The First Family

by Michael Palmer

  * * *

  WITH HIS tools and ladder, Mauser was dressed for the part. He had come to the ICU to decide how and when to take care of Susie Banks permanently. This was Rainmaker’s order, and Mauser could lose his supply if the deed was not done. The miracle of Susie’s survival confounded and infuriated them both, perhaps Mauser more than Rainmaker. He was not accustomed to failure. Susie should be dead like her parents, but no, she had to go and complicate things. No matter. Mauser had other ways to eliminate her. Other tools at his disposal.

  Now was not the time to take care of business. Too many people were on the floor. He would come back later—perhaps after dinner, when things quieted down. He’d show up with some complicated piece of machinery he’d say was needed to complete a job he was pretending to do. Being an actual heating and cooling repairman made this a relatively easy ruse. Nobody at the front desk had asked questions when Mauser presented a bogus work order. Nobody wondered what he was doing moving ceiling tiles about. Nobody asked why he was peering into dark spaces with his flashlight.

  At first Mauser thought nothing of the doctor who had come to see Susie. His perspective changed dramatically when he overheard him talking on the phone. If the acoustics up in the ceiling had not amplified the call, Mauser would have missed the conversation entirely. He knew from Rainmaker there was a connection between Susie Banks and the president’s kid. Now he knew the doctor was connected as well.

  He could inject Susie easily later tonight, but the doc was another story. Perhaps Mauser would inject him as well. Or maybe it would happen during a mugging gone wrong. Could be something else entirely. He would check with Rainmaker, and together they would decide this doctor’s fate.

  CHAPTER 24

  Lee finished up at the MDC and then drove to his office. Stacie, the office manager, had business to discuss.

  “I think the new scheduling software is extremely buggy,” Stacie said.

  Stacie’s earnest face showed grave concern. In her world, scheduling issues were matters of extreme importance, as they should be. She proceeded to provide an in-depth explanation of the software’s many perceived shortcomings. Lee listened as intently as he could until his patience ran out.

  “Look, Stacie, I can’t even get my e-mail to work on my phone. You’re in charge of scheduling. Handle it. Whatever you have to do, whatever it costs, I trust you’ll do the right thing here.”

  “Right isn’t going to be cheap,” Stacie said.

  “Seldom is,” answered Lee.

  With Stacie satisfied—for the moment, at least—Lee headed off in search of Paul, whom he found in his office, back on the phone. Of course he was on the phone.

  “Yes, I know. You’re a doctor,” Paul said snippily into the receiver. “Happy for you. But you work for an insurance company, and I am responsible for the care of my patient. And I’m telling you that Margery Theilman needs an MRI of the lumbar spine to confirm a herniated disc—yes, I have examined her. She has excruciating back pain radiating into her leg and foot and a partial foot drop from weakness.… No, she cannot wait to see a neurosurgeon. She needs the MRI today. Why are you making her suffer unnecessarily?… No, she doesn’t first need to see a physical therapist.…

  “Okay, I get it, I really do. You’re reading from a playbook called Back Pain. I’m not trying to put you down, really, but stop being an obstructionist. You’re practicing medicine on my patient from an office five hundred miles away—are you serious? You call this a peer-to-peer evaluation? Good gravy, you are so deep in the pocket of the insurance company there’s not a rope long enough to help you climb out. I live by my reputation. You live by making insurance companies even richer. That right there is our problem and our conflict. Great job, Doc. Honestly, how do you sleep at night? I hope Mrs. Theilman sues you. I’ll be sure to give her that advice.”

  Paul hung up the phone, cursing under his breath.

  “I thought you handled that well,” Lee said with a straight face.

  “You are looking at a man who is on the verge, Lee.”

  “Of greatness?” Lee sounded hopeful.

  “Insanity. I can’t take it much longer. I really can’t.” Paul shook his head in disgust. The place was wearing him down. Paul’s paunch seemed paunchier, his gray grayer, and the bags under his eyes bigger than usual.

  “The first lady is going to pay us for Cam’s care. She told me that today. Maybe we’ll get a bonus if we figure out what’s going on with him. Did you get my message?”

