The President's Doctor

by David Shobin

  “Thanks, Ellen,” he said, taking it from her. “I’ll get back to you in a day or two.”

  “Fine. How’s it going, anyway? Making progress?”

  “Definitely. Slow but steady. I should have more to tell you by the end of the year.”

  After returning to his car, it was a short drive back to the NIH. He had the use of a lab two afternoons per week. His research dovetailed with his interest in neurological diseases, along the lines he’d suggested to Senator Friedman. In addition, he and other scientists, when they legitimately followed the guidelines, were using discarded surplus human embryos as a tissue source for the stem cells. Until now, he’d been growing the tissue in cell culture.

  Jon’s ultimate goal was to induce the cells to differentiate into neural cells, which could one day be transplanted into patients with degenerative neurological problems. A similar process was involved in the making of pancreatic cells for diabetics like Ellen’s son.

  One of the many problems faced by the researchers was getting the stem cells to differentiate in the desired direction. The scientist’s goal was to foster differentiation along particular lines until the more mature tissue developed. But stem cells might, for reasons not completely understood, divide to form tissue of any of the three basic cell layers: mesoderm, ectoderm, and endoderm. Ectoderm ultimately formed neural tissue, while endoderm gave rise to the pancreas. But having the cells divide as intended wasn’t always easy.

  Late embryonic or fetal tissue, as opposed to the discarded in-vitro tissue, got around many potential problems by using cells that had already begun to differentiate. This saved time and uncertainty. If a trained technician examined a fifteen-millimeter embryo under magnification, there was no question about which tissue was developing into which organ. Isolating and growing that tissue was a surer bet if one’s goal was a particular type of mature tissue. It was here that Jon had decided to concentrate his clandestine efforts.

  Once in the lab, he closed and locked the door to his private office, which contained a large workstation and microscope. Working with one test tube at a time, he removed the specimens Ellen had collected and thoroughly rinsed them again. Then he took the first specimen and placed it in a microscope tissue chamber. Looking through the lenses, he examined the specimen for adequacy.

  Many human embryos would not survive the abortion process. With a powerful suction device extracting them from the uterus at a pressure of seventy millimeters of mercury, few were physically intact. But the ones that survived were a wonder to behold. Under low magnification, the fifteen-millimeter embryo floated in its warm, watery bath. Though it no longer had a blood supply, the embryo’s tissues could survive several hours by the process of diffusion. But once individual tissues were removed and placed in the proper medium, they could grow indefinitely.

  Jon was always fascinated by what lay in his field of view. The pink and shiny embryo showed clear signs of human development. Properly backlit, the pale, translucent skin already revealed a fine network of developing blood vessels. The tiny embryo bent forward on itself, as if its rudimentary chin were touching its developing chest. The developing head, with its easily identifiable eyes, was as large as the remainder of the body. Under the head was a prominent precordial bulge in what would later become heart. Four limb buds had the beginnings of obvious fingers and toes.

  The moving sight spoke to the miracle that was nature. While it inspired Jon, it also attested to the seriousness of what he was doing. One of the many reasons he did what he did was because he thought it a shame to discard something that held such promise for treating human disease. Now came what was, for Jon, the distasteful part.

  There was no getting around the necessity of removing tissue from the embryo. Miniature instruments had been designed for the process—tiny forceps, scalpels, and scissors. Using forceps braces to steady his hands on each side of the microscope, Jon inserted a grasper and microscalpel into the tissue chamber.

  Under magnification, the instruments looked enormous. Working the grasper with his left hand, he immobilized the embryo by its caudal end. With his right hand, he made an incision from the top of the cranial region down to the middle of what would form the spine. Then he traded the scalpel for a pointed bayonet forceps. With deft movements, he teased out the rudimentary neural tissue. It had the silvery-gray appearance of fish flesh.

  Removing the tissue, Jon rinsed it once again. He’d already prepared a cell culture tube, which was in a rack beside the microscope. The tube contained modified Eagle’s medium enriched with fetal serum albumin, to which Leukemia Inhibiting Factor had been added. The LIF would prevent cell division for several days while the tissue stabilized. On his next trip to the lab, Jon would remove the LIF, allowing the neural cells to multiply.

