CHAPTER TWENTY-NINE.

As the sun began to set beyond the hospital windows, Laura sat between her parents, the twins playing checkers in the corner. While the minutes crept by, she vowed to remember the agony of those waiting when she operated again - if she ever did. At the moment, presiding over a surgical procedure seemed about the furthest thing from reality.

Twelve hours had pa.s.sed since Patrick was wheeled into the operating room; the only feedback Tim's visit five long hours ago. His report had been a huge relief, but still so many things could go wrong. If it hadn't been for her parents' and the twins' arrival, Laura didn't think she'd get through this ordeal.

For a moment, she shut her eyes. When she opened them, Tim was striding into the room.

"Tim!" Laura rushed toward him.

The surgeon smiled a tired smile as he took Laura's hands in his. "He's going to be okay. They've taken him to the ICU. Still on a ventilator, but -"

"Oh thank G.o.d! Can I see him?"

"Right now the surgical team's meeting in the conference room, and we'd like you to come in. Being a surgeon, we thought you'd like all the details and Dr. Kamen himself is handling the debrief."

"Of course. Thank you."

Four men in surgical greens stood up as Laura entered the room with Tim. Among them was Dr. George Kamen, the venerable head of pediatric surgery at CHOP. Tumors in the heart were very rare in kids and of all pediatric surgeons in the world, he had the most experience excising them.

"Dr. Nelson," his deep, booming voice greeted her, "we had ourselves quite a case here, but your little guy's quite the fighter."

A big man of sixty with bushy eyebrows and curly gray hair, he shook her hand. "It's an honor to meet you, my dear. I didn't expect you to be so young, or so beautiful."

A touch of color permeated Laura's pallor as she held out her hand.

"You've made quite a name for yourself in Florida," he went on, "but I am so sorry that we meet under these circ.u.mstances. I'd just returned from a pediatric surgery conference in Moscow, when I learned about your son. Because it's such a rare condition I did the procedure personally."

"I'm so grateful, Dr. Kamen. Such an overwhelming tumor. I should have been more vigilant," Laura replied as the elder doctor took his place at the head of the cluttered conference table and waited for her to take a seat. "I'll never be able to thank you all enough," she said to everyone.

"Young lady, that's what surgery is all about, you know that. Now let's review your little boy's status. As you know," Dr. Kamen continued, "our objective was to resect the whole tumor since the child presented with such severe symptoms. If we couldn't get it all, we'd go for palliation, or worst case, have to wait for a heart transplant..."

"A heart transplant. So drastic." Laura sucked in her breath.

"We were able to get the tumor out, but it was not well circ.u.mscribed and it extended into both ventricles, practically destroying the mitral valve, so we put in a prosthesis -"

Laura stifled a moan. Tim had predicted this, but she'd hoped it could be repaired. Recalling the favorable statistics on valve replacements in children, however, she sighed with relief.

"We had to go to cardiopulmonary bypa.s.s. The OR was equipped with intraoperative radiation and -"

"But Tim said the lesion was benign," Laura interrupted. Then she covered her mouth with her hand.

"Yes, my dear, it was a typical fibroma. Abundant fibroblasts arranged haphazardly in interlacing bundles," he patiently explained, "but we were prepared in case there were malignant cells."

Laura nodded, mentally reviewing the pediatric texts she'd scoured and the stack of case reports from the medical library. Yes, this was good news. The cytology Dr. Kamen was describing meant that the tumor was benign, which meant it would not come back, and it would not metastasize to other organs.

"Of course. I'm so thankful." Laura stammered. "Excuse me for interrupting, I'm just beside myself with worry."

"It's understandable, Dr. Nelson," the kindly surgeon went on. "So after the valve replacement we reconst.i.tuted the anterior wall of the left ventricle with autologous pericardium and used as much pericardium patching as we could along with direct suture. But for the most part, we relied on Teflon strips." The doctor glanced at Laura. "You've probably used these extensively, Teflon b.u.t.tressed sutures for closure. And that, my dear, is why it took so long and why I'm so exhausted and will now leave your son in the capable hands of Dr. Robinson here."

