Error in Diagnosis (2 page)

Eleven minutes after Cal's student had called Palm Beach Fire Rescue, two paramedics were at Tess's side. Squatting catcher-style, the first one, a slight woman whose name tag read
R
.
P
ONTE
, wrapped a blood pressure cuff around Tess's upper arm. Her partner, a stubby man packing an extra fifty pounds, unraveled several feet of oxygen tubing, connected it to a mask and then fitted it squarely over Tess's nose and mouth.

“What happened?” Ponte asked. “Was she hurt?”

“No,” Cal answered. “She was fine until about ten minutes into the workout when she . . . she just passed out and fell from her bike.”

“She didn't hit her head?”

“No, I caught her before she hit the ground.”

“What's her name?”

“Tess Ryan.”

“Tess, can you hear me?” Ponte asked.

Cal said, “Her eyes began darting back and forth like that a few minutes ago.”

Ponte placed a tourniquet around Tess's biceps and waited for a suitable vein to pop up. Without looking up she asked, “Do you know if she has any serious medical conditions?”

“I don't think so. She's been working out with me for almost a year. She's never had a problem.”

“When did that begin?” she asked, gesturing at Tess's legs.

Unsure of what he was being asked, Cal's eyes shifted to Tess's lower body. His breath caught. Under her black leggings, her calf muscles rippled erratically as if they were being shocked by repeated bursts of an intense electric current.

“I don't know. It . . . it must have just started,” he answered, swallowing hard against a throat that had suddenly become as dry as cotton.

“The IV's in and her vital signs are okay. We can roll,” Ponte told her partner. Together they transferred Tess onto the stretcher, locked it into position, and hurried toward the exit.

“I'll call her husband,” Cal said. “What hospital are you taking her to?”

“Southeastern State University.”

“Her husband's going to ask. Do you . . . have any idea what's wrong with her?”

“Well, if we were out in the Everglades, I'd say she'd been bitten by a rather large poisonous snake.”

Cal walked across the room and sat down at a wooden desk that was beyond restoration. The three-foot, artificial and unornamented Christmas tree standing next to the desk did little to add to the spirit of the season. He didn't have to announce the class was over. In an awkward silence, the other students gathered their gym bags and moved toward the door. Lost in the moment, Cal rested his chin on his steepled fingers, half listening to the wail of the ambulance's siren fading into the morning.

He tried to reassure himself that Tess Ryan would be fine, but for all his efforts he couldn't shake the uneasy feeling that he might never see her again.

With a steady rain tapping against the ambulance's windshield, Ponte eased into the receiving dock of Southeastern State University Hospital's emergency department. Based on her en route instructions, she and her partner wheeled Tess into a critical care unit designed for the most seriously ill patients.

Much to Ponte's surprise, there were three grim-faced doctors, two nurses, a respiratory therapist and a hospital administrator waiting for them. She exchanged a guarded look with her potbellied partner as they transferred Tess to the hospital bed. In her ten-year career, she had brought dozens of desperately ill patients to emergency rooms all over the county. Some were accident victims who were traumatized beyond recognition. Others were scarcely holding on to life from a massive heart attack or stroke. The memory of those patients was vivid in her
mind. What she didn't remember was ever being met by an entourage like the one now hovering over Tess Ryan.

The physician in charge, James Lione, stood with his arms tight against his side. As soon as the two paramedics finished and stepped back, Dr. Lione stepped forward and began his examination. Sliding his stethoscope from Tess's left chest to the right, he threw a momentary glance in Ponte's direction.

“Did she have a fever when you got her first set of vital signs?” he asked.

“No.”

“Any drop in blood pressure?”

“We checked it three times. They were all normal.”

Lione looked up. “Was anybody else in the class sick with similar symptoms?”

“We didn't specifically ask, but nobody mentioned feeling ill.”

“Was she responsive at any time?”

“No.”

“Do you know if she works?”

“One of the women at the gym mentioned she works in fund-raising.”

“I don't imagine that would pose a great risk for a toxic exposure,” Lione said.

“Have you spoken to any family members to get a more detailed history?”

Ponte shook her head at the strange question. “There were none at the scene and we wanted to transport her as quickly as possible.”

With the other two physicians flanked closely at his
side, Lione completed his examination. Backing away from the bed, a restrained sigh slipped through his lips. He thumbed his ear a couple of times and then motioned the other two physicians to join him on the other side of the room. They spoke softly. Ponte tried to remain as unobtrusive as possible as she struggled to hear what they were saying.

It was at that moment that Dr. Helen Morales, the dean of the Southeastern State University School of Medicine, walked in and joined the group. Before any conversation amongst the physicians began, Lione looked over at Ponte and said, “Thanks for bringing her in. We'll take it from here.” Becoming more perplexed with each passing moment, Ponte only nodded. Generally, paramedics were considered part of the team. Most physicians went out of their way to explain things to them regarding the patients they transported to the emergency room.

They quickly collected the rest of their equipment, left the room and walked down the hall to the staff lounge. Ponte had just grabbed a cup from the cupboard and was headed toward the coffeemaker when one of the nurses who had been present in Tess's room walked in. Ponte knew K. P. Burnham well. She had worked with her for years, and her husband was a fellow paramedic.

“Three doctors and two nurses to meet the patient, and then we practically get thrown out of the room. What the hell's going on . . . what's all the mystery about?”

