The First Family

by Michael Palmer

  “That’s fine,” the president said. “Cam, give us a second, will you please? We have to talk about you.”

  The president’s attempt at levity seemed utterly lost on Cam, who slipped off the table and slunk to the waiting room.

  Dr. Gleason waited for the door to close before he spoke. “I’ll start us off, if I may.”

  The president nodded.

  “This past year Cam has become increasingly withdrawn. He’s apathetic, moody, irritable, and it wouldn’t be a stretch to say he shows signs of clinical depression. Recently there was an incident with a water glass, which Karen witnessed.”

  Gleason gave a brief explanation of the incident, though Lee sensed details were missing. He was curious to learn more from Karen or Cam.

  “There’s nothing physically wrong with Cam,” Dr. Gleason continued. “And I’m happy to show you the charts. But as you can well imagine, the White House is not an easy environment for a child. No offense, Dr. Blackwood, but it’s my belief—and before Karen inserted herself into the situation, the belief of Cam’s parents as well—that he would benefit from seeing a psychiatrist, not a—family doctor.” Gleason said “family doctor” as if the words were “country bumpkin.”

  Lee said, “Thank you for the information, and no offense taken.” He noted the icy stare Ellen gave Gleason.

  “What Dr. Gleason has left out,” Ellen said, “what Karen has convinced me of, is that we want a second opinion from someone who is not affiliated with the White House, someone with no prior relationship to Cam. I don’t want to drag him to a psychiatrist. The process has to be collaborative. We just want another point of view. If Cam was to hear the opinion of someone from outside the White House it might make him more receptive to receiving the help we believe he needs. Isn’t that right, Geoffrey?”

  “Yes, that’s right.”

  The president moved next to his wife. The president’s edginess made it obvious he wanted Lee’s involvement over with quickly, and for Cam to move on with treatment for depression. Lee felt even better about voting for the other guy.

  “What do you think, Dr. Blackwood?” Ellen asked.

  “I think I’m happy to do an exam, but my conclusions might not support your hypothesis,” Lee warned. “I’m obligated to form my own opinions. If you’re in agreement with that, I think we should bring Cam back in here.”

  A moment later, Cam strolled into the exam room, his gaze on the floor.

  Lee rolled over a metal stool, lowered it a bit, and sat down. Up on the exam table, Cam had the height advantage—the power position.

  “Why don’t you tell me in your own words what’s going on?”

  Lee tried to sound encouraging, but Cam remained tight-lipped.

  “I wouldn’t talk to me either, if I were you,” said Lee eventually, speaking in an almost conspiratorial tone. In a whispered voice, loud enough for all to hear, he added, “Usually when I do a physical exam, there isn’t an audience present.”

  Cam almost cracked a smile.

  Lee glanced at the president, next over to Gleason, and lastly to Ellen Hilliard. “What if Cam and I spoke alone for a bit?” Lee was addressing Ellen, his advocate. “I’ll do my usual exam, and we can talk after that. Does that sound good to you, Cam?”

  Cam returned a half shrug to go along with his half smile. Ellen sent Lee a look of quiet gratitude.

  “Yeah, I guess,” Cam said.

  “Mr. President, Mrs. Hilliard, are you all right with this as well?” Lee asked.

  President Hilliard spoke for them both. “Yes, that would fine. Thank you, Dr. Blackwood.”

  Dr. Gleason said nothing at all.

  CHAPTER 6

  Except for the dark circles around his eyes, and an ashen complexion, Cam appeared to be in relatively good health. Still, it was clear from his demeanor that something was amiss. Lee cleared his mind and got centered. He needed Cam’s cooperation, and judging by body language—eyes downcast, arms folded across his chest—it would be hard to get.

  “Cam, I know this is difficult, but I’m here to help. If you’re honest with me, I’ll be honest with you.”

  “Are you going to tell my parents I don’t need to see a shrink?” Cam looked at Lee pleadingly.

  “I can’t make that promise,” Lee said. “I have to examine you first.”

  “Then you can’t help me,” Cam replied glumly. “I’ve already been examined. Everyone says the same thing.”