"Thank you, Dr. Kamen. May I just ask, what complications do you expect postoperatively?"

Dr. Kamen sighed. "In my experience, ventricular arrhythmia is our main worry. Right now we can only monitor him. He's on high doses of beta-blockers. In a couple of months we'll do programmed electrical stimulation and see if we can take him off. Antibiotic prophylaxis, of course, is routine for a prosthetic heart valve, but the good news is that the myocardium is basically healthy and we expect no residual heart failure."

Newly relieved, Laura was about to thank the surgeon yet again when a knock on the door interrupted her.

"Sorry, I have an urgent call for Dr. Nelson," a pert, young a.s.sistant explained.

Laura rose from her chair to follow the young woman. "Excuse me, please."

"Take it in here," the a.s.sistant said as she led Laura back to the waiting area where Peg stood gripping the phone. She handed it to her daughter with a worried expression on her face.

"h.e.l.lo," Laura whispered.

"Laura, thank the good lord I got you," blurted Marcy Whitman in an anxious, high-pitched tone.

"Marcy?"

"It's me. Laura, I'm so sorry I have some bad news -"

"It's Mike and Kevin," Laura cut in. It was more statement than question.

"Yes, Mike and Kevin. Steve has plans to leave with them for Alaska tomorrow. The boys saw the plane tickets."

"To Alaska?" Laura's knees buckled and she grabbed the desk for support.

"Mike called a little while ago. I warned him not to let Steve know he told me. The boys are really confused - scared."

"Marcy, did you say tomorrow?" Laura felt her world swirling. She was losing Mike and Kevin. She started to sway and Peg reached to steady her.

"That's what Mike said. Can you get your lawyers to stop him? Alaska's so far away it's easy to get lost. I remember my cousin's kid went there when he got in some kind of trouble and n.o.body ever heard from him again."

"My lawyer is here in Philly with me," Laura spoke as calmly as she could. "I'll call him right away. I can't let Steve take them. Oh, Marcy, thanks for being there and for letting me know."

"We're all praying for you, Laura. I'm here, if there's anything I can do."

Laura hung up the phone and whirled around. "Where's Dad?" she asked her mother, panic flashing in her green eyes.

"He just took the girls down to the vending machines," Peg explained. "Tell me what's happening."

"I've got to see Greg. Steve's taking Mike and Kevin to Alaska!"

Peg gasped. "What? Can he do that?"

"Tomorrow, Mom. Greg's working at the hotel. Can you call him and tell him to come right over? I need to check on Patrick now, but I'll be back by the time Greg gets here."

Laura stood by Patrick's bedside in the surgical intensive care unit. It was strangely quiet except for the beeping of monitors, the hum of machines, and the occasional doctor's beeper. As she glanced around, she saw how a roomful of children could be so quiet. Most were on ventilators, deeply sedated, others too sick or weak to even babble or cry. So eerie and profoundly sad. She was surprised to see so many diverse faces - Arab, Indian, Asian, black, and white faces, all with one thing in common: a desperately ill child struggling to emerge from a dangerous yet life-saving surgical procedure. Laura recalled that most of those Siamese twin separations had been done at CHOP, but never in her worst dreams had she ever thought she'd be here, totally helpless, in street clothes no less, by the side of her own critically ill child. Even with that heart murmur, Patrick had always been so healthy, so carefree. Sure, everybody said they'd spoiled him. Steve made no pretense that Patrick was his favorite and for reasons buried deeply in her very being, Laura acknowledged that Patrick held a special place in her own heart. Yet despite this undisguised favoritism, he was just a sweet little boy.

And here he lay, so pale and still. Though his chest was covered loosely with gauze, Laura knew what lay beneath. They'd split his chest from just below the neck to the umbilicus to reach the ma.s.sive tumor in his heart - and she'd never even suspected a medical problem. Had she been so wrapped up in her own surgical conquests that she'd missed this horrible thing growing in her own little boy? She should have overruled the pediatric cardiologist and had him checked more frequently.