K. P. walked over to the watercooler and shrugged. “I'm not the one to ask.”

Ponte's stomach tensed. She raised her hands. “What's
that supposed to mean? I'm a licensed paramedic. I'd like to know what's going on with a patient I brought to this hospital. I don't feel like the request is out of line.”

K. P. took a swig of the ice water. After a cautious glance around the room, she started for the door. “I've been instructed not to discuss these cases with anybody.”

“These cases? Are there other patients with the same symptoms?”

K. P. crumpled the paper cup and tossed it into a wastebasket.

“Sorry, I'm really not supposed to say anything.”

Looking around the room as if she were searching for answers on the walls, Ponte pressed her lips into a thin line. She had great faith in the physicians and nurses who worked at Southeastern State, but if there was a method to their madness regarding their care of Tess Ryan, it was a mystery to her.

John F. Kennedy Center for the Performing Arts
Washington, D.C.

Since first seeing
La Bohème
during her freshman year at Georgetown University, Dr. Renatta Brickell, the surgeon general of the United States, had been a die-hard opera aficionado. Time had done nothing to erode her passion, and there were few things in life she coveted more than her season subscription to the opera.

With Christmas carols playing softly, she sat in her aisle seat marveling at the lavish red-and-gold silk curtain. Lost in thought, she barely noticed the light tap on her shoulder. When she looked up she saw her assistant, Julian Christakis, standing over her. His mere presence and the apologetic half smile on his baby face caused her
to groan inwardly. Five years ago, she had hand-selected Julian from hundreds of applicants. Diplomatic to a fault, he had become one of her key advisors and an invaluable member of her team.

He cleared his throat and spoke in just above a whisper. “I'm sorry for disturbing you, Dr. Brickell, but there's a . . . a situation.”

With more than an inkling her evening was in peril, she turned to her husband.

“I'm sorry, Stan. I'll be right back.”

With a dubious look, he tapped his watch crystal. “The curtain's about to go up, Renatta. You don't have much time.”

She gave his hand a reassuring squeeze, came to her feet and accompanied Julian to the lobby. After scanning the area, she motioned toward a relatively secluded area in front of the donor recognition wall.

“This better be good,” she told him.

“Once you hear what's been going on, I suspect you'll agree it is.” He exhaled a lungful of air, scanned the lobby and then continued in a guarded voice, “I've been on the phone with the Centers for Disease Control for the past two hours. It seems they've been receiving calls all day from dozens of hospitals from Florida to California that have been treating hundreds of women with a bizarre illness that none of their doctors has ever seen before.”

“What are their symptoms?”

“Mostly neurologic: memory loss, confusion and severe muscle twitching of the legs. What's particularly
disturbing is that many of the women have developed a dancing eye syndrome.”

“I thought that only occurs in infants and children.”

“Except in rare circumstances, that's usually the case.”

“How seriously ill are these women?”

“Some of them are unresponsive and have been admitted to intensive care units.”

“Any deaths?” she inquired, becoming more concerned with each passing second.

“None reported so far.”

“Just exactly how many cases are we talking about here, Julian?”

“The CDC's not exactly sure. Their best guess is around four hundred, but there could be a lot more.”

She folded her arms and stared at the ceiling for a few seconds. “Has anybody considered that this may just be the beginning of some new strain of flu?”

“None of these women has a fever, sore throat or any other flu symptoms. And, none of their immediate family members is sick. Besides, why would a flu only affect women?” He lightly shrugged his shoulders. “I've spoken to a lot of people today. None of them has the first idea of what the hell's going on.”

“For God's sake, Julian, you have nine advanced degrees in health care and epidemiology.” She paused briefly to gather her thoughts and then asked, “What's the first rule of diagnosis we all learned in medical school?”

“That's easy. The most common things occur most frequently.”

“It's a little corny, but it's also very true, which leaves us with only two rational explanations: The first is this is a contagious disease. The second is we're dealing with some type of widespread toxic exposure.”

Just at that moment, Julian's cell phone rang. He plucked it from the leather case and checked the display. “It's the CDC,” he told her, raising the phone to his ear. “This is Julian Christakis,” he answered, pacing in a tight circle while he listened. He suddenly stopped, and then with a solemn nod added, “You're absolutely sure. There's no chance of an error? I see. Thanks very much for calling, Dr. Emerson. No, that won't be necessary. I'm with the surgeon general now. I'll brief her immediately.”

Julian slid his car keys from the inside pocket of his black blazer. He was generally unflappable but at the moment his expression was ominous. He leaned back against the wall.

“There's obviously something else,” Renatta stated in a guarded tone.

“I'm afraid so. Not only are the hospitals reporting more new cases every hour but most of the women who were admitted earlier are getting worse. I don't have the exact numbers but quite a few are now in a near coma.” He paused long enough to push his hand through his curly blond hair. Renatta was familiar with the habit, which was a sure sign of his uneasiness. “Emerson also confirmed something we suspected earlier.”

“I'm listening.”

“All of the affected women are pregnant.”

With his words seemingly suspended in midair, Renatta could feel the color drain from her face.

The lobby lights flickered.

“Give me a minute,” she told him. “I'll let Stan know I have to leave. You can drive us to the office.”

Renatta made her way back into the opera hall. Clutching her rolled-up program, she descended the center aisle. With her stomach clenched and plagued by a rising sense of urgency, it occurred to her that perhaps the most sensible thing to do was skip the trip to her office and have Julian drive her directly to the White House.