Patient One (3 page)

“That’s not possible,” David said firmly. “Three of the patients are too ill to be moved off the floor. I know this for a fact, because I’m the attending physician up there.”

Warren stared at David, not certain he understood. “They have an emergency room up on this pavilion?”

David shook his head. “It’s a medicine ward for the rich and famous who have difficult diagnostic or therapeutic problems,” he explained. “All staff members are required to teach on the wards or in the clinics for six weeks, and I spend my teaching time on the Beaumont Pavilion rather than down in the ER. It’s a change of pace.”

“And a little more perspective on the real world of everyday medicine, eh?”

A
lot
more perspective, David wanted to say. The Pavilion reminded him why he liked the ER so much. In contrast to the wards that moved along at a snail’s pace and where most of the time was spent talking, the ER was action-packed and hectic, full of excitement and drama.

Warren tried to read David’s expression, but couldn’t. “Are you having second thoughts about using the Beaumont Pavilion?”

David shook his head again. “The Pavilion is fine, but those three patients must stay put.”

“They’ll have to be moved for security’s sake,” Warren insisted.

“Security won’t be a problem with these three.”

David described the three critically ill patients, highlighting the important features. The sickest was a movie star in her sixties with cirrhosis, who was drifting in and out of hepatic coma while she waited for a liver transplant. The second patient was a young college student with a lupus-induced pericardial effusion that was gradually impeding her heart’s ability to pump blood. And the final patient was an eighty-year-old man with polymyositis, a rare inflammatory disease involving the large muscles.

“These people are so weak they can’t get to the bathroom without help,” David concluded.

“I still don’t like it,” Wells said.

“If you’re worried about them, you could post agents outside their doors,” David suggested.

Wells and Warren exchanged glances, a silent message passing between them.

“Okay,” Wells consented reluctantly, now determining how the eleven suites would be used. The two presidents and their wives would occupy four rooms; four rooms would be needed for the Secretary of State and the Russian Foreign Minister and their wives; and two more would be held open for the President’s daughter and her date. The final suite would be used for operations and communications. He turned to David and asked, “How many non-patient rooms are on the floor?”

“Four,” David told him. “There’s a nurses’ lounge, a chart room, a treatment—”

A loud, coarse shriek came from the waiting area beyond the swinging doors into the ER. Then another shriek, even louder. It sounded like the cry of a wild man.

Instantly, the Secret Service agents drew their weapons and assumed firing positions, all aiming at the entrance. They waited, nerves taut, now hearing the sounds of tables and chairs being knocked over. A female voice screamed. Someone yelled for help. Then there was an eerie silence. Then thumping footsteps. Suddenly the swinging doors burst open, and a huge red-bearded man charged into the ER. Wide-eyed, he looked crazed and fierce.

“I’ll kill you all!” he roared. “I’ll tear your goddamn heads off !”

“Be careful!” David quickly warned the others. “He’s a PCP user, and he’s violent.”

Wells asked in an even voice, “Does he come in a lot?”

“At least once a week,” David said. “Everybody down here knows him.”

“Has he ever been armed?”

“Never.”

Wells rapidly studied the man, who was wearing a tight-fitting T-shirt and jeans. There were no bulges in his clothing, nothing to indicate he was concealing a weapon.

“Morris,” Wells called over to his second in command. “Do you see anything in his back pockets?”

“
Nada
,” Morris replied promptly. “He’s not carrying.”

The crazed man raised his arms and flexed his massive biceps. “I’ll kill all of you sons of bitches.”A metal pan dropped to the floor behind the barricade and rattled around noisily. The sound startled the heavily muscled man and he bolted straight ahead, making a beeline for the President’s room. Two Secret Service agents jumped on the man and tried to tackle him, but were quickly thrown off. The PCP user shrieked again and charged onward.

“Stop or I’ll shoot!” Wells yelled, but Warren was now partially blocking his line of vision.

The man ignored the warning and was almost to the President’s door. David appeared to back away, but then in a flash he lunged forward and delivered a vicious chop to the man’s trachea. The intruder dropped to the floor, grasping at his neck and sucking for air.

