Error in Diagnosis (16 page)

Bedford, Indiana

Ever since Maggie Recino could remember, she hated being alone. For reasons she didn't understand, her phobia became worse when she learned she was pregnant. Making matters even more difficult, a week after she found out she was expecting, her husband, Eric, a lance corporal in the Marine Corps was deployed to the Middle East. That was seven months ago and Maggie still had no reliable information when he'd be returning. Not long after his departure, she moved in with her mother in the two-story duplex where she'd been raised.

After a day filled with what seemed to be one long nap after another, Maggie pushed herself out of her mother's lumpy recliner and strolled into the kitchen to get something to eat. Usually, they ate dinner together, but two
days earlier her mother had left on a business trip. Maggie opened the refrigerator, scanned the shelves and then blew out a protracted breath. Hardly in the mood to create anything magical, she focused on yesterday's leftovers. Finally, she removed a large plate containing three slices of pizza, the remains of her dinner from the night before.

Her Chesapeake Bay retriever, Burty, ran over, sat by her feet and whined as if he hadn't been fed since Thanksgiving.

“C'mon, Boy. You ate your dinner. Let me eat mine.”

Just as Maggie was setting the microwave, she suddenly became unsteady on her feet. She had had the same woozy feeling twice in the past couple of days but it was worse this time. Leaving the pizza on the counter, she took a few cautious steps over to the table and sat down. Burty followed her and put his head on her lap. She folded her arms on the table and then rested her forehead on them. A few minutes passed but her light-headedness became worse. Her dizziness grew in intensity, leaving her nauseous. With food now being the last thing on her mind, she managed to push herself to her feet and find her way back to the living room.

Unsteady and breathless from the short walk, she flopped down on a denim couch. In front of the couch, two jar candles sat atop a wooden coffee table. The pumpkin-scented candles had become her only relief from the daily nausea her obstetrician promised her would subside four months earlier. She shoved one of the throw pillows under her head and closed her eyes. Hoping that
the dizziness would pass, she held her head steady. She checked the time. It was five minutes past seven.

At quarter past seven, she was still no better. Her trepidation mounting, she decided to call her mother. She searched the coffee table for her cell phone but it wasn't there. Overcome with fear, she plunged her hand between the pillows and then behind her, desperately searching for her phone. When she came up with nothing, she stopped, covered her head with her hands and flogged her memory. A few moments later, she remembered she had put the phone on the bookcase before going into the kitchen.

After steadying herself on the armrest for a few seconds, she gathered all of her strength and pushed herself to a sitting position. Looking up, Maggie could see her phone protruding over the edge of the shelf next to the television. She let out a long breath, stood up and then took the few steps over to the floor-to-ceiling bookcase. When she went to grab the phone, her coordination faltered and she knocked it to the back part of the shelf and beyond her grasp.

“Great,” she muttered.

In spite of feeling wobbly, she struggled to extend her reach. Finally, her fingertips touched the edge of the phone, but she was still unable to grab it. She looked down. By standing on the lowest shelf, she hoped to gain the extra couple of inches she needed. Cautiously stepping up, she grabbed onto the television shelf with her left hand to stabilize herself. Just as she reached back to snatch the phone, she was consumed with an intense wave of vertigo.
The room spun like an out-of-control carousel. Pushing her face against the bookcase, she held on to the shelf with a death grip. Her equilibrium faltering, Maggie felt herself tipping backward. At the same moment the television skidded forward, grazing the side of her face before slamming to the tile floor below.

With the bookcase fully tipping and trailing her to the ground, Maggie somehow gathered the wherewithal to sharply twist her body to the side and push off. She cleared the path of the tumbling bookcase by a matter of inches. Her left shoulder struck the armrest of the couch at the same moment the bookcase smashed to the floor.

For the next few seconds all Maggie did was take one labored breath after another. She said a silent prayer that she was conscious. She also gave thanks that her sister had picked her son up earlier and was watching him for the evening. She opened her eyes but her vision was blurred and the normal sharp images of the living room were a latticework of melding grays and blacks. Burty had already jumped off the couch, barking incessantly while turning tight circles in front of her.

Bedford was a small town where neighbors knew each other well and embraced a common sense of responsibility for one another. Burty's nonstop barking had not gone unnoticed by the next-door neighbor, Tim Oneida. He knew Connie was out of town and that Maggie was alone in the house. Being a naturally overprotective father and husband, Tim walked over to Connie's house and rang the doorbell. When there was no response, he went to the
other side of the porch and peered into the living room through a bay window.

