Patient One: A Novel

by Leonard Goldberg

  “You are cleared for takeoff,” the control tower notified him.

  With a roar of its engines, the cargo plane sped down the runway and lifted off into the pitch-black Mexican night.

  Ten

  David peered down at the cardiac monitor behind the President’s bed. Merrill’s blood pressure had stabilized at 104/80, but his pulse continued to race at 122 beats per minute. Not good, David thought, now envisioning the pathophysiology going on inside the President’s vascular system. The transfusion of plasma had expanded Merrill’s depleted intravascular volume, allowing his blood pressure to return to near normal. But it hadn’t replaced the red blood cells he’d lost, so his hemoglobin remained low and unable to carry adequate amounts of oxygen. To make up for this deficit, his heart had to pump faster and faster to send out more and more oxygen-poor blood to his peripheral tissues. Not good, David thought again. A continuously overworked heart could lead to arrhythmias and even cardiac failure.

  His attention went to the plastic bag of plasma dripping rapidly into Merrill’s arm. There was only a small amount remaining, not more than 25 ccs. David lowered his head through the ceiling and carefully studied the sleeping President’s face. Merrill was even paler than before, with caked blood around his nose and mouth. The basin on the nightstand was half filled with blood, but David couldn’t tell if it was old or new.

  His eyes drifted over to the suction bottle containing Merrill’s gastric juice. It was colored light brown. Maybe there was still a little bleeding, David surmised. Maybe the plasma transfusion had partially corrected the coagulation defect. And maybe it hadn’t. Maybe the President was still bleeding internally and the blood was traveling down through his colon rather than up through his gastric tube. That would cause a black, tarry diarrhea that gave off an awful smell. David lowered his head farther to sniff at the air above the President’s bed.

  Suddenly the door opened and the guard peeked in. David jerked his head back through the opening in the ceiling, but didn’t have enough time to replace the panel. He stayed motionless, holding his breath. For some reason the guard walked over to the President’s bed and stared down at him for a long moment. The guard was so close to the opened panel that David could see the early bald spot on the crown of his head. If the terrorist looked up, David knew he was a goner. The guard continued to stare down, as if contemplating some action. Then he abruptly spun around and left the room, closing the door behind him.

  David started breathing again. He wiped the perspiration from his brow and, steadying his nerves, gazed down at the President. Once more he was struck by how pale Merrill appeared. The President’s complexion was more white than pink. He desperately needs a blood transfusion, David thought, as his eyes went to the bag of plasma that was nearly empty now. It had to be replaced by the bag of blood or the IV line would become dry and clogged. Where’s Carolyn? Where the hell is she? Then, with a sigh, he answered his own question. She’s busy being doctor and nurse to a dozen patients, some so ill they belong in an ICU. And she’s holding up like a real trooper. She is some woman.

  David put the panel back in place and crawled away on the metal grid, heading for the large bathroom that adjoined the suite. He stayed well clear of the metal piping and moved noiselessly past bundles of wires. On reaching the bathroom, he made sure he was over the marble countertop and then, grasping a bar of the grid, lowered himself six feet down. He paused on the countertop, listening for any sound, then climbed off and tiptoed into the President’s suite. Again he hesitated, his eyes now on the door that was cracked open. He took a deep breath and made himself wait while listening for motion in the corridor. The only noise he heard was the thumping of his own heart.

  Quickly he went to the bedside and took down the empty plasma bag, then replaced it with a bag of packed red blood cells. After adjusting the flow rate to two ccs per minute, David hurriedly examined the President without touching him. Most of the blood on and around Merrill was old, and David didn’t detect the awful odor of a tarry stool, which would have indicated ongoing gastrointestinal bleeding. So maybe I bought some time. But how much? Not a lot, David guessed. Not with just one bag of plasma.

  Abruptly David pricked up his ears. There were approaching footsteps in the corridor. The guard began to open the door. In an instant David dashed across the suite and into the bathroom. He heard the door open wide and someone walking in. With a single bound he was on the marble countertop. But the footsteps were closer now. Much closer. He didn’t have time to climb up into the crawlspace. Silently he eased himself down from the countertop and moved behind the door to the bathroom. He crouched low and scanned the room for a weapon. Any weapon. He didn’t see any. There was a roll of toilet tissue, a big plastic cup, and a box of Kleenex. His eyes came back to the plastic cup. Maybe the cup, David thought. Yes, maybe the cup would do. He crept over to it.

  Suddenly the loud, pinging alarm of the monitor sounded. David froze in place, thinking the President had gone into shock. He’s bleeding out. The plasma didn’t hold. I’ve got to get back to him. But what about the guard? David hurriedly reached for the plastic cup, put it on the floor, and crushed it with his shoe. The cup split into pieces, one of which was long and slender with a sharp point. David knew exactly how to use it on the terrorist.

  The guard was yelling in rudimentary English above the loud pinging noise. “What wrong?”

  “It’s nothing,” Carolyn yelled back, shutting off the alarm. “One of the attachments dropped off the President.”

