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"Tough as Nails"

“I would urge you to get here as soon as possible,” the hospital psychiatrist said. “How soon would that be?”

It was already late morning. How would she get there? Should she fly or try to drive? Questions pounded her brain. She’d never been to LA, with its legendary traffic. If she flew, wouldn't she still need a car? Wouldn't it be better to have her own? Could she make that seven-hour drive by herself? My god, she was pushing seventy. She dreaded the next forty-eight hours.

And what about Rylee and the animals? She’d need to make some arrangements for them. It didn't make any sense to bring Tucker with her, much as she would have liked her pooch’s company. But Rylee? No, she was staying home, too. She had school.

Meanwhile, Dr. Choi waited on the other end of the phone. “Sorry, I've been trying to think about how quickly I can get there. There's no way I can get there today. I have to pick Shelby’s sister up after school and make arrangements for the dog. But can I talk to her on the phone?”

“She’s still pretty out of it right now, but by tomorrow we're hoping she'll wake up.”

“Okay, I'll get there tomorrow, but it’ll probably be late afternoon. Will you be available then?”

“Yes. Have them page me when you arrive.” The psychiatrist left details for how she could find Shelby's room at the City of the Angels Medical Center.

Thirty minutes earlier, on the Wednesday after Labor Day, Elin Bergstrom had gotten a phone call that turned her life upside down—again. She cursed Ian for the hundredth time for leaving her with this mess to deal with. How was she, having never been a parent, despite her years of teaching children, supposed to deal with crises like these? Really, it just wasn't fair. Fair. Hah! Who said life was fair? Isn't that what Ericka always said?

Well, she could whine and mope or she could get busy figuring out what she needed to do to get over to LA.


She drove to Rylee’s school and got into the long line of cars waiting to pick kids up. God forbid a high school sophomore take the school bus home in fancy schmansy North Scottsdale. As she waited in the pokey line inching forward, she thought about what to tell Rylee. How much could that poor kid be expected to deal with? As she approached the pick-up spot, she spied Rylee talking to a group of kids, both boys and girls. So cute in her skinny blue jeans and white tank top, long red hair pulled back into a sleek ponytail. When Elin arrived at the spot, she opened the passenger-side window and yelled “Rylee.”

“Gotta go,” she heard her say, waving goodbye to the other kids. Was she finally making some friends?

“Hi, Grandma.”

“Hey. How’d school go today?” Although it took all of her self-control not to blurt out the bad news about Shelby, she’d decided on small talk for the drive home, waiting until they were eating their snack to tell Rylee about her sister.

“Okay, I guess. Same old, same old, really.”

Why did adolescents have to be so difficult to talk to? “How was soccer practice?”

“Pretty good, actually. I scored two goals. When does it cool off here?”

“Not ’til the end of October. Two goals are great. Are you enjoying soccer again?”

“Starting to. It’s easier when you know the other girls, I guess. The group’s hard to break into. They’re pretty tight with each other.”

“Yeah, you’ve mentioned that before. I’m sure it’s been challenging being new to a group that’s been together for a while.” Rylee still resented having to move in with Elin, away from all her friends and the life she’d had in Bethesda, MD.

“Did you get your hair done today? It looks nice.” Elin had made a trip to the salon earlier, to have her newly gray hair cut into a stylish bob. As a gift to herself after Ian died she’d let it go gray. So what if it made her look older?

They arrived home and Elin pulled the Audi into the garage. As they walked into the house Elin said, “Rylee, after you put your stuff away, before you get started on your homework, let’s have a snack. There’s something I need to talk to you about.”


Elin walked into the kitchen, waiting for Rylee. What could they have as a snack? She should have something healthy, struggling as she was with her weight, but she wanted something carb-y and bad for her.

A few minutes later, Rylee walked in and took a seat at the granite island in Elin’s large sun-filled kitchen.

“Okay, so here’s our snack options. Yogurt, fruit, guacamole and chips, cereal, a smoothie—”

“I vote for guac and chips.”

“You got it.” The closer she got to starting the conversation, the shakier she felt.

“So, Grandma, what’s going on?”

Elin focused on opening the guacamole container and getting the chips out, still unsure how to begin. “I got a call from a psychiatrist at a hospital in LA a little while ago.”

“About what?” Rylee dipped a blue corn chip into the guac and shoved it into her mouth. “Do we have any diet coke?”

“In the fridge.”

As Rylee got up to get her drink Elin said, “She called to tell me that Shelby is in the hospital—”

“What’s wrong this time?”

“She’s in the ICU following a drug overdose.” Elin grabbed a handful of chips and put them on a napkin, waiting to see Rylee’s reaction.

