Patient One (5 page)

“And how many people work on this ward?” Wells asked. “Limit it to essential personnel.”

Carolyn thought for a moment. “There would be five altogether. Two nurses, two interns, and a ward clerk.”

“No resident?”

“He’s out sick.”

Wells motioned to the agents behind him. “Bill, Owen—check every room wall to wall, ceiling to floor. Throw out everything that’s not furniture.”

The agents dashed down the corridor as Wells spoke briefly into the microphone on his wrist. He was directing another agent to come up and run security checks on all the medical personnel.

Simcha’s jaw dropped as he noticed the wire snaking down from the agent’s earphone to his collar. He quickly turned to Carolyn and asked, “Are we being moved for the Pres—?”

Carolyn brought a finger to her lips, hushing him. She gestured to Kate Blanchard, who was behind the nurses’ station. “Kate! Put Sol in room twelve for me, please.”

Wells waited for the patient to shuffle away, then came back to Carolyn. “I need to look at all the rooms that won’t be occupied by patients.”

“Let’s begin here,” Carolyn said, heading for the chart room.

Two interns, wide-eyed, stepped aside as the powerfully built Secret Service agent entered. Wells quickly searched them, then turned his attention to the charts hanging on a metal rack and made certain they contained only medical records. Next he went through the drawers of two desks and the overhead shelves above them. Finally he opened the interns’ doctor bags and poured their instruments on a tabletop. He rummaged through stethoscopes, ophthalmoscopes, and small reflex hammers, and found nothing that could be used as a weapon.

“Sorry for the inconvenience,” Wells told the interns, then turned to Carolyn. “Lead on.”

They walked through a door and into a large closet, which served as the medicine room. The shelves were stocked with bottles of tablets and liquids and plastic bags of IV fluids. A locked narcotics cabinet was off to the side. There were no windows or other connecting doors.

“Okay,” Wells said, backing out.

Carolyn showed him the way into the nurses’ station. A husky young African American man with very broad shoulders and hands the size of hams was sitting behind the desk. He quickly got to his feet and straightened his tie.

“This is Jarrin Smith, our ward clerk,” Carolyn said.

“I’ve got to search you,” Wells informed the clerk.

“No problem,” Jarrin said, turning around with his hands held up high.

Wells frisked him and found only a small nail clipper. “Sorry for the inconvenience.”

“No problem,” Jarrin said again.

Carolyn led the way across the corridor and into the nearby nurses’ lounge. It was spotless, with a refrigerator, microwave oven, coffeemaker, and two couches. The tall metal lockers were open and held only jackets and umbrellas. A bathroom at the rear had been recently scrubbed.

As they left the lounge, Wells asked, “The guy at the front desk is big as a tree. Is there a reason for having a clerk that large?”

“His size is irrelevant,” Carolyn replied. “He’s a sophomore in medical school, and works some of the night shifts because he needs the money.”

They hurried on and came to the treatment room. In its center was an operating table with overhead lights. There were two metal stools around the table, and behind them a glass cabinet filled with medicines and supplies. Off to the side was a basin and, next to it, a countertop that held blood-drawing equipment. The walls were covered with white tiles, the ceiling with removable synthetic panels.

“Can they do emergency operations in here?” Wells inquired.

“Only minor procedures,” Carolyn replied. “Things like tracheotomies and thoracenteses.”

“What is the last thing you said?”

“Thoracentesis. It’s the removal of fluid from the chest using a needle.”

They continued on to the end of the corridor and entered a windowless room that had stacks of serving trays and gleaming silverware. A cabinet off to the side contained linen napkins, fine glassware, and colorful tablecloths.

“This is where we get our patients’ meals,” Carolyn said.

Wells glanced around, looking for ovens and stoves or adjoining rooms. There weren’t any. “Where is the food prepared?”

“Down one level,” Carolyn replied. “The Beaumont Pavilion has its own chefs, and all meals are ordered by the patients from a menu. The meals are sent up to us on the dumbwaiter next to the cabinet.”

Wells went over and carefully examined the dumbwaiter. It was small, not more than three feet across and three feet in height, with four adjustable shelves. “Who controls it?”

Carolyn pointed to a switch beneath the small elevator. “We can send it down by pushing that button. The light next to it stays green while the dumbwaiter is up here. It turns red when we send it down.”

“Can the people in the kitchen bring the dumbwaiter down?” Wells asked.

Carolyn shook her head. “They can only send it up. When it’s on its way up, our light will turn green and begin to flash. When it reaches the Pavilion, the flashing stops.”

Wells narrowed his eyes. “Why do you have all these precautions?”

“It’s really not a precaution,” Carolyn said with a shrug. “It just prevents the kitchen from sending up meals that could sit around and become cold.”