  “I did. What was it about? All you said was a cherry-red spot in the macula and a possible connection to Cam.”

  Lee launched into a detailed review of how he’d come to know Susie Banks and her enlarged organs. He made a point to emphasize that Susie and Cam had similar results for their respective liver enzyme tests.

  “You know a cherry-red spot could be a feature of a metabolic disorder, a storage disease like Tay-Sachs or Niemann-Pick.”

  Paul knew all this without having to look it up, which impressed Lee greatly. Much about Paul impressed Lee. A sense of profound gratitude for their years of friendship and partnership overcame him. It hurt Lee to see his partner in such distress over the state of their struggling business. Perhaps Lee was holding on to the practice for the same reason Karen held on to the camp: saying good-bye simply felt too final.

  “Well, if I remember correctly, both of those metabolic disorders are diseases of infancy, and I can assure you Susie and Cam are well beyond that.”

  Lee and Paul spent a quiet moment pondering the possibilities.

  “It would almost be easier if CO exposure caused myoclonus,” Lee said. “I know it doesn’t, but then it would be one less link between Susie and Cam.”

  Paul’s face lit up as if a sudden thought had left him thunderstruck. Lee could not recall a time when he saw his partner this animated.

  “Did you say myoclonus?”

  “Yeah, I thought I had said it before. My brain’s a bit rattled. Susie’s been experiencing myoclonic jerks in addition to the grand mal seizure she had in the ER.”

  “Hang on a second. Hang on,” Paul said. “A few years ago I took care of two sixteen-year-old twin boys, Richard and Scott Stewart. Now, I don’t know if they had a red spot on their maculas or not, but I do recall their mother brought them here because each had presented with a case of myoclonus.”

  Given there were so few family docs around these days, Paul treating twins with a symptom Susie had was no great surprise. But it was what they had that left Lee breathless with excitement.

  “In fifteen years, how many cases of myoclonus have we treated?” Lee asked.

  “Treated? One or maybe two others, in addition to the twins. People get those jerks all the time, but sleep starts aren’t a reason to go see a doctor. The severe cases are rare, and they all went straight to the neurologist,” Paul said. “But here’s the thing, Lee. Those boys never received follow-up care, because they died.”

  “Died how?” Lee swallowed hard.

  “Car accident,” Paul said. “The father lost control in Shenandoah National Park and went right off a cliff. No brake marks, just tire tracks. Both parents died with them.”

  It was a chilling image. How many nights had Lee woken with a chest-tightening panic when Josh went out with his friends for a good time? If his years in medicine had taught Lee anything, it was that nothing in life is guaranteed, and everything we hold dear could be taken away with a twitch of God’s eyelash.

  “Was it investigated? Murder-suicide, perhaps?”

  “Not that I’m aware of,” Paul said. “It was a tragedy, nothing more.”

  Lee had no memory of that particular car accident, but it was no surprise. The news pummeled him daily with stories of loss and grief. Another thing medicine had taught Lee was that good people suffered bad outcomes all of the time. But it was interesting that two of these tragedies happened to touch the lives of three people who had presented with myoclonus. He shared that thought with Paul.r />
  “Cam doesn’t have myoclonus, though,” Paul commented.

  “True, but he’s potentially been having seizures at night while asleep. And his seizures could even present as myoclonic jerks. Seizures of any type point to something wrong with his brain. Something that makes neurons hyper-excitable and fire off without control.”

  “It’s possible,” Paul said.

  “I wish we knew more about those poor twins.”

  “I’ll see what I have on file. Like I said, I had referred them to a neurologist, but never got the chance to check up on them myself.”

  Paul’s voice held an ache Lee could hear and feel.

  From his computer, Paul accessed the medical records of the Stewart twins. A few years back, Stacie had put the full-court press on the practice migrating to an electronic recordkeeping system. The expense would be worth it for the convenience alone, she said. She was right, to a point. If she had asked them this year, after such dismal earnings, Paul would have nixed the notion without much consideration. Lee would have told Stacie to do what she thought was best. They were different in that regard.

