“Where the fuck do you think you’re going?” Rick was still flushed from the meeting.
“Hospital,” he spat out. “School just called, I—”
Rick’s expression softened a little. “What’s a matter? Toby okay?”
He had no idea. “Yeah, I’m sure he’s …” Sean trailed off, not knowing what to hope for, what to imagine. The elevator made a binging sound before it opened. He was already inside and jabbing at the button when Rick told him to go. The doors closed on Rick’s solemn, single-father nod that was supposed to be supportive but instead terrified him.
It was surreal, pulling up to Mount Sinai and pushing through the heavy doors to the pediatric emergency room. The scene was just as chaotic as it had been when he’d come with Calvin, but now every crying child and bloody bandage shot him full of such dread that he thought he might pass out. His eyes darted to the gurneys lining the walls. No Toby.
The attendant pointed Sean to a small room sectioned off by a curtain. Bev Shineman stood in front of it, frowning, waving her cell phone around to find a signal.
“Sean,” she said when she saw him. Her voice was maddeningly calm. “Toby’s unconscious, but he’s stable.”
“Unconscious?” Could he go back and change his wish to a broken arm or stitches? His heart raced as he parted the curtain. Toby lay still on the white sheets, an oxygen tube running into his nose and an IV taped to his left arm. His stomach twisted and he felt light-headed. This wasn’t happening. This was not the way you were supposed to see your child.
It was cold in the room. Too cold. He reached out to touch Toby, who looked so delicate, so fragile, in his non-sleep. He ran his hand gently through Toby’s hair. “Tobe, buddy. You’re gonna be okay. I’m here and I’m not going anywhere.”
Toby had been alone in the scary cold room. How could they just leave him there like that? He called to Shineman who was still outside the curtain.
She peered in, then stepped over the threshold delicately. “Are you okay? This must be very hard for you.”
“What the hell happened?” He was livid, terrified, helpless. “What’s wrong with him?”
“Let’s wait and talk to the doctor,” Shineman said. “He knows much more than I do.”
“What the hell happened to Toby?” He wasn’t a screamer, but now he couldn’t stop. “Where’s the fucking doctor?”
Fast footsteps stopped outside the room and Jess pulled back the curtain. Her face was red and she was out of breath. “How is he?” she asked.
“Do you know what happened?” He was desperate for answers. Why was nobody giving him any?
She nodded and tried to catch her breath. “Mr. Trencher said they were doing a relay race and halfway around the track Toby went down.” She was talking fast and her eyes looked scared.
“Neither of us saw this firsthand,” Shineman interrupted.
Jess kept talking as if Shineman weren’t there. “When he saw Toby shaking and grabbing his chest, he performed CPR and had one of the kids call 911.”
Then it hit him. This was his fault. He’d done this. Despite the temperature in the room, he was covered in a panicky sweat.
“I have a hunch we’re very close,” Dr. Altherra had said when she got the new Conners scales. “This is how we do it.”
“Do what?” he’d asked.
“Find the right amount for Toby. We keep going up ’til it hits, slowly and carefully.” And we watch closely to make sure we haven’t gone over. I’ve done this hundreds of times,” she assured him. “Don’t worry.”
Worry was now the tamest emotion he felt. Then he thought: Ellie. He had to call Ellie. She would never forgive him. And she’d be right. His fault. This was all his fault. There was no one else who could share the blame—or the guilt.
He turned to Shineman. “It’s the medication.” He was afraid if he moved, his legs would give out, his body would crumple. “This is just like those stories I read online …” He turned to Jess. “But he seemed fine, right? You said he was fine.” His mind raced as he tried to remember something, anything he might have missed, a clue that Toby wasn’t responding as well as everyone said he was. It didn’t matter. He was Toby’s father, he should have known. Then a wave of nausea washed over him. Because on some level he must have known. And he’d done it anyway. He’d been an idiot, agreeing to raise the dosage, to give him the medication in the first place. What had been the point? To turn Toby into a super-student, some robot that could keep up with the other overachieving children at this Ivy-League factory? When had he decided that Toby’s academic performance was more important than his health? What had he been thinking?
