The President's Doctor

by David Shobin

  “Doesn’t get better than this,” Dave said. “Fish, food, and friends.” He lowered his voice, leaning close to Jon. “She is just a friend, right?”

  “Jeez, buddy, didn’t your mother tell you there are some questions you never ask?”

  “Can’t say she did. How’s she doing with the Phillips thing?”

  “Pretty good, from what I can see. Not one to wallow in tragedy.”

  “You sure were Johnny-on-the-spot that day,” Dave said. “Not to mention the night the president choked.”

  “I always said, I’d rather be lucky than smart. The fact is, I wasn’t even supposed to be there that night.”

  “No?”

  “No, sir. Funny thing was, neither was Mireille.”

  A frown slowly creased Saunders’ forehead. “Better run that by me again.”

  Jon slowly related the curious tale of his late arrival and the equally peculiar instruction Mireille had received to take the day off. He watched Dave’s frown deepen. “What’s bugging you?”

  “Every morning we get a briefing, and there are updates all day long,” he said. “The idea is for everyone to know who’s where and at what time, to ensure the president’s safety. The kitchen staff is an integral part of goings-on in the House. And I can tell you that no one gave us a heads-up that the chef was taking off that day.”

  “Is that so unusual?”

  “It’s unheard of that she’d be absent during a state dinner. She’s in charge of the meal, right? Having a substitute chef show up at the last minute…it’s just not done.”

  “Maybe the guest chef was a special hot shot.”

  “I’d ask him, if I could find him.”

  “What do you mean?”

  “His name’s Marcel Al-Hakeem. Works at a place in Philly. The day after there’s what we call an ‘untoward event’ involving the president, we always interview everyone around. It’s standard procedure, even for a presidential hangnail. But this Al-Hakeem, he’s disappeared. He wasn’t at his usual job or where he’s supposed to live.”

  “He probably just took some time off.”

  “Maybe, but something doesn’t smell right. I want to hear this from Mireille.” Dave put down his paper plate. “Let me have a word with her.”

  “I don’t suppose this could wait until we get home?”

  “This’ll just take a second,” Dave said. “I promise not to scare Tommie.” Animated talking and giggling came from the other side of the boat. When the men turned, they saw Mireille on her hands and knees, eyes near the center keel as she searched for a wayward fly. Her compact derriere, snug against her jeans, was uplifted their way.

  “Oh, my fucking word,” Jon whispered.

  “Like I said,” Dave added, “it doesn’t get any better than this.”

  Leaving Canada, Mahmoud was instructed to drive south on I-95 to the D.C. metro area, where he would get on the Capital Beltway. Once there, he would get off at the Oxon Hill, Maryland, exit and head for the nearby Burger King. He would wait in its parking lot until contacted.

  Arriving after dark, he was relieved to find that he didn’t have to wait long. Any swarthy looking man hanging out in a suburban parking lot was sure to attract attention. Within minutes a tall, lanky stranger wearing a Redskins jacket got in the passenger seat. Speaking tersely, he told Mahmoud to keep quiet and follow instructions. He neither stated his name nor made significant eye contact.

  “Where are we going?” Mahmoud asked.

  “Listen to me, fella,” said C.J. “Don’t ask questions. Get back on the Beltway and drive west to U.S. 1. Get off there and go north to Alexandria.”

  “Do—” Mahmoud began, only to be silenced by the tall American’s glower.

  “I’ll tell you everything you need to know. Now drive.”

  Mahmoud exited the parking lot and returned to the Beltway. Ten minutes later, after crossing the Potomac, they were in Virginia. U.S. 1 carried them into downtown Alexandria, where Mahmoud was told to get off at Russell Road and work his way up East Rosemont. Soon they parked in a downtrodden neighborhood near the railroad tracks. Trailing the stranger into a rundown apartment building, Mahmoud followed the man to a room on the third floor. The door was double-locked.

  Once inside, Walker turned on the lights, revealing a shabbily furnished one- bedroom apartment. The main room smelled of stale tobacco and garlic, and its single grease-smeared window looked out onto a small park nearby. The man picked up a remote controller and switched the TV on to a local channel.

