Tidewater Review - April 2008
The First patient
Chicanery is not exactly unknown in the nation’s capital, but rarely in so bizarre a fashion as this novel with a physician in the leading role. The author has written 12 previous novels of medical suspense, all international bestsellers. This one continues in that rarified company.
The First Patient, by Michael Palmer, M.D.. St. Martin’s Press. ISBN: -0-312-34353-1. 371 pp. $25.95.
Dr. Gabe Singleton leads a quiet life in a small town in Wyoming. He’s a beloved country doctor with a shameful blemish in his past. When Gabe was a midshipman at the Naval Academy as a young man, he and a roommate whooped it up one weekend, got roaring drunk, drove a convertible and hit a pedestrian, a young pregnant woman, killing the mother and the unborn child. Gabe was tried. convicted and spent a year in the penitentiary in Hagerstown. The Academy expelled him, but his roomie went on to graduate, become a war hero, a governor and is now POTUS, President of the United States Andrew Stoddard.
Gabe’s father never got over the shame of Gabe’s behavior and prison sentence and went to his grave estranged from his son. The president’s father, on the other hand, had always been rich as Croesus and spent huge amounts of money on lawyers for Gabe’s defense, helped Gabe afford college and medical school on his release and had been a second father to Gabe for three decades since his incarceration.
But despite the differences in their lives, Gabe and Drew are still best friends. When the president’s helicopter sets down at Gabe’s ranch and Drew steps out with a request, Gabe reluctantly agrees to return to Washington with his friend. As Drew explains, his personal White House physician has disappeared - simply gone, poof! - and Drew needs someone to temporarily take his place, someone he can completely trust. Just until his regular doctor comes back, he says.
From his first day in D.C., Gabe regrets coming back east. The old Washington hands surrounding the president all have their own agendas, their own jargon and codes that exclude Gabe. He feels patronized, criticized and judged by even common courtesy as someone with a hidden agenda. Some of his encounters are downright hostile, like a confrontation with an admiral, chief of the Military medical team in the White House. The blustery navy chief resents having a civilian on his turf and reminds Gabe that he knows all about his disgrace at the Academy.
Gabe is scarcely unpacked when he’s slated to attend a formal White House dinner to honor a visiting head of state. At the reception before dinner, he’s introduced to a fascinating woman who will be nominated to head a new cabinet department to coordinate medical technology research. She has a horse farm near Middleburg, high cotton for moneyed horse people. She invites Gabe to tea and to ride with her. The offer sounds attractive to the “cowboy doctor” who feels out of place in Washington.
Before the dinner begins, Gabe is quietly whisked away from the reception for an emergency sick call to the private quarters of the White House. His friend Drew, the president, is sitting up in bed, spouting nonsense with a cough, a flushed face, racing pulse and elevated blood pressure. None of these symptoms seem to relate to his history of mild asthma, but his trusted Secret Service officer takes an inhaler from his pocket and gives it to the president.
The attack passes, the president falls into an exhausted sleep and the dinner crowd is informed that the president is indisposed but to proceed without him. Gabe, however, insists on staying with his patient for most of the night. He puzzles over the medical mystery. Could the earlier shocking episode be a psychotic event? Is the president insane? Gabe draws two vials of blood for testing and deposits them in the refrigerator for medical supplies in his office.
Gabe’s first week in Washington is a series of odd encounters. The president’s father has his ocean-going yacht at dock on the Potomac and invites Gabe for lunch on the luxury vessel. The older man has been kind to Gabe from the time Gabe and the president were roomates, so it’s natural that he’d want to quiz Gabe about his son’s health.
It turns out that the town is whispering about the rumor that the president is mad and perhaps it’s time for the vice president to step in. Gabe’s testimony would be required for those official wheels to turn, however. Later, he meets with the president, the president’s wife, the White House chief of staff and top secret service agent and learns that the irrational attack was not the first of Drew’s presidency. It is, in fact, the fourth in a short period.
It’s almost dawn when Gabe leaves his sleeping patient to drive to his own nearby apartment. In the darkness of the wee hours on an almost deserted street, a car pulls up beside him at a traffic light and a pistol emerges from the car’s open window. Just as the blast explodes, Gabe’s car is rear-ended and the shot shatters his rear window. The would-be killer speeds off and Gabe discovers that his savior is Alison, his new nurse who claims not to have seen anything amiss but only was drowsy from a long day.
The plot thickens. Alison is privately bothered that protocol was not followed when the unverified asthma inhaler was handed to POTUS by the secret service officer. Strict procedures that govern every dose of every treatment must be observed and signed off by qualified medical personnel. Alison notes the lapse and sets out on her own background check of the venerable guardian of the president.
In the meantime, the FBI, the Justice Department and the CIA are conducting a fruitless search for Gabe’s missing predecessor. He ‘snot all that’s missing. The two blood samples in the refrigerator in Gabe’s office are also gone.
The president’s recovery appears to be complete, but Gabe is worried. He visits the missing doctor’s apartment in hopes of finding a clue to what the doctor was working on that might be relevant to the patient’s condition. His curiosity is aroused by several papers and volumes on a new science, an arcane system of creating nanorobots from various molecules and making new life forms. Nanotechnology, it was called.
Lily, the attractive woman Gabe had met at the White House reception, was slated to be named secretary to a new cabinet department, Gabe recalled, and she would surely be an expert on the subject. It was time to take her up on her invitation to join her for a ride in horse country and ask her about the new science.
Lily turns out to be as intelligent as she is beautiful and charming. They drink her specially imported tea and converse before choosing mounts from her stables and riding over rolling meadows and woods on her broad acres at the foot of the Blue Ridge. Gabe feels relaxed for the first time since arriving in Washington with all its intrigues.
A shadowy figure in the woods catches his eye - a raised gun glints in the afternoon sun. His warning shout makes Lily’s horse rear as a bullet strikes a tree trunk beside her horse and she is thrown to the ground. She’s seriously injured, so Gabe stabilizes her broken shoulder, cautions her not to move and he races back to the house and summons an ambulance.
After surgery in a local hospital, she seems to recover enough to be moved back to a Washington hospital. Her death the next day is unexpected. When Gabe reflects that he has had two attempts on his life in a few days, he feels more than ever that almost no one in Washington can be trusted.
Nurse Alison is uncovering some suspicious behavior by the trusted secret service agent and confides in Gabe, who returns to Lily’s country house to look for a connection to the tries to assassinate him. Underground tunnels lead him to complete laboratories for manufacturing nanorobots so small they can be implanted in human bodies and triggered to feign madness or even to explode internally.
Gabe decides it’s time to alert POTUS that his life is in danger.
Up to this point in the book, the emphasis is on politics, romance and medical mysteries. The mood darkens as Gabe and Drew collaborate on a scheme to fake “kidnap” the president from Camp David with shocking results.
It’s no surprise to learn that someone in the White House or otherwise close to the president is behind the chicanery. The stakes are even bigger than the survival of the good man in the president’s seat.
As the book ends, Gabe is back on his Wyoming ranch with a loving partner. Not only is the sin of the recent past erased, so, too, are scandals and miscarriages of justice in the past righted.
A thoroughly engrossing read, cleverly crafted and satisfyingly resolved.