by David Shobin
The agents left the lead and chase cars and formed a protective phalanx outside the first lady’s vehicle. As she slid across the seat, the head of her detail opened her door.
“Take your time, Ma’am. We’re a few minutes early.”
“Do we have far to go, Chip?”
“No, the auditorium’s on the first floor, just down the hall.”
Roxanne tightened her collar and stepped into the cold night air. Much as she needed an evening diversion, she was tired. On the curb, she straightened up and smoothed her coat, suddenly feeling guilty for wanting time to herself. She was already looking forward to finishing this engagement and returning home to Bob.
The instant the limos rolled to a stop, Mahmoud thumbed off the rifle’s safety. He was wearing woolen fingerless gloves that provided warmth while allowing good tactile sensation. When the motorcade rolled into view, a sudden calm settled over him like a blanket. His heartbeat slowed, and his hands were rock steady. Relaxed though he was, he also felt a steely resolve.
The scope’s duplex reticle had heavy peripheral crosshairs that gave way to finer lines in the center. Mahmoud took a deep breath and held it. As soon as the woman stepped out of the vehicle, the crosshairs fixed on her hat. Mahmoud hadn’t anticipated a hat, but it didn’t matter. The edge of its brim made a good aiming point. When the target momentarily paused, he squeezed the trigger.
Secret Service agent Chip McNally was closing the car door when he heard the horrifying splat. It was a sickening noise, the sound of a hammer striking a side of beef. Out of the comer of his eye, he noticed the first lady’s head jerk forward. As he reached her way, there came a sound like a backfire, and Roxanne Meredith collapsed in a heap.
His first thought was, this can’t be happening. But then he acted reflexively, an instinctive reaction that stemmed from years of training. He leaped on the first lady and shielded her body with his.
“FLOTUS is down!” one of the agents screamed into his mike. “We’re taking fire!”
Guns were quickly drawn. Apprehensive eyes peered up and out.
“Does anyone see the shooter?” another asked.
“Let’s get her in, Chip!” said a third.
Normally, protocol called for returning the stricken person to the protective interior of the armor-plated limousine. But McNally’s mind was racing. Even as he covered Mrs. Meredith, he could smell her blood. From the stillness with which she was lying, he knew the first lady was badly injured. If they put her in the vehicle, then what?
Mindful of a follow-up shot, he quickly rose to a crouch, keeping his torso between Mrs. Meredith and the street. He scooped her into his powerful arms and dashed toward the hospital and its shock-trauma unit. Chancing a wary look down, he spotted the dark entry wound at the top of Roxanne’s neck, just behind the mastoid bone. This is not good, he thought.
As he raced through the atrium’s opened glass doors, he was struck by how light Mrs. Meredith was. He knew he needed help, but the first order or business was to protect the first lady. Soon he knelt in a corner, still holding her in his arms, feeling the protective cordon surround him.
“Got to get her into Shock Trauma, Chip!” called one of his men.
“Which way?”
“Other corner, across the street. We alerted them. They’ll bring a gurney.” McNally chanced another glance at the first lady, who lay helplessly in his arms. The exit wound on the left side of her neck was a small dark hole that bled freely. “Fuck the gurney!” he cried. “Where the hell’s the unit?”
“This way.”
Forming a protective cordon, guns drawn and facing outward in a phalanx, members of the first lady’s team guarded her as McNally carried their charge toward the R. Adams Crowley Shock Trauma Unit. Once they’d crossed the street a gurney almost magically appeared, and a group of EMTs surrounded the stretcher as it neared the closest shock-trauma bay. As carefully as possible, McNally placed Roxanne back down on the still moving stretcher. Her face was deathly pale. A frighteningly ragged exit wound in her neck gushed blood profusely.
“Pressure!” someone shouted. “Put pressure on that wound!”
The unit was a warren of diagnostic and treatment rooms, some of them in use. Word of the shooting spread rapidly. A green-clad, scrub-suited man appeared beside the stretcher and pressed a heavy sterile white pad against the first lady’s neck.
“Whoa, whoa,” he shouted. “Where are you taking her?”
“Who are you?” McNally asked.
