by Ben Coes
Seven hours before, another plane from the Institute had flown the same course: Paris to Pyongyang, North Korea. That plane was a cargo plane, loaded with a variety of advanced diagnostic medical equipment, including state-of-the-art MRI, CT scan, blood, oxygen, and cellular analytic hardware, and cutting-edge radiologic equipment. All of the equipment was now in position at the Pyongyang Medical College Hospital.
The Bombardier carried a team of cancer specialists, all under the leadership of Dr. Marc de Saint-Phalle. De Saint-Phalle was widely considered to be the top cancer specialist in the world. A total of ten people from the Institute were with him, among them doctors, radiologists, and nurses skilled in field work and known for their proficiency and operational precision. De Saint-Phalle had handpicked every one of them.
The first six seats were occupied by a different group. Each man was young—midtwenties—and stocky. Two were bald and clean-shaven. The others had longish hair and thick beards. All of them were ex-Israeli military—Sayeret Metkal to be exact, which was, along with Shayetet 13, Israel’s most elite group of Special Forces operators. They were all highly trained, skilled at counterterrorism operations, anti-guerrilla warfare, and all manner of tight-sight envelope protection and penetration, firearms and explosives, cold weapons, surveillance, face-to-face combat, and extended field work in network-dark locations. They were from a private, London-based company called Four Winds LP, known for their military skills and discretion. The Institute was an important client. What country the Institute was going to—who they were going to see—these were state secrets and the Institute had learned to trust that the soldiers of Four Winds would not leak the secrets of the world leaders they were sometimes paid to try and heal.
The trip to North Korea had taken a month to negotiate. The North Koreans didn’t balk at the Institute’s price: $57.2 million for two days’ work—but they resisted when the Institute insisted on bringing their own security. Finally, when it was clear the Institute would not relent, Pyongyang agreed to allow a full-on security squad, armed to the teeth. Kim Jong-un had a reputation. If tests showed he had something wrong with him, he was the sort to order the execution of those giving the diagnosis. He might still do the same—but now Pyongyang understood that many people would die if Kim attempted to harm De Saint-Phalle or one of his team. De Saint-Phalle knew the drill. It was not the first time he’d traveled to hostile territory in order to examine a dictator.
Without de Saint-Phalle, Kim would have no choice but to bring in an inferior team from China—or else rely on North Korea’s own team of cancer specialists, whose knowledge and abilities were decades behind the Institute’s.
De Saint-Phalle looked across the aisle. A woman, Dr. Megan Licameli, with short, jet-black hair, was reading the same set of documents he was: Kim’s health records going back to his childhood.
“It’s in the genetics,” said de Saint-Phalle.
“What is?”
“Declination of the pancreatic mechanism. Whether it’s the trypsinogen gene or ataxia telangiectasia we won’t know until later.”
“I read it differently,” said Megan. “The primary DNA structure is decaying. Hydrolysis, oxidation, or nonenzymatic methylation. The DNA is unstable. If you look at the sequences of his parents as compared to his grandparents, there is material genetic crossover. His grandmother was related to his grandfather before they married. Then his father married his first cousin. His basic indices is falling apart. Of course he has cancer. Not to mention, he’s probably completely insane. Explain to me again, Marc, why are we going?”
De Saint-Phalle paused.
“If I had a dollar for every time I think I know what I’m going to find before I find something completely different—or nothing at all—I’d be a very rich man.”
“You are a very rich man,” said Megan. “What if you had a dollar for every time what you predicted came true? Would that pile be bigger?”
De Saint-Phalle grinned.
“Maybe,” he said.
* * *
The streets in Pyongyang were closed. All citizens not at work had been ordered inside for the four-hour period of time, in the middle of the day, that Kim would be traveling to the hospital.
The motorcade began at the Ryongsong Residence. Five vehicles in all: four black Range Rovers and, in the middle, a long, dark red Mercedes limousine, bulletproof, steel-plated undercarriage, a driver with a small pile of submachine guns on the side seat, despite the many layers of protection along the route and within flanking range of the limousine.
