She slipped on her pajamas and slid into bed, feeling the light-headedness a bit more intensely. She hated throwing up, and the idea of having food poisoning on top of her other issue felt like an unfair string of bad luck. She contemplated getting that Pepto, but decided to wait it out. If it got really bad she’d wake her parents, but it wasn’t that awful. Just a little queasiness was all. Her heart felt like it was beating funny, but that had to be a trick of the mind. The fear of getting sick must have made her heart race. A good night’s sleep was all she needed.
As she drifted off, Susie’s last thought was of her arms shooting forward as her violin tumbled from her hands.
* * *
SHE AWOKE later with a shattering pain ripping through her head. The room seemed to be spinning and the dizzy sensation would not let up, even after she managed to get both her feet on the floor.
Food poisoning, she thought, standing on wobbly legs. She took a tentative and unsteady step toward the door, then winced. The headache was like a vise compressing her temples with brutal force. She felt incredibly light-headed as she stumbled down the carpeted hallway, careening off the walls. Her balance was so off it seemed as though the house were riding atop ocean waves.
“Mom, Dad—I don’t feel well—”
Susie’s weak voice sounded far away and very faint in her ears. Her head was buzzing like static on the radio and the pain kept intensifying, making it hard for her to see. Her stomach was doing spins.
“Mom—”
She staggered into her parents’ bedroom, breathing in sputters, and saw them on the bed. Their bodies lay perfectly still.
“Mom! Dad!”
Fear wormed into Susie’s gut as she pulled on her mother’s arm. Her mother’s skin felt cool to the touch. The arm fell limply back onto the mattress. Terror replaced worry. The room teetered and twirled. Intense nausea and a blinding headache eclipsed her dizziness. With great effort, Susie managed to come around to her father’s side of the bed, where she tried to rouse him. She shook his body, but he did not wake up. Instead, his head lolled awkwardly from side to side as though he had no muscles in his neck.
Not food poisoning, Susie thought. Too sick … feel … too strange …
“Help—” Susie’s voice sounded like it was underwater. “Help me—please—”
Her parents’ eyes remained closed. They seemed so at peace.
Peace …
Susie saw a strange blackness coming toward her, a shapeless thing, like a rolling cloud of pure emptiness. It was an entity swallowing everything in its path, leaving nothing in its wake. It felt so difficult to breathe, as though air were being systematically pumped from her lungs. A thought came to her. If she closed her eyes—if she slept—if she let the blackness overcome her, then all these feelings would go away.
Susie resisted the urge and tried to push the blackness back, but it was coming on stronger, moving faster. Through the haze of her vision she spied a lamp on the bedside table. Wielding it like a spear, she hurled the lamp through the bedroom window, shattering the glass on impact.
Air—I want to breathe …
A gust of wind seeped into the room and filled her lungs with a rejuvenating effect, but only for a precious few moments. The blackness was once again sliding into her mouth, burrowing up her nostrils. She grabbed the cordless phone from the table and lurched out of her parents’ bedroom on legs made of rubber, gulping for air as she went. She peered down from the top of the stairs. They seemed to descend into infinity. She took an awkward step, lost her balance, and tumbled the rest of the way down. She fell end over end, feeling the hard wooden stairs as they slammed into her legs, back, head, and arms. Something might have broken, but the sharp pain of the fall was nothing compared to the burning sensation inside her head.
After landing in a heap at the bottom of the stairs, battered and badly bruised, Susie managed a slow crawl to the front door. From there, she reached up, and, using the doorknob for leverage, got onto her knees. She pulled the door open and fell outside onto the concrete front stoop. The phone was still clutched in her hand. Fresh air filled her lungs, but the blackness was a relentless predator and would not let her go. At last the pain and nausea were lessening. She had the wherewithal to dial three numbers on the phone: 9-1-1.
She managed two words before the blackness finally took over.
“Help me.”
CHAPTER 19
Susie awoke in a new place. She was in a room with a curtain and bright lights overhead. From somewhere far away she heard a low voice speaking slowly.
