Error in Diagnosis (28 page)

With his conversation with Lisa still playing in his mind, Jack hurried across the ICU until he reached Tess's room. When he slid the glass door open, he was surprised to see her bed was gone and Mike was nowhere in sight.

“They went down to the operating room about twenty minutes ago,” the nurse said.

Jack looked at his watch. “I thought the C-section wasn't scheduled until noon.”

“Dr. Douglas called and moved it up. If you're looking for Mr. Ryan, I'm sure he's in the OR waiting room.”

Jack started for the door. “I was supposed to meet Dr. Shaw here. Would you please ask her to meet me in the OR waiting room when she gets here?”

“Of course, Dr. Wyatt.”

Fortunately, the operating rooms were on the same floor as the ICU. Two minutes later, Jack approached
the waiting room. Through a large glass window, he spotted Mike sitting in an upholstered chair. His eyes were cast downward, blankly staring at the floor. Just at that moment, Madison appeared.

“They just put her to sleep but they haven't started as yet,” she told Jack. “I told Douglas not to make an incision until he hears from me. He wasn't happy about it and I don't think he's going to wait very long.”

Jack and Madison walked into the waiting room together. When they were a few steps away from where Mike was sitting, he looked up.

“Where the hell have you been?” he asked Jack, coming to his feet.

“I had to speak with a patient's family. How come you didn't tell me the surgery had been rescheduled?”

“I called you twice. Check your voice mail.”

“I need you to authorize Madison to tell Dr. Douglas to cancel the C-section.”

“What are you talking about? Have you lost your mind? We talked about all this last night and decided the best thing—”

Jack waved his hand. “I know we did, but something's changed. I think we may have found a way to cure Tess. It's going to sound unconventional, but I'm convinced it's the only thing that has a real chance of working.”

“I'm . . . I'm not sure—”

“I'm asking you to trust me, Mike. Please tell Madison she can contact Dr. Douglas and put Tess's C-section on hold.”

Mike took a hard look first at Jack and then at Madison. He raised his hands and covered his face for a few seconds before dropping them back to his side.

“Okay. Tell them I'd like to hold off on the C-section for right now.”

Jack turned to Madison. “Please tell Douglas it's of critical importance that he holds off for a few minutes. I'll come back into the operating room in a few minutes to explain everything, but first I have to speak to Mike.”

“I'll take care of it,” Madison said, hurrying toward the exit.

With a puzzled grimace, Mike said, “I'm listening.”

In a calm voice, Jack took the next five minutes to explain the basics of his plan. Mike asked no questions. In fact, he didn't utter a single word until Jack was finished. Finally, he looked at Jack, his face flushed with a mixture of anxiety and disbelief.

“Are you serious?” was all he could manage.

“I said my plan was unconventional.”

“‘Unconventional'? Jack,
unconventional
means straying slightly from the normal path. I'm not a doctor but what you're suggesting sounds like pure insanity,” Mike said, looking at him as if he had grown a second head right in front of him. He covered his mouth and then tapped his upper lip with his fingertips. “Do you understand what you're asking me to agree to? You're not exactly pitching me on some wing-and-a-prayer business deal. We're talking about Tess's life here.”

“If I didn't truly believe this would work, I wouldn't be proposing it.” Jack blew out a breath and said as
calmly as he was able, “I know I'm asking you to take a blind leap of faith, Mike, but I know what I'm doing.”

“But Sinclair is planning on beginning—”

“I couldn't care less about what Sinclair's planning,” Jack said, his voice gaining in intensity with each word.

Jack looked over at the door and saw Madison coming toward them. She motioned to him to continue their conversation in one of the small family rooms that adjoined the larger waiting area. After they both had taken a seat on the couch, Jack answered all of Mike's questions. He felt Mike was able to process the information. Sittting in silence, fiddling with his watchband, he appeared anxious but not on verge of becoming unglued.

“Even though you're my best friend,” Mike began in a measured voice, “if I were making this decision using only logic, I'd tell you that you were insane and to go shit in your hat. But since that doesn't appear to be the case, go ahead and do whatever you think will help Tess. I'll sign the consent.”

“Tess is already asleep but they hadn't started the C-section. I called Dr. Willwade. She's been fully briefed and is standing by if we need her.”

For a few moments, Jack tapped his chin with his fingertips. “Please let Dr. Willwade know that Mike's agreed and that we will require her services as soon as possible.”

“I'll let her know. She told me if we should decide to go ahead, she'd like to come down and speak with Mike. And in the meantime, I think you and I should go speak with Dr. Douglas. He was somewhat less than pleased about us putting his C-section on hold.”

After looking at the clock for the third time, Lyman Douglas walked over and picked up Tess's clipboard. After a few seconds, he tossed it back on the table and folded his arms in front of his chest.

“Until I hear differently, we should at least go ahead with our pre-op safety check.”

