The First Patient

by Michael Palmer

  Griswold motioned to the presidential aide to take over and helped Gabe guide Stoddard off the slightly elevated stage and back around to the chair behind the velvet drapes. By the time the aide had begun to tell the attendees to hold their seats, a cordon of Secret Service agents, facing outward, had formed a ten-foot circle from the edges of the curtains. Inside the circle, Alison had opened the FAT kit and was readying equipment. Gabe had already started his evaluation. With Griswold's help, the president removed his shirt.

  "Oh-two by mask," Gabe ordered, setting his stethoscope in place, "six liters. Griz, you have that Alupent inhaler?"

  "I do."

  Stoddard's chief Secret Service agent passed the inhaler over to Stoddard.

  "Mr. President, go ahead and take a couple of puffs from this," Gabe said. "In fact, make it three. Alison, as soon as you have the oxygen in place, please hook him up to the pulse oximeter. Tape it to the IV pole if you have to so that I can see the readings. Then get out the cortisone inhaler from the FAT kit. We have Alupent right here, so we won't need any more of that. Mr. President, you're doing fine. It's not too bad. Just take nice, slow breaths. Nice and slow."

  "I . . . I couldn't catch my breath . . . for a moment there."

  "You're moving air fine now," Gabe said with steady reassurance. "Probably just some mucus plugs in a couple of your bronchial tubes. Nothing to be worried about. I'm good at this."

  "I'm . . . glad."

  "All that prairie dust keeps people in Wyoming wheezing all the time. Alison, as soon as you can, let's give him a couple of puffs of the cortisone. Then wheel over that IV. We'll use—a twenty intracath. I'll put it in, so I'll need a tourniquet, Betadine, and some tape. If we can get him hydrated and bronchodilated quickly, this little attack should break in no time . . . Alison?"

  "Huh? . . . Oh. Oh yes. . . . Sorry. Here's the cortisone inhaler. Check the security seal to make sure it's intact. And here's the IV pole and IV. Same thing with the seal on that. We have backups for everything if there are any questions. I'll get the intracath ready."

  "Thank you," Gabe replied, surprised by her brief but striking lapse in focus. Considering who their patient was, it was hard to believe she would be even the least bit inattentive.

  Well, he thought, at the moment he was attentive enough for both of them. He felt the familiar sensations of confronting a medical emergency. His vision and hearing seemed much sharper than usual, and he was processing information rapidly—correlating at beyond computer speed what he knew about asthma and about Drew Stoddard. Although Gabe was definitely keyed up, he suspected his pulse might actually have slowed.

  From his very first days in medical school, this was the sort of situation he enjoyed the most. It was what all those countless hours of study and training and practice were all about. Now, if he could just keep the identity of his patient out of the equation, there shouldn't be any problems.

  To his right, Magnus Lattimore had worked his way through the Secret Service agents and asked the big questions of Gabe with his eyes. "Mr. President," Gabe went on, speaking as much to the chief of staff as to the man himself, "what we're going to do is to try and break this asthma attack right here, right now. That would mean no ambulance and no trip to the hospital, although we're completely ready for both."

  "You fix me up, Doc. . . . I don't want any hospital. . . . You know . . . how they are. . . . I'm sure they'll keep me hanging around in the waiting room forever."

  "Yeah, you're probably right about that. Okay, here's the deal. Are you comfortable in that chair? Otherwise we can have the paramedics bring us a stretcher from the ambulance."

  "I'm fine."

  "You always were tough." He tightened a tourniquet around the president's arm, located a suitable vein at his wrist, and after the obligatory, "Just a little stick, now," slipped the catheter in easily.

  "That didn't even hurt," Stoddard said. "You are damn good."

  "Told you I was. You run the country, I stick needles in people."

  "In my America, everyone's got to do something."

  "We're getting this IV going to improve your hydration and loosen up some of the mucus that's causing you trouble. As soon as I'm comfortable things have settled down, I'll pull it. In addition, we're giving you bronchodilator and cortisone to widen your tubes and let more air in, and to reduce any inflammation. On a scale where ten is the worst asthma attack imaginable, you're maybe a three-point-five."

