Patient One (2 page)

Three

In a light drizzle,
Dr. David Ballineau hurried up the lawn to his West Los Angeles home, a step behind his eleven-year-old daughter who was still wearing her Harry Potter costume.

“Did you really like the play, Dad?” Kit asked, her wizard’s hat tilted to one side.

“It was wonderful,” David enthused. “And you were great.”

“I think I messed up one of my lines.”

“I didn’t notice, and I doubt that anyone else did either.”

“Good,” Kit said, and smiled. “I didn’t want to embarrass myself in front of a lot of people.”

As he opened the front door, David glanced back at the dark, misty night and sampled the air. The humidity was heavy, a consequence of the big winter storm that was lingering off the Southern California coast. It would bring plenty of rain, David thought. That would make the freeways slick and cause cars to hydroplane, setting the stage for gruesome accidents, similar to the one he’d seen earlier that day. For emergency room physicians like David Ballineau, rain was unwelcome, particularly when accompanied by thick mist.

“Dad, is that woman in the audience who got sick going to be all right?” Kit asked, wiping her feet on the doormat.

“She’ll be fine, honey,” David assured her.

“She’s lucky you were there.”

“Yeah. Very lucky.” He watched Kit scamper up the stairs and called after her, “Don’t forget our agreement, Kitten. No late night phone calls. Right?”

“Just one to Susie,” she said over her shoulder. “And it’ll be a quickie.”

“How quick?”

“B-Y-K-I.”

It took him a moment to decipher her spoken text message. BYKI stood for Before You Know It. She’s growing up so fast, David mused with that combination of pleasure and terror peculiar to fathers of daughters. One day she was a toddler, the next a beautiful, spirited young girl who could steal his heart without even trying.

“Okay, Dad?” she yelled down to him.

“Okay.”

Kicking off his loafers, David stopped in the kitchen for a cold beer, then strode into the small library and, propping his feet up on his desk, began to relax for the first time in fourteen hours.
Christ! What a monster of a day!
he murmured wearily to himself, thinking back to the events that began at 7 a.m. and never ceased. From the moment he stepped into the emergency room at University Hospital, all hell seemed to have broken loose. It started with the burned firefighters who had gotten trapped in a windblown inferno just north of Los Angeles. Most were suffering from smoke inhalation and second-degree burns. But a few had been charred beyond recognition and were now fighting for their lives in the hospital’s ICU. Then came the victims from a high-speed, multi-car accident on the San Diego Freeway that left two dead and a dozen seriously injured. The injuries were horrific. Amputated limbs. Open tibial fractures. Ruptured spleens. Torn aortas. A museum of bloody horrors.

David rocked back absently in his swivel chair, still seeing the charred and severely injured patients in his mind’s eye and knowing most wouldn’t survive.

There was one life he was certain he’d saved. But that came later on, when his twelve-hour shift in the ER was over.

After giving a report to the incoming physician, David had dashed out of the hospital and hurried over to Kit’s private school, where she had one of the leading roles in a play based on a Harry Potter book. Arriving late, David had been in his seat only a few minutes when the woman behind him sucked too hard on a breath mint and aspirated it deep into her posterior pharynx. Despite numerous Heimlich maneuvers, the mint remained lodged in place and compromised the woman’s air supply. She started to panic and dashed out of the auditorium, which only made matters worse. When David caught up with her, she was gasping for air and beginning to turn cyanotic. He was forced to do a tracheotomy, using a knife from the school cafeteria. By the time the paramedics arrived and David returned to his seat, the play was nearly over. He never got to see his daughter on stage.

David swallowed a sip of cold beer and thought about how many more special moments he might miss in Kit’s life because of his profession.
I have to plan better
, he vowed determinedly.
Yeah. Better planning. Right!
he scoffed at himself, now recalling the age-old adage—
If you want to make God laugh, tell Him your plans
. David had learned the wisdom in that proverb the hard way, a long time ago.

“Wooooo!” Kit said, prancing into the room. She had a wool blanket draped over herself from head to toe.

