Error in Diagnosis (11 page)

The noon conference at Southeastern State Hospital was the medical school's most important teaching conference. It was always well attended by a host of specialists who took turns presenting topics of medical interest to the entire staff. The conference took place in the hospital's newly constructed auditorium, which boasted a thirty-foot ceiling, stadium-type seating and a state-of-the-art audiovisual system.

Jack arrived a few minutes before twelve and was escorted onstage by one of the senior neurology residents. Helen Morales stood up from a table she shared with several senior physicians and greeted him with a warm handshake.

“I hope you're ready. I saw the cases the residents have chosen to present to you. They're pretty tough.”

“I'll do my best,” he replied, knowing he'd been in the
same situation dozens of times. He was an adept speaker and had never had a problem thinking on his feet, especially in an impromptu venue.

The conference began on time with the chief resident in neurology presenting an unusual case of an elderly man with a sudden loss of his sense of smell. Jack led a discussion on the topic, which included commenting on the principle causes of the man's symptom. He then went over the possible causes of the illness until finally coming up with the correct diagnosis.

About halfway through the conference Hollis Sinclair ascended the stage and took the final seat at the table. Jack couldn't figure out if he was trying to make an entrance or he was simply being his usual ill-mannered self.

Jack had no problem figuring out the illnesses being presented to him. The final part of the conference allowed questions from the audience. When Jack had answered the last one, he stepped away from the lectern. Hollis Sinclair stood up and walked over. As Southeastern State's chief of neurology, Jack assumed he was about to thank him and close the conference. His assumption couldn't have been further from the truth.

After making a grand gesture to look at his watch, Sinclair said, “I see we still have ten minutes. As some of you may already know, Dr. Wyatt has kindly agreed to serve as a guest professor so that he might offer his expert opinion regarding our GNS patients.”

Jack inhaled sharply and then shifted his eyes to Helen Morales. The solemn look on her face betrayed what she was thinking. She had made her feelings clear to him that there would be no discussion of GNS. He was sure she must have told Sinclair the same thing. Already having a sense for her astute political skills, Jack wasn't surprised when she didn't rise to put a stop to Sinclair's uninvited commentary.

“With this growing national epidemic,” Sinclair continued, “I was hoping our distinguished guest from Ohio
might offer us his insight into these very intriguing and challenging cases?”

As soon as Sinclair stepped aside, Jack returned to the lectern.

“Unfortunately, I find myself in the same position as my colleagues are across the country. I have no theory as to what's causing GNS. Hopefully, that will change in the days to come. I would mention, however, that Dr. Sinclair and his team have done an outstanding job in caring for these patients.”

Sinclair moved toward the edge of the stage. He scanned the front row of seats.

“I see Dr. Lewis is with us today. I'm sure we'd all like to hear her opinion on a possible cause for GNS.”

Carmella Lewis was Southeastern State's longstanding chief of infectious diseases. She had been involved since the first GNS patient had been admitted. She and her team had consulted on every case and were in constant communication with the CDC.

She stood up and waited for one of the audiovisual technicians to trot down the center aisle and hand her a microphone.

“We have done extensive diagnostic tests but to date we've not been able to identify either a bacterial or viral cause for GNS. Although we haven't entirely excluded the possibility, we have no evidence at this time that GNS is a contagious disease. I believe the CDC has reached a similar conclusion.”

“Have you considered that this disease might be a new strain of parvovirus?” Sinclair asked.

It wasn't hard for Jack to understand the astonished look that instantly swept across Carmella's face. Sinclair cared for patients with neurologic problems. He had no training or expertise in the specialty of infectious diseases. His question was at the least inappropriate and at the most insulting. Jack's eyes shifted to Helen. From the perturbed look on her face, he assumed she shared his sentiments.

Ever the diplomat, Carmella responded, “We certainly considered a parvovirus infection but all of the blood tests were negative. We therefore dismissed the diagnosis. I believe the CDC followed a similar protocol and arrived at the same conclusion.”

“I'm aware of those results, but based on the extraordinary nature of this illness, I contacted Carson McPherson.” Jack was quite familiar with Dr. McPherson. He was a nationally renowned professor of infectious diseases with particular expertise in viruses. He had spent most of his career at Yale Medical School but was now at the National Institutes of Health in Washington. “Dr. McPherson and I had a lengthy discussion and we both feel that the symptoms of GNS are quite consistent with a new strain of parvovirus that's never been seen before.”

The pained look on Carmella's face was understandable, considering she had just been thrown to the curb by a fellow physician. Basic professional courtesy would have dictated that Sinclair share his parvovirus infection theory with Carmella before publicly asking for her opinion.

“I haven't spoken with Dr. McPherson, so it would be difficult for me to comment on his thoughts. That being said, Dr. Sinclair, I will again state that based on these
patients' natural immunity and the tests we conducted, we have ruled out a parvovirus infection as a possible cause of GNS. And if I'm not mistaken, the CDC has done the same thing.”

Sinclair wasted no time returning to the lectern, where he took up the position as the self-appointed principle speaker.

