Error in Diagnosis

by Mason Lucas M. D.

  It was at that moment that Dr. Helen Morales, the dean of the Southeastern State University School of Medicine, walked in and joined the group. Before any conversation amongst the physicians began, Lione looked over at Ponte and said, “Thanks for bringing her in. We’ll take it from here.” Becoming more perplexed with each passing moment, Ponte only nodded. Generally, paramedics were considered part of the team. Most physicians went out of their way to explain things to them regarding the patients they transported to the emergency room.

  They quickly collected the rest of their equipment, left the room and walked down the hall to the staff lounge. Ponte had just grabbed a cup from the cupboard and was headed toward the coffeemaker when one of the nurses who had been present in Tess’s room walked in. Ponte knew K. P. Burnham well. She had worked with her for years, and her husband was a fellow paramedic.

  “Three doctors and two nurses to meet the patient, and then we practically get thrown out of the room. What the hell’s going on . . . what’s all the mystery about?”

  K. P. walked over to the watercooler and shrugged. “I’m not the one to ask.”

  Ponte’s stomach tensed. She raised her hands. “What’s that supposed to mean? I’m a licensed paramedic. I’d like to know what’s going on with a patient I brought to this hospital. I don’t feel like the request is out of line.”

  K. P. took a swig of the ice water. After a cautious glance around the room, she started for the door. “I’ve been instructed not to discuss these cases with anybody.”

  “These cases? Are there other patients with the same symptoms?”

  K. P. crumpled the paper cup and tossed it into a wastebasket.

  “Sorry, I’m really not supposed to say anything.”

  Looking around the room as if she were searching for answers on the walls, Ponte pressed her lips into a thin line. She had great faith in the physicians and nurses who worked at Southeastern State, but if there was a method to their madness regarding their care of Tess Ryan, it was a mystery to her.

  4

  John F. Kennedy Center for the Performing Arts

  Washington, D.C.

  Since first seeing La Bohème during her freshman year at Georgetown University, Dr. Renatta Brickell, the surgeon general of the United States, had been a die-hard opera aficionado. Time had done nothing to erode her passion, and there were few things in life she coveted more than her season subscription to the opera.

  With Christmas carols playing softly, she sat in her aisle seat marveling at the lavish red-and-gold silk curtain. Lost in thought, she barely noticed the light tap on her shoulder. When she looked up she saw her assistant, Julian Christakis, standing over her. His mere presence and the apologetic half smile on his baby face caused her to groan inwardly. Five years ago, she had hand-selected Julian from hundreds of applicants. Diplomatic to a fault, he had become one of her key advisors and an invaluable member of her team.

  He cleared his throat and spoke in just above a whisper. “I’m sorry for disturbing you, Dr. Brickell, but there’s a . . . a situation.”

  With more than an inkling her evening was in peril, she turned to her husband.

  “I’m sorry, Stan. I’ll be right back.”

  With a dubious look, he tapped his watch crystal. “The curtain’s about to go up, Renatta. You don’t have much time.”

  She gave his hand a reassuring squeeze, came to her feet and accompanied Julian to the lobby. After scanning the area, she motioned toward a relatively secluded area in front of the donor recognition wall.

  “This better be good,” she told him.

  “Once you hear what’s been going on, I suspect you’ll agree it is.” He exhaled a lungful of air, scanned the lobby and then continued in a guarded voice, “I’ve been on the phone with the Centers for Disease Control for the past two hours. It seems they’ve been receiving calls all day from dozens of hospitals from Florida to California that have been treating hundreds of women with a bizarre illness that none of their doctors has ever seen before.”

  “What are their symptoms?”

  “Mostly neurologic: memory loss, confusion and severe muscle twitching of the legs. What’s particularly disturbing is that many of the women have developed a dancing eye syndrome.”

  “I thought that only occurs in infants and children.”

  “Except in rare circumstances, that’s usually the case.”

  “How seriously ill are these women?”

