“Wait a sec,” Jack said holding up his hand. “I was only the chief resident. I didn’t have the authority to fail anybody. I didn’t even assign grades. I was asked my opinion of each student’s performance but the chief of neurology was the one who assigned the grades.”
“But you were the one who gave us our final practical oral examination.”
“That’s true, but so what?”
“Are you saying you didn’t discuss the results with the attending physicians in charge?”
“Of course I did, but I never failed anybody on the test.”
She looked at him with dubious eyes. “My written evaluation couldn’t have been clearer. It said I had failed the final practical examination and therefore the entire rotation, which I would be required to repeat. Apart from being one of the most humiliating experiences of my life, I almost didn’t graduate with my class. The failing grade also appeared in big bold letters on my transcript, which didn’t help very much when I applied for OB-GYN residencies. I was so afraid I wouldn’t get one, I wound up applying to thirty programs from Gainesville to San Diego. Needless to say, I didn’t exactly get my first choice.”
In spite of her impassioned speech, Jack was certain he hadn’t been the reason Madison failed her neurology rotation.
“I don’t remember any student having to repeat the clerkship,” he informed her.
“Do you really think I would repeat it with you? I told you. I was so embarrassed I wanted to die. I signed up to repeat my neurology rotation at another hospital. And, not that this would matter to a person such as yourself, but I was going through a horrendous divorce at the time.”
“Why didn’t you speak with me after you found out your grade?”
“What for? To hear the same kind of lame excuses and denials I’m hearing now?”
“You weren’t the only student I had with a personal problem. I think I was always understanding and fair.”
In a droll voice she said, “You’re right, Jack. You were very understanding—right up until the time you fed me to the lions.” She picked up a napkin, crumpled it up and tossed it back on the tray table.
• • •
In spite of his best efforts, Jack was not recovering from the free fall.
He could understand Madison’s anger, but they were debating something that had happened a long time ago. And as it turned out, failing her third year neurology clerkship had no negative effect on her career. She had successfully climbed the academic ladder and was now the chief of perinatology at a prestigious medical school.
But Jack was politically seasoned and knew the facts of a disagreement were not always what mattered. Who was right and who was wrong were oftentimes irrelevant. Sometimes, simply apologizing in the blind was the easiest and quickest solution to a problem.
“I’m very sorry for what happened,” he began in a calm tone. “I can honestly say I have no recollection of failing you on the final exam. But if the time you spent on the neurology service caused you any personal difficulties, I apologize.”
She grinned at him. “Does that lame sorrygram really make you feel any better? Because that’s the most oblique apology I’ve ever heard.”
“I can’t make you accept my apology. If you have a problem with me—fine. But I would like to get past it so we can work together.”
“While I appreciate that—”
“Look, it’s going to be tough enough for us to figure what’s going on with these women. Dr. Morales expects us to work together in a productive manner. Certainly what we’re facing with respect to GNS is a lot more important than any misunderstanding that took place between us umpteen years ago. Being at odds with each other will only make things more difficult. I’m asking you to accept my apology so that we can move on.”
Madison’s expression changed slightly. From the loss of conviction on her face, Jack suspected she was giving serious consideration to his proposal.
“You’re right,” she told him with conviction. “Dean Morales has certain expectations. I’m sure I can put my personal feelings aside so that we can work together.”
He nodded politely and said, “I appreciate you being so open-minded and accepting my apology.”
“I didn’t say I accepted your apology. I said I’d work with you. If you’re expecting a group hug and a chorus of ‘Kumbaya’ around the campfire, you’ll be waiting a long time.” Jack sat in guarded silence, taking in Madison’s self-satisfied grin. It was as if she were happily basking in a bit of long-awaited payback. He actually found himself forced to hold back an optimistic smile. If a few verbal lashings at his expense were all Madison needed to square things between them, it would be a small enough price to pay. His ego had endured worse.
With a circumspect expression, he raised his glass in a mock toast.
“Even if you see it as a descent into the depths of hell—I appreciate your willingness to put your feelings aside and agree to work with somebody you truly despise.”
“I never said I despised you. I don’t despise anybody. I just think you’re an asshole—that’s all.”
He took a swallow or two and then set his glass down.
“Did you really just call me an asshole?”
“Absolutely.”
Grinning on the inside, he shook his head. “I can’t remember the last time a colleague called me an asshole.”
“Not to your face, maybe,” Madison said with a laugh. It was a response Jack deemed a minor breakthrough, even if it was only a small breach in her glacial exterior.
18
It was just after six P.M. when Jack and Madison’s flight touched down in West Palm Beach. With no luggage to claim, they made their way directly through the terminal and then to the same-day parking lot.
“I understand that most of the key treating physicians will be at dinner tonight,” Jack said, buckling up his seat belt. “Have you worked with Dr. Sinclair very much?”
“Our specialties don’t really overlap, but we’ve consulted on a few cases together.”
“How have you found working with him?”
With an intrigued look on her face, she said, “That’s kind of a strange question.”
