The First Patient

by Michael Palmer

  THE FIRST PATIENT

  ALSO BY MICHAEL PALMER

  The Sisterhood

  Side Effects

  Flashback

  Extreme Measures

  Natural Causes

  Silent Treatment

  Critical Judgment

  Miracle Cure

  The Patient

  Fatal

  The Society

  The Fifth Vial

  THE FIRST PATIENT

  MICHAEL PALMER

  This is a work of fiction. All of the characters, organizations, and events portrayed in this novel are either products of the author's imagination or are used fictitiously.

  THE FIRST PATIENT. Copyright © 2008 by Michael Palmer. All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews. For information, address St. Martin's Press, 175 Fifth Avenue, New York, N.Y. 10010.

  www.stmartins.com

  Library of Congress Cataloging-in-Publication Data

  Palmer, Michael, 1942–

  The first patient / Michael Palmer.

  p. cm.

  ISBN-13: 978-1-4299-2833-5

  ISBN-10: 1-4299-2833-6

  1. Physicians—Fiction. 2. Presidents—United States—Health—Fiction. 3. Physician

  and patient—Fiction. I. Title.

  PS3566.A539 F57 2008

  813'.54—dc22

  2007040443

  10 9 8 7 6 5 4 3 2 1

  To Dr. E. Connie Mariano, Rear Admiral (Ret.),

  Renaissance woman,

  physician to presidents:

  Without you, this book would never have been.

  And

  to Matthew, Daniel, and Luke,

  for making it all worthwhile

  ACKNOWLEDGMENTS

  First and always, thanks to Jennifer Enderlin, my extraordinary, brilliant, compassionate, and hard-working editor at St. Martin's Press. You are and always will be my kind of bookkeeper.

  Jane Berkey and Meg Ruley of the Jane Rotrosen Agency are everything literary agents should be and more.

  Talented singer, musician, novelist, computer wizard, songwriter Daniel James Palmer is responsible for lots of good and helpful things surrounding this book, including Alison's blues.

  In addition:

  Dr. David Grass shared his strength and vast neurological knowledge.

  Remarkably talented artist and children's book author Dara Golden shared her considerable understanding and love of horses.

  Robin Broady read and read and read some more.

  Chef Bill Collins (www.chefbill.com) reasoned out problems with me while putting together one award-winning meal after another.

  Bless you, Sally Richardson, Matthew Shear, and Matthew Baldacci at St. Martin's.

  Attorney Bill Crowe taught me how to shoot straight, Jay Esposito taught me how to buy a used car, and Dr. Ruth Solomon gave me veterinary advice.

  Thanks to the staff at the White House Medical Unit for your hospitality, and to the Big Book for always having the right answers.

  And finally, thanks to Luke for suggesting nanotechnology when I told him I was stuck.

  Anyone I overlooked, I promise to get you next time.

  THE FIRST PATIENT

  CHAPTER 1

  The rotors of Marine One slowed, then stopped. Dust clouds billowed into the still air. Minutes later, a second, identical helicopter landed twenty yards away. A short staircase lowered to the parched ground. A Marine sergeant in formal dress left the shelter of the first chopper and took a position at attention at the base of the staircase. The door of the chunky Sikorsky Sea King swung open.

  And with no more fanfare than that, the most powerful man on Earth, his ubiquitous, well-publicized dog at heel, stepped out into the warm Wyoming evening.

  Fifty feet away, still in the saddle, Gabe Singleton calmed his horse with a few pats behind the ear. The mid-morning appearance of a Secret Service agent at the Ambrose Regional Medical Center had given Gabe warning that the presidential drop-in was going to take place, but the man hadn't been specific about the time and, following an exhausting all-nighter caring for two patients in the ICU, even a visitor of this magnitude couldn't keep Gabe from his customary ride out into the desert and back.

