The President's Doctor

by David Shobin

  “Can I hold her hand?” he managed.

  “Yes, sir,” said one of the nurses. Then they both backed away to give him privacy. Meredith took a seat by the bedside, taking his wife’s hand through the raised side rails.

  “Rocky,” he softly began, his voice quaking with emotion, “can you hear me, girl?” He gently squeezed her fingers, half expecting the familiar lightness of her return touch. Her still fingers were damp and cool. “Well, maybe not.

  “I don’t know what to say, Rock. A politician, figure that. For the first time in my life, I’m at a loss for words.” He paused, eyes growing moist. “We’ve been through a lot together, haven’t we, Rock? Thick and thin. Good times and bad. I just want you to know that I’m here for you now, for however long it takes.

  “I’m not ready for you to leave yet, kid,” he continued, voice choking. “I want more time with you. Call it selfish, but that’s the way I feel. Don’t go, Rocky, I’m begging you. Fight it—fight it with all you’ve got.

  “When you’re ready to wake up, I’ll be here.” As Meredith stood up, a tear rolled down his cheek. He leaned over the rails and kissed his wife on the cheek. “I’ll always love you, Rocky.”

  Second only to international terrorist attacks, the assassination attempt on the first lady was the most moving event of the fledgling twenty-first century. The entire nation waited expectantly for any news about its beloved Roxanne Meredith. Regular TV programming was temporarily cancelled on all major networks, and news coverage of the shooting filled cable and the airwaves twenty-four hours a day.

  Gifts, letters, and flowers sent to the White House numbered in the hundreds of thousands. The White House staff was overwhelmed. Federal funds were allocated to rent temporary storage and processing space for the gifts. The White House staff was edgy if subdued, and President Meredith was in seclusion.

  The nation’s sense of personal injury was balanced by its feelings of outrage. By seventy-two hours after the shooting, it was becoming clear what had happened. By correlating the wound channel in the first lady’s neck with testimony of Secret Service agents on the scene, ballistic experts were able to trace the fatal bullet’s trajectory. The shot unquestionably came from the roof of the University of Maryland’s School of Social Work. Moreover, markings of the eighty-five grain, six-millimeter projectile revealed that it came from the rifle found next to the unidentified dead man on the school’s roof.

  Although the manufacturer’s name and serial number had been filed off the rifle, it was obviously a custom weapon. FBI ballisticians were able to read the erasures and were soon in touch with the manufacturer, who confirmed that it was one of their products. The number of rifles made in that chambering was small. Within twenty-four hours, the FBI had tracked down all customers except one. The man who remained missing was the American-born man of Palestinian descent who sold firearms in California. A nationwide manhunt was immediately begun.

  As each new piece of information became available, it was relayed to an incensed nation. The country demanded justice. Although the olive-skinned man on the roof was initially unidentified, on day three—with the assistance of Interpol and the Israeli Mossad—they got a fingerprint match. The dead man was identified as Mahmoud al-Abed, a Palestinian wanted by the Israelis for terrorism. That identity, coupled with the missing California man’s purchase of the attempted murder weapon, clinched it for most Americans. The enemy had a face, and it was Palestinian. What was not nearly as apparent was who had killed the shooter, and why.

  “This is not good, C.J. Certainly not what I expected.”

  “That boy was a shooter, Sean. A head shot, at that range? Damn,” Walker protested, “I still can’t see how he could have missed. Must’ve been that pipsqueak cartridge he was usin’. I told ya, if he’d a fired a decent .308….”

  “That’s ancient history now. The point is, we wanted to send a message. With her still alive, people are more sympathetic to Administration policies than ever.”

  “You want me to take care of it? I might be able to figure out a way to get in there.”

  “No, it’s too late for that,” said O’Brien. “We had one chance, and that was it. No, I’m going to have to figure out a new angle. Maybe go after the man himself, who knows. But there’s one thing we’ve got to be sure of.”

  “You name it.”

  “If anyone—and I mean anyone—gets close to what’s really happening, that person’s got to be taken care of immediately, understand?”