“Dr. Darmajian,” he said. “One of the surgeons on staff here.”
Darmajian, McNally thought. Iranian. But he couldn’t afford to be choosy. Any port in a storm. “This is the President Meredith’s wife, Doc.” His tone implied caution.
“I realize that, but you can’t just wheel her into the nearest open space. She’s got to be examined. And that wound has to be explored before she bleeds to death.” His fingers gently probed the back of her head. “Is this a pistol or rifle wound?”
“Rifle, we think.”
“Jesus. All right, let’s take her over to the spiral CT. And somebody get hold of Dr. Douglas.”
“Who’s that?” McNally asked.
“Cliff Douglas is Chief of Neurosurgery. I think he planned to attend the speech.” Within literally seconds, other health care workers appeared and began cutting off the first lady’s clothes. Fortunately for Roxanne, she was in the right place at the wrong time, for she could not possibly receive finer care anywhere in the world. Late in 1968, an elderly Western Maryland resident was transferred to the University of Maryland Hospital with abdominal pain and a presumptive diagnosis of severe pancreatitis. During his workup, he was discovered to have a ruptured cardiac muscle. The patient underwent cardiac surgery and a months-long rehabilitation, during which he was intensely monitored as the sole patient in a fledgling diagnostic and treatment unit. From such humble beginnings the Shock Trauma Unit at the University of Maryland Medical Center was born, later to become the preeminent such facility in the Northeast.
The agents were unceremoniously hustled toward the periphery of the care area. Shock Trauma’s admitting area was essentially a massive intensive care unit where all effort centered on treating the patient quickly. Unlike other hospitals, where the patient went to an ER or trauma station and then had the necessary diagnostic tests performed elsewhere in the hospital, everything in Shock Trauma was located within forty feet. The Trauma Resuscitation Unit, or TRU, had ten identical resuscitation bays and six ORs, all connected by audio-video-data links to a telecontrol room. This included a spiral CT scanner that could take photographs of the brain from multiple angles with a single time-saving set-up.
In less than ninety seconds, the newly arrived, hospital-gowned patient had two large-bore IVs, including a central venous pressure catheter; a urinary catheter; an elaborate blood pressure and pulse monitor; and a pulse oximeter, a device measuring the blood’s oxygen saturation. Her blood pressure had already fallen, and her pulse was beginning to rise. The next half-hour would be critical. Meanwhile, Darmajian continued his preliminary examination.
It was obvious that the patient had suffered a severe traumatic head injury. Using the well-established Glasgow Coma Scale, she was clearly in a coma, unresponsive to verbal commands or painful stimuli. The basic neurologic exam included an assessment of the GCS and evaluation of the pupils. Both pupils were mildly dilated, one slightly more than the other—not a good sign. In addition to this abbreviated physical examination, imaging the brain was important to patient evaluation. The spiral CT was best for this purpose. The first lady had just finished having the scan performed and her vital signs monitored when Cliff Douglas arrived.
Dr. Clifford Douglas, a 1968 graduate of the N.Y.U. School of Medicine, was the paradigm of an African-American success story. Growing up in Harlem, he was a gang member who seemed destined for a life of crime and imprisonment. At six-feet-four and two-hundred-fifty pounds, his imposing presence both inspired and
terrified those around him. And he might well have gone down a path of self-destruction were it not for a retired cop who steered him toward the Police Athletic League. His success on the football field landed him on the high school varsity team, and Douglas soon earned college scholarships. It was in college that he managed to turn himself around and seek a career in medicine. More than thirty years later, just as tall and a few pounds heavier, he was every bit as impressive in the OR as he had been on the gridiron.
Even in triple-extra-large scrubs, his bulk seemed to burst at the seams. But his deep baritone voice left no question about who was in charge when he entered the room. “Just the details, Hamid,” he barked to Darmajian. “I know the rough story.”
“Then you know who our patient is,” said the surgeon. “Her most recent ‘crit’s twenty-six. Vitals are low but stable. Her left pupil’s become unresponsive. You’ll want to see the CT.”
“You pushed diuretics?”