  “Some of them are unresponsive and have been admitted to intensive care units.”

  “Any deaths?” she inquired, becoming more concerned with each passing second.

  “None reported so far.”

  “Just exactly how many cases are we talking about here, Julian?”

  “The CDC’s not exactly sure. Their best guess is around four hundred, but there could be a lot more.”

  She folded her arms and stared at the ceiling for a few seconds. “Has anybody considered that this may just be the beginning of some new strain of flu?”

  “None of these women has a fever, sore throat or any other flu symptoms. And, none of their immediate family members is sick. Besides, why would a flu only affect women?” He lightly shrugged his shoulders. “I’ve spoken to a lot of people today. None of them has the first idea of what the hell’s going on.”

  “For God’s sake, Julian, you have nine advanced degrees in health care and epidemiology.” She paused briefly to gather her thoughts and then asked, “What’s the first rule of diagnosis we all learned in medical school?”

  “That’s easy. The most common things occur most frequently.”

  “It’s a little corny, but it’s also very true, which leaves us with only two rational explanations: The first is this is a contagious disease. The second is we’re dealing with some type of widespread toxic exposure.”

  Just at that moment, Julian’s cell phone rang. He plucked it from the leather case and checked the display. “It’s the CDC,” he told her, raising the phone to his ear. “This is Julian Christakis,” he answered, pacing in a tight circle while he listened. He suddenly stopped, and then with a solemn nod added, “You’re absolutely sure. There’s no chance of an error? I see. Thanks very much for calling, Dr. Emerson. No, that won’t be necessary. I’m with the surgeon general now. I’ll brief her immediately.”

  Julian slid his car keys from the inside pocket of his black blazer. He was generally unflappable but at the moment his expression was ominous. He leaned back against the wall.

  “There’s obviously something else,” Renatta stated in a guarded tone.

  “I’m afraid so. Not only are the hospitals reporting more new cases every hour but most of the women who were admitted earlier are getting worse. I don’t have the exact numbers but quite a few are now in a near coma.” He paused long enough to push his hand through his curly blond hair. Renatta was familiar with the habit, which was a sure sign of his uneasiness. “Emerson also confirmed something we suspected earlier.”

  “I’m listening.”

  “All of the affected women are pregnant.”

  With his words seemingly suspended in midair, Renatta could feel the color drain from her face.

  The lobby lights flickered.

  “Give me a minute,” she told him. “I’ll let Stan know I have to leave. You can drive us to the office.”

  Renatta made her way back into the opera hall. Clutching her rolled-up program, she descended the center aisle. With her stomach clenched and plagued by a rising sense of urgency, it occurred to her that perhaps the most sensible thing to do was skip the trip to her office and have Julian drive her directly to the White House.

  5

  DECEMBER EIGHTH

  The Island of Nevis, West Indies

  NUMBER OF CASES: 823

  Dr. Jack Wyatt’s plan to spend a relaxing week at a plush Caribbean hideawa
y had fallen well short of his expectations. After a punishing two-hour tennis lesson with a fanatic pro, he limped back to his oceanfront casita. Dumping his gear on the floor, he resisted the temptation to collapse on the canopied four-poster bed in favor of watching another spectacular sunset.

  With one brief stop to pluck a chilled imported beer from the refrigerator, he made his way out onto the veranda and flopped into a wicker love seat. With his angular legs outstretched and the fading warmth of the afternoon sun on his freckled arms and shoulders, he gazed out to sea. A couple hundred yards from the beach, two WaveRunners with their engines whining sliced across the water in tandem.

  Since his divorce nine months earlier, Jack had done little to kick-start a new social life. It had been a process, but he finally admitted to himself that his wife had stopped loving him long before she’d asked him to move out. The ink had barely dried on their divorce decree when she packed up her belongings and their daughter and moved to France, where she had been born and raised. He never pined for her, but he missed Nicole terribly.