“Why the blanket?” David asked, smiling at his daughter and loving her more than anybody could love anyone.

Kit pulled the quilt away from her face and looked at him quizzically. “Don’t you remember that part in the play, Dad? When Harry Potter wore his special blanket, no one could see him.”

“Oh yeah,” David said, reacting quickly because he’d missed that section of the play. “But I thought the blanket worked only for Harry.”

“Uh-uh,” Kit corrected him. “It does magic on anyone who wears it.”

“Got it,” David told her, nodding. “So I can’t see you, but I can still hear you. Correct?”

“Of course you can hear me,” Kit replied, placing the blanket back over her head. “We’re having a conversation, aren’t we?”

David grinned broadly. “Good point.”

“You’ve got to put a lot of feeling into your voice, Dad,” Kit urged. “You have to make people believe you really can’t see me.”

David had to bite his lip to keep himself from laughing. “Okay.”

“And you have to sound like something is spooky.”

“I can do that.”

“Excellent,” Kit approved. “Now we’ll start again.”

Just then Juanita Cruz, their live-in housekeeper, entered the library and said, “
Tomorrow
you will start again.” She removed the blanket from Kit’s head and gently stroked the child’s raven hair back into place. “That is enough play-acting for tonight, Little One. Now you must do your homework.”

“Can’t I do it later?” Kit tried to beg off.

“Now!” Juanita insisted.

“Dad!” Kit pleaded, looking to her father for support.

David shrugged. “Homework is important.”

“Five more minutes,” Kit bargained with Juanita.

Juanita ignored the girl’s plea and pointed to the door of the library with her index finger. “Are you going to embarrass us by making me say it a third time?”

“Phooey!” Kit protested, and headed out of the room.

Juanita followed her to the door, then turned back to David. “Have you had your dinner yet, Dr. Ballineau?”

David shook his head. “I’m not very hungry. Maybe I’ll have something later.”

“There is cold chicken and pasta in the refrigerator.”

David watched her leave, grateful as always that he had such a wonderful housekeeper to help him raise Kit.
What in the world would I do without her?
he wondered, but he already knew the answer.
Somehow I’d manage. I’d muddle through, just as I did when Marianne died.
His gaze drifted over to the picture on his desk of his wife, dead just over eight years. Sometimes it seemed like the tragedy happened only yesterday, other times like it occurred an eon ago. He sighed deeply, recalling that the pain had slowly and finally subsided. But the emptiness was still there, and all the joy in the world couldn’t remove it. He could forget about the emptiness for a while, but it never really left him. And never would.

His eyes went to the calendar on his desk. Kit had circled Sunday’s date with a thick red crayon. It marked the anniversary of Marianne’s death. On that day Juanita would take Kit to her church and light candles in memory of Marianne. And David would tag along. But he would refuse to sing and recite prayers about a good and merciful God, again asking himself the same questions in church. Where was this good and merciful God when Marianne was dying a slow and painful death from leukemia? And where was God when a three-year-old child cried every night for her mommy?

David shook his head at the sad memories, still wondering how a merciful God could let all that happen. A young minister once told David that God sometimes tested people in harsh ways. Well, David thought somberly, he had no use or belief for that kind of God. Not then. Not now. Not—

The phone beside the calendar rang. It was his private line, which meant it had to be the hospital. No one else called this late at night.

David reached for the phone. “Yes?”

“Dr. Ballineau, this is Betsy in the ER. We’ve got a big problem on our hands.”

“What?”

“A hundred cases of severe gastroenteritis, and even more coming in. We’re overflowing and way understaffed.”

“Get all the interns and residents to come down to the ER,” David instructed. “They should be able to handle straightforward gastroenteritis.”

“They’re already here, but it may not be straightforward gastroenteritis,” the nurse went on. “And we’re dealing with some very, very important people.”

“Such as?”

“The President of the United States.”

“I’m on my way in,” David said, hanging up.

