Error in Diagnosis

by Mason Lucas M. D.

  “What I’m asking is if any of you believe there’s a significant chance his theory’s correct and that . . . that this wonder drug will cure GNS?”

  “It’s possible,” Madison said. “But what concerns all of us is that Vitracide is extremely toxic to both mother and fetus. I think we’re all in agreement that we don’t have nearly enough hard evidence to recommend its use.”

  Kellar shifted in his chair, directing his next question at Helen Morales. “Hard evidence,” he repeated, seemingly in distant thought. “How many people at Southeastern State are aware of Isabella’s . . . special situation?”

  “That’s difficult to say with certainty but there have been many people involved in her care.”

  “Have the details of her surgery been posted in the National GNS Data Record as yet?”

  “We decided not to post any further details until we had something definite to report,” Helen responded.

  “I think that was a wise decision,” he said, standing up and moving to the back of his chair. He faced the group. “I’m not breaching national security when I share with you that over the past two days I’ve met with several highly concerned religious groups and other organizations on both sides of the aisle of the abortion issue. I’m sure it comes as no surprise that there are those who vehemently oppose any governmental agency advocating termination under any circumstances.” He paused for a moment, placing his hands on the chair. “And that would remain true even if there’s convincing medical evidence it would result in a cure for the mother.

  “As the president, I have grave concerns regarding the impact the details of Isabella’s condition could have on the nation. Even if she should recover, I’m not sure it would be advisable to make sweeping medical recommendations based on her case alone. If we should advocate termination and it turns out there was an alternative way to cure the disease . . . well, the outcry will be heard around the world.”

  Kellar pressed his palms together and continued, “Let me assure all of you that from a political standpoint, Dr. Sinclair’s treatment plan is far more appealing than anything I’ve heard here tonight. He has communicated to my staff that he believes if we don’t begin therapy soon, we’ll lose our window of opportunity and that it’s quite likely we’ll start seeing hundreds more deaths of both mothers and babies.” Jack was hanging on every word Kellar was saying. He had a strong suspicion where he was leading them. “Therefore, until I authorize otherwise, I am directing that all medical information regarding this young woman’s care remain sealed and strictly confidential.” Speaking in a voice that could leave no doubts, he added, “I consider the details of her medical condition to be a matter of national security.” He returned to his seat and looked out over the group. “I welcome your comments.”

  “With all due respect, Mr. President,” Madison began with a measure of hesitancy in her voice. “I’m not sure as physicians we can guarantee—”

  “Dr. Shaw,” Kellar began, “as I’m sure you’re aware, approximately six million women a year become pregnant in this country. About four million of those pregnancies result in a live birth. Even as we speak, thousands upon thousands of obstetricians’ offices are being flooded with frantic calls from families wondering if they should terminate their first trimester pregnancies as a precaution.” He pushed forward in his chair and placed his hands flat on the table. “I’m asking you not to discuss any of this information with anyone until we’re absolutely convinced we can’t cure this disease by some means other than termination.”

  Helen Morales said, “Let me assure you, sir, that the administration and medical staff at Southeastern State will do everything in their power to comply fully with your request.”

  “It’s not my intent to place anybody in a difficult position but until we can get a better understanding of Dr. Sinclair’s claims, I feel as if there’s no other way. A cure for this dreaded disease without resorting to termination would be the preferred scenario by far.”

  For the next thirty minutes, the president asked Jack and Madison a number of pointed questions. Jack felt he was legitimately interested in the specifics of the GNS cases, but that he had already addressed the main reason he had requested the meeting.

  The president was beyond cordial in thanking each of them for disrupting their busy schedules to speak with him. Jack and Madison returned to their seats. It was another fifteen minutes before either of them uttered a word.

  45

  Twenty minutes after they had arrived at Andrews, Jack and Madison were airborne on their way back to West Palm Beach. The much smaller military jet had few of the comforts of Air Force One but it didn’t matter. Both of them were overwhelmed by their encounter with the president and hardly in the mood to discuss it any further.

  Madison finished the last sip of her sparkling water and then asked, “How long ago was your divorce?”

  “I don’t recall mentioning I’ve ever been divorced.” She looked at him as if he were trying to persuade her the world was flat. He shrugged and said, “Nine months ago.”

  “Any children?”

  “I have a five-year-old daughter.”

  “What’s her name?”

  “Annis.”

  “Pretty. Do you see her often?”

  “Four times.”

  “A week or a month?” she asked.

  “Since the divorce. My ex-wife’s French. She had an excellent attorney who persuaded the judge to allow her to move back to Paris. So, since our divorce, I’ve made two trips to France, and twice, Nicole’s brought Annis to New York.”

  “Which one of you wanted the divorce?”

  “I’d say we both did.”

  “That’s crap. It’s always one person who wants out more than the other. Let me guess. You were never home and when you were, you had your head glued to your computer screen writing a paper or another chapter for the latest textbook in neurology. Your wife was going through life alone, you were insensitive to her needs and you had long forgotten how to enjoy your marriage.”