  "I think my breathing's already a little easier."

  "Good," Gabe said, confirming that air movement was certainly no worse. "That's a definite possibility. Alison, let's go ahead and give him zero-point-three of epinephrine subcutaneously."

  This time, she was totally present.

  "Epi, zero-point-three. Check the security seal on the box and I'll open it up and give it. Sub-Q."

  Gabe verified as he had with the cortisone inhaler that the packaging was intact. Then he unwrapped it and passed it over to Alison. Except for her brief episode of distraction, she engendered confidence and was as much of a pleasure to work with as she was to be around.

  "Gabe? . . . It's not like you think."

  What in the hell had she meant by that? he wondered now.

  Five minutes passed. Gabe stayed focused, constantly checking the president's blood pressure, pulse, respiratory rate, oxygen level, and air movement.

  Lungs clearing . . . respiratory rate down from 26 to 18 . . . BP 130/85 . . . oxygen saturation up to 95 from 92.

  Five more minutes. Half a liter of IV fluid in. . . . Color good . . . wheezing almost gone . . . O2 saturation 96 . . .

  Lattimore had returned to the audience. Gabe could hear him speaking through the microphone but couldn't make out the words. Whatever he said brought about a healthy round of applause. Moments later, the chief of staff reappeared.

  "I just told them you were doing well," he whispered to Stoddard. "The vultures want to know if you're coming back."

  "No!" Gabe snapped. "He's not."

  "I'm breathing much better," the president said. "Plus that shot—what is it, like adrenaline?"

  "It's exactly adrenaline."

  "Well, it's really pumped me up. I feel like I'm about to take off from the deck of a carrier."

  "Mr. President, you need to just stay put. You were this close to an ambulance ride to Johns Hopkins."

  "If I can pull it together and reappear, think about what my press people can do with this. The world will love it."

  "The world will think you're an absolute nut with no regard for his health and a total incompetent for a doctor."

  "Listen, Gabe. I can't help it if you happen to be really really good at what you do."

  "You've got an IV running."

  "All the better. I'll drag it out there with me. Just a minute or two, for closure . . . and a couple of photos."

  "No!"

  "Gabe, we're talking about a presidential election—my last shot at really making a difference in this country and the world. Your doctor's head will always opt for the conservative approach—well, almost always. But please try and look at the big picture. You've broken the asthma attack for me. You did it! I can feel it. Look, I don't even have to gasp for breath between sentences. Let me just go out there and say thank you and good-bye and show the people that I'm all right and I'll be back in this chair before you know it."

  Exasperated but at the same time exhilarated, Gabe turned to Latti-more.

  "How long have you been working for this guy?" he asked.

  "Long enough to know what the outcome of this one's going to be," Stoddard's chief of staff replied.

  CHAPTER 24

  It was a bad dream.

  Alison kept telling herself that as she and the paramedics packed up the FAT kit and got ready to head for the medical van.

  What she had witnessed, the conclusions she was considering—they had to be nothing more than a bad dream.

  But she knew otherwise.

  Treat Griswold, the
legendary Treat Griswold, number-one Secret Service agent to the President of the United States, had reached into his jacket pocket, withdrawn an asthma inhaler, allowed the president to administer the contents to himself, and then put the inhaler back in his pocket. It sounded innocent enough and probably looked like no big deal to anyone else who observed the incident—although there were few, if any, in a position to do so.

  The problem was that drugs of any kind, when destined for the president, had to follow a strict, immutable chain of custody. The prescription was given by the White House doc or nurse to the administrator of the medical unit, who then called it in to a specific high-clearance pharmacist, using any of half a dozen fictitious names. The pharmacist knew the drug was destined for the White House but had no idea if it was for the POTUS, another patient, or even the medical clinic in the Eisenhower Building next door. The pharmacist formulated the prescription and, if necessary, prepared multiple sealed containers, which were picked up by a White House driver. The driver signed for the drug and turned it over to the nurse in the White House medical office, who signed for it and put it in a locked medicine cabinet. The president's physician then retrieved the drug and administered it himself.