Seeing the shambles of the room and Maggie motionless on the floor, he whirled around and grabbed a metal chair. Holding it by the back, he launched the legs through the window, instantly shattering the glass. It took him three more full power swipes before he could clear all the jagged fragments from the window frame and climb through the window. He was already dialing 911 when he arrived at Maggie's side.

For the first half of his twelve-hour shift, Dr. Lewis Cole had been working feverishly to care for the predictable onslaught of Saturday night patients. In addition to the usual variety of illnesses and injuries, he was spending a lot of time reassuring one pregnant woman after another suffering from a mild headache or a runny nose that she was not the latest victim of GNS.

The ER staff checked the surgeon general's advisories every eight hours. To date, not a single case of GNS had been reported in the entire state, which made Indiana one of only ten states where there was no documented outbreak. After sewing up a jagged laceration on a sixty-year-old man who was trying to figure out the nuances of his new power band saw, Cole strolled out of the treatment room. After a peek out into the waiting room, he made his way to the nursing station.

“The paramedics brought in Maggie Recino about fifteen minutes ago,” came a voice from behind him. “She's in room four.”

Cole twisted in his chair and saw Patsy Ames, the nurse manager hovering over him like a Blackhawk helicopter. A woman with no airs or graces, she was twenty years his senior. Every time she sensed Cole was becoming too consumed with himself, she reminded him that she'd been the one to read to him from
Charlie and the Chocolate Factory
the day he broke his wrist on the playground and needed it casted.

“Connie's daughter?” he asked.

“Yeah. She fell backward off a wall unit.”

Maggie had been born at Bedford Community. She had had her appendix out there when she was seven and had given birth to her son one floor up from where she was now lying. Her first and only job since graduating from Butler University was as the director of volunteer services at the hospital. Her mother, Connie, was a hospital administrator in charge of business development.

“Is she okay? I thought only kids did that.”

“The next-door neighbor found her and called 911. Her vital signs en route were normal but she's still a little out of it.”

“Why didn't you come get me?”

“Because you were kind of tied up and we're experienced enough to triage a patient and decide if we need a physician stat or not.”

He held up his hand in surrender. “Sorry.”

“We sent her for a CT of her head just to be on the safe
side. She just got back to her room a couple of minutes ago. The radiologist already called and said it was fine—no bleeding and no skull fractures.”

Cole pushed back in his chair and then stood up. “Isn't Maggie pregnant?”

“She's in her seventh month. Her tummy's fine and she's had no vaginal bleeding. We have her hooked up to a fetal monitor. Her blood work should be back in a few minutes.”

“I don't care how smart they think they are. They still should have gotten me,” he muttered to himself, as he turned and started down the hall toward Maggie's room.

“I'm sorry, Doctor. I didn't quite hear that.”

“Nothing. It was nothing,” he said, wondering why he again allowed himself to fall victim to Patsy's superhuman hearing. He made the short walk down the hall and went into Maggie's room.

“Hey, young lady. I heard you had a little fall at home. How are you feeling?”

“Probably more embarrassed than anything else.”

“No cramps in your tummy or bleeding?”

“Nope.”

“Do you remember what happened?” he inquired.

“Kind of.”

“Tell me about it.”

“I've been feeling a little dizzy lately. It got worse tonight and then my vision got blurry. I had bad migraines with my first pregnancy. I just assumed it was the same kind of thing but without the horrible pain.”

“Is your vision still blurry?”

“A little.”

Cole walked over and examined her head and neck. As usual, Patsy was right. There was no bruising or swelling. She had no pain to any area he palpated. He had seen hundreds of head injuries in his career ranging from the most minor to the most grave. Even when it was only a mild concussion, there should be some visible evidence of an injury to the head.

“Are you sure you didn't hit your head?” he asked.

“I'm positive.”

“Tell me more about this dizziness you've been having,”

“It started on Saturday.”

“Today's Saturday. Do you mean it began today or you've had it for the last week?”

“I guess it's been about three days, not a week.”

“Patsy said you were alone when you fell.”

“Uh-huh. My mother's on vacation and my son's with my sister tonight.”

“I thought your mom was in Chicago attending the meeting on operating room safety.”

“Uh . . . that's right. I forgot. I guess I thought she was on vacation.”

Becoming increasingly more concerned with Maggie's confused responses to his questions, Cole stopped his exam and studied her face. In spite of the normal CT and absence of physical signs of a head injury, it was still possible she had a concussion, but he was unconvinced.