Jess opened her mouth to speak, but Shineman cut her off. “Sean, you should try to calm down.”
“For Toby’s sake. You’ll talk to the doctor when he comes in, but I don’t believe this could have been caused by the medication. It just doesn’t add up.”
“Where the hell is the doctor?” It came out louder than he’d thought it would, but it didn’t feel loud enough. He pulled back the curtain. “We need a doctor in here,” he yelled into the hallway. “Hello?”
“We should give Sean some space,” Shineman said.
“I don’t want space. I want to talk to a goddamn doctor!”
“I’ll get one,” Jess said, and looked at Sean with an unguarded openness he hadn’t seen since The Night. She was gone a second later. He wished Shineman had gone instead.
“Don’t jump to conclusions, Sean,” Shineman said. “That’s not useful now.”
His head spun with the horror stories Altherra and Dr. Jon had told him to disregard. “There was a story online about a boy on Ritalin who dropped dead while he was riding his skateboard.” Dropped dead. God it was a horrible expression. He fought the tears burning behind his eyes.
“You have no idea what caused that boy’s death.” Shineman was trying to be reasonable. He wanted to strangle her. “Who knows if he had a preexisting condition? There are a million things that could have hurt that child that had nothing to do with the Ritalin he was taking to treat his ADD. You’re a good father, Sean. You did not hurt Toby.”
He wanted to hurt her. “Can you just stop talking,” he snapped. Why was she here, anyway? “Where’s the fucking doctor?”
Jess ushered the doctor into the room. He was unshaven and looked like he hadn’t slept in a week.
“This is Dr. Schwartz,” she said.
It looked like it took a lot of effort for Schwartz to extend his hand and shake Sean’s. “Your son had an arrhythmia—an irregular rhythm of his heart,” he said. “Which deprived his brain of oxygen for a short time.”
“His heart stopped beating?” Sean couldn’t believe he was standing here having this conversation, that this whole thing was really happening. “For how long? What does that mean?”
Schwartz rubbed his eyes. “No one knows,” he said. “We have to wait.” He wasn’t in a coma, Schwartz said. He kept calling Toby’s condition a persistent vegetative state. Vegetative. Like vegetable. For a moment, it was as if all the molecules that made up Sean’s body, his brain, the universe, had come undone. He wasn’t sure what the purpose of anything was.
Schwartz said Toby’s organs were functioning on their own but that there was no way of knowing how extensive the damage was—especially to his brain—until Toby regained consciousness. If he regained consciousness.
Sean took deep breaths to avoid vomiting. “This is my fault,” he said, shaking. He told the doctor about the Metattent Junior. “That’s what this is from, right?”
Dr. Schwartz crossed his arms in front of his chest. He wore a thermal T-shirt under his green scrubs. He pursed his lips in thought. “I don’t know,” he said, finally. “What I do know is methylphenidate is an amphetamine. Amphetamines accelerate the heart rate, and if someone is exercising and it increases to a dangerous level yes, that can cause prob
lems.”
“So … but …” The room was starting to sway. “It’s from the pills, right?”
“Look,” he said, running his hand through his hair. “Not that this has much to do with your son’s case, but I took Ritalin all through med school as a study drug. Everyone I know did. This kind of reaction is extremely rare.”
Sean assumed this piece of information was supposed to make him feel better. He wanted to take the guy by the shoulders and shake him as hard as he could. “So why is this happening? Why is my son unconscious?”
“I wish I could tell you more. All I can say is that in healthy children with no preexisting condition, this kind of thing is very rare. Very.” He paused. “Does he have any kind of heart condition that you know of?”
“No, of course not.” Toby’s heart was fine. At least he thought it was. He did a quick mental inventory of his dead relatives, cataloguing how they died. His father’s father died of a heart attack. Did that count? Maybe there was something buried in his genes that Sean should have known about, told someone about.
