Error in Diagnosis (18 page)

Because of the late hour, the number of reporters in front of the hospital had thinned out considerably. Entering the hospital through the main entrance didn't pose a problem. Jack was a few feet from the ICU when he saw Bud Kazminski coming toward him. Since Bud had first ambushed him in the lobby of his hotel, Jack had made it a point to speak with him at least once a day to update him on his daughter Sherry's condition.

“Evening, Doc,” he said.

“How's she doing?”

“About the same. Walk with me,” he said, pointing to a bank of vending machines in a small alcove at the end of the hall. “David and I met with Dr. Sinclair earlier. He recommended to us that Sherry undergo a brain biopsy. He said the results could very likely lead to a cure.” They reached the machines. Jack said nothing
while Kaz studied the selections. “How about something to eat? I'm buying.”

“Nothing for me, thanks.”

He slid a dollar bill into the machine, tapped two buttons and retrieved his honey-glazed peanuts. Before he opened the bag, he turned and asked, “This brain biopsy thing strikes me as a little extreme. What do you think?”

It was obvious to Jack why Sinclair was recommending a brain biopsy. If he were right about GNS being a viral illness, the biopsy might be the only way to definitively prove it. As much as Jack had come to dislike Sinclair on both a personal and professional level, the idea of a brain biopsy had actually crossed Jack's mind two days earlier. Politics and emotion aside, from a pure medical standpoint, a brain biopsy was a reasonable test to consider.

“It's a little hard for me to advise you on Dr. Sinclair's recommendation. We're dealing with a disease medical science has never seen before. A biopsy could conceivably lead to the diagnosis, but it could also show absolutely nothing. There's just no way of telling.”

“What really worries me is the risk of anesthesia,” Kazminski said.

“There's simply no way of knowing what the risks of surgery and anesthesia would be.” Jack waited a few seconds and then added, “I guess I haven't been much help.”

With a quick shake of his head and a glint of his acerbic smile, Kazminski said, “Actually, you've been a big help. I'm going to give David a call and recommend that he agree to the biopsy.”

“When does Dr. Sinclair want to do it?”

“He told me if we agreed, the neurosurgeon could schedule it for tomorrow,” he answered. “Listen, Doc. When we get the results of the biopsy, do you think we could talk again?”

“Of course.”

“Thanks.”

He popped a handful of the peanuts into his mouth, nodded at Jack and then started down the hall. His limp was worse. Jack couldn't quite figure out why, but there was something about Bud Kazminski he very much admired. Jack was convinced that in spite of his bumbling exterior, he was a man of substance, uncommon insight and one who obviously loved his daughter very much.

When Jack entered Tess's room, Marc was setting up the portable ultrasound machine. A wide-eyed, third-year medical student stood next to him studying his every move.

“How's she doing?” Jack asked.

Marc shook his head. “Not great. She's still in a deep coma and she spiked another temp about two hours ago.”

“Still no idea what's causing it?”

“Not a clue. We've checked everything.”

“What do you think?” Jack asked him.

“I'd say she's getting worse by the hour. I don't know how much longer she can go before she needs medications to keep her blood pressure up. And her breathing's becoming more rapid and shallow,” he added. “Putting her on a respirator can't be too far away.” Marc checked the settings and selected a probe. “Unfortunately, we're finding the same thing in almost all of the other patients.”

“Did Tess have the MRI?” Jack asked, studying the monitors.

He nodded. “Earlier this evening. I called the radiologist who read it. He told me for the first time he's seeing subtle evidence of brain swelling.”

A number of possibilities, none of them good, flashed into Jack's mind. Swelling was a sign the brain tissue was deteriorating. The disease was progressing even faster than he had anticipated. He assumed that whatever was happening to the patients at Southeastern was being played out in every hospital in the country. Jack had never been good at concealing his emotions. He assumed the look on his face betrayed his mounting desperation.

“What's next?” he asked Marc.

“Apart from keeping a careful eye on things, we have no specific plans. Hopefully the ultrasound will show the baby's still doing okay.”

Having no new ideas or suggestions, he said, “I'll check in with you in the morning.” Finding his way to a small consultation room, Jack sat down for a few minutes to gather his thoughts. Through the open door, he stared without purpose into the ICU. When he was as ready as he was going to be, he reached for the phone and dialed Mike's number. “Did I wake you?”

“No. I've been waiting for your call. I figured you'd check on Tess before going back to the hotel. What do you think about the fever?”

“Almost all of the GNS patients have a fever. I'm assuming it's just part of the whole picture.”

“Do you think she's getting worse?”

Jack was anticipating the question. “I think she's a little worse . . . but still stable.”

“Stable?” There was a lengthy pause, and then in a voice painted with despair he said, “I guess there are a lot of questions I could ask, but at the moment, I'm too afraid.”

Understanding the immense weight of the emotional pain Mike was shouldering, Jack said, “I realize we haven't made much progress as yet, but I'm hopeful that will change in the next few days.” As soon as the words were out of his mouth, Jack realized he sounded vaguely and unjustifiably optimistic.

“I spoke with Dr. Sinclair,” Mike said. “He claims he's within days of finding the cure for GNS. He wants to meet with me as soon as possible to discuss his treatment plan. What do you think?”

“I would encourage you to talk with him, but I also think we should discuss any treatment proposals before you agree to proceed.”

“Okay.”

“You sound exhausted. Get some sleep. I'll see you over at the hospital in the morning.”

Jack realized that Mike's growing sense of doom was probably no different than Bud Kazminski's or any of the other family member's across the country gravely worried about their loved one with GNS. Jack was consumed with concerns on every level, but at the moment, his greatest fear was that within a few days, Mike Ryan and thousands of others would find themselves faced with making the hardest choice of their lives.