  "Hey, cowboy," President Andrew Stoddard called out, descending the stairs and sincerely saluting the lone Marine as he passed, "whattaya say?"

  "I say you and your choppers scared the crap out of this world-weary old nag. . . . Frightened my horse, too."

  The two men shook hands, then embraced. Stoddard, who Gabe felt looked presidential even when they were first-year roommates at the Naval Academy, showed the stress of three and a half years in office. Silver highlighted his razor-cut dark brown hair, and deep crow's-feet had appeared at the corners of his iridescent blue eyes. Still, he was every bit the man in charge—the decorated Desert Storm pilot and former governor of North Carolina, whose star had been on the ascendancy since the day he took his first privileged breath.

  "One of the downsides of the job," Stoddard said, gesturing toward his entourage. "Twin helicopters so that any whacko who decides to take a bazooka shot at one of them has only a fifty-fifty chance of blowing me away, Secret Service studs checking out every inch that's gonna be stepped on by these size elevens and every toilet seat that's gonna be graced by these presidential cheeks, plus a medical team trained to know that it's not if something terrible happens to their boss, it's when."

  "If you're looking to make a job change, I could use a wrangler on my ranch."

  "How many do you have working for you now?" Stoddard asked, glancing about.

  "You would be the first. I'm afraid our benefits package is a little thin, too, starting with that you'd have to pay me to work here."

  "Hey, put me on the list. I don't know if you follow the polls or not, but I haven't got a hell of a lot of job security at the moment. Got some time to talk with an old pal?"

  "If you'll let me put my other old pal Condor, here, in the stables."

  "Fine-looking horse."

  "And that's a fine-looking pooch. Liberty, right?" Gabe patted the dog's rock-solid flank.

  "Good memory," Stoddard said. "Liberty's making quite a name for himself, tagging along with me and changing people's misperceptions about pit bulls, just like we're changing people's misconceptions about America. I've had dogs all my life, Gabe, but Liberty, here, is the best. Strong as a tiger, wise as an owl, and as gentle and dependable as that horse of yours."

  "Maybe you should have named him Simile."

  The president laughed out loud. "I love it. This here's my trusty dog, Simile. He's tough as a Tennessee hickory nut, but gentle as baby powder. Carol will think that's very funny, too, especially since, unlike her husband, she's actually likely to know the difference between a simile and a metaphor. Hey, Griz."

  A thick-necked, barrel-chested, balding Secret Service man wearing the obligatory black suit and reflective shades seemed to materialize from nowhere.

  "You rang?"

  "Griz, this is my old college roomie Gabe Singleton. Doctor Gabe Singleton. It's been five years or so since we last saw one another, but it seems like yesterday. Gabe, this here's Treat Griswold, my number-one protector and probably the number-two man in the whole Secret Service. Obsessive to a fault. Swears he's telling the truth when he says he'll take that proverbial bullet for me, but with that crooked smile and those beady little eyes of his, I just don't believe him."

  "In that case, sir, you'll just have to wait and see," Griswold said, stopping just short of pulverizing the bones in Gabe's hand at the same time. "I'll be happy to get Condor settled in, Doctor. I used to muck
out stables and ride warm-ups when I was a kid."

  Gabe liked the Secret Service agent immediately.

  "In that case you've come a long way," he said, handing over the reins. "Tack room's in the barn. Maybe we can go for a ride sometime."

  "Maybe we can, sir," Griswold said. "Come on, Liberty, let's put this big ol' fellow to bed."

  Stoddard took Gabe by the arm and led him to the back door. The house, seven rustic rooms that still had the feel of the cabin it was before some additions, was Gabe's cut from the end of his five-year marriage to Cynthia Townes, a bright, vivacious nurse from the hospital who loved him to pieces from day one to day last. Her mistake.

  Cinnie's last words to him before she handed over her keys and took off for a teaching job in Cheyenne were to beg him to finish dealing with his past before he made any further attempts to build a future with anyone. For seven more years he had taken her at her word, and so had carefully avoided another in-depth connection. He might be done dealing with his past, but he had serious doubt it was ever going to be done dealing with him.

