Patient One (26 page)

They entered the President’s room on tiptoes. Merrill was dozing fitfully, twisting and turning and mumbling under his breath. His vital signs were stable, but the fluid in his nasogastric tube was now deep pink, with small blood clots floating in it.

“He’s starting to bleed again,” Carolyn said quietly.

David nodded. “And we have no more blood or plasma to give him.”

“Is there anything we can do?”

“We ran out of options an hour ago.”

David sighed heavily to himself, thinking that University Hospital was about to become even more famous for the wrong reason. Like Parkland Memorial Hospital in Dallas, where John F. Kennedy was pronounced dead, University Hospital in Los Angeles would now be remembered as the place where another charismatic American president died at the hands of others. And what was done and not done would be second-guessed for decades to come. David gazed over at the President and the blood-tinged fluid coming out of his stomach. It was only a matter of time now.

The stillness in the room was suddenly broken by a loud wheeze coming from the ceiling.

There was another wheeze, then another, followed by a raspy cough.

The panel above them slid open and Karen lowered her head out of the ceiling crawlspace.

“David!” Karen gasped and tried to suck air into her lungs. “I need an inhaler!”

David hesitated, wanting her to wheeze and choke for being part of a terrorist group. But his professional code of conduct gnawed at his conscience. He couldn’t let anybody with a treatable medical condition suffer. He just couldn’t. He turned to Carolyn. “Hand me one of the epinephrine syringes.”

Carolyn reached into her pocket and held out the syringe.

At that moment Aliev burst into the room and stared at David and Carolyn. He didn’t see the ceiling panel move back into place.

Everything went silent except for the soft clicks coming from the President’s monitors.

“Why all the noise?” Aliev demanded.

“The President had a coughing spell,” David answered.

Aliev glanced around the room suspiciously, then tilted his head back as if sampling the air. Gradually his eyes drifted down to Carolyn and the syringe she was holding.

“What is in the syringe?” he asked hoarsely.

“Epinephrine,” Carolyn replied.

“What is it used for?”

Carolyn thought quickly, and said, “For cardiac problems.”

“Is the President having this?”

“His heart beat is becoming weaker,” Carolyn lied.

“See that he stays alive.”

Aliev spun around and headed for the door. Just before he reached the corridor a loud wheeze sounded from the ceiling. Then another came, louder yet and more prolonged.

Aliev hurried back into the room and pointed his Uzi at the ceiling. Without emotion he squeezed the trigger, firing round after round until the panels above were peppered with bullet holes. Then he stopped and listened.

There were several seconds of silence before a weak female voice cried out, “Help me! Please help!”

Aliev yelled orders in Chechen to the two terrorists who were standing in the doorway. One of the men jumped up on the President’s bed and hurriedly removed ceiling panels. With a grunt he reached into the crawlspace and pulled Karen’s blood-spattered white blouse into view. The second terrorist helped him lower Karen onto the floor.

In a split second David was at her side. He ripped open her Oxford blouse and saw a sucking chest wound. With each inspiration, air was being sucked into the pleural space, putting pressure on the nearby lung and causing it to collapse. Karen was gasping for air, her skin becoming cyanotic.

David hurriedly turned to Carolyn. “Do we have a chest tube on the ward?”

“No,” Carolyn replied. “And nothing that will substitute for one either.”

David looked up at Aliev. “She needs a chest tube, which we don’t have on the Pavilion, or she’ll die.”

“Then she dies,” Aliev said, not caring. He motioned one of the terrorists. “Put her in the bathroom out of the way.”

As Karen was being dragged away, Carolyn reached unnoticed into a nearby medicine cart and retrieved a pack of Vaseline gauze.

“So no one else was in the ceiling with you, eh?” Aliev spat at David.

“I never saw her,” David said evenly. “She must have been hiding.”

“Do you expect me to believe that?”

David shrugged. “It’s the truth.”

“One more truth like that and you’ll find yourself dead.”

Aliev signaled to the other terrorists and barked an order in Chechen. They followed him out of the room.

David dashed into the bathroom, with Carolyn a step behind. Karen’s sucking chest wound was now shrouded with frothy blood. Her skin was growing even darker as she struggled for air.

David placed his hand over the wound and turned to Carolyn. “We need some sort of patch.”

“Like this?” Carolyn asked and handed him a packet of Vaseline gauze, along with a roll of electrical tape.

“Perfect!”

David quickly covered the wound with a thick layer of Vaseline gauze, then began to tape it in place.

