The First Family

by Michael Palmer

  Karen touched Susie’s arm. Her skin felt clammy. Valerie must have been aware, because she set a damp cloth to Susie’s forehead.

  Karen appraised Susie thoughtfully, again noticing the bruising similar to Cam’s.

  “What’s causing those?” Karen pointed to a particularly nasty purple and black discolored area near Susie’s bicep.

  Valerie removed a printout from the portable blood analyzer sitting atop an antique dresser. She pointed to an array of numbers that meant nothing to Karen. “I’m not sure,” Valerie said. “Her platelets are fairly low and her ProTime results are a bit high. That means her blood isn’t clotting normally. I don’t think it’s alarming yet, but her liver and spleen are not functioning normally.”

  Karen thanked Valerie for the update, then took hold of Josh’s arm. “Sweetheart, could we talk outside?”

  “Sure thing.”

  Josh followed Karen out of the cabin and onto the wide front porch. The sounds of the night buzzed around them.

  “Any news on Cam?”

  “Nothing yet,” Karen said, her eyes downcast. “And I’m sick with worry about it. But I’m also worried about your dad.”

  “Dad? Why?”

  “He may be closer to the truth than anyone realizes. The Dirt Bike Shooter is still out there. Whoever is behind this managed to get to Stephen Duffy. Don’t you think they’ll be able to get to your father, too?”

  Josh exhaled, low and loud. “Oh, damn. I didn’t think of that.”

  “I’m here now,” Karen said. “I’ll keep everyone safe. Maybe you can go back to D.C. for a while and watch after your father.”

  Josh peered over Karen’s shoulder to gaze through the window at Susie in her hospital bed.

  “You have feelings for her, don’t you?” asked Karen.

  Josh shrugged in a way that reminded her of Cam.

  “Believe me, you’re not the first bodyguard to fall for their protectee.”

  “She’s different—she’s…”

  “Cultured? Talented? Brilliant? Beautiful? The anti-Hannah?”

  “Yeah, all those things,” he said with a smile.

  “I saw the way she looked at you. I’d say the feelings were mutual.”

  For a moment, Josh was quiet.

  “Is she going to die?”

  “Hopefully your dad can figure out what’s wrong with her.”

  Josh peered again through the window at Susie resting in bed.

  “I’ll leave tonight,” he said.

  “It’s late and it’s a long drive. Your dad will be all right a few more hours without you. Just don’t tell him you’re coming to be his bodyguard.” Karen had a crooked grin on her face. “He’s got a lot of pride, and I’m not sure his ego can handle it.”

  Josh gave his mother a hug, then returned to the cabin. Karen stayed on the porch, enjoying the feeling of the chilly night air against her skin. Through the window she watched Josh get a glass of water from the kitchen. He brought the glass over to Susie. Taking a seat on a tall metal stool, Josh put the straw to Susie’s lips and held the glass for her while she drank.

  It’s the simple gestures, Karen thought, that often mean the most. In a way those little acts of kindness added up, and eventually coalesced into something far greater than the individual acts alone; they revealed a kind of deep commitment, not unlike the commitment it takes to dive in front of a speeding bullet meant for somebody else.

  CHAPTER 45

  TUESDAY, MAY 2

  The TPI was closed for business, its doors bolted shut, and this made Lee happy. If he had not stumbled onto Noah Pickering, the fifth afflicted student, he doubted the FBI would have bothered to shut the place down. It was a small step, but an important one. It meant the president was taking his concerns seriously—even though he had not connected Susie’s and Cam’s symptoms, or those of the others, to any known disease, and even though Yoshi insisted he never gave the kids any experimental nootropics.

  For the next several hours, Lee had to put his records search on hold, so he could concentrate on doing the job he was paid to do. He was back at the MDC, which was bustling with the usual late-afternoon rush. He worked diligently for several hours overseeing the residents before retreating to the staff lounge at the end of his shift. The TV was tuned to CNN, and, no surprise, the only story was Cam Hilliard’s disappearance.

  There was no break in that case either.