  In the case of an inhaler, the president might be given one to keep in his residence bathroom. Other inhalers would be secured on Air Force One, on Marine One, in his personal physician's bag, and at Camp David. The president might use the inhaler on his own, but otherwise, its contents should be dispensed only by his physician or the doc covering for him.

  The chain of custody would probably not stand up in a court of law, but it was a chain nonetheless, based in large measure on the assumption that none of those intimates handling any of the sealed packets would want to harm the president.

  Alison had learned the unwritten protocol from a physician, who was both showing off and possibly flirting with her, but after just a few days in Washington it appeared that Gabe Singleton had yet to be brought up to speed on it. Admiral Wright had been away when Gabe arrived on the scene, so it was possible that during Gabe's orientation whoever took Wright's place had simply forgotten or neglected to cover the handling of meds. Perhaps the other medical office docs hadn't thought to mention it, either. It made sense, then, that having Treat Griswold produce an inhaler would have seemed quite natural to Gabe, who had yet to learn that no one except the president's physician should be dispensing meds of any kind to the man.

  Perhaps, she thought, she should try to break through Gabe's fortress of mistrust and tell him, although it probably would be better if one of the other docs did it.

  "Come on, Alison," Gerrity, the physician's assistant, called out. "I've got the rest of this stuff. We have to get down to the motorcade or we're going to be left here searching for a cab so we can get home and start searching for jobs."

  Alison surveyed the area one final time. At the base of the high velvet curtain was a plastic Baggie—the one, sealed and signed by all who had touched it, that had originally contained a cortisone inhaler, which was also sealed and signed per the chain-of-custody protocol. The final step, the loop closer, was that once the seals had been broken and the medication used on the POTUS, regardless of what that medication was, it was to be disposed of immediately and a new chain of custody implemented.

  It was most likely no big deal that Treat Griswold had control of the president's inhaler. Griswold had been a loyal, even heroic guardian of presidents for two decades at least. The best thing she could do was probably let the matter drop. Still, Dr. Jim Ferendelli had vanished, and she had been placed undercover in the White House Medical Unit specifically to keep her eyes and ears open and to report to the head of internal affairs anything out of the ordinary—anything at all.

  The notion of blowing the whistle on anyone, let alone Griswold, was chilling. She thought about her horrific experience in the hospital in L.A. She had been in the right then—totally in the right. The incompetent surgeon had killed a patient and destroyed a good, caring nurse. The proof Alison had of that was solid, if not absolute. At least that was what she believed before her life was methodically undermined and sent crashing down around her.

  Not this time.

  Even if her job was to observe and report, there would be no whistle-blowing on Treat Griswold without irrefutable, undeniable proof that rules had knowingly and willfully been violated. Instead, she would learn what she could about the man, searching for a chink in his armor of competence and devotion to office or else affirming that he was beyond reproach and worthy of the honors bestowed upon him over the years.

  "Alison, this is it. We go now or we don't bother!"

  She hurried to the elevator and rode down with the PA. The career military men who served as White House valets were mess specialists—trained to observe the preparation of the POTUS's meals and personally serve whichever plate he wound up getting. They watched every bit of food he was served and from time to time would taste the meal as well. Would any of them tolerate a Secret Service agent showing up in the kitchen carrying and then serving the president's dinner?

  No chance.

  She had to proceed to look into this situation, but to do so cautiously. The likelihood was that the president himself had chosen to bend the rules for the sake of convenience and that Griswold was simply complying with his commander's wishes.

  When they arrived at the medical van in the motorcade, the Secret Service agents were poised to take off. Alison glanced up ahead at the lead limo. Gabe would be settled in next to the guy who had once been his drinking buddy in school and now was the most influential, potent person on Earth. She wondered whether the founding fathers, had they known about nuclear weapons and drug abuse, homelessness and health insurance, space exploration and runaway science, would still have chosen to cede such awesome responsibility to just a single individual.

