The First Family

by Michael Palmer

  Patrolling outside Lee’s car, the dog, a glorious German shepherd, sniffed away busily.

  “And say what? We want to have them tested to make sure Cam’s doctor isn’t poisoning him so his son Taylor can play in some chess tournament? Are you crazy? I’d be thrown out of here by the same people who work for you, and you’d be tossed out right after me.”

  “I don’t disagree,” Karen said, sounding a bit frustrated.

  “Look, I don’t trust Gleason to do right by Cam with or without ProNeural in the picture. That’s why I can’t be cut off right now. We have to tread carefully here.”

  The guard handling the canine waved them through. Following Karen’s instructions, Lee drove slowly down East Executive Avenue with the White House looming nearby. He came to a stop at an open parking space near the covered East Wing entrance.

  “So what’s this meeting all about?” Karen asked as they exited the car. “I thought you had already convinced Ellen to have Cam take the antiseizure meds.”

  “No, I did not. She said she wanted to discuss it in person before speaking with Gleason.”

  After his meeting with Paul, Lee called Ellen to follow up on Cam’s condition since his return home, and more important, offer his opinion about the meds. Never having used the private number before, Lee figured he would be patched through to Donna Whitmore, Ellen’s chief of staff, but no: the first lady answered as if he had phoned a close friend.

  In a preemptive strike, Lee voiced his concern that Gleason might not put Cam on levetiracetam as he and Dr. Piekarski recommended. Instead of coming to an understanding, Lee got an invitation to come to the White House to present his case. He hoped Dr. Gleason would not be there, waiting in ambush.

  Karen escorted Lee into a long, richly paneled hallway and past a manned security desk. They took a right turn into another corridor lined with stiff-backed wing chairs and artwork in gilded frames.

  “For your information, this area is not part of the official tour,” Karen said in a conspiratorial tone.

  The first lady’s office was located on the second floor of the East Wing, just down the hall from the White House calligrapher, a job Lee did not know existed until Karen pointed him out.

  “What does he do exactly?” Lee asked.

  “The calligraphy for all the official White House invitations.”

  “Sounds torturous.”

  “Not if you enjoy calligraphy. Don’t worry, Lee. I’ve seen your handwriting. You’re in no danger of getting the job.”

  The last door in the long hallway was wood paneled and stood out from the others. Karen knocked on that door. A moment later, Ellen Hilliard appeared, invited them inside, and gave them both a warm greeting. She looked like she did on TV, completely put together, wearing a black skirt and white blouse topped with a black cardigan, a strand of pearls secured around her neck.

  “It’s wonderful to see you, Lee,” Ellen said in a pleasant voice. To Karen she said, “If I may, I’d like to speak with Lee alone for a few minutes. Would you mind waiting outside? I’ll have you escort him out when we’re through.”

  “Of course.”

  Ellen had a spacious, nicely decorated office with a cream-colored carpet and upholstered couches and chairs. She worked at an eye-catching, two-tone executive desk, framed by two built-in bookcases painted the same color white as the house and stacked full of books. On the walls, in addition to some modest artwork, hung pictures of Cam (some taken during chess matches) and several of her and President Hilliard in various phases of life.

  “Tea? Anything to drink?” Ellen asked.

  “No, thank you, I’m fine.”

  She took a seat on a comfortable-looking couch and motioned for Lee to take a nearby chair and join her.

  Ellen spent a few moments expressing her gratitude for Lee’s involvement with Cam’s medical care. As was the case during their brief phone conversation, the pleasantries did not last long.

  “How’s he feeling?” Lee asked.

  “Sore. Tired. Out of sorts.”

  “That’s not at all unexpected. He’ll feel much more like himself in no time. What did you decide about the medicine?”

  “Dr. Gleason went over the side effects with me in detail. Moodiness, fatigue—the same as Cam’s earlier symptoms, but now add to that the possibility of hallucinations! Goodness, Lee, are you sure this is absolutely necessary? Dr. Gleason doesn’t seem to think so.”

