Error in Diagnosis

by Mason Lucas M. D.

  “I apologize for disrupting your schedule but we have some new information we’d like you to share with you.”

  Sinclair heaved an impatient breath and then looked at his watch. “Go ahead.”

  “I would ask you to listen with an open mind.”

  “If you’ll promise to get to the point, I’ll promise to listen with an open mind.”

  “Our information is still preliminary, but we’ve studied the charts of over five hundred women in Florida and found all of them received the flu vaccine from one of two companies. What’s of particular interest is that they all received it about six weeks prior to becoming ill.”

  Sinclair said nothing, glancing back and forth every few seconds at all three of them. Finally, in an incredulous voice he asked, “That’s it? You dragged me away from what I was doing to tell me that? As I recall, the flu vaccine is recommended for pregnant women. I would guess to date, millions of doses have been administered. And what difference does it make which company manufactured it?”

  “Because there are six companies that manufacture a vaccine. It’s too much of a coincidence that five-hundred-plus women with GNS all received the vaccine from one of the two companies.”

  Leaning back in his chair, Hollis raised a finger and inquired, “How many pregnant women received the vaccine from either of these two companies who are perfectly fine?” When Madison didn’t answer, he said with a smirk, “That’s what I thought.”

  “We believe the vaccine may be an important factor in facilitating the disease,” Jack said. “We’re not saying it’s the direct cause.”

  “A factor facilitating the disease? For God’s sake, man, we’re looking for a cure not a facilitating factor.” With undeniable disbelief on his face, he continued, “First it was an elevated hormone level that you were going to cure by removing an ovarian tumor. The last I checked Isabella Rosas is worse now than she was before the operation. Now it’s the flu vaccine?” He laughed and threw his hands up. “What are you going to tell me next—all women with GNS use the same brand of mouthwash?”

  “We think that both the elevated inhibin level and the flu vaccine are factors necessary for GNS to take hold,” Madison answered.

  “I’ll restate my question. How do you explain how thousands of pregnant women, all of whom have elevated inhibin levels and all of whom have received the flu vaccine, don’t have GNS?”

  “We don’t know that yet,” Madison said.

  He came to his feet with a dismissive sneer. “As soon as you do figure it out, let me know. In the meantime, I would remind you that our patients’ families aren’t interested in wild theories about shots and hormones. They are interested in a treatment that will cure their loved ones. This isn’t a high school science fair; this is real medicine. The only thing you two have accomplished is to plunge further into the depths of irrelevance and absurdity.”

  “We disagree,” Madison said in a clear and calm voice.

  “Really? I’ve laid out in detail why I think GNS is caused by a virus. What’s your evidence that it’s not?”

  “We just don’t feel it fits clinically,” Madison said.

  “That’s it?” he demanded, looking at each of them in turn. “Speaking as a perinatologist with no training in neurology or infectious diseases, you have a feeling?” His eyes switched to Helen. “I can’t believe they have you believing this ridiculous bedtime story about the flu vaccine.”

  Helen said, “Jack and Madison are just asking you to hold off beginning Vitracide treatment until they can look into these findings a little further.”

  “Nothing that was said here this morning would give me the slightest reason to delay treatment.” He took a few steps toward the door before stopping and turning around. “Since the day you arrived, Dr. Wyatt, you’ve been uncooperative and openly dismissive of my professional efforts. Based on your personal relationship with Michael Ryan, I’ve chosen to overlook your rude and unprofessional behavior. But now we’re on the cusp of curing this disease and saving not only Tess Ryan’s life but thousands of others. I understand you’re under great personal pressure and I’m sorry you weren’t the one who discovered the cause of this disease, but isn’t it time to set your ego aside and do the right thing?” Sinclair didn’t wait for a response. With a tired shake of his head, he strolled out of Helen’s office.

  Feeling no need to explain himself to a man such as Sinclair, Jack did nothing to stall the retreat. Jack had never been one to throw a quick punch, but at the moment he was hard-pressed to think of a better solution to Sinclair’s arrogance than taking matters into the alley.

  “I guess none of us is surprised at Hollis’s reaction,” Helen said. “I’m not sure he’s as difficult as he tries to be. He’s just so convinced he’s right.”

  “It’s obvious he’s not going to cooperate with us, so our only choice is just to keep working,” Madison said.

  “I’m afraid it’s not quite that simple. Hollis has put the full-court press on everybody he’s ever met in the hospital or at a cocktail party. We’re not the only ones he’s told that Jack’s presence is disruptive to the care of the patients. He’s made several requests that his guest professorship be terminated. He’s also complained that your argumentative and inflexible approach is impeding measures to cure GNS.”

  “As the dean, isn’t there anything you can do?” she inquired.

  “Unfortunately, this isn’t a monarchy. I, too, have people to answer to. For reasons beyond comprehension, Hollis Sinclair has the sympathetic ear of a lot of influential people. He’s already gone over my head. I have the tire tracks to prove it.”