“Nineteen-year-old white female. Banks. Susie Banks.”
There was a woman talking to a bearded man wearing a white coat.
“Carbon monoxide poisoning,” the woman said in her distorted speech. “We brought her to the MDC because you have the hyperbaric oxygen unit.”
“Smart thinking,” said the bearded man.
Carbon monoxide. Not food poisoning.
“BP was sixty when we got to her. Couldn’t get a pulse, but got leads on her quick and she was in sinus tach, one forty per minute. Respirations very shallow, only six to eight. We strapped on an O2 mask, started an IV, and got a finger stick sugar of eighty.”
While the doctors spoke, people dressed in scrubs placed things on Susie’s body, and connected her to monitors with wires. A dollop of cool gel made Susie’s skin tingle. Her eyes were closed, but Susie could hear people talking all around her. She could hear the bearded doctor clearly, even though she did not understand what all his words meant.
“I want a carboxyhemoglobin, stat! Let’s get a carbon monoxide oximeter reading as well. Add a urine myoglobin and blood for lactate and cardiac enzymes. Also a toxicology screen and cyanide level. Increase her oxygen to one hundred percent.”
At that moment, Susie wished the blackness would come back to take her away. She could smell the soaps and astringent cleaners; she could feel the prodding, pricking, and poking against her limbs; she could hear whispers, low voices amped up with anxiety.
“Blood pressure is stable. Ninety over sixty.”
Moments passed. For Susie, time had lost all meaning.
“Carboxyhemoglobin is twenty-five percent, and most of the other labs are back.”
Susie’s breathing echoed in her ears, making it hard to pinpoint the location of the woman who spoke.
I want to go to sleep now, Susie thought.
“CBC is normal except for a slightly high white count of eleven point five. But I’d expect that with carbon monoxide. Tox screen is negative. Arterial blood gases seem pretty good, considering. Lactate is high at one point seven. Again, fits the situation. Her liver function tests are mildly high, too. Not sure what that means.”
“She’s nineteen. Where are the parents? Are they coming, too?”
I want them … where are they … I want my mom …
“Her parents are dead.” Susie startled briefly. “They were found in the second-floor bedroom. Nothing we could do. We think Susie broke a window with a lamp, but it was too late for them.”
In the next instant, Susie’s heartbeat accelerated. She could hear it racing in the monitors, too, the beeps getting louder and faster.
Mom … Dad … no … they can’t be …
Everything felt suddenly strange, as if Susie had gone hot and cold simultaneously. The odd warning seemed to signal a coming explosion from inside her body. Something horrible was about to happen to her, she could just tell. An intense chill came over her. For a moment she felt simultaneously weightless and unbelievably heavy. A strange whiteness filled her eyes and she could feel her whole body shake.
“She’s seizing!”
She heard the voice cry out, but could see only white.
“BP fifty-six over thirty-six, pulse one fifty. Sinus rhythm, but with frequent ectopy. A very unstable heart. Not much time before she codes. Respirations too shallow to even register. Temp one oh one. Call anesthesia and let’s get her intubated. Now!”
> Time slipped away and then returned. Faceless voices spoke from the void where Susie had gone.
“Amp of D-fifty now. Diazepam eight milligrams IV. Where’s anesthesia? Open the IV to two hundred an hour. Let’s get fosphenytoin ready. I doubt the diazepam alone is going to hold her seizures.”
“Ready to intubate. Let’s stop these convulsions. How much does she weigh?”
“Fifty kilograms by the bed scale.”
“Let’s get a portable chest film, and get her on a ventilator. Where’s anesthesia? We need to tube her!”
CHAPTER 20
THURSDAY, APRIL 20
Being the president stinks.
On the morning after Cam’s surgery, this was the only thing about the case Lee knew for certain. Last night, Mom and Dad, aka the president and first lady, had to say their good-byes to Cam in the surgical ICU while he was still heavily sedated. There was no easy way for them to hang around until their son woke up fully, because some damn fool had alerted the media.
