by David Shobin
Flanked by Secret Service agents and Vietnamese security, Jon and the president strolled through the ratted dirt roads grown soft with winter mud. Insects buzzed around their heads, and pot-bellied pigs squealed when driven from their path. Occasional thatch-roof, stilted huts were beside the road, but most structures were the hauntingly familiar hootches. Women in colorful sarongs peered from doorways, and the silent, dark-eyed babies on their backs resembled dolls.
“Smell that?” asked the president, nose to the air. “This country never lacked for smells. Gotta be chicken.”
“I’d bet on pork,” Jon said. “Might be fish, but we’re pretty far from the coast.”
“What I remember most is the smells. The smells and the heat.” His gaze slowly fixed on the villagers watching him, and as it did, a smile spread across the president’s face. “Well, will you look at that. I don’t believe it.”
“Sir?”
“Last time I saw that guy, he was wearing a camo shirt, a loin cloth, and a bandoleer. At least, I think it’s him.”
Jon spotted the man Meredith was staring at. The short Vietnamese appeared to be Bob’s age, although his withered face was deeply corrugated by the sun. “You recognize him?”
“We called him Joe. Then, we called everyone Joe. I never knew his real name. Dave,” the president said to Agent Saunders, “see if that guy knows me. If he does, bring him over.”
“Was he ARVN?” Jon asked.
“No, Hmong tribesman. Know anything about them?”
“Just the name.”
“The Hmong were good guys. They’re mountain people, over near Laos. They served in guerrilla units. A lot of them fought with the Special Forces. I met them on some ops way up into the mountains.”
“This Joe, he was a guide?”
“A scout, mainly. He knew the territory, and we needed him on recon. The Hmong cooked for us, guarded us, and carried us when we were wounded. They wrapped up the bodies of guys who got killed. About twenty thousand of them were KIA.”
The short, silver-haired man who accompanied Saunders had a smile that broadened with each approaching step. He wore a khaki shirt and trousers and carried a small lacquer box. He bowed when he reached the president.
“Is that you, Joe?” Meredith asked.
“Yes, Captain Bob. It is me.”
“Well, I’ll be damned. Come on over here!”
As the president stepped forward to bear hug the smaller man, Saunders deftly pulled away the box, not knowing what it contained. Numerous cameras caught the embrace. Meredith towered over his old ally. At length, he pulled away.
“You haven’t changed, Joe. I’d recognize you anywhere. Everybody,” he said, addressing those around him, “this is my buddy Joe, an old friend of mine. He sure saved my ass a time or two. So, how’re you doing, old friend?”
“Very good, Captain Bob. I know you are president now. I have family in Milwaukee. Someday, I will visit.”
“I’m sure we can help you there. What’s in the box?”
“You remember the night I cook for you, in the mountains? You tired, you not want to eat, but I cook for you, remember?”
“Oh Jesus. Is this what I think it is?”
“Danh tor.”
The president opened the lacquer box, which emitted a pungent aroma. “I remember all right. Danh tor He showed the contents to Dr. Townsend.
Jon squinted. “Looks like eggs in barbecue sauce.”
“Actually, Doc, it’s brains. Monkey brains in nuom mam sauce. It probably saved my life in 1970, and I sure as hell am not going to refuse it now.”
“Sir, I’m not so sure….”
“Don’t worry, I’m just going to taste it. Let’s go over to the hooch with the pork, and we’ll have a little photo op for the press.”
Thinking back, Jon wondered if the president’s impulsiveness in Vietnam had been a deadly mistake. He didn’t have to taste the gift; he only had to accept it. But Meredith was a very demonstrative man. Was it possible that he’d contracted a prion disorder from eating contaminated monkey brains?
Infected animal brains were a rare but recognized source of human prion infection. Members of certain tribes in New Guinea, for example, contracted a disease called Kuru through cannibalism. In the U.S., isolated Appalachian hill folk developed spongiform encephalopathy from eating infected squirrel brains. Although Jon wasn’t aware of it, he thought it possible that the brain tissue of monkeys could also be a vector.
