Point of Balance

by J. G. Jurado

“You like it?” Hastings said in a friendly voice.

  “There was one exactly like it in my father’s consulting room. I know, because it had the same typo on the subclavian vein.”

  Hastings smiled and rapped the mistake twice with a long bony finger.

  “A memento of happier days. More straightforward and more humane.”

  I nodded. I liked that guy. He reminded me very much of the old Dr. Evans. Right then I missed him dearly.

  “What’s your specialty, Captain?”

  “Internal medicine. It’s been an essential job requirement for years.”

  “Are you in the army?”

  “Navy. Each of the five services provides a doctor to the eighteen acres.”

  Seeing my puzzled look, he hastened to add:

  “It’s the term of endearment we use for the complex,” he said, pointing all around him. “Come, let’s make ourselves comfortable.”

  “Are you in sole charge of this?” I asked, surprised to see the place so empty.

  “Not at all. I have ordered the rest of the staff to take part in an emergency drill this morning. I wanted you and me to talk alone.”

  “Anyone would think you were all ashamed of me, Dr. Hastings.”

  We sat in a large but chock-full office. A mahogany desk wedged between bookcases with heaps of books took up the middle of the room, lit up by the daylight pouring in from the Rose Garden. But a smiling skeleton hanging from an old hat rack stole the show.

  “That’s Fritz. We go way back, to the days when I started off. I won him playing poker with a medical orderly in Pearl Harbor, who in turn had won him off his boss in Korea. He swore blind it was the remains of a Nazi killed in Berlin at the end of the war.”

  “And you believe that?”

  “He’s too short.”

  “They also had short Nazis. At least one of them,” I said, raising my right arm in an unmistakable imitation.

  Hastings pulled a sly smile.

  “Well, that would be poetic justice. Adolf’s bones hanging from a hat rack in the White House!”

  We both had a good laugh.

  “I’m glad you have a sense of humor, Dr. Evans. It’s a trait we greatly appreciate in the service, despite everything they say. Without it, a job like this would never get done.”

  “A lot of burning the midnight oil, I guess.”

  “And then some. When I tell people what I do the first thing I hear are sighs of envy. People think it’s all parties, travel and power. But the reality is much harsher. We live for and by this administration, Dr. Evans. We go with the patient to the asshole of the world, Shitistan, and make sure he sleeps, drinks bottled water, that the heat doesn’t get the better of him in the middle of the day’s fourth speech. And all in eighteen-hour shifts, sorting out all the migraines and sprained ankles that can befall the rogues’ gallery of political staff and journalists. And always, always, we fear the inevitable, the moment when somebody in the crowd will stand up, revolver in hand, and make our worst nightmares come true.”

  “Inevitable, you say?”

  “Among the Secret Service there’s an old saying about assassinating the president: it’s not ‘if’ but ‘when.’ ”

  “Jeez, they won’t be getting any medals for optimism.”

  “It’s their way of preparing for the worst. So far we’ve been lucky. Remember the grenade they threw at the last guy?”

  I nodded. The Texan was at a rally and the device landed at the foot of his podium but did not go off.

  “Well, that’s one of dozens of threats dealt with every day that we don’t talk about, as long as they’re kept hush-hush,” Hastings added, his face drawn. “Luck will run out sooner or later. We live on borrowed time and merely struggle to ensure it doesn’t happen on our watch.”

  There was an awkward silence. We both had to broach the topic, but Hastings couldn’t bring himself to do it, so I made the first move.

  “Why am I here?”

  “You’re here against my better judgment, Dr. Evans,” the medic said, looking me in the eyes with an expression that mixed distaste with apology. “The president’s health care has always been the services’ prerogative. If it were up to me, the chief surgeon at the National Military Medical Center in Bethesda would treat the patient.”

  “I’ve heard about him. He’s a great doctor. He’s operated on several celebrities. Why isn’t he sitting in this chair?”

  Hastings leaned over the desk and lowered his voice to a hoarse whisper.

  “Because the First Lady played the same trick she played on you on many others as well. She sent a flunky with the MRI scans to prevent the patient’s status from overshadowing the diagnosis.”

  I wasn’t too surprised; after all, the little man in the bow tie had warned me.

  “Even the service doctors?”

  “She took it up with them first. They all gave the patient up as lost. They said the risk was too great to operate.”

  “I . . .” I hesitated. “Was I the only one who said it was feasible?”

  Hastings shook his head and rustled the papers on his desk before answering.

  “No. There were others.”

  “Then . . . Why me?”

  The medic left that unanswered, because at that moment the door opened and Hastings sprang to his feet. Not so much a jack-in-the-box as a self-pitching tent.

  I turned to the door and also stood up. Although I’ve never been a dresser, I found myself instinctively buttoning up my jacket and folding down my coattails.

  “Well, it’s a pleasure to meet you, Dr. Evans.”

  There he was, elegantly shaking my hand. Tall—an inch or two taller than I, and I’m pretty big—charismatic, steeped in authority. I was so used to seeing him on TV that I had the automatic feeling we’d known each other all our lives. Or maybe that was an evolutionary advantage some people had, their ability to imbue a feeling of instant familiarity and closeness to undermine your defenses.

