Error in Diagnosis

by Mason Lucas M. D.

  “Is . . . is that it?” he asked.

  “I beg your pardon,” Madison said.

  “I asked if that was everything you wanted to tell me.”

  “Yes, Hollis. That’s everything.”

  Jack was hardly surprised at Sinclair’s rude response. From the moment he learned Helen wanted all of them to discuss Isabella, he was less than optimistic Sinclair would embrace Madison’s theory.

  “There are no secrets here,” Sinclair said. “I’ve already heard about this case in detail. And as interesting as it may be from a medical oddity standpoint, I’m afraid it’s equally irrelevant. Whatever the factors are that make these women susceptible to GNS are totally immaterial. I don’t deny that an elevated inhibin level may be an associated finding of the disease, but it’s not the cause.”

  “So, it’s still your belief that GNS is a viral illness,” Madison said.

  “Why shouldn’t it be? Nothing you’ve said here this morning gives me any reason to alter my opinion. Especially now that all of the patients have a fever. As sure as the sun will set this evening, these women are suffering from a new strain of parvovirus. If somebody has frostbite you treat the injury, not the blizzard that caused it. In order to eradicate GNS, you have to find and treat its cause, which is a virus, not an elevated hormone level.” He stopped for a moment to blow out a tired breath. Then, in a controlled voice he stated, “It’s inevitable we’re going to see the death rate accelerate. If there’s any hope of curing these mothers and babies, we have to begin a program of Vitracide therapy immediately.” He stood up and pushed his hands deep into the pockets of his white coat. “You may have removed this girl’s tumor, but you’re not going to cure her.”

  “I guess that still remains to be determined,” Madison said.

  “Even if she does recover, that’s still not hard evidence the pregnant women with GNS will also recover if their pregnancy is terminated. I think the vast majority of families will opt to treat the disease per my treatment plan and not disturb the pregnancy.” Sinclair turned to Helen. “I have several pressing matters to attend to. If there’s nothing further . . .”

  The disappointment in Helen’s eyes was unmistakable, but Jack said nothing. He realized attempting to discuss other possible causes of GNS besides a virus with Sinclair was a waste of time.

  “I understand how busy you are, Hollis,” Helen said. “I appreciate you finding the time to speak with me.”

  Sinclair stood up, shook his head a few times and then waltzed out of the room.

  Jack had seen all forms of professional faux pas and rude behavior, but they all paled in comparison to the gross disrespect Sinclair had just shown Helen.

  “Is there anything else we can do?” Madison asked her.

  “I’m running out of wiggle room. It would certainly help if you and Jack could discover how to cure this damn thing before Hollis Sinclair checkmates me.”

  49

  DECEMBER FOURTEENTH

  NUMBER OF CASES: 4,323

  NUMBER OF DEATHS: 19

  Madison and Jack hovered over Isabella’s bed like two nervous medical students awaiting the results of their first anatomy exam. A few minutes earlier, Jack had checked on Tess. Her condition was still critical. He had spoken to Mike and they had agreed to meet for lunch. For good reason, Jack was expecting another difficult conversation.

  “Has there been any improvement in her neurologic status?” Madison asked Dr. Josh Marcos, who had been at her bedside for the past eight hours. Sporting a three-day crop of bristly whiskers, Marcos’s eyes were colored crimson from sleep deprivation.

  “None,” he answered. “In fact, she’s probably a little worse.”

  “Maybe it’s still too early to see any improvement,” she suggested. She then looked at Jack, and in a voice struggling to cling to any shred of optimism, asked, “What do you think?”

  “It’s difficult to say. Neurologic injuries can have a slow recovery process. Even if the factor that’s causing GNS has been completely removed with the tumor, it’s still hard to know when we might see signs of improvement. We also have to consider that whatever neurologic damage has occurred . . . well, it might be permanent.”

  “So, what do we do from here?” she asked.

  “Nothing, I’m afraid,” Jack answered. “All we can do is support her vital functions, closely monitor her neurologic status and . . .”

  Just at that moment the door opened. When Jack saw it was Sinclair, he did his best to force a cordial smile.

  “How’s your patient doing?” he inquired, making his way over to the bed.

  “She’s about the same.” Madison answered.

  “Really? I heard she’s worse. I understand her inhibin level’s zero. If my memory serves me correctly, you predicted we’d see signs of recovery by this time.”

  “It hasn’t even been two days yet, Hollis. It’s still too early to dismiss the possibility she’ll recover.”

  Sinclair rolled his eyes, moved up to the bed and then reached down and ever so slightly elevated Isabella’s chin.

  “I see she still has the rash. What about fever?”

  “She still has a fever,” Madison answered.

  “Boy, it looks like you got that tumor out just in the nick of time,” Hollis said, with a sardonic smirk as he shook his head and started toward the door.

  50

  After his visit to the ICU, Hollis Sinclair was convinced the chances of Isabella Rosas’s recovering from GNS were a pipe dream at best. He bounded up the three flights of stairs to the office of Dr. Liam Kenney in the department of pathology.