But even if it were possible, Jon doubted he could prove it. After the Vietnamese photo op, the Hmong known as Joe melted away, returning to his people. To now send research teams into the mountains searching for infected monkeys would take months, perhaps years. In the meantime, the president was deteriorating. Therefore, although this mode of transmission was theoretically possible, Jon couldn’t be certain. He’d have to rely on his judgment. And his most educated guess said President Meredith had a prion disease.
Where it came to the president’s life, no physician wanted to guess. But the art and science of medicine didn’t always provide cut and dried answers. Sometimes, one had to go with one’s best impression. For now, at least, an unusual prion disorder was Jon’s diagnosis, and he was sticking to it. Yet the whole clinical picture nagged him, like threads hanging loose from a sleeve. He couldn’t put his finger on it, but he had a sense of incompleteness, of something lurking, the way a distant memory hovers just out of recollection.
When he would ultimately convey his diagnosis to the president, Jon wanted to have maximum certainty about his professional opinion. Right now, he just didn’t have it. He’d promised Bob an answer, but he hadn’t been pinned down as to when. He needed a little more time—time to mull everything over, to let things sort themselves out, perhaps to gather more information. Considering Roxanne’s illness, the president certainly had enough on his plate that delivering yet more bad news wasn’t imperative. When the time was right, Jon thought he’d know it.
He was eager to see Mireille again. The time they’d spent together was a blissful memory that lingered in his subconscious. He wasn’t sure where their relationship was headed, but he liked the general direction. Yet for everyone involved with the administration, there was such turmoil following the first lady’s shooting that finding quiet time was a near impossibility. Everyone felt the strain, and they were all living on the collective edge. Jon did manage to speak with Mireille every day, however. They both hoped to get together as soon as possible.
As the CNN talk show was winding up, the moderator asked each participant to sum up his viewpoint. The subject that night was U.S. policy in the Mideast. Since the shooting of the first lady, the average American’s opinion had changed considerably. The opinions of the guest congressman and senator differed considerably.
“The time has come to rethink our relations with all the Arab states,” said the congressman. “Time and time again, we’ve tried to be evenhanded in the region, and you can see where it’s gotten us.”
“So, you would have us withdraw from the region entirely?”
“Well, I certainly wouldn’t send American troops in harm’s way. We’re not appreciated over there as much as we think. I’m not talking about geographic isolationism; I’m talking about retrenching. And maybe we should get tough with these guys instead of kissing their you-know-whats.”
“I love it,” said the senator sarcastically. “Excuse my French, but back in seventy-three they called it, ‘nuke their ass and take their gas.’ It didn’t make sense then, and it makes less sense now. I agree with the president’s strategy of constructive engagement. Now’s the time to circle the wagons, not get out of Dodge.”
“That’s not what most Americans are saying,” the congressman said.
“What about that, senator?” asked the moderator. “Since the assassination attempt on the first lady, most polls have shown that Americans want us out of the region by a three-to-one margin.”
“That kind of knee-jerk reaction
is understandable, but not helpful. The area is critical to us economically, politically, and militarily. Beyond that, hasn’t the president suffered enough already? I think we owe it to him to give his policies more time.”
“Congressman, you get the last word.”
“What a bunch of baloney.”
More quickly than anyone dared hope for, Roxanne Meredith’s clinical condition stabilized. A week post-op, she showed no signs of infection. Her skin sutures were removed and her head wound was clean. Her ICP catheter was removed. Her vital signs were strong and normal. Yet she simply lay there in an ongoing coma, eyes peacefully closed, her shaved head just starting to grow stubbly.
The president continued to visit no less often than every other day and was in nearly continuous phone contact with the unit. The first lady’s remarkable physical recovery made unchanging mental status all the more discouraging. She continued to be the nation’s most talked about female, but now all discussions about her regarded her coma. Everyone wanted Rocky to just wake up, make some lighthearted, self-effacing quip, and get on with mothering the nation. But it was not to be. President Meredith’s impatience with her condition was growing obvious.