  “The pleasure’s mine, sir.”

  I moved forward to greet him, somewhat nonplussed by the presidential aura, and got a warm, strong, vigorous handshake. He was in shirtsleeves, rolled up to the middle of his forearms, his red tie slightly askew, and his face was weary.

  “Doc, can you get me a Tylenol?”

  Hastings obediently removed himself from the consulting room and the Secret Service agent took two steps forward, never taking his eyes off me. The president turned to him and said:

  “That’s okay, Ralph. Go to the relaxation area.”

  “Sir, the visitor has not been security cleared. The special agent in charge has ordered me to—”

  “Ralph.”

  He gave the first order with a friendly smile, the second in a steely tone. It left no doubt. That was true power, and it didn’t come merely from the office but from within the person holding it. It inspired a little fear mingled with a feeling that I wouldn’t call envy, although it comes close.

  The agent bowed his head and left the clinic.

  When the door was shut the president sank into the chair I had been sitting in a minute before and massaged his temples. The wrinkles drew huge deadwood trees in his habitually serene face.

  “Here, sir,” said Hastings, who was back with the painkillers and a cone paper cup. The president took the pills, then squashed the cup. He closed his eyes again and leaned his head back for more than a minute before he turned to us once again.

  “I’m sorry,” he said. He seemed angry with himself for that show of weakness.

  “How many are you taking a day?”

  “Six or seven.”

  “Are the headaches nonstop, or do they come and go?”

  “They come and go. When they come, they are intense but don’t last long. I had no pain at all yesterday, but the day before was excruciating.
”

  “Were you prone to headaches before?”

  “Not particularly. I tend to get them the day after I’ve had less than five hours’ sleep, but not as bad as these.”

  “Was that the first symptom?”

  “A splitting headache. It seemed like the worst ever back then. I was wrong.”

  I nodded in understanding. The words the worst headache ever should be taken as a matter of course by every husband, wife, child and sibling to mean “let’s book an appointment with the neurologist.” I’ve lost count of how often patients have come to me too late because they’ve smothered a telltale headache with painkillers for a few months. Chugging down a jar of eighty Tylenols a week should tip anyone off, although amazingly the idiots prefer to ignore it. Not so amazingly, they die.

  “When was that?”

  “Four weeks ago,” Hastings said. “We had the first MRI scan that same night.”

  “Where? Don’t tell me you’ve got an MRI scanner here . . .”

  The president and Hastings eyed each other hesitantly. The former vaguely shook his head.

  “We cannot comment on the specifics, doctor. We didn’t go to Bethesda for obvious reasons. It would have been much more difficult to contain a leak.”

  They stayed silent. Hastings produced the envelope with the scans and gave it to me. I sought the latest and held it up to the light. The soft, golden light shining through the curtains afforded the black-and-white death sentence a snug, dreamy appearance.

  “Who did them, then?”

  “I did myself,” Hastings said.

  “Only a handful of people are aware of the situation, all with the highest security clearance, except for your bosses, Dr. Evans. And it must stay that way.”

  “I hear you, sir. Have there been any other symptoms apart from headaches? Vomiting, impaired vision?”

  “I can see fine and I have not been sick.”

  That was normal. Every patient was a world unto themselves and a tumor which in some triggered the vomit reflex, blindness or splitting headaches hadn’t the slightest effect on others. In a neurosurgeon’s career, you learn something basic: take nothing for granted. You learn that from seeing one weird thing after another. I once treated a woman at noon who had been shot through the head in a robbery and was back home eating with her family the day after. The bullet entered between her eyes and exited the rear of her skull, no damage done. But that’s another story and I was all out of being shocked. What alarmed me was the possibility the US president was in the dark.

  “How much have they told you about the problem, sir?” I asked with a glance at Hastings.

  “I’ve given the president a summary briefing,” the medic said while staring at the toes of his shoes. “He has declined to treat this other than in the utmost secrecy. There are other complications of a political nature which—”

  “Hastings,” the other man cut him off.

  The poor captain zipped up so fast I feared he had bitten his tongue.

  “Mr. President,” I barged in. “Glioblastoma multiforme is an irregular tumor. It is not like a ball, compact and smooth, but an octopus. It’s a self-replicating alien inside your head. It recruits blood from all the vessels it comes across and advances relentlessly. There is no way to make it recede significantly through treatment without seriously hampering your body and your performance in office.”

  “But there is surgery, Dr. Evans.”

  I shook my head.

  “You’re going to die. Real soon, and there is nothing I or anyone else can do to alter that. All I can do is turn the ‘real soon’ into ‘soon.’ ”

  He nodded.

  “I am well aware of that.”

  “I can operate on the tumor. I can eliminate a good part of it, enough to delay the inevitable and buy you a few months.”

  “Then do it.”

  “I could also kill you. The tumor has reached the arcuate fasciculus, on the border between the Wernicke’s and Broca’s areas. It’ll be a long and complicated operation, at least seven to nine hours. And it’s a high-stakes game when we get there. A tiny slip and I turn you into a cabbage.”