“Yes, and steroids are on board. The cops don’t know what she was shot with yet, but the entrance wound looks under thirty-caliber.”
“Not that it matters.” Douglas was addressing the fact that even small-caliber, high-velocity rifle bullets could produce devastating injuries; but if they were dealing with an elephant-killing caliber, chances of survival were negligible. Douglas performed a quick physical exam on the first lady, confirming the grave prognosis.
Surrounded by residents and staff, the two physicians evaluated the ultra-fast CT scan. Douglas’ first impression of the films was that they were not dealing with an ultralightweight hollow point bullet. Such a projectile rapidly expanded when it entered the cranial cavity, producing an explosion of brain tissue, fragments of skull, and shards of copper-jacketed bullet. Rather, from the neat, downward trajectory of the wound, it appeared that they were dealing with a solid projectile, often used to gain accuracy or penetration at the expense of expansion. For Roxanne Meredith, this was one small piece of good news. But the CT scan did reveal a significant, or growing, mass of blood called a hematoma, and the presence of considerable edema, or swelling. Bullets did more damage through edema and hematoma formation that from actual destruction of brain tissue.
“But no herniation, though,” said Darmajian of the films.
“Not yet, anyway,” Douglas agreed. “But we’ve got to get in there fast.”
Unlike bone or cartilage, brain tissue was highly compressible. It responded to swelling and hemorrhage and clot by squeezing together more tightly. However, within the closed space of the skull, its ability to squeeze ever tighter was limited by space and pressure. If the swelling rose precipitously or became too great, it caused a phenomenon called increased intracranial pressure, or ICP. The effect of dramatically increased ICP on brain tissue was similar to squeezing a tube of toothpaste: the gray matter would shift, or herniate, following the path of least resistance. Unless relieved, severe brain herniations were fatal. Thus, Douglas’ role as a neurosurgeon, in the case of traumatic brain injury, was to reduce that build-up of pressure by controlling hemorrhage and eliminating clot. That meant immediate surgery.
The technical term for such surgical gymnastics was exploratory craniotomy with debridement. In a sense, this kind of neurosurgery was akin to sophisticated plumbing. Although it was impossible to repair damaged brain tissue with cautery and sutures, the leaks could be controlled. Also, evaluation of the patient with a penetrating, traumatic head injury during the immediate post-operative period relied on frequent monitoring of the patient’s neurological examination, the GCS score, the pupils, arterial blood gases, and in most cases, the ICP. This meant that Douglas had to insert an ICP catheter into the brain during surgery. And he had to do it soon.
The rifle bucked. When Mahmoud regained the image, he saw that the target was down. He wasn’t certain his bullet struck the point of aim, because the woman moved the instant the rifle fired. Yet from the way she’d fallen, there was no question he’d done his job. He was filled with intense elation, and gratitude. This was truly God’s work.
He had to get out of there immediately. The plan was to make his way back through the building and leave through one of the first-floor office windows. From there he’d cross over to Paca Street, well behind the School of Social Work and far enough from the killing ground that the searchers would take a while to arrive. By then, he’d be long gone.
Mahmoud hurriedly repacked the rifle and tripod and closed the case. In spite of the cold wind, he was sweating. He felt more alive than he’d ever felt before. He was pumped, and the case no longer seemed heavy. As he crossed the roof to the fire door, there was spring in his step. But when he reached for the metal handle, the door unexpectedly swung open. Startled, Mahmoud stopped in his tracks. There was a man in the doorway, his features indistinct in the stairwell’s dim light. Yet as Mahmoud’s vision focused, fear set in.
“Who are you?” he said.
There was a sound like a muffled “pfft,” and Mahmoud fell backward. The gunman stepped onto the roof and approached his victim. The thirty-two-caliber bullet had struck Mahmoud below the right eye, and was probably fatal. Nonetheless, the man pointed the silenced semi-automatic at Mahmoud’s forehead and fired twice more, finishing the job. Then he bent over, pocketed the three shell casings, and left.
