Error in Diagnosis (12 page)

After the noon conference, Jack caught up with Madison and accompanied her to the auditorium exit. Most of the physicians had dispersed but a few remained in the expansive atrium talking in small groups.

“What do you think about Sinclair's parvovirus theory?” Madison asked.

“I'm a neurologist. What I know about parvovirus infections wouldn't fill a thimble.”

“The most common one is called fifth disease and is seen mostly in children. It's generally a mild flu-like illness that's frequently accompanied by a very distinctive rash. It's called a slap-cheek rash because it's bright red and looks like the patient's been smacked. Most women already have natural immunity to the virus before they ever get pregnant. If not, there's a vaccine. The few who do get the illness usually have a pretty mild case, and
there's only a very small chance they can pass it along to the baby.”

“What happens if the virus does reach the baby?”

“They generally do okay,” Madison explained. “But a few will develop serious heart and liver problems, and very occasionally, the disease is fatal.”

“I'll ask you the same thing you asked me. Do you think there's any chance Sinclair's right about some new strain of parvovirus being the cause of GNS?”

“Hollis is an extremely well-read, talented doctor. But I don't know if he's truly convinced GNS's a viral infection or he's just showboating for the hospital board hoping to find a shortcut to the chief of neurology's office. He's made no secret that he sees himself as the only logical choice for the position.”

“His personal agenda aside, sometimes a physician can have a vague hunch about a disease that turns out to be right on the money.”

“I guess anything's possible,” she said, “But I prefer to practice medicine by sticking to proven scientific facts. At the moment, this parvovirus theory has all the scientific basis of an Ouija board prediction.”

“You said the rash was very distinctive. It almost sounds a little like the one Tess and the other women developed. Maybe that's why Sinclair's convinced GNS is a parvovirus infection.” They exited the stairwell on the second floor and then made their way toward the ICU. They continued to talk about the cases, focusing on what further diagnostic steps could be taken that might lead to an answer. “I'm supposed to meet with Isabella's grandmother in a few
minutes,” Jack said, stealing a glance at his watch. “Do you think we should touch base before our meeting with Helen?”

She shrugged. “I don't but if you think it's necessary, I will—”

“No. I just thought it might be a good way to . . .”

“I have a lot to do, so unless there's anything pressing, I'll see you at the meeting.”

He cleared his throat twice and said, “Absolutely, sounds good.”

With slumped shoulders, Jack watched Madison disappear down the hall. He felt as if he were in eleventh grade and had just been turned down cold for a date. Although she'd been a little more civil to him since they spoke on the plane, it was apparent she had no intention of forgetting the past. After an inward sigh, he told himself that Madison's opinion of him had no bearing on anything. She had promised to work with him in a collegial and productive manner, and that was all that mattered. Jack started down the hall toward Isabella's room. He hadn't taken more than a few steps when he made a firm promise to himself to accept the way Madison Shaw felt about him, and give up the ghost trying to convince her he was a decent guy.

Hollis Sinclair strolled into the ICU family conference room for the urgent meeting his administrative assistant had set with Bud Kazminski and his son-in-law, David Rosenfelt.

The moment Sinclair entered the room, Kazminski and David rose from the couch. With a quick gesture, he invited them to retake their seats while he sat down in a plaid upholstered chair across from them.

“I assume I have your permission to speak freely in front of your father-in-law.”

“Of course,” David responded.

“As you know, I've been very much involved in your wife's care since she was admitted. For many reasons, it's my belief that her illness is being caused by a new strain of a powerful virus. My suspicion is that both mother and baby are infected with the virus.” He paused for a
moment and then with a hard stare added, “I feel certain if we don't begin treatment soon, this illness will ultimately prove to be fatal to both of them. I am, therefore, recommending to you that you consent to a test that will very likely lead to a diagnosis.”

Kazminski stole a peek at David. The skin bunched around his eyes in a pained stare. From the time he and Sherry began dating it was clear that she was the alpha member of the relationship. David was a considerate and caring husband, but he was short on confidence, and predictably indecisive relating to matters of importance.

“Dr. Sinclair,” Kazminski began, “before we agree, I think both David and I would like to hear something of the specifics of this test.”

“I'm proposing that your daughter undergo a brain biopsy. I believe a microscopic analysis of her brain tissue will confirm conclusively that a virus is causing her illness. And, as I mentioned, such a confirmation will open the doors to beginning treatment for her and the baby.”

Over the course of a very long career as an investigative reporter, Kazminski had interviewed all types of people. Anybody who knew him professionally would say he'd been around the block more times than the UPS truck and that he had developed an astute sixth sense about people. He combed the stubble under his chin with his finger for a few moments. David remained expressionless, his eyes frozen open.

