I sat up in bed. "What's happening?"

"Billy escaped from Payne Whitney two and a half hours ago."

I sat up. "Escaped? How?"

"Believe it or not, he just walked out of the emergency room. He'd been complaining of a cough for hours. They sent him down with an attendant for a chest x-ray. As far as I can tell, the guy kind of lost track of him."

That was easy to believe. Psychiatry units that aren't built for violent offenders don't have true security protocols in place. I had seen inpatients wander away from "smoke breaks" when they were taken outside for a quick cigarette, from AA meetings that took place in another building on campus, and from "supervised" grounds passes to the hospital gift shop.

"I'm sure they've alerted the police in Manhattan and given them Billy's description," I said. "They can pick him up on a Section Twelve and rehospitalize him against his will."

"Actually, they can pick him up without a Section Twelve, if they find him. Billy's timing was flawless. As of seven p.m. last night, there was a warrant for his arrest. Tom Harrigan had everything set to go, including a court order for Billy's extradition back to Massachusetts. They planned to have New York Police arrest him on the locked unit at six a.m. today. Two officers would have accompanied him on a flight to Logan at seven-thirty."

"I'm having lunch with Julia Bishop today. She's coming to Boston," I said. "I'll find out if she has any sense where Billy might have gone."

"You called her, or she called you?" Anderson asked.

"She did," I said.

"Did she say why?"

"No. But she sounded a little panicked."

"She'll be missing Garret's tennis tournament," Anderson said wryly.

"He's in a tournament?" I asked. "Today?"

"The Bishops sponsor a charity competition at the Brant Point Racket Club. Garret Bishop is the top seeded player in his age group. According to the newspaper, he's set to defend his singles title from last year."

"Business as usual," I said. "All the way around Darwin 's world."

"No stopping him," Anderson said. He paused. "Listen, you know I've never been convinced that Billy is guilty of murder. But I have to tell you, having him out of that hospital, on his own, really worries me. Because if he is the one who killed Brooke, he knows he has nothing left to lose."

Those words gave me a chill because I remembered Billy telling me the same thing at the end of our meeting. "If I were you, I'd add a few cruisers to those Range Rovers outside Bishop's 'watch house.' Billy wasn't happy with his father hospitalizing him."

"I tried," Anderson said. "Bishop thanked me for my concern and refused my offer."

"True to form," I said.

"I'll call you right away with anything new," he said.

"Same here." I hung up.

I lay back and stared into the darkness, my heart racing, thinking how I could really use that scotch I had set aside at Sir Galahad's. I wondered where Billy Bishop might be at that very moment. Would he have sought refuge at a homeless shelter? Would he bunk with a friend in Manhattan whose parents were out of town? Was he brazen enough to hide out at the Bishops' own penthouse? Or would he be huddled in a corner of the Port Authority, over on Eighth Avenue, waiting for a Bonanza Bus to take him back to Hyannis, where he could catch a ferry to Nantucket?

More important, what was he thinking of-escape or revenge?

Tuesday, June 25, 2002

I talked with Anderson before leaving my loft in the morning and learned that Billy was still at large. I had a couple hours before my 1:00 p.m. meeting with Julia, so I headed to Mass General for my third visit with Lilly Cunningham.

I expected to see her doing better, but she looked worse. Her skin was even paler than before. Her breathing was erratic. As her eyes followed me in from the doorway, she squinted to bring me into focus.

I pulled an armchair to the side of the bed and sat down. Above me, to the right of the window, the IV tree had grown new branches. A total of five hanging bottles and plastic bags dripped into the central line running into Lilly's subclavian vein. I looked at her leg, still suspended midair, and saw that another serpentine incision had been cut into the flesh to help her abscess drain.

"It's in my heart," she said weakly.

I knew she was talking about the infection having traveled to her heart, probably to the pericardial sac that surrounds it or to the valves deep inside its chambers. But I heard her words in another way, too. Because it was also true that the psychological trauma which had caused her to inject herself with dirt had reached the center of her being, the emotional toxin pumped now with the blood to every tissue, sparing only her central nervous system, walled off as it is by that baffle of membranes known as the blood-brain barrier. The lines of conflict were at last clearly drawn: Whatever had happened to Lilly as a girl had finally laid siege to the kingdom of her body, leaving the soul, and its own miraculous ability to heal, as her last defense-and my greatest ally.

I noted that, during my three meetings with Lilly, she had never had any visitors. Patients with Munchausen's often end up isolated; family and friends become enraged when they learn they have been caring for a person who has made herself sick. A wave of sadness-and, strangely, embarrassment-swept over me. The thought of Lilly suffering so terribly, without a hand to hold, made me want to reach out to her even more.

"The sadness and shame you feel is hers, not yours" the voice at the back of my mind whispered. "Help her own it."

"The last time I came to see you," I said, "you told me how frightened you were of being alone. Where does that fear come from, do you think?"

She cleared her throat. "Probably from losing my father," she said. She closed her eyes and slowly reopened them. "I haven't stopped missing him. I've thought of him every day since I was six."

"There are people you love today?" I said.

"Yes, of course. My husband. My mom and grandparents. A few good friends."

I leaned closer. I decided to gamble that Lilly's fear of being alone would translate into an even more imposing fear of death. "This is a very important moment, Lilly," I said quietly. "The infection is overwhelming your defenses. You could die. And that means saying good-bye to your husband and your mother and each of your friends. It means being completely and utterly alone." She seemed to be listening to me. "The only way to stay with the people you love is to open up to them, to let the truth flow. If you do that, I think all the stress you're under will start to fade away and your body will start to heal itself."

She looked away and shook her head. Several seconds passed. I sat still. Nearly a minute more went by. I was ready to gamble again by telling Lilly that I knew she had injected herself with dirt. But, of a sudden, she turned back toward me. Her eyes had filled with tears. "I did this," she whispered.

"Tell me what you mean," I said.

"I used a needle to inject… I caused the infection. I did this to myself."

I nodded. "I understand," I said.

She started to cry.

"I understand," I said again. I waited while she dried her eyes. "Can you tell me why you did it?" I asked.

"I don't know," she said. "I'm so ashamed."

"But she does know. Ask about the shame" the voice said.

"Is there something that happens to you around the time you inject yourself? Are there memories that bother you?"

She didn't hesitate this time. "I do it," she said, "when I feel filthy. I do it to punish myself."

"And what makes you feel filthy?" I asked.