Error in Diagnosis (24 page)

DECEMBER NINETEENTH

NUMBER OF NEW CASES: 7,850
NUMBER OF DEATHS: 31

It was twenty minutes to ten when Madison and Jack pulled into the visitors' parking lot of Orlando Memorial Hospital. They went directly to the patient welcome center, where an elderly woman wearing a pin recognizing her two thousand hours of volunteer service to the hospital directed them to the third-floor office of Dr. Lucien Androise, the chief of pathology. Before accepting the position, Androise had spent fifteen years at Case Western Reserve University. Over the years, Jack had worked with him on at least a dozen cases. They had an
excellent professional relationship and there wasn't a pathologist alive he respected more than Lucien.

Jack and Madison followed the main corridor to its end outside Lucien's office. The door was ajar, and Jack saw his old colleague, a squat man with fatty ears and stubby fingers hunched over a microscope. Jack rapped on the door of couple of times. Lucien looked up, smiled broadly and waved them in.

After exchanging a warm greeting, Jack introduced Madison.

“My pleasure to meet you,” he said, shaking her hand. He redirected his attention back to Jack. “Let's see what you two have.”

Jack handed him the leather case containing the slides. Lucien invited them to have a seat at the Formica-topped counter. Spaced equally apart were four state-of-the-art microscopes. They were of the teaching variety, manufactured with two eyepieces; one for the pathologist and one for the student.

“I can't thank you enough for agreeing to review the case,” Jack said.

“It's my pleasure. We're taking care of a lot of women with GNS, but we haven't performed any biopsies as yet.”

“To my knowledge, Southeastern State's the only hospital that has,” Jack said.

Lucien ran his finger down the slides until he reached the one he wanted to look at first.

“So, did you pluck anybody's tail feathers at Southeastern State by sneaking away with these slides and coming up here?”

“We may have ruffled a few,” Jack answered. “Officially, the request for your opinion comes from Arnold Kazminski, the father of the young lady whose brain tissue you're about to look at. So, from a medical ethics standpoint, we're on solid ground. I can't say the same is true regarding the wisdom of the decision from a political standpoint. But, even if we come under fire when we get back, it shouldn't amount to much more than a flesh wound.”

“You've always been the consummate diplomat, Jack.”

After arranging the two dozen slides in his preferred order, Lucien slid the first one on the viewing platform. He removed his five-dollar flea market reading glasses and looked in the eyepiece of the microscope.

“As I mentioned on the phone, I'm interested to know if you see anything at all that's definitely diagnostic of a viral infection,” Jack said.

Lucien took several minutes studying a large sampling of the slides before he invited Jack and Madison to have a look.

“There's a component of inflammation here that could possibly be the result of a viral infection,” he said.

Jack lifted his eyes from the microscope. “You're saying possibly. The pathologists at Southeastern State were more on the definitely side.”

Androise interlaced his fingers behind his neck. “In my opinion, the findings on these slides are not specific. I can't exclude a viral infection but it's by no means the only possibility.” He raised his hands and turned his palms toward the ceiling. “You asked for another opinion.
All I can say is I don't feel nearly as strongly as the Southeastern State pathologists do that this young lady's brain tissue is infected with a virus.” With an easy shrug of his shoulders, he reached for one of the few slides he hadn't as yet looked at and positioned it on the microscope.

Jack glanced over at Madison. Her face was painted with a stony expression.

“I certainly appreciate you coming in on Sunday to have a look at—”

“Wait a sec,” Lucien said abruptly. He rotated the lenses to a higher magnification. “This is interesting. On this slide, there are some very subtle features of . . .” Lucien said nothing for the next minute or so, but then glanced up from the microscope with a puzzled look on his face. “Let me have a closer look at these and I'll give you a call.”

“What are you . . .”

“I'd rather not say anything right now.”

With narrowed eyes Jack asked, “I don't mean to sound pushy but we're on a pretty tight schedule, Lucien—do you have any idea when we might hear from you?”

“I understand. I'm only talking about a day or two. I don't suppose you brought any of the original biopsy material. I might want to do some different stains on them.”

“I thought you might ask for that,” Jack said, removing a small container of formaldehyde and handing it to Lucien.

“Great,” he said, sliding his glasses back in place and coming to his feet.

