Error in Diagnosis
Page 1
EMERGENCY ACTION!
Brickell glanced to the side of the room. Urging her to wrap things up, Julian gave her his most subtle cut sign.
“I have time for one more question,” she said.
Before she could recognize anybody, an uninvited voice asked, “Is there any possibility GNS is an act of biological terrorism?”
Her eyes found the young woman in the center of the room who had asked the question. She had no clue who she was, but she didn’t feel she could use her refusal to follow proper protocol as a way of dismissing the extremely valid question.
“All possibilities will be carefully evaluated,” she was careful to answer. “But at this time, we have no evidence that GNS is the result of a biological weapon.” Brickell took two short steps backward. “I’m sorry. I’m going to have to stop here. I encourage all of you to refer to our website for the exact date and time of our next briefing.”
She turned away from the lectern, and with Julian in tow, she quick-walked out of the briefing room.
“Excellent job,” he told her. “Especially that last question.”
“Excuse me?”
“Your responses were honest and on point. I’m sure they helped to diminish the anxiety of an impending crisis.”
Brickell was well aware that part of Julian’s job was to contain prickly situations and curry favor with her regardless of how difficult the situation seemed. But today, his fairy-tale optimism was over the top.
“Julian, we’re dealing with a potentially devastating disease that’s spreading out of control. To make matters worse, it’s selectively attacking pregnant women, one of any society’s most vulnerable groups.” She looked at him as if he should know better. “What did you call it—‘an impending crisis’? This crisis is hardly impending. It has a large gray fin, is finished circling, and just about ready to bite us all on the ass.”
An imprint of Penguin Random House LLC
375 Hudson Street, New York, New York 10014
ERROR IN DIAGNOSIS
A Berkley Book / published by arrangement with the author
Copyright © 2015 by Gary Birken.
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eBook ISBN: 978-0-698-18506-7
Cover design by Jason Gill.
This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental.
Version_1
For Jax, Lucas, Charlee, Jacob, Maya, Mason, and Madison, who continue to keep me young and provide me with inspiration.
Contents
Title Page
Copyright
Dedication
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Chapter 63
Chapter 64
Chapter 65
Chapter 66
Chapter 67
Chapter 68
Chapter 69
Chapter 70
Chapter 71
Chapter 72
Chapter 73
Chapter 74
Chapter 75
Chapter 76
Chapter 77
Chapter 78
Chapter 79
Chapter 80
Chapter 81
Chapter 82
Chapter 83
Chapter 84
Chapter 85
Chapter 86
Chapter 87
Chapter 88
Chapter 89
Chapter 90
Chapter 91
Chapter 92
Chapter 93
Chapter 94
Chapter 95
Chapter 96
Chapter 97
Chapter 98
Chapter 99
1
DECEMBER SEVENTH
West Palm Beach, Florida
Tess Ryan was lost.
Gradually maneuvering her SUV down one indistinct street after another, she bemoaned her spinning instructor, Cal’s, decision to build his new gym in a warehouse district that was more confusing than an English hedgerow maze. But in spite of the fact that every building and street appeared identical, she still couldn’t explain how she had gotten lost driving to a location she had easily found four times a week for the past eleven months.
Fearing she would miss the beginning of her class, she allowed a frustrated sigh to escape her lips. Had this morning’s dilemma been an isolated event, she might not have been so dismayed, but of late, she had been plagued with repeated mental errors and memory lapses. Earlier, she had had to look up her sister’s phone number, a call she had made a hundred times a year for as long as she could remember. A couple of days ago, she was stuck at an ATM machine struggling to remember her PIN number.
Heading west, she shaded her eyes from a sun that was settling above an endless row of flat gravel roofs. After a few more minutes of randomly creeping up and down the grid-like streets, she spotted a line of familiar cars parked in front of the gym. With an appreciative glance overhead to acknowledge the divine intervention, she pulled in behind the last car. Grabbing her gym bag, she pushed open the door. With her first step she was out of the car, and with the next she was standing in front of the gym. C
urling her fingers around the knob, she took a cleansing breath, and then with a ginger push, she slipped inside.
