The First Family

by Michael Palmer

  Lee waved to Cam as he rolled by him.

  “I’ll be in to see you in a minute,” said Lee.

  Cam returned a slight hand wave and away he went.

  A few moments later, Lee entered Cam’s room and found the patient already tucked into his hospital bed. Dr. Seneca had gone off to check in on another patient. A different nurse, this one with the body build of a greyhound, busied herself hooking up Cam’s telemetry leads and adjusting his IV.

  “Bet you haven’t had one of those in before,” Lee said to Cam, as he checked out the IV for himself. It was a saline drip, standard hydration for any hospital patient.

  “The nurse said I had good veins.”

  “Just one of the many privileges of being young,” Lee said.

  “Hopefully another privilege is getting out of here soon. I hate hospitals.”

  “You kidding me? This place is like the Ritz!”

  “I live in the White House, remember?”

  “Point taken,” Lee said with a smile. “Sorry you’re here, but Karen told me your symptoms, and well, they didn’t sound great. I like to err on the side of caution.”

  “All I know is you’re not going to make Dr. Gleason’s Christmas card list,” Cam replied.

  Instead of answering with a smile, Lee burst out laughing. “Good to see you haven’t lost your sense of humor. Dr. Seneca told me you’re doing fine. Maybe this will be just a quick overnight stay.”

  “Hmmm,” Cam said, sounding contemplative. “Now I’m wondering if Taylor might have hit me on purpose.”

  “Why is that?”

  “Because he’s first alternate for the U.S. team at the world juniors tournament. If I’m out of commission, he takes my place.”

  It was obvious Cam said this only in jest.

  “I have all the confidence you’ll be able to play, but I’d still like to examine you again, if you don’t mind?”

  “No problem,” said Cam.

  Lee wondered if he needed to get the president’s permission to proceed. He decided to follow the same advice he had given Karen, and ask for forgiveness instead.

  CHAPTER 14

  Cam’s plush hospital room quickly cleared out. Lee thought he looked a bit pale, and a bit bloated from the IV fluids he had been receiving, but in good general health.

  “First, tell me how you’re feeling. Any pain?” Lee asked.

  “Not too bad,” Cam answered quietly, “except when I cough or take in a full breath. Then, I feel a little twinge in my left shoulder.”

  “Anything else?”

  “I’m a little sick to my stomach. Can I have a Coke, maybe?”

  “No can do, pal,” Lee answered without hesitation, thinking about Cam’s spleen and the CT scan. “Let’s see what we find, shall we?”

  Compressing Cam’s lower ribs, Lee confirmed the slight wince that Dr. Seneca had observed. He took out his stethoscope and listened to Cam’s chest. Good equal breath sounds on both sides. No signs that he was splinting, favoring movement on one side that could be a clue to a tiny rib fracture missed on the CT. He listened over the belly. No bowel sounds. That could mean a sign of irritation in the abdomen. Leaking blood, perhaps? Next, Lee pressed down gently over the abdomen and let go quickly. Cam winced ever so slightly.

  “Sorry. That hurt?”

  “Yeah, a little.”

  Lee finished his examination and put away his stethoscope. He glanced at Cam’s vital signs on the monitor. BP 96/60, P 104, R 18. Oxygen saturation 99 percent. No fever. All normal.

  But then again …

  “Cam, I’m going to do what all doctors on TV do about this time.”

  “You’re going to talk with my parents and tell them you’re still worried.”

  “How come you’re such a smart kid?”

  Lee and Cam both said, “Chess,” at the exact same moment. “And I can see it on your face,” Cam added. “I could really use that Coke. I’m feeling queasy.”

  “Sorry, Cam. You can’t take anything orally until we decide on whether you need surgery. I’ll talk with the nurse and get you something for your nausea.”

  * * *

  A SECRET Service agent guarding access to the president and first lady frisked Lee at the doors to the family waiting room before letting him inside. The first person Lee saw when he entered was President Hilliard. He sat on a cracked leather armchair, poring over documents in a folder embossed with the presidential seal. Mounted on the wall behind him, a CNN broadcast showed stock footage of President Hilliard walking the grounds of the White House. The volume was turned off, but according to the graphics they were running a story about a recent flare-up with Iran.