  “That you need a shrink.”

  “You got it.”

  “Why are you so against therapy?” Lee asked. “I know it sounds scary, but it’s helped millions of people suffering from all sorts of issues.”

  “I’m not against therapy. I’m just not depressed.”

  Lee nodded, as if to say, Touché.

  “Look, I’m here now, so why not make the most of it. Perhaps I can help.”

  “Please, can you tell them I’m not depressed? It’s something else. I can feel it.”

  But Cam’s whole demeanor seemed morose. He barely made eye contact, and he spoke in a flat voice with hardly any facial expression.

  At first blush, Dr. Gleason’s concern did not seem without merit. But Lee could not reach any conclusion until he completed a thorough exam, and for that he’d need Cam’s cooperation. Clearly, he needed another strategy to win this patient over.

  Thinking of strategy gave Lee an idea. He took out his cell phone and launched a chess application he had downloaded a while back on a whim. He had played a few games, without winning one, and maybe that was why he had forgotten about the app until now.

  Lee moved the pawn in front of his bishop forward one space and handed the phone to Cam, whose face screwed up, confused.

  “What’s this?” he asked.

  “It’s chess,” said Lee.

  “I know it’s chess,” Cam said. “Why are you handing this to me?”

  “I’m playing you in a game.”

  Cam shrugged and moved the pawn in front of his king forward two spaces. He handed the phone back to Lee, who studied the board intently. Eventually, Lee settled on moving the king-side pawn in front of his knight forward two spaces. He handed the phone back to Cam and thought little of his sly smile.

  Cam said, “Queen h4. Checkmate.”

  He gave Lee the phone. Sure enough, Cam’s queen had a diagonal line to Lee’s king.

  “It’s called the fool’s mate,” Cam said.

  Lee grimaced. “I feel so much better knowing that’s the name. Thank you.”

  Cam returned a quiet laugh. Even though Lee had lost the game to an embarrassing two-move fool’s mate, he took it as a victory. The lines of communication were now open. It was a start.

  “You’re pretty good at this game,” Lee said.

  “Got an Elo rating over twenty-six hundred.”

  “Elo? What’s that?”

  “The FIDE uses it to rank players.”

  “FIDE?”

  “Fédération Internationale des Échecs,” Cam said, speaking in an exaggerated French accent. “It’s the World Chess Federation. They’re the governing body of international chess.”

  “You compete internationally?”

  “I told you my Elo rating. I’m one of the top junior players in the world.” Cam did not sound cocky, just reciting the facts.

  “Impressive,” said Lee, who took a moment to think about what he would say next. Every word with this patient mattered. He knew he had one and only one chance to be of help. “Look, Cam, I promise you I’m not here to put a rubber stamp on Dr. Gleason’s diagnosis, if that’s your worry. I’m here to do my own exam, and it’s medical, not psychological. Will you let me help you?”

  “I don’t know what else to tell you,” Cam said.

  To Lee’s ears, Cam sounded desperate. He wanted to have something useful to reveal.

  “You’ve been irritable. Tell me about that.”

  “I take it you heard about the water glass,” Cam said.

  “You
mean the projectile?”

  Cam gave a shrug typical of any teenager.

  “What was the glass all about?” Lee asked.

  “I lost a chess match to Taylor Gleason, Dr. Gleason’s son. Guess I was pissed.”

  “You don’t lose to him?”

  “I don’t usually lose to anyone.”

  “What’s Taylor’s Elo rating?”

  “He’s high for the U.S., but not as high as me.”

  “Why do you think you lost?”

  Cam gave another shrug.

  “Any chance you’re feeling extra anxious for some reason?” Lee asked. “You might be under a lot of stress. This isn’t an easy place to grow up, I’d imagine.”

  “Now you sound like Dr. Gleason.”

  “I’m trying to understand how you’re feeling.”

  “I don’t know. I’m just—just angry a lot of the time.”

  “Angry about what?”

  “I don’t know.”

  “Have you felt angry before?”

