The Killing Vote

by Bette Golden Lamb

  Desisto was born.

  While he hadn’t grown to like Tyler any better, he had grown to dislike Wilson more and more. But Abrams knew W.W. was a survivor. That’s what the country needed now. Survivors.

  Wilson convinced him that redemption lay in making a significant change the Medicare system, a change that wouldn’t be noticed until it was too late to stop it; provided they could slip it in under the wire, tag it onto an appropriations bill up for almost automatic congressional approval. The process didn’t dare attract the negativism that previously had accompanied introduction of the Affordable Care Act.

  Timing was crucial. Secrecy was paramount.

  The simplicity of the plan made Abrams see success. They would have a real cost-effective solution with the kind of zeros that added up to a trillion. One that could not only halt the rise of Medicare costs, but could make the program’s projected debt figures plunge until costs were stabilized.

  Abrams knew he was being used by W. Wade Wilson and the people who owned him. But he’d managed to retain a certain amount of control by coercing the President into bringing on an opposition party member, Maurice Seldon, as his HHS Secretary.

  The carrot: They could wipe out the deficit, fix a badly broken Medicare, and create a bipartisan flair that would keep the pointing fingers at bay.

  And President John Armistead Tyler could nail the whole thing as his idea.

  He found it interesting how certain important and memorable policies and programs, good or bad, were forever associated with the President at the time, whether he had anything significant to do with them or not.

  A knock on his door, followed by the uninvited appearance of his assistant, brought Abrams back to the present. The assistant carried a tray with all the accoutrements for a bountiful coffee break. Abrams’ eyes focused on, and immediately claimed, a large strawberry Danish, buttery and sugary.

  “Good morning, sir,” the young man said. “Thought it was about time for a pick-me-up.”

  Abrams looked at the twenty-something and once again kicked himself for not choosing a woman to be his personal assistant. But he’d been advised against it. Gossip in the White House corridors could be vicious. That and a couple of threatened, unearned, female sexual harassment incidents in the past dictated a male in his front office.

  “Thanks,” he said. This kid did a great job, but he was convinced women added a certain positive flair to the running of an office; they were not only more observant, but they were quick to let you know when a reality check was in order. They also had the kind of common sense that his testosterone-driven assistant wouldn’t have for a few years, maybe never.

  Abrams hadn’t been sleeping nights and drinking the strong hot coffee was the only thing that kept him focused. The Desisto Project was giving him a sensitive stomach, and his wife was starting to complain about all the ultra-late hours and his absences from home for days at a time. With all the sex scandals popping out like teenage acne, she’d become suspicious. There were a lot of questions, the most specific one being: Was he sleeping around?

  Hell, who had time?

  * * *

  The out-of-the-way, pseudo-Italian cafe in Alexandria had only three other sit-down patrons this morning, but, to Dick Abrams’ surprise, the place was doing a brisk pizza take-out business.

  He pulled the food-spotted menu from between bottles of hot sauces with unfamiliar names, then glanced at his watch. Wilson was late.

  It was after 10, the agreed upon time in this spot far from their element. A perfect place not to be noticed.

  Abrams shifted on the saggy, torn vinyl seat, checked to see if he’d snagged the soft merino wool of his Hugo Boss slacks. Overhead, garish plastic flowers and imitation stuffed birds were suspended from the ceiling, drooping from layers of dust and greasy steam.

  He was about to use his cell when the lobbyist appeared. Wilson started to sit down, scowled at the decrepit upholstery, then slid in across from Abrams anyway.

  “How’s it shaking,” Wilson said, grabbing a menu.

  Abrams spent a brief moment studying Wilson before he answered. The man was in terrific physical condition. It was no secret he was a fanatic about exercise even though he still ate all the junk food he could get his hands on. Word was he used to be a drinker’s drinker, but found a way to retreat from conspicuous over indulgence to unassuming moderation. Some said he could still be the last man standing if the situation demanded it.