Inside the hospital, the mood was hushed as Kim Jong-un, North Korea’s supreme leader, waddled down the quiet, brightly lit sixth-floor hallway.
Other than a three-man security detail, the only individual accompanying Kim was General Pak Yong-sik.
Yong-sik was the head of the North Korean armed forces, the Korean People’s Army, or KPA. By number of soldiers, KPA was the largest military force in the world. But this was not why Yong-sik was here. Yong-sik was Kim’s most trusted confidante, the only other man in North Korea who knew something was very wrong with the thirty-five-year-old Kim. Yong-sik had served under Kim’s father, Kim Jong-il. Back then, Yong-sik had become Kim Jong-il’s closest ally and friend. Yong-sik had been appointed head of the KPA at age thirty, leapfrogging over more than a hundred more senior officers. General Yong-sik was older now but remained the second-most-powerful man in North Korea. If he’d been like a brother to Kim Jong-il, he was like a father to Kim Jong-un, who, at age thirty-five, was not only infected with cancer, but was also a chain-smoking alcoholic who snorted cocaine throughout the day and could not sleep unless he passed out.
Kim was his own worst enemy. He started smoking at age nine and drinking by eleven. He lost his virginity at age twelve to a stunning prostitute flown into Pyongyang from New York City. He attended a highly exclusive, highly secretive boarding school in Switzerland and returned home during his last year there, expelled after attempting to rape the fourteen-year-old daughter of one of the instructors at the school. Kim Jong-il’s gift to the school—to keep the story of his aberrant son out of the press—was a $50-million check.
Kim’s life had been one of moneyed debauchery mixed with the sudden acquisition of power in a country trained like dogs to believe their supreme leader was a demigod.
At the end of the long hallway, a set of double doors was closed. Outside, two of the Israeli gunmen stood at attention, each man clutching a submachine gun, trained at the ground.
Kim approached. Rather than being angry at the sight of the armed foreigners, he smiled and extended his hand.
“Welcome to North Korea,” he said in nearly flawless English, a soft accent the only giveaway that it wasn’t his first language.
“Thank you, sir,” said one of the Israelis, nodding politely and scanning Yong-sik and the three-man security detail.
The other Israeli reached for the door handle and opened it for Kim and the others in his entourage. One of the North Korean guards remained outside the doors with the Israelis while the others trailed Kim and Yong-sik inside.
The examination room was cavernous. For the purposes of the examination, the Institute’s team of medical engineers had appropriated the hospital’s largest operating room. The Institute’s equipment was set up in a horseshoe around a central operating table. The room was two stories high. A second floor opened up to a balcony filled with seats, now empty. Beeping and pinging from various machines provided a steady din.
Two more Israeli gunmen stood on opposite sides of the examination room. A third man was in the balcony amphitheater, standing and watching from above, a high-powered rifle across his chest.
The French medical team stood in the room, motionless and silent as Kim entered. They all wore uniforms that were light blue. Everyone had on surgical hats, except for the man in the middle of the group, de Saint-Phalle, who stood before the large stainless steel examination table.
De Saint-Phalle stepped toward Ki
m and bowed slightly, then extended his hand.
“Mr. President,” said de Saint-Phalle. “I am Marc de Saint-Phalle from Gustave Roussy. It is a pleasure to meet you, sir.”
Kim shook de Saint-Phalle’s hand but though he wanted to smile, a nervous, distressed, even vulnerable look appeared on his face. He said nothing. He couldn’t speak. For a moment, it appeared he might break down.
“Does it hurt right now?” said de Saint-Phalle, trying to ease Kim’s fears by engaging him in a simple question.
Kim nodded, placing his right hand on the side of his torso.
“On a scale of one to ten, with ten being the worst pain you’ve ever felt, and one being no pain at all, how would you rate the pain?”
“Six,” said Kim. “It never goes away, except with the painkillers. Can you help me?”