  Lee drummed his fingers restlessly on his armrest, while Paul perused the files.

  “Nothing here that will help,” he said. “Though I feel really awful now.”

  “Why is that?” asked Lee.

  “Not only are the boys dead, I didn’t buy their CD like I had promised. I even put a note in their file here to remind me. Dammit. You don’t think it was foul play, do you?”

  “It is a little odd for three patients with such unusual conditions to all suffer these terrible accidents,” Lee said. “These boys were musicians, you said?”

  “Incredible musicians,” Paul answered. “One played cello and the other piano. Their mother was distraught about the myoclonus because it was starting to interfere with their practice and performances.”

  “Hold a moment.” Lee sounded excited. “Cam is an incredibly gifted chess player, world-ranked. Supremely talented. Are we talking that level?”

  “They were concert-level performers, as I recall,” Paul said. “It was their life. They were destined for Julliard and great things after, at least according to the mother.”

  “So we have myoclonus in three cases at least,” said Lee. “The same condition perhaps presenting in Cam as well. Add to that some tragic incidences—CO exposure for one, a car accident for another, resulting in two fatalities, and we have at least two patients with enlarged organs and elevated liver function tests, one of whom we know has a cherry-red spot on the macula that could be a rare side effect from the gas exposure, or it could be related to these other symptoms, we just don’t know. Sound about right?”

  “Does to me. Is Susie Banks gifted in any way?” Paul asked.

  “Google her,” Lee said.

  Paul put the name “Susie Banks” into a search box, and in a blink of Internet magic, the Web browser produced a series of links. Lee confirmed they referenced the same Susie Banks who was in the hospital. Among those links was a story about a recent performance of Susie’s at the Kennedy Center that had ended horrifically when she appeared to lose control of her limbs.

  “Myoclonus,” Lee said.

  Paul did some more clicking, and it was not long before another article related to Susie caught Lee’s interest. He pointed it out to Paul.

  “Have a read. Pretty interesting where Susie Banks honed her craft,” Lee said.

  “The True Potential Institute,” Paul said, reading from a profile about Susie that had appeared in a local newspaper.

  “I’ll bet anything the Stewart twins had studied at this TPI place as well,” said Lee.

  “And I bet you’re going to want me to stop what I was working on to find out if there are any toxins other than carbon monoxide known to cause a cherry-red spot on the macula,” Paul said.

  “Damn straight,” answered Lee.

  CHAPTER 25

  Lee got Karen on the phone while she and Josh were out doing some shopping. She invited Lee to join them for a bite to eat. He could not remember the last time the three of them had dined together, settled on too long, and decided the idea was a good one. Rather than launch into a long explanation of all he had discovered on the phone, Lee thought they could brainstorm an action plan over dinner. They would meet at Olivio’s, an Italian restaurant they had frequented when Josh was young.

  A maître d’ escorted Lee over to a table where Karen and Josh were seated with drinks already served.

  “Thanks for including me,” Lee said to Karen, taking a seat. The restaurant, dimly lit and well appointed, was not particularly crowded at 5:30 in the afternoon. The waiter approached and took their orders. Josh settled on the fish, but only after some internal debate. Lee ordered a glass of red wine and opted for the eggplant special, while Karen went for the chicken. If he had to guess each person’s order beforehand, Lee would have been right on all three counts (including Josh’s hemming and hawing). He knew their personalities, had their habits and tastes ingrained.

  This was his family. Fractured and small as it was, it brought him great joy to be in their company. His parents were gone, his sister an infrequent visitor, but Karen and Josh were constants in Lee’s life. They were signals that all was right in the world, everything was as it had been and as it should be.

  “You got here just in time,” Karen said to Lee, her tone a bit off. “Josh was just telling me that he’s quit his job.” She turned her head so only Lee could see her eyes grow wide as her expression shifted from pleasant to deeply upset.

  Yessiree, all was right in Lee’s world.

  “I figured Josh should be the one to tell you,” Lee said in his own defense.

  “When are you going to tell him that he’s throwing his future away? He has to commit to something, Lee. Anything, really.”