  “You keep your ass here until I get back to you,” he said. “I don’t know how long that’ll take. Could be several days or several weeks. Everything you need is here. You have clothes, a lot of food in the kitchen, stuff to read, and the TV. Use it to practice your English.”

  “When will—?”

  “What’d I say about questions?” the stranger said, raising his hand. “That phone there,” he indicated, “only receives calls. You can’t call out. It’d be better for everybody if you stayed inside, y’know? But if you’ve gotta stretch those skinny legs of yours, make sure it’s dark first. You don’t want to be attractin’ any attention, now. If you do go out, make it short and snappy, and don’t go far. This is a dangerous neighborhood, brother.”

  “I am not your brother.”

  Walker ignored him. “Two final things,” he continued. “I was told you might ask what’s goin’ down. That, I don’t know, but I’ll let you know when the time comes. Just keep a cool head, all right? Finally, I’ll deliver your tools once I get the go ahead about the mission. That’s everything. Got it?” He turned to leave. “And hey—good luck.”

  “Everything?” Mahmoud asked. “Am I to sit here watching television until I am contacted again?”

  “No, not everything,” the man said. He lifted a copy of the Koran from a nearby table. “You can also pray.”

  CHAPTER 15

  The complex of buildings comprising the Smithsonian Institution was a short drive from the White House. At noon the following day, the first lady’s limo pulled up outside the National Air and Space Museum. The short drive down Independence Avenue was a last-minute addition to her scheduled stop at the Smithsonian’s African Art Museum, where she briefly attended an eleven a.m. fundraiser.

  Normally, once her Secret Service detail learned of a change in plans, two agents would be sent ahead for advance security. But inasmuch as the new destination was only several hundred yards away, there was no time for that. Security would be handled on the fly. All she said was that Dr. Townsend was in the area and she wanted to have a private word with him. She did not mention that her meeting was pursuant to a phone call she’d made last night.

  En route, the museum’s security chief was notified. The limo was instructed to pull around to a rear loading entrance. Simultaneously, space was made available in the museum’s movie theater, which was between showings.

  With a Secret Service agent guarding each aisle, Roxanne took a front row center seat. Minutes later, Dr. Townsend arrived and was escorted into the theater. He shook hands with the first lady.

  “Don’t get up, Roxanne,” he said, sitting beside her. He looked around the empty theater. “Now this is service, the whole place to yourself. I’m impressed.”

  “Don’t let the word get out. I wouldn’t want the taxpayers to think I’m squandering their dollars.”

  “The taxpayers are crazy about you, and you know it.” He paused. “What’s up?”

  “I apologize for calling so late, Jon. But I’m at my wit’s end, and I don’t know where to turn.”

  “That’s a start. Go on.”

  “It’s…it’s Bob,” she finally said with a sigh. “I don’t really know how to put this diplomatically

  “Don’t play politician, Roxanne. I’m his doctor. Just tell me what happened.”

  “What happened is that there’s something wrong with him. He’s…he’s not himself. He hasn’t been for months. I’m scared to death he’s developin
g Alzheimer’s.”

  “Hold on a minute. Diagnosis is my job, and I hardly think he qualifies for a diagnosis of Alzheimer’s. Is he forgetting things?”

  “Yes, but it’s way beyond forgetfulness. Take last night. He was heating a sandwich, forgot about it, and cooked it to a crisp.”

  “So what?”

  “He also forgot to take it out of its wrapper. He nearly set the room on fire. Then he accused me of cooking it and screamed so loud one of the agents came into the bedroom.”

  As precisely as possible, Roxanne related the events of the recent past, emphasizing the president’s memory and personality changes. Jon listened with concern. From the tears that filled her eyes, it was apparent that the first lady was very upset about what was happening. Her husband’s faulty recall, she went on, didn’t upset her so much as his flashes of temper, irritability, and obstreperousness. At length, she stopped talking and looked him in the eye.