  “That . . . and Nicole was sleeping with her boss.”

  Madison chuckled but quickly covered her mouth. “I’m sorry, I shouldn’t laugh. It was just the way you said it. How did you find out?”

  With a slight head shake, he asked, “Are you sure you want to hear this?”

  “Pretty sure.”

  “We used to eat out a lot, but every Thursday we would stay home and order pizza. Well, I had just finished my third slice and was working on my second glass of Chianti when Nicole took my glass from me and set it down. I thought she was going to tell me how much she adored me but, instead, she used the tender moment to inform me she had never really loved me the way a married person should. Before I could get a rational explanation, she confessed she’d been horribly lonely for a long time and that she was in love with someone else.” He spun the ice cubes in the bottom of his empty glass before going on. “She then told me the best thing for the both of us would be a divorce. The whole thing was very well prepared and took all of two minutes.”

  “You really had no clue how unhappy she was?”

  “Nope. I guess she viewed being married to me as a little bit worse than residing in the seventh circle of Hell.”

  “Did you know him?”

  “Her boss?”

  “Yeah.”

  “No, and, not that it’s important, but him was a her.”

  “Actually, that makes things a lot easier. You had what my laser club calls a no-brainer divorce.”

  “What’s your laser club?”

  “A group of my friends, mostly doctors, one of whom is a plastic surgeon, get together every couple of months for dinner at somebody’s house. We spend the evening bitching, drinking margaritas and lasering off anything that might make us look older.”

  “And the no-brainer divorce?”

  “Simple. Once
you had the information about your wife, you had to get a divorce. You didn’t have to waste six months beating yourself up wondering why your marriage failed or how you could have saved it.”

  “Why did you get divorced?” Jack asked.

  With a bemused grin, she said, “I guess I finally figured out he just wasn’t worth fighting for.”

  “Any kids?”

  “Only him. Our breakup was one of the great legal olympiads in modern history. The worst part was that a couple of months into it, we talked seriously about reconciliation. By an incredible act of stupidity, I got pregnant. Two months later, I lost the baby. I always blamed it on the stress.”

  “What did you do?”

  “After a few months of self-loathing, I went into a complete emotional free fall. I wound up taking some time off and getting a lot of help.” She sighed and added, “It was a struggle but I finally put my life back together.”

  “I . . . I’m sorry. I wasn’t really trying to . . .”

  “No need to apologize, Jack. People recover. It was a long time ago and I’m fine now. It doesn’t matter what happens to you or who’s to blame. If you can’t figure out how to get comfortable in your own skin . . . well, life winds up being intolerable.”

  Jack was surprised how candid Madison was being with him. It was the human side of her he hadn’t seen a particle of until this moment. Nothing further was mentioned about either of their divorces. Instead, they covered a host of much less depressing topics. He enjoyed speaking with her and it made the rest of the flight seem like it only lasted a few minutes.

  It was just after eleven when their driver pulled up to the hospital. Instead of heading back to his hotel, Jack decided to stop by the ICU to check on Tess and Isabella. Finally seeming like a mere mortal, Madison told him she was too exhausted to join him and would meet him first thing in the morning in the ICU.

  46

  Because of the late hour, the number of reporters in front of the hospital had thinned out considerably. Entering the hospital through the main entrance didn’t pose a problem. Jack was a few feet from the ICU when he saw Bud Kazminski coming toward him. Since Bud had first ambushed him in the lobby of his hotel, Jack had made it a point to speak with him at least once a day to update him on his daughter Sherry’s condition.

  “Evening, Doc,” he said.

  “How’s she doing?”

  “About the same. Walk with me,” he said, pointing to a bank of vending machines in a small alcove at the end of the hall. “David and I met with Dr. Sinclair earlier. He recommended to us that Sherry undergo a brain biopsy. He said the results could very likely lead to a cure.” They reached the machines. Jack said nothing while Kaz studied the selections. “How about something to eat? I’m buying.”

  “Nothing for me, thanks.”

  He slid a dollar bill into the machine, tapped two buttons and retrieved his honey-glazed peanuts. Before he opened the bag, he turned and asked, “This brain biopsy thing strikes me as a little extreme. What do you think?”

  It was obvious to Jack why Sinclair was recommending a brain biopsy. If he were right about GNS being a viral illness, the biopsy might be the only way to definitively prove it. As much as Jack had come to dislike Sinclair on both a personal and professional level, the idea of a brain biopsy had actually crossed Jack’s mind two days earlier. Politics and emotion aside, from a pure medical standpoint, a brain biopsy was a reasonable test to consider.

  “It’s a little hard for me to advise you on Dr. Sinclair’s recommendation. We’re dealing with a disease medical science has never seen before. A biopsy could conceivably lead to the diagnosis, but it could also show absolutely nothing. There’s just no way of telling.”

  “What really worries me is the risk of anesthesia,” Kazminski said.

  “There’s simply no way of knowing what the risks of surgery and anesthesia would be.” Jack waited a few seconds and then added, “I guess I haven’t been much help.”