  “I’ll throw your question right back at you,” Abrams said. “You’re the man of the hour, or at least the one who keeps the clock wound.”

  A gaunt counter woman, who doubled as waitress, appeared at the booth with a carafe of coffee and filled their cups without asking. She set the pot down, wiped her hands on the sides of her wilted yellow uniform, and asked, “What can I get you boys this fine Virginia morning?”

  “I’ll have a slice of deep-dish pepperoni pizza,” Wilson said. “But bring me a stack of rye toast to go with my coffee. Lots of butter, please, darlin’.”

  “And for you, honey?” she asked Abrams, her eyebrow lifting suggestively.

  “I’ll take Number 3 under the fruit section, with a side of plain yoghurt.”

  “Got it!”

  “Uh, is the fruit fresh?” Abrams asked.

  “As fresh as I am,” she said and headed back toward the cash register to ring up a Goth teen couple who were waiting to pay.

  “Since this is the last time I intend for us to meet,” Abrams said, “tell me now exactly how everything stands; no lies, exaggerations, or omissions. I mean, I can still stop this thing anytime I don’t like what I’m hearing. Or not hearing.”

  “You think I’d lie, Dick?”

  “That must be a rhetorical question,” Abrams said stone-faced.

  W.W. turned bright red from forehead to chin.

  “No, bullshit, Wade. Can I tell the President everything is set and ready to go?”

  “Locked and loaded.”

  * * *

  Wilson was royally pissed at Abrams. Although the lobbyist was used to being a shadowy player on the Congressional stage, this super-secret undercover stuff was beginning to weigh heavily on his shoulders.

  He blasted the interior of his rented Audi with every profanity he could dredge up during the drive back to his office. Even the thought of having had to rent a car for the trip made him dig even deeper into his repertoire of vulgarisms to express his feelings for “that fucking Jew Abrams.”

  Plain and simple: He liked to be chauffeured. Didn’t want the aggravation, the responsibility of maneuvering through heavy Beltway traffic.

  “Asshole!” Wilson muttered for the umpteenth when he was back in his office. “Too bad that self-styled prince leads such a pristine life. He brushed the seat of his pants, getting rid of imaginary crumbs from the rundown pizza parlor. “God, how I’d love to slop something gooey and dirty all over that sanctimonious hide of his.”

  But his best efforts to dredge up any scandal involving Abrams, sexual or otherwise, had produced absolutely nothing, even after going all the way back to the man’s high school years. Honor student, sports star, marriage to his college sweetheart, clean political campaigns for city councilman, state legislature, and the U.S. Senate. Not a chink anywhere.

  “Gonna have to play it straight with that prick,” he told the portrait of Edward Bernays that hung on the wall next to his desk. Wilson kept a stack of passes to the Smithsonian as prizes for anyone who recognized “The Father of Public Relations” without being told. He still had the original rubber-banded ten.

  Regardless of what he thought about Abrams, the Desisto Project continued to be his primary concern. He knew it was the right time.

  Desisto had taken on a life of its own and was moving with the speed of an avalanche. But without the White House connection—Abrams, Seldon, and the President—the whole kit-and-caboodle would keep on crashing down the mountainside into a bottomless crevasse.

  Wilson had an
unexpected chill, his scrotum tightened as he envisioned his drug company clients dropping him one by one. They’d made him more money than he ever imagined he could make as a political flack. And it could all disappear as rapidly as yesterday’s news if he didn’t stay on top of things, keep a tight hold on every part of Desisto, from CORPS to the final Senate vote on the Medicare funding.

  His heart raced.

  Shouldn’t have let Rudge give me the jitters about the journalist. Should have just left that old has-been alone. All it did was bring him and his wife to D. C. Nothing but a mess of trouble, unnecessary trouble.

  God, it was hard to imagine some sixty-something broad outsmarting two badass pros.

  All that drama and expense just to keep one old blogger at bay. Shit!

  Sen. Angelle Savage and that Nevada whore were the last pieces. Once they were set into the humongous Desisto jigsaw puzzle, the picture would be complete.