  He had never given serious thought to vacationing alone, and it was only at the insistence of a few concerned friends that he needed some time off that he finally caved in and booked the trip. Unfortunately, the change of surroundings did little to improve his emotional indifference.

  A few days after he arrived, he gave serious consideration to cutting his vacation short and returning to Columbus. But his grueling schedule of teaching and patient care as chief of neurology at the medical school left him precious little time off. In spite of the disappointment with his vacation, the meager two weeks he could manage each year were far too precious to give up.

  It wasn’t long before the rigors of his tennis lesson, the premium beer and the light tropical wind levied their full effect. With the droning of the WaveRunners disappearing to the north, Jack closed his eyes and yielded to the inevitable.

  It wasn’t more than a few minutes later, when the shrill alert of his phone snapped his eyes open, that his tranquil nap came to an abrupt end.

  “Hello,” he muttered, assuming it was the concierge confirming his dinner reservation.

  “Jack. It’s Mike. I’m sorry to bother you on vacation but something’s happened to Tess.” Jack pulled his legs in and shook the fuzz from his head. “She’s pretty sick. The doctors put her in the intensive care unit at Southeastern State.”

  Jack was unaccustomed to the trepidation in his best friend’s voice. Having grown up in Fort Lauderdale across the street from each other, Jack and Mike had been inseparable from their first day of kindergarten until high school graduation in spite of diametrically opposed personalities. Even though they had attended different colleges, time and distance had done nothing to erode their friendship. They spoke frequently and still shared an inviolate golf trip to Arizona every September.

  “Was she in an accident?” he asked Mike with a mixture of alarm and uncertainty.

  “No, nothing like that. I got a call yesterday that she had passed out during her spinning class. Her instructor called nine-one-one and the paramedics took her to Southeastern State.”

  “Is she still unconscious?”

  “No . . . not exactly. I . . . I guess you’d call it more like a daze. Her eyes were going crazy, so they called in a specialist. As soon as he saw her, he had her admitted to the intensive care unit.”

  “Is the baby okay?”

  “They told me she’s okay . . . but I’m not sure anybody . . .” Mike paused for a few moments. “I need you to come up here, buddy. I’m scared shitless. I guess I didn’t realize how bad things were until a few hours ago. The ICU doctor told me she’s . . . she’s not sure Tess is going to make it.”

  “I’ll call the airlines as soon as we get off the phone,” Jack said, pushing his sunglasses atop his head. “I’ll be there tomorrow.”

  “Don’t bother calling the airlines. I’ll fly down tomorrow and get you. Just come to the general aviation center at the Saint Kitts airport at around ten.”

  “Has Tess had an MRI or CT scan of her head?”

  “Both,” he answered. “Look, I’m calling from Dr. Helen Morales’s office. She’s the dean of the medical school. She can fill you in a lot better than I can.”

  Although they had never met, Jack recognized the name immediately. Helen Morales was a trained radiologist but for the past fifteen years, she had been a nationally recognized innovator in medical education. Two years ago, she had left her position at Dartmouth to become dean of Southeastern State University’s medical school.

  It wasn’t hard for Jack to connect the dots why Mike was calling from her office. In addition to Tess and Mike being alumni of Southeastern State, they both had an undying passion for philanthropy. Mike was a dorm-to-empire techno-genius. By the time he was thirty, he had made his fortune designing and producing video games. Last year he had been named to Southeastern State University’s board of trustees. Soon after the appointment, he pledged five million dollars toward construction of the new business school, an architectural marvel that would bear his name.

  “Dr. Wyatt?” came a pleasant voice. “This is Helen Morales. Let me begin by adding my apology to Mike’s for disturbing you on vacation, but we’re all very concerned about Tess.”

  “Mike and Tess are family, Dr. Morales. You’re not disturbing me.”

