Point of Balance (9 page)

“I've heard about him. He's a great doctor. He's operated on several celebrities. Why isn't he sitting in this chair?”

Hastings leaned over the desk and lowered his voice to a hoarse whisper.

“Because the First Lady played the same trick she played on you
on many others as well. She sent a flunky with the MRI scans to prevent the patient's status from overshadowing the diagnosis.”

I wasn't too surprised; after all, the little man in the bow tie had warned me.

“Even the service doctors?”

“She took it up with them first. They all gave the patient up as lost. They said the risk was too great to operate.”

“I . . .” I hesitated. “Was I the only one who said it was feasible?”

Hastings shook his head and rustled the papers on his desk before answering.

“No. There were others.”

“Then . . . Why me?”

The medic left that unanswered, because at that moment the door opened and Hastings sprang to his feet. Not so much a jack-in-the-box as a self-pitching tent.

I turned to the door and also stood up. Although I've never been a dresser, I found myself instinctively buttoning up my jacket and folding down my coattails.

“Well, it's a pleasure to meet you, Dr. Evans.”

There he was, elegantly shaking my hand. Tall—an inch or two taller than I, and I'm pretty big—charismatic, steeped in authority. I was so used to seeing him on TV that I had the automatic feeling we'd known each other all our lives. Or maybe that was an evolutionary advantage some people had, their ability to imbue a feeling of instant familiarity and closeness to undermine your defenses.

“The pleasure's mine, sir.”

I moved forward to greet him, somewhat nonplussed by the presidential aura, and got a warm, strong, vigorous handshake. He was in shirtsleeves, rolled up to the middle of his forearms, his red tie slightly askew, and his face was weary.

“Doc, can you get me a Tylenol?”

Hastings obediently removed himself from the consulting room and the Secret Service agent took two steps forward, never taking his eyes off me. The president turned to him and said:

“That's okay, Ralph. Go to the relaxation area.”

“Sir, the visitor has not been security cleared. The special agent in charge has ordered me to—”

“Ralph.”

He gave the first order with a friendly smile, the second in a steely tone. It left no doubt. That was true power, and it didn't come merely from the office but from within the person holding it. It inspired a little fear mingled with a feeling that I wouldn't call envy, although it comes close.

The agent bowed his head and left the clinic.

When the door was shut the president sank into the chair I had been sitting in a minute before and massaged his temples. The wrinkles drew huge deadwood trees in his habitually serene face.

“Here, sir,” said Hastings, who was back with the painkillers and a cone paper cup. The president took the pills, then squashed the cup. He closed his eyes again and leaned his head back for more than a minute before he turned to us once again.

“I'm sorry,” he said. He seemed angry with himself for that show of weakness.

“How many are you taking a day?”

“Six or seven.”

“Are the headaches nonstop, or do they come and go?”

“They come and go. When they come, they are intense but don't last long. I had no pain at all yesterday, but the day before was excruciating.”

“Were you prone to headaches before?”

“Not particularly. I tend to get them the day after I've had less than five hours' sleep, but not as bad as these.”

“Was that the first symptom?”

“A splitting headache. It seemed like the worst ever back then. I was wrong.”

I nodded in understanding. The words
the worst headache ever
should be taken as a matter of course by every husband, wife, child and sibling to mean “let's book an appointment with the neurolo
gist.” I've lost count of how often patients have come to me too late because they've smothered a telltale headache with painkillers for a few months. Chugging down a jar of eighty Tylenols a week should tip anyone off, although amazingly the idiots prefer to ignore it. Not so amazingly, they die.

“When was that?”

“Four weeks ago,” Hastings said. “We had the first MRI scan that same night.”

“Where? Don't tell me you've got an MRI scanner here . . .”

The president and Hastings eyed each other hesitantly. The former vaguely shook his head.

“We cannot comment on the specifics, doctor. We didn't go to Bethesda for obvious reasons. It would have been much more difficult to contain a leak.”

They stayed silent. Hastings produced the envelope with the scans and gave it to me. I sought the latest and held it up to the light. The soft, golden light shining through the curtains afforded the black-and-white death sentence a snug, dreamy appearance.

“Who did them, then?”

“I did myself,” Hastings said.

“Only a handful of people are aware of the situation, all with the highest security clearance, except for your bosses, Dr. Evans. And it must stay that way.”

“I hear you, sir. Have there been any other symptoms apart from headaches? Vomiting, impaired vision?”

“I can see fine and I have not been sick.”

That was normal. Every patient was a world unto themselves and a tumor which in some triggered the vomit reflex, blindness or splitting headaches hadn't the slightest effect on others. In a neurosurgeon's career, you learn something basic: take nothing for granted. You learn that from seeing one weird thing after another. I once treated a woman at noon who had been shot through the head in a robbery and was back home eating with her family the day after. The bullet entered between her eyes and exited the rear of her skull,
no damage done. But that's another story and I was all out of being shocked. What alarmed me was the possibility the US president was in the dark.

“How much have they told you about the problem, sir?” I asked with a glance at Hastings.

“I've given the president a summary briefing,” the medic said while staring at the toes of his shoes. “He has declined to treat this other than in the utmost secrecy. There are other complications of a political nature which—”

“Hastings,” the other man cut him off.

The poor captain zipped up so fast I feared he had bitten his tongue.

“Mr. President,” I barged in. “Glioblastoma multiforme is an irregular tumor. It is not like a ball, compact and smooth, but an octopus. It's a self-replicating alien inside your head. It recruits blood from all the vessels it comes across and advances relentlessly. There is no way to make it recede significantly through treatment without seriously hampering your body and your performance in office.”

“But there is surgery, Dr. Evans.”

I shook my head.