Fifteen minutes later, Roxanne Meredith was in the OR, intubated, head shaved, and prepped for surgery. As Dr. Douglas backed away from the scrub sink, bent arms raised and dripping soapy water, he was aware of the awesome responsibility he carried. He had operated on thousands of patients with head trauma, some more critically injured than the first lady. But none had the added burden of being the wife of the most powerful man in the world. Accepting a towel from the scrub nurse, Clifford Douglas took a deep breath and concentrated on the task at hand.
In spite of driving wildly through rush hour traffic, Jon still reached the White House much too late. In the world of White House scheduling, punctuality was king. He was supposed to have been there at five-thirty; and now, at six-fifteen, he doubted the day’s events had waited for him. As he pulled up at the gate, attired in his overcoat and dress uniform, he lowered the window.
“Have they left yet?” he asked the guard.
“Who’s that, sir?”
“The first lady. I was supposed to go to Baltimore with her.”
“Afraid they’ve gone, Doc. Left fifteen, twenty minutes ago.”
Muttering under his breath, Jon parked and entered the White House. He was still shaking from what had made him late in the first place. He didn’t think Mireille was still there, but it was worth a look. He needed a friendly face to talk to. Surprisingly, she was just putting on her coat when he caught her in the kitchen. He kissed her on the cheek and hugged her warmly.
“Am I glad you’re still here,” he said. “I was afraid you’d left.”
“Weren’t you supposed to attend a conference?”
“Yeah, I was. But just before I left the office at five, I got a call about Tommie.”
“What kind of call?”
“It was someone from her school who said that Tommie was missing. I thought I was going to fall over. They said she’d stayed late to work on some kind of project, and the next thing they knew, she’d disappeared.”
“Oh my God,” Mireille whispered. “You wouldn’t be here if they hadn’t found her. Where was she?”
“That’s just it, she wasn’t anywhere. It was a prank call, but I only found that out after I drove over there. It turns out Tommie had been at Victoria’s all along. By the time I discovered that, I was late getting here. I missed Roxanne’s limo.”
“That’s terrible. Do you think someone did it on purpose?”
“You mean scare the hell out of me, or make me late getting here?”
“Both. Either.”
“I doubt it,” he said. “That’s just too weird. It’s probably someone with a grudge who wanted to piss me off. And he succeeded.”
“Poor Jon,” she said,
taking his hand. “Is there anything I can do to un-piss you?”
“What a delightful thought. A drink would be nice. Followed by dinner.”
“Okay. Where would you like to go?”
“Someplace casual, if it’s okay with you.”
“Sure. What about my place?”
When the Secret Service relayed word of Mrs. Meredith’s shooting to the White House, security increased dramatically. Protecting the First Family was a well-rehearsed drill that was regularly practiced. The president, who was preparing for dinner, was immediately hustled to a secure room below ground. There, the chief agent in charge informed him of the events in Baltimore.
Meredith paled. He sat down and mumbled something incomprehensible under his breath.
“Can I get you something, Sir?”
“We’ve got to get over there.”
“Mr. President, the situation is very fluid right now. I think they’re going to take Mrs. Meredith into surgery. We should wait until things calm down a bit.”
The president slowly appraised him. “You’re married, right?”
“Yes, sir.”
“How long?”
“Sixteen years, sir.”
“Well, I’ve been married twice that long. And I’ll tell you something. Every time I’ve been ill, even if it’s sniffles, the first lady’s been by my side. And I’ve tried to do the same for her. So you see, son, staying here’s not an option.”
“Sir—”
“How soon can you get me there?” the president persisted.
“I’ll look into it, Mr. President. I’m not sure about their landing facilities. We might have to use the limo.”
“Then see to it. I want to leave in five minutes.”
The helipad at Shock Trauma, normally used by the Maryland State Police helicopter system, was very sturdy, but it was not designed to support the weight of the presidential helicopter. Formally known as a Sikorsky Vh-3D Sea King, the craft was simply called Marine One when the president was aboard. Instead, the Secret Service called in one of its many back-up helicopters, a new Bell 412 EP. On the south lawn ten minutes later, eleven agents and presidential staff climbed aboard for the short flight to Baltimore. At its maximum speed of one hundred forty miles per hour, the chopper was on site fifteen minutes later.