  “He obviously feels the same way about you. As Mike mentioned, Tess was brought to ER early yesterday morning with a major alteration in her mental status. We ran two complete urine and blood toxicology panels thinking she might have accidentally ingested something, but they were completely negative. She’s had both an MRI and a CT scan of her brain, both of which were normal.” Even as she spoke, Jack was racking his brain trying to recall any neurologic illness that fit Tess’s symptoms. “So, as you can see, in spite of a rather extensive evaluation, we don’t have a diagnosis.”

  Jack was well aware that Dr. Morales’s call was a courtesy briefing only. Being a family friend and not a treating physician, he was mindful not to step across the line of professional ethics by making any suggestions regarding Tess’s care.

  “It certainly sounds like you’ve done everything by the book,” he told her.

  “Coming from a neurologist of your preeminence, I’ll take that as a compliment. All of us here are quite familiar with your outstanding work on elusive neurologic diagnoses. Your book chapters and scientific publications are required reading for our neurology residents.”

  “That’s kind of you to say.”

  “As I’m sure you’re aware, we consider Tess and Mike extremely important members of the Southeastern State family. When Mike mentioned to me that you two were extremely close friends . . . well, I encouraged him to call you. I understand your main reason for coming here tomorrow is to support Mike, but I was hoping I might be able to persuade you to make your visit a little more formal. I’d like to extend you an invitation to serve as a visiting professor of neurology at Southeastern State. That way you’d be able to formally consult on Tess’s case.”

  Jack was quite familiar with visiting professorships. It was a common practice amongst medical schools to invite faculty members of other schools to spend time with their residents and students in order to expose them to different medical insights and perspectives. Over the years, Jack had been invited to serve as a guest professor on many occasions. His schedule permitting, he always accepted. But Dr. Morales’s invitation was a bit different. Serving as a guest professor at Southeastern State would directly involve him in the care of his closest friend’s wife, which was a touchy situation at best and one fraught with a host of potential problems. But his concerns paled in comparison to his friendship with Mike, which meant that turning down Helen Morales’s invitation was not an option.

  “I would be happy to accept your invitation,” he said.

  “That’s excellent, Jack. I’ll ma
ke sure the staff’s prepared to familiarize you with the details of Tess’s hospitalization as well as with the other cases.”

  A little puzzled by Helen’s comment, he inquired, “The other cases?”

  “We’ve admitted several other women with the exact same symptoms as Tess. Our information’s still pretty sketchy, but it seems there are numerous other hospitals in the country which are also treating women with the same illness.”

  Planting his bare feet firmly on the teak deck, Jack stopped the love seat from rocking. He stroked the three-day stubble that roofed his straight jaw and said, “You’ll have to excuse me but I’ve been cut off from the world for the past few days.”

  “Specific details of the illness haven’t been widely publicized as yet, but I’m sure it won’t be long until the media gets wind of things.”

  “I suspect I’m repeating what the physicians at Southeastern State have already suggested, but if there are multiple patients with the same symptoms, wouldn’t the diagnosis be more likely a contagious disease rather than a primarily neurologic one?”

  “That’s exactly what we thought at first, but that doesn’t seem to be the case. Hopefully, you’ll be able to help us figure this out,” Helen responded.

  “I’ll be happy to help in any way I can,” he said. “I should give Dean Hutchins at Ohio State a call just to let him know that—”

  “I hope you won’t consider it too presumptuous of me, but I already called Hutch to make sure he’d have no objection. Fortunately, there have been no reported cases in Ohio or I’m sure he would have already summoned you back. He asked me to tell you to stay as long as we need you.” Jack thought to himself that there weren’t too many people in the country who called Eric Hutching, the venerable dean of the Ohio State University College of Medicine, Hutch. “Mike would like to speak with you again. I’ll put him back on. I look forward to meeting you tomorrow.”

  Jack stood up and walked over to the railing where he spent the next ten minutes trying to calm his friend down. Mike had a litany of questions, very few of which Jack was able to answer with any authority or certainty. Nobody was more aware than he that patience was not one of Mike Ryan’s virtues. Regrettably, at the moment his need for answers that simply weren’t there stoked the fires of his frustration.