_____

It was like talking to a statue, and hoping it would respond.

Carolyn Ross sat across from her mother in the living room of their Santa Monica home and tried to make conversation. But her mother just stared into space, lost in the deep haze that came with Alzheimer’s disease.

“Mom,” Carolyn asked softly, “Can I get you something to drink?”

The woman stayed silent.

“Are you thirsty?”

Again, nothing. Saliva drooled out of the woman’s mouth and down onto her chin.

Carolyn reached over for a Kleenex and dabbed it away. Her mother didn’t seem to notice as more saliva dripped out, now spilling onto the woman’s bib.

Carolyn continued to clean the drool, remembering back to a time when her mother was so neat and tidy she wouldn’t tolerate even a speck of dirt or dust. And she’d been so independent, never wanting to need anyone for anything. But now the poor woman was totally dependent, Carolyn thought sadly. Her mother had to be fed and bathed like a baby, and had to wear diaper-panties that required changing every few hours. It was a living nightmare.

At least I know how to care for Mother and keep her comfortable,
Carolyn told herself.
And my salary as a nurse means I can afford to hire a sitter to look after Mother during the day while I’m away. Thank goodness for that.

Carolyn discarded the saliva-laden Kleenex into a nearby trash can, now wondering how the poor and those with modest incomes managed to care for family members afflicted with Alzheimer’s disease. How do they afford it? How? Between the sitters and medicines and doctor visits, the expenses never stopped mounting. For these families, Alzheimer’s must be an overwhelming burden. A double living nightmare.

Carolyn’s cell phone chirped. She stared at the phone, then at her mother, hoping the high-pitched sound would register in the woman’s mind. It didn’t. The costly drugs her mother was taking weren’t helping at all.

Sighing resignedly, Carolyn reached for the phone. “Hello.”

“Carolyn, this is Kate Blanchard on the Pavilion,” said the junior nurse. “The head nurse had to leave for a family emergency and we’ve going to be really shorthanded. According to the doctors in the ER, we’re about to be swamped up here with acutely ill patients that have severe gastroenteritis. Apparently they’ll be coming in droves.”

“To the Beaumont Pavilion?” Carolyn asked. The Pavilion’s plush suites were always reserved for the rich and famous. “When I left this evening, all fourteen rooms were occupied.”

“They still are. But since most of our patients are here for diagnostic workups, they can temporarily be transferred to the Intermediate Care Facility. That will make room for some of the terribly ill patients who also happen to be dignitaries.” The junior nurse paused as if to catch her breath. “It’s bad, Carolyn. It sounds like they’ll be needing every bed they can free up.”

Carolyn groaned inwardly. She had no choice but to go in. It would be impossible for one nurse to handle a ward overflowing with really sick patients.

“I’ll be there in fifteen minutes.”

“Don’t come through the ER,” Kate warned. “It’s a madhouse down there.”

Carolyn clicked the cell phone off and quickly thought of the essential things she had to do. First, she had to call the sitter and hope the neighbor could come and spend the night. Hastily, she punched in a phone number. The sitter answered on the second ring. “Dolly, I’ve got an emergency at the hospital. I need you to look after my mother tonight.” She listened for a response, then said, “Of course you can bring your dog. But you must come now.”

Carolyn placed the phone down and turned to her mother. “Mom, I’ve got to go back to the hospital. But Dolly will be here soon to stay with you. Okay?”

The woman continued to stare ahead with a blank expression.

“I love you,” Carolyn whispered and kissed her mother’s forehead.

Her mother showed no response.

“I have to go upstairs and change,” Carolyn said and hurried to the door. Halfway there, she stopped abruptly. Behind her, her mother was making some sort of sound. Carolyn spun around. Her mother had her lips pursed and was sending Carolyn kisses. There even seemed to be a hint of a smile on the woman’s face. Then, in an instant, the expression disappeared and the woman went back to staring into nothingness.

“Oh, Mom!” Carolyn whispered, her tears welling up as she ran for the stairs.