  Karen seemed to be hanging in as best she could, or at least that was Lee’s assessment from their phone conversation last night. He hurt for her, but there was little he could do to help her, or Susie for that matter, and frustrations were mounting.

  After downing a cup of extra-muddy coffee, Lee touched base with Paul, who was still at the clinic after hours, sorting through medical records, hunting for another Noah Pickering.

  “Any luck?” Lee asked. “Not that it would be luck to find another TPI kid with a bright future cut short.”

  “Nope, no luck at all,” Paul said. “But thank you for another mountain of paperwork to go along with our other mountain of paperwork. We officially have a mountain range.”

  “You’re a bitter man, Paul.”

  “No, I’m a loved husband and an adored father. I’m a bitter doctor. There’s a difference.”

  “Noted.”

  “How about doing an old pal a favor and swing by Chip Kaplan’s office while you’re at the MDC,” Paul said. “Tell him we’ll take half of his last offer.”

  “I don’t think that’s how negotiations are supposed to work,” Lee said with a laugh.

  “I don’t want to blow the deal,” said Paul.

  “And I’d like to avoid Chip at all costs if I could. Dr. Rajit gave him an earful about my abducting Susie Banks, and I got an earful from Chip about my continued role at the MDC.”

  “Fine. But next week, pitch him the sale and pitch him hard.”

  “Fear not, my good man,” Lee said. “You help me figure out what the TPI is doing to these kids, and I’ll help you get a job as the new White House doctor. Few patients, no insurance companies to deal with, and plenty of perks.”

  “Promise?”

  “Just hang in there, buddy. We’ll talk later.”

  Lee was headed back to the sixth floor to finish his charting, when his cell phone rang. He assumed it was Paul, but no, the number came up as the White House. Lee tensed. Was it about Cam?

  He answered the call. “Dr. Lee Blackwood.”

  “Dr. Blackwood, please hold for the president of the United States,” said an officious female voice Lee did not recognize.

  A moment later, President Hilliard came on the line.

  “Lee, it’s Geoffrey—”

  Geoffrey—I’m on a first-name basis with the president.

  “We have an emergency and I need your help right away. Where are you?”

  “I’m at work at the MDC. Is this about Cam? Is everything all right?”

  “The MDC, you said? Good, that’s where they brought him.” The president pulled the phone away from his mouth. “Forget the car, Lee’s already at the MDC,” he said to someone else.

  “Brought who to the MDC?” Lee asked.

  “Yoshi,” Hilliard said. “I’ve had the FBI watching his apartment.”

  “And?” Lee’s voice rose with anticipation. “What’s happened?”

  “Our agents hadn’t seen movement inside the home for some time. They got worried he might have snuck out. They broke in and found him unresponsive on the kitchen floor. There was a bag of mushrooms nearby.”

  “Oh no.”

  “He should be at the hospital now, Lee. If he knows something—anything—about Cam, he can’t die. Promise me. Promise me, Lee, you won’t let him die.”

  “I’ll do everything I can, Mr. President,” Lee said.

  CHAPTER 46

  Lee raced through the double doors to the emergency room, fully anticipating its atmosphere of everyday chaos and confusion. Doctors and nurses hurried about, but the
intense commotion coming from bay 6 told him where his patient would be found. Two men dressed in dark suits with short haircuts—FBI, had to be—waved Lee over and pointed to that bay.

  “He’s in there,” one of the agents said.

  Lee rushed in, throwing back the curtain, and found himself looking down at Yoshi, lying flat on an emergency room bed surrounded by six nurses, gloved and gowned for isolation, scurrying about adjusting lines and monitor leads, drawing labs and calling for a stat portable chest x-ray and a head CT. Two ER doctors in scrubs barked orders.

  Dressed in his trademark black, Yoshi lay unresponsive on a hospital gurney. A sickly bluish cyanosis signaled oxygen in his blood was dangerously diminished and presaged imminent death. Traces of blood dribbled from his nose, over his lower lip, and down his chin.

