Error in Diagnosis (19 page)

After his visit to the ICU, Hollis Sinclair was convinced the chances of Isabella Rosas's recovering from GNS were a pipe dream at best. He bounded up the three flights of stairs to the office of Dr. Liam Kenney in the department of pathology.

Kenney, a specialist in neurologic pathology, was a pallid man with bony fingers and sharp angular shoulders. Sinclair found him hunched over his microscope, humming a Broadway tune.

“Good morning, Liam.”

Kenney lifted his head from the microscope's eyepiece, sat straight up and then reached up to his balding head, where his glasses were perched, and slid them down.

“Kind of early for a neurologist, isn't it?” he asked Sinclair.

“I'm here every morning at seven. How's the family?”

“Everybody's fine.”

“Good. By the way, I understand you're coming up in front of the tenure committee again at our next meeting.”

“That's right.”

“Well, I've always found you to be a highly competent pathologist. You should have been granted tenure the first time around. You've built your reputation on being a team player. I don't have to tell you how political these things can get, but I'm sure with the right people in your corner, there shouldn't be a problem this time.”

“Thank you, Hollis,” he said. “I was extremely disappointed the committee failed to recognize my contributions to this university.”

“As I mentioned, these things can get pretty political.”

“I suppose,” Liam said with uncertain eyes.

“I was wondering if you had any preliminary news on Sherry Rosenfelt's brain biopsy.”

“Actually, I still have a few more slides to go over before I complete my report.”

“I'm well aware of the official process, Liam. I'm asking you for any preliminary thoughts you might have. I'm not going to hold you to anything. I understand nothing's official until you dictate your final report.”

Liam eased back in his chair. “I can appreciate how anxious you are, Hollis, but maybe it would be best—”

“C'mon. We've known each other a long time. Anything we discuss is completely off the record and confidential. I would really appreciate your help.”

“Of course, Hollis. What would you like to know?”

“Is there any evidence on the biopsies to confirm a viral illness?”

“Her brain tissue shows gliosis and a few other nonspecific findings, which are all signs of inflammation.”

“A viral illness?”

With a wrinkled brow, he answered, “It certainly could be.”

“You realize that these women have been running a high fever. When you consider their other symptoms, especially the rash, we have overwhelming evidence that GNS is a viral disease, and one, I might add, that's spreading out of control. I'm convinced I have the cure for this devastating illness, but I need the support of strong-willed men who have the courage of their convictions to commit.”

“I understand, Hollis, and I admire your passion.”

“I look forward to reading your final report. When did you say it would be ready again?”

“Hopefully, later today.”

“I truly appreciate your help,” Sinclair said, extending his hand. “I suspect within a week's time, there will be thousands of grateful family members who will share my feelings.”

For a few moments after Sinclair was gone, Liam stared across his office with a vacant expression. He had just been summarily checkmated by his esteemed colleague and there was little he could do about it. The last thing he needed at this stage of his career was to make
a political enemy of every influential member of Southeastern's medical staff. Unable to see much wiggle room, Liam resigned himself to the fact that his biopsy report would state that Sherry Rosenbluth's brain tissue was infected by a virus.

Metropolitan Clinic
Birmingham, Alabama

Every Thursday morning, Dr. Mary Grandeson made formal teaching rounds with her residents and medical students. She had just finished answering the last of the group's questions when Wright Zarella stepped up with a self-satisfied grin. Humility in the face of accomplishment was not a social grace he possessed.

She looked at him and shook her head a couple of times. “Before you explode, I suggest you tell me what's burning in your mind.”

“I got a call about a half an hour ago from the New Hampshire Department of Health and Human Service. New Hampshire has a very sophisticated electronic health data bank. They are meticulous to a fault in their
information gathering regarding all forms of public health disorders.”

“I'm sure New Hampshire appreciates your praise. What did you find out?”

“About eight weeks ago two pregnant women were treated for strange neurologic symptoms.”

“What type of symptoms?”

“Muscle twitching of the arms and legs, fatigue and seizures.”

“Dancing eye syndrome?”

“No.”

“So, what happened?”

“They both fully recovered after a few days, so the illness didn't attract an enormous amount of attention. But no cause was ever found. The cases caught the attention of the epidemiologist who put them in the state registry. When he read my blast e-mail, he responded right away and briefed me in detail on the cases. He also put me in touch with the women.”

“And?”

“Well, it seems both of them began using a new skin moisturizer a week or so before they got sick. The manufacturer's a new boutique company headquartered in Dover, New Hampshire. Nanotechnology was used in the product's creation. The company decided to confine the distribution of the moisturizer to New Hampshire as kind of a test market.”

“And there have been no further cases?”

“None to my knowledge, but remember we're talking
about a fairly small distribution with respect to both area and population.”

“There are no cases of GNS in New Hampshire. Do we have enough information from our patients here in Alabama to cross-reference this data?”

“Only partially, but none of our patients used the same product the women in New Hampshire used, which obviously makes sense.”

With her posture stiffened, Grandeson drew a deep breath. “Leave me everything you have on this. I'm going to ask Kendra and Roger to pursue it.”