  Kenney, a specialist in neurologic pathology, was a pallid man with bony fingers and sharp angular shoulders. Sinclair found him hunched over his microscope, humming a Broadway tune.

  “Good morning, Liam.”

  Kenney lifted his head from the microscope’s eyepiece, sat straight up and then reached up to his balding head, where his glasses were perched, and slid them down.

  “Kind of early for a neurologist, isn’t it?” he asked Sinclair.

  “I’m here every morning at seven. How’s the family?”

  “Everybody’s fine.”

  “Good. By the way, I understand you’re coming up in front of the tenure committee again at our next meeting.”

  “That’s right.”

  “Well, I’ve always found you to be a highly competent pathologist. You should have been granted tenure the first time around. You’ve built your reputation on being a team player. I don’t have to tell you how political these things can get, but I’m sure with the right people in your corner, there shouldn’t be a problem this time.”

  “Thank you, Hollis,” he said. “I was extremely disappointed the committee failed to recognize my contributions to this university.”

  “As I mentioned, these things can get pretty political.”

  “I suppose,” Liam said with uncertain eyes.

  “I was wondering if you had any preliminary news on Sherry Rosenfelt’s brain biopsy.”

  “Actually, I still have a few more slides to go over before I complete my report.”

  “I’m well aware of the official process, Liam. I’m asking you for any preliminary thoughts you might have. I’m not going to hold you to anything. I understand nothing’s official until you dictate your final report.”

  Liam eased back in his chair. “I can appreciate how anxious you are, Hollis, but maybe it would be best—”

  “C’mon. We’ve known each other a long time. Anything we discuss is completely off the record and confidential. I would really appreciate your help.”

  “Of course, Hollis. What would you like to know?”

  “Is there any evidence on the biopsies to confirm a viral illness?”

  “Her brain tissue shows gliosis and a few other nonspecific findings, which ar
e all signs of inflammation.”

  “A viral illness?”

  With a wrinkled brow, he answered, “It certainly could be.”

  “You realize that these women have been running a high fever. When you consider their other symptoms, especially the rash, we have overwhelming evidence that GNS is a viral disease, and one, I might add, that’s spreading out of control. I’m convinced I have the cure for this devastating illness, but I need the support of strong-willed men who have the courage of their convictions to commit.”

  “I understand, Hollis, and I admire your passion.”

  “I look forward to reading your final report. When did you say it would be ready again?”

  “Hopefully, later today.”

  “I truly appreciate your help,” Sinclair said, extending his hand. “I suspect within a week’s time, there will be thousands of grateful family members who will share my feelings.”

  For a few moments after Sinclair was gone, Liam stared across his office with a vacant expression. He had just been summarily checkmated by his esteemed colleague and there was little he could do about it. The last thing he needed at this stage of his career was to make a political enemy of every influential member of Southeastern’s medical staff. Unable to see much wiggle room, Liam resigned himself to the fact that his biopsy report would state that Sherry Rosenbluth’s brain tissue was infected by a virus.

  51

  Metropolitan Clinic

  Birmingham, Alabama

  Every Thursday morning, Dr. Mary Grandeson made formal teaching rounds with her residents and medical students. She had just finished answering the last of the group’s questions when Wright Zarella stepped up with a self-satisfied grin. Humility in the face of accomplishment was not a social grace he possessed.

  She looked at him and shook her head a couple of times. “Before you explode, I suggest you tell me what’s burning in your mind.”

  “I got a call about a half an hour ago from the New Hampshire Department of Health and Human Service. New Hampshire has a very sophisticated electronic health data bank. They are meticulous to a fault in their information gathering regarding all forms of public health disorders.”

  “I’m sure New Hampshire appreciates your praise. What did you find out?”

  “About eight weeks ago two pregnant women were treated for strange neurologic symptoms.”

  “What type of symptoms?”

  “Muscle twitching of the arms and legs, fatigue and seizures.”

  “Dancing eye syndrome?”

  “No.”

  “So, what happened?”

  “They both fully recovered after a few days, so the illness didn’t attract an enormous amount of attention. But no cause was ever found. The cases caught the attention of the epidemiologist who put them in the state registry. When he read my blast e-mail, he responded right away and briefed me in detail on the cases. He also put me in touch with the women.”

  “And?”

  “Well, it seems both of them began using a new skin moisturizer a week or so before they got sick. The manufacturer’s a new boutique company headquartered in Dover, New Hampshire. Nanotechnology was used in the product’s creation. The company decided to confine the distribution of the moisturizer to New Hampshire as kind of a test market.”

  “And there have been no further cases?”

  “None to my knowledge, but remember we’re talking about a fairly small distribution with respect to both area and population.”

  “There are no cases of GNS in New Hampshire. Do we have enough information from our patients here in Alabama to cross-reference this data?”

  “Only partially, but none of our patients used the same product the women in New Hampshire used, which obviously makes sense.”

  With her posture stiffened, Grandeson drew a deep breath. “Leave me everything you have on this. I’m going to ask Kendra and Roger to pursue it.”