The circulating nurse again confirmed Tess's identity by checking her identification band. When she had finished, Douglas went through each and every critical piece of information related to the C-section.

“Has the neonatologist on call been advised we're almost ready to begin?”

“She's in the suite,” his scrub nurse answered.

“If we don't hear from Dr. Shaw in the next sixty seconds, page her.”

Just then, Madison poked her head into the operating
room and motioned to Douglas. He put Tess's chart down and joined her and Jack outside in the hall next to the scrub sink.

“Lyman, this is Jack Wyatt. Jack's a visiting professor from Ohio State. He's been working very closely with us on the GNS cases.”

Douglas shook his hand, and with a slow smile said, “Yes, I believe I've heard Hollis Sinclair mention your name a time or two. If you don't mind me saying so, Madison, you look like a lady with something on her mind.”

“Before you scrub, we'd like to speak to you. It's rather important.”

“Of course.”

“It might be better if we spoke in the patient consultation room.” From the look on his face, Jack got the feeling Douglas sensed he was about to hear something completely out of the ordinary.

Douglas blew a breath out between pursed lips. “Let me tell my team I'll be a few minutes.”

•   •   •

Fifteen minutes later, Douglas walked back into the operating room with Madison at his side. Standing next to them was Dr. Amy Willwade, the chief of head and neck surgery at Southeastern State. Everybody in the room stopped what they were doing, their attention locked on Drs. Douglas and Willwade.

“We have a change in plan,” Douglas announced. “The C-section is canceled. Dr. Willwade will explain how we'll
be proceeding.” He raised a hand above the murmur. “I understand this is a little unorthodox but I assure you everything's been carefully thought out. I'm sorry but we don't have the time to answer a lot of questions.”

Douglas took a few steps back. He caught Willwade's eye, who raised her hand and crossed her fingers.

Willwade said, “My instrument trays are being pulled now and should be ready in five minutes. I'm going to scrub. The consent for the new operation we'll be performing is signed and on the chart. I'll explain the rest when I get back in the room.”

The circulating nurse, who was anything but a rookie, asked in a hesitant voice, “Is there anything we should do while you're scrubbing?”

Without breaking stride or turning around, Willwade said, “Yes. Put a roll behind Mrs. Ryan's shoulders, prep her neck and say a prayer.”

Not long after Tess's C-section was on put on hold, Hollis Sinclair received an urgent phone call from one of his moles in the ICU. Before he'd stormed out of his house, he'd called Helen and left her a message that he needed to meet with her urgently. By the time he'd reached the hospital, he had left two more.

It normally took him twenty-five minutes to make the drive to Southeastern State University. On this particular morning, he made it in fifteen. He parked in the overflow doctors' lot behind the hospital. He slammed his door shut and quick-walked toward the entrance. This was one morning he had no interest in courting the press. To his dismay, fifty yards short of the entrance, he was descended upon by a drove of reporters. Over the cacophony of their questions, he raised his hand in a dismissive manner and kept walking.

“I have no comment on anything at this time.”

Finally, one reporter broke through the crowd. Walking backward, he practically blocked Sinclair's path to the hospital. He shoved a microphone a few inches from his face.

“There are unconfirmed reports there's been a breakthrough. Are you sure you have no comment, Doctor?”

“I have no knowledge of any breakthrough other than the one I've already discussed with you linking GNS to a virus.” His denial did nothing to quell the barrage of questions.

A reporter in the middle of the gaggle made her voice heard above the rest. “We have received an unconfirmed report that an operation is underway that could possibly cure GNS. Are you saying there's no chance this could be true?” Sinclair stopped. A dozen more microphones were thrust in his face.

“It doesn't make a difference if it's true or not. You can't cure a devastating viral infection like GNS with surgery; you need an antiviral drug.” He picked up his pace. “Now, if you'll excuse me, I have patients to attend to.”

In a headlong charge of sorts, Sinclair managed to reach the hospital without answering any more questions. With his blood practically bubbling out of his veins, he stormed toward the back elevators. The moment he arrived, he slapped the Up button repeatedly. Waiting for the doors to open, he swore out loud that before the sun went down, he'd have Jack Wyatt's and Madison Shaw's collective asses in his briefcase.

Hollis Sinclair was not the only doctor at Southeastern State with a network of sympathetic informers. When Jack saw Helen Morales walk into the waiting room, he nudged Madison. They both stood up. Fifteen minutes earlier, she had phoned Madison, informing her she'd like to meet with them as soon as possible.

With a blend of circumspection and worry etched on her face, Helen walked straight over.