“Kendra and Roger are two years behind me. I was the one who found out about this,” he said, dropping his hands to his side. “Don't you think I should be the one to. . . ”

She smiled. “The surgeon general and I have much more important work for you.”

“I beg your pardon.”

“I sent Dr. Brickell the article you gave me the other day. Last night, she called me back and we had a nice long chat about it. She was very intrigued and thinks the researchers in Germany may be onto something. She called Dr. Kurt Dressin, who's the researcher heading up the project. He trained in Chicago.”

“This is all very interesting, but I'm not sure . . .”

Mary paused long enough to button the middle button of her white coat. “We'd like you to spend a few days in Magdeburg.”

“You want me to go to Germany? Are you serious?”

“Don't I sound serious?”

“But, why?”

“Because that's where the medical school and the research unit are. Dr. Dressin personally extended the invitation.”

“What exactly am I supposed to do over there?”

“Observe, ask a lot of questions and bring home as much information as you can. This group is obviously a lot more advanced than any research team in the U.S.”

“I agree, but I'm just not sure going to Germany is necessary.”

“The surgeon general and the president disagree. They think it's a good idea to send the individual who may have stumbled across the cause of GNS. If you feel like taking up your objections with them, be my guest.”

He cupped his chin. “The president of . . .”

“Yes, Wright, of the United States.”

Wright's face filled with surrender. He blew out every molecule of air in his lungs and then shrugged his shoulders. “When do I leave?” he asked.

Pleased with his meeting with the pathologist, Hollis returned to his office. He was just beginning to review the information he had requested on the national supply of Vitracide when his assistant buzzed him on the intercom.

“Dr. Sinclair. I have a call from a Dr. Cole in Indiana. I forwarded the call to the crisis center but they suggested you take it. The doctor said it was very important.”

Sinclair stole a peek at his watch. He only had a minute or two before he was to attend a phone conference with six physicians across the country—all of whom strongly supported his viral theory.

“Put him through,” Sinclair told her.

“Dr. Sinclair. My name is Cole. I'm an emergency physician in Bedford, Indiana.”

Neither the name of the hospital, nor the physician was familiar to Sinclair. He rolled his eyes. He was tired of answering inane questions from every hick physician in the country taking care of a pregnant woman.

“How can I help you?” he asked.

“I recently transferred a patient by the name of Recino to Illinois Memorial. This patient's of particular interest because she's the only documented case of GNS within a two hundred mile radius of Bedford. In spite of taking a detailed medical history, I just discovered that Ms. Recino omitted an important piece of information.”

“Really?” Sinclair said, wondering when Cole would get to the point.

“It seems Maggie and her mother spent the early part of her pregnancy in Fort Lauderdale. She received her initial prenatal care from a Dr. Charles Lipshank. I thought you might want to speak with him and get her obstetrical records.”

“That's an excellent suggestion Dr. Cole,” he answered, half-listening as he picked up a letter on his desk. He had already decided that Dr. Cole's information had no practical value. “Of course. I'll make sure we thoroughly review Dr. Lipshank's records.”

“I've already called Illinois Memorial about the matter. They said they would enter the revised information into the National GNS Data Record.”

“We certainly appreciate you calling,” Sinclair said while reading the first paragraph of the letter. “We'll be in touch with you if the information leads us somewhere.
Thank you, again.” With several other issues crowding his mind, Sinclair called his assistant. “I'm ready to join the conference call now.” By the time his call ended thirty minutes later, his conversation with Dr. Cole of Bedford, Indiana, was a faint memory at best.

DECEMBER FIFTEENTH

NUMBER OF CASES: 4,812
NUMBER OF DEATHS: 20

Agent Maxime Barbier stepped off the airplane into a deeply overcast morning. The flight from Quebec City to Port-Menier, the island's principle city, had taken just over two hours. Barbier was a ten-year veteran of the Royal Canadian Mounted Police. He was regarded by most as one of the most outstanding agents, especially in the area of missing persons. After obtaining a computer science degree from McGill University, he served a four-year stint in the military, volunteering for the elite Special Operations Forces Command. His beanpole appearance and mild methods disguised a man highly
trained in many forms of combat weaponry and the martial arts.

He began researching the ex-biological weapons scientist Alik Vosky five minutes after the director of the CSIS personally handed him the Russian's dossier. The director made it a point to inform him he'd been handpicked to head up the operation. He was instructed to put all of his other cases on the back burner until Vosky was located. In a pledge Barbier had never heard the director make, he promised him any and all resources he might require to bring Vosky in.

He rolled up the collar of his coat and made his way to the car rental agency.

Fortunately for Barbier, Vosky wasn't the most sophisticated individual he'd ever encountered when it came to changing identities. To get the job in Winnipeg at the pharmaceutical company, Vosky had assumed the name of Eli Steinhoff. Because he was still using it, it hadn't taken Barbier very long to discover the Russian had rented a small house on Anticosti Island.

After filling his lungs with the moist salt air, he stuck his hands deep into the pockets of his coat. He took another look around and then got into his rental.

