“We caught a break on identifying the gunman,” Warren said, his eyes on the surface of his cup. “We ran his fingerprints through the system and got a hit almost immediately.”
Lang looked up with interest. Warren wondered how the Secret Service agent could be this alert despite little or no sleep for the past day and a half. The detective had snatched a few hours of shut-eye on a couch in his lieutenant’s office last night while others worked on the case, but so far as he could tell Lang’s head hadn’t touched a pillow. Maybe the agents of the Secret Service really were a special breed.
“What did you find?” Lang asked.
“The name he gave Miss Moore and Dr. Pearson was Bill Smith, which was eminently forgettable,” Warren said. He sipped from his cup, made a face, and put it down. “Of course, that was his intent. His fingerprints identified him as a Ukrainian named Leonid Malnyk.”
Lang pursed his lips. “So there’s a Ukraine connection. We’d better try to run that down.”
Warren moved his hand toward his coffee cup, then thought better of it and rested it on the table once more. “Don’t bother. Malnyk was for hire to anyone with enough money. It’s unusual that he actually was the triggerman, though. Generally, he put together jobs, farmed them out, and kept half the money for himself. Someone must have really greased his palm well for Malnyk to do this on his own.”
“What about the body-snatching, or whatever you want to call it?”
“I was checking on that when this shooting went down. There’s a veterinary clinic in South Dallas that has a crematory oven. A dog owner went by there yesterday to pick up the remains of his dog and found the vet shot dead. The oven, which is big enough for large pets, was still warm.”
“So . . .”
“So we think Malnyk took Lambert’s body to this place, got the veterinarian out of the way, and reduced the body to ashes,” Warren said. “That would take an hour or two at most. He took Lambert’s effects, the wallet and jewelry, and delivered them along with the cremains to the local funeral home. A few phone calls would tell him which one he wanted. The note was designed to indicate that all this was a mistake, hoping that would satisfy the police and they’d let their investigation drop.”
“How do you explain the absence of Lambert’s class ring?”
“Who knows? Did the mortician in South America steal it? Did Malnyk decide to take it? Was it burned up in the crematory oven? I have no idea. But I feel certain that the cremated remains delivered to Sparkman Hillcrest are those of Ben Lambert, and thus there will never be an autopsy to show his cause of death.”
Lang said, “So I need to backtrack and see if Malnyk’s shooting attempt was related to the incident in South America that probably infected Mr. Madison and Ms. Moore.” He looked at his watch. “I guess I’ll start by interviewing the remaining members of the party, who should be returning sometime tonight or early tomorrow.”
As though on cue, Lang’s cell phone rang. He looked at the caller ID and said to Warren, “And wouldn’t you know it, this is Dr. Dietz, the other physician who accompanied Mr. Madison on the trip.”
Lang answered the call. Warren could only hear one side of the conversation, but it was enough. “I’m sorry your flight was delayed, but you know how that goes. Is the group about to leave for the U.S. now?”
There was a pause. “I’m sorry, Dr. Deitz, but Mr. Madison can’t talk right now. But I’m sure he wishes you and the rest of the delegation safe travels. Call me after you get back to the U.S.”
Lang ended the call and said, “Be glad you don’t have to handle all these people.”
“I think I have enough on my plate with the disappearance and reappearance of Dr. Lambert’s body, plus this latest shooting episode.” It appeared to Warren that the Secret Service agent had his hands full guarding the former president, investigating what happened almost three thousand miles away, and keeping a lid on the number of people who knew about it. Better him than me.
Warren took another look at the cold coffee in his cup. Oh, well. Maybe it would help keep him going. He finished the dark liquid in two large gulps.
***
“Would you mind coming into the room with me?” Josh asked Derek. “I think President Madison would like to meet you.”
“Sure,” Derek said. He began the routine of donning a paper gown, gloves, and mask. “Remind me after we’re through here to tell you some things about isolation precautions for decimus.”
Josh let that slide. He had to concentrate on the decision he was facing. “I appreciate what you’re doing, Derek.”