David stepped aside, and felt his pulse racing as adrenaline flowed through his system. It was an instinctive act, a maneuver drilled into him by special training years and years ago. It was an instinctive act, all right, and a stupid one too. It could have gotten him killed by the PCP-crazed intruder, or by a trigger-happy Secret Service agent. David took a long, deep breath and gathered himself.

“Je-sus!” one of the nearby agents muttered in wonderment, his eyes going from the doctor to the huge man on the floor who was still trying to catch his breath.

“Put restraints on him, hands and legs,” David directed calmly. “Then take him to the holding room. The nurse will tell you where it’s located.”

Wells repeated the instructions to a trio of agents, then turned to David.

“Where did you learn how to do that?”

“I took a self-defense class,” David said tonelessly.

Like hell
, Wells was thinking.
The doc moved like a pro. And besides, the hit he put on the crazy guy wasn’t defensive.
Wells glanced at the doctor’s name tag and decided to run a quick security check on David Ballineau. “We need you to clear that floor for us now.”

“First, I should place a nasogastric tube in the President,” David advised. “We’ve got to know whether or not he’s still bleeding.”

Wells looked over to Warren, who nodded in agreement, then took David’s arm and guided him past another agent and into the treatment room.

The President was lying motionless on an operating table under a set of kettledrum-shaped lights. His coat had been removed, but not his bloodstained shirt. One sleeve was rolled up to make room for an IV line that was slowly dripping saline into his arm. A nearby monitor showed the President’s blood pressure to be 98/70, his pulse 90 beats per minute.

David stared at the President. The man projected an aura of power even when he was sick and on his back. He had chiseled, aristocratic features with a strong, jutting chin and graying brown hair. And he appeared to be larger, much larger, than he seemed on television. David did his best to maintain his professional composure, but his brain kept reminding him that he was about to treat the President of the United States, the most powerful man on the face of the earth.

David watched Warren increase the flow of saline into Merrill’s arm, then brought his gaze back to the President. David’s awe at the man’s office was tempered by the fact that he was no fan of John Merrill, and had voted against him twice. Unlike his predecessor, who had fought like hell to stop terrorism, regardless of the cost or consequences, Merrill was more deliberate and cautious, always reaching out to backstabbing allies to form a consensus that never really worked. The end result was inaction that allowed terrorism to grow and flourish, and intimidate people around the globe. A perfect example was when Hezbollah opened fire on a U.S. naval vessel sailing for Haifa. Merrill decided to consult with the Arabs before bombing a lone Hezbollah encampment in Lebanon. One goddamn raid! A single bombing run on a base that had probably been vacated because the terrorists had been warned in advance by our so-called allies. It was a feeble response that only encouraged the terrorists more.

And Merrill’s soft stance on immigration, and his unyielding opposition to stem cell research, also irked David to no end. If he could, he’d vote against Merrill a third time.

“Your blood pressure is up over a hundred,” Warren commented. “That’s a good sign, Mr. President.”

David quickly cleared his mind and pushed his personal feelings aside. The Hippocratic Oath instructed him to treat, not judge. And so the President would be looked upon as just another patient, an important one to be sure, but nevertheless just another patient. David’s mantra in the ER was
See ’em, fix ’em, and send ’em on their way
. That’s exactly how he would deal with John Merrill.

“Mr. President,” Warren asked quietly, “are you feeling any better now?”

Merrill waved away the question and inquired, “How’s my wife?”

“She’s doing fine, Mr. President,” Warren reported.

“And my daughter?”

“We think she’s gone to another hospital, Mr. President,” Warren replied. “They’ll notify us as soon as she’s located.”

“I want her brought here.”

“It’ll be done, Mr. President.”

Merrill tried to sit up but was too weak. “Give me a hand here, Will.”

Warren rushed over and helped the President up, then watched closely for any signs of hypotension caused by his blood loss. The President remained steady.

“Are you okay, sir?”

“I’m fine,” Merrill said, sitting on the edge of the table and letting his legs dangle. In truth, he felt a little lightheaded. “So what do we do next?”

“You should stay here overnight for observation,” Warren recommended.