“Shit, really? Is she okay?”

“I’m actually not sure. From what Dr. Choi said, it sounds serious. I have to drive over there tomorrow. I’m not looking forward to it.” Probably shouldn’t have said that.

“Did you talk to Shelby?”

“I asked to but the doctor said she’s in a coma—”

“A coma! Shit, she’s really fucked herself up this time.”

Elin gave her a warning look about her language. Her parents Drew and Meredith had been very permissive with both girls when it came to language, and both had potty mouths.

“Sorry, Grandma.”

Something about her apology caused Elin’s eyes to fill. Rylee noticed right away.

“Grandma, I’m sorry about my reaction, I am. But I’m tired of Shelby’s antics and screw-ups. I lost both of my parents, too, you know. And you don't see me—”

“I know, sweetie. It’s just that I’m really worried. Did you know she was using drugs?”

“Weed, of course. But not anything more than that. It was always her drinking that Mom and Dad were worried about . . .”

Elin knew about the booze. Two years ago, when Shelby was a freshman, her drinking had landed her in the emergency room, leading to a twenty-eight-day rehab. Marisa had told Ian about it, but she was pretty sure they never told Rylee, wanting to protect her. Just one of the many secrets festering in that family. Apparently, rehab didn’t take.

Rylee ate another corn chip slathered with guacamole. “Did the doctor say which drug?”

“Fentanyl, synthetic fentanyl.”

“O. M. G.! Are you kidding me? They just talked about that in our health class. That’s crazy. It’s supposed to be, like, a hundred times more powerful than heroin or something like that. Why the hell would she ever take something like that?”

Elin wondered the same thing, having followed some articles in the newspaper about it. Even before her parents were tragically killed, Shelby seemed to be teetering on a precipice. Elin knew when she agreed to be guardian that Shelby would be a handful, already out of the house and running wild since high school, but she could never have envisioned something this scary.

“Here’s the thing, Rylee, I need to see what’s going on, and I’ll be gone at least a couple day—”

“No problem, Grandma, I’ll be fine here by myself.”

Nothing doing. “No, I don’t think that would be a good idea.”

“Are you saying you want me to come with you?”

“No!” Elin said, too sharply. “I mean that we need to figure out where you can stay for a couple of nights.” Even as she said it, she realized this was going to be a challenge.

“Is there anybody you can stay with for a couple nights, any friends at school?”

“Nobody. If I was at my old school . . .”

A sore point. When Ian’s son and daughter-in-law were killed in a terrorist attack outside of DC, Rylee had to move to Arizona. Elin had just lost Ian to cancer six months earlier, and was still grieving herself, as well as recovering from a year of heavy-duty caregiving. She reluctantly agreed to serve as guardian for her two granddaughters, but she wasn’t willing to move across the country. So Elin had made Rylee—and Rylee made it clear it was coercion—move to Arizona and change schools. Change her whole life really. That had been almost a year ago. The move had been brutal for both of them. Tears all around. Learning to live with a teenager wasn’t exactly a picnic for Elin. Since that time, they’d forged a fragile truce, Rylee gradually starting to adjust to Scottsdale. But Elin saw Rylee’s loneliness. And anger. And then there was Shelby . . .

“How about this?” Elin proposed. “How about if my friend Greta comes and stays here with you. You’ve met her. She’s nice. She’ll leave you alone. Just make sure everything’s okay. Take you to school. That way you can stay with Tucker and Chessie and Boots.” When Rylee moved, she brought Drew and Meredith’s two cats with her. Elin wasn’t sure how they’d get on with the dog, but Tucker was okay with them. And they were a great comfort to Rylee, sleeping with her every night.

She waited to see Rylee’s reaction. “That would be a huge help to me,” Elin added, putting a little pressure on her to agree. She really didn’t have too many options here. And she still had to get Greta to agree.

She could see Rylee’s hesitation. Finally, Rylee said, “All right. If it’ll make it easier for you.”

“Thanks. Let me call Greta.”


The drive to LA across I-8 was long and boring, the desert desiccated and brown at the end of a long hot summer. Feeling sorry for herself, Elin couldn’t help but think that a woman her age shouldn't have to be doing things like this alone. As if the long drive weren’t bad enough, then she had to face LA traffic and unfamiliar roads and doctors and a messed up twenty-year-old who was angry and lost. What had happened to that adorable little girl she had loved to read books to? To play dolls with?

She had planned to talk to both Ericka and Greta in the car on the way there, bringing them up to speed and getting their input on how she should approach her first meeting with Shelby. She tried her sister Ericka first. Had to leave a message explaining why she called. Couldn’t reach Greta either. Crap. In the meantime, to keep herself from obsessing too much, she turned on some upbeat bossa nova music.