“Just trying to help out a colleague. And, oh yes, a former president.” He tied the strings of his gown. “And since I’m the one who brought the medicine and discussed its use with you, my presence might help you spread the blame around if what you’re doing fails.”
Josh had no answer for that, mainly because there was a grain of truth in it.
As they stood in the doorway, Derek said, “I suspect you know this better than I, but I notice that sometimes you call him Mr. Madison, sometimes President Madison. Isn’t it correct to reserve that title for the current office holder?”
“Maybe, but there are times I’m in a hurry, others when my respect for him trumps what etiquette dictates. Only a few years ago this man was arguably the most powerful person in the world, and even though he no longer holds that office, he’s still larger than life to me.”
“No argument there.” Derek stepped back from the door and gestured to Josh. “Lead on. I’ll be right behind you.”
Madison was lying quietly in his bed, but as Josh approached he noticed that his patient’s bedclothes were soaked. The man’s brow was dry, but the reason was soon evident, as Mildred Madison reached out with a washcloth and blotted her husband’s face. Because of the continued presence of the fever, together with the airway obstruction that made an emergency tracheotomy necessary, Josh was more determined than ever to bring this man through the crisis he saw inching nearer.
“Mr. Madison, this is Dr. Derek Johnson. He’s the chief medical officer of Argosy Pharmaceuticals, the developer of this new drug we hope will help with the infection you have.”
Madison nodded. He lifted the whiteboard from where it lay on his bed and printed, “Whatever you have to do.” Then he dropped the board and lay back, obviously exhausted.
“Mrs. Madison,” Josh said, turning to the woman standing at the bedside. “Do you have any questions?”
She shook her head. Josh was certain she understood the gravity of her husband’s infection. This was a last-ditch effort to save him. No one was interested in talking about alternatives and complications. RP-78 was the only chance they had.
Mary Wynn, the head nurse, handed Josh the papers giving permission for this latest treatment. Madison scrawled his signature and Mildred Madison added hers.
Josh handed the permit back to Mary. “Why are you still here?”
“We’re working twelve-hour shifts. I go off at seven p.m.”
Josh wondered if the move was to keep the number of personnel moving through the area at a minimum, or if the staff felt as he did: it was important to do everything to save the life of this man. “Thank you,” he muttered.
Josh raised his eyebrows to request permission before he lifted the whiteboard and felt-tip pen from the ex-president’s bed. He calculated the dose, then showed the work to Derek who studied it and nodded. With the limited supply of RP-78, there was no room for mistakes.
Derek handed Josh the vial containing the drug. He cleaned the rubber diaphragm with an alcohol swab, then inserted a needle attached to a syringe and carefully withdrew the proper amount of the clear solution.
Josh cleaned Madison’s upper arm with another alcohol swab. He took a deep breath, said a silent prayer, and plunged the needle into the mass of the deltoid muscle in Madison’s arm.
Mary Wynn reached to a side table and retrieved the pad and pen that lay there. She jotted the time and details of th
e procedure. “I’ll enter these in the electronic medical record when we finish here,” she said.
Josh nodded. “And now, Mr. President . . . we wait.”
“And pray,” Mildred Madison added.
Both Josh and Derek nodded.
When the two men were back outside Madison’s room, Derek said, “I can understand the isolation precautions, but what about the people who were exposed to Madison and Rachel before you confirmed the diagnosis?”
Josh nodded. “When this started, we thought it was a straightforward case of diphtheria. I made sure all of us had been immunized. Since I had close contact with Rachel, I started on prophylactic antibiotics as well. If we were just dealing with diphtheria, we could stop the isolation protocol a couple of days after treatment started. For Bacillus decimus, I don’t think anyone knows, but the people in close contact with Madison and Rachel when they were getting sick could be at risk, I guess.”
“You’ve been so busy thinking about others, you ignored yourself. Let me put your mind at ease. It takes a massive exposure to Bacillus decimus to get an infection. The men in the prison in Colombia had such a massive exposure, but we didn’t even isolate them once they got sick.”
