Michael Palmer - The First Patient

"Got it," she said.

Stoddard apologized. Muttered something about a little cold and began speaking again. This time Gabe could almost hear the wheezing.

"Wrangler, Wrangler, are you on top of this?" Griswold's urgent whisper asked.

"I'm not going to let it get any worse before I pull the plug," Gabe replied.

He noticed that several of the attendees were watching him as he spoke into his sleeve, and sensed an instant change in the mood of the room.

"… Our envoy, Mr. Chudnofsky, is in Amman at this…"

The president took a sip of water and glanced over at Gabe. Without hesitating Gabe crossed over to him.

"Mr. President," he whispered, "let's go backstage and sit down before we have a big problem. Excuse us, please," he said to the deathly silent audience.

"All of a sudden," Stoddard whispered hoarsely as Gabe led him away, "my chest just got real tight."

Griswold motioned to the presidential aide to take over and helped Gabe guide Stoddard off the slightly elevated stage and back around to the chair behind the velvet drapes. By the time the aide had begun to tell the attendees to hold their seats, a cordon of Secret Service agents, facing outward, had formed a ten-foot circle from the edges of the curtains. Inside the circle, Alison had opened the FAT kit and was readying equipment. Gabe had already started his evaluation. With Griswold's help, the president removed his shirt.

"Oh-two by mask," Gabe ordered, setting his stethoscope in place, "six liters. Griz, you have that Alupent inhaler?"

"I do."

Stoddard's chief Secret Service agent passed the inhaler over to Stoddard.

"Mr. President, go ahead and take a couple of puffs from this," Gabe said. "In fact, make it three. Alison, as soon as you have the oxygen in place, please hook him up to the pulse oximeter. Tape it to the IV pole if you have to so that I can see the readings. Then get out the cortisone inhaler from the FAT kit. We have Alupent right here, so we won't need any more of that. Mr. President, you're doing fine. It's not too bad. Just take nice, slow breaths. Nice and slow."

"I… I couldn't catch my breath… for a moment there."

"You're moving air fine now," Gabe said with steady reassurance. "Probably just some mucus plugs in a couple of your bronchial tubes. Nothing to be worried about. I'm good at this."

"I'm… glad."

"All that prairie dust keeps people in Wyoming wheezing all the time. Alison, as soon as you can, let's give him a couple of puffs of the cortisone. Then wheel over that IV. We'll use-a twenty intracath. I'll put it in, so I'll need a tourniquet, Betadine, and some tape. If we can get him hydrated and bronchodilated quickly, this little attack should break in no time… Alison?"

"Huh?… Oh. Oh yes… Sorry. Here's the cortisone inhaler. Check the security seal to make sure it's intact. And here's the IV pole and IV. Same thing with the seal on that. We have backups for everything if there are any questions. I'll get the intracath ready."

"Thank you," Gabe replied, surprised by her brief but striking lapse in focus. Considering who their patient was, it was hard to believe she would be even the least bit inattentive.

Well, he thought, at the moment he was attentive enough for both of them. He felt the familiar sensations of confronting a medical emergency. His vision and hearing seemed much sharper than usual, and he was processing information rapidly-correlating at beyond computer speed what he knew about asthma and about Drew Stoddard. Although Gabe was definitely keyed up, he suspected his pulse might actually have slowed.

From his very first days in medical school, this was the sort of situation he enjoyed the most. It was what all those countless hours of study and training and practice were all about. Now, if he could just keep the identity of his patient out of the equation, there shouldn't be any problems.

To his right, Magnus Lattimore had worked his way through the Secret Service agents and asked the big questions of Gabe with his eyes. "Mr. President," Gabe went on, speaking as much to the chief of staff as to the man himself, "what we're going to do is to try and break this asthma attack right here, right now. That would mean no ambulance and no trip to the hospital, although we're completely ready for both."

"You fix me up, Doc… I don't want any hospital… You know… how they are… I'm sure they'll keep me hanging around in the waiting room forever."

"Yeah, you're probably right about that. Okay, here's the deal. Are you comfortable in that chair? Otherwise we can have the paramedics bring us a stretcher from the ambulance."

"I'm fine."

"You always were tough." He tightened a tourniquet around the president's arm, located a suitable vein at his wrist, and after the obligatory, "Just a little stick, now," slipped the catheter in easily.

"That didn't even hurt," Stoddard said. "You are damn good."

"Told you I was. You run the country, I stick needles in people."

"In my America, everyone's got to do something."

"We're getting this IV going to improve your hydration and loosen up some of the mucus that's causing you trouble. As soon as I'm comfortable things have settled down, I'll pull it. In addition, we're giving you bronchodilator and cortisone to widen your tubes and let more air in, and to reduce any inflammation. On a scale where ten is the worst asthma attack imaginable, you're maybe a three-point-five."

"I think my breathing's already a little easier."

"Good," Gabe said, confirming that air movement was certainly no worse. "That's a definite possibility. Alison, let's go ahead and give him zero-point-three of epinephrine subcutaneously."

This time, she was totally present.

"Epi, zero-point-three. Check the security seal on the box and I'll open it up and give it. Sub-Q."

Gabe verified as he had with the cortisone inhaler that the packaging was intact. Then he unwrapped it and passed it over to Alison. Except for her brief episode of distraction, she engendered confidence and was as much of a pleasure to work with as she was to be around.

" Gabe?… It's not like you think ."

What in the hell had she meant by that? he wondered now.

Five minutes passed. Gabe stayed focused, constantly checking the president's blood pressure, pulse, respiratory rate, oxygen level, and air movement.

Lungs clearing… respiratory rate down from 26 to 18… BP 130/85… oxygen saturation up to 95 from 92 .

Five more minutes. Half a liter of IV fluid in… Color good… wheezing almost gone… O2 saturation 96…

Lattimore had returned to the audience. Gabe could hear him speaking through the microphone but couldn't make out the words. Whatever he said brought about a healthy round of applause. Moments later, the chief of staff reappeared.

"I just told them you were doing well," he whispered to Stoddard. "The vultures want to know if you're coming back."

"No!" Gabe snapped. "He's not."

"I'm breathing much better," the president said. "Plus that shot-what is it, like adrenaline?"

"It's exactly adrenaline."

"Well, it's really pumped me up. I feel like I'm about to take off from the deck of a carrier."

"Mr. President, you need to just stay put. You were this close to an ambulance ride to Johns Hopkins."

"If I can pull it together and reappear, think about what my press people can do with this. The world will love it."

"The world will think you're an absolute nut with no regard for his health and a total incompetent for a doctor."

"Listen, Gabe. I can't help it if you happen to be really really good at what you do."

"You've got an IV running."

"All the better. I'll drag it out there with me. Just a minute or two, for closure… and a couple of photos."