“Really? In what way?”
“I’m not sure, but I’m getting the feeling you and Marc must be getting pretty chummy. So what it is that you’re really asking me?”
“Nothing,” he insisted, trying to deflect her question by sounding as vague and nonchalant as possible. With Madison already having misgivings about his integrity, the last thing he wanted was to be caught flirting with the truth.
“It sounds more to me as if you already have a preconceived notion about him.”
“I wouldn’t exactly put it in those terms.”
“Really? Then what terms would you put it in?”
“From what little I’ve heard, I get the impression he feels comfortable managing the GNS cases without a great deal of assistance.”
“Hollis Sinclair’s a well-trained neurologist, and he’s an excellent clinician. There are some who think he’s a tad inflexible and self-important at times.” She paused just long enough to cast a cautionary glance his way. “I guess we’ve all been guilty of that from time to time in our careers.”
A few more minutes passed and they pulled up to the hotel. With no further mention of Dr. Sinclair, they strolled past the concierge’s desk and down a carpeted hallway. The walls were decorated with grainy photographs of Boca Raton’s high society and dignitaries from the turn of the twentieth century.
They reached a group of meeting suites. A cardboard announcement resting on an easel identified the dining room reserved by Helen Morales. Jack opened the door for Madison and they walked into a room heavily steeped in history. The royal blue carpet was as thick and lavish as the antique satin drapery. But the showpiece of the room was an eighteenth-century e
xquisitely crafted crystal chandelier. Helen Morales greeted them immediately and began introducing Jack and Madison to the fifteen other physicians in attendance.
After a few minutes, Helen left Jack and Madison to chat with a few of the latecomers. It was at that moment that Hollis Sinclair strolled up.
“Good evening,” Madison said. “Hollis, I’d like you to meet Jack Wyatt.”
“Ah, the prophet from Ohio State,” he said, removing the two impaled olives from his martini and popping them into his mouth. Jack extended his hand. Sinclair stared at it for a few seconds before giving it a hasty shake. The limp-wristed greeting had all the warmth of a get-well card from one’s worst mortal enemy.
“It’s nice to meet you,” Jack said.
“I haven’t had the opportunity to ask you, but when exactly did you arrive?”
“Yesterday morning,” Jack said, suspecting Sinclair already knew the answer to his question.
Appearing uninterested in Jack’s answer, Sinclair held up his glass and motioned the bartender.
“Have you got it figured out yet?” he asked Jack.
“I beg your pardon?”
“Do you have any idea what’s causing GNS?”
“I’m afraid not, but I’d certainly like to compliment you and your team on the way you’re managing these difficult cases.”
“Speaking on behalf of all the second-stringers,” he said with a smile that displayed thirty-two perfect teeth, “we thank you.”
Jack could recall getting off to a stilted start with a colleague a couple of times in his career, but the last two days had been unprecedented. He wasn’t one to make snap judgments about people, but in the case of Hollis Sinclair he was ready to make an exception. He found his pompous and sarcastic manner repugnant. Jack had no way of being certain but he strongly suspected Sinclair had a privileged life growing up and believed pedigree trumped civility. “So, Dr. Wyatt. You were about to share your impressions of GNS with me.”
“Hollis,” Madison said, “this is supposed to be the social part of the evening. There’ll be plenty of time to discuss GNS after dinner.”
The bartender walked over and handed Sinclair another vodka martini.
“Nonsense. You don’t mind talking about the cases now, do you, Dr. Wyatt?” he asked, taking two swallows of the premium alcohol.
“Not at all but I’d prefer hearing your thoughts first. And please, call me Jack.”
“Okay, Jack,” he said, raising his glass in a pseudo toast. “Everybody has made two assumptions, both of which I believe to be totally erroneous and both of which have led all of the investigators down the path of misdiagnosis.”
“Interesting,” Jack said. “What assumptions are those?”
He raised his hand and with a wry smile wagged his finger. “I’m close to finalizing my theory regarding the cause of this disease, so I’d prefer not to say anything at this time. I will mention, however, I’ve been speaking to some of the brightest minds on three continents. I find it interesting that nobody besides myself appears to be intrigued by the fact that there are no cases of GNS reported outside of the United States.”
“Will you be recommending a treatment plan?” Jack asked.
“Naturally.”
“I hope it doesn’t include termination of the pregnancies,” Madison said.
“I’m a doctor. I don’t have the luxury of addressing the moral and religious matters of this disease. I’m far too busy trying to cure it. I suggest we leave the spiritual issues to the clergy. The plan of treatment I’ll be suggesting will be both unconventional and aggressive.” He shifted his gaze to Madison. “With respect to termination, I’m not ruling out any possibility. But I think you would have to agree that common sense would dictate there’s no point prolonging a pregnancy if it means certain death for the mother and baby. In any event, termination is a matter for the families to decide, not their doctors.” The conversation was rapidly heading south. Jack had enough political savvy to remain a listener. Sinclair was acting as if he had just shared a point of profound wisdom with them that neither of them had the insight to see on their own.