  For twenty-four precarious hours post-op, Rocky clung to life. She was every bit as much of a fighter as her husband had predicted. On two occasions her blood pressure fell precipitously and her heart threatened to stop, but the team at Shock Trauma successfully juggled IV medications to bring her vital signs back to acceptable levels. Finally, early on the morning following her surgery, her condition was deemed to have stabilized.

  The news was relayed by a pool reporter, the only journalist permitted in Shock Trauma. Over the airwaves, virtually all TV programming had been preempted by news of the assassination attempt and the first lady’s condition. A grateful nation gave a guarded sigh of relief when her condition was updated. But she was in deep shock, still in critical condition.

  Both the president and Dr. Douglas remained in the unit for thirty-six hours.

  Shock Trauma had sleeping areas for staff, and the neurosurgeon managed to steal catnaps in one of the on-call rooms. Meredith, however, couldn’t sleep. He alternately paced to and fro or informally attended to Administration duties in the secure space reserved for him and presidential staff. By mid-morning, Douglas called the president aside.

  “If I could be so bold, Mr. President, this is going to be a long, slow process. Your wife is gradually improving. I’m fairly confident that, barring some catastrophe, she’s going to survive. But there’s nothing to be gained by your hanging around every minute.”

  “It sounds like you’re kicking me out.”

  “No, sir, but I wish I could. I’m not your doctor, but I can tell when someone needs rest. Also, you’re making the staff here nervous as hell. They don’t function like they should with the president looking over their shoulder.”

  “Come on, Doctor,” Meredith protested, “I’m not looking over anyone’s shoulder. I’m just a husband concerned about his wife.”

  “And I appreciate that. I’d do the same thing. But you’re no good to her like this. You can’t take care of someone else if you don’t take care of yourself.”

  The president’s head sagged, and he sighed deeply. “You’re right. I just needed someone to tell me. I presume I can come back whenever I want, though? No silly visiting hours restrictions?”

  “You, sir, are welcome any time.”

  For the next several days, the president helicoptered back daily, staying three to four hours at a clip. Rocky’s condition continued to improve, but in tiny increments. Importantly, she showed no signs of infection, and her critical bodily functions, such as cardiac output, kidney function, and respiration, were strong. Throughout, her ICP readings remained excellent. Unfortunately, however, she showed no signs of waking up. Douglas told the president that this could occur unpredictably. Rocky might open her eyes at any moment, or she could remain in a coma for many, many months.

  President Meredith’s intense worry was palpable. His shoulders sagged, and deep bags hung beneath his sunken eyes. To those around him, there was no question that his concern was profound. He delivered a brief, televised address about his wife’s condition and promised the nation that with everyone’s help, he would persevere. When he finished, his eyes were red and his legs weak.

  Only Jon noticed that the president’s tremor seemed more pronounced than ever. Jon also thought that some of Bob Meredith’s difficulty standing was due to a balance problem rather than emotional weakness alone. He was still waiting for the results of the president’s spinal tap, which should arrive any day. In the meantime, Bob had asked for something to help with his
nerves. Jon wanted to avoid any drugs that might impair memory, like the benzodiazepines. He ultimately prescribed small doses of trazadone to help the president sleep, along with Zyprexa to control anxiety.

  On the political front, there was a lot of posturing. The Palestinian authorities, while expressing condolences for the first lady’s injury, vehemently denied any complicity in the assassination attempt. The Americans were friends and honest brokers, they claimed. What motive would they have for wanting Mrs. Meredith dead?

  The reaction of the American people was equally vehement, although mixed, reflecting a split in approach. Half of the electorate demanded immediate retaliation, although how, and against precisely whom, wasn’t clear. The other half favored a dump-the-Arabs approach in which the U.S. removed itself from any involvement with Arabic causes, Middle Eastern oil, and Islamic considerations. In the end, America renewed its centrist approach, favoring the president’s former priorities—at least temporarily.

