My guilt.

Up ahead, Elizabeth made a right at the big semi-phallic rock and there, on the right, was our tree. Our initials were, yup, carved into the bark:

E.P.

+

D.B.

And yes, a heart surrounded it. Under the heart were twelve lines, one marking each anniversary of that first kiss. I was about to make a wisecrack about how nauseating we were, but when I saw Elizabeth's face, the freckles now either gone or darkened, the tilt of the chin, the long, graceful neck, the steady green eyes, the dark hair braided like thick rope down her back, I stopped. I almost told her right then and there, but something pulled me back.

"I love you," I said.

"You're already getting laid."

"Oh."

"I love you too."

"Okay, okay," I said, feigning being put out, "you'll get laid too."

She smiled, but I thought I saw hesitancy in it. I took her in my arms. When she was twelve and we finally worked up the courage to make out, she'd smelled wonderfully of clean hair and strawberry Pixie Stix. I'd been overwhelmed by the newness of it, of course, the excitement, the exploration. Today she smelled of lilacs and cinnamon. The kiss moved like a warm light from the center of my heart. When our tongues met, I still felt a jolt. Elizabeth pulled away, breathless.

"Do you want to do the honors?" she asked. She handed me the knife, and I carved the thirteenth line in the tree.

Thirteen. In hindsight, maybe there had been a premonition.

It was dark when we got back to the lake. The pale moon broke through the black, a solo beacon. There were no sounds tonight, not even crickets. Elizabeth and I quickly stripped down. I looked at her in the moonlight and felt something catch in my throat. She dove in first, barely making a ripple. I clumsily followed. The lake was surprisingly warm. Elizabeth swam with clean, even strokes, slicing through the water as though it were making a path for her. I splashed after her. Our sounds skittered across the lake's surface like skipping stones. She turned into my arms. Her skin was warm and wet. I loved her skin. We held each other close. She pressed her breasts against my chest. I could feel her heart and I could hear her breathing. Life sounds. We kissed. My hand wandered down the delicious curve of her back.

When we finished – when everything felt so right again – I grabbed a raft and collapsed onto it. I panted, my legs splayed, my feet dangling in the water.

Elizabeth frowned. "What, you going to fall asleep now?"

"Snore."

"Such a man."

I put my hands behind my head and lay back. A cloud passed in front of the moon, turning the blue night into something pallid and gray. The air was still. I could hear Elizabeth getting out of the water and stepping onto the dock. My eyes tried to adjust. I could barely make out her naked silhouette. She was, quite simply, breathtaking. I watched her bend at the waist and wring the water out of her hair. Then she arched her spine and threw her head back.

My raft drifted farther away from shore. I tried to sift through what had happened to me, but even I didn't understand it all. The raft kept moving. I started losing sight of Elizabeth. As she faded into the dark, I made a decision: I would tell her. I would tell her everything.

I nodded to myself and closed my eyes. There was a lightness in my chest now. I listened to the water gently lap against my raft.

Then I heard a car door open.

I sat up.

" Elizabeth?"

Pure silence, except for my own breathing.

I looked for her silhouette again. It was hard to make out, but for a moment I saw it. Or I thought I saw it. I'm not sure anymore or even if it matters. Either way, Elizabeth was standing perfectly still, and maybe she was facing me.

I might have blinked – I'm really not sure about that either – and when I looked again, Elizabeth was gone.

My heart slammed into my throat. " Elizabeth!"

No answer.

The panic rose. I fell off the raft and started swimming toward the dock. But my strokes were loud, maddeningly loud, in my ears. I couldn't hear what, if anything, was happening. I stopped.

" Elizabeth!"

For a long while there was no sound. The cloud still blocked the moon. Maybe she had gone inside the cabin. Maybe she'd gotten something out of the car. I opened my mouth to call her name again.

That was when I heard her scream.

I lowered my head and swam, swam hard, my arms pumping, my legs kicking wildly. But I was still far from the dock. I tried to look as I swam, but it was too dark now, the moon offering just faint shafts of light, illuminating nothing.

I heard a scraping noise, like something being dragged.

Up ahead, I could see the dock. Twenty feet, no more. I swam harder. My lungs burned. I swallowed some water, my arms stretching forward, my hand fumbling blindly in the dark. Then I found it. The ladder. I grabbed hold, hoisted myself up, climbed out of the water. The dock was wet from Elizabeth. I looked toward the cabin. Too dark. I saw nothing.

" Elizabeth!"

Something like a baseball bat hit me square in the solar plexus. My eyes bulged. I folded at the waist, suffocating from within. No air. Another blow. This time it landed on the top of my skull. I heard a crack in my head, and it felt as though someone had hammered a nail through my temple. My legs buckled and I dropped to my knees. Totally disoriented now, I put my hands against the sides of my head and tried to cover up. The next blow the final blow hit me square in the face.

I toppled backward, back into the lake. My eyes closed. I heard Elizabeth scream again she screamed my name this time but the sound, all sound, gurgled away as I sank under the water.

Eight Years Later

Another girl was about to break my heart. She had brown eyes and kinky hair and a toothy smile. She also had braces and was fourteen years old and' Are you pregnant?" I asked.

"Yeah, Dr. Beck."

I managed not to close my eyes. This was not the first time I'd seen a pregnant teen. Not even the first time today. I've been a pediatrician at this Washington Heights clinic since I finished my residency at nearby Columbia-Presbyterian Medical Center five years ago. We serve a Medicaid (read: poor) population with general family health care, including obstetrics, internal medicine, and, of course, pediatrics. Many people believe this makes me a bleeding-heart do-gooder. It doesn't. I like being a pediatrician. I don't particularly like doing it out in the suburbs with soccer moms and manicured dads and, well, people like me.

"What do you plan on doing?" I asked.

"Me and Terrell. We're real happy, Dr. Beck."

"How old is Terrell?"

"Sixteen."

She looked up at me, happy and smiling. Again I managed not to close my eyes.

The thing that always surprises me – always – is that most of these pregnancies are not accidental. These babies want to have babies. No one gets that. They talk about birth control and abstinence and that's all fine and good, but the truth is, their cool friends are having babies and their friends are getting all kinds of attention and so, hey, Terrell, why not us?

"He loves me," this fourteen-year-old told me.

"Have you told your mother?"

"Not yet." She squirmed and looked almost all her fourteen years. "I was hoping you could tell her with me."

I nodded. "Sure."

I've learned not to judge. I listen. I empathize. When I was a resident, I would lecture. I would look down from on high and bestow upon patients the knowledge of how self-destructive their behavior was. But on a cold Manhattan afternoon, a weary seventeen-year old girl who was having her third kid with a third father looked me straight in the eye and spoke an indisputable truth: "You don't know my life."