Four

The emergency room at
University Hospital was in turmoil. Doctors and nurses were racing back and forth in the corridors, clearly overwhelmed by the influx of sick people. And more were coming through the front entrance. The noise they made was deafening, with shouts and yells and cries for help mixed in with moans and groans and the sounds of individuals retching. Every room was taken, every bed and gurney occupied by nauseated patients. Even the space on the floor was filled with elegantly dressed people throwing up into handheld basins. The overcrowding was made worse by the Secret Service, which had closed off an entire section of the ER for the President of the United States. Two agents were hurriedly placing waist-high wooden barricades across a corridor to discourage the curious.

Aaron Wells pointed to the barricade, saying, “I want another row of those things about ten feet back, and line them up so you can knock over one without knocking over all the others.” He waited for the additional barricades to be put in position, then added, “And I want two agents behind each row. Nobody in, nobody out, without my say-so.”

Wells quickly surveyed the interior of the ER again, looking for weak spots. The two examining rooms in the middle of the section, which held the President and the First Lady, had no windows or exits except for their closed doors, and those were being guarded by a pair of agents. There was no staircase or fire escape to be concerned with. At the end of the corridor was an elevator on hold, its door open and guarded by two more agents. Secure enough, Wells told himself, but he was still worried about the mass of sick people, which could provide cover for an attack on the President. If the crowd, for any reason, suddenly rushed the barricades, they would rapidly overrun the agents guarding the President. Or terrorists could jump out of the crowd with automatic weapons or grenades, and kill everybody in the section.

“The crowd!” Wells grumbled to himself. “The goddamn crowd!” He couldn’t throw them into the street, and there was no way to check them all out. The President was in a dangerous position and had to be moved.

Wells saw Agent Dan Morris, the second in command, coming through the barricade and waved him over. In a low voice he asked, “Did you locate the President’s daughter?”

Morris shook his head. “We’re still looking.”

“Look harder,” Wells urged. The first thing on the President’s mind would be the well-being of the First Lady and their daughter. “Did you check the hotel?”

“She’s not there,” Morris said. “And she’s not here. I’ve got men posted at the entrance to all the ERs in the vicinity. As soon as she and her date are found, they’ll be brought here.”

“What about Suslev and his wife?”

“They’re in another part of the ER, with their own security.”

“Are they as exposed as we are?”

“More so.”

“Shit!”

“Yeah.”

Morris asked, “What caused all this? Food poisoning?”

Wells shrugged. “I guess.”

Morris moved in closer and quietly inquired, “How’s Liberty?”

“Not good.”

A middle-aged man just beyond the barricades began retching loudly, then threw up a stream of brownish liquid. The vomit gushed from his mouth, like a projectile. The patients around him ducked and brought up their arms to cover themselves from the spray. A few were so ill they barely moved. The stench of vomit filled the air and made the patients nearby even more nauseated. Wells looked away and over to a set of swinging doors that led to the outer waiting area. It was another weak point. He considered having an agent circulate beyond the doors, but decided against it. All the agent would see was a swarm of people throwing up over each other.

Wells cursed to himself. He wished the President had taken the Secret Service’s advice and had his meeting with the Russian leader in Washington, where everything could be tightly controlled. But Liberty insisted on having the official dinner in Los Angeles. It was a gesture of goodwill to the President of Russia, who would later fly to San Francisco, where world leaders were gathering for a celebration of the United Nations Charter. To hold the official dinner in Los Angeles, with its generous political donors, would be convenient for everyone, the President had said. It would also be much more dangerous, the Secret Service had argued. But the President had insisted. And the end result was a nightmare in the making, Wells thought grimly. Nothing in the ER was under control. Everything was in a maddening state of flux, and this left the President vulnerable. Very vulnerable.

“Aaron,” an agent by the barricade called out, “the ER doc wants to talk with you.”

Wells signaled the young resident over and asked, “What?”

“We’re having trouble finding a ward we can empty out,” the resident answered.