“Have you had any muscle cramping?”

“In my legs a little. I didn't have that when I was pregnant with Matt.”

He removed his stethoscope. “How's your mom?” he asked again on purpose.

“She's fine. I should have called her to meet me here.”

Taking note of her answer, Cole quickly shifted his exam to her eyes. They appeared normal. He then moved straight to his neurologic assessment. Before he tested her ankle and knee reflexes, he examined her thighs. It was barely perceptible but there was a fine tremor of the muscles. He swallowed against a tightening throat and took a step back. His fingers quivered from the bolus of adrenaline filling his bloodstream.

“How long have your legs been twitching like that?”

Her eyes were closed and she didn't respond. Cole renewed his question but she again failed to respond. He quickly checked her vital signs. According to the cardiac monitor, her blood pressure and pulse were normal. She was breathing without difficulty and the level of oxygen in her blood was fine.

His sense of urgency climbing, Cole walked over to the other side of the room and picked up the phone.

“Have one of the nurses come down and sit with Maggie,” he told Patsy in a calm voice. “No, Patsy. Right now.”

He walked back to the bed. A few seconds later one of the nurses hurried into the room.

“Keep an eye on her, please. I'll be right back.”

Cole quietly closed the door behind him and made his way back to the control desk.

“What's going on?” Patsy asked.

Cole said nothing at first. Instead, he studied a bulletin board, which contained dozens of advisories, lab bulletins and memoranda. When he found the posting from Illinois Memorial in Chicago he was looking for, he removed it from the board and picked up the phone.

“I'm worried about Maggie,” he said, dialing the number.

“What do you mean?”

He covered the receiver and then touched his index fingers to his lips.

“Illinois Memorial transport team. This is Chris speaking.”

“Good evening. This is Dr. Cole. I'm calling from Bedford Community Hospital in Indiana. I'd like to arrange an emergency transfer. I believe the patient may have GNS.” Patsy sat down next to him. Her stare was intense and her lips widely parted. “Yes, I'll hold.”

“The nearest reported case of GNS is over a hundred miles from here,” she said in just above a whisper.

“Up until now,” he said, again cupping the mouthpiece with his palm. “Get on the phone and alert the other hospitals in the county that this may be the beginning of a local outbreak.” He again raised a restraining hand to her. “Yes, this is Dr. Cole. Thank you for taking my call. I'm seeing a twenty-seven-year old in her seventh month whom I believe has early GNS. She has a
several-day history of intermittent confusion. On physical examination, she has a fine tremor of her thigh muscles. She has no rash or fever.” He paused for a few moments to take a breath and to listen to Dr. Gaylord Smithey's response. “Yes, I realize there have been no cases in Indiana, but I'd still like to transfer this young lady up to your facility as soon as possible. She's stable for transport.” He nodded his head while he listened. “Thank you, Dr. Smithey. We'll expect the helicopter within the next hour or so.”

Cole hung up the phone and came to his feet.

“Are you going to call Connie?”

“If you can track her down for me, I'll speak with her. I'll tell her to meet us in the emergency room in Chicago.”

“Us?” Patsy asked with raised eyebrows.

“I'm going with her. The ER physician said I could accompany her. Once she's tucked in, I'll rent a car and drive back.” Cole started back down the hall. “Would you give Dr. Almont a call and tell him I'll need him to cover the rest of my shift?”

“Sure, but this still doesn't make any sense. Emergency rooms are being flooded with cases. They're not seeing one isolated case here and there.”

“I think Maggie has GNS,” Cole insisted. “But I'm happy to let the folks in Chicago sort things out.”

•   •   •

Maggie was awake when Cole walked back into her exam room. In spite of her confusion, he expected she'd understand everything he was about to tell her. He pulled up a
chair and took her hand in his. Taking his time to explain his concerns to her, Cole emphasized that his desire to send her to Illinois Regional was only out of an abundance of caution. Cole couldn't be sure how much Maggie understood. In front of his eyes and in a matter of minutes, she was worsening. He could sense that she was struggling to keep her eyes open.

Lewis Cole was no different from any other physician. Making a difficult diagnosis always evoked a sense of pride and accomplishment. But tonight was an exception. Every optimistic cell in his body hoped he was dead wrong, and that he'd be getting a call from the doctors at Illinois Regional in the days to come that Maggie Recino was doing fine and that she didn't have GNS. But his pragmatic side, the one that had been engrained in him through medical school and residency, was telling him something entirely different.