“He’s going to be okay, right?” Sean asked, focusing all his mental powers on the doctor’s brain and willing him to say yes. Yes. It was such a simple word.
“You have to understand,” the doctor said, “in any given population of children, there are always a few instances of sudden death whether they’re taking medication or not.” The word death hung in the air. This guy was brutal. Had he ever heard of bedside manner?
Dr. Schwartz tried to gloss over the ominous report he’d just given. “The good news is he’s still alive and he’s breathing on his own. Let’s hope he wakes up in the next forty-eight hours.” The doctor paused. “Because if he doesn’t, the chances that he will, get slimmer and slimmer. Mr. Benning, you should be prepared. This kind of thing can go either way.”
The doctor might as well have told him to prepare himself for the end of the world. Sean collapsed into the chair next to Toby’s bed and listened to the monitor’s hypnotic beeps. He wasn’t at all prepared, much less remotely willing to entertain the idea that Toby might … He couldn’t even think the word. He couldn’t bear it.
He had to call Ellie. And Nicole. Dick and Maureen. He had to get everyone on board so that Toby would not be alone for a second. He had a surge of energy when he realized there was something he could do. It wasn’t much, but it changed everything. He took out his cell phone but he couldn’t get reception.
“Fuck, fuck, fuck!”
“Go,” Jess said. “I’ll stay.”
Gratitude surged through him. “I’ll be right back,” he said to Toby. “I’m going to call Mommy.”
He left Ellie a message telling her to get into the city and come to Mount Sinai as soon as humanly possible. He told her that Toby was unconscious, but he didn’t tell her why. Why should he? At least not on her voice mail, not like this. That conversation could wait. Besides, the doctor didn’t say for sure it was the pills.
Sean also left a message for Ellie’s parents. Their machine said they were on a Queen Elizabeth cruise. Since they didn’t believe in cell phones, they wouldn’t get the message until they came home. Nicole was on her way.
When he got back to the ER, Shineman was gone, thank God. Jess watched Toby silently. She looked like she might cry.
“Thank you,” he said.
“Can I talk to you?”
A nod was all he could manage.
“I don’t know how to …” And then she was crying. “I noticed something earlier today at school. I don’t know how to describe it exactly, but Toby was acting, well, kind of off. I started to email you, but …” She took a deep breath, trying to stop crying, but the tears came in another wave. “I wanted to give it ’til the end of the day, to make sure Toby wasn’t just … coming down with a cold or something.”
His lungs quivered. “Off how?”
“There were no jokes, no smiles, no goofing around.”
Another surge of anger, no, hatred as he remembered Shineman’s constant nagging about Toby’s behavior. “That’s what the school wanted,” he said bitterly.
“He just didn’t seem like himself, is the only way to say it. He didn’t eat lunch again today. And I’m not sure about this, but … I think his left hand was twitching a little during reading.”
Sean closed his eyes, trying to imagine what it must have been like for Toby at school, before it happened.
“I didn’t want to jump the gun.”
“So you just let him suffer?” Jumping the gun could have prevented this. An easy phone call. An email. Toby’s life had been in her hands. He could never have imagined Jess would be the target of the kind of anger building in him.
“I made the wrong choice,” she said. “I’m so sorry.”
“Sorry? You’re sorry?” Screaming at her wasn’t going to change anything, but he couldn’t help it. “Look at him.”
He stared at Toby, rehashing every moment, every wrong decision along the way, wishing he could go back and do it all again. He was mad at Jess—furious—but not as mad as he was at himself.
She touched his arm, an offer of solace. But he didn’t want solace. He wanted Toby back.
“Get out,” he said, shaking.
“I’m so sorry.” She looked stricken, miserable.
“Could you just get the fuck out?!”
