Error in Diagnosis (15 page)

Dr. Jeff Schiller turned sideways and used his hip to shove open the doors to operating room seven. It had been just over three hours since he had consulted on Isabella's case. Moving toward the center of the room, he waited for his scrub nurse, Beth, to drop a sterile towel on his freshly scrubbed arms and hands. A common sense thinker who rarely took no for an answer, Schiller seemed old school for a physician who was only five years out of his residency.

The second nurse in the room was already in the process of applying an iodine jelly to Isabella's abdomen. When she was finished, Schiller and his chief resident, Sam Erving, draped the surgical field with four sterile towels, followed by a large drape that covered Isabella's entire torso. Beth pushed her small metal table containing all of the sterile instruments closer to the surgical field. Just as
Schiller was about to call for the scalpel, the doors to the operating theater swung open.

He looked up. “Are you sure you don't want to scrub in?” he asked Madison. “We're just getting started.”

“I'm fine just watching. I did enough gynecological surgery as a resident to last me a couple of lifetimes.”

Schiller opened his outstretched hand and Beth handed him the scalpel. Normally, he would have allowed Sam to do the case with him assisting, but because of the special nature of the illness, he decided to do it himself.

“Let's go,” he told all present, making a careful incision across Isabella's lower abdomen. After four years, Schiller and Sam had done hundreds of cases together. Each knew the other's moves as well as two seasoned trapeze performers would. The result was invariably an effortless operation that unfolded in perfect synchrony.

Madison moved to the head of the table. Standing next to the nurse anesthetist, perched on a metal stool, she had an excellent view of the procedure. Five minutes after the skin incision, Schiller opened the final layer of the abdominal wall giving them access to the organs of the abdominal cavity. After setting the exposure with a large retractor, he reached an exploring hand deep into Isabella's pelvis.

“Apart from the obvious tumor,” he began, “the other ovary's normal. So is the uterus.” Another minute passed. “I don't feel any enlarged lymph nodes and there's no fluid in the abdomen, which is a good sign.” Schiller allowed a lungful of air to slip out. Finished with his exploration, he pulled his hand out of Isabella's abdomen
and stepped back for a few seconds. “Okay, let's get this thing out of here.”

The two worked for the next few minutes dividing all of the arteries, veins and attachments of the ovary. When everything had been divided, Schiller gently rocked the tumor out of the abdomen and placed it into a stainless steel bowl held over the operative field by the scrub tech.

“Send it for both frozen section and permanent per protocol,” he said to her.

Schiller looked up over the anesthesia screen at Madison. “That should do it. We're going to close. Assuming this works, when do you think you'll see signs of recovery?”

His question made her stomach roll. “I don't have the first damn clue,” she told him.

As soon as Southeastern's administrative team realized the GNS outbreak was a major threat to public health, they set up a command crisis center in their executive boardroom. The IT department moved quickly to fit the room with a dozen computer stations and a sophisticated teleconference system.

Jack was seated at one of the stations reviewing the latest patient information posted on the National GNS Data Record when his phone rang.

“I just got off the phone with Helen Morales,” Madison said in a shaky voice. “She asked us to meet her at her office in half an hour.”

“What's going on?” he asked, checking his watch.

“It seems Helen called the surgeon general to brief her on Isabella Rosas's surgery. Dr. Brickell then called
the president to update him. He told her he wants to talk to us personally about her condition.”

“When?”

“Tonight.”

“We should probably take the call right here, that way we'll have all the information at our fingertips and we—”

“He wants to talk to us in person, Jack.”

“I beg your pardon?”

“The president of the United States wants to have a face-to-face with us tonight.”

“He's coming here?”

“No. At Homestead Air Reserve Base.”

“Why Homestead?”

“Because he called us from Air Force One and that's where they'll be landing in just over an hour.”

As Madison and Jack approached the black Denali that had been sent by the president's team to take them to Homestead, a young man in a dark suit and a Marine Corps haircut emerged from the car. Jack thought to himself he didn't look much older than most of his medical students.

“My name is Robert Carson. I'm a special assistant to President Kellar. He sends his greetings and asked me to thank you in advance for meeting with him on such short notice.” He opened the door. “Dr. Morales is already in the car. On our way to Homestead, I'll be briefing you on the security measures and protocol for all Air Force One guests.”

According to information Madison had received from Helen, the president had been in Louisiana all day touring the hospitals that were caring for GNS patients. His
original itinerary called for him to return directly to Washington at the end of the day, but after his conversation with Dr. Renatta Brickell, he decided to make a stop in South Florida.

Once they arrived at Homestead, Carson escorted Madison, Jack and Helen to a cordoned-off security area where they answered a series of questions and went through a metal detector. A young woman carrying a tablet escorted them on board the four-thousand-square-foot aircraft. She introduced herself as Caitlin Nance.

“Dr. Brickell accompanied President Kellar on his trip to Louisiana and is already aboard. She'll be sitting in on your meeting with the president.”

Caitlin showed Jack and Madison to their seats. She then escorted Helen back to sit with Dr. Brickell. Jack shifted in his seat, trying to settle in. The plush leather chair was anything but standard airline issue. His awe at his surroundings equaled his nervousness about meeting the president of the United States.