“Since the two patients have received treatment for diphtheria, are you suggesting we stop isolating them?”
“No,” Derek said. “Since you started it, I’d suggest you continue it for now. Better safe than sorry, I guess. You can stop when their fever has been down for a day or two.”
Not if . . . when. Josh loved Derek’s optimism. But his relief was short-lived, because Derek’s next words, words he didn’t want to hear, brought him face to face with the major decision facing him.
“Now comes the hard part, friend. Now you have to decide whether to hold back the remaining RP-78 and give a second dose tomorrow to Mr. Madison, or administer it today to Rachel Moore.”
Josh looked at Derek, hoping for some word of guidance, but in his heart he knew the decision was his alone. And whatever he decided, it was likely to be wrong . . . and the consequences would be huge.
12
Josh had read what he could about the infection, and authorities seemed in agreement on the way symptoms would present and progress. Initially the infection produced a clinical picture that was similar to diphtheria, with a membranous swelling of the throat and airway, along with fever and generalized constitutional symptoms. After about a week the bleeding would start—bruises after the slightest touch, a progressive cough producing bloody sputum. Then came internal bleeding, with vomiting and diarrhea, the products containing massive quantities of pure blood. At some point, the patient’s fever would no longer respond to medications. After that came convulsions and bleeding into the brain. This could take the form of a massive event, in which case the patient died immediately. Still as fatal, but sadder, were instances in which slight, repetitive bleeds gradually affected multiple areas of the brain, sending the patient into a vegetative state before the vital centers shut down entirely.
Josh wished he hadn’t read the details, yet he couldn’t ignore them as he scoured the scant medical literature about Bacillus decimus infections in hope of finding some way to treat it. Now he had at his disposal a tiny amount of the drug that might reverse the otherwise-fatal disease. What if one dose wouldn’t help but two stopped the march of symptoms? On the other hand, perhaps one dose was enough. Derek said that in the pitifully small sample, treatment had continued for ten days . . .
but that was simply because most antibiotics were given that way, at least in early trials. It was only in later dose-ranging studies that the optimum length of treatment would be determined. And those hadn’t been done with robinoxine.
Derek had declined Josh’s offer to go into Rachel’s room with him. “This is a decision you have to make,” he said. “I’ll pray for wisdom for you, and I’ll pray for the recovery of those two patients. But as for the decision, you’re on your own.”
Now Josh stood silent at Rachel’s bedside. He looked down at her, relieved that her breathing was easier now with the tracheotomy in place, worried because despite that seeming relief, her infection with Bacillus decimus was proceeding unchecked.
He hesitated to make his presence known. The longer Rachel rested, the longer Josh could put off the decision that continued to torment him. After what seemed like an eternity, Rachel opened her eyes and smiled. She picked the whiteboard and felt-tip pen up off her bedside table and wrote, “I’m glad you’re here.” Then, in a move that tore at Josh’s heart, she added, “How’s Mr. Madison?”
“He’s doing about like you. The tracheotomy gives him an airway, but I have to stop the progression of the disease.”
Rachel frowned. Next she wrote, “This is more than diphtheria, isn’t it?”
Josh nodded. In a few sentences he explained about the Bacillus decimus infection. He honestly didn’t know how far to go, but eventually he told her that he’d managed to acquire a tiny amount of a medication that had been effective in a very small series. “But we don’t know how many doses it will take,” he said. “And we don’t have much at all.”
Rachel closed her eyes, and for a moment Josh thought she was sleeping. Then she opened them, took the whiteboard, and wrote, “If you only have enough for one patient, give it to Mr. Madison.”
Josh’s reflex reaction was to shake his head, but Rachel wrote again. “He’s done so much, and has so much more to accomplish. Save him.”
Josh blinked to clear the tears from his eyes. He knew what he was going to do.
***
The ring of his cell phone brought Josh from deep sleep to full wakefulness with a speed born of years spent practicing medicine. In the time it took for him to reach to the bedside table and retrieve the instrument, he reoriented himself—he was in a call room at Prestonwood Hospital.