Amid a maze of tubes, all of which Laura recognized so well, Patrick did not move. The clear plastic endotracheal tube, which extended into the main bronchial tube leading to the lungs, was taped to his face and secured with a strap around his neck, the other end connected to the rasping ventilator. She walked around to look at the settings. Still set on mandatory, which meant that the machine was driving each breath. So far no signs of spontaneous breathing, but it was too early to expect this. Next she checked the gastric tube draining his stomach and found a yellow tinted liquid with flecks of mucus. There was a Foley catheter draining his bladder and the urine in the plastic collection bag looked normal, a clear pale yellow. The wires attached to his flesh were connected to the EKG monitor at the left-hand side of his bed, displaying every heartbeat. As she expected, there was a catheter in the large subclavian vein to infuse blood, antibiotics, and electrolytes and to monitor pulmonary artery pressure and heart function. The insertion was just below the right clavicle and protected by a large, bulky dressing.

Though she knew that her child would still be heavily sedated, she wasn't prepared for the awful stillness - except for the wheezing of the ventilator and the heart monitor's beeping. Surrounded by the frenetic activity so characteristic of ICUs everywhere, Laura stood as if paralyzed.

As she closed her eyes, Tim Robinson's words floated through her mind again: "Laura, I know what you're thinking, but these tumors are silent. Silent until they cause an arrhythmia or heart failure. There's no way that you or anyone would have a clue that he had a serious problem until very late. This has absolutely nothing to do with the patent foramen. Nothing."

"If only I'd taken him in to be checked or gotten an X-ray or an EKG -" she remembered saying.

"You know very well that these things aren't routine in healthy kids. They would have thought you were paranoid."

She heard Tim's real voice then and felt a hand on her shoulder. She opened her eyes.

"Laura, that lawyer is outside the ICU looking for you. Some kind of emergency? I couldn't let him in."

"Greg's here? Tim, I have to see him."

"What's wrong?" He squeezed her shoulder. "That phone call?"

She nodded. "I'll tell you about it later. Can you stay with Patrick, just in case he wakes up? I'll be back as soon as I can."

"Sure. Okay." Tim slid onto the lone chair with a tired groan.

After filling Greg in on Steve's plan to take the boys to Alaska, Laura returned to her son's bedside. Soon after, she slept fitfully in the surgical on-call room across from the ICU. There were four narrow cot-like beds and one unis.e.x bathroom for the house staff that wandered in and out all night, thanks to their beepers. All shared the same shower, and the shelves were kept stocked with clean surgical scrubs. Tim Robinson slept there often and, without official permission, offered the off-limits room to Laura after finding her dozing on her feet by Patrick's bed earlier when he himself awakened in the chair beside the boy's bed. The child was still too heavily sedated to recognize her, but between lapses of fretful sleep, she rose throughout the night and walked across the hall, trying to stay out of the way of the doctors and nurses ministering to the desperately ill children in the beds all around her.

At three in the morning she'd returned to the narrow bed across the hall and drifted wearily back to sleep. Almost simultaneously, three individual beepers sounded, waking the occupants of the other three beds who immediately jumped up and bolted across the hall. A code - cardiac arrest. Patrick! Oh G.o.d, no, she prayed. He would be most vulnerable to fatal arrhythmias as he emerged from the heavy sedation, which was why she insisted on being nearby to calm him if he panicked. She jumped off the bed, fumbled for her gla.s.ses, and followed the others into the hall, running directly into one of the doctors rushing into the ICU. It was Tim.

"Tim!"

"Not now, Laura."

Laura bolted toward Patrick's bed. Curtains were drawn around his cubicle and she felt her heart lurch as she jumped to the ghastly conclusion that Patrick had died, that they'd already p.r.o.nounced him while she slept.

She felt a strong arm around her shoulders. "Get a grip, Laura," Tim said sternly. "Patrick's okay. They're just adjusting the ventilator settings, trying to wean him off."

