's a very good question, Stan. Most likely I'd tell him it's a transference resistance. Feelings about therapy Victoria doesn't want to talk over with me."

"Let's not forget feelings about you."

"That's right. Do you think she's retaliating against me for abandoning her over Christmas?"

"Yes, maybe, but it can't be that simple. If it was that and that alone you would have worked it through by now."

Jonas said, "I got a call from her pharmacy a few weeks ago to renew one of her medications. I told them to give her a week's worth and have her call for an appointment. I still haven't heard from her. You don't think she stopped her meds, do you?"

"Could well be. Have you heard from her husband?"

"I was just getting to that. Martin called the other day. Other than the night her kids nearly died, he's never contacted me. When she came back into therapy, Victoria made it clear she didn't want me communicating with her husband; I knew she was holding back, but I didn't want to break confidentiality. But with things the way they are now, I felt I could use the man's viewpoint, so I told him I'd listen, even though I couldn't reveal anything about Victoria's therapy. I can't be stumbling around in the dark. That was right, don't you think, Stan?"

"Absolutely. Everyone agrees you can't treat bipolar disorder without feedback about how the patient is doing outside therapy. What did Martin say?"

"He sounded frightened. He says the better Gregory and Melinda are doing, the more Victoria's falling apart. She's always on the phone when he wants to talk with her, and she waves him away whenever he tries to communicate about the most commonplace issues. He said she's up all night working on briefs and teaching herself computer programs she's never even taken out of the box before. That high-profile case she was working on is starting up again. Martin's in D.C. for the next few days, but he wants to meet with me in person after he gets home. My gut tells me not to."

"I agree. Follow your instinct. This could cause a permanent rupture; she could easily get paranoid that you and Martin are colluding. Maybe she'll meet with you while you're in Philadelphia."

"You mean a home visit?"

"Doctors have made house calls before."

"That's not a bad idea," Jonas said.

"Then again, she might get the wrong idea. Especially with Martin away."

"You don't think she's having an affair?"

"I doubt it. I think this has more to do with her feelings for you. Don't be alone with her outside an office. You can use mine if she agrees to meet. But watch out, Jonas. If she's manic and off her meds, she could easily misinterpret your motives."