“Perhaps we should speak in one of the consultation rooms. I suspect it will afford the privacy we're going to need.” Jack and Madison came to their feet and followed Helen into the largest of the three family consultation rooms. “Please sit,” she told them. She did not, electing instead to pace as she spoke. “I'm sure you two can imagine my surprise to learn that Tess Ryan's C-section had been canceled and that she was being operated on by Amy
Willwade, who, the last time I checked, was a neck surgeon.” She turned back around, folded her arms. “I know both of you are highly skilled and thoughtful physicians, so I'm going to assume there's a logical explanation for why Tess Ryan is having her thyroid gland urgently removed. I was also informed that Mike's pulled the plug on Vitracide therapy too.” She paused for a few seconds, and then, after a few measured shakes of her head, she continued, “It seems you two have had a rather busy morning. I've had at least ten phone calls already, most of them from frantic board members and administrators wanting to know what the devil's going on around here.” Her focus on each of them intensified. “I've been informed . . . no, make that
warned
, that Hollis Sinclair's in a volcanic uproar. He's already awakened every living soul of authority connected with Southeastern State University, the State Health Department and the Surgeon General's Office. If he had the president's cell phone number, I'm sure he would have called him as well.” She paused for a few seconds and then walked over to the coffeemaker but didn't reach for a cup. Jack was accustomed to prickly political situations, but at the moment he felt like an intern on his first day trying to stay out of trouble.

“Something unexpected happened this morning,” Madison explained. “I was making rounds when Jack called to fill me in. We had to move quickly. The bottom line is we think we've figured out what's causing GNS and how to cure it.”

Helen took a seat and in a calm voice said, “I'm all ears, but could you be a little more explicit than that?”

Jack's eyes shifted to Madison. From her expression, it was obvious she wanted him to take the lead.

“One of our GNS patients, Sherry Rosenfelt, has an identical twin sister who is also pregnant. We did some checking and she received the same flu vaccine at the same time Sherry did. So, for all intents and purposes, they're genetically identical in every way.”

“Except that she's fine and Sherry has GNS,” Madison said. “So there has to be some critical difference between the two of them that gave Lisa immunity to the disease.”

With her lips pressed together, Helen shook her head slowly. “I still don't see how all of this leads to Tess having her thyroid gland removed.”

“We believe it's the chimera cells,” Jack explained, “which are in part responsible for GNS. When Lisa was a teenager she was diagnosed with severe Graves' hyperthyroidism. She was given radioactive iodine, which destroyed all of her thyroid tissue. We've recently come across some convincing evidence that GNS may be an autoimmune disease like rheumatoid arthritis or lupus.”

“I haven't heard anything about that. How did you happen to come across that information?”

“I asked another pathologist to have a look at the slides from Sherry's brain biopsy,” Jack explained, with the full knowledge his judgment would be called into question. “His opinion was that GNS was likely to be a new, never-before-seen autoimmune disease. He also asked a colleague who's an expert in the area to look at the slides and he agreed.”

Her eyes squinting, Helen asked, “Would it be safe to assume that this pathologist is not affiliated with Southeastern State?” When neither of them responded, she added, “I thought so. For now, I'll reserve whatever comments I might have regarding the wisdom of that decision for another time,” she said. “So, what's your theory, Jack? What's really causing GNS?”

“If GNS is a new autoimmune disease, then we have to assume the patient's antibodies are the problem. We believe the chimera cells of the GNS patients are interacting with their normal antibodies. This interaction somehow makes these antibodies defective.”

“In what way? How are they defective?”

“They mistakenly recognize normal brain tissue as foreign and react by attacking it. We believe this . . . this faulty interaction is the cause of GNS.”

“The antibodies only form in the presence of chimera cells,” Madison said. “So, if we can eliminate the chimera cells . . . well, we eliminate these destructive antibodies, which should result in a cure.”

“But my understanding is that chimera cells are found in several different areas of the body, not just the thyroid gland. What about these other cells that aren't in the thyroid?”

“Based on our tests, and for reasons we don't totally understand, women with GNS have almost all of their chimera cells in their thyroid gland.”

Helen's eyebrows lifted. “So you're saying no thyroid gland—no GNS.” They both nodded at the same time. “Theoretically, what you're saying might make some
sense, but that's still a pretty thin limb you two have climbed out on.”

“It's the only limb we have,” Madison said.

“And I assume Mike Ryan has been fully briefed and has given . . .”

“He understood everything and gave his consent for the thyroidectomy,” Jack assured her.

“Since Tess is already in surgery, I guess there's not much I can do to unring this bell,” she said coming to her feet. “I better get going. I have a lot of phone calls to make. I can't decide if the first one should be to the surgeon general to inform or Hollis Sinclair, to try and calm him down.” Gazing upward, she added, “The rumors are already flying. We have to figure out some way to keep a lid on this thing. If any of this becomes public knowledge before we know if the surgery's been successful . . . well, it could cause a national frenzy.”

“Do you think Hollis will talk to the press?” Madison inquired.

Helen shook her head. “He'd have to be crazy. That would be a serious breach of professional ethics with significant consequences. I don't think he'd risk it.” She paused and after an audible sigh that faded to an edgy smile, she added, “I'm going to set up a meeting with him right away. I'd prefer to find him before he finds me.”