  His long, white hair was helter-skelter and caked with blood, spittle, and vomit. Lee saw that he was bleeding from below, too, as one of the nurses inserted a rectal tube to help get some control over what appeared to be unstoppable choleric diarrhea.

  “I can’t get him to stop bleeding,” another nurse said while she kept constant pressure on an intravenous access site.

  The FBI had identified the type of mushrooms found on Yoshi’s kitchen floor. Lee was hardly an expert on mushroom toxicity, but it was obvious this was no accidental ingestion. Yoshi, who had studied mycology, had to know what the Amanita phalloides, the death cap, would do to him.

  Quick as that thought came, another followed. What if it wasn’t deliberate? What if someone forced Yoshi to eat them?

  These questions would have to wait. Right now, Lee was dealing with a dying man.

  An FBI agent showed up, flashed a badge to the triage team. “This is a matter of national security,” the agent announced. “Dr. Blackwood is taking over. Everyone please stay here to assist him.”

  The two ER docs showed no interest in defending their turf. As if someone had pinned a sheriff’s star to his chest, Lee was officially put in charge.

  “BP is sixty over palp,” said a nurse, taking the measurement by palpating with her fingertips.

  “Pulse one forty-eight by monitor. I can’t even feel a carotid pulse.”

  “Call vascular surgery to see if they can help us with a central line,” Lee said. “Right now, D-five normal saline at two hundred an hour. Wide open. What’s his potassium? Let’s get him intubated. Blood gases?”

  The rhythm of the ER took practice to perfect, and Lee was surprised how easily, how naturally the orders came to him. Triaging Susie had apparently woken something inside him.

  “We’re just getting his labs back,” a nurse in blue scrubs said. “Potassium is high at six point two. BUN is fifty. Creatinine two point nine. Both elevated. Sodium is low at one twenty-eight. Bicarb is low at eighteen. His blood gases show a pH of seven point two eight, pCO2 of thirty-six and a pO2 of sixty-four on room air.”

  Renal failure and metabolic acidosis, Lee concluded. Not good.

  “What about liver function?” he asked.

  Those labs indicated sudden, acute liver failure.

  All markers pointed to hepatorenal syndrome, a rapid deterioration in kidney and liver function.

  No, not good at all.

  Yoshi’s nonstop bleeding meant that his dying liver had run out of clotting factors. Nothing to do now except pull out all the stops and hope.

  “Get him typed and crossed for transfusion,” Lee said. “Let’s try and stop that bleeding. Vitamin K ten milligrams and prothrombin complex concentrate five thousand units. Fresh frozen plasma at fifteen milliliters per kilogram.”

  The nurses ran about with schooled efficiency, preparing IVs and calculating infusion drip rates, stat calling labs and pharmacy, continuously monitoring leads, vitals, intake and output, and charting nonstop.

  “Drop a large-bore nasogastric tube and start him on activated charcoal fifty grams every four. That should help to keep any poison that’s still in his stomach from getting absorbed,” Lee said. “Also get him on penicillin G, ten million units,” he added. “See if it competes with the toxin.”

  “He’s going to need dialysis,” the ER doc said.

  “Call in renal, gastroenterology, and hematology consults,” Lee answered. “He’s probably got cerebral edema from acute liver failure. He’s going to need a CT scan once we get him stable—”

  If …

  “And a neuro consult,” Lee continued. “Let’s get him tubed. Can’t wait for anesthesia. Get me a seven-oh endotracheal tube and a blade. Suction out his airway!”

  Yoshi’s organs were vanishing. He was bleeding out.

  In the background he heard someone yell, “I can’t get a blood pressure! He’s flatline on the monitor!”

  Lee called out, “Put the pads on him and start CPR. One milligram of epinephrine and two amps of bicarb.”

  Though it had been years since he had last intubated a patient, Lee’s instincts and experience paid off, and he slid the endotracheal tube smoothly into Yoshi’s trachea.

  “Compressions at ten per minute. Give him forty units of vasopressin.”