  The first lady sat on a different leather sofa, her attention fixed firmly on her cell phone. Her shoes sank into the plush gold carpeting. Two Secret Service agents, each as animated as houseplants, stood in the corners opposite the door. Karen was seated on an upholstered armchair looking extremely uncomfortable, while not far away sat Dr. Gleason, wearing a suit instead of his white lab coat, his focus also on his phone.

  Off in a far corner, Lee spied a military aide wearing the bold blue uniform of the U.S. Navy, white hat under his arm, gold aiguillette draped from the shoulder, holding a large black briefcase. The nuclear football, Lee mused. The gravity of this moment, of the patient he was treating, came into sharper focus.

  The first lady sprang up from her seat the moment Lee entered. She might have been one of the world’s most recognized figures, but in that instant, she looked like any mother worried for her son.

  “Lee, thank you for being here,” Ellen said quickly. “Is Cam all right?”

  “He’s doing fine,” Lee said. “But I’m glad he’s here for now.”

  “Me too,” added Karen, joining Lee and Ellen in the center of the room.

  Dr. Gleason came over, conspicuously avoiding eye contact with Lee. The president approached and Lee shook his proffered hand. He had to remind himself that the president and first lady put their pants on one leg at a time, just like he did.

  Dressed in a charcoal suit, his eyes strained and tired, the president could not hide his utter exhaustion.

  Congratulations, Lee thought. You spent millions of dollars and fought countless battles to win the worst job in America.

  It was hard for Lee to fathom the constant pressure Hilliard was under, now compounded with worry over the health of his only child.

  “I had you brought here because I wanted Cam to have consistency with his medical care,” President Hilliard said to Lee. “You’re a part of this process now, and I want you to know, I fully support Karen’s decision to bring Cam to the hospital.”

  Hilliard shot Gleason a stern glance, putting an end to any possibility of fisticuffs with Lee.

  “Please,” Ellen said, taking a disparaging tone. “Don’t pretend you wanted Lee here. It was my idea to bring him back. Let’s not make this political too.”

  “Regardless of who instigated the call, we are both glad you’re here,” said the president, tightening his lips some. “So what’s your opinion? How is Cam?”

  “Mr. President, I think Cam will need to have surgery today. I think we need to remove his spleen.”

  “You just said he was fine,” retorted Gleason with a smirk of pique.

  “He is fine—right now, that is.”

  “Is this connected to his … other issues?” Ellen asked.

  “I can’t say for certain, but possibly, yes. His examination—”

  Lee could not complete the thought because Dr. Seneca entered the room, interrupting the conversation. He seemed relaxed, but then again Seneca had grown accustomed to dealing with high-powered clients, the way a mountaineer could adjust to thin air. He immediately assumed command, the dark shade of his beard and blue surgical scrubs adding to an oracular aura.

  “Sorry, I’m late,” Seneca said. “I got caught up with a patient. What have we discussed?”

  “Lee thinks Cam will need surgery to remove his spleen,�
�� Ellen said.

  “I strongly doubt that,” Seneca said. “His scans looked good. It’s most likely nothing more than a bruised rib. He’ll need rest and observation, of course.”

  Relief registered on the faces of the president and first lady. Lee should have seen that coming when he and Seneca had not agreed on the interpretation of those scans. Good chance this was going to get contentious.

  Gleason shot Karen a look that might as well have been a slap in the face. “Mr. President, I’m deeply sorry for all the trouble Karen has caused. We need to reevaluate roles and responsibilities so this won’t happen again.”

  The president offered Gleason only a fleeting glance. “Later, Fred,” he said dismissively. “Can we take Cam home now?”

  “Actually, I don’t agree with Dr. Seneca, and I don’t think you should take Cam anywhere.”