Wells nodded and moved over to a metal crank on the side of the dumbwaiter. “And what’s this for?”

“In an emergency we can manually operate the elevator,” Carolyn told him. “But we almost never—”

Abruptly, Wells brought his hand up, interrupting her. He listened intently to the message coming in over his earphone, then turned for the door. “The President is on his way up.”

They dashed into the corridor, which was now clear of beds and personnel. At the far end, Wells spotted the two agents and signaled them with a rapid rotary gesture to hurry up.

“Where do you want the President?” Carolyn asked.

“In the room farthest away from the elevator,” Wells answered and listened to another message coming over his earphone. “And I want the First Lady directly across from him. Put the Secretary of State and his wife between the President and the Russians.”

“Do you want the windows covered?”

“We’ll take care of that.”

They ran down the hall at full speed, racing past the treatment room and the lounge. At the nurses’ station Kate Blanchard, the clerk, and two interns were seated around the desk, chatting with one another.

Carolyn yelled over, “Everybody on their feet for the President!”

The group quickly stood, their postures ramrod straight. The ward clerk placed his hand over his heart.

All eyes went to the elevator panel and watched the floor numbers flash by. 6 … 7 … 8 … 9 …

The elevator jerked to a stop and the door opened.

Two Secret Service agents quickly stepped out into the corridor and made sure the way was clear, then signaled back to David and Warren before moving aside.

David pulled the front of the gurney out of the elevator and swung it around. The fluid in the suction bottle draining the President’s stomach was now colored bright red, and fresh blood was coming out of his nose and mouth.

“Call the blood bank and tell them we need two units of whole blood up here stat!” David cried out.

The President groaned and gagged.

More fresh blood poured out of his mouth and nose.

Six

The President continued to
ooze blood around his nasogastric tube. It was bright red and coming mainly from his mouth. With effort he turned on his side and hacked up enough blood to cover the bottom of a small basin.

“Why am I bleeding so much?” Merrill gasped.

“In all likelihood, whatever caused your food poisoning has eroded away some of your esophageal lining,” Warren answered. “And we think the lining was already weakened by your acid reflux disease. That would explain why you bled and the others didn’t. Dr. Ballineau has also raised the possibility that you might have Mallory-Weiss syndrome.”

Merrill’s eyebrows went up. “What the hell is that?”

“It’s bleeding due to a tear in mucosa of the esophagus caused by strenuous retching,” Warren described.

Merrill looked over to David. “Does it require surgery?”

“Not if it’s a small tear, Mr. President,” David said.

“You keep using the word
if
,” Merrill complained.

“That’s because I want to be totally forthright,” David said. “Until we can confirm what’s going on inside your gastrointestinal tract.”

“So these are all mere guesses, aren’t they?” Merrill asked irritably.

“Yes, Mr. President,” Warren had to concede. “The only way to be sure of the diagnosis is for you to undergo endoscopy.”

“I hate those damn things,” Merrill growled his displeasure. He could still remember the last time an endoscope was passed into his stomach. His throat had stayed sore for a week and he had developed widespread hives from the anesthetic that lasted off and on for a month. “It’s absolutely necessary?”

Warren nodded firmly. “Not only will it give us an accurate diagnosis, it might also reveal a localized bleeding site. And if that’s the case, we can cauterize the area and stop the bleeding immediately.”

Merrill thought for a moment, then slowly nodded back. “Where will it be done?”

“Here,” Warren replied.

David stepped forward and suggested, “It might be best to do it in the endoscopy unit. They have the setup for it, with the necessary drugs and equipment and cameras.”

Warren promptly shook his head. “We’ll do it here on the Pavilion, where we can protect the President.”

David considered the matter briefly before saying, “I guess we could do it in the treatment room. But it’ll be awfully crowded. Of course, the final decision will be up to the gastroenterologist who will be performing the endoscopy.”

“He’ll do exactly what we tell him to do,” Warren asserted. “We’ll need the name of the gastroenterologist so the Secret Service can run a security check.”

There was a quick rap on the door.

“Yes?” Warren called out.

Aaron Wells walked in and hurried over to the President. “Sir, we’ve located your daughter and her date. They had gone to the emergency room at Cedars-Sinai. We’re having them transported over here by helicopter. They should be arriving shortly.”

“Thanks, Aaron,” Merrill said with genuine gratitude.

Wells nodded, trying not to stare at the bloodstained sheet covering the President. “Sir, your daughter will probably ask to see you as soon as she gets here.”

“Check with Dr. Warren first,” Merrill directed.

“Yes, sir.”

Merrill waited for Wells to leave, then looked over to his personal physician. “Find out how ill she is.”