  Lee took over giving compressions. His arms ached. Sweat dripped into his eyes. He kept pumping. His back started to hurt. He thought about Cam and the secrets Yoshi would take to the grave. He kept pumping. He thought about his promise to the president. He kept pumping.

  “Still flatline,” a nurse said after ten minutes. “No shockable rhythm.”

  Lee checked Yoshi’s pupils. Fixed and dilated. No spontaneous respirations. No response to painful stimulations. No brain stem reflexes. No pulse. No blood pressure.

  Dead.

  CHAPTER 47

  “Please hold for the president of the United States.”

  Lee was seated at a narrow desk in the ER, feeling his pulse hammer away in his fingertips. Yoshi’s body was gone, shipped off to the MDC morgue. He was not the first person to have died despite Lee’s best efforts, but it was the first time he’d let down the leader of the free world.

  Lee’s mind swirled with questions and possibilities while he waited for the president to come on the line. With Yoshi out of the picture was someone else’s secret safe? Not surprisingly the first name to pop into Lee’s mind was Gleason’s. He did seem to know a lot about the ProNeural nootropics. Maybe he knew something else—something he worried Yoshi might reveal.

  It was an interesting theory, but what to do with it?

  Glancing at his phone, Lee noticed two voice mail messages in his inbox. He must have missed the calls while triaging Yoshi. He would have to check those messages later; the president had come on the line.

  “Lee. What the hell happened in there?”

  “Well, he died, sir. I tried to save him. There was nothing I could do. I’m very sorry.”

  The silence lasted so long Lee thought the call may have gone dead.

  “Mr. President?”

  Lee heard a shaky breath, followed by a loud sniff.

  “Sir?”

  “I just want—I want my son back. If Yoshi knew something—if—” Is the president crying?

  “Mr. President, I understand. And again, I’m sorry.” Lee did not know what else to say, but added, “I’ll do anything I can to help.”

  President Hilliard sucked down a few more ragged breaths before regaining his composure.

  “I’m sorry, Lee, I’m sorry. There’s no room in the White House for a personal crisis, but I have one and there’s not a damn thing I can do about it. Ellen blames me. Did you know that? She doesn’t believe Cam suffered an emotional collapse. She thinks he was frightened, that he didn’t trust anyone in the Secret Service to protect him, didn’t know who might try to kill him next. She thought I should have done away with the whole damn lot of them, except for Karen. The one person I blame the most, she holds blameless. Now, we’re barely speaking to each other. Oh hell, I shouldn’t trouble you with this, I know.”

  But he did need to trouble Lee, or at least he needed to confide in someone.
Having spent time inside the White House, Lee had come to have a better understanding of how truly isolating, how deeply lonely it was to be president. For the benefit of a nation, he had to hold his pain inside. Cracks in his façade meant cracks in the country. The little bit Hilliard did share had told Lee plenty. The family doc whom the president’s physician held in such contempt was now one of the few people the president had come to trust.

  Now, Lee thought. Now is the time.

  The president had taken him into his confidence. Lee knew he’d never have this opportunity again.

  “Mr. President, I have to ask you something, and it’s difficult, but I have to ask.”

  A beat of silence, and then, “Go ahead.”

  “How well do you know Dr. Gleason? What I mean to say is, how much do you trust him?”

  “Why are you asking me this?” The president’s indignation was apparent.

  “I’m trying to make the connection between the TPI and the symptoms I’ve seen, including those in Cam, not to mention everything else that’s happened. Dr. Gleason is there in every link on the chain. From day one he’s battled to keep me from examining Cam. Why? Maybe he knew the kids were taking something they shouldn’t have been taking. Maybe he was the one giving it to them and Yoshi has been telling us the truth.

  “The profit for a brain pill that could produce people like Cam and Susie would be enormous. Not to mention, he knew Stephen Duffy well. He could have been aware of the man’s money troubles and promised to … well, you know … with Cam.”

  “Why, that’s preposterous! Fred?!” There was a tremendous bite to Hilliard’s voice.

  For a moment, Lee shrank inside, but quickly regained his resolve. “Cam said something to me in private when I checked his eyes for the red spot on his retinas.”