  "Sorry I haven't gotten out here for so long," Stoddard said. "I used to really enjoy the evening rides and our fishing trips up into those mountains."

  "The Laramies. There's no place on earth quite like them. But stow the apologies, matie. From what I've heard, you've had a few other things on your plate—like saving the world."

  Stoddard grinned wistfully.

  "It's a little bigger a job than I once thought," he said, settling in at the round oak table in the kitchen, "but I still intend to make a dent in it."

  "I remember you talking like that during our first or second night of bar-hopping together at the Academy. I kept trying to stay cynical and believe that you were an idealistic jerk, but this little voice inside me kept saying that this was a guy who might actually be able to do it. Then, when you drank me under the table, I really decided to give you the benefit of the doubt."

  "That was beginner's luck, and you know it. You must have had a virus or something."

  "Speaking of which, it should come as no surprise that I can't offer you a beer, but I can brew you some coffee, or—or some tea."

  "Tea would be great," the president said, placing a manila folder in front of him. "While I'm in apology mode, sorry I couldn't make it in for your dad's funeral. I appreciated your letting me know he had passed."

  "And I appreciated that you would take the time to call from South America."

  "Your dad was a bit . . . quirky, but I always did like him."

  "He was very proud of you, Drew, you being a fellow Annapolis grad and all."

  The instant he spoke the words, Gabe wished he hadn't. Cinnie's pleas notwithstanding, he had done what he could to deal with Fairhaven and his father's reaction to it. He hadn't meant the statement to come out the way it did.

  "I'm sure he was very proud of you, too, Gabe," Stoddard said, a bit uncomfortably, "what with your M.D. degree and all those medical missions you've been on, and that youth foundation you're running."

  "Thanks. Hey, speaking of sires, how's yours doing?"

  "Same old LeMar. Still trying to micromanage everything, including me. He tells me he's bought his way onto a Russian space shot. Fifteen million and he becomes the first seventy-five-year-old to soak his hemorrhoids in the international space station tub."

  "Fifteen million. God bless him."

  "Hey, come on. When we're talking about my father, it's like Monopoly money. Just do the math. The ten billion or so he's worth minus the fifteen million or so he spent is . . . um . . . take away three, carry the one—still ten billion or so. I wouldn't be surprised if he paid in cash with bills he pulled out of his sock drawer."

  Gabe smiled. If, over the years, he had suffered from too little father, Drew Stoddard had suffered from too much. From his days in diapers, Stoddard had been molded by the charismatic, wildly successful industrialist. The heartache Buzz Singleton endured when Gabe was drummed out of the Naval Academy had to pale next to LeMar Stoddard's having to explain to his pals at the hunt club or the polo pitch or wherever that Drew had become a Democrat—and one of the shining stars of the party at that.

  Did Drew's remarkable transformation from elitist Republican to populist Democrat have its roots in the accident at Fairhaven all those years ago? Gabe often wondered. In such an inestimable tragedy, not even the bystanders and innocents like Drew Stoddard escaped unchanged.

  Gabe set a pot of Earl Grey tea and some shortbread on the table. There was a time before the last presidential election when the two of them got together once or twice a year to hike and fish in the Smokies or Laramies, and exchange news and stories, but now, despite their long-standing friendship, Gabe felt strangely edgy about taking up the time of the most powerful man in the solar system with small talk. Still, this last-minute trip to Tyler was Stoddard's doing, so it seemed right to let him set the agenda.

  Gabe didn't have long to wait.

  "Did you know that in addition to the comprehensive medical facility on the first floor of the Eisenhower Office Building we have our own medical clinic right in the White House?" Stoddard began.

  "You said something about it in one of our conversations, yes."