“Don’t forget to leave one end open to act as a valve,” Carolyn advised.

David smiled at her. “Where did you learn so much about treating a pneumothorax?”

“As a flight nurse on a MedEvac helicopter,” Carolyn replied before injecting Karen with epinephrine to abate the asthma attack. “We saw at least one case a week.”

With the patch in place and the epinephrine starting to work, Karen’s breathing and color improved. She slowly took long, deep breaths, savoring each one.

“Better?” David asked.

“Much,” Karen said, grimacing with pain. “And thanks for saving my life—again.”

David’s face hardened. “If it had been the Secret Service rather than me, they’d have let you die.”

“You can’t be serious.”

“Oh yeah,” David went on. “They know you’re part of the terrorist group.”

Karen’s eyes bulged. “What!”

David repeated the accusation, then gave her details. “They know you worked in Chechnya, that you contributed to the Chechen charity that’s a known terrorist front, and that you switched your on-call date so you would be in the hospital the night the terrorists attacked.”

“That’s insane!” Karen argued vehemently, despite the discomfort in her chest. “Of course I worked in Chechnya. So did dozens of other foreign doctors. And everybody contributed to that relief fund. We were told it was the quickest and surest way to get money to the hospitals.” She coughed briefly and this worsened her chest pain. Clenching her jaw, she went on, “If you had seen the torture and rape victims and the little children with their limbs blown off, you would have written checks, too.”

“And what about the switch in the on-call schedule?” David asked pointedly.

“I didn’t request that,” Karen said without hesitation. “Harry Summers did. It was his twentieth wedding anniversary and he had a special dinner planned for his wife. They can check that out with Harry.”

David nodded slowly, thinking that all the evidence against Karen had been circumstantial and easily explained away. “It seems like they really had you pegged wrong.”

“I’ll say.” Karen winced as another sharp pain shot through her chest. “If I don’t make it and you do, make sure you clear my name.”

“I’ll take care of it,” David promised.

“And one last thing,” Karen told him. “I’ve got some pre-filled syringes of Propofol in my blouse pocket. I was going to use it as a general anesthetic for the President’s endoscopy.”

“So?”

“So, if you’re able to subdue any more of the terrorists, you can inject them intravenously with the Propofol. They’ll be out for hours.”

“Won’t I have to dilute it?”

“Fuck ’em!” Karen spewed. “If the concentrate makes them go too deep, it’ll be a bonus.”

David grinned at the unexpected profanity and patted her shoulder reassuringly. He fetched the syringes of Propofol from her blouse and hurried back into the President’s room. There was a guard at the door, but his back was to them.

David leaned over to Carolyn and said, “She’s not out of danger by any means. If that seal doesn’t hold, she could die in minutes.”

“I’ll keep an eye on her,” Carolyn whispered, then lowered her voice even more. “David, you’ll have a hard time injecting Propofol into a vein if the terrorist is squirming around.”

“It’ll be easier to stick it into an artery,” David whispered back. “That may kill him, but who the hell cares?”

Carolyn looked toward the bathroom, still keeping her voice down. “I never really believed Karen Kellerman was a traitor.”

“I did,” David said honestly. “But I’m glad she’s not.”

Behind them the President groaned loudly. They looked over and watched him continue to twist and turn, but now he was awake. Their gaze went to the fluid in the nasogastric tube. It was filling up with poorly formed blood clots. All hell was about to break loose.

Twenty-nine

The fluid in the
President’s nasogastric tube rapidly turned bright red in an instant. His bleeding was coming back with a vengeance.

“How are you doing, Mr. President?” David asked.

“Not as well as I’d like,” Merrill complained mildly. “And this tube in my nose is bothering the hell out of me. Is there any chance we can remove it?”

“No, sir,” David said. “We need it to lavage your stomach.”

Merrill’s face grew concerned. “Am I bleeding again?”

David nodded but downplayed it. “Oozing is a better description.”

“Christ,” Merrill muttered.

David motioned over to Carolyn to restart the ice-water lavage, then glanced at the cardiac monitor. The President’s blood pressure remained borderline low at 98/60, which meant he was still volume depleted. And now he was bleeding more.

“What are those terrorists doing?” Merrill asked around his nasogastric tube.

“They haven’t killed any of the hostages so far,” David replied. “If that’s what you want to know.”

“But you think they will?”

“I know they will,” David said bluntly. “Unless their demands are met.”

Merrill sighed to himself, wondering how far negotiations had gone with the terrorists. “Has there been any talk of releasing those Chechen prisoners?”