  Carolyn! It was Carolyn. David lowered his makeshift dagger and gathered himself, not daring to peek out. The guard was either with her or watching her through an open door. Better to stay put, he thought. David pressed up against the wall and waited.

  “Well, Mr. President, I see you’re awake,” Carolyn was saying. “It’s time to start your blood transfusion.”

  “Do I need another needle stick?” Merrill asked weakly.

  “Oh, no. We’ll use the IV line that is already—” Carolyn stopped in mid-sentence. She saw the bag of blood running into the President. David, she realized immediately. She quickly looked up at the ceiling, then into the empty bathroom. He’d come and gone with a guard at the door. How did he manage that? How … ?

  The guard blurted out something in Chechen, breaking into her train of thought.

  “Goddamn it! If you want to speak to me, do it in English!” Carolyn said sharply. She wasn’t being overly brave. She knew they weren’t going to shoot her, at least not now. They needed her to keep the President alive—or so they believed.

  Out of habit she checked the label on the bag of blood to make certain it had the President’s name on it. It did. He was AB negative, a rare blood type that was hard to come by, even under normal circumstances. Bringing her hands down, she noticed blood on them. A shiver went through her as she wondered if the bag had been damaged by the terrorists’ bullets that had shot up the messenger’s box. She quickly examined the plastic bag and found it intact. The blood was old and had probably come from the bags in the box that had ruptured. Thank goodness!

  She headed for the bathroom to wash her hands. At the basin she gazed in the mirror and studied her face. Her lipstick was gone, her hair a mess, and there was a blood smear on her cheek. I look like hell— Suddenly her eyes bulged. David was standing beside the door behind her. He had his index finger on his lips. He signaled for her to turn on the faucets.

  Peering around the doorway, he made certain the way was clear, then rushed over and pressed himself against the wall.

  “Where’s the guard?” David asked quickly.

  “By the door,” Carolyn replied.

  “Facing in or out?”

  “Out.”

  “Good,” David said. “Now run the water faster.”

  Carolyn turned the faucets up to full force, then looked over to him. Her lower lip began to
quiver and she had to bite down to calm it. Then she flew into his arms. “Oh, David! I’m so frightened!”

  “You’re doing fine,” he whispered, holding her close. “You’re saving lives, left and right.”

  “But for how long?” Carolyn asked, her voice trembling. “We’re all going to end up dead. None of us will leave this floor alive.”

  “Don’t be so sure.”

  She stared up at his face. “Are you saying there’s a way out?”

  “We’ll see,” David said, although he knew their chances for escape were slim. “But we’ve got to play it very smart.”

  Carolyn nodded, trying to read his face and decide if there really was a glimmer of hope. “What do you want me to do?”

  “Leave everything to me,” David said, keeping his voice low. “First off, you should know that Karen Kellerman also got out alive. She’s in the ceiling crawlspace with me.”

  “Is she wounded?” Carolyn asked at once.

  “No, but she has asthma and doesn’t have an inhaler with her,” David said rapidly. “Do you have any inhalers in the Pavilion?”

  Carolyn shook her head. “Not that I know of.”

  “Check and see,” David went on. “If not, I want you to prepare some small syringes with a cc of 1:1000 epinephrine in them.”

  “That won’t help much in a bad asthma attack.”

  “It’s better than nothing,” David said. “Now tell me about our patients.”

  “Dr. Warren is starting to have PVCs again despite the increased dose of lidocaine,” she reported.

  “If they become frequent, give him bretylium, ten milligrams IV, then maintain him at one milligram per minute,” David said automatically. “And keep the defibrillator at hand. What about Marci?”

  “Not good,” Carolyn told him. “She’s having trouble breathing.”

  “Is she leaning forward to get a full breath?”

  Carolyn nodded again. “Just like before.”

  “Shit!”

  “Yeah.” Carolyn stared up at his pale blue eyes and studied them. “Aren’t you frightened?”

  “Some,” David admitted.

  “You don’t show it.”

  “That’s because you’re not looking closely enough.”

  “I’m looking plenty close enough,” Carolyn whispered, standing on her tiptoes and kissing him firmly on the lips.

  “What was that for?”

  “Good luck,” she lied.

  David kissed her back, even harder. “Let’s make it double good luck.”

  They heard footsteps coming toward them, the guard grumbling to himself.

  David quickly disengaged and stepped away. He positioned himself against the wall beside the door and whispered. “If he starts to come in, scream at him.”

  “What?” Carolyn asked, not certain she’d heard him correctly.

  “Scream at him,” David instructed. “Like you would if he walked in while you were sitting on the john.”

  Carolyn took a deep breath and readied herself.

  David reached for his handkerchief and wrapped it around the flat end of the plastic sliver, converting it into a dagger. He held it up high and waited, his heart pounding in his chest.

  Carolyn summoned up all of her courage and turned to face the approaching guard. She tried to appear surprised, then screamed at the top of her voice, “Get out of here, you perverted son of a bitch!”

  The guard stopped in his tracks, caught off balance.

  “Out!” Carolyn yelled and pointed to the corridor.

  The terrorist gave Carolyn a long, menacing look and spat on the floor, then mumbled something in Chechen and walked away.