An hour later, Ericka called back. Elin related what had happened with Shelby and that she was on her way to LA to see her in the hospital and talk with the psychiatrist.

Before she could even get her take on how to approach Shelby, Ericka said, “I told you not to take that on. I knew those girls would give you nothing but headaches. How come you never listen to me?” Ericka was the older of the two, very bossy and controlling. She’d been opposed to Elin assuming responsibility for Rylee and Shelby from the beginning.

“It’s not as though I really had much choice, Ericka.”

“Of course, you did. There’s always a choice. You could have said no. Your husband just died and you couldn’t handle it. They’re not even technically your granddaughters.”

She wasn’t even going to take that one on. Of course, they were her granddaughters. The fact that they weren’t biologically related to her was immaterial. She had been in their lives since they’d been born. She’d held them when they weighed six pounds. Touched their silky skin. Changed their diapers. Sung them to sleep. Read them Goodnight Moon. Loved them. She was the only grandmother they’d ever known. “And who else would have done it?”

“Not your problem their parents were killed and nobody younger was available to take over.” Ericka could be heartless.

Andrew was Ian’s only son. His mother, Ian’s ex-wife, had died from metastatic breast cancer twenty years ago, right after Shelby’s birth. And Drew’s wife Meredith had been estranged from her parents for years. Moot point since they were both dead now.

Ericka wouldn’t stop talking about how stupid it was for Elin to think she could take care of two teenagers and how she should call the lawyer back and say she’d come to her senses and changed her mind. How Elin had aged ten years since taking on this responsibility. “You look seventy years old, for god’s sake!”

She was almost seventy years old. What was she supposed to look like? Finally, she said, “Enough Ericka! This isn’t helping. I made a commitment to take care of these girls. And that’s what I’m going to do. If you can’t at least be supportive then I don’t want to speak to you.” And she hung up. Ericka would be pissed, but tough.

By the time she got off the phone with Ericka she felt even more rattled. Not only had the conversation not helped, it had made Elin feel worse. Why should she feel guilty for taking on the responsibility of caring for these girls? Of course, it wasn’t ideal. In fact, it was the last thing she would have thought about doing after losing Ian, but there just weren’t any other decent options. Those poor girls didn’t ask to have their parents killed. They needed someone who loved them to be looking after them, not some stranger. She switched to new age music in the hopes of chilling out as the traffic got heavier.

Then Greta finally called back. “Hey. Thanks a million for agreeing to stay with Rylee. I just got off the phone with my sister.”

“How’d that go?”

“About as badly as you might expect. She just thinks I’m a sucker for having agreed to be guardian to Rylee and Shelby.”

“Nonsense. I’m over at your house right now. Tucker says hello. We’ll all be fine here. So, how’re you doing?”

“I wouldn’t say I’m a mess, but yesterday was a pretty hard day. I just don’t think I’m cut out for all this drama. Maybe Ericka’s right . . . It’s not a coincidence I never had kids, you know. I’m just not any good at this kind of stuff. All I want at this point in my life is peace and serenity. I had enough drama with Ian’s ups and downs. And then Drew and Meredith were killed . . .” She could feel the tears stinging her eyes. “You know what? I am a mess, a total mess. I’m trying to keep it together for Rylee and this meeting with the psychiatrist, but I’m not doing a very good job.”

“Yes, you are! Not completely falling apart with all that’s happened in the past couple years is defined as a good job. A very good job. I wish I could do more. It pains me to hear the tears in your voice.”

“Staying at the house with Rylee is a huge help, really.”

Elin explained as much as she knew of what happened with Shelby—not much—and the upcoming meeting with the psychiatrist.

“Have you thought yet about what you’re going to say to Shelby?” asked Greta.

“Been obsessing about it. I’m so pissed off at her I could spit.”

They talked a bit longer before the traffic got so heavy that Elin finally said, “Greta, I’m gonna have to say goodbye. I need to pay attention to what I’m doing here. These California drivers are the take-no-prisoners type. I should be there in an hour. I’ll call tonight when I know more. Thanks again.”

After getting lost a couple of times, she finally found the medical center, grateful that Rylee had showed her how to navigate using Siri on her iPhone. She parked—twenty bucks!—found the nursing station on the eighth floor ICU, and asked to have Dr. Choi paged.

While she waited she tried to compose herself, wishing she had brought a written list of questions with her. There was a lot going on around her, what with constant announcements paging doctors and people in green scrubs rushing here and there, everyone in a hurry. That antiseptic smell made her queasy and took her right back to those anxiety-filled days of Ian’s illness. Her heart rate quickened the moment she walked in. Then she heard her therapist’s voice in her head saying, “Close your eyes and take a few long, slow deep breaths” and closed her eyes.