“Don’t tell me your problems. Just get it done.” Wells was a big man, with broad shoulders and a square jaw. His balding blond hair had been shaved off down to the skin, leaving his steely gray eyes as the most prominent feature of his face. He gave the resident a hard stare, then said, “And do it now.”

The resident wasn’t accustomed to being intimidated, but the agent’s glare caused him to look away. “Maybe we could clear out the special unit.”

“What’s that?” Wells asked.

“It’s a restricted ward that’s used for patients receiving experimental drugs,” the resident replied. “But it may not be possible to evacuate—”

“Just do it!” Wells cut him off. “I don’t care how you do it. Just do it!”

The door to the trauma room holding the President opened, and his personal physician, William Warren, stepped out. There was blood on his hands and on the sleeves of his coat. Glancing over to Wells, he immediately sensed the agent’s worry. “The President is stable.”

Wells breathed a sigh of relief inwardly.
Thank sweet Jesus in heaven above!
he thought, but said only, “Good.”

“Do we have a ward cleared for the President?” Warren asked.

“Not yet,” Wells replied unhappily.

“What’s the holdup?”

Wells gestured with his thumb to the young resident. “He’s a little slow following orders.”

“Well, let’s see if we can speed him up,” Warren said in a neutral tone, but his temper was rising. He turned to the resident. “I want you to listen carefully because I’m only going to say this once. We need a safe ward for the President and we need it now. If necessary I can have a fleet of ambulances outside this hospital in a half-hour with a doctor in each one. We’ll pick a floor and have the chief of service meet us there. Then we’ll roll out the patients and put them in ambulances which will take them to other hospitals. And we’ll end up with a safe ward for President Merrill. So the choice is as follows—either you do it or we’ll do it for you.”

The resident swallowed nervously. “But, sir, I can’t just …”

“Let’s get those ambulances,” Warren instructed Wells. “Twenty-five should do.”

“What about the doctors?” Wells asked.

“Get a list of all the physicians who live within a ten-mile radius of the hospital and have the police …”

“Aaron,” an agent at the first row of barricades yelled out, “there’s another doctor who wants to see you.”

The resident peered over and said hurriedly, “That’s the director of the emergency room. Maybe he can do what you want.”

“An ER specialist isn’t going to be of much help,” Warren groused.

“He’s also a senior staff member at the medical center,” the resident informed him. “When he gives an order, people jump.”

Warren briefly studied the doctor by the barricades. “So he has a lot of pull, eh?”

“And a lot of push,” the resident added. “He runs a tight ship down here, and knows how to move patients out. Nobody stays for long.”

Warren looked over to Wells and nodded. “Let’s see what he has to say.”

Wells waved the doctor in and watched him approach, keeping his eyes on the new arrival’s hands and making sure they were always in sight. “Are you in charge of any of the wards?”

The doctor shook his head. “Just the ER.”

Wells groaned to himself.
Shit! This guy isn’t going to be any help.
“Who’s in charge of the beds?”

“No one person,” the doctor replied. “Each specialty controls its own ward.”

Shit!
Wells thought again.

Warren stepped forward and introduced himself. “I’m William Warren, the President’s physician.”

“And I’m David Ballineau, the staff physician on call tonight.” He was tall and lean, in his mid-forties, with an angular face, close-cropped salt-and-pepper hair, and pale blue eyes that seemed to be fixed in place. His clean-cut good looks were marred by a jagged scar across his chin. “The nurse notified me that you need a special area for the President.”

“I need more than an area,” Warren told him. “I need an entire ward cleared so that the President can be protected. Can you help us with that?”

“I can certainly try,” David said. “But first, I have to know the President’s diagnosis.”

“That’s not your concern,” Wells blurted out.

“Yes, it is,” David answered, standing up to the powerfully built agent. “We have special wards for specific illnesses. If he has just food poisoning, he can go to a general medicine ward. If he’s had a myocardial infarction on top of it, he’ll need to be in the ICU.”