  Brian Seneca stared piercingly at Lee, clearly taken aback by his candor. This was surgical turf. What right did a family practitioner have interfering with more experienced judgment? But Lee felt he had no choice. He would have preferred a private conference, out of earshot, a consensus opinion with a family briefing to follow. But now Seneca had put the battle out in the open with everyone taking notes, and friendship would have to take a backseat, at least for the moment.

  “I agree that the CT scan looks fine for the most part,” Lee said. “But there could still be a tiny rib fracture. More important, I thought the spleen looked a little enlarged.”

  Lee demonstrated the spleen’s anatomic location by pushing up against his stomach just beneath the rib cage.

  “Lee, I reviewed the scan with Tushar Patel, the radiologist. He did not comment on any splenetic enlargement. He’s good. I’ve relied on his judgment for years.”

  Gleason said nothing, though his gloating expression spoke volumes. The president and first lady listened attentively, neither showing any hint of emotion.

  Lee cleared his throat, sensing a need to convince and take command while minimizing any threat to civility or ego. “You know me, Brian. I still put a lot of weight on old-school history and physical examination in making a diagnosis. First, Cam certainly suffered the type of injury that could fracture a rib, or lacerate his spleen. So, history alone should make us suspicious.”

  “Agreed.”

  “I’ve just examined him. He tells me that he feels pain in his left shoulder when he coughs, which could represent referred pain from the diaphragm, most likely irritation from blood. And he has rebound tenderness when I release from pressing down on his abdomen. Another sign suggestive of blood from a leaking spleen. And—”

  “We can treat him expectantly,” Dr. Seneca interrupted. Clearly, he too wanted to minimize any suggestion of public disagreement between doctors who were treating the president’s son. “We’ll watch closely and wait. If his blood pressure falls, we’ll go in.”

  Seneca would have preferred the conversation to have ended at that point, and to debate with Lee in private. Lee refused to pick up on his cue.

  “I stand by what I said. Cam is going to need surgery, and if we wait for major bleeding to occur, we will be putting him at greater risk. I say we go in now, laparoscopically. Just a tiny incision. It’s much easier on Cam and clearly safer than putting him through a full laparotomy should the whole spleen rupture.”

  “You’re rushing this, Lee,” Seneca said.

  At that moment, everyone’s attention went to the waiting room door, which burst open with Cam’s nurse in the threshold. “Dr. Seneca, the patient’s blood pressure is down to eighty and he’s diaphoretic!”

  Seneca exhaled loudly.

  “Call the OR and tell them we’re on our way,” he announced, eyeing Lee as though he were a soothsayer. “Cam’s already been typed and crossed. Change the IV to Lactated Ringer’s at two hundred cc an hour. We’ll put in a central line in the OR. Lee, I’m going to try this laparoscopically. I hope we’ll have time. Mr. President, Mrs. Hilliard—I will speak with you as soon as I can.”

  Seneca raced from the room.

  Lee stayed behind and put his hands on the arms of the president and first lady.

  “Dr. Seneca is a supremely talented surgeon. Please take comfort in knowing that Cam is in the best possible hands and in the right place. And for that, we all have Karen to thank.”

  CHAPTER 15

  Lee was in the operating room, sent there to observe at the president’s request. The game had changed. President Hilliard had come off the sidelines and was now draped in the colors of Team Lee, much to Dr. Gleason’s chagrin.

  It was six thirty in the evening according to Karen’s watch. Normally at this hour, the first family would be sitting down for dinner prepared by the White House chef. Family time was sacred for the president and his wife. They had vacated their Maryland home for the White House with a pledge to live as normal a life as possible. Any chance he got, President Hilliard would trumpet the importance of the family meal, but Karen thought it was just his way of relating to voters.

  When it came to politics, Geoffrey Hilliard was an unabashed centrist who shamelessly cut deals both ways, which was why people both loved and despised him. His centrist position made it difficult to know what was truly important to him.

  There was no question what was most important to the first lady. The anxiousness on Ellen’s face was pronounced. She sat on the leather couch next to Geoffrey, holding his hand. Hospital staff had switched off the television, which had been broadcasting CNN. The president followed the example of his predecessor and rarely watched the talking heads or politicos on the twenty-four-hour news cycle. The media was seldom centrist, and skewered him based on their leanings.