CHAPTER EIGHTEEN
SEAN’S EYES BURNED. HE RUBBED THE BRILLO SPROUTING FROM his cheeks. Somewhere around three a.m. they’d moved Toby into the Pediatric Intensive Care Unit, or pick-you as everyone kept calling it, like Toby had been specially selected, chosen as the sickest of the sick kids. The PICU, which circled back on itself in an endless loop, existed outside the parameters of the real world where time, space, life, and death were clear-cut concepts. Here, even the basics seemed surreal. The sound was muted, the light unnatural. Nurses padded around the hallways to incessant beeps. They seemed unaware of day and night as they tended to patients who, though not dead, were not fully alive either. Definitions were blurred. Sean’s head hurt.
He kept checking his cell phone, but it had died at some point. He sat and watched Toby, waiting for something to happen while the math circled through his brain: Toby hadn’t moved in twenty-six hours. He had another twenty-two hours left—just under a day—to pull himself out of it.
The throbbing lodged in the fleshy base of his skull. Had Ellie called him back on his dead cell? Why the hell wasn’t she here? He’d tried one more time, but again the call went straight into voice mail. Maybe she’d lost her phone, or it had been stolen and she hadn’t gotten his messages. That thought was better than the alternative—that she simply didn’t give a shit.
Seeing Nicole and Kat in the doorway caused something inside him to crumble. “God I’m glad you’re here.”
When Kat saw Toby, she buried her head in her mother’s fleshy stomach.
“We talked about this,” she told Kat. “It’s okay.”
Kat nodded, looking at the floor. This would probably traumatize poor Kat, but right now he didn’t care. He needed family. He needed not to be alone.
“How you holding up?” Nicole asked.
He shrugged to show he wasn’t holding up at all.
“Sean,” a voice whispered from the doorway. Dr. Altherra had slipped into the room. He vaguely remembered leaving her a message in the middle of the night.
“I’m so sorry,” she said. “I thought I’d come by to see how he was doing. I hope you don’t mind.”
She’d been the one to diagnose Toby, turning all the school’s bullshit into reality. She was to blame, at least as much as he was, and she was going to have to answer some basic questions. “We need to talk.”
He led her around the loop of the hallway and into the lounge, a hodgepodge of chairs and couches upholstered in purple and turquoise, while Nicole kept watch over Toby. Now, face to face with the doctor, his rage had drained away and he was left with a profound sadness. What was it about shrinks? One look at them
and all you wanted to do was cry.
“I’m terribly upset by this,” she said. “But there’s a very good chance this is all completely unrelated to the medication. I’ve given his doctor the pertinent information.”
“Come on, just admit you were wrong,” he said. He wanted to sound more angry, but desperation was winning out. “He never needed those drugs.”
“Sean, I understand your desire to reinterpret the facts.” She paused to show she was human. “I do.” She leaned forward in her chair. “But here’s how I saw it and still do see it. Toby was acting out because his lack of attention in class was causing him to fall behind. Three separate teachers filled out Conners scale questionnaires that without a doubt pointed to ADHD behavior. The medication focused him in class. His teachers saw results—that was clear from the questionnaires they completed. He was doing better. As for my part diagnosing the disorder, it was open and shut. I prescribe Ritalin and Metattent Junior frequently for ADHD and negative reactions are extremely rare. Extremely. Toby’s collapsing in gym class is very disturbing, and I’m honestly not sure what to make of it.”
The teacher questionnaires had factored heavily into the diagnosis and he realized he had no idea what they said. “I need to see the Conner things.”
“They’re in my office. I—”
“I need to see them.”
“I’ll send them to you this afternoon,” she said. “You’ll see that Toby—”
“Toby didn’t need those drugs.”
She set her mouth and stared at him impenetrably.
He didn’t know what to believe, and it didn’t matter anyway. Toby needed him and he was wasting his time with Dr. Altherra. “I need to get back.” There was nothing else to say. He pushed his chair away and headed into the hallway, which was unnaturally quiet for housing sixteen children. He tried not to look at the sick kids on his walk to Toby’s room, but the walls were made of glass so the nurses could see their delicate charges at every moment, from every possible location on the floor. These kids were not only sick, they were hanging on by a thread. He wondered how many of them would leave the floor alive. He wondered whether Toby would be one of them.