She was startled when she heard a voice say, “Are you Mrs. Bergstrom?”

“Yes, sorry, I am. I was just trying to . . .uh . . . center myself. Are you Dr. Choi?”

“I am. Let’s find a quiet place with some privacy.”

Dr. Choi escorted her down a wide hallway to a small, windowless room that said “Consultation” on the door. There was a ratty sofa and a single red vinyl-covered chair. “Have a seat.”

“Before we get started,” Elin said, “I have a question. Why a psychiatrist, rather than a doctor with a medical specialty?”

“When the EMTs brought Shelby to the emergency department, after they revived her, the only words she said indicated that she was disappointed to be alive after her overdose. So it appears that the overdose may have been a suicide attempt.”

She stopped when she saw Elin’s quick intake of breath, letting her absorb that information. “So we have a lot of questions about Shelby that we hope you can answer. We need to decide where she should go from here. Were you aware of her drug use?” Dr. Choi, whom Elin assumed was Korean, spoke almost unaccented English.

Her head bowed, Elin forced herself to take long, deep breaths to try to get a handle on her rapidly escalating anxiety. “I’m not sure where to begin. Shelby is my granddaughter, whom I assumed guardianship over about a year ago after both of her parents were killed in that terrorist attack in DC.” It had been all over the news for weeks afterward, so Elin assumed Dr. Choi would be familiar with it. She pulled a tissue out of her purse, buying time, trying to decide what to say next.

“Oh dear, that must have been very traumatic for her, especially with the constant news coverage in the aftermath.” Dr. Choi wore a white coat over a red dress. Her straight, jet black hair was pulled back into a bun. Very put together and professional.

“It was. Both girls—her fourteen-year-old sister Rylee moved in with me—were pretty traumatized and both are very, very angry. I think Rylee’s doing okay. I insisted on counseling, which she resisted, but she’s still going.” She blew her nose, struggling not to cry. “Shelby was another story. She was already at college, living away from home, and already pretty wild. I tried to get her to come and stay with me this past summer, when she didn’t have classes, but she refused.

“I knew she had an alcohol problem—her parents had sent her to rehab at the end of her freshman year—but I wasn’t aware of drugs, other than pot, which I assume they all use—”

“Actually, not everyone, but continue.”

“I’m not sure what happened after that rehab. Her parents kept it very hush-hush—Rylee didn’t even know, for example. I’m afraid they assumed rehab solved the problem. She lived back at home that summer, but some things came out after her parents’ deaths to suggest they were fairly preoccupied with their own issues right before the attack and not paying much attention to the girls.”

Dr. Choi said, “Were you aware of any suicide attempts before this?”

“No. Of course I’m shocked, but at the same time I’m not all that surprised, if that makes any sense.”

“Can you explain what you mean?”

“So you know what happened to her parents, and I’ve already mentioned the wildness—staying out all night, getting involved with unsavory boys and the like—and the drinking. And to top it off, not surprisingly, her grades were poor and she was always on academic probation, on the verge of being kicked out of school.” She stopped and sighed, twisting the tissue in her lap.

“So this young lady was not in a good place.”

“Not at all, and hadn’t been for a while.”

“Would you say she was depressed?”

“Probably, but she was so closed off it was hard to tell. Always sullen. Not once since her parents were killed have she and I had a serious conversation about what was going on with her. She’s resisted all of my attempts to get close to her. She resents that I control the trust fund her parents left—thank God for that—and don’t just turn the money over to her completely.”

Dr. Choi looked at her watch. “Okay, that information helps. Now we need to decide what’ll happen next when she’s discharged from ICU—”

“We haven’t talked about her medical status yet.”

“She’s stable right now, out of the coma. Her heart rate, blood pressure and breathing are almost normal, although she’s still very sleepy. The good news is that it doesn’t appear that there will be any long-term effects of the overdose. What’s not clear is whether she needs treatment for substance abuse. It would appear that she does. If so, we would want to make sure that wherever she goes has excellent mental health treatment available as well. This young woman needs intensive evaluation and counseling. I suspect she may be suffering from posttraumatic stress disorder as well as depression.”

Elin let out the breath she’d been holding. “In the past, she’s been very resistant to acknowledging that she has any issues. I’m concerned that she won’t be receptive to getting treatment . . .”

“What I’d suggest at this point is talking with her, seeing where she’s at, and how open she is. Then the three of us can meet and decide what the options are, maybe tomorrow afternoon.”