  "It's run by the White House Medical Unit. Which, for reasons lost in antiquity, is actually a division of the White House Military Office. Pretty nice setup, too—recently renovated, state-of-the-art equipment, top-notch nurses and paramedics, and the best doctors from all branches of the service. Twenty-five or thirty staff altogether. They take care of me and Carol and the boys when they're home from school, as well as Vice President Cooper and his family, and anyone else who happens to need medical care while they're at the White House."

  "The boys—they doing well?"

  "Terrific. Andrew's going into eleventh; Rick'll be in ninth. Both are at school in Connecticut. Right now they're at soccer camp. Andrew's an all-star goalie. Rick plays because he thinks he should. He wants to go to the Academy and be an astronaut."

  "Think you can get him in?"

  "I think he can get in on his own, but I may keep an eye on his application."

  "Eleventh and ninth—that's amazing."

  "They're happy and healthy. That's all that really matters."

  "Speaking of healthy, you had your doc from North Carolina come up to D.C. to care for you, yes?"

  "Jim Ferendelli. He's been a great doctor for me and the family. The best. Kind, knowledgeable, empathetic. Plays beautiful classical piano, too."

  "I'm really glad to hear all that, Drew. Having a doctor one can trust is a huge weight off of anyone's shoulders."

  "I agree, but I'm glad to hear you verbalize it just the same."

  "Well, that's how I feel, although when it comes to caring for the President of the United States, I assume you know I'm just stating the obvious. Your well-being and good health have an effect, one way or another, on every person on the planet."

  Stoddard laughed with no great glee. "I understand what you're saying, but I still get the willies thinking about things that way."

  "It's a hell of a job you signed on for. I don't envy that responsibility in the least."

  "But I still have your support?"

  "Of course."

  "In that case, it should come as no surprise that I didn't break away to fly here in the midst of a heated campaign just because I missed your smiling face. I need something from you, Gabe. Something important."

  "Name it."

  "I need you to come to Washington and be my doctor."

  Gabe sank back in his chair and stared at his onetime roommate in utter disbelief.

  "But . . . you said this Jim Ferendelli is a terrific doctor."

  "He is . . . was."

  Gabe felt as if a band were tightening around his chest.

  "I don't understand," he finally managed.

  "Gabe," Stoddard said. "Jim Ferendelli's gone. . . . Vanished."

  CHAPTER 2

  What about the FBI?" />
  "You don't think they're all over this? Hundreds of agents have been on the case for almost two weeks. Nothing."

  Evening had settled in, and a steady breeze from the north had dispelled the last of the day's warmth. Gabe had listened in stunned silence to the description of a fifty-six-year-old widower, devoted father of a grown daughter, personable and diligent, churchgoing and humble, who one day simply failed to show up at work. A search of his apartment in Georgetown and his Chapel Hill home revealed nothing out of the ordinary, and a check of his phone and e-mails had also been of no help.

  With the presidential campaign just heating up, Andrew Stoddard's advisors had managed to keep the potentially distracting disappearance out of the news until they were certain the search was not going to be successful. For more than a week, now, that was clearly the case, and what scant details there were had just been released to the press.

  "They've all been told that for now the White House Medical Unit would handle any problems I might have, but as competent as the unit is, I really want my own physician."

  "This is absolutely incredible," Gabe said. "The doctor to the President of the United States has vanished without a trace. What about his family? Have they heard anything?"

  "As I said, Jim's wife died of cancer about five years ago. His mother's in a nursing home, and two older sisters haven't heard a word from him."

  "But you also said he had a daughter. Has she heard anything?"

  "Actually, Jennifer's disappeared, too."

  "What?"

  "She's a graduate film student at NYU. The evening of the day Jim disappeared, Jennifer's roommate came home from a date and Jennifer wasn't there, but the FBI already was. There was no evidence she had packed anything, no note, nothing. They tried every number the roommate could think of, but just like her father, the girl had simply . . . vanished."