Error in Diagnosis (31 page)

“You look like hell,” Jack said to Marc when he walked into the ICU.

“I didn't exactly make it home last night. We had another GNS death at about three. We did an urgent C-section. The baby's pretty sick but holding his own in the newborn ICU.”

“I'm glad the baby survived,” he said. “Has there been any change in Tess's condition?”

“No, not really.”

“I know it's only been an hour or so, but did you have any time to look at those patients on the National Data Record we talked about?”

“I did,” he answered, pulling out four pages of patient printouts from his pocket. “And, as it turns out, I was able to locate four women in Florida who were suspected of having GNS, but they turned out to have something
else. Two were from Miami, one was from Tampa and one was from Pensacola.” Marc continued to refer to the printouts as he spoke. “The two from Miami were hospitalized at Suncoast Medical Center. They both presented with mild confusion, spasms of their legs and a sore throat. Neither had a dancing eye syndrome, fever or a rash. But to be on the safe side, the physicians at Suncoast admitted them with the diagnosis of possible GNS. Both were in the hospital for a couple of days, got better and were sent home.”

“What was their discharge diagnosis?”

“Viral syndrome.”

“Did their records mention if they had the flu vaccine?”

“They both got it.”

“What about their past medical history?”

“Nothing of interest. They were both very healthy.”

“Was there any mention if they had their tonsils out?” Jack asked.

“Their tonsils out? Is that important?” Jack returned Marc's inquiry with an icy stare. “Sorry,” he said, leafing through the pages. “According to their past surgical history, neither of them had any prior surgery.”

“What were the final diagnoses on the other two women who turned out not to have GNS?”

“They had pretty similar symptoms and hospital courses. They both had received the flu vaccine and neither of them, apart from C-sections, had undergone any other surgery.”

“Did any of the four women have a strep screen done?”

“Let me check,” Marc said with a degree of hesitation
while he again shuffled through the printouts. At the same time, Madison walked up. “It looks like two of them did, and they were both positive.”

“You didn't call me,” she said to Jack.

“I've been a little busy. I need to talk to you two,” he said, before turning to Madison and adding, “and then you and I need to meet with Helen Morales immediately.”

Jack watched as Madison rolled her head from side to side as she massaged her neck.

“Sure, we can talk in the conference room.”

She made a grand gesture toward the other side of the ICU and the three of them walked off.

Madison had no trouble arranging the meeting with Helen that Jack had requested. They were already seated in her office in front of her desk when she came in and sat down.

As Helen's eyes fixed on him with guarded anticipation, Jack cleared his throat and slid forward in his chair.

“I no longer believe that removing Tess's thyroid by itself will cure her,” he said.

Helen's face went slack. “I hope you're kidding, because after all we've been through . . . I mean, are you now telling me you want to abandon your plan and give Hollis the go-ahead to start Vitracide?”

“Absolutely not,” Jack said with complete certainty. “We're convinced we can still cure Tess and every other woman with GNS. We still believe GNS is a new autoimmune disease. In order to cure Tess or any other women
with GNS we have to eliminate the abnormal antibodies that are attacking their brain tissue.”

“I believe you've already explained that to me. That was our justification for removing Tess's thyroid.”

“Removing the thyroid will prevent the formation of any new toxic antibodies but what I overlooked was that the operation won't eliminate the abnormal antibodies that are already present. Based on cutting-edge research I've just become aware of, the existing antibodies will continue to attack the brain tissue for at least six weeks. I don't believe any of the women will be able to survive that long.” Jack moved back in his chair and placed his hands on his thighs. “If we don't eliminate the antibodies that already exist, we won't cure GNS.”

“Is there a way to do that?” Helen asked.

“I believe there is. There's a group at Rockefeller University who have recently discovered that certain strains of streptococcus bacteria produce an enzyme that destroys these abnormal antibodies. They're calling the preparation Streptogenase V. The result has been a complete reversal of the neurologic symptoms.”

“Theoretically, every woman with GNS should recover if she receives Streptogenase V,” Madison added.

Helen guarded her silence, tapping her leather blotter with a pencil. “I've had people try to sell me encyclopedias door-to-door who offered a more persuasive argument than that.” Her expression suddenly changed, and with ping-ponging eyes, she asked, “Do you two realize when the average person hears the word
streptococcus
they don't think of a sore throat? They think of the deadly flesh-eating
bacteria or toxic shock syndrome, which instantly makes their blood run cold. It would be like telling people we want to cure GNS by giving their loved ones arsenic or the Black Plague.” She stopped for a few moments. And then, in a calmer voice inquired, “Do you have anything else to support this theory besides this experimental information?”

“Sherry Rosenfelt had her tonsils out but Lisa didn't. I spoke with Lisa this morning. She told me right before she got pregnant she was treated for a strep throat.” Jack then spent some time informing Helen of the other four women Marc had located in Florida who were thought to have GNS but turned out not to. He made a point to emphasize that they had all received the flu shots and that at least two had positive strep tests.