  “Well, like I said on the phone, I’m not surprised there,” Lee replied. “But Mrs. Hilliard—”

  “Please, call me Ellen.”

  “Ellen, then. This is not just my opinion, but the opinion of the neurologist, Dr. Marilyn Piekarski, as well. We can start Cam on a very low dose and build it up slowly to a more therapeutic level. We’ll watch closely for side effects. If his symptoms resolve, if he stops waking up extremely fatigued, we will be that much more confident in our diagnosis that Cam is experiencing seizures. It could have a positive impact on his mood. We won’t know until we try. This is Dr. Piekarski’s plan, and she will repeat his EEG and MRI in six to eight weeks.”

  Ellen got up from the couch and went over to a window, which showed off a view of the South Portico and White House grounds.

  “It’s funny,” she said. “Weekday or weekend, every day is a workday around here. My husband’s at work in the Oval Office right now, getting his morning debrief, keeping the world from imploding, all the weight and responsibility of millions of lives on his shoulders—and here I am, responsible really for one life in addition to my own. Yet somehow it feels equally as weighty.”

  “He’s your son,” Lee said. “I understand your struggle, but I strongly advise he take the medicine.”

  Ellen returned to her seat. “My job, my—role, here at the White House, can be challenging at times.”

  “I can imagine.”

  “There’s no clear objective, no defined path for a first lady, but it comes with tremendous scrutiny. One wrong move can get you branded in the harshest possible way. Motherhood feels a bit similar. You do your best without much guidance, and you hope you don’t do damage to your kids.”

  “In this case, I don’t believe you will.”

  “Perhaps that’s true. But I’d like to make another observation, if I may. My job here, Lee, is mostly to stay on the sidelines and support my husband. Sure, I have my causes. My Aim Higher initiative. My work with military families. But my most important role, aside from motherhood, is to present a unified front to the American people. That’s what they want from a first family, and it’s what they’ll remember most when we leave the White House. We’re role models whether we like it or not. And people want a team. They like things to be together, not fractured.”

  “I can sort of relate to your struggle,” Lee said. “I was married once. Didn’t do a very good job presenting my own unified front.”

  “Well, I need you to do a good job of it now. I’ll confess it’s not always easy for me to play the good wife, not let the East Wing affairs mix with those in the West. I may not agree with everything Geoffrey has done as president, but my support of him has never wavered. Not for one instant. For Cam’s sake, I need you to take a similar approach with Dr. Gleason. You might not agree with everything he says and does, but I do think he has Cam’s best interests at heart.”

  If ever there was a time to bring up the nootropics it was then and there, but Lee worried it would add confusion to the levetiracetam issue.

  “I’ll make sure Cam takes this medication you’re recommending,” Ellen continued. “But you need to do something for me.”

  “What’s that?” Lee asked.

  “I don’t want to be at odds with my husband over the direction of Cam’s medical care. I need you to get on the same page as Dr. Gleason. Immediately.”

  “I’m trying, he just seems—opposed to the idea.” Again, Lee resisted the urge to say more.

  “None of us has an easy job, Lee. I know you have your work cut out for you. I�
��ll cover all of your expenses for Cam’s care, and not to worry, no scandal here. It’s not the government paying, it’s me. I’ll have my chief of staff, Donna Whitmore, coordinate. Just make sure Dr. Gleason sees things your way from now on. I’ve come to trust you, so I believe your way is the right way.”

  Ellen stood again. This time Lee took it to mean, and correctly, that he should do the same. He shook Ellen’s proffered hand.

  “For now, I’m content standing on the sidelines, doing my part while my husband fights the bigger battles,” Ellen said. “But when it involves my son, I’m the one in the game getting muddied and throwing punches. I’m counting on you, Lee, to make it all work out.”

  Ellen opened her office door. Karen was standing there.

  “Thank you again for your time,” Ellen said.

  She closed the door, leaving Lee and Karen alone in the quiet hallway. Meeting adjourned.

  “What did she say?” asked Karen.

  Lee chuckled softly to himself as they ambled down the hall past the calligrapher’s office.