“What the hell is going on, Doctor?” the president asked Douglas. “You keep telling me she’s getting better, but it doesn’t look that way to me.”
“With all due respect, Sir, what I think I said was….”
“I know damn well what you said!”
“—what I said was,” Douglas slowly continued, “that your wife continues to improve. But there are several aspects to improvement. The neurological aspect, the mental part, is the most unpredictable. There’s simply no way I can tell when she’s going to wake up.”
“But there must be some kind of tests!”
Douglas struggled to remain patient. He’d already been down this road with the president. Usually, he was accustomed to throwing his weight around, both literally and figuratively, anywhere from the playing field to the OR. But this was the president he was dealing with. “As I’ve explained before, sir, we use severed laboratory yardsticks. The imaging procedures, the MRIs and ultrasounds, have been helpful. We rely most on serial spiral CT results. These have shown definite improvement. There’s no indication of further bleeding and the swelling is way down. There is some destruction of brain tissue in the wound channel, but it’s not excessive. But unfortunately, there’s no lab test that can predict the level of consciousness. We’re just going to have to wait and see.”
“Wait? How long is it going to be until I get my wife back?”
“I’m sorry, Mr. President. I just can’t say.”
Maggie Valley, North Carolina
The small hamlet of Maggie Valley lay ten miles east of the Cherokee village at Oconaluftee. This was bourbon country, and the acrid smells of sour mash and illicit fermentation hung thickly in the air above the meandering backwoods roads. The slow- moving Ford van weaved unpredictably, as its driver was intoxicated. On the van’s front seat, between Smith and C.J. Walker, was a half-empty jug of white lightning.
“Ah cain’t believe he holds you responsible,” Smith growled. “Damn, warn’t your finger on the trigger.”
“If it had been,” said C J., spitting out the rolled-down window, “That’d be one dead woman.”
As he drove, smoke curled upward from the cigarette wedged between Smith’s yellowed fingers. His gravelly voice was a harsh rasp. “Shit, so what the hells’ he want us to do now? This was his bright idea to begin with!”
“He don’t want us to do nothin’, from what I can tell. ’Cept keep an eye out for anyone who comes too close.”
“Just sit on our ass, huh? Fuck that,” Smith grunted. “This is God’s work, C.J. We’ve come too damn far to back off now.”
“So, what’re you sayin’?”
“I’m sayin’ that if Sean O’Brien don’t want to do God’s will, we just might have to do it ourself.”
It was now December. Sunset came early, and it was dark well before five. Jon spent long hours at work. The various parts of his professional life were equally demanding, yet he did his best to pursue them all. Perhaps most important, he went to the White House every morning to check on the president’s physical and emotional health. Bob Meredith was a strong man of resilient character, and after several expectedly stormy days following his wife’s admission to Shock Trauma, he managed to move on with his life. Still, he was grateful his doctor was keeping an eye on him.
Jon’s patient load was as full as ever. As the winter neared and the temperature dropped, flu season was well underway. Many of his regular patients had become ill, including several VIPs, but not Senator Friedman. At her two-week follow-up, Jon was pleasantly surprised to see that she was doing well on the L-dopa. She was so impressed, in fact, that her committee was about to hold a round of hearings on fetal stem cell research.
Jon’s own research was moving ahead rapidly. Two weeks ago, when he had an abundant supply of fetal neural stem cells in purified culture, he began testing. Yet before he dared inject human beings—Ellen’s son, and particularly Tommie—he needed some idea of efficacy. He was reasonably certain stem cells would be helpful because of foreign reports in the literature where they seemed to be successful. Equally important, it seemed to do no harm. First, however, he had to test his batch on lab animals.