“You're going to die. Real soon, and there is nothing I or anyone else can do to alter that. All I can do is turn the ‘real soon' into ‘soon.' ”

He nodded.

“I am well aware of that.”

“I can operate on the tumor. I can eliminate a good part of it, enough to delay the inevitable and buy you a few months.”

“Then do it.”

“I could also kill you. The tumor has reached the arcuate fasciculus, on the border between the Wernicke's and Broca's areas. It'll be a long and complicated operation, at least seven to nine hours. And it's a high-stakes game when we get there. A tiny slip and I turn you into a cabbage.”

“That has all been spelled out to me, doctor. And it is also something which will come to pass anyway.”

“If I don't operate, inside two or three months you will lose the ability to understand and verbalize concepts. Or the ability to speak. Or both at the same time.”

“And if I do go under the knife, I may lose both in no time. Before then.”

“Exactly.”

A dense and unpleasant silence descended. The president leaned forward, his head in his hands, and gazed at the floor with his shoulders hunched and his back bent. Until a few weeks ago he was indestructible, a king among men. Now he was forced to confront his mortality like the next guy, with the added burden imposed by the demands of his throne.

“I'll do it.”

I closed my eyes, overwhelmed for a second, and breathed deep before I answered.

“All right. When?”

“How long do I need to recover?”

“Nine or ten days' hospitalization, if all goes well.”

“That time frame is unacceptable.”

“You tell God that,” I said slowly.

He went quiet again for a good while. I could almost hear him going over his schedule, thinking ahead of his rivals' moves. What to do and say. How to spin it. And all without aides, from memory. He was sitting in front of me, with his elbows on his knees, his hands cupping his forehead, his head inches from mine. Seen from above, it had an odd shape, slightly oblong with close-cropped, prematurely gray hair. For me it was easy to ignore his scalp, the skin and bone, which were mere hindrances in the problem's way. For a second, I saw myself prizing apart the structure's casing and sectioning the dura mater to expose the three pounds of brain tissue that made the most important decisions in this country, and a raft of others besides. In the middle of those three pounds of jellylike matter, a
couple of unfettered ounces were waging a war with no quarter and just one possible winner.

“I can't for three weeks,” the president said. “There are unavoidable commitments. Is that doable?”

“Yes, sir. Although I must tell you that by then the symptoms will most likely have worsened. There is some medication that can help,” I said, jotting something down on a scrap of paper and handing it to Hastings.

“Very good,” he said when he read it. “I'll entrust myself to take timely steps to book an operating theater at Bethesda in the name of an anonymous patient.”

I gasped in disbelief when I heard that.

“I beg your pardon, but I will not operate at Bethesda,” I said with a shake of the head.

“It's a flagship hospital. And it has the best equipment, as well as being able to guarantee the privacy of—”

“Please don't go on,” I said. “I know the objective arguments, but first answer me this. Why me and not one of the others who said yes?”

“You have operated on two hundred and thirty-four glioblastomas in the past four years,” the president said. “Of which sixty-one affected the speech area. Thirty-nine of them recovered without any problems.”

“That data's confidential,” I said, nettled. “You had no right to—”

“You have the second-best average in the country, doctor. Your college professors said you have natural talent and in your residency—” Hastings began.

I raised two fingers, definitely mad.

“I left two patients paralyzed in that same period due to complications with the brain stem. Another eleven glioblastomas came out as cabbages. Do they not count?” I objected.

“What's your point, doctor?” the president said coldly.

“This is an inherently difficult operation. It is not purely about my ability, nor is it enough to quote my tumor ranking. As it hap
pens, I'm not a slugger for the Yankees. I'll need luck, luck and concentration, and if I operate in a theater that is not my own, with a team that is not my own, then I'll be tense. And that will affect the outcome.”

“Doctor, I am sure there's a way you can adapt—” Hastings said.

“No there is not, Captain. It's the president of the United States, for God's sake. You're heaping on my shoulders the biggest responsibility a surgeon can have. I won't take it lightly.”

I turned to the president.

“Don't think I'm asking you to be operated on in my own hospital to massage my ego or overcome an inferiority complex, or for the hell of it. I am doing so because otherwise I'll be scared shitless. You understand?”

He chewed on this for a few seconds and I wished with all my heart he'd say no. The situation was too complicated and I had to think of Julia. The risk it would turn out badly was so great, the odds of screwing up so stratospheric, that the chances of successfully completing that operation struck me as ridiculous. “I hear you. But I cannot accept an operation in an elite hospital. Not I, who have fought so hard for quality public health care. Public opinion would run riot for months,” he replied, and I sighed with relief.

He'd given me the excuse I needed.

“Then we had better let matters rest there.”

The three of us rose to our feet. I shook the president's hand in farewell and Hastings saw me out of the consulting room.

“I'm sorry about all that,” I told him in the broad, red-carpeted corridor of power.

“Don't worry. I understand your reasons, and in your shoes I'd have done the same.”

Hastings was wrong, naturally. He was a calm, kindly man, as sturdy and loyal as a shire horse. If the president said jump, he'd be in the air before the word was out of the chief's mouth. Somebody with that kind of personality could never be a neurosurgeon, so his understanding was as empty as it was well intentioned.

“Will you see me out or must I wait for somebody?”

“Actually, Dr. Evans, before you go I would like to introduce you to someone very special.”

We went back to the Map Room, and there she was.

Seated on the edge of a velvet sofa with her legs crossed at the ankles, she was so engrossed in typing on her iPad she didn't hear Hastings's polite knocks on the door. She raised her eyes when we entered and rose to greet me. Her bearing was even more impressive in person, with an aristocratic air, but there was also a warmth in her voice that belied her expression.

“Good afternoon, Dr. Evans.”

I mumbled a polite response, but she appeared not to hear it as she turned to quiz Hastings: