Error in Diagnosis

by Mason Lucas M. D.

  “Dr. Fuller’s here. I’ll put him on.”

  “Hi, Jack. Tess had a stable night. I see no sign there’s been any change in her mental status. Her vital signs are holding but she’s still in a coma.”

  “I was hoping for a little better news than that.”

  “Let’s see how she does today,” he suggested. “By the way, I’m concerned she may be getting blood clots in her legs. I’d like to start her on some heparin. It won’t dissolve any of the clots that are already there but it will prevent the formation of any new ones.”

  “I think that’s a good suggestion, John. I should be there in the next hour or so. Have you seen Mike?”

  “He finally left a few minutes ago. He said he’d be back in a few hours.”

  “I should be there in about forty-five minutes.”

  “I’ll see you when you get here. I assume you’ve heard.”

  “Heard what?”

  “The hospital officially informed everybody that the Vitracide program will begin the day after Christmas. They’ve already started scheduling the first group of C-sections.”

  Through sliding glass doors leading to the balcony, Jack watched the last few minutes of the dawn. His mind wandered in several directions but he kept coming back to the same thing: Two days earlier he was convinced that removing Tess’s thyroid gland would cure her, but during the last twenty-four hours, his conviction had eroded.

  He got out of bed and walked over to the coffeemaker. Reaching for a cup, he thought about his conversation with Fuller. He was just about to hit the Brew button when it suddenly struck him. He closed his eyes and threw back his head. It wasn’t a revelation or realization born of careful thought. It was like a crack of thunder followed by somebody shaking him to wake up and see the obvious.

  “Shit,” he muttered, as he grabbed for his phone to call Madison.

  “I think I screwed up,” he told her.

  “What are you talking about?”

  “Tess isn’t going to get better. I missed something. I’m certain of it.”

  “What makes you think that?” she asked.

  “I just got off the phone with Dr. Fuller a few minutes ago. It was something he said. He wanted to let me know he was putting Tess on a blood thinner. He mentioned he was going to use heparin. He reminded that it would take care of new clots but not the old ones.”

  “And that comment made you realize you had overlooked some critical piece of information? Excuse me for saying this, Jack, but you’re starting to sound like somebody who’s ready to stick his head in an oven.”

  “What’s your point?”

  “My point is you’re panicking. It’s only been a couple of days since Tess’s surgery. You need to give this more time.”

  “I’m not saying we should have seen a complete recovery. I’m saying we should have seen at least some subtle signs of improvement by now.”

  After a quiet few moments, Madison said, “I’m not trying to be harsh or unfeeling, but do you think it’s just possible your relationship with Tess and Mike is clouding your objectivity, and that you’re becoming a little desperate? Jack, we’ve done everything we can. Helen told us it’s over the morning of the twenty-sixth. She’s not going to change her mind. If Tess doesn’t start to improve pretty soon . . . well, I guess we’re both going to have to get on board with what the hospital officially recommends.”

  “I’m not going to worry about politics and deadlines right now, he said.”

  “What are you going to do then?” she asked.

  “One of our assumptions has to be wrong. I have to make another phone call. Then I’m going to get back on the computer. I have a suspicion . . . no, call it an inkling, of where I went wrong.”

  88

  An hour later, Jack had again reviewed most of the scientific articles he had accumulated on autoimmune diseases. He continued to be plagued by a vague recollection of one of the articles, but the more he prodded his memory to recall which one, the further he found himself from remembering. As he approached the end of his review, his confidence that he would find the article was waning.

  It was at that moment, when he brought up the next article, that he knew he’d found what he was after. The article was written by a group from the University of Texas in Galveston discussing novel new therapies for patients with autoimmune diseases. The author mentioned a group at the Rockefeller University in New York that was conducting exciting new research on treating the neurologic symptoms of autoimmune diseases. The article then went on to mention the work was under the leadership of Dr. Jessica Tau.

  Raising his eyes from the screen, Jack drummed the desktop. He brought up Rockefeller University’s website. Moving to the faculty tab, he was able to locate Dr. Jessica Tau. Her bio was impressive. Not only did she hold an M.D. and a Ph.D. in immunology, but she had also been awarded several NIH grants. It was still early, but he dialed her office number anyway, assuming he’d be prompted to her voice mail.

  To his great surprise a woman answered on the second ring.

  “This is Dr. Tau.”

  Jack stood up. “Dr. Tau. My name is Jack Wyatt. I’m a neurologist at Southeastern State working on the GNS cases. I apologize for the early hour, but I was hoping you might have a few minutes to speak with me.”

  “It seems everybody’s arriving at work early these days, Dr. Wyatt. I’d be delighted to speak with you. By the way, I’m quite familiar with your extensive work and contributions in the area of difficult neurologic diagnoses.”

  “Thank you. I recently became aware of the innovative work you’re doing on the neurologic symptoms of some of the autoimmune diseases. I was wondering if you had published any of your findings as yet?”

  “Actually, we received notification a few days ago from the New England Journal of Medicine that they intend to publish our first manuscript in the fall.”

  “Congratulations.”