A few moments passed and Caitlin returned.

“We'll be departing in about fifteen minutes,” she told them, scrolling down the tablet, reviewing the president's agenda. “President Kellar has a very busy schedule all the way to Andrews. You'll be meeting with him in about an hour. He fully understands the inconvenience this is causing you, and he has asked me to express how much he appreciates you meeting with him this evening. As soon as we land, you will be escorted to another plane that will take you back to West Palm Beach. If there's anything you need, please let me know.”

After she walked away, Jack looked over at Madison with surprise on his face.

“I thought we were just meeting with the president on the plane,” he said. “You didn't say anything about flying to Washington.”

“I guess the president forgot to call me to go over the exact details of his plan,” she responded in a sarcastic voice. “What's the difference, anyway? What would you have said if you did know? Oh, I'm sorry, Mr. President, I'd love to discuss a matter of grave national importance with you but I'm not in the mood to fly to Washington tonight?”

With his lips pressed together, Jack glared at her. “I'd answer that but you'd probably accuse me of being a disingenuous liar.”

With a tolerant smile, Madison shook her head a few times.

“Okay, Jack. Ever since we discussed this whole UF mess, you've been dying to bring it up again. We have an hour to kill so I guess now's as good a time as any. So, why don't you just go for it?”

“What's the point? You've already made up your mind.”

She shrugged. “Whatever you want, but don't say I didn't offer.”

Sensing his golden opportunity evaporating, Jack said, “Do you remember Marietta Rhodes from the neurology department at UF?”

“I don't think so.”

“She's the administrative coordinator. She's kind of the go-to person for all the students and residents on the
neurology service. She was there when you and I were. She's the unofficial eyes and ears of the neurology department. Nothing happens without her knowing about it.”

“And the reason this would be of interest to me is?”

“I called her yesterday. Students very rarely failed the neurology rotations, so she had quite a good recollection of what happened to you. I remembered that after I gave a student his or her final exam, I had to fill out a written evaluation but I never assigned a grade. All of the old reports have been scanned into the computer. I was hoping Marietta could locate the one I filled out on you.”

“I assume you're now going to tell me that she was able by some miracle to find it, and it proved that you gave me a glowing evaluation.”

“Actually, the report I filled out on you was missing from your file,” Jack said. “Do you remember Dr. Gaitley?”

“Of course. He was the pompous jerk in charge of all student rotations. He personally summoned me to his throne room to inform me I had failed neurology and that I would have to repeat the rotation. He seemed to enjoy telling me. He had all the warmth and compassion of Jack the Ripper. The man was a complete and total jackass.”

“Marietta told me that a year or so after you and I had left, he was fired. He was accused of committing a number of ethical violations including a host of academically dishonest acts. According to Marietta, his dismissal resulted in a scandal that was quite an embarrassment to the medical school.” Jack paused, waiting for a response, but Madison looked at him plain-faced, clinging to her silence. Undaunted, he went on, “Evidently Gaitley was
going through a really ugly divorce of his own at the same time you were.”

“So?”

“You mentioned to me the other day you were married to David Casas, the neurosurgeon.”

“I still don't understand what all this has to do with—”

“Gaitley was the one in charge of assigning the students' final grades. He decided who passed and who didn't. According to Marietta, Gaitley and your ex-husband had the same divorce lawyer and got pretty chummy.”

With narrowed eyes, Madison said, “Are you proposing that there was some kind of a conspiracy against me?”

“I'm not proposing anything. I'm simply giving you some facts. But you don't have to be a genius to connect the dots here. The physician in charge of assigning grades is fired for academic dishonesty. He turns out to be buddy-buddy with your ex-husband and my evaluation of your examination mysteriously disappears from your file.” Jack shrugged his shoulders. “This isn't exactly the unsolved enigma of the century.”

“But why would my ex do that?” she asked.

“To get even,” he said flatly, taking a couple of swigs from his bottle of water. After blotting the corners of his mouth with a napkin, he added, “I'll be happy to give you Marietta's number if you'd like to speak with her personally about it. I'm sure she'd be happy to talk to you.”

“I'm sure that won't be necessary.”

“You can think I'm an . . . what was it you called me again? Oh, yes—an asshole. It's not a big deal. I just thought you'd like to know what really happened.”

After a giant stretch of his arms, he reached into the seat-back pocket, pulled out a magazine and began flipping through the pages as if nothing had happened. Madison stared down at her hands. More than pleased with the way the conversation had gone, Jack had to admit he couldn't have scripted things better. He realized it wasn't exactly the courthouse at Appomattox with the lady wearing gray and he in blue, but he did feel vindicated.

“You think I owe you an apology, don't you?” Madison asked.

“Not really. I'm sure if things were the other way around, I would have felt the same way.”

“Sure, Jack,” she said, with a skeptical grin.

Although he was gloating on the inside, and as much as he wanted to, he saw no gain in breaking into a fist-pounding victory dance. Instead, he said nothing. Air Force One's engines pitched louder. Jack looked out the window, watching as the massive jet began to creep forward.