Error in Diagnosis

by Mason Lucas M. D.

  “We are under considerable time constraints, gentlemen. Thousands of families from here to California are in a panic, demanding we find a cure for this disease. Your daughter’s in the unique position to be instrumental in ending this horrible epidemic.”

  Kazminski massaged the knots that continued to tighten in his neck muscles. “May I ask you one last question, Doctor?”

  Sinclair nodded.

  “Why Sherry? There are thousands of young women in the country with GNS. Why her?”

  “I can’t speak to what physicians in other parts of the country are doing. I practice medicine here at Southeastern State. I believe we’re way ahead of the curve when it comes to finding a cure. From my perspective, Sherry’s one of our stronger patients. I believe she would tolerate the procedure well. But you are correct, there are other women who are potential candidates for the biopsy.”

  “How many other families have you already asked?”

  “I’m afraid that’s a private medical matter.”

  “Of course, excuse me for asking,” Kazminski said, not believing Sinclair for a minute.

  Sinclair started for the door but after a few steps he turned and looked squarely at David.

  “I should also mention, when the biopsy does confirm GNS is a viral illness, there will be an enormous demand for the drug that will cure it. It’s likely the supply will be woefully inadequate. If you do agree to the biopsy, Sherry would, of course, be amongst the first treated.”

  With his lips pressed together to help disguise his disdain, Kazminski forced a polite nod in Sinclair’s direction. “Thank you for taking the time to meet with us.” An empty stare covered his face. He felt he had acquired a sense for the man. And, it wasn’t a flattering one. He didn’t question his ability as a physician. He did, however, wonder if his personal agenda trumped the well-being of his patients. Kazminski had no proof but he was suspicious Dr. Hollis Sinclair viewed the care of his daughter, Sherry, as a bridge to personal gain.

  32

  Jack arrived for the meeting with Helen Morales a few minutes early. He barely had enough time to leaf through an outdated hospital administration journal when Helen’s assistant stepped out from behind her desk and escorted him into her office. Helen, who was seated behind an ornate antique desk, stood up and met him in the center of the room.

  She shook his hand. “Thank you for coming.”

  She then gestured to the other side of the office and led him over to a richly carpeted adjoining area that contained a racetrack-shaped conference table and an oak bookcase. A curved bay window provided a spectacular view of the coastline.

  Jack had just taken a seat when the door again opened. Madison and Sinclair entered the office together.

  “I hope I’m not late,” she said, sitting down directly across from Jack.

  Taking the chair next to Helen, Sinclair said nothing.

  “You’re right on time,” Helen assured her. “I wanted the four of us to get together, so we might discuss Hollis’s parvovirus theory. I was a little taken back when you announced your possible discovery at the noon conference. I wasn’t aware we were seeking any outside opinions.”

  “You mean apart from Dr. Wyatt’s?” he responded with a note of sarcasm in his voice. “We are in the middle of a national emergency. As a department chief, I naturally assumed I had both the authority and academic freedom to discuss these cases with any colleague whom I felt might help shed some light on finding a cure.”

  “Of course you do, Hollis. I just would have preferred to have been briefed on your conversation with Dr. McPherson before the conference.” With arched eyebrows, she added, “I suspect Carmella Lewis and her colleagues in the infectious diseases department share my sentiments.”

  “With all due respect, Dean Morales, either we have a transparent system regarding academic freedom or we don’t, and if—”

  She raised her hand in restraint. “I think academic freedom at Southeastern State University, while interesting, is a conversation for another time. At the moment, we have important matters to discuss and limited time to do so, so perhaps we should move on.”

  Jack had to push his lips together to avoid grinning. Helen had just done a nifty job of dealing with a difficult faculty member. Perhaps Sinclair hadn’t learned it as yet, but diplomacy was an essential part of being an effective department head.

  Helen reached for a white legal pad and slid it in front of her. Uncapping her silver fountain pen, she said, “I’m very intrigued by your theory, Hollis. I’d like to hear more of the details.”

  Drumming the glass tabletop, he said, “As I’ve mentioned in conference, I’m convinced GNS is being caused by a new strain of parvovirus.”

  “There are many strains of parvovirus, but to my knowledge, there’s only one that infects humans, and that’s the B-19 strain,” Madison said.

  “That’s old information. Right now as we sit here, groundbreaking research is being conducted that will show new strains of parvovirus do exist, and that they can infect humans.”

  With a slight shake of her head, Madison said, “I’m pretty compulsive about keeping up with the most current scientific journals, and I haven’t seen anything about that.”

  “It’s cutting-edge work. It will be months before the results of this research appear in any of the medical journals. If doctors waited until every medical breakthrough appeared in a scientific journal, they’d all be twelve to eighteen months behind the most recent advances.”

  Helen said, “I’d like to hear more details about these studies.”

  Sinclair pressed his palms together. “Dr. McPherson advised me there are several studies ongoing in Canada and Europe which have identified two new strains of parvovirus that infect humans. There’s a group in Leuven, Belgium, who has taken the research one step further and is working on a plan to treat these new strains.” Sinclair moved forward in his chair. “I called the principal investigator, Jacques Aaron. He firmly agrees with the group in Canada regarding the existence of these two new strains.”

