Chapter 18
From the airport Norman drove to O Street in Georgetown. The houses along there were three to five stories, red brick and white trim. Narrow older houses side against side, long ago done with their settling. It was a charming, choice area. Mid-block on the north side of the street was where Tom Longmire lived.
Longmire answered the door before Norman could ring the bell. Must have seen him coming. A longtime acquaintance, Norman closed the door after himself and took off his suit jacket as he followed Longmire up the narrow carpeted stairs to the third-floor study.
The study was in the rear of the house, its tall federal windows nearly brushed by the topmost leaves of a lacy locust. It was a small room, given character by a clutter of books and memorabilia. Framed photographs—none really personal, mostly Longmire with recognizable politicians past and present, one with Margaret Thatcher, another with Giscard d'Estaing, a few with movie stars—hung on the walls or were propped around like spectators. The warmth that all the books and mementos should have created wasn't there. The atmosphere was transient, cool. Dust coated all but the most frequently used and obvious surfaces, giving away a slapdash housekeeper. A worthwhile mahogany table served as a bar. Its gold-tooled Moroccan-leather top was discolored by alcohol.
Norman poured himself an ample drink, peeked into the lidded brass ice bucket.
"No ice," Longmire said. "I forgot to put the trays in." He had a tall red drink in hand that appeared to be a Bloody Mary but was plain V-8 juice. He said he'd just returned from a jog along the canal, had on a gray sweat suit with a black towel wrapped around his neck. He didn't look as if he'd jogged much. If at all. The getup might have been merely to impress Norman, his doctor, who had recommended aerobic exercise.
Longmire was an Assistant Secretary of State. He had been with the Department for thirty years and doubted he'd ever go higher. Now the reward was a matter of how much importance was placed on him and, of course, from how high up the well-dones came. When he wanted he could be a very proficient scene stealer. He gave the opposite impression. An ordinary appearance was one of Longmire's stocks in trade. He was a medium person: medium height, medium weight, medium everything down to the width of his shoes. He usually wore frameless eyeglasses. For the past two years he had been assigned to make announcements to the press—when, for instance, one of America's overseas embassies had been bombed or one or more of its diplomats assassinated. Longmire didn't consciously wish anyone ill, though if there were more of that, more of the television lights and firing of questions, more opportunities to look the world right in its camera eye and say, "No further comment will be made at this time," he would have enjoyed it.
Now, ambidextrously, left fingers to left foot, right to right, he tugged loose the laces of his running shoes and paired them precisely on the floor beside his chair. "They'll probably give you a citation. Secret, of course."
A sardonic grunt from Norman. He gulped Scotch.
"At the very least, from now on you should be having dinner at the White House twice a week," Longmire said lightly. "By the way, what was the diagnosis?"
"Acute gastritis."
"On the record."
"That's it."
"What about the other medical records, the ones that were being kept?"
"Destroyed."
"You saw them being destroyed?"
"I handed them over to McDermott and he said they would be."
"EKGs and all?"
"Yeah."
"Every scrap?"
"Every scrap."
"What about the film?"
"I assume McDermott—"
"McDermott's reliable. But perhaps you should have shredded or burned everything yourself."
"Then my trustworthiness would have been questioned," Norman remarked.
"You're bitter about it, aren't you?"
Norman didn't reply. He knocked down the Scotch in his glass and went for a refill.
"Reputation is a commodity," Longmire said.
"As is pig iron." The Scotch was getting to Norman. All he'd had to eat was a pear and a few grapes about three that morning—from the bowl of fruit the President's wife had arranged.
"You save the life of someone who is not just someone and can't take credit for it. Must make you feel like shit."
"I feel like shit, but that's not the reason."
"Credit should go where it's due."
"Exactly," Norman said ambiguously.
Longmire knew he would have felt just as embittered under the circumstances. He'd do his best to pull Norman out of this funk, be more genuinely sympathetic. He got up and clicked on the stereo player, chose a cassette at random that turned out to be Liszt's Piano Concerto No. 1 in E-flat Major. Just right, lively. He adjusted the volume so the music would be dominant over their voices. That way Norman might tire of complaining a bit sooner.
Norman was again at the bar. "No more Scotch," he said, inverting an empty bottle. He dropped it noisily into a metal wastebasket and twisted open a fresh bottle of Wild Turkey.
For the next half hour Longmire tried to counter Norman's mood with various irrelevant topics, ranging from the sexual compulsions of an elderly high-echelon French diplomat to the reminiscences of a time during the previous summer when Longmire and Norman had happily caught huge bass in the private pond of a wealthy South Carolinian. Norman offered few words to the conversation. He just sat there finishing off drink after drink. At times, he looked as though he might erupt, Hing his glass through the window. At other times he seemed on the verge of tears. Longmire told himself that was the last thing he needed, a self-pitying drunk. He was expressing his inclination toward buying a getaway place on the island of St. Barts when Norman broke in.
"What a fucking travesty."
Longmire sighed and impatiently told him, "What the hell. For what it's worth. Norm, you can be sure everyone on the inside will be acknowledging your bows."