  He’d been repeating the process for months and already had a good supply of fetal neural stem cells. The main problem he faced was that he didn’t know how much was enough. There were several case reports of fetal neural tissue transplantation, generally into diseased adult nervous systems for treatment of disorders like Parkinson’s Disease. However, the amounts transplanted, and the method of transplantation, differed from one report to the other. Jon would have to figure this out for himself, for there was as yet no standardized dosage, or regimen. Too little might prove ineffective, while too much might potentially be harmful.

  Where it came to his daughter’s health, no additional harm would be tolerated.

  “Thanks for coming by, Jon. I know this exam is window dressing, but Mitch thought it’d look good to the voters.”

  They were in the president’s bedroom of the private residence. Finished taking the president’s blood pressure, Jon put away his sphygmomanometer and had Meredith lie down. Earlier that afternoon, Mitchell Forbes had called and requested that Jon perform a brief physical before Tuesday’s reelection announcement.

  “You’re going to have to remove your shirt, Mr. President. And I need you to roll your pants legs up to your knees.”

  That done, Jon listened to the Commander in Chiefs heart and lungs. The heart sounds were normal, and the breath sounds were those of a much younger man. Then Jon opened his portable EKG machine and plugged it into the wall socket. After securing the limb leads, he applied the precordial leads and turned on the machine. The EKG pen traced smooth, healthy patterns. Twenty seconds later, he was finished. Trying not to pull off too many chest hairs, Jon carefully removed the thoracic leads.

  “This looks fine to me,” he said, comparing the printout with a similar tracing performed several months earlier. “If they ask you, you can tell them your doctor’s given you a clean bill of health. Would you like me to let Mitch Forbes know?”

  “Thanks, but I’m meeting him in ten minutes. He’ll probably want you to put something in writing, though, just in case

  There was a hurried knock at the door, and Secret Service Agent Dave Saunders poked his head in. “Excuse, me, gentlemen, but there’s an emergency downstairs. Could you take a look, Doctor? We’ve sent for an ambulance.

  The president waved his hand. “Go, go.”

  Jon grabbed his bag and dashed out of the room, following Saunders. He and the agent were personal friends, having met shortly after the last election. The nearby elevator was waiting. Once they were inside, Saunders pushed the button for the first floor.

  “What’s going on, Dave?”

  “They say somebody had a heart attack in the kitchen.”

  “Who?”

  “You know that old guy, Mr. Phillips? One of the ushers?”

  Jon did. The white-haired African-American had been a White House fixture for years. Although, physically, he was a caricature of a traditional black servant, he was an exceedingly warm man, with a reassuring basso voice.

  “You bet I do. Any idea what he was doing when it happened?”

  “Not a clue.”

  The doors opened and they raced toward the kitchen. Inside, Mr. Phillips was lying on his back on the floor. Two Sec
ret Service agents were trying to resuscitate him, one doing external chest compressions while the other breathed mouth-to-mouth. Jon stopped beside them, checking the wall clock.

  “How long have you been at it?”

  One of the agents looked up. “About four minutes. No response.”

  “Dave, give us a hand. Let’s get him onto this table. Then find the emergency cart we used the other night.”

  The four men lifted the stricken patient onto one of the stainless steel food preparation tables. As Saunders went to retrieve the emergency equipment, Jon hurriedly removed Mr. Phillips’ shirt and undershirt. Then he had the agents resume their CPR.

  The old man looked moribund. His cheeks were sunken, and his eyes appeared lifeless. When Jon shined a penlight into Phillips’ eyes, the already-dilated pupils didn’t react. Further efforts were probably futile, but once begun, there was no turning back until the man recovered or was pronounced dead. Jon quickly looked around.

  “Did anyone see what happened?”

  Most of the kitchen staff shrugged, but several turned toward the chef. Mireille was standing against a wall, eyes red and hands balled in front of her mouth. Jon stared at her, and she nodded.