He used albino Wistar-Hannover rats, a general-purpose species. Around Halloween, three weeks before he began testing the stem cells, he’d anesthetized the rats and transected their spinal cords to make them paraplegic. He disliked harming lab animals, but for the purpose he had in mind, it couldn’t be helped. Dragging themselves around their cages on forepaws, the rats could feed normally. Once they’d recovered from their wounds, he could proceed.
Anesthetizing the rats once more, he used a hair-fine, thirty-gauge needle to inject their injured spinal cords with varying amounts of neural stem cells. Since this was an inter-species transplant from human to rodent, there would be considerable immune response. Therefore, he also administered anti-rejection drugs. He wasn’t looking for a cure. That wasn’t feasible between species, and even if it were, complete neural regeneration would take months. He knew he’d be satisfied just to see the nerves start growing again. This would only take several weeks. He should know by Christmas. If it were successful, he’d feel safe moving on with humans. When the injections were finished, all he could do was wait.
CHAPTER 19
For Jon, the weeks preceding Christmas passed with infinite slowness. President Meredith’s odd behavior and foibles were partially masked by the medication he took after his wife was shot. Those times he did appear to act peculiarly, his behavior was attributed to ongoing stress and concern. Jon felt pressured to firm up his diagnosis with the lab results, but the reports were endlessly delayed due to the source they came from. No one was willing to sign off on a presidential test without triple-checking the result and having it verified by a supervisor. For those exotic tests that had to be sent cross country, where specimens from the president had never been previously evaluated, the paperwork and duplication was even more pronounced. This was matched by the need for secrecy, which made the already stressed lab workers nearly schizophrenic. There was little Jon could do to speed up the process.
The already weeks-old investigation into the first lady’s shooting was going nowhere. It was a journalistic field day, and speculation was as boundless as solid clues were absent. A thick blanket of tension covered the country like a smoky pall, and preholiday festivities were subdued.
Jon was under extraordinary pressure, particularly regarding the lab results. Still, he carried himself with great dignity in his frequent visits to the White House. His own workload was monumental. He looked forward to a time when he could lie unencumbered on some distant beach, basking in the sun. Until then, his twin rays of sunshine were his daughter and Mireille.
“Jon,” the president said, calling him aside one morning, “I’ve always tr
usted your advice. I want a second opinion.”
“On what?”
“On Rocky. I know Dr. Douglas is supposed to be good—”
“He’s the best there is, Mr. President. I checked his credentials myself.”
“Then….” Meredith sighed and slowly shook his head. “Then why isn’t she coming around already? And don’t give me any of this ‘it takes time’ shit!”
Bob Meredith was anything but a stupid man. Jon knew that Douglas had emphasized the gradual nature of the first lady’s neurological progress, and he knew that the president understood that, at least logically. But as Jon looked into the president’s eyes, he detected just a hint of mania. He realized that the president’s impatience was just another aspect of the medical problem that was affecting him.
“All right, Bob, I won’t. But I can honestly tell you my opinion won’t differ at all from Dr. Douglas’. And my advice would be the same.”
“But there must be something else that can be done. For God’s sake, it’s been weeks already!”
“Mr. President,” Jon calmly continued, “the standard medical treatments—”
“To hell with standard!” Meredith fumed. “We’re talking about my wife here! Surely there must be something new, different. Experimental, even—isn’t there?”
This caught Jon by surprise. “You’d be willing to try something experimental on the first lady?”
“If it meant the difference between her remaining in a coma and returning to the person I know and love, you’re damn right I would!”
“Okay, Mr. President,” Jon said, a new possibility suddenly occurring to him. “I’ll look into it.”
The week before Christmas, Jon was finally visited by good news. During his last visit to his lab at the NIH, Jon began his first test of the injected mice. He was using a miniature EMG, an electromyograph, a machine that recorded electrical currents in muscles. Atrophied muscles downstream from damaged nerves traced a characteristically flat, denervated pattern. If, after the stem cell injections, he could record restored electrical activity, he could conclude that the experiment was successful—and human treatments could begin.