Cal’s gym was hardly a showroom for the modern workout facility. The collection of basketball jerseys that hung randomly from the rafters did little to divert one’s eye from the grit and black smudges that tattooed the cinderblock walls. His artistic masterpiece was the wall outside of his office that he had wallpapered with dozens of collapsed Red Bull cartons. Over the relentless objections of his students, he insisted on keeping the gym oppressively hot. Normally, Tess didn’t mind but today, she felt as if she were standing in front of a wood-burning oven. Making matters worse, the pungent smell of ammonia cleaner permeating the air sent her stomach into a series of backflips.
By the sound of Paul Simon’s “Diamonds on the Soles of Her Shoes” blaring from Cal’s boom box, Tess knew the class was still in its warm-up run. She chanced an apologetic smile his way. From his bike, which sat atop a three-foot wooden platform, the ex–Navy corpsman wagged a reprimanding finger in her direction, but then with a wink and an indulgent grin, he motioned her to join in. Tess mouthed, Thank you, made her way between the first two rows, and climbed on her bike.
Long-legged with elevated cheekbones and shadowy blue eyes, she was in excellent physical condition and never had any difficulty keeping up with the class. But today, after only five minutes, she was breathless. Assuming the heat and ammonia fumes were to blame, she decided to press on. To ease her breathing, she stood up and leaned forward over the handlebars. But her performance didn’t improve, and she found herself grunting and gulping for air even more feverishly. While she struggled to figure out what was happening to her, she felt the room begin to spin. Setting her ego aside, she slowed her pace and sat back down. She waited a few seconds but the whirling sensation only got worse.
Wondering if Cal hadn’t noticed her struggling, she raised her head and looked toward the front of the gym. Instead of seeing his usual determined face pushing the class on, all she could make out was an obscure silhouette. She craned her neck forward and squinted, trying to bring his blurred image into focus, but everything around her became a shapeless convergence of oscillating gray and white shadows.
Consumed with terror, she clutched the handlebars and closed her eyes. To her further dismay, the loss of visual cues only made her vertigo worse. She felt her body rolling and pitching as if she were in a fragile skiff on high seas. She could still hear the music and Cal’s shouts of encouragement but they were garbled and soon became distant echoes—echoes that would be the last thing her brain would process.
Tess’s head plunged forward and her body wilted. Toppling from the bike like a Raggedy Ann doll, she was moments away from her head hitting the cement floor when the woman next to her screamed. Fortunately, Cal had seen Tess falling several seconds earlier and was already racing toward her. His final stride was followed by a desperate lunge. With his arms fully extended, he snatched her up before she hit the ground. Then, with one powerful jerk, he had her safely cradled in front of him.
“Get me some water and a cold towel,” he announced to the class.
Hurrying toward the other side of the gym, he carried her past his bargain-basement artificial Christmas tree before easing her down on a sprawling canvas mat used for a women’s self-defense class. Well trained in CPR, Cal knelt down beside her and studied her breathing pattern. It was rapid but not labored. Her lips were pink—a reliable sign she wasn’t suffering from oxygen starvation. Her pulse was strong and regular. Next, he checked her pupils. They were neither pinpoint nor dilated—another good sign.
“Can you hear me, Tess?” he asked, taking note of a small pool of foamy saliva gathering at the corner of her mouth. When she didn’t answer, he repeated his question, “Tess, if you can hear me squeeze my fingers.” Still no response. He looked up at the group and in a voice that now boomed to a fever pitch said, “Somebody call nine-one-one right now.”
Just at that moment, the woman standing next to Cal gasped. With a quivering finger, she pointed at Tess’s face. Cal’s head snapped back. Seconds earlier Tess’s eyes were motionless—now they ricocheted back and forth as if they were two Ping-Pong balls in a wind tunnel. Cal had spent six months of his enlistment at the Great Lakes Naval Hospital assigned to the neurology floor. He was quite familiar with the signs of a seizure. If Tess were having one, it was unlike any he’d ever seen. His eyes remained locked on her like a laser. He felt helpless knowing the only thing he could do until the EMTs arrived was to monitor Tess’s pulse and breathing. If either faltered, he’d begin CPR immediately. He swept his clammy hand across his forehead, wiping away a few beads of sweat. And then, in a room overtaken with a deafening silence, he waited.
2
Eleven minutes after Cal’s student had called Palm Beach Fire Rescue, two paramedics were at Tess’s side. Squatting catcher-style, the first one, a slight woman whose name tag read R. PONTE, wrapped a blood pressure cuff around Tess’s upper arm. Her partner, a stubby man packing an extra fifty pounds, unraveled several feet of oxygen tubing, connected it to a mask and then fitted it squarely over Tess’s nose and mouth.