  “Kendra and Roger are two years behind me. I was the one who found out about this,” he said, dropping his hands to his side. “Don’t you think I should be the one to. . . ”

  She smiled. “The surgeon general and I have much more important work for you.”

  “I beg your pardon.”

  “I sent Dr. Brickell the article you gave me the other day. Last night, she called me back and we had a nice long chat about it. She was very intrigued and thinks the researchers in Germany may be onto something. She called Dr. Kurt Dressin, who’s the researcher heading up the project. He trained in Chicago.”

  “This is all very interesting, but I’m not sure . . .”

  Mary paused long enough to button the middle button of her white coat. “We’d like you to spend a few days in Magdeburg.”

  “You want me to go to Germany? Are you serious?”

  “Don’t I sound serious?”

  “But, why?”

  “Because that’s where the medical school and the research unit are. Dr. Dressin personally extended the invitation.”

  “What exactly am I supposed to do over there?”

  “Observe, ask a lot of questions and bring home as much information as you can. This group is obviously a lot more advanced than any research team in the U.S.”

  “I agree, but I’m just not sure going to Germany is necessary.”

  “The surgeon general and the president disagree. They think it’s a good idea to send the individual who may have stumbled across the cause of GNS. If you feel like taking up your objections with them, be my guest.”

  He cupped his chin. “The president of . . .”

  “Yes, Wright, of the United States.”

  Wright’s face filled with surrender. He blew out every molecule of air in his lungs and then shrugged his shoulders. “When do I leave?” he asked.

  52

  Pleased with his meeting with the pathologist, Hollis returned to his office. He was just beginning to review the information he had requested on the national supply of Vitracide when his assistant buzzed him on the intercom.

  “Dr. Sinclair. I have a call from a Dr. Cole in Indiana. I forwarded the call to the crisis center but they suggested you take it. The doctor said it was very important.”

  Sinclair stole a peek at his watch. He only had a minute or two before he was to attend a phone conference with six physicians across the country—all of whom strongly supported his viral theory.

  “Put him through,” Sinclair told her.

  “Dr. Sinclair. My name is Cole. I’m an emergency physician in Bedford, Indiana.”

  Neither the name of the hospital, nor the physician was familiar to Sinclair. He rolled his eyes. He was tired of answering inane questions from every hick physician in the country taking care of a pregnant woman.

  “How can I help you?” he asked.

  “I recently transferred a patient by the name of Recino to Illinois Memorial. This patient’s of particular interest because she’s the only documented case of GNS within a two hundred mile radius of Bedford. In spite of taking a detailed medical history, I just discovered that Ms. Recino omitted an important piece of information.”

  “Really?” Sinclair said, wondering when Cole would get to the point.

  “It seems Maggie and her mother spent the early part of her pregnancy in Fort Lauderdale. She received her initial prenatal care from a Dr. Charles Lipshank. I thought you might want to speak with him and get her obstetrical records.”

  “That’s an excellent suggestion Dr. Cole,” he answered, half-listening as he picked up a letter on his desk. He had already decided that Dr. Cole’s information had no practical value. “Of course. I’ll make sure we thoroughly review Dr. Lipshank’s records.”

  “I’ve already called Illinois Memorial about the matter. They said they would enter the revised information into the National GNS Data Record.”

  “We certainly appr
eciate you calling,” Sinclair said while reading the first paragraph of the letter. “We’ll be in touch with you if the information leads us somewhere. Thank you, again.” With several other issues crowding his mind, Sinclair called his assistant. “I’m ready to join the conference call now.” By the time his call ended thirty minutes later, his conversation with Dr. Cole of Bedford, Indiana, was a faint memory at best.

  53

  DECEMBER FIFTEENTH

  NUMBER OF CASES: 4,812

  NUMBER OF DEATHS: 20

  Agent Maxime Barbier stepped off the airplane into a deeply overcast morning. The flight from Quebec City to Port-Menier, the island’s principle city, had taken just over two hours. Barbier was a ten-year veteran of the Royal Canadian Mounted Police. He was regarded by most as one of the most outstanding agents, especially in the area of missing persons. After obtaining a computer science degree from McGill University, he served a four-year stint in the military, volunteering for the elite Special Operations Forces Command. His beanpole appearance and mild methods disguised a man highly trained in many forms of combat weaponry and the martial arts.

  He began researching the ex-biological weapons scientist Alik Vosky five minutes after the director of the CSIS personally handed him the Russian’s dossier. The director made it a point to inform him he’d been handpicked to head up the operation. He was instructed to put all of his other cases on the back burner until Vosky was located. In a pledge Barbier had never heard the director make, he promised him any and all resources he might require to bring Vosky in.

  He rolled up the collar of his coat and made his way to the car rental agency.

  Fortunately for Barbier, Vosky wasn’t the most sophisticated individual he’d ever encountered when it came to changing identities. To get the job in Winnipeg at the pharmaceutical company, Vosky had assumed the name of Eli Steinhoff. Because he was still using it, it hadn’t taken Barbier very long to discover the Russian had rented a small house on Anticosti Island.