DECEMBER THIRTEENTH

NUMBER OF CASES: 3,125
NUMBER OF DEATHS: 19

Jack was hardly surprised when he received a call from Helen Morales's assistant requesting his presence at a ten o'clock meeting in her office. He checked his watch. He still had time to go the ICU and check on Tess's condition before the meeting. After reviewing her record and examining her, he concluded she was the same as when he'd last seen her eight hours earlier.

At ten
A.M.,
Jack, Madison and Sinclair were assembled in Helen's office.

“I wanted to get together so that Madison might update
us on Isabella's condition since surgery, and perhaps give us some more details about her theory.”

“I'm all ears,” Sinclair said. In spite of his obviously sarcastic comment, Madison spent the next few minutes briefing him on the tumor they had discovered in Isabella's ovary and every aspect of her care. She stressed the significance of the finding, especially with respect to a possible cure for GNS. When she was finished, he stared at her as if she were trying to sell him the tollbooth concession at the Golden Gate Bridge.

“Is . . . is that it?” he asked.

“I beg your pardon,” Madison said.

“I asked if that was everything you wanted to tell me.”

“Yes, Hollis. That's everything.”

Jack was hardly surprised at Sinclair's rude response. From the moment he learned Helen wanted all of them to discuss Isabella, he was less than optimistic Sinclair would embrace Madison's theory.

“There are no secrets here,” Sinclair said. “I've already heard about this case in detail. And as interesting as it may be from a medical oddity standpoint, I'm afraid it's equally irrelevant. Whatever the factors are that make these women susceptible to GNS are totally immaterial. I don't deny that an elevated inhibin level may be an associated finding of the disease, but it's not the cause.”

“So, it's still your belief that GNS is a viral illness,” Madison said.

“Why shouldn't it be? Nothing you've said here this morning gives me any reason to alter my opinion. Especially
now that all of the patients have a fever. As sure as the sun will set this evening, these women are suffering from a new strain of parvovirus. If somebody has frostbite you treat the injury, not the blizzard that caused it. In order to eradicate GNS, you have to find and treat its cause, which is a virus, not an elevated hormone level.” He stopped for a moment to blow out a tired breath. Then, in a controlled voice he stated, “It's inevitable we're going to see the death rate accelerate. If there's any hope of curing these mothers and babies, we have to begin a program of Vitracide therapy immediately.” He stood up and pushed his hands deep into the pockets of his white coat. “You may have removed this girl's tumor, but you're not going to cure her.”

“I guess that still remains to be determined,” Madison said.

“Even if she does recover, that's still not hard evidence the pregnant women with GNS will also recover if their pregnancy is terminated. I think the vast majority of families will opt to treat the disease per my treatment plan and not disturb the pregnancy.” Sinclair turned to Helen. “I have several pressing matters to attend to. If there's nothing further . . .”

The disappointment in Helen's eyes was unmistakable, but Jack said nothing. He realized attempting to discuss other possible causes of GNS besides a virus with Sinclair was a waste of time.

“I understand how busy you are, Hollis,” Helen said. “I appreciate you finding the time to speak with me.”

Sinclair stood up, shook his head a few times and then waltzed out of the room.

Jack had seen all forms of professional faux pas and rude behavior, but they all paled in comparison to the gross disrespect Sinclair had just shown Helen.

“Is there anything else we can do?” Madison asked her.

“I'm running out of wiggle room. It would certainly help if you and Jack could discover how to cure this damn thing before Hollis Sinclair checkmates me.”

DECEMBER FOURTEENTH

NUMBER OF CASES: 4,323
NUMBER OF DEATHS: 19

Madison and Jack hovered over Isabella's bed like two nervous medical students awaiting the results of their first anatomy exam. A few minutes earlier, Jack had checked on Tess. Her condition was still critical. He had spoken to Mike and they had agreed to meet for lunch. For good reason, Jack was expecting another difficult conversation.

“Has there been any improvement in her neurologic status?” Madison asked Dr. Josh Marcos, who had been at her bedside for the past eight hours. Sporting a three-day
crop of bristly whiskers, Marcos's eyes were colored crimson from sleep deprivation.

“None,” he answered. “In fact, she's probably a little worse.”

“Maybe it's still too early to see any improvement,” she suggested. She then looked at Jack, and in a voice struggling to cling to any shred of optimism, asked, “What do you think?”

“It's difficult to say. Neurologic injuries can have a slow recovery process. Even if the factor that's causing GNS has been completely removed with the tumor, it's still hard to know when we might see signs of improvement. We also have to consider that whatever neurologic damage has occurred . . . well, it might be permanent.”

“So, what do we do from here?” she asked.

“Nothing, I'm afraid,” Jack answered. “All we can do is support her vital functions, closely monitor her neurologic status and . . .”

Just at that moment the door opened. When Jack saw it was Sinclair, he did his best to force a cordial smile.

“How's your patient doing?” he inquired, making his way over to the bed.

“She's about the same.” Madison answered.

“Really? I heard she's worse. I understand her inhibin level's zero. If my memory serves me correctly, you predicted we'd see signs of recovery by this time.”

“It hasn't even been two days yet, Hollis. It's still too early to dismiss the possibility she'll recover.”

Sinclair rolled his eyes, moved up to the bed and then
reached down and ever so slightly elevated Isabella's chin.

“I see she still has the rash. What about fever?”

“She still has a fever,” Madison answered.

“Boy, it looks like you got that tumor out just in the nick of time,” Hollis said, with a sardonic smirk as he shook his head and started toward the door.