“It sounds as if some have been flown out of Guantanamo Bay,” David answered.

But to where, and for how long?
Merrill asked himself. Flying prisoners out and releasing them altogether were two different things. He couldn’t be sure if an exchange was underway, or if the move was just a stalling tactic. “If there’s to be some sort of prisoner swap, I want my wife and daughter to be the first ones out. Understood?”

“Understood, Mr. President.”

“David,” Carolyn called over and pointed to a syringe filled with gastric juice. It was redder yet and now contained only a few small blood clots.

David and Carolyn gave each other knowing glances. Things were going sour again, and quickly. Merrill’s condition would soon become critical if he didn’t receive blood or an infusion of Factor VIII. Since neither was going to happen, it was only a matter of time before the President bled out and died.

David’s gaze went back to the monitor. The President’s blood pressure was unchanged, but his pulse was rapidly increasing. It was up to 112 per minute. A bad sign.

The President urgently needed another transfusion, David told himself.
Somehow I’ve got to get him fresh blood, and fast. But how do I do it? The terrorists won’t let anybody or anything come up to the Pavilion. And I’m too weak to give any more of my blood.
David groaned inwardly. He was out of therapeutic options, and he knew it.

“David,” Carolyn broke into his thoughts and gestured to Merrill’s nasogastric tube. Now pure blood was flowing up through it.

“Crush up some ice and flush out his stomach with small pieces of it,” David ordered out of desperation. “And let the ice chips remain in his stomach longer.”

Carolyn tried the maneuver over and over, with only a modicum of success. The President’s gastric juice was just a little less red than before. “I think the bleeding is slowing some, but not by much.”

“Keep the lavage going,” David directed. “Hopefully, we can stop him from really bursting loose.”

“I don’t think we—”

“Shhh!” David quieted her, now picking up the sound of helicopters in the distance. There were at least two of them. They seemed to be coming and going, like they were circling the medical center. David pricked his ears and concentrated on the distinctive put-put noise.
They were Black Hawks! Attack helicopters! It had to be the Secret Service team! The rescue attempt was starting! Good! Good!

David felt the adrenaline rushing through his system, all senses suddenly heightened and alerted. Quickly he cleared his mind and pondered what he could do to assist. He was the man on the inside, and that was worth three coming through the front door. But he could only help if he knew what they were going to do. He had to know their plan. Most importantly, he had to know if his earlier message had gotten through. Was it to be like Mogadishu? Or had they chosen another way in?
I’ve got to know! Then I could give the President some protection!

David hurriedly glanced around for a means to communicate. The suite’s phone had been ripped from the wall, and his personal cell phone was long gone.
What about breaking a window and sending down a message in a bottle?
he asked himself. No good. The terrorist at the door would hear the glass shattering. And even if he didn’t, no one would notice a small bottle dropping down at 1:45 a.m. in the black, misty air. The Secret Service might have their eyes glued on the President’s window, but they’d never see—

David suddenly blinked.

In a flash the answer came to him. He leaned closer to Carolyn and whispered softly, “I’m going to walk over to the window. When I get there, I want you to place yourself between me and the guard at the door. Block his line of vision as much as possible.”

“Why?” Carolyn whispered back.

“Just do it,” David urged.

He ambled over to the window and waited for Carolyn to move into position. Then he reached for his pocket flashlight and quickly put his hand under the blanket covering the window. When the sound of the Black Hawks grew louder again, he began sending a message in Morse code, using his flashlight.

N-E-E-D T-O K-N-O-W

M-O-G-A-D-I-S-H-U O-R N-O-T

David peeked around the edge of the blanket and searched for a response. He saw only blackness. Perspiration started trickling from his neck and down his back. His pulse began to race as the guard standing in the doorway turned sideways. David hurriedly peeked out again and scanned the darkness. There was still no answer.

Come on, goddamn it!
he growled inwardly, and sent out the message once more.

The sound of the helicopters faded as David’s spirits sank.
My phone message to the Secret Service didn’t get through! They don’t know what the hell I’m talking about, and I don’t know which way they’re coming in. Not via the roof again,
he hoped.
That would be suicide for the agents, and for a lot of the hostages.

The guard at the door barked loudly in Chechen at David. Then he repeated the order and waved his Uzi toward the President’s bed.

David saw the look of displeasure on the terrorist’s face. The guard didn’t like him standing by the window. David pulled at his collar as if he were warm and getting a breath of air.