  “Did you speak with the group in Canada?” Helen asked.

  “Of course. They believe these strains are treatable with Vitracide, which is an FDA-approved antiviral drug.”

  “They think? I’m quite familiar with Vitracide,” Madison was quick to point out. “It’s recommended only for severe viral infections.”

  With a smug grin, he responded, “I think GNS would fall into that category.”

  “Are you aware that Vitracide can be extremely toxic to the heart muscle of both mother and baby?”

  “Of course I’m aware. I feel quite well versed regarding all aspects of the drug.”

  “In that case, I’m sure you know that this toxicity has been scientifically documented and is not based on guesswork or half-completed research.”

  With a face now filled with boredom and annoyance, he said, “All drugs have side effects, Madison. What’s your point?”

  “Do I really need to answer that?”

  “Let’s stay calm,” Helen suggested. “I’d like to go off in another direction, Hollis. Can you offer an explanation why, with one exception, GNS appears to affect only pregnant women?”

  “Viruses flourish in different environments. Obviously, there’s something unique about pregnancy that makes these women vulnerable. Maybe the virus was already present in a dormant state and became activated for some unknown reason—a situation similar to shingles perhaps.” He exhaled sharply and added, “We’re embarking upon new ground here. We can’t be held hostage by conventional, uninspired thinking. Without going into great detail at this time, I will tell you that I expect to have irrefutable proof that GNS is being caused by a parvovirus in a matter of days. The moment I do, I’ll make a national plea that every woman stricken with this catastrophic illness be urgently treated with Vitracide.” Sinclair made a grand gesture to l
ook at his watch and then started to stand up. “I’m sorry but you’ll have to excuse me. I have another commitment. I think we should all bear in mind that the more time we spend on unproductive meetings, the more time we take away from helping our patients. Left untreated, I assure you GNS will make SARS and H1N1 flu look like a mild case of the sniffles.”

  Without waiting for a response, he turned and left the room. Jack’s gaze shifted to Madison. Her eyes were flinty from anger.

  Helen was the first to speak. “I already know how you feel, Madison. Jack, you’re a nationally recognized expert on uncommon neurologic diseases. Do you think GNS is being caused by a virus?”

  “I’m not an infectious diseases expert, but from what I’ve been able to gather to this point, I’d say it’s unlikely.”

  “I know you’ve only been here a short time and that you didn’t want to say anything speculative at the conference today, but do you have even an inkling of what might be causing GNS?”

  “I’m sorry, I don’t.”

  They spoke for a few more minutes. When they were finished, Helen escorted Jack and Madison back to her outer office. Helen’s silence did little to conceal her frustration. Jack sensed she was disappointed he hadn’t a clue what was causing GNS.

  Walking back to the ICU, he wondered if Helen Morales was developing second thoughts about inviting him to Southeastern State.

  33

  Hollis Sinclair strolled through Southeastern State Hospital’s main lobby. A choir of students from a local high school stood behind a white baby grand piano filling the lobby with melodious Christmas carols. He walked over to the Family Welcome Center and randomly reached for one of the many brochures describing the hospital’s special programs. He opened the pamphlet but instead of reading about Southeastern’s advanced program of knee and hip replacement surgery, he peered above it to the area in front of the hospital. As he expected, the sea of reporters that had been congregating outside all day was still there.

  Replacing the brochure, he buttoned his freshly pressed white coat, straightened his tie and, finally, made sure his identification badge was in clear sight. Because of the unrelenting presence of the media, the administration had advised all physicians to use alternative hospital exits to avoid an ambush—an advisory that Hollis Sinclair fully intended to ignore.

  He gave a final tug on the lapels of his coat and then made his way out of the hospital into an early dusk. Having participated in two of the regularly scheduled hospital press briefings, he was immediately recognized by the reporters. They scampered forward en masse, gathering around him like frenetic autograph seekers at a rock concert. Above the clamoring of their questions, he held up his hand.

  “I’m sorry. I would prefer not to answer any questions at this time.”

  “Can you just tell us if you’re still involved in the care of these women?”

  “GNS is a neurologic disease. I’m the chief of neurology. Naturally, I’m involved.”

  The same reporter again made his voice heard above the others. “Can you share with us your impression of the overall condition of the victims of GNS?”

  “As I just mentioned, I’d prefer not to make any specific comments at this time.”

  A second reporter, waving his notebook in the air, asked in a booming voice, “Are the doctors any closer to discovering the cause of GNS?”

  “Without going into detail, the answer to your question is yes.”

  A television anchorwoman from one of the local channels had managed to weave her way to the front and was now flanking Sinclair.

  “Does that mean you’re also getting closer to finding a treatment?”

