Patient One (19 page)

Twenty

They weren’t able to
stem the President’s bleeding. Blood kept gushing up around his nasogastric tube and into the back of his throat. He spat out one mouthful after another.

David hurriedly aspirated Merrill’s gastric juice into a large syringe. It was colored deep red. The hemorrhaging was not letting up, not even a little. He quickly filled the syringe with ice water and again lavaged the President’s stomach.

“David,” Carolyn said urgently. “His pressure is down to ninety over sixty, and dropping.”

“I know, I know.” David wiped the beads of perspiration from his forehead with the back of his hand, and tried to think of a way to raise the President’s systolic pressure.
I’ve got to replenish his intravascular volume or he’ll go into shock, and I’ve got to do it without any blood or plasma. But how? How the hell do I do that?
His gaze went up to the IV bag above Merrill’s bed. “Open up the albumin drip all the way.”

“It
is
open all the way.” Carolyn called back.

“Then put your hands around the plastic bag and squeeze it,” David directed. “That’ll push in more albumin faster.”

Carolyn reached up and applied firm pressure to the plastic bag, using both hands. The albumin-saline solution began running into the President’s arm in a steady stream. Carolyn looked down at Merrill, with his ghostly white color. His gown and sheet and pillowcase were heavily soaked in red. She glanced over to the cardiac monitor and reported, “His pressure is up to eighty-eight.”

“Keep squeezing,” David urged. “You’ve got to maintain his systolic pressure above ninety.”

“I’ll try,” Carolyn said, her eyes still on the monitor. “Oh, hell. He’s dropping again.”

“Squeeze the bag harder!”

Merrill started gagging and choking as more blood accumulated in the back of his throat. He now had trouble catching his breath. Gasping, he hawked up maroon-colored phlegm and asked, “Dr. Ballineau, am … am I dying?”

“Not yet,” David replied calmly, beginning another ice-water lavage.

“I’ll want to know,” Merrill gulped. “I’ll want to say goodbye to my wife.”

“I understand,” David acknowledged.

Carolyn sighed to herself, moved by the President’s words. The man was looking at death, and the only thing on his mind was saying goodbye to his wife.
I’d like to be loved like that
, she thought wistfully.
And love someone back the same way.
The President suddenly groaned. Carolyn jerked her head down.

“What’s that, Mr. President?”

“I’ve got a pain in my side,” Merrill complained.

“Where?”

“By my right hip.”

Carolyn quickly examined the area. Merrill was lying on the sharp edge of a used, wrinkled plastic bag of albumin in saline. She reached for the bag and tossed it aside. “Better?”

“Much,” Merrill replied, inhaling deeply, his throat now clear. “I think I’m breathing easier, too.”

“And I think we’re making some progress with the ice-water lavage,” David informed him. He held up the syringe containing the gastric contents he’d just aspirated. Its color was halfway between pink and red.

“Has the bleeding stopped?” Merrill asked.

“No,” David answered honestly. “But it’s slowed, and that’s a good start.”

“Will it begin again?” Merrill asked anxiously.

“Let’s hope not,” David said. But he knew it was just a matter of time before the hemorrhaging returned. And the next time they wouldn’t be able to stop it, or even slow it. The simple fact was that whatever Factor VIII the President still had in his blood was quickly being used up by his continued bleeding and poor clot formation. It wouldn’t take much of a bleed to kill him now.

David lavaged Merrill’s stomach once more. The gastric contents were pink, with no clots present. He glanced over to the monitor. Merrill’s blood pressure was 95/60 and climbing.

“Good news, Mr. President,” David told him. “I think we’ve got a handle on it now.”

“Thank you,” Merrill said gratefully, and closed his eyes.

David motioned for Carolyn to follow him into the bathroom, well out of earshot from the President. The terrorist at the door stepped in so he could keep an eye on them.“One more big bleed and the President is dead,” David said quietly. “And there’s nothing we can do about it.”

“Won’t the ice-water lavage hold him?” Carolyn asked.

“Not for long,” David answered. “He could break loose again in a matter of minutes.”

“Shit!”

“Yeah.”

“We’re going to be famous,” Carolyn said disgustedly. “We’ll be known as the people who let the President die while we just stood by and watched.”