  “I committed to Hannah and look how that turned out,” Josh said. The comment was meant in jest, but it was obvious to Lee he still hurt over the breakup.

  “Let’s give him some space, Karen,” Lee said. “He’s dealing with enough as it is.”

  “What he said,” Josh tossed in.

  “Well, I’m glad you waited until just before your father sat down to break the big news.”

  Karen shot Lee another hard-eyed stare over the rim of her wineglass as she took a long swallow to chase down the bread she’d been chewing. A waiter brought over Lee’s wine.

  “Look, I know it doesn’t seem like I have my act together,” Josh said, trying out a placating tone. “But I don’t need rehab, or cash, or anything like that. I just need to have a nice dinner with two people I love more than anybody else in this world.”

  “To that, I propose a toast,” said Lee, hefting his glass of wine. Karen and Josh raised their respective glasses as well. “To family. We might not be together like we once were, but we’ll never be apart.”

  They clinked and drank, and the talk turned breezy and easy for a while.

  “So, Karen,” Lee said, the tenor of his voice changing to signal a shift in topic. “I think we need to take a careful look at those nootropics Cam is taking.”

  “Why’s that?” Karen asked.

  Lee gave a little speech, mostly for Josh’s benefit, about this being privileged information not to be shared or discussed with anyone. The consequences could be dire for him, he explained.

  Once all were in agreement, Lee launched into a detailed rehash of the conversation he had overheard in the doctor’s lounge; the links he had made to Susie’s symptoms and those of Cam; a connection between Susie and the twins who had also presented with myoclonus; how they had died while Susie miraculously survived; and lastly a connection, at least in two cases (perhaps all four, if the twins attended as well), to the True Potential Institute.

  “No wonder you need help,” Karen said at last.

  “Typically a cherry-red spot is caused by a genetic defect. But carbon monoxide can produce a cherry-red spot on the macula as well. Given that, I’m thinking
why couldn’t some other compound produce a cherry-red spot, something Susie and Cam both had exposure to?”

  Lee opened the question to the table. No one had an answer.

  “Why can’t it be genetic?” Josh asked.

  “Well—if we assume Susie, Cam, and the twins all experienced some type of seizure activity, most likely myoclonic jerks, and if we assume the twins studied music at the TPI, it would be highly unusual, no—make that statistically impossible—for four kids connected to the same place to have the same incredibly unusual metabolic disorder. It has to be something environmental, a compound, something they’ve been exposed to. It’s more like a cancer cluster from contaminated groundwater than a genetic disease.”

  “The cherry-red spot is a disease?” Josh asked.

  “It’s a sign of a disease,” Lee clarified. “What I want to know is could the cause be something intentional, possibly even malicious?”

  “Malicious?” Josh sounded surprised. “What’s the motive for that?” He was always a practical thinker like his mother.

  “There’s a big chess tournament coming up,” Karen said. “Cam’s the captain of the U.S. junior squad and Taylor is the alternate. We’ve tossed around the idea that Gleason wanted Cam out so that Taylor can be in.”

  “How competitive is this Gleason guy?” Josh sounded incredulous.

  “Pathologically so, I’d say,” Karen answered. “I’ve seen him on the tennis court, and I hear he’s just as bad playing contract bridge and golf.”

  “As a doctor, I’d say he protects his ego to the detriment of his patient,” Lee added.

  “Or, like we’ve discussed, he’s keeping the patient from you,” said Karen.

  “Precisely,” Lee answered. “He clearly wants me at more than an arm’s length. The question is why.”

  Josh did not appear convinced. “That motive’s pretty weak, if you ask me,” he said. “All that effort just so his kid can play in some chess match?”

  “If I told you a mother once hired a hit man to take out her daughter’s rival on the cheer squad you’d have said that’s preposterous too, but it happened. Google Wanda Holloway,” said Lee. He was thinking of the Lifetime movie about the crazed Texas mother he’d seen not too long ago, on one of those dreary evenings when the wine bottle was half empty, his ex-girlfriend left a dull ache in his heart, and regrets about not becoming a surgeon took center stage.