Elin tried to remember if there had ever been a conversation in the past she had dreaded more than this next one.


Elin walked into Shelby’s ICU room, where three other patients lay on beds hooked up to all kinds of machinery, just like Shelby. Lights of different colors blinked. She could hear faint beeping sounds. In the dimmed lighting, she could see Shelby propped up on pillows, her eyes closed, a clear narrow tube coming out of her nose. She had an IV attached to her left hand. Her dark hair had been dyed white blonde but had four inches of roots and looked greasy, dirty against her pale skin. She appeared to have lost weight. Was she sleeping? Should she wake her?

She pulled a chair up close to the bed, leaning her arms on the white, flannel blanket covering Shelby, bowing her head. This seemed like a good moment for a prayer or a conversation with Ian. Ironically, being here made her feel close to Ian, his last days spent in an ICU much like this one. She wished her racing heart would slow down.

She needed guidance, desperately wanting someone to tell her what to do. How to act. Even though she knew that “someone” didn’t exist. How could she have a clear head when so many different emotions ricocheted around in her brain?

“Is that you, Grandma?”

“It is, Shelby. How’re you feeling?”

“Very groggy. I’m sorry, Grandma.”

“For what.”

“You know what. For putting you through this.”

Elin considered saying, That’s okay. But it wasn’t. “The main thing is, we need to get you some help, Shelby, to figure out what put you in a place so dark you wanted to take fentanyl.”

No response.

Struggling to understand what had preceded and maybe caused this fentanyl overdose and possible suicide attempt, Elin said, “Shelby, you didn't come home this past summer so what did you do instead?”

“Your house in Scottsdale is not my home. I don't have a home. I'm homeless, Grandma. I lost my home when I lost my parents, remember? Plus, I hate the desert.”

Southern California is the desert too. Damn. This girl was still so angry.

“Okay. Bad choice of words. I ’spose my house isn’t your house, not yet.” When was she going to get over this anger? “I’m sure it’s hard not having a real home, but the question remains how did you spend this past summer?”

“I'm an adult and that's frankly none of your business.”

“Hah!” It slipped out before she could even stop it. Now her anger was getting the best of her. She couldn’t help herself. “An adult is someone who’s responsible and makes good decisions and financially supports themselves. Last time I checked you were doing none of those things.” She was tempted to remind her who wrote all the checks but decided against it.

Shelby said nothing. Tears leaked out of the corners of her eyes.

Elin, get a grip. How did that last statement help anything?

“I'm sorry. The last thing I said was below the belt. But here's the thing, Shelby. You're a mess. You need help, and my job, whether you like it or not, is to help you.”

Then the faucets really opened. “I'm such a loser. I couldn’t even kill myself.”

So it definitely had been a suicide attempt. Elin got up out of her chair and sat down on the edge of the bed, carefully avoiding all the tubes that seemed to be coming out of everywhere. Shelby scooted over to give her room, and Elin took her hand. “I’m so worried about you.” She grabbed a tissue and dried Shelby’s tears, kissing her on her forehead. It took all of her willpower not to dissolve into tears herself. “Sweetheart, I love you so much. The past couple years have been so, so hard for both of us. Don't forget I lost Grandpa, too. I know that's not the same thing as losing both your mom and dad, but he was the love of my life.”

Suddenly Shelby’s sadness morphed back into anger again. “This whole thing completely sucks.

“It does completely suck. I couldn't agree with you more.” She decided not to point out how much it sucked to have to take care of two traumatized teenagers, all by yourself, at age sixty-nine. Instead she said, “We’re stuck with each other. Can we try to make the best of it? We've got some decisions to make, and the first one for me right now is figuring out where I'm going to stay tonight. But the big one that we're going to make together is where you're going to go after ICU. So please give that some thought. I’ll be back tomorrow.”

She rushed to get out of there before her anger drove her to say something else she’d regret. As she closed the door to Shelby’s room a young man—boy really—approached her in the hall, lanky, hunched over, with long, disheveled hair and a thin, straggly beard.

“Are you Shelby’s grandmother?”

Taken aback, she answered, “I am.”

Big smile. “Hi, I’m her friend, Jayden.” He wore baggy bell-bottom blue jeans, frayed at the hem, and a faded green tee shirt with holes, feet clad in black flip flops.

“They wouldn't let me see her ’cause I’m not family. How’s she doing?”

He looked so scruffy that Elin wondered if this guy was her dealer. She hesitated to share information with him.

Sensing her reluctance perhaps, he said, “She and I were students together at Cal State.”


“I told her not to take that stuff, that it was poison. But she wouldn’t listen. I’m the one who called 911.”