  “And stay the hell outside!” Carolyn called after him.

  David nodded to himself. She was so damn smart! She was telling him the guard was on his way out of the room. And what a performance she put on with her scream. It was perfect, just perfect. Jesus, he thought again, she is some woman!

  He waited another ten seconds and moved over to the marble countertop, now noticing how tightly he continued to grip the makeshift dagger. And the dagger was trembling in his hand. For a brief moment he wondered if he could have really used it. Did he still have the nerve and skill to kill? Would he have sliced into the man’s carotid artery, giving it about as much thought as opening a can of tomatoes? Yeah. I guess so. I guess I could have done it to save Carolyn and myself. But he knew that was just talk. And talking about killing a man was a lot different from actually doing it.

  Before putting the makeshift dagger in his pocket, David rewrapped it with his handkerchief to protect himself from its pointed end. But the increased pressure caused the plastic sliver to crack and crumble. Shit! David growled at his stupid blunder. Now he was weaponless again. Mistakes! I’m making too many mistakes! Fuming at himself, he threw the pieces of plastic into a trash can. Quickly he mounted the countertop and reached for the metal grid, then pulled himself up through the opening in the ceiling.

  David hurriedly put the panel back in place and made certain it fit snugly. His heart was still racing and skipping beats from the narrow escape. Gathering his nerves, he remained motionless and waited for his pulse to slow, all the while listening to see if the terrorist was going to return for a second look.

  Karen came up alongside him and whispered in his ear, “Jesus Christ! You almost got yourself killed.”

  “What the hell are you doing over here?” David whispered back harshly. “I told you to stay by the far wall.”

  “It got really musty in that area and I started to wheeze,” Karen explained. “So when I saw the opening in the ceiling, I crawled over to breathe some fresh air.”

  “How’s your asthma doing?”

  “So-so,” Karen reported and coughed mildly. “But I’m more worried about you than me. Had that terrorist taken one more step, you would have been a dead man.”

  “But Carolyn saved the day, didn’t she?” David asked with a crooked grin. “She put on quite a show, eh?”

  “I guess.”

  “There’s no guessing to it. She stared that terrorist in the face and didn’t back up an inch,” David said admiringly. “That takes something special.”

  “I didn’t know you two were so close,” Karen remarked, keeping the jealousy out of her voice.

  “We aren’t.”

  “That’s not what I saw going on down in the bathroom,” Karen said. “I think you’ve got yourself a new girlfriend.”

  “We’ll see after all this is said and done.”

  “For being as clever as you are, David, sometimes you’re awfully blind to the obvious.”

  “That’s one of my flaws,” David said gruffly. “Now I want you to return to your space by the far wall without making a sound. Do you think you can manage that?”

  “I can try.” Karen nestled up against him and kissed his neck before backing away to her hiding place.

  Eleven

  David felt the vibration of his cell phone through his pants pocket. He moved quickly and quietly over the nurses’ station. Jarrin Smith and the Russian security agent were seated at the desk, a terrorist standing guard over them. The floor around them was littered with trash and soaked with blood. The stale odor of decay was everywhere, and triggered a flashback in David’s mind, but he pushed it aside and crawled on until he was close to the treatment room, where there was little chance he’d be overheard.

  He reached for his cell phone and answered in a whisper. “Yes?”

  “Dr. Ballineau, this is Special Agent Cassidy. Are you still in the crawlspace?”

  “Yes.”

  “Good. Now we have to talk fast, because we don’t know how much power is left in your phone’s battery.”

  “Fire away.”

  �
��We finally got the floor plans for the Beaumont Pavilion and the floor beneath it,” Cassidy said hurriedly. “Let’s start with who is in which rooms. Begin with the President and his family.”

  “Do you have numbers for the suites?”

  “Yes.”

  “The President is in suite one, the First Lady is in two, their daughter in three.” David rapidly went through all the rooms and the patients they contained. Then he described the nurses’ station, treatment room, nurses’ lounge, and kitchen area.

  “Where is the First Daughter’s date?” Cassidy asked.

  “Dead.”

  “Is the President still hanging on?”

  “Just barely,” David reported. “The plasma seems to have slowed his bleeding, and he’s receiving a blood transfusion now.”

  “Hold on,” Cassidy said. “I want you to speak with a hematology specialist.”

  David heard background noise. Then a voice came on. “David, this is Bill Gershon. Can you hear me?”

  “I hear you,” David said, pleased to be talking with the medical center’s expert on coagulation defects. “We’ve got a big problem up here, Billy.”

  “Are you certain it’s von Willebrand’s disease?” Gershon asked.

  “Not positively,” David replied. “But the disorder runs in his family.”

  “That’s good enough for now,” Gershon said. “What have you treated him with so far?”

  “One unit of fresh frozen plasma and one unit of packed red cells.”

  “In all likelihood that’s not going to hold him long.”

  “I know.”

  “He needs Factor VIII–rich concentrates.”

  “I’m aware of that, but the terrorists won’t let anything or anybody come up to the Pavilion.”

  “The concentrates may well be his only hope.”

  “Then you’d better think of a way to get those bags of concentrates up here.”