  “He was helping me carry something,” she said, her voice tremulous. “He didn’t have to, but that’s the way he is, and….”

  “What happened?” he interrupted.

  “He said he didn’t feel well, and he went outside to smoke. He has been smoking a lot lately. When he came back, he looked worse than ever. Then he just….”

  Saunders brought over the emergency supplies, which Jon wheeled toward the patient’s head. He hurriedly removed a laryngoscope and cranked open the oxygen. “Dave, go up to the residence and see if you can get that portable EKG machine, okay?”

  “No problem.”

  As the rhythmic CPR continued, Jon quickly located an endotracheal tube, tape, and an ambu bag. As he got everything ready, he continued talking.

  “How’s his health been, Miss Courtois? Do you see him often?”

  “Every day. He comes down here for coffee.”

  Jon had the agents stop a moment as he tilted back the patient’s chin and extended the neck. Mr. Phillips had full dentures, which he whisked away. Then he inserted the laryngoscope’s blade over the patient’s tongue. “How did he look today?”

  “Not well,” she replied. “He’s been acting strangely for a few months.”

  Using the instrument’s blade, Jon lifted the tongue and lower jaw until the larynx was exposed. The usual ivory color of the vocal cords was now an unhealthy gray.

  Nevertheless, Jon took the endotracheal tube in his right hand and slid its tip past the cords into Mr. Phillips’ trachea.

  “Strange?” he said, removing the scope and taping the tube to the patient’s cheeks. He quickly motioned for the agent to resume chest compressions. “Strange in what way?”

  She shrugged. “He hasn’t been himself. He’s been very irritable,” she said in French. “What is the word? Cranky.”

  Jon quickly inserted the oxygen tubing to the ambu bag, which he attached to the ET tube. “What else?” he asked, as he rhythmically squeezed the bag.

  “He has these little jerks—twitches? And his memory is not so good as it once was.”

  “Okay.” Saunders dashed into the room with the small EKG machine, which Jon opened and turned on. He told the agent to stop working on the chest while he applied the limb leads and turned on the power.

  “EMTs are here, Doc,” someone said.

  “Good. Send ’em in.”

  “Is he going to be okay, Doctor?” Mireille said.

  The machine’s pen traced the formless pattern of an agonal rhythm. “No, Mireille, I’m afraid not.”

  The paramedics wheeled over the stretcher. “Want us to take him, Doc?”

  Jon looked at the wall clock. It was now ten minutes into the arrest. The patient’s pupils were fixed and dilated, he wasn’t breathing, and his EKG showed a dead heart. “I don’t think so, guys. He’s a little beyond our reach. Call the time, and then take him to the ME’s office.”

  Thusly pronounced dead, the efforts on Mr. Phillips ended. It was pointless to keep trying once a person’s brain and heart ceased to function. They might persevere with a child or someone in midlife, but not on a seventy-year-old whose best years were behind him. As the EMTs put the deceased on the stretcher for the trip to the morgue, Mireille began to cry.

  Jon realized that the death was going to generate hours of paperwork for the Secret Service agents, the paramedics, and the kitchen staff. Also, since performing CPR on a food preparation table was rather unusual, the kitchen would doubtless be temporarily closed down for sanitizing and employee downtime. But he also knew that such minutiae were not the reason for Mireille’s tears.

  She had retreated to a corner where, in the shadows, she hugged herself and cried unashamedly. It was a soft noise, the lost and poignant sound of an abandoned child. Jon slowly approached and placed a hand on her shoulder.

  “I’m sorry, Miss Courtois. I won’t ask if you’re okay, because I can see you’re not. He must have been pretty special.”

  “You have no idea,” she said.

  “You’re absolutely right. I realize this isn’t the best time, Miss Courtois—”

  “Mireille. Call me Mireille.”

  “Sure,” he said. “What I’m getting at, some of what you said doesn’t fit, medically. I’m trying to make sense out of all of this.”

