Compulsion by Keith Ablow Page A

ward at night, and watching Lilly breathe.  I tried to imagine the emotions she might have experienced each time she buried a hypodermic needle in her flesh, soiling her insides.  I didn’t settle on rage or panic or even sadness.  For the moment, she could shed the pretense of normalcy.  Her sham self-esteem and self-confidence could melt away, yielding to her real unconscious vision of herself as dirty and infected.  Trash.  Like someone finally allowed to drop her arms after holding them aloft for hours, she could give up the struggle to fend off her demons and, instead, let them spirit her away.
    "Lilly," I said softly.
    She didn’t stir.
    A little louder:  "Lilly."
    She slowly opened her eyes, but didn’t respond.
    "It’s Dr. Clevenger," I said.  "I told you I’d stop by after the procedure."
    She took a dreamy breath, then closed her eyes again.  "They gave me something for the pain."
    "Would you rather sleep?  I could try to stop back tomorrow."
    She looked at me, squinting to focus.  "No.  Stay."
    I walked the rest of the way to her bedside, pulled up a chair, and sat down.  "How did it go?" I asked.
    "Dr. Slattery says the infection had gotten into the bone.  They had to take a piece of it."
    I nodded, looking at the steel rods holding he leg together.  "Opening the wound and letting the bad stuff out should prevent that from happening again," I said, picking up on the metaphor for her psychological trauma that I had started to build during out last meeting.
    "Right," she whispered, obviously unconvinced.
    I remembered telling her that I wasn’t afraid to see the truth — even if it was ugly.  I needed to prove that that was true in the physical realm, in order to coax her to reveal her emotional wounds.  I leaned forward and touched one corner of the gauze bandage.  "Do you mind if I take a look?" I asked.
    She shook her head.  Her gaze focused intently on my hand.
    I gently pulled the gauze back far enough for me — and Lilly — to see the incision.  She turned her head immediately and stared at the wall.  I kept looking at the dissected layers of skin, fat, and muscle.  Sterile gauze, soaked with bloody drainage, filled the base of the wound, which clearly went bone-deep.  "Good," I said.
    "Good?" she said bitterly.
    "All the tissue they left looks healthy," I said.
    She rolled her eyes.
    "The last thing you’d want," I said, "would be a surgeon who wasn’t willing to follow the infection all the way to its source."  I noticed a tear start down Lilly’s face.  I grabbed a tissue from the nightstand and blotted her cheek dry.
    She turned her head toward me, but said nothing.
    "It’s really no different that what I try to do," I said.  "I have to help my patients trace the roots of their pain as deep as they go."
    A few seconds passed.  "What if your patient doesn’t know what caused the pain?" she asked.
    " Asking the question is half the answer ," the voice at the back of my mind said.  " She wants to take the journey.  At heart, everyone wants the truth ."
    My breathing slowed.  My eyes closed an instant, then reopened.  "If you don’t know, then we both have to find the courage to figure it out," I said.
    Lilly blushed.  "I have trouble talking about myself," she said.
    "Why is that?" I asked.
    "I guess I think it’s safer to keep things inside."
    "Safer?"
    She didn’t respond.
    "What’s the danger in opening up?" I asked.
    "People who tell too much about themselves end up..."  She stopped short.
    "End up... what?" I asked.
    "I don’t know."  Her brow furrowed.  "Alone, I think."
    That statement spoke volumes about Lilly.  Fabricating an illness — lying — had brought her close attention from a team of doctors.  Coming to terms with the real source of her suffering, especially if that source was abuse at her grandfather’s hand, would end her relationship with him, and possibly with other family members as well.  The risk of abandonment was real and had