"My what?" Drunkenly rankled.
"Your curtain calls, so to speak."
"What faith are you, Longmire?"
"Printed on my T-shirts or privately?"
A loose shrug from Norman.
"Episcopalian, I believe."
"How about down in your balls?" Norman asked.
"When I get to dying I'll cover myself and be everything." Longmire thought that true and amusing enough to repeat some other time.
Norman used the under edge of his chair to remove his shoes. He kicked them aside as though they represented him. His mouth was slack, his hands floppy.
It occurred to Longmire at that moment that Norman might be strongly tempted to disclose the situation. "What do you think the chances are of the truth getting out?" he tested.
"Which truth?" Norman sluned.
"Even if there is a leak it won't make any difference. Not now. We can deny everything, can't we?"
"The funny fucking thing is I won't tell even more than you won't tell."
"Right. We're of one mind. No reason to cause any economic quakes. Do you have any idea how many points the market would have dropped tomorrow if it hadn't been for you?"
"I'm hot shit."
"When will the President be able to leave Bethesda?"
"Couple of days."
"That soon? You mean a couple of weeks."
"Day after tomorrow he'll walk the fuck out, climb into the chopper, and land ass at the White House to meet the chief Staffs of joint like nothing happened."
Drunk talk, Longmire figured. There had to be a fairly long recuperative period.
"All our Prez had was a little upset tummy," Norman said facetiously.
"But we know better."
"I know shit." Norman made a face to go along with his self-depreciation. He snapped his head up to Longmire, asked, "You think I'm a good doctor?"
"The best."
"As they go, I suppose, as they go," Norman grumbled.
Longmire was getting bored with it. He thought he'd go down to the kitchen and make som
e coffee, leave Norman with the booze. Maybe by the time he came back Norman would have passed out.
"But!" Norman blurted out of his thoughts and went on. "There's one thing I could tell you that would knock you flat on your State Department ass."
That mildly alerted Longmire. "Nothing would surprise me."
"You shouldn't be so fucking smug."
"I've seen and done it all," Longmire baited him.
Norman felt as though his forehead were unfolding. Any moment his brain would eject and plop against the wall.
Longmire was an expert at baiting and drawing out. Norman, especially in his drunken condition, was no match for him.
Besides, it was merely a professional reflex reaction that had caused Norman to promise himself he would never reveal what had actually occurred. It had shaken him right down to his Hippocratic marrow, diminished his respect for the knowledge he had worked so hard to glean for so many years, belittled his methods. Once he started letting it out, it all came. Some of it Longmire already knew.
Sunday night a week ago. Norman had been called from Bethesda Naval Hospital and told to get out there on the double. The President had been brought there by chopper, was actually in the air on his way back from the weekend at Camp David when he began feeling not right. The Secret Service men on duty with the President got him into the hospital swiftly and clandestinely, and as that was often the way he went in and out of places, anyone who happened to notice did not believe it irregular. Somehow, with the Secret Service close around, supporting him, he managed to walk in. For all anyone knew he was there for one of his normal two-to-three-day physical checkups.
The President was placed in the third-floor wing that he usually occupied and tight security measures were immediately put into effect. That part of the wing was virtually sealed off from the rest of the hospital.
By the time Norman arrived three other doctors, specialists who cared for the President, had recognized the symptoms, agreed on a general diagnosis, and taken preliminary measures. They had him hooked up to an electrocardiogram and blood pressure monitor with audio and visual components, and, of course, he was receiving glucose intravenously.
The other doctors backed off. Norman took over. Norman was the heart man, and, according to the President's complaints, he was who was needed. The President informed Norman that his symptoms were worse now. It felt as if an elephant were stepping on his chest, both arms had an electrical current running down them, and he was about to vomit. He couldn't get a deep breath. Not mentioned was the fact that he was sweating profusely, had already soaked the sheets.
The symptoms were classic.
Acute myocardial infarction. Heart attack.
Norman knew by memory each phase of the President's normal electrocardiogram. The readout he now looked at was drastically changed.
Abnormal Q waves, elevated ST segments, and inverted T waves.
Blood pressure 100 over 60.
Respiration rate 20 a minute.
Norman injected intravenously 15 milligrams of morphine sulfate into the President's arm and 10,000 units of the anticoagulant sodium heparin. He put nasal cannulas on the President, inserted one into each nostril, and adjusted the flow to 5 to 6 liters per minute to allow 50 percent oxygen. This made breathing easier. The President's respiration rate dropped to 15 and steadied, and by then the morphine had eliminated much of the pain. It hadn't, however, cut the fright. The President's eyes asked Norman if he was going to die.
Norman didn't have the answer.
The danger of ventricular fibrillation and sudden death was always greatest during the first few hours. Norman went about making sure that the defibrillator, the machine used to administer electrical countershock, was in ready order. He checked its electrodes and paddles. If the President's heart went racing out of control—or stopped—countershock would be vital. Norman preset the machine at 300 watt seconds (joules) and saw that there was an ample supply of electrode paste on hand. He uncapped one of the tubes of electrode paste to save even that much time. He saw to it that syringes containing digitalis, verapamil, and quinidine were in place on a nearby tray. Also a syringe containing epinephrine—Adrenalin—in case it got to that. He had to be ready for anything.