The guard grunted his disapproval, then reached into his back pocket for a plastic bottle of water. He took a big gulp and gave David another stern look. But before he could bark out another order, a loud yell in Chechen came from down the corridor. The guard hastily placed the plastic bottle on a chair just inside the door and rushed out of the room.

David watched the terrorist disappear from sight, then quickly glanced out into the heavy mist. He couldn’t see the helicopters, but he could hear their sounds. They were closer now. An attack had to be imminent! But where and how? And how could he help without drawing the terrorists’ attention? Just stepping out into the hall could get him killed. His eyes went to the door. The guard was still gone, but that wouldn’t last for long. David’s gaze dropped down to the guard’s bottle of water sitting on a chair beside the door. It was open. No top. He thought of a way to better the chances of the rescue team.

David hurried over to Carolyn and asked, “Did you get those vials of Valium for the President?”

“Yes,” Carolyn answered, then told him about the injection she’d given the wounded terrorist. “He got ten milligrams of Valium intramuscularly.”

“Perfect,” David praised. “How many vials do you have left?”

“Two.”

“What’s the dose in each vial?”

“Fifty milligrams of Valium in ten ccs.”

“Draw up ten ccs in a syringe for me.”

While he waited, David looked out into the black night again. And again he heard the helicopters but couldn’t see them. Now they appeared to be circling the medical center.

“Here you are,” Carolyn said, handing him a syringe filled with liquid Valium. “What’s it for?”

“You’ll see.” David dashed over to the open bottle of water and estimated its contents. It was a 500-cc bottle that was a quarter full, and that meant it held approximately 125 ccs. Quickly David squirted the Valium solution into the bottle, swirled it around, and placed it down on the chair.

“Did you put the whole vial in?” Carolyn asked.

“Every drop.”

“It has a preservative in it,” Carolyn warned. “He might taste it.”

“That’s a chance we’ll have to take.”

Carolyn smiled slyly. “If he drinks the whole damn thing, he’ll sleep for days.”

“Or longer.”

David raced back to the window and peered around the edge of the blanket, searching and hoping for a response from the helicopters. He saw only darkness.
Come on, damn it!
He desperately tried to think of another message to send to the Secret Service. In it he would have to identify himself and ask about their planned point of entry.
Jesus! How can I do that and keep the message short?
In the distance he heard the sound of an approaching helicopter. It grew louder and louder, then seemed to hold its position. David pulled the blanket back a little more and scanned the night. A light began to flash intermittently in the darkness. They were answering his message! It read:

M-O-G-A-D-I-S-H-U

0-2-0-0

“Yes,” David hissed softly, his spirits soaring. He glanced over his shoulder at the door. The guard still hadn’t returned, but now there were footsteps in the corridor. David hurriedly turned back to the window and tried to come up with a way to warn the Secret Service of an impending nuclear attack. And tell them how the weapon was going to be delivered.
How do I do that? How? Just say it, goddamn it!
He rapidly flashed out a final message.

N-U-K-E O-N P-L-A-N-E

A rapid reply came from the helicopter.

R-E-P-E-A-T

David flashed the message again, and added two words.

B-I-G C-H-E-R-N-O-B-Y-L

David closed the blanket over the window and checked his watch. 1:50 a.m. Ten minutes to go! Quickly he collected his thoughts and walked over to Carolyn.

He leaned in very close to her, his lips almost touching her ear. “Do exactly as I tell you, and don’t ask any questions.”

“O-okay,” Carolyn said hesitantly, struck by the gravity in his voice.

“When I give you the signal, I want you to walk into the President’s daughter’s room and make like you’re checking on her. Tell her to wait until you leave, then to count to sixty in her mind. That should be approximately one minute. Got it?”

“Got it.”

“Then tell her when she reaches sixty she is to go into her bathroom and climb into the bathtub and stay there, curled on her side and protecting her head.”

Carolyn’s mouth flew open. “Is this—?”

David brought his index finger up and pressed it against her lips, quieting her. “Do the same with the First Lady. Say only what I told you to say. Get in and get out. But make certain they understand their lives depend on doing exactly what they’re told.”

Carolyn nodded quickly. “After I have them squared away, what do you want me to do?”

“Come back in here,” David instructed. “You’re going to help me move the President.”

The guard suddenly reappeared and carefully eyed the presidential suite. He stared at David, then at the blanket covering the window, then came back to David. Satisfied, he picked up his bottle of water and took a generous swallow.

Good
, David thought.
Drink it all, you son of a bitch. It’ll save us the trouble of killing you later.