  Ellen did her best to stay dignified under the relentless scrutiny, but the spotlight of the White House was a harsh glare to live in. The public could be profoundly cruel. The pitfalls of public life that she had experienced early in her marriage to Geoffrey, then a young state senator from Maryland, grew exponentially when he decided to run for the U.S. Senate, and it got even worse after he announced his candidacy for the presidency. Ellen played the good wife, ever supportive, careful to curate an image she felt was digestible to the American people, while behind closed doors she was dealing with personal losses from multiple miscarriages.

  Right now, however, public scrutiny and political appearances were the least of her concerns. In this regard, hospitals were the great equalizer.

  Eventually, a nurse entered the waiting room—a bit starstruck at first, but she pulled it together enough to deliver a message from Lee. The operation was going well. They could do laparoscopic surgery as opposed to an open splenectomy, which would greatly reduce recovery time. Cam would need a day or two in the hospital before returning to the White House to rest at home.

  The media, unlike Cam, would not rest, not even for a moment. Presidents were unable to move about without media teams, pools of reporters following their every step. The media and the White House press office had an understanding: play by the rules, follow at a distance, and your question may be the one the president answers during a briefing. But in this situation, the press could not be allowed to tail the president to the MDC, so a diversion was hastily arranged. A fake motorcade had departed from Walter Reed for the White House with a body double playing the role of President Hilliard, while a separate motorcade, this one smaller, had ferried the president to the MDC without arousing suspicion.

  It would not be long, however, before reporters figured out they had been duped, and that a patient at the MDC named “Lincoln Jefferson” was in fact Cam Hilliard. Like hyenas to carrion, the media were expert scavengers who picked away at privacy until no meat remained on the bone.

  Ellen found the lack of privacy one of the most difficult aspects of her life in the White House. There were innumerable restrictions on her movements, many of which Karen had to enforce. She would gripe almost daily about not being able to stand in front of an open window in her own home or breathe fresh air while out for a dr
ive. Those were big no-nos for the Secret Service. Good guys with guns had to take extraordinary measures to protect her from bad guys with guns.

  For a career-minded, brilliant businesswoman, a woman with ambition and drive, the White House was a challenging bubble. Ellen had well-formed opinions about important matters, but instead of her thoughts, people were more interested in the brand of her pumps. Right or wrong, any policy matter she discussed ended up reflecting negatively on Geoffrey.

  The White House had sandwiches couriered over, saving the Secret Service from having to test the hospital cuisine. Good as those sandwiches were, Gleason hadn’t taken a bite. He was too busy trying to find ways to contradict Lee.

  “In addition to my own research, I’ve had several calls with colleagues, and I can assure you, Mr. President, Mrs. Hilliard, nothing about an enlarged spleen correlates with Cam’s psychological issues.”

  Karen leapt to her feet. “Why do you keep insisting Cam’s troubles are psychological?” she said. “With all due respect, Dr. Gleason, Lee had reached a very different conclusion.”

  The president sensed the tension and opted to play referee. “Easy, Karen. Let’s not make a bad situation worse.”

  Gleason was not about to let it go. Backing away from a challenge ran counter to his makeup.

  “Where do you get off, Karen?” Gleason said. “You’re not a doctor. You have no footing to stand on here.”

  “Now, Fred, you take it easy.”

  Gleason held his angry stare for a beat before redirecting his attention to the president.

  “What I’m trying to say, Mr. President, is that Cam’s symptoms developed when Taylor started to beat him at chess. That’s when all his moodiness began.”

  Ellen joined the circle. “What are you getting at, Fred?” she asked.

  “I’m simply saying that we both admire our kids’ abilities to play the game, but we also know that Cam was the better player up until recently. Now I’m not trying to say that Taylor has outworked Cam, but he’s been going to the TPI every day after school to practice. Every day. The results speak for themselves. Taylor’s game has improved remarkably.”