“He has straightforward food poisoning,” Warren said. “He’s got nausea and vomiting, and is throwing up some blood.”

David looked at Warren oddly. “People with garden-variety food poisoning don’t throw up blood. Never. You’d better look for another diagnosis.”

Warren hesitated. He did not want to discuss the President’s medical history with anyone, not even with another doctor—who might turn out to be loose-tongued. But he knew there was no getting around this conversation, if they were to make the necessary arrangements for protecting the President. Warren took David’s arm and guided him away from the Secret Service agent.

“What I say to you goes no further than this hospital corridor. Understood?”

“Understood,” David replied.

“The President has acid reflux disease with moderately severe esophagitis,” Warren described, keeping his voice low. “I believe his esophageal mucosa is already thinned out, and the toxins from the food poisoning must have eroded through it. That’s why he’s bleeding.”

David nodded slowly. That combination
could
be responsible for the bleeding. But bacterial toxins rarely caused upper gastrointestinal hemorrhaging, even under extreme circumstances. In all likelihood, there was another reason for the President to be vomiting blood. “How much blood has he lost?”

“Enough to drop his hematocrit to 40 percent.”

David knitted his brow and did a quick mental calculation. The hematocrit was the ratio of packed red cells to a given volume of plasma, expressed as a percentage. The normal value was 46 to 50 percent. David estimated the President had lost at least 500 ccs of blood.

“Is he still bleeding?”

“Not actively,” Warren answered, then corrected himself. “At least, he’s not throwing up red blood any more.”

“We should scope him as soon as possible,” David recommended.

Warren hesitated again. The quickest way to make an accurate diagnosis was to pass an endoscope into the President’s stomach and search for the bleeding site. But the procedure required anesthesia, and the President had had a severe allergic reaction to the anesthetic when he was endoscoped a year ago.

“We’ll hold that for the present.”

“If he’s still bleeding, now would be the time to check him endoscopically,” David urged.

“But he may no longer be bleeding.”

“Let’s pass a nasogastric tube and find out.”

Warren considered the suggestion carefully before asking, “Are you experienced at that?”

“I’ve done it easily a hundred times,” David said. “And while we’re doing that we should have him typed and cross-matched for four units of whole blood.”

“I’ve already ordered two units.”

“That’s not enough.” David reached for his cell phone and called the blood bank. After speaking briefly, he came back to Warren. “If the President starts gushing blood, we’ll need at least four units to hold him.”

“That’s not likely,” Warren said.

“Maybe not,” David said with a shrug. “But if he does, we don’t want to get caught short, do we?”

“Lord, no,” Warren concurred. This doctor was obviously experienced when it came to acute G.I. bleeding.
Excellent! I can use him until the specialists arrive. And they will tell me whether there’s an urgent need to call in an endoscopist or some other expert. But wait a minute! Who were these specialists being called in to treat the President? I don’t know them or how good they really are. This is a teaching hospital after all, and the most senior specialists could be academicians rather than active practitioners.
Warren glanced back into the treatment room where the President lay. The cardiac monitors at his bedside showed a steady pulse and blood pressure, with no evidence of new hemorrhaging. “We could have the President helicoptered to Air Force One in fifteen minutes,” Warren said, more to himself than to David, “then zoom like hell back to Washington.”

“You may not have fifteen minutes,” David cautioned. “If he starts to really spout blood aboard that helicopter, you could have a dead president on your hands. Then you’d be flying his corpse back to Washington on Air Force One.”

“You’ve got a point,” Warren agreed, and for a moment envisioned what a nightmare that would be. He hurriedly cleared his mind. “Dr. Ballineau, can you quickly get us the ward we require?”

“The best location for the President would be the Beaumont Pavilion,” David proposed. “It’s a closed-off floor with a single corridor and has a total of fourteen individual suites.”

“Excellent,” Warren approved immediately and beckoned Wells over, saying, “I think we’ve got a ward for the President.”

David thought for a long moment before adding, “But I can only give you eleven of the suites.”

“I need the entire floor.”