Maybe it was a patient on the deluxe floor, or perhaps someone on the MDC staff had put out the word. However the leak got out, news vans were soon parked outside the hospital in convoy numbers, and a crush of photographers blocked the hospital entrance. Police had to be called in to clear the scene. Requests for privacy were ignored. Anything involving the president was news, including his kid’s spleen—or lack thereof.
Dr. Chip Kaplan, CEO of the MDC, gave a news conference that failed to placate the hungry mob. It was deemed no longer safe for the president to be on the premises. Hordes of Secret Service agents descended like locusts on the MDC and quickly whisked the first family, minus Cam, back to the White House.
Karen was there for the fracas. She had something to tell Lee, but the conversation had to wait, as she got swept up in the commotion and did not even have time for a two-second chat.
Being a Secret Service agent also stinks, thought Lee.
As for Ellen Hilliard, she planned to return today to visit with Cam, but told Karen to check first with Lee so she knew the best time to come. Lee was her conduit now, and it seemed she trusted him more than Dr. Gleason to relay important information about Cam’s care. She gave Lee her private cell phone number, which he stored in his phone’s contacts under her code name: Black Bear.
Cam had come out of surgery like a champ. They still had to watch for signs of infection, but Lee was not overly concerned. Considering Cam’s age he should be able to bounce back in no time. Another bounce-back was Lee’s relationship with Dr. Seneca. All seemed forgiven there.
“I’ll admit you embarrassed me a bit in front of the president,” he had said to Lee post-surgery. “But I’m also big enough to admit you were right. Feel free to inject yourself into my job anytime.”
Lee hoped Dr. Seneca would not forget those words, because he had no intention of standing on the sidelines. As far as he was concerned, Cam was as much his patient as he was Dr. Gleason’s.
Even though Lee had admitting privileges at the MDC, he still had to be searched for weapons and show ID to the Secret Service agents guarding the entrance to the hospital suites. They checked his name against the approved list.
At the nurses’ desk, Lee ran over Cam’s chart, reviewing the lab results from 5:00 A.M., and the portable chest x-ray from 6:00 A.M. He listened in as the overnight nurse gave the day nurse an update on Cam’s condition.
“Any problems, Wendy?”
Lee did not work on the fancy floor, but he had made it a point to learn the names of all the nurses who did. Wendy, who was short with a chipper smile, was one of the better ones.
“Not a one,” said Wendy. “His vitals are enviable. Afebrile. His crit’s stable. Hemoglobin nine point eight. White count ten point seven. Didn’t even ask for Tylenol, even though he’s obviously having some discomfort. A genuine stoic. Very minimal drainage. I’m sure Dr. Seneca will be able to remove the drain tube this morning. Getting a call from the president and first lady in the middle of the night was sure something! I’m glad I could tell them Cam was doing so well. I was so darn nervous.”
“I understand, but at times like this they’re just worried parents. I’m sure you handled it well.”
Lee glanced at Cam’s labs and again noted the asterisks next to his liver enzyme values. AST 47, ALT 68, both minimally elevated. Most likely nothing, Lee thought. Could have bruised his liver a bit in that hard tackle. Coagulation profile was normal, so nothing to worry about in terms of any major liver injury or bleeding risk.
Still …
Lee signed off the computer and glanced up, only to notice Dr. Fred Gleason standing behind him.
“Kind of early for a family doc to be making rounds.”
He was headed straight for Cam’s room.
“He’s doing great,” Lee said, falling into step behind him. “Glad you asked. We’ll get that drain out soon, and gradually advance his diet. Hopefully, we’ll have him home tomorrow.”
Lee intentionally left out the neurological consult he had ordered last night. Normally, he would have waited longer to do the testing he wanted, but there was no telling when Gleason might try to pull Cam out of the MDC. If that happened, those tests might never get done.
Dr. Marilyn Piekarski was one of the best neurologists Lee knew. He wanted her to advise him on Cam’s behavioral issues. He was especially keen to get her take on seizures and whether she thought, as he did, that Cam might be having them at night. The president and first lady were aware, and had approved the consultation and testing beforehand. Lee was a bit disappointed not to see the results logged in Cam’s medical records. He had hoped for a rush job. Either way, Dr. Piekarski was due back here this morning and could update him then.
