Error in Diagnosis

by Mason Lucas M. D.

  Watching as the last bit of daylight dissolved into the temperate night, Jack made the short walk to the beach. He strolled along the water’s edge, staring at a massive freighter steaming to the south with its running lights flickering off the water. Taking a few steps back, he reached dry sand. He thought about Tess. Ever since Mike had started dating her in high school, she and Jack had been close friends. She was one of the most even-tempered, caring people he’d ever met. She was as devoted to Mike as he was to her. As innovative as he was, she founded a company that specialized in event planning for major children’s charities. The corner of his mouth creased into a hint of a smile when he thought about how often he had kidded Mike that he was lucky he’d met Tess first.

  Trying to make sense out of everything Helen Morales had said, he sat down and pulled his knees up to his chest. With a growing sense of trepidation regarding the days to come, he continued to watch the huge freighter until it dwindled to a speck on the horizon and then finally vanished into the darkness.

  In spite of his efforts to force it from his mind, he was left with one chilling thought. Even if the cause of this strange new disease could be discovered, there were no guarantees it could be cured.

  6

  DECEMBER NINTH

  James S. Brady Press Briefing Room,

  the White House

  NUMBER OF CASES: 1,265

  With a measure of reluctance, Dr. Renatta Brickell approached the lectern for her nine A.M. press briefing. Ill at ease in front of a microphone, the surgeon general tightened her fist around the gold butterfly charm her father had given her for luck the day she’d graduated from medical school. She had never held a press conference in the White House, nor to the best of her knowledge had any of her predecessors. It was at the suggestion of the president, Kellar, that the briefing take place there. Renatta waited a few seconds for the last of the journalists and other media correspondents to find their seats.

  “Ladies and gentleman, before I take your questions, I have a brief statement,” she began with her signature smile conspicuously absent. “I’d like to summarize what we know to this point regarding the outbreak. Beginning approximately two days ago, a large group of otherwise healthy women began contracting a severe illness. The disease attacks the nervous system and, to the best of our knowledge, has never been seen before. What is particularly disturbing is that all of the women are at least twelve weeks pregnant. The disease has been identified in twenty-two states across the country.” She paused briefly to pull the microphone a few inches closer to her lips. “We are calling this illness GNS, which is an acronym for Gestational Neuropathic Syndrome.” She flipped her legal pad back to the first page and looked up. “That concludes my statement. I’ll be happy to take your questions.” The room was filled with a sudden flurry of hands. Brickell had a good idea which reporters had an argumentative, bulldog style. At least for the first few minutes, she would intentionally avoid recognizing them. Scanning the audience for a few seconds, she pointed at a wiry man wearing a sweat-stained white dress shirt seated in the front row. “I’ll begin with Ben Halpern from the AP.”

  “Have there been any deaths to either the mothers or their babies?”

  “None that have been officially reported.”

  “What about brain damage or other permanent injuries?”

  “We have no way of knowing for sure, but considering the impaired mental status of these patients . . . well, frankly, it would be impossible to completely rule out the possibility.” An instant murmur filled the room. Brickell raised her hand. “I would, however, like to point out that the consensus amongst our perinatologists is that the babies are stable.”

  “Have you been able to determine for certain if the fetuses are suffering from the disease—or is it only affecting the mothers?”

  “Unfortunately, at this point, we have not been able to determine that.”

  Brickell next recognized Melinda Casey, a health care analyst for C-SPAN.

  “In his remarks earlier today, the president said he considers this disease to be a significant threat to the public health of this country and that he would make every conceivable resource available to find the cause and a treatment. Can you provide us with some of the specifics?”

  “Of course. The Centers for Disease Control in Atlanta has been working around the clock investigating this outbreak. Hundreds of physicians and medical researchers have been assembled from a wide variety of specialties to participate in the GNS project. A select group will be part of a presidential task force. The most up-to-date equipment and support services have been placed at their fingertips. With over a thousand women already affected, I expect this investigation will become as comprehensive and far-reaching as any medical inquiry the Centers for Disease Control has ever embarked upon.”

  “Has there been any progress at all with respect to finding the cause?” Casey asked.

  “Not so far, but we are pursuing any and all plausible leads.”

  Not wanting to entertain any further follow-up questions from Casey, Brickell hastily shifted her eyes to the opposite side of the room. She gestured at John Versellie, from the Boston Globe.

  In a high-pitched voice, he inquired, “Do you have any idea at all how the disease is being transmitted?”

