Error in Diagnosis (20 page)

Barbier walked out of Vosky's bedroom and headed for the front door. He suspected it would take the forensic division of the RCMP days to analyze all the material. He stopped when he saw Martin Daigle standing in the middle of the living room looking past him into Vosky's room.

“There'll be some other agents arriving in the next few hours. I'd appreciate it if you would assist them.”

“Of course. What is all that stuff in there?”

“I don't know but it's way beyond anything I'd understand,” he answered, escorting Daigle out of the house and back to his car. Barbier did take the time to remind Mr. Daigle that he had assisted him in a highly confidential matter that involved the national security of Canada. He handed him one of his cards.

“Please call me if Mr. Steinhoff should return unexpectedly.”

Daigle glanced at the card. “I'm a patriotic man, sir. You can count on me.”

With his inward grin, Barbier climbed back into his car and reached for his cell phone. He tapped in the number to the director's office so that he could make the arrangements to get a team out to Vosky's house to gather up the contents and get them back to RCMP headquarters.

“It's Barbier. Would you please see if the director is available to speak with me?”

“Please hold.” The director was a compulsive and highly organized man but was rarely available when Barbier called. He was, however, generally good about returning his phone calls in a reasonable amount of time. Barbier knew he couldn't leave the island until he had heard from him. He figured his best bet was to go into town and get something to eat. Barbier started the engine and pulled away from the curb expecting to hear from his assistant that the director would call him back as soon as possible. He had just pulled away from the curb when she came back on the line.

“The director will speak with you now. Please hold.”

DECEMBER SIXTEENTH

Centers for Disease Control and Prevention

NUMBER OF CASES: 6,123
NUMBER OF DEATHS: 24

Dr. Renatta Brickell had always been a stickler for punctuality. At precisely nine
A.M.
she called the third meeting of the Presidential Task Force on GNS to order. There were a few new faces at the table but the remainder of the group was the same. At the invitation of the surgeon general, one of the new physicians in attendance was Hollis Sinclair.

To begin the meeting, Dr. Mary Grandeson from Birmingham brought the group up to date on her investigation into the possibility that GNS was being caused by a
toxic skin product. Wright was still in Germany. She had received more than one phone call from him informing her that he was duly impressed with the German group's cutting-edge research. He couldn't give her a definite answer, but felt the possibility GNS was being caused by a nanotoxin found in a cosmetic product was real. Knowing how desperate everybody in the group was for encouraging information, Grandeson shared the conversation with them. She finished her comments by assuring the task force her group would diligently continue their work on nanotoxins.

When Grandeson concluded, Brickell made a special point to thank her before continuing with the meeting's agenda.

“I'm sure we all know Hollis Sinclair, who is presently serving as the acting chief of neurology at Southeastern State. As you are aware, he strongly questions the CDC's feeling that GNS is not a viral illness. I thought it was important to invite him to join us today so that we all might hear his theories firsthand.” She smiled at him and took her seat.

“Thank you, Dr. Brickell. To expand on what the surgeon general just mentioned, I'm far more suspicious GNS is being caused by a virus than Dr. Cox and his colleagues at the CDC.” He then turned to Mary Grandeson. “And, as compelling and as extraordinary as your work is, Mary, I don't believe you'll be able to show that this illness is the result of a toxic nanoparticle or an e-waste product. As many of you already know, I'm convinced GNS is being caused by a new strain of parvovirus.
With your indulgence, I've prepared a short presentation that will explain how I arrived at that conclusion.”

Sinclair spent the next fifteen minutes presenting what Jack would call a well-organized argument for his theory. Because the president had lifted the gag order on Isabella Rosas the night before, Sinclair wasted no time informing the group that she was no better and expecting her to recover was a pipe dream at best.

After he concluded, Renatta Brickell was the first to ask a question.

“Hollis, I think I speak for many of us in the room when I express my concern that you've not been able to identify or grow this new parvovirus in the laboratory from any specimen taken from a GNS patient.”

“I understand your concern, but we believe in time we will able to grow the virus in the laboratory. The problem is it will probably take weeks, maybe months, which naturally begs the question: Do we have the luxury of waiting that long? From where I sit, the answer's no. I believe we have enough solid medical evidence to prove GNS is a parvovirus infection.” He looked over at Jack as if he expected him to make a comment on the assertion, but Jack was not so inclined to do so. Sinclair continued, “I'm quite comfortable recommending that a national program of Vitracide therapy be initiated immediately. I would remind everyone that not only are we diagnosing hundreds of new cases every day, but the women we're presently treating are getting sicker and sicker by the hour.” He shook his head slowly and then in a grave voice added, “Treating these women and their babies with Vitracide is
the only hope we have of saving them. To wait any longer would be a medical error of catastrophic consequences.”

Douglas Fraiser, an epidemiologist from New York, raised his hand. “I completely agree with Dr. Sinclair. I would like to make a motion that this committee inform President Kellar we strongly endorse the use of Vitracide.”

“Dr. Fraiser, I can assure you the president is keenly interested in any recommendation this committee might make, but please remember we serve in an advisory capacity only. We don't make policy.”

“I would be interested in hearing Dr. Sinclair's thoughts on treating the mother and fetus together,” Madison said.

All eyes in the room fell on Sinclair.

“From a medical standpoint, I believe both mother and fetus are infected and need to be treated. On the other hand, I'm not naïve to the complex moral and religious issues involved. I believe we should educate the families and make it clear to them that they have options. Those options should be handled on an individual basis by the families in consultation with their physicians and spiritual advisors.”

“I'd like to say something,” came a voice from the far end of the table.

Dr. Carol Quinton from Stanford University raised her hand. Quinton was highly respected and had achieved a praiseworthy list of academic accomplishments during her thirty-year career. She was a woman of short stature who generally spoke in a hushed tone.