A glance at his watch told Josh it had been almost twelve hours since Derek asked him how long he'd been without sleep. Josh recalled responding that it had been about thirty-six hours.
“Well, you’d better get some now,” Derek had said. “That drug isn’t going to act immediately. We probably won’t see any change in anyone’s condition for at least twelve hours.”
“But—”
“You heard Dr. Neeves say she was going to spend the night in one of the call rooms at the hospital, in case she was needed. I’ll be around as well. I suggest you get some rest.”
Josh picked up the cell phone and pressed the button to answer the call.
“Josh, this is Derek.”
“Don’t you ever sleep?”
“Sometimes, but not much. Allison Neeves and I are at the nurse’s station going over both patients’ vital signs. I thought you might want to join us.”
“Let me splash some cold water on my face,” Josh said. “I’ll be right there.”
Fifteen minutes later, Josh, Derek, and Allison Neeves congregated at the nurse’s station. “So the fever’s going up?” Josh said.
“Just a little. It certainly isn’t going down. It had been stable at about a hundred and three Fahrenheit,” Allison said. Neither she nor Josh was a fan of the new tendency to measure body temperature in degrees Celsius. “This morning it’s a hundred and four.”
“That’s not a big spike,” Josh said.
“No, but it certainly doesn’t indicate any response to the RP-78,” Allison said. “Not a positive one, at least.”
Derek thought a moment before speaking. “You know that our series was small—actually, tiny when compared with most clinical trials. But I seem to recall that there was a further spike in fever before patient temperatures started to drop. Sometimes it took a second dose of the RP-78 before we saw improvement. Remember I said twenty-four to forty-eight hours.”
Josh felt the eyes of both doctors on him. “And if I hadn’t given the remaining drug to Rachel last evening, we’d have another dose for the former president.”
“We’re not judging you, Josh,” Allison said. “You mi
ght be the presidential physician, but you’re also a doctor . . . and that woman means a lot to you. You did what you thought was right to give two patients the best chance to live.”
“Okay, enough of that,” Derek said. “Let’s reconvene in the cafeteria and put our heads together over some breakfast to see what else we can figure out. Remember what Yogi Berra said—‘It’ ain’t over ’til it’s over.’ Well, the fat lady hasn’t sung yet.”
***
Rachel opened her eyes and tried to focus on where she was and why she was there. In the middle of her thoughts, she realized that her respirations were producing a raspy sound—her tracheotomy tube was partially occluded by secretions. There was no clock on the wall of this room, and she had no idea where her watch was, but the noise in the hall told Rachel it was about the time of shift change. One of the nurses had mentioned to her that they were working twelve-hour shifts—not complaining, simply mentioning it—but Rachel had no idea if this was morning or evening. Would someone come in soon? And who would it be? No, she couldn’t wait.
She was reaching for the nurse call button when the door to her room opened and a gowned and masked figure walked softly toward her. The personnel that entered her room had been limited, and Rachel had become adept at identifying them despite their isolation garb, but this one was different. Remembering what she’d heard via snippets of conversation outside her door about the recent attempt on David Madison’s life, she kept her finger on the nurse call button. It dawned on Rachel that since she couldn’t cry out for help, this intruder might be able to harm or even kill her before anyone responded.
“Rachel, I’m Barbara Carper. I usually work on weekends, and I’m relieving Mary Wynn today. I haven’t had the opportunity to work with you yet, so I thought I’d better introduce myself.” The newcomer reached inside her isolation gown, and Rachel cringed but didn’t move.
The nurse made a few motions with her gloved hand and pulled out a hospital ID badge. “See, that’s me.”
Sure enough, the name matched the one the supposed Barbara Carper had given. Seeing the questions still in Rachel’s eyes, the woman shrugged. “Please don’t cough on me while I do this.” She flipped up her plastic visor and pulled down her mask for a moment, allowing Rachel to compare the face on the badge with that of the nurse. The nurse restored the visor and mask to their proper places, and said, “Now let’s clean up that trach tube and suction you. That should help you breathe better.”
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