  “Well?”

  “I think I need to examine him,” he said. “I don’t want to venture a guess until then. The physical I just gave him was pretty basic—heart, lungs, EKG. I’m going to have to focus on neurological areas.”

  “But what do you think? Could it be Alzheimer’s?”

  “Anything’s possible, but early Alzheimer’s wouldn’t be my first choice. His symptoms are too mild and varied

  “But they’re getting worse!”

  “Okay, but you’re describing a hodgepodge. The jitters, memory loss, irritability, and personality changes are a neurological stew. There are dozens of possibilities, like organic brain syndromes, other dementias, infections, and psychiatric disorders, to name a few.”

  Deep worry lines etched her face. “Whatever it is, is it treatable?”

  “I can’t tell yet. I’m not trying to be evasive. It’s just that everything depends on the proper diagnosis. He’s going to need a thorough workup. Let me ask you this: does he know he has a problem? Is he aware of what’s happening?”

  She shrugged. “Yes and no. I think there are times he gets little glimpses of his behavior, like when he catches himself in the act of forgetting. I can tell it embarrasses him, because he changes the subject. Of course, if I point it out to him, which I try to avoid, forget it. It’s denial with a capital D.”

  “That’s not unusual. Most people who get trapped by memory loss find it painful and humiliating. But what about his moodiness? Does that embarrass him too?”

  She sighed audibly. “I honestly don’t know. When that happens, he’s like an exposed nerve. Everything’s so raw and angry, I can’t tell what lies underneath.”

  “All right. By any chance does he know you’re telling me about this?”

  “No way,” she said, shaking her head. “I’m doing this behind his back. I feel like I’m betraying him.”

  “That’s not true, and you know it. You’re a concerned wife who wants the best for her husband, president of the United States or not. What I don’t understand is what took you so long to tell me about this.”

  “Actually, I’ve been wanting to tell you for a while. But Mitch Forbes begged me not to.”

  He was jolted. “Did he say why?”

  “The reelection, mainly. He’s convinced that if word gets out that Bob has a problem, it will kill his chances.”

  “Well, I can understand that. Mr. Forbes is one of the smartest guys around. I’ll leave the politics to him if he leaves the medicine to me. But don’t worry, this won’t go beyond you, me, and the president.”

  “Thanks, Jon,” she said with a wan smile. “I can always count on you.”

  “Yes, you can.” Mind racing, he slowly stood up, not mentioning how alarmed he was that the president’s symptoms resembled those of the late Mr. Phillips. “One more thing, Rocky. We’ve talked about your husband, but what do you hope will come out of all this?”

  “It’s very simple. I’m losing my husband, and I want him back. That’s not too much to ask, is it?”

  Jon left the museum and returned to work. The first lady went back to the White House. Outside the museum, their conversation was dutifully recorded by a sophisticated listening device within a nondescript government Ford Taurus.

  The National Naval Medical Center was undergoing hard times. Although it was the flagship of Navy medicine, it had been criticized recently by members of Congress who reported numerous complaints of substandard medical care. Consequently, for over a year an outside panel had been conducting an independent review of operations. Nonetheless, the Bethesda hospital continued providing care for governmental VIPs.

  The Presidential Suite in the outpatient building had been used for decades. The facilities were slightly altered to suit each Chief Executive, but the primary mission of providing an up to date treatment facility was unchanged. At the appointed time, the president and his Secret Service detail were waiting in the suite. Jon and a corpsman met the president in the examining room.

  “Thanks for making the time, Mr. President. How’re you feeling?”

  “About the same as a few weeks ago. Too good to be here, that’s for sure. This is an incredible waste of time, if you ask me.”

  “Why do you say that?”

  “Because it’s much ado about nothing. Sure, I might forget something from time to time, but who doesn’t? Jesus, that doesn’t exactly make me senile, does it?”

  It wasn’t what the president said, but how he said it—little flashes of annoyance, like a flame’s flickering blue spark. It was so out of Meredith’s character that it was instantly noticeable. “Of course not, but I’m glad you’re aware of it. What else?”