“Why?” Merrill asked at once. “I’m not vomiting blood anymore.”

“But you still may be bleeding, Mr. President,” Warren cautioned. “It’s in your best interest to remain under observation for the next twenty-four hours.”

Merrill sighed resignedly. “All right. If you think I must.”

“I do,” Warren assured him. “And while they’re clearing a ward for us, I’d like Dr. Ballineau to pass a tube into your stomach.”

“What!” The President stiffened at the thought of a tube going into him. “What the hell is that for?”

“To determine if you’re still bleeding,” Warren answered.

“It’s really necessary, eh?”

“It’s really necessary,” Warren replied. “And Dr. Ballineau here is an expert at doing it.”

Merrill looked over at David, and studied him at length. “How’d you get that scar?”

“I jumped out of a helicopter and landed on my face rather than my feet,” David answered flatly.

“Were you in the military?” Merrill asked.

David nodded. “A long time ago.”

Merrill smiled thinly. “Well, let’s hope you’re better at passing tubes than jumping out of helicopters.”

David smiled back wryly at the President’s quick wit. “I am, Mr. President.”

Warren interjected, “He’s done the procedure a hundred times, Mr. President.”

Merrill took a deep breath, readying himself, his eyes never leaving the expressionless doctor. “So tell me, how is this tube put in?”

“Through your nostril, into your throat, and down into your stomach,” David detailed. “All you have to do is swallow, Mr. President. Done right, it’ll take about ten seconds and you’ll barely feel it.”

Merrill glanced over to Warren, who nodded back reassuringly. “Okay, let’s get it done.”

David stepped over to a large basin and quickly washed his hands. After drying them, he put on latex gloves and reached for a cellophane packet containing the nasogastric tube. He slowly unwound the clear plastic tube. It was three feet long and the diameter of a pencil. From a distance it had the appearance of a long gray snake.

Merrill’s eyes widened. “Don’t tell me that whole damn thing is going into me!”

“No, sir,” David told him. “Only about a foot’s worth.”

“Goddamn lemon-cured salmon,” Merrill cursed under his breath.

“What?” David asked.

“Nothing,” Merrill said and prepared himself for the worst. “Let’s get this over with.”

David lubricated the tip of the plastic tube with a clear jelly and brought it up to the President’s nose. “Here we go,” he said and gently threaded the tube in.

Merrill felt only a little discomfort as the tube passed through his nostril and into the back of his throat. But when the tube reached his hypopharynx, the President began to gag, and this caused the burning pain to return.

“Swallow, Mr. President.” David encouraged him. “Swallow.”

Merrill gulped and gagged, then gulped again. With a final swallow, the tube entered his stomach.

“Well done, Mr. President,” David said, and taped the nasogastric tube in place. Next he used a large syringe to aspirate gastric juice from the President’s stomach. The fluid was colored deep brown and had a few tiny clots floating in it. After capping the syringe, David connected the nasogastric tube to a suction bottle and watched the gastric juice flow into it.

“Why is it so brown?” the President asked. His voice was nasal-sounding because of the placement of the nasogastric tube, but he had no problem speaking since the tube went directly from his pharynx into his esophagus, bypassing the larynx.

“It’s old blood,” David explained. “The stomach’s acid turns hemoglobin that color.”

“Does that mean I’m not bleeding now?” the President asked hopefully.

“It tells us you aren’t hemorrhaging,” David said. “But you may still be oozing. We’ll leave the tube down for a while and watch. If the gastric juice becomes clear, it’ll mean the bleeding has stopped.”

Warren looked down at the peculiarly colored gastric fluid. It was so deep brown it resembled coffee grounds, and that made him wonder if the entire lining of the President’s stomach had sloughed off. Warren considered the possibility that the President wasn’t suffering from a simple gastroenteritis. He shuddered at the next thought that went through his mind. Maybe someone had tried to poison the President! Some poison might had eroded away the mucosal lining of his stomach. But the food served at the official dinner had been carefully scrutinized, and all the chefs, kitchen personnel, and waiters thoroughly checked. Still, the possibility of poisoning couldn’t be excluded.