  If not, he might well spend the rest of his days sunning himself in The Caymans.

  Wilson looked out his office window, saw that it was snowing again. He thought about the cold waters of the Potomac and how sitting by a pool on a Caribbean island, sucking up a piña colada, sliding his hand up into the crotch of a lovely island woman might not be such a bad life.

  No, no, no! A little trouble had never put him on the run, and he wasn’t about to start running now. He barked a harsh laugh and sang out to Edward Bernays and the empty office,

  “I’m a D.C. man, I am, I am.”

  He smacked the flat of his abdomen with the palm of his hand, sat taller in his chair, and reached for the phone.

  Chapter 28

  Garrett Rudge tapped in his password and scrolled to the ICU AM Report that he was looking for. The Della Paoli update was written by Sarah Silver, RN and signed off by Terence Emory, MD.

  Sarah Silver, RN? That could be a real stroke of luck.

  He loosened his tie, pulled out a handkerchief and blew his nose.

  Or maybe not.

  The morning update covered the projected Desisto target; Della Paoli’s physiological and neurological systems. Rudge scrolled through most of the report before skipping to the conclusion:

  Diagnosis: Locked-In Syndrome. Condition: Moribund. Prognosis: Grave.

  “Good news,” he said to the empty office. The sound of his own voice jarred him back to reality. The words were hollow.

  For years and years, he and his cohorts had railed against euthanasia in all its guises.

  Even Congress had put on a big show with the Terry Schavo case. Their cry: Don’t Americans deserve the best care possible to the end?

  All talk.

  The real goal: Drive costs down.

  It would be political suicide to push for more birth control or abortion. Forget the ethics. It was the perception not the reality that brought the votes.

  The population was exploding and the cost of healthcare with it. Putting end-of-life economies into place was the easy answer.

  His mind kept tricking him into visualizing Della Paoli—a person in trouble with no one there for her. No advocate in her corner

  And the numbers weren’t going to be there for her either.

  Right now, six other Hygea offices were poised and ready—they had no ethical problems with the directives, the protocols Rudge had sent. They’d all fallen into line, each with its own candidate—six Della Paolis. Their fingers were on the THAT WAS EASY button.

  Rudge broke out in a full sweat.

  It was at times like these that dark memories of his twin sister Evie reached out to him. He could swear he felt her hand squeezing his.

  * * *

  “Mrs. Paoli!” Dr. Terence Emory said, standing by the woman’s bedside. “Can you hear me?” He ran his fingers through his matted hair, didn’t like the way it felt. He quickly checked his watch—8:00 pm.

  Man, after 48 hours, I need a shower and some sleep

  “Mrs. Paoli!” he repeated, lowering his head until his lips were close to her ear. “My name is Doctor Terence Emory. We’re trying to help you. Do you understand?”

  The lack of response made him uneasy. Emory straightened and looked down at the patient, glanced again at her chart, and said, “Mrs. Paoli! Can you hear me?”

  He knew his display of irritation was causing a negative reaction among the nursing staff.

  “Let’s try something different,” he said in a more conversational tone. He needed to get this over with before he could go off duty. He took one of Della’s hands.

  “Are you awake, Mrs. Paoli? Just a nod is okay.” He waited, knowing from her test results that probably wasn’t going to happen.

  “Okay,” He gently squeezed her hand. “Don’t even worry about trying to open your eyes. Just move them back and forth or up and down; either way will do.”

  * * *

  Della disliked the man speaking to her. His voice was cold and it came from far away. She could barely make it out. But what if he was her only contact with the outside? She made a supreme effort to do as he asked.

  * * *

  “Ah,” Emory sighed, watching her eyes flick back and forth under her lids. The doctor pulled a chair close to her bed and sat down. He was encouraged, but wanted to make certain that what he’d witnessed was not some kind of erratic reflex.