  “I’ll make one comment because I think it’s important the American people understand that there’s a small group of forward-thinking doctors who are convinced GNS is a curable disease. Even as we speak, I am planning on a bold diagnostic test that will answer a great many questions about this dreaded disease and lead to a treatment plan.” Sinclair’s prediction prompted an immediate cacophony of fever-pitched voices. He started forward and again raised his hand. “I’m sorry. That’s all I can say at this time. If you will excuse me, I have important patient-related matters to attend to.”

  Sinclair made his way slowly through the reporters, who, for obvious reasons, were not deterred by his insistence he would make no further comments. But Sinclair had already accomplished what he had set out to do. He picked up his pace and ignored all the questions being posed to him.

  By the time he reached the main medical office building, the reporters had retreated. With a satisfied grin, he looked back at the group and then continued on his way toward the doctors’ parking lot. His less than impromptu meeting with the press went exactly as he’d planned. He knew there would be a price to pay, and it would come in the form of an urgent summons to Dr. Helen Morales’s throne room—but he didn’t care. In matters with such profound life-and-death consequences, the ends always justified the means.

  34

  DECEMBER TWELFTH

  NUMBER OF CASES: 2,654

  NUMBER OF DEATHS: 13

  Jack’s first stop when he arrived at the hospital was Tess’s room. He took over a half an hour examining her and reviewing her medical record. His conclusion was that there was no improvement in her neurologic condition. He was also concerned her ability to breathe on her own was deteriorating.

  When he had finished his evaluation, he called Mike to give him an update. He was honest but chose his words carefully to avoid eroding the small amount of hope his friend was still clinging to. After arranging to meet him for lunch, he started down the hall to visit Isabella Rosas. Even though she wasn’t pregnant, her medical condition continued to worsen, making her no different from the other women with GNS.

  “Her grandmother’s in the waiting room,” Peter McLeod, the ICU nurse caring for Isabella, said. “She’s been here for the past ten hours. She’s pretty anxious to speak with you. Would you like me to get her now or do you need a little time?”

  “Now’s fine,” Jack answered.

  Peter left the room. For a time, Jack studied the monitors. The flashing colors of the various displays were hypnotic, and he soon found himself lost in thought. One of his favorite mantras regarding the art of diagnosis came to mind: Focus, simplify and execute. Each failure along the way was no different than a false start in a hundred-meter dash. The only way to deal with it was to reset yourself in the blocks, wait for the crack of the starter’s gun and explode out of the gate again. He smiled when he thought about the corny poster on the wall of his college dormitory room that advised, It’s not how you fall that’s important. It’s how you get up.

  The sound of Peter clearing his throat snapped Jack back to the moment. Standing just inside the door was an elderly, square-chinned woman with wiry gray hair and a slight droop at the corner of her mouth.

  “Dr. Wyatt. This is Audrey Phillips; Isabella’s grandmother.”

  Jack moved toward her and shook her hand, the back of which was crisscrossed with a nest of tortuous veins. Her skin was craggy and furrowed from years of working in the sun caring for and training horses.

  “It’s nice to meet you,” he told her. “I’m one of the neurologists looking in on Isabella.”

  “I know who you are, Doctor. You were brought in from Ohio to help with the GNS cases. How’s my granddaughter doing today?”

  “The best I can tell you is that she’s stable and no worse.”

  “That doesn’t sound very encouraging,” Audrey said, reaching into her purse. She fished around for a few seconds and then pulled out a pair of plain black glasses with smudged lenses. She put them on and said, “To me, Isabella seems worse every day. Do you have any idea when we might start to see some improvement?”

  “That’s very difficult to say.”

  “I was hoping she might be home in time for our big spring horse sho
w.”

  “Ms. Phillips,” Jack began slowly, suspecting Audrey was either in denial or simply didn’t comprehend how sick her granddaughter was. “I’m sure you understand that Isabella’s very ill. It would be impossible for me to offer an opinion as to when she might be going home.” Jack waited a few moments for her to gather herself before going on, “I know you’ve spoken to a great number of doctors, but I was hoping you might be willing to answer just a few more questions.”

  With a tense face and a downward gaze, she nodded in agreement. “Of course, Dr. Wyatt.”

  “Do you remember how Isabella first got sick?”

  “She plays on her junior high school softball team. A few weeks ago they were getting ready for a Christmas tournament and she told me her stomach was hurting.”

  “Where exactly?”

  Isabella pointed to her own abdomen. “Down low, on the right side. I spoke to our family doctor about it. He said it was a woman thing and not to worry about it.”

  “What about her mental function. Did you notice anything different?”

  “Maybe she was a little forgetful. I do remember the day before she was admitted, she said something about being dizzy.”

  Jack continued posing questions on a wide range of topics. To his dismay, there was nothing new or helpful in Audrey’s answers. It was remarkable how similar her responses were to those of the other family members when asked about their loved ones with GNS.

  His frustration was mounting rapidly. “I’m going to ask you to forget about the idea of an illness for the moment. Was there anything . . . anything at all over the last several weeks or even months regarding your granddaughter’s health that was . . . out of the ordinary?”

  A pensive expression came to her face. It remained there for a few seconds before the corners of her mouth lifted into a tender smile.