  “Not at this time.”

  “According to the information released by your office, many of these women are in their final trimester, yet none of them has gone into labor or delivered. Can you tell us why?”

  “The simple answer to your question is, no, I can’t. What we do know is that none of our patients is beyond thirty-two weeks, which means none has reached her expected delivery date. Another possibility is the disease itself may be delaying the onset of labor. We know that certain neurologic conditions such as multiple sclerosis and spinal cord injuries can do that.” Versellie again raised his notepad, but instead of recognizing him, Brickell said, “In anticipation of your next question, John, we don’t know why women in their final few weeks or those in their first trimester seem to be immune to GNS.”

  Brickell next called upon Maggie Fitzsimmons from MSNBC, a physician who had resigned from her internal medicine residency at the University of Miami five years earlier to pursue a career as a medical correspondent.

  “Generally, a baby born at thirty-two weeks would have an excellent chance of survival. Has any consideration been given to either inducing labor or performing a cesarean section to see if ending the pregnancy will cure the illness?”

  “Yes, we have considered that possibility. The problem is that delivering these babies could be extremely dangerous and perhaps even fatal to both mother and baby. The stress of labor and the administration of anesthetic drugs are all unknowns in patients with GNS. The other issue is that these infants might be highly contagious and even using the most sophisticated isolation techniques, they might represent an enormous risk to other infants and their caretakers.”

  “If it is determined that ending the pregnancy will halt the disease, will President Kellar address the possibility of recommending termination for those women whose babies are too premature to be delivered?”

  “I don’t speak for the president, but as a rule, the chief executive doesn’t make medical recommendations.”

  “But wouldn’t the president and his administration consider this more of a moral question than a medical one?”

  Brickell raised her hand above the murmur.

  “Ladies and gentlemen, we have a serious problem on our hands. For the moment, our goal is to quickly isolate the cause of GNS and to formulate an effective treatment plan that will lead to a cure. That’s what we all need to stay focused on.”

  As Dr. Brickell expected, the reporters were relentless, and for the next thirty minutes she continued to field one difficult question after another. Finally, she leaned forward and placed her hands on either side of the lectern. Her eyes fo
und a persistent young man who had moved into the aisle. With a nod and a gesture, she recognized Tony Williamson, a new correspondent from Reuters whom she had met at her last press conference. It was immediately obvious to her then that whatever he lacked in experience he more than made up for with his instincts and talent.

  “With an epidemic of this magnitude has the president given any consideration to—”

  “Excuse me for interrupting, Tony, but GNS is not an epidemic. An epidemic, by definition, is a dramatic rise in the expected number of cases of an established disease with a known epidemiological history. Since GNS has never been seen before, this present situation can’t technically be classified as an epidemic.”

  Regarding Brickell through unconvinced eyes, Williamson said nothing for the moment. It wasn’t hard for her to read his thoughts. Her comment was evasive, making her look as if she were sidestepping a tough question by providing a piece of information that was true but at the same time totally irrelevant.

  After a forced smile and a slow nod, Williamson renewed his question, “Irrespective of what we call this . . . this outbreak, the fact remains our nation’s facing a disease that’s spreading to the tune of roughly five hundred new cases a day. Can you give us some sense of what the CDC and our other key government health care agencies are recommending to thousands of pregnant women and their families who are becoming increasingly more terrified with each passing day?”

  Brickell wasn’t surprised by the question. Before she’d even walked up to the lectern, she’d expected someone would ask it. She took a few seconds to gather her thoughts before responding.

  “We are working closely with local, state and national medical societies, public health organizations and physician groups to help us educate and inform all pregnant women and those who are considering becoming pregnant of the present situation. We’ve created a telephone hotline and an interactive website for doctors. I assure you, we are critically aware of the rising anxiety across the country. But until we have more specific information about this illness, it would be irresponsible of us to make any recommendations beyond general cautionary measures.”

  Brickell glanced to the side of the room. Urging her to wrap things up, Julian Christakis 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. Brickell 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 answered cautiously. “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.”

  “I understand, Dr. Brickell but we—”

  She waved her hand, which prompted his immediate silence.

  “This is an enormous problem, which isn’t going to go away by simply sprinkling a little pixie dust on it. It’s probably only a matter of days, maybe hours until we start seeing fatalities. Americans are a resilient people, but I don’t think they’re ready to see helpless pregnant women and unborn babies die.”

  Just at that moment, a young man tapped on the door. Julian waved him forward.