“I guess.” David tried to think through the dilemma, but knew there was no answer to the problem. Without blood or plasma transfusions or Factor VIII replacement, the President was as good as dead.

“I think you should speak with the head terrorist again,” Carolyn suggested. “If you stress how desperate the situation is, maybe he’ll let them send up more blood for the President.”

David shook his head. “He won’t change his mind. Never in a million years.”

“Why not?”

“Because he’s got a secure situation, and he plans to keep it that way.”

“But how can he be threatened by a couple of units of blood?” Carolyn asked.

“You’d be surprised,” David said. He, like Aliev, knew that all it would take was one little breach, one small opening, and the enemy would find a way to use it to his advantage. “It’s similar to asking how a dumbwaiter can end up threatening the life of the President of the United States. On the surface, a dumbwaiter sounds innocuous, but here it turned out to be deadly, didn’t it?”

“But surely they don’t want the President to die,” Carolyn argued. “A dead President is of no use to them.”

“Sure he is,” David countered. “They just won’t let the outside world know. And after their demands are met, they’ll load his body into a helicopter and fly off, promising to release him later.”

“Jesus!” Carolyn cringed. “How can people be so cold-blooded?”

David gestured with his hands, but he knew the answer. Just instill enough hatred in them, then train them how to kill. That’s all it took. Like the terrorists in Mogadishu
who had known nothing but dire poverty and felt they had little to live for, but plenty to die for—particularly if they could kill infidels in the process. Death in battle held no fear for them because it promised eternal happiness in paradise. And so they killed and died eagerly, yelling with their last breath that “God is great.”

And the Chechen terrorists were no different from the ones in Mogadishu. They were ruthless and cold-blooded, longing to kill and not afraid to die. They were perfect soldiers. And perfect bastards who were more than willing to blow up a hospital and murder a lot of innocent people.
With a bomb! A goddamn bomb!

“We’ve got to do something,” Carolyn said, breaking into his thoughts.

“Yeah,” David agreed. “But what?”

Carolyn shrugged helplessly. “I don’t know.”

“The only thing that will really help is a unit of fresh whole blood,” David said. “With anything else we’re wasting our time.”

Carolyn nodded dejectedly. “And even if the terrorists agreed to let the blood come up, we’d still have a problem finding a match for Merrill. Remember how difficult he was to cross match earlier. And to make matters even worse, he’s got a rare blood type, very rare. He’s AB negative.”

David’s eyes suddenly lit up. “Are you absolutely certain about his blood type?”

“Yes,” Carolyn said, trying to read his face. “Why?”

“Are you doubly sure?”

“Yes,” Carolyn said and headed for the bedside. “Apparently, the blood bank was able to get a match for him after all. Come on and I’ll show you.”

At the foot of the bed she reached into a trash can and extracted an empty plastic bag that had been used to transfuse the President. She held it up and pointed to the label. “See? It’s AB negative.”

“That’s my blood type.”

“So?”

“So we can use my blood to transfuse the President,” David explained rapidly. “It’ll be risky, but it’s all we have to offer. And it just might work.”

Carolyn hesitated, a look of concern coming across her face. “What if he has a bad transfusion reaction?”

“That’s a risk we’ll have to take,” David said at once. “This is his only chance, Carolyn. It’s either do or die.”

Carolyn nodded slowly. David was right. But she also realized that a severe transfusion reaction could be fatal, particularly in a patient whose condition was already so fragile. “We could give the President a small amount of your blood as a test dose.”

“Right,” David agreed immediately.

“But there’s a problem,” Carolyn warned.

“What?”

“We don’t have the setup to draw your blood and put it in a plastic bag to transfuse the President. Only the blood bank has that.”

“There’s a way to get around that.”

“How?”

“Come on,” David said, taking her hand. “I’ll show you.”

They ran out of the suite and down the corridor, the terrorist guarding them close behind. Aliev came alongside, running hard to keep up. Two more terrorists appeared out of doorways, their Uzis at the ready.

“Where are you going?” Aliev huffed.

“To the treatment room,” David told him.

“Why?”

“For medicine to stop the President’s bleeding.”

Aliev moved aside and yelled out orders in Chechen. The other terrorists peeled off and went back to their duties. Except for the balding one. He remained close to David, even entering the treatment room with him.