  “I think she and Geoffrey are perfectly suited,” said Lee.

  “How so?”

  “She wants me and Gleason to get on the same page and then in the next breath tells me she trusts me completely.”

  “Bit of a double message, don’t you think?” said Karen.

  “More like a pitch right down the center of the plate.”

  CHAPTER 23

  Lee was still processing his meeting with the first lady when noon rolled around. He had arranged with Paul to have the time off, but with his camping trip canceled, Lee decided to take a shift at the MDC supervising medical residents. It was good in a way to get back to business as usual, and the extra pay did not hurt. But it was hardly a return to normal.

  He was supposed to form some sort of alliance with a man who might be intentionally harming the first family’s son for personal gain. Either the man was so egotistical he would risk medical malpractice just to be right, or he was devious, trying everything possible to keep Lee from discovering what was making Cam Hilliard sick.

  Lee headed straight to the coffee station in the MDC lounge to fuel up for his afternoon rounds. He poured himself a cup of coffee thick as mud and chuckled, thinking Paul would never suffer such a beverage. He had called to see if Josh wanted to meet up for lunch, but he was already out with friends. Dinner remained a possibility, though Josh had made plans to eat with his mother.

  On his walk to a nearby empty chair, Lee noticed his knee acting up again. It was a nagging little pain, right where the patella connects to the ligament. His nightly run was suddenly in question. Someday those runs would turn into walks. After walks, maybe downshift into a stroll. The next phase after that got a little grim.

  Lee took his seat, sipped at his coffee, and pondered ways to get Gleason on his side. His focus wandered when he overheard a snippet of conversation between two nearby doctors he did not know. Both were young, with full heads of hair (one blond and curly, the other straight and dark). They probably had good knees.

  “We’ve weaned her off fosphenytoin,” the curly-haired doc said. “But she’s still on a pretty aggressive course of diazepam.”

  “No more seizures?” the darker-haired of the two asked.

  “No, but I was hoping the diazepam might bring her myoclonus under control. It hasn’t. She’s had episodes even when we had her sedated. Her arms keep snapping like whips without warning.”

  “What did the CT scan show?”

  “Slightly enlarged spleen and liver, but nothing else.”

  Lee’s ears perked up like a dog hearing a whistle. He was standing in a flash, knee pain be damned. The two doctors watched him approach.

  “I’m sorry to bother you, but I couldn’t help but overhear,” Lee said. “Your case sounds similar to a patient of mine. Have you figured out what’s causing her symptoms?”

  “No, she’s a young girl who came in the other day with CO poisoning,” the dark-haired doctor said. “She lost her parents. It’s a real tragedy.”

  Lee had heard about the fatal gas leak on the news, but yesterday it seemed like a sad headline and nothing more.

  “Say, if you come up with something on your patient that can help ours, let us know.”

  The curly-haired doc fished a business card out from a leather wallet and handed it to Lee. The doc was a hospitalist, a physician who cares for patients while they are hospitalized—the same profession helping to put Lee out of business.

  “Will do,” said Lee, shaking hands good-bye. He had no intention of involving them in his case, because they could not know his patient was Cam Hilliard. But still, seizures and an enlarged spleen and liver? Even though he was not her doctor, there were enough symptoms overlapping for Lee to investigate. Using his phone to check the news, he quickly found the girl’s name, Susie Banks, and decided to pay her a visit.

  Locating the patient was a matter of locating a hospital computer. He entered his log-in credentials into the terminal and was soon directed to the ICU on the sixth floor of the main building. While Lee was not responsible for Susie’s care, he was at least dressed for the part in a white lab coat, striped cotton shirt, blue tie, and the slacks from the Brooks Brothers suit he had worn to his meeting with Ellen.

  He marched over to the nurses’ desk, taking confident strides, acting like he was in a hurry, but pretending not to know exactly where he was headed.

  “I’m looking for Susie Banks’s room,” Lee said to a dour-faced nurse with dyed black hair. She peered out from behind her expansive monitor and appraised Lee with some skepticism.

  “And you are?”