  “I would be happy to e-mail you a copy of the manuscript if you’d like to review it.”

  “I’d greatly appreciate that.”

  “If you’ll give me your e-mail address, I’ll send it right now.”

  Jack proceeded to ask Tau a number of questions regarding her work. She was more than cooperative, answering all of them in extreme detail.

  “I look forward to reading your manuscript. In the event I have further questions, would you mind if I call you back after I have a look at it?”

  “Of course not. I’ll give you my cell number.”

  Jack provided Dr. Tau his e-mail address and entered her number into his electronic phone book.

  “Thank you again, Dr. Tau. I look forward to speaking with you again.”

  He walked over to his nightstand to grab his legal pad and pen. By the time he returned to his computer, Tau’s manuscript had arrived.

  For the next hour Jack drank coffee, read and then reread every word of it. It was an incredible piece of scientific work, a true research marvel. Finally, he lifted his eyes from the screen. His mind was doing backflips. When he finally snapped back to the here and now, he reached for his phone and located Lisa’s number.

  “Good morning. This is Dr. Wyatt. I apologize for the early hour, but I have something rather important to ask you.” He nodded a few times as Lisa assured him he had not awakened her. “You mentioned that Sherry had her tonsils out but you didn’t.”

  “That’s right. I think we were about six at the time.”

  “Have they ever given you any trouble?”

  “I’ve had strep throat a few times over the years. It always got better right away with antibiotics. I asked my internist about having them taken out, but she said it wasn’t necessary.”

  “Do you recall when you last had strep throat?”

  “Let me think a moment,” she answered. “It was right before I got pregnant. I took antibiotics f
or a week and I was fine.” Before the words were out of her mouth, Jack felt his stomach drop.

  “Thank you, Lisa. I apologize again for calling you so early.” He found Marc’s number and dialed it. The phone rang several times before kicking over to voice mail.

  “C’mon, Marc,” Jack said out loud as he ended the call and then hit the Redial button. “Pick up your damn phone.” While the phone rang, Jack paced the carpet. He assumed he was one ring away from getting his voice mail again when Marc answered.

  “Good morning, Dr. Wyatt.”

  “I need some information from the National Data Record as soon as possible. It’s urgent.”

  “Sure. Just tell me what you need.”

  Jack paused to gather his thoughts. He then took the next few minutes to tell Marc in very specific terms the patient information he was interested in, and that he’d meet him in the ICU within the hour. Jack set his phone down on the nightstand and started getting dressed. His hands were shaking and he could feel drops of perspiration creeping down his brow. Although it was a rare experience for him, Jack Wyatt recognized an overwhelming adrenaline rush when he felt one.

  89

  “You look like hell,” Jack said to Marc when he walked into the ICU.

  “I didn’t exactly make it home last night. We had another GNS death at about three. We did an urgent C-section. The baby’s pretty sick but holding his own in the newborn ICU.”

  “I’m glad the baby survived,” he said. “Has there been any change in Tess’s condition?”

  “No, not really.”

  “I know it’s only been an hour or so, but did you have any time to look at those patients on the National Data Record we talked about?”

  “I did,” he answered, pulling out four pages of patient printouts from his pocket. “And, as it turns out, I was able to locate four women in Florida who were suspected of having GNS, but they turned out to have something else. Two were from Miami, one was from Tampa and one was from Pensacola.” Marc continued to refer to the printouts as he spoke. “The two from Miami were hospitalized at Suncoast Medical Center. They both presented with mild confusion, spasms of their legs and a sore throat. Neither had a dancing eye syndrome, fever or a rash. But to be on the safe side, the physicians at Suncoast admitted them with the diagnosis of possible GNS. Both were in the hospital for a couple of days, got better and were sent home.”

  “What was their discharge diagnosis?”

  “Viral syndrome.”

  “Did their records mention if they had the flu vaccine?”

  “They both got it.”

  “What about their past medical history?”

  “Nothing of interest. They were both very healthy.”

  “Was there any mention if they had their tonsils out?” Jack asked.

  “Their tonsils out? Is that important?” Jack returned Marc’s inquiry with an icy stare. “Sorry,” he said, leafing through the pages. “According to their past surgical history, neither of them had any prior surgery.”

  “What were the final diagnoses on the other two women who turned out not to have GNS?”

  “They had pretty similar symptoms and hospital courses. They both had received the flu vaccine and neither of them, apart from C-sections, had undergone any other surgery.”

  “Did any of the four women have a strep screen done?”

  “Let me check,” Marc said with a degree of hesitation while he again shuffled through the printouts. At the same time, Madison walked up. “It looks like two of them did, and they were both positive.”

  “You didn’t call me,” she said to Jack.

  “I’ve been a little busy. I need to talk to you two,” he said, before turning to Madison and adding, “and then you and I need to meet with Helen Morales immediately.”

  Jack watched as Madison rolled her head from side to side as she massaged her neck.

  “Sure, we can talk in the conference room.”

  She made a grand gesture toward the other side of the ICU and the three of them walked off.