“We’re physicians, Hollis. There’s a humanistic side to what we do. I could agree with you on your theory of termination, but then we’d both be wrong.” Madison took a few seconds to regard him with a glassy stare. “If you’ll excuse me, I’m going to join the others.”
Sinclair didn’t respond to Madison’s comment. Instead, he continued to hold Jack captive, droning on endlessly about his accomplishments and the inevitability that he’d be named the new chief of neurology at Southeastern State School of Medicine. Every minute or so Jack found himself glancing over at the table. Madison was seated between two colleagues, apparently involved in an amusing conversation. She never once looked in his direction.
A few more minutes passed and at Helen Morales’s behest everybody began to find his or her place at the table. A young woman entered the room and handed Helen Morales a folded note. She took a moment to read it, sighed deeply and then raised her eyes.
“Excuse me,” she began, “but I’m sorry to have to report that I just received word that there’s been another death. A twenty-five-year-old woman in Reno, Nevada, suffered a cardiac arrest approximately an hour or so ago. They were able to deliver the baby by C-section. The infant weighed three pounds and was transferred immediately to the neonatal ICU.” After a hushed pause, she added, “As soon as additional information becomes available, it will be posted on the National Patient Data Record.”
The dining room was noticeably quiet for the next few minutes. But eventually, the conversation picked up and Jack found himself inundated with questions from his colleagues. He didn’t particularly mind, but he was relieved when Helen stood up and reminded everybody there would be plenty of time to discuss GNS and any other medical topics of interest later. Before retaking her seat, she strongly suggested a brief moratorium on the topic of GNS in favor of lighter conversation and enjoying their dinner.
19
Army War College
Carlisle, Pennsylvania
Dr. Benjamin Milton was a career-hardened military physician. Holding the rank of colonel, he had served as the director of the Army’s Strategic Studies Institute Center. His specific area of interest was the study of biological weapons. Having chaired numerous national and international committees, Colonel Milton had published dozens of scientific papers and had lectured all over the world. Of all the bioterrorism experts in the country, it was Milton that President Stephen Kellar wanted at this evening’s meeting.
Renatta Brickell was met at the entrance to the college by two security personnel who escorted her to a small private dining room on the second floor. Glancing over at the table, she was surprised to see it had only been set for three people. When she heard voices, she shifted her gaze to the far side of the room to a rawboned man with a grainy complexion wearing a tweed sports coat. She pushed a smile to her face, filled her lungs with a cautious breath and walked toward the man who had appointed her to the position of United States surgeon general.
“Good evening, Mr. President,” she said, extending her hand.
“Happy holidays. It’s nice to see you,” he answered taking her hand in both of his with the same winning grin that had paved his way to the White House. At forty-seven and only halfway through his first term, the former governor of Rhode Island had moved from a charismatic upstart with a marginal amount of political experience to a seasoned pro. “I don’t believe you’ve had the pleasure of meeting Dr. Milton.”
She turned toward the unimposing man with a snub nose and shook his hand.
“It’s a great pleasure to meet you. I’m quite familiar with your outstanding contributions to the field.”
“Let’s sit down,” the president suggested, gesturing toward the table. “I considered a larger meeting, but then I thought it might
be better if just the three of us chatted.” A tall server wearing a white vest entered and placed a garden salad in front of each of them. As soon as he exited, the president continued, “I’ve spent most of the afternoon being briefed on certain aspects of GNS. I’ve spoken to several key members of the scientific community and . . . well, my sense is that these young women are not the victims of bioterrorism.” He turned to Milton. “Do you agree?”
Milton didn’t answer at once. Instead he placed his salad fork down and patted the corners of his narrow mouth with his napkin. Brickell was familiar with his reputation as an articulate man, measured in his responses and one who never presented information he couldn’t back up with the facts.
With little inflexion in his voice, he answered, “GNS has an unusual and distinct set of symptoms. Considering what we know about the development of biological weapons, I’d say that the likelihood this disease is a weaponized virus or bacteria is small.”
“How small?” Kellar asked in a cautious tone.
“To manufacture a biological weapon of such sophistication is probably beyond the capability of any terrorist group we are currently familiar with.”
Kellar smiled but appeared circumspect. “You said probably, Colonel.”
“Unfortunately, sir, I can’t give you an unqualified guarantee.”
The president laced his fingers behind his neck and pushed back in his chair. His salad remained untouched.
“I hope you’re simply speaking with an abundance of caution, because as president, I have to know if our country could possibly be under a biological attack. You sound to me like a man with something on his mind. So, irrespective of how remote your concern is, I’d like to hear about it in detail.”
“Of course, sir. As soon as the first cases of GNS were reported, we began looking into the possibility we were facing an act of bioterrorism. In conducting that review, we came across several political groups and individuals of interest. We were able to dismiss most of them fairly quickly, but there was one who stood out. His name’s Alik Vosky. He was a Russian scientist.”
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