  “Dr. Lee Blackwood. I’m a member of the internal medicine practice. I’m consulting on the case for Dr. Sarah Anderson. I thought you were informed.”

  He used a name of a doctor who he knew worked on this floor. The tone Lee had taken implied any lack of cooperation might result in a ding on this nurse’s next performance review.

  “Of course, Dr. Blackwood,” the nurse said, feigning awareness as convincingly as a Broadway actress. “She’s in 601.”

  Lee thanked her and moved on. The scene inside Susie’s ICU cubicle was a familiar one. Sick person, lying on a bed, hooked to an array of machinery. The sweet-faced girl with long brown hair was on high-flow oxygen therapy delivered via a nasal cannula. Her eyes were closed, but only because she was sleeping, not sedated. He was glad to see she was not on ventilation, which was far more invasive and would leave her prone to infection.

  The telemetry monitor showed good vitals. Steady sinus rhythm, though her oxygen saturation was a low ninety-two percent: safe, but far from normal.

  From a plastic pouch affixed to the end of the bed, Lee removed Susie’s medical chart and began to give it a careful read while keeping an eye out for one of Susie’s doctors or a nurse. They would be harder to fool than the duty nurse. It was all clear for the moment. The only person nearby was a maintenance worker, standing on a ladder, with his head and shoulders hidden inside the drop ceiling.

  Lee resumed his evaluation. Susie’s medical history was sparse. There was no primary care physician listed, and with her parents gone, nobody could fill in the blanks. The line for next of kin was also a blank. Lee felt heartbroken for this girl. Her parents were dead and either she did not have, or could not provide, the name of her closest living relative.

  She was alone, and had to be terribly frightened.

  A CAT scan confirmed what the doctors in the lounge had said—both the spleen and liver were enlarged. Lee could think of no reason why CO gas would have affected her organs in such a way. She’d been given urine myoglobin in the ER to combat rhabdomyolysis, but that would not cause organ enlargement, either.

  Lee felt a jolt, a tingle telling him to read on. After suffering a grand-mal seizure in the ER, she had briefly slipped into a coma before regaining consciousness. Later, she began experiencing myoclonic jerks, another type of seizure, unrelated to her acute car
bon monoxide poisoning. Neurological issues, liver and spleen enlargement—indeed, her case was sounding a lot like Cam’s.

  When Lee read Susie’s labs, his eyes went wide. The liver enzymes were elevated, only slightly, again similar to Cam. Susie’s doctor noted something else: a very unusual cherry-red spot in the retina of both eyes, a rounded red dot surrounded by a halo of pallor, like a target’s bull’s-eye right where the macula was, that part of the retina where rays of light are directly focused. There were multiple comments about it in the record, the consensus being it was most likely a rare manifestation of carbon monoxide poisoning. But Lee wondered: If CO gas could produce a red spot in the eye, could a different toxin also do the same?

  Lee called Paul’s cell, but after several rings got patched through to his voice mail.

  “Paul, it’s Lee. There’s a patient at the MDC with a possible connection to Cam Hilliard. Could you do some research for me on cherry-red spots in the macula? Curious to know if you can find any connections to these red spots in the eyes and various toxins like we discussed. Thanks much, and I’ll see you soon.”

  Lee put his phone away and went back to flipping through pages of Susie’s medical chart when he noticed her eyes flutter open. He could see her struggle to focus her vision. When she spoke her voice was whispered, soft as a breeze.

  “Are you my doctor?”

  Lee returned a friendly smile, slipped the chart back into its pouch, and came around to the side of the bed. He poured water into a plastic cup and gave her a drink.

  “I’m a doctor,” Lee said. He set the water cup on the side table after Susie finished taking a sip. “How are you feeling?”

  Tears flooded Susie’s big round eyes. Answer enough.

  “I’m okay,” she said without any conviction.

  Lee gave her hand a squeeze. “You stay strong, Susie Banks. I promise, I’m going to check up on you again very soon.”

  Lee did not tell her his checkup would happen after he dilated Cam’s pupils and used an ophthalmoscope to look for a cherry-red spot on his macula.