“Thank you, Dr. Lewis. In response to your comments, I would like to point out that Dr. McPherson feels it's a strong possibility we may be dealing with a new strain of parvovirus that our current tests wouldn't detect.”

Sinclair's comments were met with a flurry of raised hands. He recognized Kenton Biggs, the chief of internal medicine.

“Are you saying the CDC and most of our leading experts in the area of contagious diseases are wrong?”

“That's precisely what I'm saying. And the sooner we realize it, the sooner we can shift our focus in the right direction and begin helping these women and their unborn infants. There's credible data suggesting that certain drugs are quite effective in treating parvovirus.”

Helen had already come to her feet and was quick-walking toward the center of the stage. Before Sinclair could make any further comments, she reached the lectern.

“It's already a few minutes past the hour, so I'm afraid we'll have to end the discussion here. I want to again thank Dr. Wyatt for agreeing to lead today's conference. This has certainly been one of the more lively discussions we've had in quite some time.” She turned toward Jack and began to applaud. The audience followed. Sinclair
wasted no time in descending the stage and falling in amongst the physicians who were quick to barrage him with questions.

“That was very well done,” she told Jack, motioning to Madison to join them.

“Thank you,” he responded, seeing no reason to offer any thoughts on Sinclair's inappropriate behavior.

“Maybe it would be a good idea for us to get together later today,” Helen suggested. “Say about four in my office? I'm going to ask Dr. Sinclair to join us. I want to hear more about his parvovirus theory.”

At that moment, Paul Boland, one of the senior radiation oncologists strolled up.

“That was an excellent presentation,” he told Jack in a South African accent that hadn't faded a drop since he'd moved to the United States twenty-seven years earlier. Boland then turned his attention to Helen. “I wonder if I could have five minutes of your time. I'm afraid my department is in dire need of your help.”

“Of course, Paul. We can talk in my office.”

Helen turned to Jack and Madison. “I'll plan on seeing you two at four.”

Jack was well aware Helen Morales hadn't reached the position in academic medicine she had without learning how to sidestep a few politically charged landmines. This was one of those situations. Jack suspected she was seething but her manner was controlled and diplomatic. He wondered if she would be as calm at their four o'clock meeting.

Malcolm Athens quick-walked through the West Wing of the White House. Clutched in his hand was a report he'd received five minutes earlier from the Royal Canadian Mounted Police. Athens had been a White House liaison to the CIA for the past four years. It was his principal responsibility to brief the president regarding matters of national security.

He walked past two Secret Service agents standing like pillars on either side of the entrance to the Situation Room, a five-thousand-square-foot chamber consisting principally of six flat-screen televisions and a large conference table. An eight-foot ornately decorated Christmas tree brightly lit with a ceiling-mounted floodlight stood in the near corner.

Casually dressed in a plaid shirt, President Kellar was
seated at the table. The only other person in the room was Zachary Carlton, his chief of staff.

“I just received this report from the RCMP,” Athens began. “It seems our Canadian colleagues have been able to determine that Alik Vosky took a job with Bitrax Industries in Winnipeg a little over a year ago. They are a small pharmaceutical company.”

The president frowned. “With his immigration history, how in the world did he get a job like that? I thought drug companies were more cautious in their hiring practices.”

“I'm sure they are, unless somebody applies under a false name. Vosky's no amateur. The documents he used in support of his application were all excellent forgeries. He even had three phony letters of reference.”

Kellar steepled his fingers. “In what capacity did this drug company hire him?”

“As a senior laboratory technician.”

“In what area?”

Athens fidgeted in his chair. “He was assigned to the research and development department. He participated in several areas. One of them was developing new antibiotics for the treatment of serious obstetrical infections.”

“Great,” the president muttered. “Does anybody have an idea how all of this might tie into Mr. Vosky's disappearance?”

“There was an . . . an incident at the company. Vosky's computer skills were exceptional. The IT department at Bitrax discovered he had acquired certain sensitive files that contained information that went light-years beyond
his pay grade. Their first thought was he was involved in an industrial espionage scheme, but before they could sort things out, Vosky must have realized they had nailed him. He never showed up for work again. The company pressed charges but it wasn't the type of case that was going to receive a lot of resources. As of today, Vosky's whereabouts are still unknown and the case remains open.”

“Has anybody considered that perhaps it wasn't his intent to sell the information to a competing pharmaceutical company?” Turning his palms up, he continued. “Maybe he had more personal plans for the information.”

“We agree with you, sir. The Canadian authorities have undertaken a major initiative to locate Vosky. I'll be receiving daily briefings from them.”

“Perhaps you and I should have a similar arrangement,” Kellar suggested with a manufactured half smile.

“Of course,” Athens said. “I'm sure they'll locate him soon, Mr. President. They're putting their best agents on it.”

The president pushed back in his chair and stood up. With a stiffened posture, he said, “Optimistic predictions are not what I need at the moment. What I want is for somebody to locate this son of a bitch. If the American people should even get an inkling that GNS might be an act of bioterrorism, it's going to touch off a national panic the likes of which this country's never seen before.”