  “Just because he’s a persuasive man with the gift of gab doesn’t mean he’s right about GNS,” Madison said.

  “There’s enormous pressure in every state of this country to find a way to treat GNS. Politicians, public health officials and hospital boards are getting thin on patience. In addition to the families of the GNS victims, they’re being squeezed by every social organization and religious organization under the sun to come up with a cure. We already have numerous reports of a cottage industry of scam artists selling a host of products guaranteed to prevent or cure GNS.” She covered her mouth for a few moments and added, “People are desperate for an answer right now, and unfortunately, Hollis Sinclair is the only one claiming to have it.”

  Jack looked squarely at a woman he had grown to admire. “I’m here at your invitation, Helen. If you feel my presence at Southeastern State has become a . . .”

  “I have no such concerns, Jack. I’m still the dean of this medical school, and until I say otherwise, your invitation is good.” She turned to Madison. “If you could keep your head down a little, it would help. I’ll do the best I can to keep Dr. Sinclair calm, but you and Jack need to come up with something pretty damn quick—even if it’s only the promise of a cure. My phone’s ringing off the hook and I’m running out of ways to keep the enemy from storming the gate.”

  61

  After spending most of the morning in the ICU, Jack went to the doctors’ dining room to meet Madison for lunch. Earlier, they had visited Isabella Rosas and finally agreed the removal of her ovarian tumor had done nothing to improve her condition.

  “Did Mike call?” Madison asked, taking the seat across from him.

  “A couple of hours ago. I’m going to meet with him tonight at his house.”

  “I’m happy to come along if you think it would help.”

  Jack thought about Madison’s offer for a few moments. “Thanks. I think that’s probably a good idea.”

  They were just starting to get up to go through the food service line when Madison’s phone rang.

  “We’re in the doctors’ dining room.” Madison nodded a few times. “No, that’s fine. We’ll wait right here for you.” Replacing her phone in the pocket of her white coat, she said, “That was Helen Morales. She wants t
o talk with us. There appears to be another new development. She’ll be here in a couple of minutes.”

  Helen Morales waved as she approached Jack and Madison’s table. From the somber look on her face, he assumed that more bad news was on the way. She sat down, interlacing her fingers as she placed her hands on the table.

  “I just got off the phone with the surgeon general. She called me as a courtesy to let me know she met with the president and his key health care advisors earlier today. The president has decided to make a national address tonight. In his speech, he will talk about the option of using Vitracide.”

  “I can’t believe it,” Madison said averting her gaze. “How can the president of the United States come out in support of such a potentially dangerous and unproven treatment?”

  “I’m not sure you’re going to see an across-the-board endorsement. The president’s in a tough spot. Try and remember the mood of the country is somewhere between irate and terrified. A lot of people believe the medical community and government haven’t been forthcoming or effective in the way they’re dealing with GNS. Emergency rooms are packed, obstetricians are working till midnight and state and federal health agencies can’t begin to handle the volume of calls they’re receiving.” Helen shook her head slowly. “You can’t blame the president. He’s got to do something to get the country out of this tailspin. From a political standpoint, it’s the smart move.”

  Madison frowned. “Politically smart. That’s great.”

  “I assume Southeastern State will make Vitracide available for those families who elect to go that route?” Jack asked.

  “I don’t think we’ll have a choice,” Helen responded.

  “So, I guess the key question is how long will it take Sinclair to get his treatment protocol up and running?” Jack asked.

  “Once he has the tacit approval of the federal government, which I think the president’s address will provide, he’ll be ready to start treating within a few days.”

  “That doesn’t leave us much time,” Jack said.

  “What are you two going to do?” Helen asked.

  “I don’t think Madison and I are ready to cut and run just yet,” he said with the slightest of shrugs. “We’ll just keep working. Hopefully, we can gather enough information in the next few days to convince our colleagues and the public that the last thing in the world they want to do is authorize the use of Vitracide.”

  62

  Jack pulled into Mike’s driveway at a few minutes after seven. When Tess had discovered the two-story Spanish-style house, she knew it was a treasure. As soon as they purchased it, she began a major renovation. Her efforts became a labor of love, and one year later she finished the home she’d been building in her mind since she was a freshman in college.

  Walking up to the house, Jack took a second look at the lighted crystal sleigh with Santa sitting in it. It was the same one Tess had been displaying since the first Christmas she and Mike had spent in the house. Mike opened the door and escorted them through the foyer and into his library. The room was paneled in mahogany wood, with the far wall a floor-to-ceiling bookcase with a rolling library ladder on brass rails. A series of marble tables displayed Mike’s collection of military-styled chess sets from numerous historical eras. Tess’s hand in things was clearly present in the elaborate Christmas decorations that filled the room. The tree was in the far corner, adorned with shimmering ornaments and an arrow-shaped sign pointing to Santa’s workshop.

  “Would anybody like something to drink?” Mike asked, pointing to the couch. They both declined with a wave of the hand. Once they were all seated, he said, “I spent all afternoon with Tess. I never saw her move once and her face is lifeless.”