  From the president's point of view, the day had been an incredible success. Thanks to Gabe Singleton's quickness, clinical judgment, and quiet competence, his asthma attack had been aborted before it could evolve into a full-blown medical crisis. Once broken, the bronchospasm and mucus production abated, and within less than half an hour Stoddard had tucked his shirt in (leaving the collar and cuffs open), taken hold of his IV pole, and bravely wheeled it out to the podium. He stood there, bracing himself on the pole just a bit as boisterous applause filled the hall. Then he explained that his doctor had easily broken what he described as a mild asthma attack and would be removing the IV as soon as the last of the solution had run in. Stoddard then spoke ad lib for two minutes or so—more than enough to gain closure with the donors, exposure before the reporters and cameras, and, Alison guessed, smiling to herself, control of at least 90 percent of the nation's asthmatic vote.

  The move to return to his supporters was blatantly theatrical—Ringling Brothers all the way. But given the potential danger of his asthma attack, there was nothing bogus about it. And judging from the prolonged, enthusiastic response of the audience, what could have been something of a body blow to his campaign—increased concern about his health—had instead become a war cry signaling that he was fearlessly ready to move forward with his Vision for America.

  Down the road, it seemed as if Andrew Stoddard might point to this day as one in which the many facets of his run for reelection were triumphantly brought together.

  Still it seemed possible—just possible—that within the ranks of his supporters, specifically in the person of his favorite, most trusted Secret Service guard, there was potential trouble.

  CHAPTER 25

  There was no one who passed the blind man, making his way through the throngs at Reagan National Airport, who did not take notice of him. He was tall and broad shouldered, with a long ebony ponytail protruding from beneath a white cowboy hat that featured an ornate band of turquoise medallions linked by hand-tooled silver. He strode ahead with surprising confidence, his thin white cane tapping away at the tiled floor like an insect's antenna. His face, high cheekboned and
powerful, was the reddish brown of the clay that for centuries had been the bedrock of his people, the Arapaho.

  As the man emerged from the security zone, Gabe quietly fell in stride beside him.

  "Dr. Singleton, I presume," Dr. Kyle Blackthorn said after just a step or two, though there had been no physical contact between them.

  "How'd you guess?"

  "It was no guess, my friend, I assure you of that. And I really don't think you want to know which of my senses were at work."

  "No. No, I suppose I don't. Luggage?"

  "Right here. One night's worth of clothes and my testing materials. I'm due back to teach at Wind River the day after tomorrow."

  "You still go out to the reservation every week?"

  "Just one of the tribulations of being a role model."

  "Those kids are lucky to have you."

  "I am the lucky one, just as are you for the work that you do when you don't have to."

  "Well said. Thank you for dropping everything and coming so quickly. I know how busy you are."

  Gabe smiled as one traveler after another turned to watch them pass. He had wondered how easy it was going to be to sneak the six-foot, three-inch Indian into the president's residence at the White House. Now Gabe found himself searching for another place the two men could meet for a three- or four-hour evaluation. As difficult as Blackthorn was to hide, the President of the United States was even more so. Their session was simply going to have to be in the White House residence.

  "You ready to go to work?" Gabe asked.

  "The president?" Blackthorn asked in a near whisper.

  Gabe nodded.

  "Good guess," he said.

  "Not too difficult. You were front-page news in the local rag when you left. Everyone was talking about it. Before this, they were proud of the things you have done with the children. Now, they are absolutely in awe."

  With no prompting from Gabe, Blackthorn turned toward the stairway leading down to the parking area. Perhaps it was some telltale sound from the roadway below, perhaps an increase in the foot traffic heading in that direction or maybe just a slight gust of breeze. Whatever senses he was reacting to, the psychologist responded with certainty, his cane confirming more than directing.