Laura gasped with relief and finally saw the commotion in the opposite corner, crowded with the on-call doctors and ICU nurses. A young girl had coded. The one with Eisenmenger's syndrome, caused by a congenital defect in the heart that produces pulmonary hypertension. If not surgically corrected in time, damage was irreversible. The four-year-old daughter of a Saudi prince had already been cyanotic when she reached CHOP, and Laura and Tim had discussed her pessimistic prognosis despite the heroics of an experimental surgical technique. Laura's professional instincts told her that they'd lose this child, and she was almost ashamed as she thanked G.o.d that it was not her son.

Peeking behind the curtains, Laura confirmed that Patrick was indeed stable - as stable as a child could be a few hours after a huge tumor had been carved out of his heart. She stood there watching the respiratory specialist tweak the dials to ensure the precise combination of pressure and gases to support Patrick until he could breathe on his own.

Would G.o.d continue to punish Patrick? It was she who should be punished, she prayed. It was she, not her innocent son, who had sinned.

As he strode across his hotel room Monday night to answer the ringing phone, Greg dropped the printed confirmations for the flight back to Tampa onto the bed.

"h.e.l.lo?"

"Greg, it's Carrie."

"Oh, hi."

"You sound disappointed."

"I...I thought you might be Celeste."

"What? Don't tell me you two still haven't made up?"

Greg hesitated. "Carrie, I need to get back to Tampa. I did stand her up Friday night."

"Anything I can do?"

"You know, yesterday I mentioned you coming up here. Have you made a decision yet about the Palmer situation? About Elizabeth going with them, I mean."

Carrie cleared her throat. "She left with them yesterday and I'm a nervous wreck. I just can't see leaving town right now."

"I understand," Greg rea.s.sured. "Carrie what you're doing is already over and above. Now that Laura's son made it through surgery, I've decided to head back to Tampa tomorrow."

"So surgery went okay?"

"No cancer, but he's still in the ICU."

"That's great news. And Laura's legal troubles should be clearing up now that the charges against her have been dropped. I was so relieved that Judge Potter came through. The draft press release you worked out with the D.A. today worked like a charm," she added.

"I spent almost my whole day on the phone back and forth with Jake Cooperman himself. Politics. We finally agreed that quote, the defense working with the prosecutor were able to determine Laura's innocence, etcetera, etcetera."

"And the fact that he's going public with Frank Santiago as the new suspect should be all over town by tomorrow. I'm glad we got Molly out of here, but I'm not sure I should have let Elizabeth go."

"Listen, you hang in there. When I get back we'll sit down and figure out how long the girls should stay put on the island."

Carrie exhaled. "Greg, you read my mind."

Moments later, the phone rang again. Greg's heart filled with the thought that it might be Celeste, but it was Peg Whelan. After learning the bad news from Traverse City, he rushed over to find Laura at the hospital and then back to the hotel to immediately set up a conference call with Carrie, Chuck, and Rob to develop a strategy for this new Nelson bombsh.e.l.l. They would retain a Detroit law firm to work with the Michigan courts to get a restraining order in the morning, and Greg would fly directly to Detroit to expedite. In the meantime, Rob would work the custody angles out of Florida, and Chuck would fly to Traverse City to track the boys' whereabouts, ready to take them to Laura if and when they got a court order. Because Rob would be in the Tampa courts all day tomorrow, Greg designated Carrie as the continuity person at the office to coordinate any loose ends and facilitate communications between the courts in Florida and Michigan, and Laura in Philadelphia. As he worked out the schedule in his mind, Greg realized he had forgotten to tell Laura about the subpoena. Sam Sanders, that sleazy attorney for the Ruiz family, was going forward with the case against the hospital and the ER doctor, and he planned to serve Laura with a subpoena as a hostile witness.

It was after midnight by the time Greg hung up the phone for the last time that night. Though he tried several more times, he never reached Celeste.

CHAPTER THIRTY.