  90

  Madison had no trouble arranging the meeting with Helen that Jack had requested. They were already seated in her office in front of her desk when she came in and sat down.

  As Helen’s eyes fixed on him with guarded anticipation, Jack cleared his throat and slid forward in his chair.

  “I no longer believe that removing Tess’s thyroid by itself will cure her,” he said.

  Helen’s face went slack. “I hope you’re kidding, because after all we’ve been through . . . I mean, are you now telling me you want to abandon your plan and give Hollis the go-ahead to start Vitracide?”

  “Absolutely not,” Jack said with complete certainty. “We’re convinced we can still cure Tess and every other woman with GNS. We still believe GNS is a new autoimmune disease. In order to cure Tess or any other women with GNS we have to eliminate the abnormal antibodies that are attacking their brain tissue.”

  “I believe you’ve already explained that to me. That was our justification for removing Tess’s thyroid.”

  “Removing the thyroid will prevent the formation of any new toxic antibodies but what I overlooked was that the operation won’t eliminate the abnormal antibodies that are already present. Based on cutting-edge research I’ve just become aware of, the existing antibodies will continue to attack the brain tissue for at least six weeks. I don’t believe any of the women will be able to survive that long.” Jack moved back in his chair and placed his hands on his thighs. “If we don’t eliminate the antibodies that already exist, we won’t cure GNS.”

  “Is there a way to do that?” Helen asked.

  “I believe there is. There’s a group at Rockefeller University who have recently discovered that certain strains of streptococcus bacteria produce an enzyme that destroys these abnormal antibodies. They’re calling the preparation Streptogenase V. The result has been a complete reversal of the neurologic symptoms.”

  “Theoretically, every woman with GNS should recover if she receives Streptogenase V,” Madison added.

  Helen guarded her silence, tapping her leather blotter with a pencil. “I’ve had people try to sell me encyclopedias door-to-door who offered a more persuasive argument than that.” Her expression suddenly changed, and with ping-ponging eyes, she asked, “Do you two realize when the average person hears the word streptococcus they don’t think of a sore throat? They think of the deadly flesh-eating bacteria or toxic shock syndrome, which instantly makes their blood run cold. It would be like telling people we want to cure GNS by giving their loved ones arsenic or the Black Plague.” She stopped for a few moments. And then, in a calmer voice inquired, “Do you have anything else to support this theory besides this experimental information?”

  “Sherry Rosenfelt had her tonsils out but Lisa didn’t. I spoke with Lisa this morning. She told me right before she got pregnant she was treated for a strep throat.” Jack then spent some time informing Helen of the other four women Marc had located in Florida who were thought to have GNS but turned out not to. He made a point to emphasize that they had all received the flu shots and that at least two had positive strep tests.

  “Are you trying to tell me that if a woman still has her tonsils in, she can’t get GNS?” Helen asked.

  “Not exactly. We’re saying that a certain strep infection contracted just at the right time offers a high-grade protection or even a cure against GNS. Marc’s combing through the Data Record right now trying to find more women with the same clinical history.”

  “This research being done at Rockefeller University. How many women have taken part in it?”

  Jack tugged at his collar. “Unfortunately, all of their studies to this point have been done on animals.”

  “I beg your pardon.”

  “But Dr. Tau did mention that they have received permission from the FDA to begin clinic
al trials in humans.”

  “Assuming I should agree to this, how do you plan to administer this Strep . . .”

  “Streptogenase V,” Madison said in a meek voice.

  “Streptogenase V,” Helen repeated. “You can’t inject a preparation like that directly into the bloodstream. It would be too dangerous.”

  “Actually, Dr. Tau and her group have determined that’s the only way it works.”

  “You’re telling me this . . . this bacterial concoction, or whatever in God’s name you want to call it, is nowhere close to being FDA approved. That means the only way we could justify administering it would be as the only conceivable treatment to save a life.”

  “I’ve been involved in a few cases where we did that,” Jack said.

  “I have also. But I think you’d agree, not on this level.”

  “I’m not sure this country’s ever faced an epidemic like GNS before,” Madison said.

  After a deep sigh, Helen stood up. “So tell me exactly what you’re proposing.”

  “We already have Mike’s full approval, so we’d like to acquire the strep preparation from New York and administer it to Tess as soon as possible. Dr. Tau has agreed to provide us with enough as long as you’ll sign off on it.”

  “I must be out of my mind. I should be calling psychiatry to come down here and drop a net over the three of us.” Helen leaned forward, placed her palms squarely on her desk and locked eyes with both of them. “I sure hope you two know what the hell you’re doing. “

  “I’m not sure I can offer you that guarantee,” Jack said.

  “How long after administering this drug will we know if it’s been successful?”

  “We can’t predict exactly but according to Dr. Tau, the effects of the Streptogenase V occur fairly quickly.”

  “In mice, you mean,” Helen said with a slow shake of her head. “I’m going to have a lot of people to answer to on this thing. As soon as the word gets out, they’ll be coming after us with pitchforks and lanterns. And it’s not too hard to figure out who’ll be leading the mob.” She raised her eyes. “How soon can you get this stuff from New York?”