by David Shobin
“Or with explosives, delivered by truck.”
“Impossible,” Ibrahim said, shaking his head. “Wherever they build that base, it will have only one, well-guarded access road. No, we will cripple them here. We are still working on the details.”
“But whatever it is, I will play a role, won’t I?”
Ibrahim smiled. He momentarily thought back to the recent car crash near Washington, D.C., in which one of their operatives had been killed, and the other maimed for life. It was because of that fiasco that they were here now. Not to mention the not-insubstantial sums certain Americans were giving to him alone. “I brought you here, habibi, to show you my complete trust in you. You are our best marksman. Others will carry out our plans here. But you, ah. For you, I have even greater plans.”
Washington, 2005
The original Naval Medical Center, built with 1200 beds—whose size expanded or contracted over the years depending on the state of American military conflict—was consolidated into one command in 1973. A new state-of-the-art hospital was constructed in 1980 directly across the street from the National Institutes of Health. The center contained a five-hundred-bed inpatient building and a spacious, adjoining outpatient facility. Jon Townsend was a highly regarded internist on staff who performed both research and direct patient care.
His first-floor office in Building 9 of the National Naval Medical Center, still referred to locally as Bethesda Naval Hospital, had seen its share of celebrities, mainly politicians. Although his primary responsibility was the care of Naval personnel and their beneficiaries from military commands around the world, his civilian patient base had grown in tandem with his notoriety.
Harriet Friedman was a new patient of Dr. Townsend. The sixty-year-old, two-term senator had made an appointment for a general physical exam. Jon, who’d met her several times before at the White House, knew her to be an articulate, well-liked politician. Friedman was a modestly attractive woman with dark eyes and stylish graying hair. Although Jon’s cramped office was intended for administrative duties, he used it as a pre-examination consultation area for the VIPs, who sometimes resented being crowded into a clinic. Soon Jon finished with his history.
“You sound pretty healthy, Senator. You’re basically a low-risk individual from a genetically good background who’s up to date with her immunizations and tests,” he said, putting down his pen. “A corpsman will take you to the exam room to get changed.”
“All right,” she said pleasantly. “Are you going to do a pap smear?”
“If you’d like. Or you can see your own gynecologist.”
“A little problem there, Admiral,” looking sheepishly at Jon, who was dressed in his everyday whites. “One of the reasons I’m here is because my old gynecologist, who I knew and loved for twenty years, retired. He was my doctor for everything. To be honest, I might not even be here if I didn’t need my prescription for hormones.”
“I know how you feel, Senator. I hate going to the doctor myself.”
She laughed. “You’re very charming, Doctor. I feel comfortable with you, and that’s important to me. It’s no wonder Bob Meredith recommended you.”
“That’s very kind of him. How many other doctors can count on the President of the United States for referrals?”
“None I can think of. How long have you been his doctor, anyway?”
“About ten years,” he replied. “The president and I go back a long way, thirty years or so.”
“Really? You couldn’t have been more than a boy then.”
Coming from a patient, especially one he barely knew, such personal inquiries were irrelevant, and perhaps inappropriate. But Jon was aware that their interchange was part of an intricate ballet performed by the two of them. Not only was Harriet Friedman a patient looking for a doctor, but she was also a U.S. Senator checking out information on another public servant.
“Actually, I was twenty. The president and I were in the Marine Corps together in Vietnam. He was a captain, and I was a platoon corpsman. After he got elected to Congress, he helped me get a navy scholarship to med school.”
“You went into internal medicine when you graduated?”
“That’s right. And once I finished up, I had to give time back to the navy. I got stationed here, liked it, and stayed ever since.”
“It’s obviously agreed with you,” she noted. “You’re an admiral.”
“That comes with time in uniform. When you’ve been a naval officer as long as I have, getting promoted is inevitable.”
“You’re married, I presume?”