Should she talk to this guy? Would he have information that might be helpful? “She’s out of the coma now and doing better. We’re hopeful that there won’t be any long-term damage.”

A big grin overtook his face. “Awesome! I was so scared.”

She decided to take a risk and see what this guy knew about Shelby’s drug use. “Had Shelby been using fentanyl for long?”

He looked confused.

“Never, as far as I knew. Booze and weed, that’s all we did. Well, maybe molly occasionally . . .”

So much for that rehab two years ago.

“So this was the first time she’d ever used it?”

“Yep. And I kept telling her not to do it! That stuff can kill you.”

“Then why did she take it, Jayden?”

“Is there someplace we can go for a cup of coffee?”

“Sure, good idea. I’m sure the hospital has a coffee shop.”

They walked to the nursing station and found out there was a Starbucks—inside the hospital—on the first floor. Very West Coast.

They went down in the elevator together, not saying a word. Elin’s stomach was in knots trying to anticipate what Jayden might have to say about why Shelby tried to kill herself with fentanyl. When they got to the Starbucks she bought Jayden’s coffee while she opted for green tea. They found a quiet corner in the lobby and she said, “So what do you know about why she used the fentanyl?”

“You know, Shelby, she was really, um, really unhappy. She just couldn’t accept her parents’ death. Obsessed about it all the time. Like, she was so, so angry. Kept saying she hated Muslims. The only time she was at all mellow was after she drank a bottle of wine and smoked some weed.”

No real news there. “I was kind of aware of that. But had something happened recently that made her want to do something more extreme?”

“When she got kicked out of Cal State, that was, like, the last straw.”

She blew on her tea, trying to absorb that. Shelby never told her she’d been kicked out of college. “When did that happen?”

“Last December. She kinda went, um, downhill after that.”

What? Ellen had been sending checks faithfully every month for the past nine months, for living expenses and tuition, thousands of dollars. What had happened to that money?

“So what has she been doing since that time? Where has she been living?”

“We’ve been crashing with some friends of mine in Malibu near the beach, just hanging out really.”

For nine months? While cashing her school checks? Elin could feel the anger welling up at this latest deception. Trying to keep her voice even she asked, “Is there anything else that I should know?”

“Not really. I don’t think so . . . what’s going to happen now?”

“I’m not sure. She needs a lot of help. We’ll be talking with the psychiatrist tomorrow to figure that out.” She had to leave. She couldn’t talk about this anymore. “Thanks for talking with me.”

“Tell her I said hi, okay?”


The next morning Elin returned to ICU to discover that Shelby was no longer there. A quick trip to the nursing station revealed that she’d been transferred to a regular floor. She took the elevator down to four. At the nursing station, she asked them to page Dr. Choi to meet her in room 409, deciding to wait outside until the psychiatrist arrived so they could go in together.

Ten minutes later Dr. Choi arrived, and they walked into Shelby’s new room together. She was sitting up when they walked in, looking at a magazine.

“Hi Shelby. How’re you feeling today?” Elin asked.

“Much better. Not so out of it.”

“Glad to hear it. I met your friend Jayden yesterday. Said he was worried about you.”

Shelby shot her a wary look.

“He said a couple of interesting things.”

“Like what?” That sullen tone immediately returned.

“Let’s see, where to start? First, he said he had warned you about using the fentanyl, but you wouldn’t listen. But most interesting was that you got kicked out of Cal State at the end of last fall semester—”

“Grandma, I can explain.”

“I’m not done yet. I found that interesting since I’d sent a couple of tuition checks and monthly living expenses for you. Okay, now it’s your turn.”

“Okay, you’re right, I should’ve told you that those shits kicked me out. They couldn’t accept that having your parents killed was a good excuse for failing courses—”

“Maybe that meant you shouldn’t be in school until you’ve dealt with that,” Dr. Choi said, observing the interaction between Elin and Shelby.

“And I wasn’t!”

“Yes, but you never bothered to tell me that, so I kept sending checks” Elin said. Should she play hardball? She had powerful leverage, but did she have the balls to use it? Fueled by her anger, she decided to go for it, first glancing over at Dr. Choi.

“Here's the thing Shelby. That money in your trust fund is for your education, and if you're no longer in school I can't financially support you—”

“Wait, what? That's my money!”

“Not until you reach thirty, it isn't.” If you reach thirty.

“What am I supposed to live on?”

“As I see it, there are a couple of options,” Elin said, casting another quick glance at Dr. Choi’s expressionless face. "Option number one is that you go into a twenty-eight-day substance abuse program that has good mental health services—”

“Who's going to pay for that?”

“There's plenty of money in your trust fund to cover that—”

“You said that was for my education.”