“Dr. Sinclair, are you suggesting we perform brain surgery on my daughter?”

“Technically, yes.”

“This whole thing sounds a bit risky to me,” Kazminski said.

“I assure you, it's a very routine procedure performed by neurosurgeons across the country every day. It's done with a needle using a CT scan for guidance. It's called a stereotactic biopsy. I believe the benefits far outweigh the risks. And, as I've already mentioned, I'm convinced the biopsy will reveal the cause of Sherry's disease.”

“Would she feel any pain?” David asked.

“Absolutely not.”

Kazminski asked several more questions, most of which Sinclair answered in a manner somewhere between offhanded and overly confident. As he expected, David was unable to give his consent for the biopsy even when pressed by Sinclair.

Finally, when Kazminski sensed Sinclair's patience was going from thin to exhausted, he said, “I think my son-in-law and I need a little time to consider your recommendation. When do you need an answer by?”

“The sooner the better,” he said, getting up from his chair. “I've already discussed the matter with the chief of neurosurgery, Dr. Constantine. He agrees fully with the need for a biopsy and is ready to do it as early as tomorrow.”

“What if the biopsy doesn't provide the information you're looking for?” Kazminski inquired.

“I don't believe that will be the case, but even if it is, we'll be no worse off than we are now.”

“Except that my daughter would have undergone an operation that did her no good.”

“We are under considerable time constraints, gentlemen. Thousands of families from here to California are in a panic, demanding we find a cure for this disease. Your daughter's in the unique position to be instrumental in ending this horrible epidemic.”

Kazminski massaged the knots that continued to tighten in his neck muscles. “May I ask you one last question, Doctor?”

Sinclair nodded.

“Why Sherry? There are thousands of young women in the country with GNS. Why her?”

“I can't speak to what physicians in other parts of the country are doing. I practice medicine here at Southeastern State. I believe we're way ahead of the curve when it comes to finding a cure. From my perspective, Sherry's one of our stronger patients. I believe she would tolerate the procedure well. But you are correct, there are other women who are potential candidates for the biopsy.”

“How many other families have you already asked?”

“I'm afraid that's a private medical matter.”

“Of course, excuse me for asking,” Kazminski said, not believing Sinclair for a minute.

Sinclair started for the door but after a few steps he turned and looked squarely at David.

“I should also mention, when the biopsy does confirm GNS is a viral illness, there will be an enormous demand for the drug that will cure it. It's likely the supply will be woefully inadequate. If you do agree to the biopsy, Sherry would, of course, be amongst the first treated.”

With his lips pressed together to help disguise his
disdain, Kazminski forced a polite nod in Sinclair's direction. “Thank you for taking the time to meet with us.” An empty stare covered his face. He felt he had acquired a sense for the man. And, it wasn't a flattering one. He didn't question his ability as a physician. He did, however, wonder if his personal agenda trumped the well-being of his patients. Kazminski had no proof but he was suspicious Dr. Hollis Sinclair viewed the care of his daughter, Sherry, as a bridge to personal gain.

Jack arrived for the meeting with Helen Morales a few minutes early. He barely had enough time to leaf through an outdated hospital administration journal when Helen's assistant stepped out from behind her desk and escorted him into her office. Helen, who was seated behind an ornate antique desk, stood up and met him in the center of the room.

She shook his hand. “Thank you for coming.”

She then gestured to the other side of the office and led him over to a richly carpeted adjoining area that contained a racetrack-shaped conference table and an oak bookcase. A curved bay window provided a spectacular view of the coastline.

Jack had just taken a seat when the door again opened. Madison and Sinclair entered the office together.

“I hope I'm not late,” she said, sitting down directly across from Jack.

Taking the chair next to Helen, Sinclair said nothing.

“You're right on time,” Helen assured her. “I wanted the four of us to get together, so we might discuss Hollis's parvovirus theory. I was a little taken back when you announced your possible discovery at the noon conference. I wasn't aware we were seeking any outside opinions.”

“You mean apart from Dr. Wyatt's?” he responded with a note of sarcasm in his voice. “We are in the middle of a national emergency. As a department chief, I naturally assumed I had both the authority and academic freedom to discuss these cases with any colleague whom I felt might help shed some light on finding a cure.”

“Of course you do, Hollis. I just would have preferred to have been briefed on your conversation with Dr. McPherson before the conference.” With arched eyebrows, she added, “I suspect Carmella Lewis and her colleagues in the infectious diseases department share my sentiments.”