He continued smiling to avoid showing how intensely wounded he was by the question. The last thing he needed was some well-intentioned public servant snooping into his private life, especially when that life had been as painful as his was. The scar left by his former marriage had never completely healed. Whenever someone brought it up, it felt like an open wound. He thought about his ex-wife often, although not as much as he thought about his daughter.
Ah, Tommie. Ten-year-old Thomasina was the light of his life. She’d been born a year before his separation from Victoria. He regretted not having fought harder for custody during the settlement, but it would have been an impossible battle. Victoria had few flaws and no vices, unless being a gold-digger was considered a character defect.
At the time of their divorce, they’d been married eleven years. Jon met Victoria during his last year of residency, and they were married shortly after he finished his training. Victoria was five years his junior—a stunningly attractive woman with golden hair and azure eyes. Jon initially considered her to be out of his league, but he was soon captivated by her. Victoria was an artist, a promising oil painter who’d already had one successful show in Manhattan.
Jon thought she was the perfect foil to his personality. On the occasions he might be withdrawn, she was a social butterfly, outgoing and upbeat. Where he thought he lacked guts, she was assertive. She was laid back when he was intense. It was the attraction of opposites, a complementary match. She even seemed to understand his need to repay the military for what the navy had given him.
With Congressman Meredith’s help, Jon had been one of the first students to enter the medical program of the newly formed Uniformed Services University Health Service in Bethesda, Maryland. The fact that he was a Vietnam vet hadn’t hurt. Like many of his classmates, Jon incurred significant debt—in his case, the need to give the navy four years of service for the schooling they’d given him. Such payback could be deferred until after the completion of specialty training. Yet although, while they were courting, Victoria seemed to accept the necessity of repayment, it was all lip service. Once they were married, it was an entirely different matter.
Victoria came from a family of means and prestige. She told him she’d been speaking with her parents, and with an attorney. They were convinced they could find a loophole—such as post-traumatic stress disorder, from his days in Vietnam—that would keep him from having to remain in the navy. Other people did it all the time. Once freed from his obligations, Jon and she could go to New York, where the action was. Jon patiently explained that he wasn’t other people. He was not the kind of person who’d use some lame excuse to dodge a debt. Besides, he’d only been in country for a month when he was wounded and in the Marines all of one year before being medically discharged.
It was then that Victoria’s baser motives emerged. Jon slowly realized that all along, she’d been using him as a stepping stone toward success in her own career. As an artist, she believed that no mate could legitimatize her work more than a prestigious physician. Her prenuptial career fantasy consisted of one successful showing after another, a high-profile husband with a Park Avenue medical office, and perhaps a child or two. Her dreams could never come true if Jon remained in the Navy as an underpaid government employee. Once she understood that he had no intention of leaving the service, their marriage began to fall apart.
To Victoria’s credit, there was a brief period when she seemed to try t
o make things work. Telling Jon she was certain they could iron out the kinks in their relationship, she came on to him like a tigress. There were several months of delirious, passion-filled nights during which Jon was convinced they’d put their differences aside. But it was not to be. It turned out that Victoria had been the consummate schemer. All along she’d wanted to get pregnant, hoping that Jon’s honorable stance would soften once he became a father. In this, she was completely mistaken. Not long after Thomasina was born, they went their separate ways.
Naturally, Jon still saw his daughter every weekend. Victoria never did move to Manhattan, and Jon was grateful for that. Tommie was the light of his life. Rarely did a day go by that he didn’t speak with her on the phone. And try though he did to keep his ex-wife out of his mind, he never fully succeeded. Even though they lived apart, thoughts of Victoria haunted him like a reappearing ghost.
The senator’s exam took twenty minutes. If Jon had a hallmark as a physician, it was his thoroughness. Some colleagues kidded him that their five-minute exams looked bad in comparison. But Jon was compulsive, and he evaluated every organ system in detail. He spent extra time on the neurological exam, carefully evaluating all twelve cranial nerves. Over the years he’d developed a special interest in neurology, and for an internist, he was unusually competent. When the exam was complete and the Senator had dressed, she returned to his office.