“What happened?” Ponte asked. “Was she hurt?”
“No,” Cal answered. “She was fine until about ten minutes into the workout when she . . . she just passed out and fell from her bike.”
“She didn’t hit her head?”
“No, I caught her before she hit the ground.”
“What’s her name?”
“Tess Ryan.”
“Tess, can you hear me?” Ponte asked.
Cal said, “Her eyes began darting back and forth like that a few minutes ago.”
Ponte placed a tourniquet around Tess’s biceps and waited for a suitable vein to pop up. Without looking up she asked, “Do you know if she has any serious medical conditions?”
“I don’t think so. She’s been working out with me for almost a year. She’s never had a problem.”
“When did that begin?” she asked, gesturing at Tess’s legs.
Unsure of what he was being asked, Cal’s eyes shifted to Tess’s lower body. His breath caught. Under her black leggings, her calf muscles rippled erratically as if they were being shocked by repeated bursts of an intense electric current.
“I don’t know. It . . . it must have just started,” he answered, swallowing hard against a throat that had suddenly become as dry as cotton.
“The IV’s in and her vital signs are okay. We can roll,” Ponte told her partner. Together they transferred Tess onto the stretcher, locked it into position, and hurried toward the exit.
“I’ll call her husband,” Cal said. “What hospital are you taking her to?”
“Southeastern State University.”
“Her husband’s going to ask. Do you . . . have any idea what’s wrong with her?”
“Well, if we were out in the Everglades, I’d say she’d been bitten by a rather large poisonous snake.”
Cal walked across the room and sat down at a wooden desk that was beyond restoration. The three-foot, artificial and unornamented Christmas tree standing next to the desk did little to add to the spirit of the season. He didn’t have to announce the class was over. In an awkward silence, the other students gathered their gym bags and moved toward the door. Lost in the moment, Cal rested his chin on his steepled fingers, half listening to the wail of the ambulance’s siren fading into the morning.
He tried to reassure himself that Tess Ryan would be fine, but for all his efforts he couldn’t shake the uneasy feeling that he might never see her again.
3
With a steady rain tapping against the ambulance’s windshield, Ponte eased into the receiving dock of Southeastern State University Hospital’s emergency department. Based on her en route instructions, she and her partner wheeled Tess into a critical care unit designed for the most seriously ill patients.
Much to Ponte’s surprise, there were three grim-faced doctors, two nurses, a respiratory therapist and a hospital administrator waiting for them. She exchanged a guarded look with her potbellied partner as they transferred Tess to the hospital bed. In her ten-year career, she had brought dozens of desperately ill patients to emergency rooms all over the county. Some were accident victims who were traumatized beyond recognition. Others were scarcely holding on to life from a massive heart attack or stroke. The memory of those patients was vivid in her mind. What she didn’t remember was ever being met by an entourage like the one now hovering over Tess Ryan.
The physician in charge, James Lione, stood with his arms tight against his side. As soon as the two paramedics finished and stepped back, Dr. Lione stepped forward and began his examination. Sliding his stethoscope from Tess’s left chest to the right, he threw a momentary glance in Ponte’s direction.
“Did she have a fever when you got her first set of vital signs?” he asked.
“No.”
“Any drop in blood pressure?”
“We checked it three times. They were all normal.”
Lione looked up. “Was anybody else in the class sick with similar symptoms?”
“We didn’t specifically ask, but nobody mentioned feeling ill.”
“Was she responsive at any time?”
“No.”
“Do you know if she works?”
“One of the women at the gym mentioned she works in fund-raising.”
“I don’t imagine that would pose a great risk for a toxic exposure,” Lione said.
“Have you spoken to any family members to get a more detailed history?”
Ponte shook her head at the strange question. “There were none at the scene and we wanted to transport her as quickly as possible.”
With the other two physicians flanked closely at his side, Lione completed his examination. Backing away from the bed, a restrained sigh slipped through his lips. He thumbed his ear a couple of times and then motioned the other two physicians to join him on the other side of the room. They spoke softly. Ponte tried to remain as unobtrusive as possible as she struggled to hear what they were saying.