  Cam mulled this over. “I thought this exam was going to be medical.”

  “Your feelings are medical.”

  Cam seemed to accept Lee’s explanation. “I mean, sure, everyone gets angry sometimes, but I don’t typically throw things.”

  “Would you say the anger began around the same time you started losing to Taylor?”

  Cam thought it over and gave a nod. “Yeah. Maybe around then. It’s probably hard for you to understand because it’s not sports or something normal like that, but chess is what I do. It’s who I am. Chess means everything to me.”

  Lee could see the distress on Cam’s face and his heart broke for him.

  “It’s not hard for me to understand at all,” said Lee. “Any star quarterback would be equally devastated if they couldn’t play because of an injury.”

  Cam nodded in vigorous agreement. “But this isn’t like a normal injury,” he said. “It’s more like that quarterback one morning suddenly couldn’t throw the ball and nobody knew why.”

  Interesting, thought Lee.

  “How’s school going for you?” he asked.

  “It’s okay, I guess. It’s easy for me, but I don’t like going as much anymore.”

  “Are you losing interest in things?”

  Cam shrugged again. “A little. Maybe I’m bored or something.”

  More signs pointing to some sort of depression.

  “What about girls?”

  “What about them?”

  “Do you date?”

  “I’m the president’s kid. It’s not really easy to date.” He put “date” in air quotes. “And besides, there’s no one I’m that interested in anyway.”

  “What about your friends?”

  “They’re cool. We hang out.”

  “What do you like to do with them?”

  “Um—I dunno, we just hang out. My friends think it’s cool here.”

  Lee made a little noise to underscore the observation. “It is cool here.”

  Cam gave what Lee now thought of as his signature shrug. “Guess I’m used to it,” he said.

  To Lee’s ears, Cam sounded more apathetic than adjusted.

  “Do you play chess with your friends?”

  Cam shook his head. “I go to the TPI for that, or to tournaments.”

  “What’s the TPI?”

  “The True Potential Institute. It’s where I learned to play. I still go there because they have some of the best chess instructors in the world. Every few years the FIDE hosts the junior team championships, and this year the tournament is being held in New York.”

  “Big deal?”

  “Very. Teams from all over the world compete. I’m captain of the U.S. squad.”

  “Lots of practice?”

  “Online mostly, but there are some weekend retreats, and we’re expected to work on our own. That’s why I go to the TPI so much. The competition is really intense.”

  “Are you the best player at the TPI?”

  “I was until Taylor started beating me. I’m team captain and Taylor is first alternate. I shouldn’t be losing to him. Now, I’m thinking I might quit playing altogether.”

  Lee was looking again at those dark circles around Cam’s eyes, thinking how important concentration was to winning at chess.

  “Are you having any headaches? Confusion? Issues with your vision?”

  “Dr. Gleason checked my vision and gave me a new prescription. You think my eyes are the reason I’m losing?”

  “I’m not sure yet. Does your vision ever go blurry on you?”

  Lee was thinking back to when he first came into the exam room and saw Cam cleaning his glasses with the sleeve of his shirt. Maybe he was trying to clear his vision and not clean away the grime.

  “Sometimes when I’m reading, the words get blurry for a moment. Even with the new prescription.”

  “Are you sleeping well?”

  Cam turned his head, a giveaway something was amiss. “I guess. Some mornings I wake up and I’m super tired. It feels weird, like I was beat up in my sleep or something. I dunno how else to describe it.”

  Lee was keenly interested, but for reasons Cam could not have suspected.

  “Achy muscles? Foggy feeling?”

  “Yeah, all of that.”

  “Do you ever feel confused?”

  “That too. Like a ‘where am I’ kind of thing.”

  “Does it happen often?”

  “Maybe a couple of times a month. Maybe more.”

  Lee thought again of the glass Cam had thrown. Irritability now coupled with unexplained and intense fatigue after a night’s sleep. Cam might need to be evaluated by a discerning psychiatrist after all. There were enough arrows pointing toward depression, but they pointed somewhere else, too, and that was the direction Lee wanted to go.