  “She’s not improving,” Jack said, “but I’d say she’s holding her own.”

  “Dr. Sinclair disagrees,” Mike said flatly.

  “That doesn’t mean he’s right,” Madison said.

  “He called me earlier. He told me the hospital’s close to authorizing his Vitracide program. He wants me to consent to treatment as soon as possible.” He set his glass of red wine down on a coffee table. “Would you agree with him that the young girl who was operated on is not going to recover?”

  “I’d say the possibility’s remote,” Jack answered.

  “If you decide to go ahead with treatment, what’s your plan regarding the baby?” Madison asked in a cautionary tone. “Did Dr. Sinclair make a recommendation?”

  “He said the decision was mine. Right now, I’m leaning toward a C-section.”

  “Tess is only in her twenty-eighth week. The baby will be extremely premature.”

  “I guess being very premature is better . . . better than the alternative.”

  Mike stood up and walked over to one of his Civil War chessboards and mindlessly moved a few of the pieces around. “A few days ago, you said if the girl didn’t get better after the operation and Tess didn’t improve, you would agree to go with Sinclair’s recommendations. But I’m getting the feeling you still think I should wait.”

  “I do.”

  “If I wait and do nothing, what are my guarantees we won’t lose them both? The thought of losing the baby is painful enough, but the thought of Tess dying is beyond anything I can possibly imagine. I just don’t know what losing . . .” His voice was choked and his eyes became glazed by a veil of tears. With his hands folded in his lap, he added, “Most men are brothers by circumstance. I was fortunate enough to choose you. There’s no man I admire more than you, Jack, but you’re going to have to explain to me why you’re right and Sinclair’s wrong.”

  “I can’t do that. And I don’t have any guarantees that I’m right. The only thing I can tell you is that my gut’s telling me Vitracide is not the answer.” After a weighted sigh, he added, “This is not a decision you have to make right now. We still have a couple of days. If another option becomes available . . . well, we can talk about it then and you can decide if you want to reevaluate your decision.”

  “Okay,” he said in a monotone, staring down at the floor. “Okay.”

  Mike spent the next few minutes talking to Madison about the baby’s condition. Jack only listened, but he studied his closest friend carefully. Mike’s voice and manner were like a beleaguered marathoner too cramped and spent to take another stride. From the beginning Jack had considered the consequences for Mike if he lost Tess but the true impact hadn’t crystalized for him until now. The price his friend would pay in untold suffering from losing the love of his life was, at least for the moment, more than Jack could fathom.

  63

  Thirty minutes before President Stephen Kellar was to make his national address, Renatta Brickell was escorted into his office by one of his assistants. He sat behind his desk, his eyes intently focused on the pages of his speech. A few moments later, he looked up and saw her. He glanced around the Oval Office at the harried group of aides and technicians.

  “May I have a few minutes, please?” he asked them as he stood up and escorted Renatta to the couch. “My address is only twenty minutes long. I thought I should speak a bit longer but Carmondy and the rest were opposed to the idea. What do you think?”

  “I think the length is fine, sir. It covers all the key points without belaboring or skimming over any of them.”

  He flipped through the pages, making little eye contact with her.

  “I know you’ve looked over the text but I’d like to read a part of it aloud to you.” He reached for a glass and took two quick sips of water. “From the beginning, my administration has viewed the safety of both the mothers and the fetuses as paramount in importance. We have invited the leading scientific and religious minds in the country and individuals from all walks of life to attend meetings and fact-finding sessions. Every one of those participants has searched his or her soul in evaluating this difficult moral dilemma. Ultimately, this decision has to be left to the famili
es, their consulting physicians and spiritual advisors.” He looked up. “What do you think?”

  “It’s well phrased, Mr. President.”

  Just then, one of his aides entered the room.

  “Ten minutes, sir.”

  “Thank you.” He turned to Renatta. “Is there anything else you can think of?”

  “No, Mr. President. I wouldn’t change or add a word. It’s an excellent speech.”

  Kellar stood up and walked back to his desk. The cameras and lighting equipment had been in place for hours. He picked up the phone and told his administrative aide to send everybody back in.

  “Any last-minute thoughts?” he inquired, his face just slightly flushed.

  Renatta was taken back. President Stephen Kellar’s calm but stalwart confidence was conspicuously absent.

  “Sir, in a few minutes the people of this country are going to know how seriously their president is reacting to this catastrophic outbreak. They’ll know as a result of your efforts, thousands of scientists, doctors and other health care professionals are doing everything humanly possible to stop the spread of this disease.”

  “I wish I shared your unbridled optimism,” he said with a wrinkled brow.

  Renatta again wished Kellar luck and then exited the Oval Office to watch his address with other key members of his team. She wasn’t an expert on the political process; she was a doctor. But at the moment she was convinced that President Stephen Kellar was five short minutes away from making the most important address of his career.

  64

  After watching the president’s speech at Mike’s house, Jack and Madison headed back to the hospital.

  “What do you have planned for the rest of the evening?” he asked her.