  A week after Roxanne was shot, the president’s final test results came in. The routine blood tests were of little diagnostic help. Blood chemistries, blood count, and the differential count were generally normal, except for slight elevations of BUN and creatinine. The neuroimaging studies, including the CT scan and MRI, revealed no tumor, but suggested increased T2 signals in the thalamus and the striatum. The “official” EEG report corroborated Jon’s initial impression of background slowing, but the examiner’s interpretation of the spikes was much more specific. According to the report, the sharp wave complexes were highly suggestive of CJD, or Creutzfeld-Jacob Disease.

  When he first got the report, Jon was shaken. CJD was a degenerative neurologic disorder that might account for the president’s dementing symptoms. Pathologically, it was characterized by deposition of amyloid material in the brain, eventually causing the brain to develop a spongy appearance. Taken as a whole, the spectrum of diseases like CJD were called transmissible spongiform encephalopathies, infectious cerebral amyloidoses, or prion diseases.

  Such diseases were caused by the prion, a protein-containing infectious particle. The most notorious prion disorder was European mad cow disease, in which spongiform encephalopathy was transmitted to humans through contaminated beef. The tragedy of the disease was that it was progressive and invariably fatal. All that could be offered the patient was good nursing care, symptomatic relief, and palliative measures. Jon shook his head. He didn’t relish the thought of conveying this sort of news to the president.

  But however suggestive the EEG, it wasn’t the final word. Since the most definitive test—examination of actual brain material—was impossible, the spinal tap results would be crucial. The cerebrospinal fluid, or CSF, of patients with diseases like CJD often contained abnormal proteins, like neuron-specific enolase, S-100 glial protein, tau protein, and a significant player called 14-3-3 protein.

  It took several weeks for the CSF results to come in. Waiting for them to arrive, Jon was very apprehensive. He didn’t want to consider the fact that, on the heels of the first lady’s shooting, the president might be diagnosed with a disease that could kill him within a year. Jon was in his office when the CSF reports were hand-delivered. When he looked at the values, he was crestfallen.

  Levels of CSF 14-3-3 protein were definitely elevated. The test was not diagnostic of a prion disorder, and could be raised in cases of herpes, metabolic or toxic encephalopathy, metastatic cancer, and hypoxia. But his patient didn’t have those other conditions. Given the 14-3-3 level, the EEG, and the president’s symptoms, Jon was ninety-five percent certain that Bob Meredith had a prion disorder.

  He shook his head as he let the report fall to his desk. This was precisely the sort of news an ailing country didn’t need. Jon hadn’t the faintest idea how to break the news to the president. Medical schools didn’t teach precise ways of delivering bad tidings. Every physician developed his own method of conveying the worst. In Jon’s case, when the need arose in terminal HIV or cancer patients, he delivered an upbeat version of the “there’s always hope” approach. He thought it might improve the patient’s attitude, or work by placebo effect. In any case, it certainly helped him.

  Jon knew he also had to inform the chief of staff and the vice president. Both were pragmatic men who understood the political ramifications far better than he did. The news would undoubtedly derail the reelection process. A disease like CJD was far more significant than the Alzheimer’s Mitch Forbes had postulated. With the president’s permission, Jon would certainly talk with the chief of staff—but only once he was certain.

  The problem with ninety-five percent certainty was that there was always a loophole of doubt. Indeed, something about the diagnosis nagged the back of Jon’s mind. He couldn’t put his finger on it; and until he could, he’d keep his diagnosis to himself.

  Equally important were the questions of how, and why. Contrary to public belief, few cases of spongiform encephalopathy were contagious. Most were actually sporadic in nature, or familial. But there were some notable exceptions, like mad cow disease and some disorders found in the South Pacific.

  Could that be a factor? he wondered. The more Jon thought about it, the more he wondered if he already knew the answer.

  One Year Earlier Hanoi

  “Air Force One, on heading one-six-zero degrees, descend and maintain flight level one zero zero,” said Hanoi control.