“Yes, Mr. President,” Warren said.

“And I want all the blood cleared off of me,” Merrill ordered. “I don’t want my daughter seeing me like this.”

“It’ll be done, Mr. President.”

Merrill lay back on his pillow, feeling weak and lightheaded. Another wave of nausea came and went. “Let’s get this endoscopy done ASAP.”

Warren rapidly checked the cardiac monitors next to Merrill’s bed. The President’s blood pressure was 98/68, his pulse 96 beats per minute. The pulse rate was fast, but not that fast, considering how much blood had been lost. “Mr. President, Dr. Ballineau and I will be just outside if you need us.”

As they headed for the door, Merrill called after them, “When can I have this damn tube removed from my nose?”

“As soon as the endoscopist arrives, Mr. President,” Warren called back.

Out in the corridor Warren turned to David and asked, “Who is the best endoscopist at University Hospital?”

“Jonathan Bell,” David replied. “He runs the endoscopy unit and is co-chairman of the gastroenterology department.”

“Get him up here,” Warren said, then signaled Wells over. “Aaron, the President will have to be seen by a specialist whose name is Jonathan Bell. Check him out.”

Wells spoke hurriedly into the microphone on his lapel, fully aware there wasn’t enough time to obtain a complete security profile on the specialist. But using the Secret Service’s computerized system, which checks through all the national intelligence indices, they’d rapidly get whatever information was available quickly on Jonathan Bell, and his wife, his children, and his associates. If the specialist’s background wasn’t spotless, he wouldn’t be allowed to come anywhere near the President.

Warren watched David click off his cell phone and asked, “Did you reach Dr. Bell?”

David nodded. “He’s on his way in. He lives in Pacific Palisades, so it’ll take him about twenty minutes to get here.”

Warren asked, “How many people will be involved in the endoscopy?”

David thought briefly and replied, “Three altogether. There’ll be the endoscopist, an anesthesiologist, and someone experienced in the treatment of shock in case the President has further complications.”

“And who will that someone be?”

“Me.”

David checked his watch. It was 10:10 p.m. He’d never make it home in time to tuck his daughter, Kit, in bed and kiss her goodnight and tell her to have sweet dreams. It was a reassuring ritual he did every night, without fail for eight years, since the death of Kit’s mother from leukemia. His kiss always brought a smile to the girl’s face, and that made everything in the world seem right—at least for a moment. He reached for his cell phone and said, “I have to call home and tell them I’ll be late.”

“Don’t mention the President,” Warren said. It wasn’t a request.

“I won’t.” David stepped away and punched in his home number. Juanita Cruz picked up on the first ring. In the background, David heard the sound of a television set tuned to a Spanish channel.

“The Ballineau residence,” Juanita answered.

“Hey, Juanita,” David said. “Is everything okay?”

“Everything is fine,” Juanita replied. “Your daughter is hard at work on her homework.” There was a pause before she asked, “Is something wrong, Dr. Ballineau?”

“Only that I will be home very late tonight,” David told her. “We have an emergency at the hospital and it looks like I’ll be here for the next two hours. There’s no way I’ll be able to tuck Kit in tonight.”

Juanita waited before answering. “She will be disappointed.”

“I know.”

“And she will worry.”

“I know that, too.”

Juanita paused again, then said, “I will tell her that you will kiss her forehead while she is asleep.”

“Good,” David said, thinking how wise and caring Juanita was, and how fortunate they were to have her.

“Hold while I get the little one for you.”

David grinned to himself. “The little one” was Juanita’s pet name for Kit, and she never addressed her by any other title, even though Kit insisted she was almost a teenager and that Juanita would have to accept that fact.

“Fine,” Juanita had said. “I will call you ‘the little one who is now almost a teenager.’”

Juanita had come to work for them six months after Kit was born. The kind, strong woman had left an abusive husband in Costa Rica and had emigrated to America with a young daughter who became a registered nurse and currently worked at Grady Hospital in Atlanta. When David’s wife died, he asked Juanita to move into the guest house and look after Kit full time. Juanita was delighted to do so, since she was living alone in an apartment then. And she loved Kit almost as much as she loved her own daughter.

“Hi, Dad,” Kit said as she came on the phone.

“Hi, beautiful,” David answered. “What are you doing?”

“Homework. We’re studying the bees.”

“Bees, eh?”

“Yeah. Did you know we’d all be dead in four years if the bees suddenly disappeared?”

“You don’t say.”

“Ah-huh,” Kit went on. “Without bees there’d be no pollination and without pollination there’d be no plants and without plants there’d be no food and all the animals would die.”

“Wow!” David enthused. “And we’d all be gone in four years, huh?”

“That’s what the teacher said, but he was just quoting Albert Einstein.”