“So,” the Senator said brightly, “I take it I’m going to live?”
“No doubt about it. Your best years are ahead of you. But there is one thing I’d like to talk about. I’m sure you noticed the way your hand shakes a little.”
Friedman raised her right hand, which had a fine, resting tremor. “This? That’s just nerves.”
“Maybe. But I noticed one or two other things, all very subtle. Your posture shows what’s called instability, and your movements are slightly slow, at least clinically.”
“Meaning what?”
“I think you may be in the early stages of Parkinson’s Disease.”
She was stunned. “Are you sure?”
“Reasonably sure. There are other possibilities, like an old stroke, an infection, or drug side effects, but they’re pretty unlikely.”
The Senator seemed shell-shocked. “I…. What does this all mean? I want to keep working. This is my life. I can do that, can’t I? There’s so much I have to do!”
“And you will, believe me.” He leaned forward at his desk, effecting his most reassuring posture. “Look, Senator. I know this is upsetting, but it’s not the end of the world. I won’t bore you with statistics, but most people with Parkinson’s have a normal life span and lead full and useful lives. I’m going to send you for some blood tests, and I’m going to send you for an MRI, so I don’t overlook anything. Radiology and the lab are just down the hall, and I’ve already called them. Then, I want to start you on levodopa.”
“L-dopa?”
“Exactly. The key to managing this condition is early diagnosis and treatment. It’s a harmless enough medication. The results are very gratifying. Your symptoms are minor now, and they may even disappear. So, why don’t you take it for two months,” he said, writing out a prescription, “and then I’ll reexamine you. If, at any point, you’d feel more comfortable with a neurological consultation, or if I think you need one, I won’t hesitate to refer you.”
She tapped a finger on his desk. “What happens if it progresses? I’ve known people with Parkinson’s who are completely debilitated by it.”
“That’s always a possibility, down the road. Levodopa is a first-line drug. There are plenty of fallback medications, and a number in the pipeline. Speaking of which, I don’t know your position on stem cell research, but I hope I can count on your support on The Hill.”
“Is that something you’re working on? Does it have anything to do with Parkinson’s?”
“Yes to both. There are some neurological problems I’m interested in. In fact, I testified before your committee on Jacob-Kreutzfeld Disease.”
“I recall. I was very impressed. You’re some sort of expert on Mad Cow Disease, aren’t you?”
“I’m unofficial liaison to the Europeans, who had a much bigger problem than we did. But another of my projects is the use of fetal stem cells. I’m doing research in that area over at the NIH, and there’s every indication that stem cell implantation in patients with Parkinson’s has a dramatic effect.”
“That’s very interesting. To be honest, I’m not sure what my position is on stem cell research. But I’ll try to keep an open mind, especially since it’s now personal. Isn’t this an unusual area for an internist to become involved in?”
He caught her eye, pursed his lips, and then looked away. It was not the time to reveal how he’d become involved largely because of Tommie. “Oh, it’s just a pet project of mine. Now, about the L-dopa. Is it a deal?”
The Senator found Dr. Townsend’s confidence and manner reassuring. Although she still had many questions, she admired decisiveness in her physician. “It’s a deal. I can see why the president recommended you.”
They rose and shook hands.
“You know what I like most about you, Dr. Townsend?” she continued. “You seem to care. I don’t know if you really do, or if that’s just the way you come across. But it’s important these days, because so few doctors do.”
“I appreciate that.”
“And you’ve got guts. It takes a lot of courage to come right out and say what you think, especially when the news is not the greatest. I admire that.”
“Thank you, Senator. I’ll talk with you soon.”
After Senator Friedman was gone, Jon gazed out of his window. He thought about what she’d said, for her comment about caring was right on the mark. Over the years, he’d known a number of colleagues who’d burned out for various reasons: overwork, disenchantment, or just plain boredom. For them, medicine no longer held the interest or intrigue it did when they started their careers. But in reality, Jon thought, many who burned out simply ceased to care.