“With all due respect, Dean Morales, either we have a transparent system regarding academic freedom or we don't, and if—”

She raised her hand in restraint. “I think academic freedom at Southeastern State University, while interesting, is a conversation for another time. At the moment, we have important matters to discuss and limited time to do so, so perhaps we should move on.”

Jack had to push his lips together to avoid grinning.
Helen had just done a nifty job of dealing with a difficult faculty member. Perhaps Sinclair hadn't learned it as yet, but diplomacy was an essential part of being an effective department head.

Helen reached for a white legal pad and slid it in front of her. Uncapping her silver fountain pen, she said, “I'm very intrigued by your theory, Hollis. I'd like to hear more of the details.”

Drumming the glass tabletop, he said, “As I've mentioned in conference, I'm convinced GNS is being caused by a new strain of parvovirus.”

“There are many strains of parvovirus, but to my knowledge, there's only one that infects humans, and that's the B-19 strain,” Madison said.

“That's old information. Right now as we sit here, groundbreaking research is being conducted that will show new strains of parvovirus do exist, and that they can infect humans.”

With a slight shake of her head, Madison said, “I'm pretty compulsive about keeping up with the most current scientific journals, and I haven't seen anything about that.”

“It's cutting-edge work. It will be months before the results of this research appear in any of the medical journals. If doctors waited until every medical breakthrough appeared in a scientific journal, they'd all be twelve to eighteen months behind the most recent advances.”

Helen said, “I'd like to hear more details about these studies.”

Sinclair pressed his palms together. “Dr. McPherson
advised me there are several studies ongoing in Canada and Europe which have identified two new strains of parvovirus that infect humans. There's a group in Leuven, Belgium, who has taken the research one step further and is working on a plan to treat these new strains.” Sinclair moved forward in his chair. “I called the principal investigator, Jacques Aaron. He firmly agrees with the group in Canada regarding the existence of these two new strains.”

“Did you speak with the group in Canada?” Helen asked.

“Of course. They believe these strains are treatable with Vitracide, which is an FDA-approved antiviral drug.”

“They think? I'm quite familiar with Vitracide,” Madison was quick to point out. “It's recommended only for severe viral infections.”

With a smug grin, he responded, “I think GNS would fall into that category.”

“Are you aware that Vitracide can be extremely toxic to the heart muscle of both mother and baby?”

“Of course I'm aware. I feel quite well versed regarding all aspects of the drug.”

“In that case, I'm sure you know that this toxicity has been scientifically documented and is not based on guesswork or half-completed research.”

With a face now filled with boredom and annoyance, he said, “All drugs have side effects, Madison. What's your point?”

“Do I really need to answer that?”

“Let's stay calm,” Helen suggested. “I'd like to go off in another direction, Hollis. Can you offer an explanation why, with one exception, GNS appears to affect only pregnant women?”

“Viruses flourish in different environments. Obviously, there's something unique about pregnancy that makes these women vulnerable. Maybe the virus was already present in a dormant state and became activated for some unknown reason—a situation similar to shingles perhaps.” He exhaled sharply and added, “We're embarking upon new ground here. We can't be held hostage by conventional, uninspired thinking. Without going into great detail at this time, I will tell you that I expect to have irrefutable proof that GNS is being caused by a parvovirus in a matter of days. The moment I do, I'll make a national plea that every woman stricken with this catastrophic illness be urgently treated with Vitracide.” Sinclair made a grand gesture to look at his watch and then started to stand up. “I'm sorry but you'll have to excuse me. I have another commitment. I think we should all bear in mind that the more time we spend on unproductive meetings, the more time we take away from helping our patients. Left untreated, I assure you GNS will make SARS and H1N1 flu look like a mild case of the sniffles.”

Without waiting for a response, he turned and left the room. Jack's gaze shifted to Madison. Her eyes were flinty from anger.

Helen was the first to speak. “I already know how
you feel, Madison. Jack, you're a nationally recognized expert on uncommon neurologic diseases. Do you think GNS is being caused by a virus?”

“I'm not an infectious diseases expert, but from what I've been able to gather to this point, I'd say it's unlikely.”

“I know you've only been here a short time and that you didn't want to say anything speculative at the conference today, but do you have even an inkling of what might be causing GNS?”

“I'm sorry, I don't.”

They spoke for a few more minutes. When they were finished, Helen escorted Jack and Madison back to her outer office. Helen's silence did little to conceal her frustration. Jack sensed she was disappointed he hadn't a clue what was causing GNS.

Walking back to the ICU, he wondered if Helen Morales was developing second thoughts about inviting him to Southeastern State.