  With a quick shake of his head and a glint of his acerbic smile, Kazminski said, “Actually, you’ve been a big help. I’m going to give David a call and recommend that he agree to the biopsy.”

  “When does Dr. Sinclair want to do it?”

  “He told me if we agreed, the neurosurgeon could schedule it for tomorrow,” he answered. “Listen, Doc. When we get the results of the biopsy, do you think we could talk again?”

  “Of course.”

  “Thanks.”

  He popped a handful of the peanuts into his mouth, nodded at Jack and then started down the hall. His limp was worse. Jack couldn’t quite figure out why, but there was something about Bud Kazminski he very much admired. Jack was convinced that in spite of his bumbling exterior, he was a man of substance, uncommon insight and one who obviously loved his daughter very much.

  47

  When Jack entered Tess’s room, Marc was setting up the portable ultrasound machine. A wide-eyed, third-year medical student stood next to him studying his every move.

  “How’s she doing?” Jack asked.

  Marc shook his head. “Not great. She’s still in a deep coma and she spiked another temp about two hours ago.”

  “Still no idea what’s causing it?”

  “Not a clue. We’ve checked everything.”

  “What do you think?” Jack asked him.

  “I’d say she’s getting worse by the hour. I don’t know how much longer she can go before she needs medications to keep her blood pressure up. And her breathing’s becoming more rapid and shallow,” he added. “Putting her on a respirator can’t be too far away.” Marc checked the settings and selected a probe. “Unfortunately, we’re finding the same thing in almost all of the other patients.”

  “Did Tess have the MRI?” Jack asked, studying the monitors.

  He nodded. “Earlier this evening. I called the radiologist who read it. He told me for the first time he’s seeing subtle evidence of brain swelling.”

  A number of possibilities, none of them good, flashed into Jack’s mind. Swelling was a sign the brain tissue was deteriorating. The disease was progressing even faster than he had anticipated. He assumed that whatever was happening to the patients at Southeastern was being played out in every hospital in the country. Jack had never been good at concealing his emotions. He assumed the look on his face betrayed his mounting desperation.

  “What’s next?” he asked Marc.

  “Apart from keeping a careful eye on things, we have no specific plans. Hopefully the ultrasound will show the baby’s still doing okay.”

  Having no new ideas or suggestions, he said, “I’ll check in with you in the morning.” Finding his way to a small consultation room, Jack sat down for a few minutes to gather his thoughts. Through the open door, he stared without purpose into the ICU. When he was as ready as he was going to be, he reached for the phone and dialed Mike’s number. “Did I wake you?”

  “No. I’ve been waiting for your call. I figured you’d check on Tess before going back to the hotel. What do you think about the fever?”

  “Almost all of the GNS patients have a fever. I’m assuming it’s just part of the whole picture.”

  “Do you think she’s getting worse?”

  Jack was anticipating the question. “I think she’s a little worse . . . but still stable.”

  “Stable?” There was a lengthy pause, and then in a voice painted with despair he said, “I guess there are a lot of questions I could ask, but at the moment, I’m too afraid.”

  Understanding the immense weight of the emotional pain Mike was shouldering, Jack said, “I realize we haven’t made much progress as yet, but I’m hopeful that will change in the next few days.” As soon as the words were out of his mouth, Jack realized he sounded vaguely and unjustifiably optimistic.

  “I spoke with Dr. Sinclair,” Mike said. “He claims he’s within days of finding th
e cure for GNS. He wants to meet with me as soon as possible to discuss his treatment plan. What do you think?”

  “I would encourage you to talk with him, but I also think we should discuss any treatment proposals before you agree to proceed.”

  “Okay.”

  “You sound exhausted. Get some sleep. I’ll see you over at the hospital in the morning.”

  Jack realized that Mike’s growing sense of doom was probably no different than Bud Kazminski’s or any of the other family member’s across the country gravely worried about their loved one with GNS. Jack was consumed with concerns on every level, but at the moment, his greatest fear was that within a few days, Mike Ryan and thousands of others would find themselves faced with making the hardest choice of their lives.

  48

  DECEMBER THIRTEENTH

  NUMBER OF CASES: 3,125

  NUMBER OF DEATHS: 19

  Jack was hardly surprised when he received a call from Helen Morales’s assistant requesting his presence at a ten o’clock meeting in her office. He checked his watch. He still had time to go the ICU and check on Tess’s condition before the meeting. After reviewing her record and examining her, he concluded she was the same as when he’d last seen her eight hours earlier.

  At ten A.M., Jack, Madison and Sinclair were assembled in Helen’s office.

  “I wanted to get together so that Madison might update us on Isabella’s condition since surgery, and perhaps give us some more details about her theory.”

  “I’m all ears,” Sinclair said. In spite of his obviously sarcastic comment, Madison spent the next few minutes briefing him on the tumor they had discovered in Isabella’s ovary and every aspect of her care. She stressed the significance of the finding, especially with respect to a possible cure for GNS. When she was finished, he stared at her as if she were trying to sell him the tollbooth concession at the Golden Gate Bridge.