Not that they always had. When Jon entered med school, he’d been struck by how few students were motivated by altruism. There was the occasional classmate who wanted to do primary research, who wanted to become a missionary, or who hoped to become a small-town family doctor. There were no Albert Schweitzers or Marcus Welbys. After repaying the military, most of his fellow students aspired toward a thriving civilian practice with the attendant material rewards. In short, med students hoped for the good life like anyone else, and it was the rare student who really cared, in an idealized sense.
Did he care, as Senator Friedman implied? Jon wasn’t sure. Certainly, he always tried to provide the best possible medical care. In his compulsivity, he was very thorough, overlooking nothing. Whenever a patient had a problem, at the end of the day he would ask himself, have I done everything I possibly can? Is there another test, or a different medication that I forgot about? Yet Jon was astute enough to realize that part of that thinking was a cover-your-ass mindset, a fear of blame that was not the same as the deep empathy necessary for real caring. So in the end, he still wondered: did he, or didn’t he?
As for courage, well, of that he had no doubt. He possessed none of it. What the Senator mistook for courage was little more than his diagnosis. He’d discovered a problem and told her about it—period. It was simple professional honesty. True, he knew other physicians who beat around the bush. Or who played things down, patronizing the patient. But that paternalistic approach always struck him as a lot of work, something easily avoided by being straightforward. It was the sort of role-playing for which he had no patience. The fact was, the only real courage he might have had vanished on a mountainside a generation ago.
The very word, he thought, was tossed around so loosely, so glibly. It was a romantic term, the stuff of poets. But had they personally experienced it? Plato, he recalled, claimed courage was knowing what to fear, while Mark twain held that courage was resistance to fear, not mas
tery of it. Jon thought the person who defined it best was Harper Lee, who wrote that courage is when you know you’re licked before you begin, but you begin anyway. Gazing outside, Jon sighed. Whatever courage was, he didn’t have it. Anyway, courage was the province of patients, not physicians.
He’d best stick to medicine and leave something as illusory as courage to patriots.
CHAPTER 10
By Halloween, autumn in Washington was well underway. Due to an exceptionally damp summer, tree foliage had been unusually verdant; and as night temperatures fell into the forties, metabolized leaf sugars brought forth dazzling colors in flaming displays of red and gold. The city was at a latitude where sunny days retained their warmth. It was fifty-nine degrees this morning, with a blue sky overhead and a fair weather pattern that would drive temperatures well into the seventies.
The president’s day began at eight a.m. with a national security briefing over coffee and croissants in the Oval Office. The National Security Adviser was none other than Mitchell Forbes, the White House chief of staff. Both positions were full time jobs. It was unusual, although not unheard of, for one man to serve in both capacities. Wearing two hats called for someone whose stamina matched his intelligence. Forbes had those qualities in abundance.
The fifty-two-year-old Forbes began his career as a Stanford-trained computer engineer. Twenty years ago, by marketing his company’s software, he’d become a millionaire. He was a gregarious, hardworking, designer/engineer with considerable people skills. Forbes dealt with personalities and persuasion as well as he did with bits and bytes, perhaps better. He was called to Capitol Hill several times to testify on behalf of the computer industry. He proved a stellar witness. Finding the Washington political scene to his liking, he embarked on a career change. In his early thirties, with his financial future secure, he cashed in on his holdings and went to work as a lobbyist.
Here, too, he was a standout. There was something about wheeling and dealing, wining and dining, which appealed to his extroverted personality. A standout in a crowded field of men and women with similar skills, Forbes excelled at genteel arm-twisting and the tactful distribution of perks. By that time, Bob Meredith was already a U. S. Senator. During their first lunch together, they realized they were kindred spirits. Both men were outgoing, sociable, and easy to talk to. As time went by, their professional relationship grew and prospered; and eventually, perhaps inevitably, Forbes became the most trusted adviser to the Senator from South Carolina. Long before he was elected President, Meredith knew Mitchell Forbes would be the go-to guy in his administration.