“It is, but I have a good deal of discretion about how it’s used. Unless you get sober and deal with your mental health problems, there’ll be no education.”

Shelby sat with her arms across her chest, lips pursed, a dour expression covering her face. Not thrilled with option one.

Elin continued. “Option number two is that you come back to Scottsdale to live at the house with me and your sister. And you enroll in intensive outpatient treatment. There’s an extra bedroom for you, and you can even use Grandpa’s old car. But if you're living under my roof I will insist on random drug and alcohol testing.” She stole a quick look at Dr. Choi who responded with a slight nod of agreement.

“That's so unfair. I can't believe you don't trust me.”

“Shelby, I love you very much, and I want for you to get better. But you're right. At the moment, I don't trust you. You have drug and alcohol and mental health issues. If you can stop drinking and using drugs and behave in a trustworthy manner, I'll start to trust you again. At that point, we can talk about community college or other options. But first you're gonna have to get sober and deal with your anger and other problems.”

Still pouting, Shelby said not a word.

Meanwhile, Dr. Choi had a big smile on her face which Elin hoped meant she did good.

Hearing nothing more from Shelby, Elin got up. “I’ll be here for the rest of the day if you want to talk. And I’ll stop in tomorrow morning before I get on the road to find out what your decision is.” She walked over to her bed and leaned over to give her a quick kiss and hug. But Shelby turned away and rebuffed her. Annoyed but not surprised, she turned on her heel and marched out of the room, Dr. Choi trailing behind her.

Dr. Choi said, “Well done. If I didn't know better I’d have thought you had training in tough love.”

Elin, fighting tears and shaking, said, “That was so damn hard. I feel like an ogre, but I saw how that girl’s parents mollycoddled her, and look where that got us.” She wiped a tear from her left cheek. “But I meant every word of it.”

“Good for you,” said Dr. Choi. “Because if she comes to live with you, you're going to need to be tough as nails.”

Oh boy. “But what I'm most scared of is that she won't go for option one or option two and then what? Left to her own devices, I’m afraid she's lost.”

“But I think she knows that,” said Dr. Choi. “I think she's going to go for option two.”


Elin drove back to the Marriott. She needed a long walk. With advice from the concierge, she got back into the car and found a lovely park. While walking she phoned Greta to see how things were going back in Scottsdale and gave her the update on Shelby’s status. She found it reassuring to learn that everything back home—Rylee, dog and cats—were doing fine. And Greta approved of her strategy for dealing with Shelby, so that was affirming. She found a cute little cafe and ate a nice dinner. After returning to the hotel, she watched a movie on her iPad and read before turning in for the night. She had another big day ahead of her tomorrow.


She rose on Saturday morning after the best night’s sleep since hearing about Shelby. She checked out and drove back to the hospital. On the ride over she thought about what awaited her there. Would Shelby agree to go into treatment or to live with her in Scottsdale? She refused to think about whatever option three might be. Too unnerving to contemplate what might happen to Shelby on her own with no financial support. Don't go down that road, she thought. She rode the elevator to the fourth floor and walked down the hall to Shelby’s room. With her hand on the door handle, she took a deep breath, then another, and opened the door.

The bed was empty, made up with new sheets and blanket all tucked in. Did she have the wrong room? She walked outside and checked the number, 409. Nope, correct room. She walked down the hall to the nursing station and waited for the clerk to get off the phone, wondering why they had moved her granddaughter again, hoping she hadn't taken a turn for the worse.

"Whew," said the young clerk. "Some people." She looked up at Elin. "Can I help you?"

"Yes, I'm looking for Shelby Satterwhite. She was in room 409 yesterday. Has she been moved?"

"Hmm, let’s see. Satterwhite . . . Here we go. She left at about 7:30 this morning AMA.


"Sorry, against medical advice. Meaning she left before the doctor officially discharged her."

Shit. Wasn't that just like Shelby? Now what? She stood there thinking about her next move. Finally, she decided to consult with the psychiatrist. "Can you page Dr. Choi?"

Ms. Flores, according to her name tag, consulted yet another binder and said, "Sorry, she’s off today. Is this an emergency?"

Was it? "I'm not sure . . ."

"There’s another psychiatrist on duty. Shall I page him?"

Elin thought about that. Would it make sense to talk to someone unfamiliar with Shelby’s case, starting from scratch to explain what was going on? Nah, might just as well get on the road.

"No, thanks."

As she walked back to the car she tried Shelby’s cellphone number. Went straight to voicemail. No surprise there. Elin mulled over her next move. Was there any point in trying to track her down? Other than Malibu, she had no clue where Shelby lived or where she might have gone. It appeared that she had made her choice, not selecting option one or option two. Shelby chose option three, whatever that was. She'd have plenty of time to think about it on the way home in the car.