  “Well, I’ve been getting pretty annoyed at Rocky lately. But she’s really getting on my case, God knows why. If you want my opinion, she’s the one who should be here, not me.”

  “Okay. What about your habits? Has there been any change in the amount you smoke or drink, or what you drink?”

  “None at all. This has nothing to do with drinking, Jon.”

  “What about food? Are you eating anything differently—snacks, health food, whatever?”

  “I’m not sure the chef’s food qualifies as health food, but no. Nothing whatsoever.”

  “What about vitamins and over the counter products?”

  Meredith shrugged. “Just the antioxidants you gave me.”

  There was an occasional twitch in Meredith’s face, a fine muscular spasm near the eyes. For the first time, Jon noticed a subtle, intermittent tremor in the president’s fingertips. Little things, to be sure; but combined with the memory and personality changes, they were enough to concern Jon. He began a lengthy review of systems, paying particular attention to questions that might relate to neurological findings.

  Foremost among these questions were simple tests designed to evaluate memory, and it was here that the exam began. Realizing the topic’s sensitivity, Jon asked the corpsman and the agents to temporarily leave the room. Jon started by asking the president to respond to commands. Meredith easily followed two-step commands, but some three- and four-step commands were hard for him. He could complete six digits forward and repeat a four-word list immediately, but his recall after one minute was substantially impaired. He had difficulty with serial sevens, in which seven was subtracted from one hundred and then consecutively subtracted from the answer.

  The results were troubling enough for Jon to conclude that the president would require formal psychological testing. Meredith had short-term memory deficits, but other aspects of memory, like semantic memory, were also questionable. Moreover, the president displayed very subtle paraphasia, or verbal comprehension, sufficient to warrant in-depth testing. Finally, Meredith’s attention wasn’t what it should be. When Jon finished this line of inquiry, he called in the others for the neurological exam.

  The straightforward physical was similarly troublesome. Besides the fine tremors, the president had mild spasticity and muscular rigidity. His cranial nerves were intact, although there was questionable weakness in the lower e
xtremities. On one occasion, Jon was able to elicit a coarse myoclonic jerk. Meredith’s eyes had a beat of nystagmus, an oscillatory movement of the eyeballs. Finally, there were some soft visual-oculomotor and extrapyramidal signs.

  The exam completed, Jon folded his arms in quiet thought. The medley of neurological findings was a medical stew of unrelated ingredients. The myriad of minor abnormalities was diagnostic of nothing in particular, but the variety of possible diagnoses ran across the medical landscape. At various points, Jon thought he was dealing with encephalopathy, then drug intoxication, then an Alzheimer’s variant, only to conclude it was none of the above. The only thing that was clear was that additional testing was mandatory.

  “Am I going to live?” the president asked.

  “No question about that. But there are a couple of minor things that bother me.”

  “My memory’s not the best, is it?”

  “It could use some improvement,” Jon said. “You won’t ace the SATs, but you can still run the most powerful nation on earth.”

  “That’s a joke, right?”

  Jon smiled. “My humble attempt at humor. The point is, Bob, even though I think what you’ve got is pretty minor, I can’t pin it down. In an ideal world, I’d send you to a hotshot neurologist. But there’s nothing ideal about reelection politics, particularly where it comes to rumors. Mitch Forbes already asked me to keep a low profile on this, so this is what we’re going to do. First, the corpsman will draw some blood. Then we’ll bring in an EEG, a brainwave test. It won’t take long, and we can do it right here in the suite. Finally, I’ll do a spinal tap. After you rest here a little while, you’ll head back. How does that sound?”

  “A spinal tap? That should be the most fun I’ve had in years. But if that’s what I have to do to keep you and Rocky happy, so be it.”

  After the blood samples were taken, Jon checked off the tests he wanted and sent the slips to the lab. In addition to routine chemistries and blood count, he ordered hormonal, serologic, and metabolic studies, plus several exotic tests. It would take several weeks for all the results to come it.