“We’re here to determine what is wrong, Mr. President,” said de Saint-Phalle. “We’re doctors and researchers who’ve devoted our lives to understanding and treating all forms of cancer. At this point, we don’t even know what it is.”
“You saw the results of the blood test.”
“Yes, I did,” said de Saint-Phalle. “You have elevated platelets and white blood cells, but it doesn’t necessarily mean it’s cancer, sir.”
“Can you save me if it is?” whispered Kim.
De Saint-Phalle cast a glance to Yong-sik.
“If you can be saved, yes, we will save you,” said de Saint-Phalle. “But first, let’s determine what’s causing the pain in your side. Your doctors were not allowed to run the sort of tests that will be needed to diagnose what is going on. We’re going to run those tests.”
“What if it’s cancer?”
“Let’s cross that bridge if and when we get to it.”
“I want to know.”
De Saint-Phalle looked at Megan for a moment, then back to Kim.
“One of four outcomes will come from our two days of tests,” said de Saint-Phalle. “One, you don’t have cancer. We find out what the pain is and recommend a course of action. Then we fly home. Two, you have cancer and it’s treatable with various strategies and treatments available right here in Pyongyang, with our guidance from Villejuif. Three, you have cancer and it cannot be treated locally, in which case we would advise you to come to Villejuif, where we can treat it properly.”
Kim nodded.
“And what is the fourth?” said Kim.
“The last scenario is some sort of advanced inoperable cancer,” said de Saint-Phalle evenly. “But again, we don’t know anything yet, and the fact that you walked in here and are not displaying signs that would normally signal terminal cancer is a promising beginning. Now, if you will, please sit down on the examination table and point to where it hurts.”
* * *
By the end of the first day of tests, de Saint-Phalle and his team knew what was wrong. It didn’t take long. With each set of test results, like a sculpture forming out of a mass of rock, they honed in on a precise picture of what was wrong. They would not need a second day of tests. The results of the four biopsies were conclusive.
That it was advanced cancer of the pancreas was immediately apparent, but the biopsies performed on Kim’s liver, kidneys, and stomach showed an even more frightening discovery. The cancer was an extremely aggressive, rapidly metastasizing type of the disease that rendered any more tests unnecessary and any potential cures impossible. The team from the Institute all agreed that it was inoperable. The only thing they couldn’t agree on was how long Kim had to live. De Saint-Phalle believed Kim had, at most, a month, Megan Licameli predicted that North Korea’s leader would be dead within a week.
What de Saint-Phalle told no one was that he’d known the moment he looked into Kim’s eyes. He didn’t know what exact form the cancer would take, but he’d learned to recognize the look. He’d seen it so many times he could tell the difference; the difference between the normal, horrible worry that all patients emoted before knowing whether or not they were sick, and the spectral, indescribable chill of those poor souls who already knew they were dying, that they were almost dead.
De Saint-Phalle called Yong-sik at just after ten o’clock that evening.
“I think you should come to the hospital,” said de Saint-Phalle.
“I’ll leave right now.”
Forty-five minutes later, Yong-sik entered the operating room. De Saint-Phalle was alone. The medical equipment, brought in by the Institute, was gone, already on the plane. The rest of the medical team was back at the airport. Even the Israelis were back on board the waiting Bombardier, something Saint-Phalle insisted upon. He wanted to handle this alone.
Yong-sik was still dressed in military uniform, his chest emblazoned with colored insignia and medals. De Saint-Phalle looked at Yong-sik with a steady, emotionless stare.
“Where’s the rest of your team?” said Yong-sik.
“On the plane, General. A second day of tests won’t be necessary.”
Yong-sik paused. His hand reached for the table to steady himself.
“Tell me.”
“President Kim has inoperable cancer,” said Saint-Phalle. “It started in his pancreas and spread. It’s now in virtually every part of his body, including his bones, which is likely the reason he’s having breakthrough pain. But it’s everywhere.”
“Metastasized?” said Yong-sik.
“Correct. A very aggressive form of cancer.”
“What about radiation?” asked Yong-sik. “Chemotherapy? What about operating on him? Right now. Tonight.”