  Mireille knew who Dr. Townsend was, having seen him several times before. It was always from a distance, and they’d never had any conversation of substance. Now, she was starting to resent his interference. Yet when she looked his way, his expression was so sincere that she softened. She accepted his offered handkerchief.

  “Sometimes, when someone dies, there is no sense,” she said, sniffling. “But what do you want to know?”

  “Just go over a few things with me. It looks to me that Mr. Phillips had a killer heart attack. His increased smoking played right into that.”

  She took a pack of Marlboros from her pocket. “Here, these were his. He won’t need them anymore.”

  Jon lifted the box’s lid and took one out. The cigarette resembled a joint. “He rolled his own?”

  “Pardon?”

  He lifted the cigarette to his nose. “This isn’t marijuana, is it?”

  That made her laugh. “No, those are the cigarettes he made!”

  “Interesting. A real cowboy. I haven’t seen one of these in years. But what else can you remember? You mentioned irritation, twitching, and forgetfulness. Those symptoms suggest a neurological problem more than a cardiac one.”

  “You’re the doctor, not me. I’ll take your word for it.”

  “Yes, but was there any pattern to his new habits? I’m not asking you to guess at a diagnosis. Just give me your impressions.”

  Lids narrowed, she gazed up at the ceiling in recollection. “All I can say is that everything happened together. It was around Father’s Day. That was when I first noticed the changes in his behavior, the movements, the memory problem.”

  “Did he ever complain of heart trouble?”

  “Not to me, no.”

  “What about the smoking? You said you thought he smoked more. Did he always smoke his own cigarettes?”

  “Oh. No. He used to smoke regular Marlboros until…. Now that I think about it, that is about the same time his other symptoms began. Does that mean something?”

  He pocketed the box of smokes. “I don’t know. I’ll have to check the literature on roll-your-own cigarettes. Anything else?”

  “No, I don’t think so.”

  “Okay. Look, Miss…Mireille. I appreciate your help. I hope you didn’t have a big dinner planned for tonight,” he said, gesturing toward the rest of the kitchen, “because I think you’re going to be shut down a few hours.”

  “Nothing big. The First Family’s meal is already prepared. We were working
on things for tomorrow.”

  “Perfect. I hope you don’t think I’m out of line here, but when something like this happens, I usually tell my patients that they are their own worst enemy.”

  “I’m sorry?”

  “They should avoid being alone. Seriously. When there’s a tragedy like this and you’re trapped inside your own head, you’re behind enemy lines.”

  “I see. But I’m not your patient.”

  “True,” he conceded, “but I also tell them to avoid depressing situations and try to relax. So, would you like to go out for a drink? It might be helpful. Medically speaking, of course.”

  For the first time, she had a smile. “Are you hitting on me, Doctor?”

  “Perish the thought.”

  “Thank you for the offer, but I really need some time by myself.”

  “Okay. You’re sure you’ll be all right?”

  She nodded. “I’m sure.”

  For several seconds Jon stood there in artless silence before he found his voice. “Give me a call if I can be of any help.”

  Mireille watched him walk away. She thought he was very professional, and he certainly meant well. Yet he seemed like a wounded little boy, crushed by her reply. His expression was somewhere between a pout and being shot at sunrise. In truth, she thought, she really didn’t want to be alone right now. Perhaps his suggestion was a good one.

  “Dr. Townsend?”

  He turned. “What?”

  “Maybe I could use that drink. Medically speaking, that is.”

  It was his turn to smile. “Of course.”

  Near Gafsa, Tunisia

  The Al-Maidah camp was a base in name only. It was little more than a collection of tents and rickety wooden supply shacks. There was, however, a deep freshwater well, around which all camp life centered. Its water was slightly brackish, due to the salinity of the local water table. Indeed, there were large salt lakes just south of the camp.

  The area around the camp was semi-desert. As far as the eye could see, there were only dunes, rocks, and low ridges. It was very arid, for only Tunisia’s north was reliably watered. Yet amid the dunes, near the well, there were signs of life: a palm, a few twisted trees, patches of grass, and a half dozen sheep.