With a knowing smile, Jack extended his hand. “Thanks again for having a look at the slides.”

“I'm happy to help . . . but I'm not sure I've done anything more than further muddy the waters.”

“I doubt that's the case,” Jack assured him. “I look forward to your call. One last favor: Would you mind keeping our little visit here today confidential?”

“What visit?” he asked Jack before turning to Madison and extending his hand. “It was such a pleasure meeting you.”

Jack followed Madison out of Lucien's office and down the main corridor. He was more than familiar with Lucien's coy and cautious manner. Jack had a feeling his old friend was onto something.

“Do you feel like making a stop on the way back?” Jack asked Madison as they waited for the elevator.

“What kind of a stop?”

“My mother lives on Hutchinson Island. I owe her a visit.”

“Jack, I hate to sound like a jerk but do you really think with the time constraints we're under this is the best time for a family—”

“You might find her interesting to talk to. She recently retired from the University of Georgia as the chief of pediatric cardiology. She spent her entire career doing research. Her department became pretty renowned for their work on congenital heart disease.”

“Really? Do you know if she worked with Charlotte Duffy?”

“I would say they were inseparable. She is Charlotte Duffy.”

“I beg your pardon?”

“You've obviously heard of her.”

“Are you kidding? I'm a perinatologist. Of course I've heard of her.”

“Does that mean you wouldn't mind stopping by?”

“I'd love to meet her.”

Jack removed his cell phone and tapped in a text message. A minute later his phone chimed twice. He looked down at the message.

“Okay, she's expecting us.”

Madison's Mini kicked up a spray of gravel as it pulled into the driveway of Charlotte Duffy's oceanfront home. A few yards away, standing on the freshly cut lawn, Jack saw his mother waving at him. She was wearing orange-tinted sunglasses and a straw sun hat. He pushed open the door, stepped out and gave her a hug. She was only a few inches shorter than he was and had a lean face with long curving eyelashes.

“This is Madison Shaw. She's working with me on the GNS cases.”

“It's wonderful to meet you,” Charlotte said, taking both of her hands in hers and kissing her once on each cheek.

“Madison's a perinatologist at Southeastern State.”

“I know, dear. You told me that last night on the phone, and the night before.” Jack pretended to look toward the
house. He prayed his face wasn't as red as he suspected it was. He watched Madison press her lips together, struggling to hold back a grin. His mother turned back to Madison. “I'm so pleased to have this opportunity to chat with you. I knew Jack would figure out some way of getting you up here.”

“It's certainly a great pleasure for me to meet you. I'm very familiar with all of your groundbreaking cardiac research.”

“Thank you, my dear, but I'm afraid all of that has become of historical interest only now.” She took Madison by her arm and started down the driveway. “I'd much rather hear about you.”

Jack absently tugged at his ear a couple of times while the two of them walked off leaving him standing there. For as long as he could remember, his mother had a unique penchant for embarrassing him, mostly by being painfully blunt. He looked past the house at the deserted beach, wondering if either of them remembered he was there.

Finally, after an exasperated sigh, he followed them to the side entrance that led into the kitchen, which Charlotte had decorated to be a mirror image of the rustic one in her Vermont summer home. She was an accomplished chef, and all forms of cookware dangled from an oval-shaped iron rack that hung over a rose-colored granite center island. It had been Jack's impression for many years that his mother's unpretentious choice of décor seemed to match her personality.

“May I get either of you something to drink?” she asked.

“Do you have any beer?” Jack asked.

“Don't be ridiculous. But I do have a lovely Chablis.”

“My absolute second choice.”

“Madison?” she asked.

“Just water for me, thank you.”

With a glower, Charlotte said, “Jack, you're starting to remind me more and more of your father. God rest his soul.”

“I'm sorry,” Madison said. “Jack didn't mention that his father had passed away.”

“That's because he's still alive,” he said emphatically.

“Jack's right, I'm afraid. He's been living in London for the past twenty years.” She sighed and then continued, “I keep checking the obituaries, but so far there hasn't been any good news.”

“It's been a long time, Mom. You really need to let this go. Dad's really not that bad.”

“Whatever you say, dear.”

“I think this would be a good time to move on,” he answered, arching his back and then stretching his neck muscles.