De Saint-Phalle shook his head.
“It’s too late, sir. At this point, to kill the cancer we’d have to kill Kim. No amount of radiation, drugs, or surgical procedures would be adequate. It would simply be a waste of President Kim’s final days. A painful waste, I might add. Because at the end of the day it wouldn’t work. There’s simply no way to halt the progression. I’m very sorry.”
Yong-sik looked at de Saint-Phalle for several moments. His eyes became red with emotion. He sidled up to the examination table and pulled himself onto it, sitting down.
“I’d like to inform President Kim as soon as possible,” said de Saint-Phalle.
“I will tell him.”
“It’s my responsibility as his doctor,” said de Saint-Phalle. “He’ll have questions you can’t answer.”
Yong-sik shook his head.
“Thank you for coming,” said Yong-sik, wiping his eyes and standing. He reached out and shook hands with de Saint-Phalle. “You are a good doctor, an honest man. There is only one person who can inform the supreme leader. I’ll have you driven to your plane. When you’re in the air, I will go see him. You might have armed men protecting you, but he is unpredictable. If he’s going to kill someone, it should be me.”
* * *
An hour later, Yong-sik stepped inside President Kim’s massive, palatial bedroom. Kim was seated in bed, beneath the covers, dressed in maroon silk pajamas. He was smoking a cigarette; the ashtray was on the duvet in the middle of the bed. A lone light was on in the room, a large glass lamp on the bedside table, and it cast a gold hue across the room. A glass of red wine was on the bedside table.
Behind Kim, on the wall, was an oil painting. It showed his father, Kim Jong-il, and Kim. In the painting, Kim was a child. He was seated on his father’s lap, a big smile on his face. His father was holding Kim’s hand in his own, a tender look on his face as he held his young son.
Yong-sik walked across the soft Oriental carpet and came to Kim’s bedside. He bowed before Kim for a few seconds, then raised his head and looked at him. Kim took a drag from his cigarette, then exhaled.
“How bad is it?” said Kim.
Yong-sik started to talk, but then became choked up.
“Come now, General, certainly it cannot be that bad?”
Yong-sik nodded. “I’m afraid it is, my leader,” he said.
Over the next few minutes, Yong-sik relayed the medical findings by the team from Gustave Rou
ssy. Kim calmly sipped from his wineglass as he listened, then lit another cigarette. His face was blank as stone, though it was not a look of resignation or fear. It was a frightening look, a look Yong-sik recognized, when Kim wanted—needed—someone to blame, a scapegoat, a release valve for the deep, unquenchable anger that coursed through him like boiling metal. When Yong-sik was finished, he looked up at Kim. He couldn’t hide his own emotion. It wasn’t fear, but rather something only he knew, something he could never say to anyone, not even Kim. It was the sorrow of a father who suddenly understands his son is going to die.
“How dare you!” said Kim, seething. “I’m the one dying, not you!”
Yong-sik nodded.
“I … I’m sorry,” said Yong-sik quietly.
Kim took another sip of wine.
“You wanted me to go see these doctors two years ago,” said Kim, staring off into space, thinking aloud. “You were right. You’re always right, General. You were the one who told me my father died. I would never harm you. You’re the only family I have ever known. Did you know I can’t even remember what my father was like? It is only through your stories of him that I have any idea.”
“He would be very proud of you,” said Yong-sik.
“Do you mean that?”
“Yes.”
Kim put the empty wineglass down and leaned back into a big pillow. He stared again off into the darkness of the room, lost in his thoughts. His eyes abruptly cut to Yong-sik. The look had returned, as Yong-sik knew it would—the anger and resentment, the fury of a man dying, a man who believed he was immortal. His black eyes flashed slashes of hatred and rage.
“No, he wouldn’t be proud of me,” said Kim, his voice inflecting with emotion. “But he will be. If I am going to die, I will bring others with me like nobody else has. I always knew the sign would come, the reason my father built the nuclear weapons. Finally, the sign is upon me. Don’t you see?”