“Are you trying to tell me that if a woman still has her tonsils in, she can't get GNS?” Helen asked.

“Not exactly. We're saying that a certain strep infection contracted just at the right time offers a high-grade protection or even a cure against GNS. Marc's combing through the Data Record right now trying to find more women with the same clinical history.”

“This research being done at Rockefeller University. How many women have taken part in it?”

Jack tugged at his collar. “Unfortunately, all of their studies to this point have been done on animals.”

“I beg your pardon.”

“But Dr. Tau did mention that they have received permission from the FDA to begin clinical trials in humans.”

“Assuming I should agree to this, how do you plan to administer this Strep . . .”

“Streptogenase V,” Madison said in a meek voice.

“Streptogenase V,” Helen repeated. “You can't inject a preparation like that directly into the bloodstream. It would be too dangerous.”

“Actually, Dr. Tau and her group have determined that's the only way it works.”

“You're telling me this . . . this bacterial concoction, or whatever in God's name you want to call it, is nowhere close to being FDA approved. That means the only way we could justify administering it would be as the only conceivable treatment to save a life.”

“I've been involved in a few cases where we did that,” Jack said.

“I have also. But I think you'd agree, not on this level.”

“I'm not sure this country's ever faced an epidemic like GNS before,” Madison said.

After a deep sigh, Helen stood up. “So tell me exactly what you're proposing.”

“We already have Mike's full approval, so we'd like to acquire the strep preparation from New York and administer it to Tess as soon as possible. Dr. Tau has agreed to provide us with enough as long as you'll sign off on it.”

“I must be out of my mind. I should be calling psychiatry to come down here and drop a net over the three of us.” Helen leaned forward, placed her palms squarely on her desk and locked eyes with both of them. “I sure hope you two know what the hell you're doing. “

“I'm not sure I can offer you that guarantee,” Jack said.

“How long after administering this drug will we know if it's been successful?”

“We can't predict exactly but according to Dr. Tau, the effects of the Streptogenase V occur fairly quickly.”

“In mice, you mean,” Helen said with a slow shake of her head. “I'm going to have a lot of people to answer to on this thing. As soon as the word gets out, they'll be coming after us with pitchforks and lanterns. And it's not too hard to figure out who'll be leading the mob.” She raised her eyes. “How soon can you get this stuff from New York?”

“I was planning on flying up to New York tomorrow on Mike's plane. We can give Tess the first dose as soon as I get back.”

Helen started for the door. “I hope you two understand this is it. The board and the medical staff are at the end of their respective ropes. Once they hear about this strep treatment, I can assure you we have played our last card. If there's nothing more, I have some phone calls to make.”

Jack and Madison came to their feet. A number of worries leapt to Jack's mind but he said nothing. Madison gestured toward the door and he followed her out of the office.

DECEMBER TWENTY-FOURTH

NUMBER OF CASES: 9,676
NUMBER OF DEATHS: 56

The last thing Jack did before leaving for the airport was stop in the ICU and check on Tess. She had had an uneventful morning and fortunately hadn't deteriorated. Regrettably, she hadn't shown any signs of improvement either.

The flight to New York took a little over two hours. Jack had the opportunity to spend quite a bit of time with Dr. Tau going over every aspect of her work. She was careful to advise Jack of all the possible complications Tess might encounter from receiving the specially formulated
strep preparation. It was Dr. Tau's advice to administer two doses five hours apart.

Thirty minutes after his plane touched down in West Palm Beach, Jack walked into Tess's room. It was three
P.M.
Mike, Madison and Marc were there waiting for him. Mike had already signed a litany of documents, which Southeastern State's legal department had prepared outlining in great detail his agreement to treat his wife with an experimental drug. The nurse manager and the attending physician were also present. A few minutes before Jack had arrived, Marc had wheeled the crash cart into the room. The cart contained all the necessary medications and equipment to deal with a cardiac arrest.

Mike pointed at the portable incubator Jack was holding. “I assume that's it.”

Jack shook his head. “Have you changed your mind about going ahead with this?”

“I've made my decision, Jack.”

Jack removed one of the single glass containers from the incubator. He was normally steady-handed but on this occasion his hand was quivering like a feather in a gusty wind. After cleaning the top with an alcohol swab, he carefully drew up three CCs of the sky blue fluid into a syringe. After checking the amount twice more, he walked over to Tess's bed. Selecting one of the rubber ports on the IV line, Jack slid the needle in the sterile tubing. His thumb found the back of the plunger, but instead of pushing the fluid into Tess's bloodstream, his thumb froze in place. He raised his eyes to Mike.

“Go ahead,” he told Jack with an encouraging smile. “You're just a couple of seconds away from saving Tess's life.”

With his mouth as dry as a handful of gravel, Jack gently eased the plunger down, sending the Streptogenase V coursing through Tess's veins.