  “Very good, Mrs. Paoli. Can you do that again, move your eyes?” He watched and waited, surprised at the tension he felt. She responded with distinct movement. It was the most positive response he’d experienced from a patient during the 48 hours he’d been on duty.

  “Excellent!” he said as much for his own benefit as for hers.

  Emory sat back in his chair, exhausted. With the cutbacks in staff, he was living more and more on the ragged edge.

  He stared at Della Paoli’s chart and once again went through the computer readouts clamped firmly between blue carbon filament covers—history (what there was of it), ER notes, nurses’ notes, doctors’ notes, orders, diagnostic test results.

  Everything they knew about the woman was in this computer read out. He slumped and forced himself to acknowledge that within the hospital system, this patient had no identity, no substance, no reality without the chart he held in his hand. But it really told him nothing about the human being in the bed.

  Frustrated, he scanned the information again, checking and rechecking, hoping to find some clue that would allow him to do something positive for her before he was forced to dismiss her from the ICU ... the satellite ... his mind.

  Emory closed the chart and dropped it onto his lap. He pinched the bridge of his nose, sighed, and talked to the patient again.

  “Mrs. Paoli, you’ve been in a very serious automobile accident. At first we thought you’d injured your spine. But after running many tests and taking numerous scans and x-rays, we know that’s not the problem.” He hesitated, searching for the right words.

  He looked down at the old woman and took a tissue from the bedside stand, gently blotted the perspiration from her face. He could feel heat radiating from her parchment-like skin and knew she was running a fever without checking any of the various electronic or telemetry readouts to confirm it.

  “You probably suffered a stroke and lost consciousness while driving your car. Our tests indicate a clot is blocking the signals from your brain stem that control movement and speech. That’s why you haven’t been able to talk or move.”

  Emory sighed and stretched his neck muscles. He was feeling the numbness that usually overcame him during these 48-hour stretches.

  It didn’t help knowing that this woman was doomed—time, her age were all against her—only a very small percentage of stroke victims suffered this type of total incapacity. The “Locked-In Syndrome” was simply rotten luck.

  It was the rareness of her case that kept him riveted to the chair, had him devote more time than he normally would have given to a patient. He mentally reviewed the statistics for people in her condition. For one thing, it was unusual for someone like h
er to survive even this long. Nevertheless, he felt a sense of loss, a sense of sadness and pain over the fact he could not save her from going through this ordeal.

  He was surprised by his emotional response—he thought he’d finally learned how to bury all those kinds of feelings.

  Emory knew what her life would be like confined to a bed, unable to care for herself or even communicate meaningfully. She had a right to know the facts, but he couldn’t bring himself to just spill it out. He stared at Della while swallowing down a lump in his throat.

  God, I hate this. This isn’t what I signed on for.

  He’d wiggled his way into Galen because it was in a mostly affluent community. He’d faced all of the old and destitute patients he ever wanted to see while in medical school. He simply didn’t have whatever special commitment it took to deal with indigent, isolated patients.

  Like a number of doctors in their early training, he’d identified with many terminal patients under his care. He became certain he had whatever it was that was killing them—brain tumor, lung cancer, emphysema, heart attack—he developed the same symptoms. Everyone of them. But each time he’d survived.

  Now, as he sat staring at Della Paoli, he envisioned the blood clot lodged in her brain. Death would definitely be preferable. But there she was, alive, locked-in, no different than any other prisoner in solitary confinement—shut out from a world that gave her no hope of release or escape. He doubted anyone would ever hear her voice again.

  Emory pictured himself in Della Paoli’s situation. He clutched at the almost unendurable pain growing in his stomach.

  “Mrs. Paoli,” he said, “in medicine we try to never use the word never. I know you’re unable to move right now, but that doesn’t mean you never will.”

  He cringed at the lie.

  “You should be able to regain full use of the muscles that control your eyelids. So, you will be able to see. You may even regain limited use of the rest of your body. How much, I don’t know. There’s no way to know for sure.”

  And now you know the truth.

  Again, he grasped one of her hands, took some deep breaths. He was beginning to feel better.