  “Tell me, Cam, have you ever bitten your tongue?”

  Cam leaned back, perplexed. “My tongue?”

  “Yeah, does it ever feel sore when you wake up feeling tired?” Lee asked.

  Cam thought it over, but seemed unsure. “Maybe,” he said. “Everything feels sore on those mornings, but not so bad I can’t go to school or anything.”

  “Let me have a look.”

  Cam stuck out his tongue.

  Nothing abnormal. Maybe it was somewhat generous in size, but the tissue and color appeared normal and there were no bite marks or indentations from Cam’s teeth to suggest macroglossia, the medical term for a pathologically enlarged tongue.

  “Are you having any other issues with your sleep?”

  “No.” Cam said this too quickly, too sharply.

  Waking up tired and sore, possibly biting his tongue—these were telling clues. Diagnosis was 90 percent history and 10 percent physical exam. To get real answers Lee needed to probe deeper, but some questions were difficult to answer, like the one he was about to ask.

  “Cam, I want you to be honest with me. Have you wet the bed?”

  “No.” Cam would not look Lee in the eyes.

  “It’s nothing to be embarrassed about, I promise. But I need to know. It could be important.”

  He hesitated, but Lee could tell Cam’s walls were coming down.

  “Once. A couple weeks ago,” Cam eventually said, looking away.

  “Was it one of those mornings you felt achy and fatigued?”

  “Yeah,” Cam said, making eye contact now.

  “Did you tell anyone?”

  “No.”

  Lee wondered if Cam hid the sheets out of embarrassment, or if it really did happen just one time.

  “Cam, from what you’re telling me, I think we may need to do some further testing.” Lee’s voice was reassuring, his expression earnest. “I’m thinking this might not be entirely a mental health issue.”

  Cam seemed overcome with relief—it was in his eyes, the way his facial muscles relaxed.

  “I want to do a complete physical, and after that I’ll speak with Dr. Gleason and your parents. Is that okay w
ith you?”

  “Are you going to tell my dad? About the bed, I mean.” He appeared to be horrified by the thought.

  Poor kid is more worried about disappointing his father than his health.

  “Let’s not even worry about that for now.”

  “What’s wrong with me?” Cam asked. “I’ve never done that before.”

  “Well, I’m not sure, but let’s see what the exam tells us. Deal?”

  “Deal,” Cam said.

  And they shook.

  CHAPTER 7

  Lee got the first lady’s permission to conduct a more thorough physical exam before he asked Cam to put on a hospital gown in a private changing area. Lee took Cam’s vitals—blood pressure a healthy 114 over 65, heart rate sixty-five, temperature and respirations all normal. Cam said he took no prescription medications.

  All visual field tests, eye movement, speed, and quality came out normal, and Cam’s pupils were equal and briskly reactive to light. Using an ophthalmoscope, Lee examined the retinas of Cam’s eyes so he could directly observe the arteries, nerves, and veins, looking for evidence of papilledema—swelling of the optic nerve head that might indicate increased pressure within the skull. The marginated optic nerve and the visible pulsations of retinal veins were normal and reassuring, but did not exclude an underlying tumor.

  No sign of one-sided facial weakness. Touch felt equal on both sides of his face, no signs of any sensory loss.

  “Can you hear this?” Lee asked as he ever so gently rubbed his fingers together beside each of Cam’s ears. He got a thumbs-up. No problem there.

  Next, Lee aimed his penlight inside Cam’s mouth, checking the soft palate, the back of his throat, and seeing Cam’s uvula rise symmetrically and stay midline when he said, “Ahhhh.” The gag reflect was as expected. Cam hated that test. That was expected, too.

  Lee asked Cam to stick out that slightly large tongue of his once more, and noted it did not deviate to one side or the other. His neck muscles were strong and equal. After finishing the cranial nerve examination, Lee directed his attention to the remainder of the neurologic exam. Motor function, fine. Strength, good. Coordination intact. No involuntary movements or tremors. With Cam’s eyes closed, Lee tested for sensation, touching a light cotton swab gently over his limbs.