David ignored the terrorist and asked Carolyn, “How many heparinized test tubes have you got?”

“Let me count.” Carolyn hurriedly opened a drawer and removed two cartons of test tubes that were coated with the anticoagulant heparin. “I’ve got forty-two tubes, each ten ccs.”

David calculated rapidly. “That’s a total volume of over four hundred ccs we can use for transfusion.”

“But how do we pool forty-two tubes of blood into a transfusable unit?” Carolyn said.

“That’s easy,” David explained. “And this is how we’ll do it. Using a Vacutainer, I want you to draw my blood into all forty-two tubes. The blood won’t clot because it’ll be heparinized. We’ll then take big 50-cc syringes and aspirate up the blood from the test tubes. In the end we’ll have over eight large syringes filled with my blood.”

Carolyn nodded quickly, now catching on. “And we’ll connect those syringes to the President’s IV line and slowly inject your blood. It’ll be like giving him eight mini-transfusions.”

“You got it,” David said, nodding back. “Grab a tourniquet and get started.”

Carolyn reached for a Velcro tourniquet and placed it tightly around David’s arm, then waited for a vein to pop up. “We’d better keep in mind that you’ve already lost a lot of blood, David. You may not have much to spare.”

“I’ve got a hell of a lot more than the President does, and I’m not the one dying,” David said. “So let’s get on with it.”

Carolyn found a vein in David’s antecubital fossa and expertly slid the needle in. As blood began to drip out, she pushed a test tube into the Vacutainer and watched it fill up with blood. Quickly she went through one test tube after another, loading each to the brim. Within minutes she had filled twenty tubes. “If you start to feel weak, let me know.”

“I’m fine,” David said, taking a deep breath. Suddenly he was aware of the perfume she was wearing. It was a fragrance he was familiar with. His late wife had used it. “Is that Arpège you have on?”

“It is.” Carolyn looked up at him and smiled. “How did you know?”

“Can I tell you another time?” David asked evasively.

“You sure can,” Carolyn said, removing a filled test tube from the Vacutainer and pushing in a fresh one. “If we ever get out of here, you’re going to have a lot of stories to tell me, aren’t you?”

“Just a few.”

“Liar,” she said, still smiling.

The terrorist guarding them moved in for a closer look. He obviously didn’t understand what was going on. He muttered something in Chechen and pointed to the thirty-two test tubes filled with David’s blood.

The smile vanished from Carolyn’s face. “What do you think he wants?”

“Nothing important,” David replied. “Otherwise he’d speak in English.”

The terrorist’s expression tightened. “Why blood?”

“For the President,” David answered.

“Oh,” the terrorist said and backed off.

Carolyn continued filling test tubes, one after another. David’s blood seemed to be flowing much faster now. “Three more to go,” she announced. “Do you want to aspirate the blood into the large syringes in here?”

“No,” David said after a brief pause. “We’ll do it in the President’s suite. That way one of us can be aspirating the blood into a syringe while the other is injecting the blood into the President’s IV line.”

Carolyn shook her head in admiration. “Is there anything you haven’t thought of ?”

“I haven’t thought of a way to get us out of here.”

“But you will, won’t you?”

“We’ll see.”

Carolyn watched the last test tube fill, then removed the tourniquet and needle from David’s arm. Quickly she gathered up all the test tubes as well as a carton of 50-cc syringes and a handful of #16 gauge needles. “All set!”

David jumped off the operating table and headed for the door. Abruptly he stopped and put his hand on Carolyn’s shoulder to steady himself. The room started to spin.

“Are you all right?”

“Just getting my sea legs,” David said and waited for the wooziness to pass. Gradually the spinning sensation stopped and his balance returned. “Okay, let’s go.”

They walked quickly down the corridor, David keeping his arm hooked into Carolyn’s. He tried not to lean on her, but found himself doing it anyway. And now his legs felt heavy as lead.

“You’re not all right,” Carolyn hissed, becoming alarmed.

“It’ll pass,” David attempted to reassure her.

“No, it won’t. And you know it.”

“Once we get the President squared away, we’ll infuse a liter of saline into me. That’ll expand my intravascular volume and I’ll be fine.”