After the boring drive home, dominated by her obsessing about Shelby, Elin limped into the house, sore everywhere from the long drive. Greta and Rylee sat in the kitchen, finishing a pizza. Witnessing this normal domestic scene after the craziness of the hospital was a blessing.

“Welcome back. How’d it go?” Greta said. “You look exhausted.”

“I am.” Elin plopped down, uncertain how honest she should be in front of Rylee. This family had had its fill of secrets. No more. Heaving a big sigh, she said, “Not so good.”

“What d’you mean?” Rylee said. “Is Shelby okay?”

Both looked at her expectantly. “I honestly don’t know.” She summarized what happened. “In the end, she left against medical advice. I told her I wasn’t going to financially support her unless she took one of the two choices I gave her. It looks like she rejected both. I have no idea where she is or what she’s going to do. I’m worried sick.”

The three discussed the situation further, Elin peppering Rylee with questions about what she thought Shelby might do. Bottom line: Rylee had no idea. She hadn’t had much contact with her sister over the past year, as much in the dark as Elin was about what she might be up to.

Elin grabbed a piece of cold pizza, but it tasted like cardboard in her mouth. She thanked Greta again for staying with Rylee and turned in.


In her bedroom, with the door closed, Elin pulled out a family photo album. Starting at the beginning, when they were babies, she studied various photos of the girls over the years. Baby pictures. Rylee as a toddler, on her first day of preschool. Shelby starting kindergarten, in a cute little red plaid dress. Rylee learning to ride a two-wheel bike, with skinned knees. Shelby and Rylee with the family’s chocolate lab, Cocoa. Shelby in front of the fireplace, on the way to her first prom, all dressed up with her boyfriend, both grinning madly. The whole family on a vacation in Hawaii.

Ian, she thought, how did we ever get to this point? What happened to this family? I’m afraid I blew it. Tough love didn’t work. I don’t know if Shelby will ever get better. She’s not a bad kid, but she’s so lost. I don't know what to do to help her, other than leave the door open.

And then Erica's words echoed in her ears. “Elin, despite what you think, you can't save everyone.”


The end of September arrived with no word from Shelby. Both Elin and Rylee tried Shelby’s cellphone repeatedly, to no avail. The police were no help—Shelby was too old. Elin had no idea where to turn. She had spoken to the family’s estate lawyer back in Maryland, but he had no suggestions. She made an appointment with her therapist, who tried to assuage Elin’s guilt, pointing out that Elin had done everything a reasonable person could. She counseled Elin to work on accepting her powerlessness over the situation and trying to focus on taking care of herself and Rylee. Elin considered hiring a private detective to search for Shelby and waited every day for a phone call that she had been found dead.

At nine p.m. on the last Saturday of September, the doorbell rang. Rylee was out with some friends—that was nice!—and Elin was already in her nightgown getting ready to get into bed and read. Who could possibly be at the door at that hour? Instantly she started worrying about Rylee. Had something happened to her?

She opened the door and there stood Shelby and Jayden, both looking bedraggled. A beat up old Toyota sat in the driveway. Shelby looked emaciated, hip bones poking through her black leggings, even thinner than she’d looked at the hospital, face pallid. Her hair hung in strings. She didn’t say a word.

Jayden, dressed in the same bell bottoms and ratty green tee-shirt, said, “Hi Mrs. Bergstrom.”

He knew her last name? “Come on in, you two.”

Standing in the foyer, Jayden continued, “Shelby has something to say . . .”

Elin waited, stunned, confused.

“I need help, Grandma. I’m a total mess.” Her eyes looked terrified. She started to cry.

As Elin stood there, relieved, deciding what to say, Jayden piped up with, “Shelby said you wouldn’t mind if I stayed the night, ‘cause that was a long drive! Jeez, you’ve got a really nice place here. I sure wouldn’t mind living here . . .”

Not gonna happen, Jayden. Elin leaned over and hugged Shelby’s skeletal frame. “Sweetheart, it’s so good to see you. I’m so glad you’re okay. Have you got more stuff in the car? Jayden, can you go get the rest of her stuff?” As Jayden went back out to the car, Elin put her arm around Shelby. “Let’s go into the kitchen. I’ll bet you guys are starved.”

Now the real work would begin.


Bonnie E. Carlson is a retired professor of social work. She lives in Scottsdale, AZ with her husband, dog and too many cats. She has published several short stories in magazines such as Foliate Oak, Down in the Dirt, Fewer Than 500, and The Normal School. She is completing a novel.

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