  “That has all been spelled out to me, doctor. And it is also something which will come to pass anyway.”

  “If I don’t operate, inside two or three months you will lose the ability to understand and verbalize concepts. Or the ability to speak. Or both at the same time.”

  “And if I do go under the knife, I may lose both in no time. Before then.”

  “Exactly.”

  A dense and unpleasant silence descended. The president leaned forward, his head in his hands, and gazed at the floor with his shoulders hunched and his back bent. Until a few weeks ago he was indestructible, a king among men. Now he was forced to confront his mortality like the next guy, with the added burden imposed by the demands of his throne.

  “I’ll do it.”

  I closed my eyes, overwhelmed for a second, and breathed deep before I answered.

  “All right. When?”

  “How long do I need to recover?”

  “Nine or ten days’ hospitalization, if all goes well.”

  “That time frame is unacceptable.”

  “You tell God that,” I said slowly.

  He went quiet again for a good while. I could almost hear him going over his schedule, thinking ahead of his rivals’ moves. What to do and say. How to spin it. And all without aides, from memory. He was sitting in front of me, with his elbows on his knees, his hands cupping his forehead, his head inches from mine. Seen from above, it had an odd shape, slightly oblong with close-cropped, prematurely gray hair. For me it was easy to ignore his scalp, the skin and bone, which were mere hindrances in the problem’s way. For a second, I saw myself prizing apart the structure’s casing and sectioning the dura mater to expose the three pounds of brain tissue that made the most important decisions in this country, and a raft of others besides. In the middle of those three pounds of jellylike matter, a couple of unfettered ounces were waging a war with no quarter and just one possible winner.

  “I can’t for three weeks,” the president said. “There are unavoidable commitments. Is that doable?”

  “Yes, sir. Although I must tell you that by then the symptoms will most likely have worsened. There is some medication that can help,” I said, jotting something down on a scrap of paper and handing it to Hastings.

  “Very good,” he said when he read it. “I’ll entrust myself to take timely steps to book an operating theater at Bethesda in the name of an anonymous patient.”

  I gasped in disbelief when I heard that.

  “I beg your pardon, but I will not operate at Bethesda,” I said with a shake of the head.

  “It’s a flagship hospital. And it has the best equipment, as well as being able to guarantee the privacy of—”

  “Please don’t go on,” I said. “I know the objective arguments, but first answer me this. Why me and not one of the others who said yes?”

  “You have operated on two hundred and thirty-four glioblastomas in the past four years,” the president said. “Of which sixty-one affected the speech area. Thirty-nine of them recovered without any problems.”

  “That data’s confidential,” I said, nettled. “You had no right to—”

  “You have the second-best average in the country, doctor. Your college professors said you have natural talent and in your residency—” Hastings began.

  I raised two fingers, definitely mad.

  “I left two patients paralyzed in that same period due to complications with the brain stem. Another eleven glioblastomas came out as cabbages. Do they not count?” I objected.

  “What’s your point, doctor?” the president said coldly.

  “This is an inherently difficult operation. It is not purely about my ability, nor is it enough to quote
my tumor ranking. As it happens, I’m not a slugger for the Yankees. I’ll need luck, luck and concentration, and if I operate in a theater that is not my own, with a team that is not my own, then I’ll be tense. And that will affect the outcome.”

  “Doctor, I am sure there’s a way you can adapt—” Hastings said.

  “No there is not, Captain. It’s the president of the United States, for God’s sake. You’re heaping on my shoulders the biggest responsibility a surgeon can have. I won’t take it lightly.”

  I turned to the president.

  “Don’t think I’m asking you to be operated on in my own hospital to massage my ego or overcome an inferiority complex, or for the hell of it. I am doing so because otherwise I’ll be scared shitless. You understand?”

  He chewed on this for a few seconds and I wished with all my heart he’d say no. The situation was too complicated and I had to think of Julia. The risk it would turn out badly was so great, the odds of screwing up so stratospheric, that the chances of successfully completing that operation struck me as ridiculous. “I hear you. But I cannot accept an operation in an elite hospital. Not I, who have fought so hard for quality public health care. Public opinion would run riot for months,” he replied, and I sighed with relief.

  He’d given me the excuse I needed.

  “Then we had better let matters rest there.”

  The three of us rose to our feet. I shook the president’s hand in farewell and Hastings saw me out of the consulting room.

  “I’m sorry about all that,” I told him in the broad, red-carpeted corridor of power.

  “Don’t worry. I understand your reasons, and in your shoes I’d have done the same.”

  Hastings was wrong, naturally. He was a calm, kindly man, as sturdy and loyal as a shire horse. If the president said jump, he’d be in the air before the word was out of the chief’s mouth. Somebody with that kind of personality could never be a neurosurgeon, so his understanding was as empty as it was well intentioned.

  “Will you see me out or must I wait for somebody?”

  “Actually, Dr. Evans, before you go I would like to introduce you to someone very special.”

  We went back to the Map Room, and there she was.