Before addressing the group, she stood up. “It's well known the majority of errors we make as physicians are
those of commission, not omission. In other words, when we screw up, it's usually because we did something ill-advised as opposed to failing to act. Dr. Sinclair makes a convincing argument that GNS should be treated with Vitracide, but before we agree to a wholesale endorsement of this plan, I urge you to strongly consider the price our patients will pay if we're wrong. For all we know, a week from now, most of these women could fully recover without any intervention on our part and go on to give birth to perfectly healthy babies.” She shook her head slowly. “Let's not shoot from the hip because we're all frustrated. I'm quite familiar with Vitracide. It's an effective drug but it's also nasty as hell. It can destroy normal heart tissue after only a few doses.” A guarded look came to her face before she continued. “We shouldn't kid ourselves: If we do decide to use it, there are going to be some bad results—including deaths to both mother and baby.”

After the buzzing in the room subsided, Brickell thanked Dr. Quinton for her insightful comments. For the next half an hour, there was considerable debate on both sides. Almost everyone in attendance offered an opinion on the use of Vitracide. Jack didn't tabulate the votes exactly, but his impression was there were more in favor of recommending the drug's use than those who were opposed.

“The president's well aware that at this time of the year everybody would prefer to be at home with their families and not traveling. He's asked me to convey his profound gratitude to all of you for attending these meetings.”

Brickell stood by the door to personally thank each
of the physicians as they exited. When the last one had left the room, she returned to the table and sat down.

“That was an interesting meeting,” she told Julian Christakis.

“Sinclair seems pretty convinced he's got the answer to GNS.”

“Maybe,” she responded, reaching for her cell phone. “But I couldn't tell if that's gifted medical intellect or unbridled ego doing the talking. I'm going to call the president.”

“Maybe we should let some time pass so we can get a better feel for—”

“I think time is something we're running out of. You may not have noticed, but Hollis Sinclair was quite perturbed with my failure to provide him with a blanket endorsement of his plan.”

“Just how important is it that Hollis Sinclair is perturbed?”

She grinned at Julian's naïveté.

“Hollis Sinclair's a man consumed with an enormous sense of purpose. Before the sun comes up tomorrow, the president's going to know every detail of what transpired here today. I can't predict how he'll react, but if he gets bombarded with calls from Hollis Sinclair's allies and we haven't briefed him, well . . . we both might be looking for a job.”

“It's hard for me to believe it's—”

She raised her finger to her lips to silence him. “This is Dr. Renatta Brickell. I'd like to speak with the president, please.”

DECEMBER SEVENTEENTH

NUMBER OF CASES: 6,823
NUMBER OF DEATHS: 26

After yawning and then stretching his arms high over his head, Jack closed his laptop and got up from the desk. He was just about to step out on the balcony to watch the last few minutes of the sunrise when his cell phone rang. It was Marc.

“There's been an interesting development,” he told Jack. “Every couple of days I check the National GNS Data Record for late entries. If you recall, there was a single case reported in a small town in Indiana. The patient's name was Maggie Recino. They transferred her up to Chicago. Initially Ms. Recino's travel history was
reported as negative, but later her mother informed Dr. Cole in Indiana that she was staying in Fort Lauderdale when she learned she was pregnant.”

“For how long?”

“About a month. I called Cole. He really didn't have anything to add, but he did mention he'd called Dr. Sinclair and shared the information about Fort Lauderdale with him.”

“When was that?”

“Two days ago.”

“Dr. Sinclair didn't say anything to me,” Jack said. “Maybe he mentioned it to Madison or Dr. Morales.”

“I can't speak for Dr. Morales, but I checked with Madison. She said she didn't know anything about it.”

Jack noticed Marc was careful not to make any judgmental comments about Sinclair's failure to share the information with them.

“And we're sure there haven't been any further cases from the same area in Indiana?”

“Zero.”

“If that's true, it doesn't take a genius to connect the dots,” Jack said. “Obviously, something happened to Ms. Recino when she was in South Florida that allowed her to contract GNS. It might be interesting to have a look at her Fort Lauderdale obstetrical records.”

“I already put them in the Patient Data Record. You can access them there.”

“Do we know why she was in Fort Lauderdale?”

“No idea. Her husband's in the military and was out
of the country. Her mother's in Chicago with her. I'm assuming her reasons were personal. I was planning on giving her a call later this morning to get a more detailed history.”

“Where are you going to be later?” Jack asked.

“The ICU. I should be there all morning. Madison wants to repeat all the fetal ultrasounds.”

“I'll see you there.”

Jack returned to his laptop and brought up Maggie Recino's file. Her Fort Lauderdale obstetrical record contained only one office visit, which looked to be a fairly routine initial prenatal appointment. As Jack reviewed the form Maggie had filled out detailing her past medical history, a vague idea played in his mind. But as hard as he tried, he couldn't bring it into focus. Finally, his frustration escalating, he shut down the computer.

After a ten-minute shower, he got dressed, gathered up his personal items and headed for the door. It wasn't until he was halfway to the elevators that the vague idea that had eluded him thirty minutes earlier finally crystalized. He stopped and turned around, staring back in the direction of his room.

“Idiot,” he muttered to himself, removing his cell phone from its case and tapping in Madison's number. She answered on the second ring.

“Can you and Marc meet me in the crisis center?”

“Sure. We're about halfway through rounds, and then we're supposed to meet with the radiologists,” she answered. “Is a couple of hours okay?”

“That should be fine. I want to check out a few things in the National Data Record before we meet. I'll see you in the crisis center.”

“You sound a little . . . weird. What's going on?”

“We'll talk about it when I see you.”

With a sudden burst of adrenaline coursing through his veins, Jack turned around and sprinted toward the elevator.