David shook his head admiringly, now envisioning his daughter with her raven hair, cream-colored skin, and sky-blue eyes. She was just gorgeous. And smart as a whip, making all As and always on the honor roll. And she was starting to like boys almost as much as she liked soccer.
Oh, Marianne!
David thought sadly, now seeing his dead wife in his mind’s eye.
You’re missing so much.

“Dad?” Kit broke the silence.

“Yeah?”

“Why the phone call?”

“I have an emergency at the hospital,” he explained. “Someone very, very important is really sick, so I’ll be getting home late and won’t be able to tuck you in.”

“Oh,” Kit said, her voice barely audible.

David’s heart sank. His daughter sounded so let down.

“I can stay up and wait for you,” Kit offered.

“That’s not a good idea,” David said. “I won’t be home until after one or two o’clock, and you need your sleep. Remember, you’ve got a big soccer game tomorrow afternoon.”

“You’re right,” Kit agreed, brightening up a little. “You’ll be there for the game, won’t you?”

“I wouldn’t miss it for the world,” David promised. “Now you finish your homework and crawl under the covers and have sweet dreams.”

“I love you, Dad.”

“I love you too, Kitten.”

David put his cell phone away, still feeling guilty about not being home with his daughter to kiss her goodnight. His absence would only remind Kit that, unlike most other children, she had only one living parent—and that, if something happened to him, there was no backup and she would be all alone in the world. Just the thought of it had to frighten her. But David was stuck, and he knew it. There was no way he could abandon the President—or any other sick patient, for that matter.

Warren stepped over and studied the expression on David’s face. “Is there a problem?”

“No,” David answered curtly. “No problem.”

“Then our next step is to set up the endoscopic equipment,” Warren said. “How do we go about doing that?”

“We don’t,” David told him. “We wait for Dr. Bell. It’s his show.”

Warren was about to ask another question about the procedure but held his tongue.

The Secretary of State and his wife were being wheeled on gurneys into nearby rooms. They were a handsome African American couple with light skin and silver-gray hair. Both looked very ill. Coming in behind them was the Russian president and his wife and two security guards. Ivana Suslev was in a wheelchair, her head drooped onto her chest and her blond hair in disarray.

When the corridor was finally cleared, Warren came back to David and kept his voice low. “With the drugs the President will receive for his endoscopy, how long will he be out of commission?”

“An hour and a half, maybe two hours,” David estimated.

“Well, we won’t have to worry about the Twenty-Fifth Amendment then.”

“What’s that?”

“It’s the part of the Constitution that transfers presidential powers to the Vice President.”

“On second thought,” David backtracked quickly, “it might be best to check with the anesthesiologist. The President could be down a lot longer if something complicated is found.”

“Who will be the anesthesiologist?”

David shrugged. “That will be up to Dr. Bell.”

“We’ll have to have him—”

“Will!” the President shouted from inside his room. “Will!”

Warren spun around on his heels and hurried into the suite, with David a step behind. The President had propped himself up on an elbow and was vomiting red blood into a small basin. He was retching so hard his body was bouncing off the mattress. He threw up again and again, then dropped back on his pillow exhausted.

“You’d better get that endoscopy fellow in here,” Merrill said weakly.

“He’s on his way, Mr. President.” Warren’s eyes went to the cardiac monitor. The President’s blood pressure was 92/60, his pulse was 104 beats per minute. And he looked pale now. Warren turned to David and asked very quickly, “Do you have any suggestions?”

David studied the monitors, then glanced over to the basin that was brimming with blood. The President had filled the basin twice, and that alone amounted to nearly a quart of blood.
One more massive hemorrhage could kill him
, David thought, as he desperately searched his mind for an answer to the dilemma. Then he remembered back to a patient with erosive gastritis who was bleeding and wouldn’t stop. Quickly David gazed over to a bucket of crushed ice on a night table. It was sitting next to a pitcher of water. He dashed across the room and poured the water into the bucket of ice chips, then swirled the slush until it was freezing cold. “Mr. President, I’m going to rinse your stomach with ice water through the tube in your nose. The name for the procedure is ‘lavage.’”

Merrill swallowed back another wave of nausea. “What good will that do?”

“Very cold liquids will cause the blood vessels to constrict, and that might slow down the bleeding,” David explained. “I think it’s worth trying.”

Merrill nodded quickly. “Do it.”

David hurried over and filled a 50cc syringe with ice water, then attached it to the end of the nasogastric tube. Over and over, he lavaged the stomach with water so cold it burned his fingertips. At first, the gastric juice David retrieved was colored deep red. Then it turned light red, and finally pink. “It’s working,” David said.

“Do you have any idea how long it will last?”