Cam was sitting upright and alert when Lee entered his hospital room. Dr. Gleason was busying himself with a check of Cam’s IV and vitals, work the nurses had already done.
“How’s it going, Cam?”
Dr. Gleason asked the question, but Cam directed his answer to Lee.
“I’m feeling pretty good. Just a bit hungry.”
“An appetite. Now that’s good news,” Lee said, coming to Cam’s bedside. He placed his hand over Cam’s belly and examined the surgical dressing.
“Dr. Blackwood, I think you can go back to your office now,” Gleason said. “I’ve got it from here.” The look he shot Lee could have chilled ice.
“May I please speak with you at the nurses’ station a moment,” Lee said through gritted teeth.
He left the room, not waiting for an answer, and sure enough Gleason followed. Lee checked to make sure they were out of earshot.
“Look, Fred, I don’t know how to say this, so I’m just going to come right out and say it. I know you don’t want me involved with Cam’s care, and I don’t blame you. But I am involved. The first lady and the president are looking to me for guidance right now. I admit that’s a lot for a family doc to handle, but I feel pretty confident I’m up to the task.”
Dr. Gleason stared Lee down like a heavyweight at the prefight ceremony. At that moment, Dr. Seneca came bounding down the hall, cheerful as could be.
“How’s our patient this morning?” Seneca asked. “I was coming to take the drain out.”
“Cam’s doing fine,” Gleason answered quickly. “We want to get him back to the White House as soon as possible. It’ll be better for him there.”
“Understood,” Seneca said.
Lee thought it was too soon to move Cam, but knew it was a battle he’d lose if he tried to fight it. His bigger concern was for Dr. Piekarski’s neurosurgical consult, which he hoped had been done last night as he had requested. Now with Cam leaving the MDC it might not get done at all.
“What about the pathology on the spleen?” Lee asked.
“Should get it back in four to five days,” Seneca said. “By the way, the spleen weighed two hundred twenty grams. They’re usually less than two hundred. Funny how you picked that up looking at the CT. You’ve got quite the eye, Lee.
And the liver, too, was maybe a little large.”
Lee’s thoughts went spinning. The moodiness, possible epilepsy, and now he had a mildly enlarged spleen and liver to add to the mix. Cam’s elevated liver enzymes suddenly took on a whole new significance. But what does it all mean? Lee had tremendous confidence in his ability as diagnostician, but these symptoms did not fit any medical condition he could name. He knew better than to try and brainstorm all this with Dr. Gleason.
“You get that drain removed right away, Dr. Seneca,” Gleason said with authority. “I want Cam out of here by noon sharp. The president and first lady are in agreement. Cam can be monitored at the White House clinic, and it’ll be safer for him there.”
Gleason was not going to wait around for a response. He spun on his heels and bounded down the hall.
Some minutes later, Dr. Marilyn Piekarski arrived on the floor. She was trim and prepossessing, with dark-rimmed glasses, long black hair, and pretty brown eyes. Much to Lee’s disappointment, she was also happily married.
“Hey Lee, Brian. How are we this morning?”
“We’re good,” Lee said, trying not to sound anxious. “How about those tests?”
“Showed what I suspected,” Dr. Piekarski said. Lee was glad to hear the tests had actually been done. “The spinal fluid is clear and colorless,” Dr. Piekarski continued. “No cells. Normal protein and sugar. The EEG shows normal background rhythms. Normal sleep architecture for the most part, but we did capture two isolated generalized spikes and wave discharges during sleep that would be consistent with primary generalized epilepsy.”
“And the MRI?”
“The MRI does show some subtle signal abnormalities in the basal ganglia, but I think the radiologist may be overreaching. I see findings like this all the time, and it usually means nothing.”
“Would you say definitively that he’s been experiencing nocturnal seizures?”
The First Family Page 11