  “I have a message for Dr. Brickell.”

  Julian took the note and handed it to her.

  “We haven’t even begun to hear the outcry from the conservative and religious organizations,” she said, unfolding the note. “Every government agency having anything remotely to do with health care is being barraged with thousands of frantic calls. Families are desperately looking for answers, and our only response is to tell them to remain calm and give us more time. And in case you didn’t get the memo, Christmas is three weeks away, so the timing of this disaster couldn’t be worse.” She shook her head as she read the note. “Great,” she muttered, crumpling it in hand. “C’mon, we have to get back to the office. We have a lot of prep work to do.”

  “What’s going on?”

  “The president’s cutting his trip short. He arrives at Andrews at seven forty-five tonight. He wants to meet with us at soon as he gets to the White House.”

  Leading the way out of the room, Brickell wondered what new information she could gather in the next ten hours that might help her respond to the tough questions President Kellar was sure to pose. At the moment, the only thing she could tell him was that if the task force she’d assembled didn’t figure out how to stop this outbreak pretty damn soon, they would have to brace for what would likely be the worst national health crisis since HIV.

  7

  Standing at the stern of the aging ferry, Jack watched a frenzied formation of seagulls swoop down to snatch bread chunks that had been tossed into the churning wake by a raucous group of tourists.

  A product of modest means and an only child, Jack grew up in Fort Lauderdale less than two miles from the beach. As far back as he could remember, he had always loved spending time on the ocean. He preferred sailing catamarans but irrespective of the vessel, he liked being on the water. He enjoyed boating just about as much as he detested flying. Since the moment Mike had offered to send his plane, he had been unable to shake the lingering discomfort of traveling in a small corporate jet.

  The ferry trip took just under an hour and, after a short but perilous ride in a taxi held together by daily prayers and superglue, the cab pulled up in front of the general aviation terminal at the Saint Kitts airport. With no assistance from the apathetic driver, Jack retrieved his luggage from the trunk.

  Through a heavy cloud of dust kicked up by the fleeing taxi, he saw Mike walking toward him. With peach-fuzz for a beard and cropped brown hair, Mike had barely attained the height of five foot six. His small stature had left him five inches shorter than Jack; a fact Jack had teased him about with regularity since they were teenagers.

  With a container of coffee in hand, he gave Jack a firm one-armed hug.

  “How’s Tess doing?”

  “I checked on her right before we left,” Mike answered with an uneasy half smile. “There’s been no real change overnight.”

  Mike took a step toward the plane but Jack put his hand on his shoulder. “How are you doing?”

  “Tess was born a Christmas fanatic. The house is decorated like Rockefeller Center and she’s been consumed with planning our yearly holiday party for the past two months,” he answered in a forced but even tone. “A few miles from here, the woman I cherish more than anything in this world is lying comatose in an ICU.” With a darting gaze, he asked, “How do you think I feel?”

  Jack nodded a few times, but said nothing.

&
nbsp; “I’m sorry, buddy,” Mike said.

  Jack gave his best friend a reassuring smile. “No apology necessary.”

  Mike managed a quick grin in return and then pointed at the red-and-white Hawker parked on the tarmac. “C’mon, we can talk on the plane.”

  Jack studied the eight-passenger aircraft. His slumped shoulders revealed his mounting angst.

  “Where’s the rest of it?” he asked.

  “Don’t tell me you’re still afraid of flying.”

  “I love flying. It’s the crashing part that bothers me.”

  Shaking his head, Mike now placed a hand on Jack’s shoulder. “Relax. I have the two best pilots in the business.” Feeling only slightly reassured, Jack reached for his bags. Mike took his arm. “Just leave them. I promise they’ll be in West Palm when we get there.” Mike tapped his lip and asked, “When did you shave the mustache off?”

  “Last week.”

  “Part of the new image?”

  Jack responded by rolling his eyes. They climbed the stairway and stepped aboard. Jack ducked his head as he trailed Mike toward the back of the cabin. “Take that one,” he told him, gesturing at one of the cream-colored leather captain’s chairs. Jack settled in and immediately yanked his seat belt across his lap. Mike looked at him askew, “You’ll be more comfortable if you can still breathe.”

  Jack took a brief look around. He had to confess the upscale appointments were nicer than anything in his apartment. His eyes flashed forward when he heard the whoosh of the cabin door being secured by the pilot. Being more accustomed to the glacially slow world of commercial aviation, he was astonished at how quickly things were moving.