He stood at the foot of the bed with the President's eyes upon him. He watched the variations on the electrocardiograph monitor, had, from experience, a fairly accurate idea of what was happening within the President's body. He tried to picture it exactly, and the impossibility of that reminded him, as it had numerous times before, of his limitations.
Blood was drawn.
The laboratory rushed for results.
They told Norman that the serum enzymes in the President's blood were already above normal range. Serum creatine phosphokinase was up, as was the level of serum glutamic oxaloacetic transaminase. Already elevated and they wouldn't peak for at least another 12 to 35 hours. They indicated damage to the heart muscle tissues.
How much damage up to now?
How much more to come?
It looked bad, morbid.
The only way Norman could decide what steps were best to take, even if they were futile steps, was for him to know what he was up against. He reminded himself who this patient was, but immediately his better judgment warned him not to be overcautious. If he lost the President it wouldn't matter whether he'd done too much or too little. The mark would be on him either way. That went with the territory. Worse within himself, however, would be to have done too little.
When, after three hours, the President's pain increased, Norman decided on coronary angiography.
He himself performed the procedure.
The President was strapped to a rotating x-ray tilt table. Electrocardiogram and blood pressure monitoring was connected and a direct-current defibrillator stood nearby.
An incision was made just above the bend of the President's right arm, exposing the right brachial artery. The artery was opened and into it Norman inserted an 8-French woven catheter with a special top that tapered to 5-French diameter. Steadily but carefully, feeling for any resistance, Norman fed the catheter up the artery. He was able to view this progress through an image intensifier equipped with closed-circuit television. Pressure on the catheter tip from a narrowing or closing off anywhere along the arterial walls was measured and recorded by a Statham P-23 D-G strain gauge.
Norman extended the catheter into the orifice of each coronary artery and, in turn, injected through it a 70-percent solution of Hypaque, a substance that would make the arterial courses appear opaque, thus defining them. His foot pressed the activation pedal of the 35mm motion picture camera that was connected to the optical periscope system above the table. Eastman Double X negative film recorded every phase. Norman worked the table, tilting controls, automatically changing the President's position, rotating him as much as 60 degrees one way and then the other to get both right and left anterior oblique views. The Hypaque passed into all branches of the coronary tree.
Next, Norman manipulated the catheter so it traveled across the aortic valve and into the heart itself—the left ventricle. He opacified that cavity with 40 milliliters of a 9-percent solution of Hypaque. He exposed film to cover that, withdrew the catheter, and sutured up the brachial artery and arm.
None of these procedures were new to Norman, yet when he removed his surgeon's gloves and gown he felt as though his torso was too great a burden for his legs. He hooked his thumbs into the waistband of his trousers to conceal the tremble of his hands. He drew in several deep breaths because he had been breathing shallowly for so long.
The President was returned to his bed and again hooked up to the monitors there, apparently no worse off for the risky measures he had just been put through.
There were two rooms off the one the President occupied: one for the President's wife and family, the other for the attending doctor, in this instance Norman. Norman was in his bathroom in the middle of taking a much-needed piss when McDermott walked in on him. McDermott
gave no thought to the fact that Norman was cock in hand as he gave Norman chapter and verse regarding confidentiality. McDermott was the presidential Press Secretary, an appropriately agile-minded, assertive fellow in his mid-thirties. He told Norman that until there was an eventuality, as he put it, it had been decided that the President's condition be kept in strictest confidence. By no means should Norman respond to any questions put to him by the press. Surely, McDermott said, Norman could appreciate the sensitivity of the circumstances. The Soviets or who knew whatever bastards would very possibly take advantage during this time of weakness. Foreign policy and national security were involved. He could count on Norman, couldn't he?
A weary Norman zipped up his fly and nodded.
At dawn Norman viewed the angiographic films. They were clear, well-exposed pictures that showed beyond a doubt that the President was suffering myocardial ischemia. Portions of heart muscle were dying from a deficiency of blood caused by the narrowing of the arterial channels. Distal radicles of the President's coronary artery tree as small as 100 to 200 microns in lumen diameter were visible. Larger, major branches were easily distinguishable. Nearly all were being affected to some extent. At various points the buildup of plaque along the walls of the arteries was so severe the flow of blood was clogged. All those years of political campaign luncheons and dinners, all those occasions that were made special, calling for fancier, richer food because of the President's presence, were now being paid for.
Norman had hoped the angiography would tell him what helpful measures to take, perhaps indicate the feasibility of one or more surgical bypasses. However, the atherosclerotic problem was so widespread and segmented and had already caused so much damage that these prerogatives were not open.
Norman realized he was going to lose this patient. It could happen at any moment or a week from now. The most he could do was keep the President as comfortable as possible on his way to death.
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