After a short drive that took him through the center of the city he pulled up in front of a Queen Anne house with a wide porch and gable that were crying out for a couple coats of fresh paint. The driveway was empty. He stepped out of the car. The heavy clouds had faded and were now nothing more than a delicate haze. Barbier walked up the front path of the house and then climbed
the three steps to the front door. Shading his eyes with his hand, he attempted to peer through a small glass pane. Even squinting, he couldn't see a thing. Unable to locate a doorbell, he knocked several times on the arched door.

“Nobody lives there,” came a gravelly voice from behind him.

Barbier turned around. A stocky man with a sparse gray beard dressed in stained overalls and a baseball cap was standing on the sidewalk. He walked back down the steps and approached him. He was a stone-faced man of short stature. His unsteady hand reached for the cigarette that drooped from the corner of his mouth. Barbier guessed he was at least eighty years old.

“Do you live around here?” he asked, showing the man his RCMP identification.

“As a matter of fact I do. My name's Martin Daigle.”

“I'm looking for a man by the name of Eli Steinhoff. Do you know him?”

“Yeah. He rents the guest house in the back,” Daigle said, pointing down the driveway.

“How well do you know him?”

“I speak to him from time to time.”

“Would you mind answering a few questions about him?”

Daigle took a second look at Barbier's identification. The corners of his mouth curled into a slight grin.

“Do I have a choice?”

“Let's just say your country would appreciate your help.” The old man smiled proudly. “Did Mr. Steinhoff
ever mention anything about his prior jobs, political views, family . . . anything of that nature?”

Daigle shook his head slowly. “The few conversations we had were pretty short and boring.”

“Did he have any regular visitors?”

“None that I've ever seen. He was kind of a loner. He told me once all of his friends and relatives lived in Europe somewhere.”

“When was the last time you spoke with him?”

“A couple of days ago. He said he had urgent business outside the country. He told me he wouldn't be back for a week or so.” Daigle shrugged and then pawed at his stubbly gray whiskers.

“Are you the . . . the caretaker of the property?”

“No. I'm the landlord.”

“You didn't mention that.”

“You didn't ask.”

“What kind of tenant is he?”

“He pays his rent in cash and always on time. I got the feeling he had plenty of money.”

“Really? What made you think that?”

“His clothes were pretty nice and he drove an expensive car. My father always taught me never to count another man's money, so I guess I could be wrong . . . but I don't think so. I'll tell you one thing, though. He's a pretty strange fellow.”

“What makes you say that?”

“Sometimes, he'd barricade himself in that house for days. And for the last week or so the lights have been
on all night. He has about ten different newspapers from the U.S. delivered every day.”

Barbier again glanced down the driveway. “I'd really like to have a look inside,” he said, slipping his hand into the pocket of his coat and handing Daigle a search warrant.

“This is official business, right?”

“Absolutely,” he answered the old man's irrelevant question.

“I guess it'll be okay then,” he said.

“After you,” Barbier said, gesturing toward the house.

With a slight limp, the man escorted him down the dirt driveway. When they reached the entrance to the single-story house, he pulled out a key ring. After a few seconds of fumbling, he located the correct key.

Daigle unlocked the door and pulled it toward him. He reached in and flipped on the lights. They both stood in the doorway, staring into the living room.

The room was small and had been painted a drab shade of gray. A light but even layer of porous dust covered a set of shabby green drapes. In the center of the room there was a long table. Three desktop computers each with its own monitor occupied the majority of the space. Barbier stopped briefly at the table and quickly examined the computers. They were all shut down and he decided against trying to boot any of them up. He crossed the teak floor. He felt it give just a little with each step.

The door to the first bedroom was closed, but it was poorly hung and a crescent of light streamed from beneath it. He reached for the handle, pushed open the
door and turned on the light. Taking a few steps forward, he stopped in the middle of the room. If Barbier were exploring a gallery of a modern art, he would have called it one of the most intriguing exhibits he'd ever seen.

Vosky had left without dismantling his scientific workshop. There were still countless papers affixed to bulletin boards and piles of books and scientific journals were festooned across the floor. In disbelief, Barbier walked over to the far wall and began scrutinizing the documents. He had never excelled in foreign languages but he knew enough from his training to recognize Russian when he saw it. Vosky's handwriting was impeccable, but each line of writing had a slight upward bend to it. Some of the pages were filled with mathematical formulas and equations. Others contained complex graphs, algorithms and long narrative paragraphs.

After spending time in front of each of the four walls, Barbier walked over to the kidney-shaped desk. It, too, was piled high with scientific books and journals with dozens of bookmarks sticking out from between the pages. He opened each of the five drawers in turn. They were all empty except the middle drawer, which contained a single manila folder. Opening it, he found a couple dozen newspaper clippings that had been cut out with meticulous precision. The articles were from various newspapers across the United States and Canada, but all of them dealt with the same topic—the GNS crisis. At the back of the stack, there was a separate group of articles fastened together by a large paper clip. Barbier removed the paper clip and slowly began thumbing
through the articles. To his surprise, they were all from newspapers published in various cities in the U.S. In many of the margins, Vosky had made notes and each time a doctor's name appeared in the text, he had underlined it in green ink.