Free Patient One by Leonard Goldberg Page A

pink. “It’s working,” David said.
    “Do you have any idea how long it will last?”
    “It’s impossible to say,” David replied. “If we’re lucky, it’ll hold until the gastroenterologist gets here.”
    “My stomach feels like it’s frozen,” Merrill complained.
    “That’ll pass, Mr. President,” David assured him.
    Merrill turned on his side and spat a mouthful of pink saliva into the basin.
    “Do you know I had an uncle who bled to death this way? They said something was wrong with his blood.”
    David’s eyebrows went up instantly. “Did he have a coagulation defect?”
    Merrill nodded and looked over to Warren. “What was the name of that strange disease he had?”
    “Von Willebrand’s disease,” Warren replied.
    “Jesus Christ! You’re a bleeder!” David blurted without thinking. “You’ve got an inherited defect.”
    “No, he doesn’t,” Warren disagreed immediately. “The President’s father, who was a senator and the brother of the man with von Willebrand’s disease, had no bleeding tendency. And the President has never shown any propensity to bleed. But to be on the safe side, the President was evaluated with a bleeding time and Factor VIII level. Both tests were within normal levels, excluding the diagnosis of von Willebrand’s disease.”
    David asked the President, “Have you ever had major surgery or a tooth extracted?”
    “I had a molar extraction years ago.”
    “How much blood did you lose?”
    “It took almost a week for the bleeding to finally stop,” Merrill recalled, then glanced over to his personal physician. “And, Will, the fact of the matter was that Father had the same bleeding disease as my uncle. They kept it quiet because it could have been politically damaging to him. He, too, once had presidential aspirations.”
    “And you knew you had the disease, as well?” Warren asked incredulously.
    Merrill shook his head. “My blood tests were always negative. I thought the disease had skipped over my generation.”
    David gave the President a skeptical look. With Merrill’s family history and his prolonged bleeding after a simple dental extraction, he must have known he had the disease and, like his father before him, was hiding it for political purposes. But then again, people believed what they wanted to believe. Maybe Merrill was actually convinced he didn’t have the disease. After all, this was his first major hemorrhage.
    Finally David said, “Mr. President, von Willebrand’s disease is an inherited disorder of coagulation characterized by a prolonged bleeding time and a low level of a protein in the blood called Factor VIII, which is essential for clot formation. But these abnormalities can vary in a given patient, with the tests being normal one week and abnormal the next. So, even with normal tests you can still have the disorder, Mr. President. And this would explain why you’re bleeding so much.”
    “Jesus Christ!” Merrill groaned sourly. “Am I going to just lie here and bleed?”
    “No, sir,” David answered at once. “The bleeding responds to injections of fresh plasma and to concentrates containing high levels of Factor VIII.”
    “Then inject me with them,” Merrill said.
    David hesitated, now in over his head. He sounded impressive, but his knowledge of von Willebrand’s disease was limited to the single case he’d heard discussed at a Grand Rounds conference. He could define the disease, but treating it could be a tricky matter.
    “Mr. President, I have no experience in the use of concentrates, which is the preferred treatment for this disorder. That requires a specialist in blood diseases. So what I’d like to do is give you fresh frozen plasma, which will stabilize your bleeding, and call in a hematologist to advise us on how to administer the Factor VIII–rich concentrates.”
    “Do it,” Merrill directed.
    David turned quickly to Warren. “If he starts bleeding again, lavage his stomach with more ice