  “Roger. Air Force One descending to flight level one zero zero, heading one-six- zero,” replied the captain.

  “Air Force One, contact Hanoi approach control on one-two-one-point-zero.”

  “Roger. Approach on one-two-one-point-zero. Good day.”

  Air Force One was thirty miles from Hanoi and descending through the clouds for a landing on runway eleven at No Bai International Airport. President Meredith was a hands-on passenger who often flew up front with the cockpit crew. Nearing the end of their long flight, he and Dr. Townsend went forward as the 747 began its descent. They strapped themselves into jump seats behind the crew.

  “What are you feeling, sir?” Jon asked.

  “God, it’s weird. When I left this godforsaken country, I never thought I’d return. But here we are survivors of a bygone age. And they’re actually welcoming us back.”

  Through the cockpit windows, the coastline was rushing up toward them, and beyond it were the lush green hills of their former enemy. “This place still gives me the creeps. When I look out there,” Jon confessed, “all I feel is terror.”

  “I hear you. But we’re both marines, and marines get the job done. This time, on our own terms.”

  The long-delayed trip to Vietnam was an integral part of President Meredith’s policy of economic globalization. The visit had two goals, both of which arose after the 1994 lifting of the trade embargo. One was to draw Vietnam out of its self-imposed economic isolation, and the other was to suggest that prosperity in the information age required a measure of political openness and the free flow of information. Ultimately, the president hoped to loosen state control that had choked the local economy and sent foreign investors fleeing.

  The apprehensive body language of the men in the jump seats made it clear that the trip was more than a state visit. By facing the demons of their past, they were confronting their fears, putting closure on a chapter in their lives that should have ended a generation ago. As the airport became visible, they shared a feeling of deja vu, for Air Force One was descending through the same skies that were once thick with B-52s.

  “Air Force One, this is the final controller, turn left now to heading one-four-zero. Descend and maintain two-five-zero-zero feet, Intercept ILS/DMR runway eleven. Cleared approach.”

  “Left turn one-four-zero,” said the captain. “Descending to twenty-five hundred feet. Cleared to intercept localizer, cleared for the ILS/DME runway eleven approach.”

  “Air Force One,” said the final controller, “you are established on the localizer, runway eleven. Contact Hanoi tower at Charlie, frequency one-one-eig
ht-point-two. Good day.”

  Slowly, the huge 747 lined up with the runway. It came in low over rice paddies once pitted with bomb craters but that now bore billboards advertising Korean made electronics. Soon the jumbo jet landed and taxied to a stop near the hangar. There was a brief welcoming ceremony, and then a motorcade sped the president and his entourage over the Red River into Hanoi.

  En route to the president’s hotel, there were thousands of onlookers lining the streets. The curious bystanders waved constantly, but didn’t cheer. It was the largest motorcade the city had ever seen, and children were held aloft to glimpse the most powerful leader in the world. Curiously, the president’s limo had Washington, DC license plates, with the Vietnamese flag on one front fender, and the Stars and Stripes on the other.

  It was to be a three-day trip. After the visit to Hanoi, the presidential party would go to Quang Tri Province on day two before heading to Ho Chi Minh City, the former Saigon, on the third and final day. Jon was in a limo several cars behind the president. He didn’t notice he was clenching his fists until halfway through the drive.

  The scene around him was surreal. Hanoi was a charming city that retained the flavor of France in its architecture and tree-lined boulevards. It was a city of orderly landscaping and a dozen lakes and the ever-present aroma of food prepared by street corner vendors. People were everywhere, on foot, or on bicycles. Everyone looked young. If anyone besides Jon and the president remembered the war, it had to be a distant memory.

  A gala state dinner was held the first night. The next day, while the first lady remained in Hanoi for a well-publicized shopping trip, Jon, elected officials, and the press helicoptered to the area of the abandoned fire support base Ross. The trip was intended to be symbolic of the American desire to keep the war in the past. But once on the ground in the hamlet that arose where the base had been abandoned, the sights and smells of the village carried Meredith back in time.