Charlotte led them into the great room with its ornate crown moldings and a rich hardwood floor. A bay window offered a sweeping view of the Atlantic. Next to it stood an eight-foot tree decorated with poinsettias, which was the only type of Christmas tree Jack could remember his mother displaying.

Charlotte ushered them over to the sofa and then left them to get the drinks.

Madison leaned back, smiled and silently applauded.
In just above a whisper, she said, “She's great, Jack. Talk about meeting somebody with no airs or graces.”

“A true national treasure. No question about it.”

Charlotte returned with their drinks on a silver tray, and for the next hour and a half there was no shortage of conversation. She asked Madison a litany of questions about her life. She answered openly and honestly and the conversation between them rolled on. Barely allowing Jack to wedge a word in from time to time.

It was almost three o'clock when Jack caught Madison's attention and tapped the crystal of his watch.

“We should get going, Mom.”

“I was hoping you would stay for dinner.”

“We're up against a pretty tight schedule. We really should be getting back.”

“I'll agree to this abbreviated visit on one condition,” she said sternly. “You have to promise to bring this lovely young lady back again very soon.”

“I'll look forward to that,” Madison said, shaking Charlotte's hand. She then excused herself for a few minutes.

“She's a very impressive young woman, Jack.”

He held up his hands. “I know what you're trying to do and you can forget it. We're just working together. Our relationship is purely professional.”

She touched his cheek. “I'll tell you what, dear. You can pretend you're not infatuated with Madison, and I'll pretend you're not trying to fool me about it.”

He looked down the hall. “I really don't think now is the best time to—”

“If you don't mind me saying so, you looked stressed and completely exhausted.”

With a furrowed brow, he said, “That's probably because my best friend's wife is on the verge of dying and I can't seem to help her. Mike's terrified and every time I look at his face I feel like I've failed him.

“Did he tell you that?”

“He doesn't have to.”

“What have you done about it?”

“Other than beating my brains out twenty hours a day trying to figure out what's causing GNS and how to treat it—nothing.”

“I understand you haven't made the kind of progress you had hoped to, but tell me what you have learned about the disease.”

“Our sum total of knowledge is that the affected women have all recently received the flu vaccine and the vast majority have already been pregnant at least once. We're in the process of testing them, but we suspect they're all chimeras, but I have no idea of the significance of that . . . if any.”

“You said chimeras.”

“It's a genetic situation where—”

With a knowing smile, she whispered, “I'm quite aware of what chimerism is.”

“Sorry,” he said, realizing his mistake of underestimating his mother's vast knowledge. “I keep looking at these women over and over again, and I feel like I have five miles of medical data, but the whole thing is one inch thick.”

“Maybe you're studying the wrong group of women.”

“I beg your pardon.”

“You're a gifted physician, Jack, but your entire life you've suffered from tunnel vision. You're too pragmatic and structured in everything you do. Sometimes medical research is about letting your mind go. You can't always be a slave to conventional thinking.”

“What are you trying to tell me, Mother?”

She gently patted his cheek. “Sometimes, to understand a disease you have to look at the people who don't have it instead of the ones that do.”

“Thanks,” he responded in an unconvinced tone, “but I'm not sure you fully understand the . . .”

“The full breadth of the problem?” she asked with a quirked eyebrow.

“I didn't mean to imply . . .”

Before Jack could finish his thought, Madison strolled back into the room. Charlotte took her by the arm. With Jack trailing behind, she escorted her back to the car.

“It was an absolute pleasure meeting you, Madison. I look forward to your next visit.”

“I'll look forward to that as well. Your home is beautiful. It was wonderful spending time with you.”

Charlotte walked over to Jack, gave him a hug and then a quick peck on the cheek.

“Call me later, dear.”

Jack again waved to his mother as Madison backed down the driveway. Nobody knew better than he how insightful she was. She was never one to shoot from the hip, make idle comments or offer gratuitous advice.

“What are you thinking about?” Madison asked. “Your lips are moving. My father does the same thing when he's lost in thought.”

“Just something my mother said. It's probably not important.”

During the drive back, they covered ground they'd already been over countless times. It came as no shock to either of them that they came up with no startling revelations or new directions to move in. In the morass and chaos that GNS had become, Jack was losing hope he'd figure out how to help these women before it was too late.