Error in Diagnosis (30 page)

Helen Morales sat behind her desk reviewing the agenda for the emergency meeting of the hospital board that was scheduled to take place in a few hours. When Hollis Sinclair had told her he would make sure such a meeting took place, she hadn't doubted it for a second. She was still looking over the agenda when the beep of her intercom startled her.

“Dr. Morales. President Carmichael would like to speak with you.”

“Put her through, and please hold any other calls.”

“She's not on the phone . . . she's here in the office,” Ali said in a voice just loud enough for Helen to hear.

“I'll be right out.”

Donna Anne Carmichael had been the president of Southeastern State University for the past sixteen years. Formally educated and having earned her doctorate in
ancient languages, she was a consummate academician, masterful at defining crucial initiatives and rallying people to the cause. Her fund-raising efforts and accomplishments were a model for all university presidents to aspire to.

Helen greeted Carmichael warmly and escorted her to the couch.

“I hope you don't mind me dropping in without calling first, but I thought it might be a good idea if we spoke before today's meeting. To begin, I want you to know I have supreme confidence in your judgment.”

“Thank you.”

“As president, the only higher-ups whom I'm constantly massaging are the university trustees. I'm not generally bombarded with phone calls from the hospital board members,” she explained. “But it's understandable that this whole GNS thing has left them . . . well, in a prickly mood. Some of them have been persuaded by Hollis Sinclair that Dr. Wyatt's presence here at Southeastern State has been quite counterproductive.”

“Jack Wyatt is an outstanding physician with a laudable national reputation. I feel fortunate he agreed to serve as a guest professor. His input has been very helpful. Hollis Sinclair's a talented physician but he's been behaving badly for the past week or so. The bottom line is I have no regrets about inviting Jack Wyatt here.”

“I'm sure you're aware that there are a number of highly respected doctors on Southeastern State's medical staff who believe his chimerism–flu vaccine theory is a Hail Mary at best.”

“I guess that remains to be seen.”

“Has Tess shown any signs of improvement?”

“It's only been a little more than two days since we removed Tess's thyroid, Madame President.”

“I'll take that as a no. What's your long-term plan?”

“I'm not sure I have a long-term plan. For now, we're going to continue to wait for signs of recovery.”

“Any idea how long?” Carmichael asked.

“I think that's up to her husband. As far as the other families are concerned, we can offer them other treatment options.”

“Dr. Sinclair strongly opposes that idea, and I believe both the trustees of the University and the hospital board members agree with him. And to be honest with you, I'm not sure I don't as well. We don't want to come across as desperate and experimenting with people's lives. Dr. Sinclair insists as long as we're observing Tess Ryan, it would be a grave error in judgment to proceed with Vitracide.”

“Are you asking me for a specific date when we should abandon Jack Wyatt's treatment plan?” Helen asked.

“Yes, I am. On a national level, Dr. Sinclair's been by far the most verbal proponent of Vitracide. I think our colleagues across the country are watching us here at Southeastern State waiting to follow our lead.” By her tone and demeanor, Donna struck Helen as a woman who was sensing she was running out of room to maneuver.

“If we don't see any improvement in Tess's condition in the next three days, I'll support abandoning Dr. Wyatt's treatment plan and recommend moving ahead immediately with Vitracide.”

“Shall we say the morning of the twenty-sixth?”

“Of course.”

“One final thought: If and when we do begin Vitracide therapy, perhaps that would be an appropriate time for Dr. Wyatt to . . . to resume his responsibilities at Ohio State.” Helen shook her head and splayed her fingers out on the armrests of her chair.

Carmichael started to get up and Helen followed. “I'll ask you again. This time just between us girls: Any regrets about inviting Jack Wyatt here?”

Helen sighed. “I'm not sure. Ask me again in forty-eight hours.”

DECEMBER TWENTY-THIRD

NUMBER OF CASES: 9,123
NUMBER OF DEATHS: 52

Lying wide-awake in bed, Jack stared overhead at an antique-style ceiling fan. It was six
A.M.
To say the least, it had been a restless night's sleep. He had been at Tess's bedside until midnight before he finally left the hospital and returned to his hotel.

Tess had shown no real signs of improvement. Watching the fan making the slowest revolutions it was programmed for, Jack tried to convince himself to the contrary. But in his heart he knew her coma was just as deep as the day Dr. Willwade had removed her thyroid gland.

He threw back the covers and sat on the side of his
bed for a minute or two staring aimlessly across the room. Finally, he picked up his phone from the nightstand and dialed the ICU.

“How's she doing?” he asked the nurse caring for Tess.

“Dr. Fuller's here. I'll put him on.”

“Hi, Jack. Tess had a stable night. I see no sign there's been any change in her mental status. Her vital signs are holding but she's still in a coma.”

“I was hoping for a little better news than that.”

“Let's see how she does today,” he suggested. “By the way, I'm concerned she may be getting blood clots in her legs. I'd like to start her on some heparin. It won't dissolve any of the clots that are already there but it will prevent the formation of any new ones.”

“I think that's a good suggestion, John. I should be there in the next hour or so. Have you seen Mike?”

“He finally left a few minutes ago. He said he'd be back in a few hours.”

“I should be there in about forty-five minutes.”

“I'll see you when you get here. I assume you've heard.”

“Heard what?”

“The hospital officially informed everybody that the Vitracide program will begin the day after Christmas. They've already started scheduling the first group of C-sections.”

Through sliding glass doors leading to the balcony, Jack watched the last few minutes of the dawn. His mind wandered in several directions but he kept coming back to the same thing: Two days earlier he was convinced that
removing Tess's thyroid gland would cure her, but during the last twenty-four hours, his conviction had eroded.

He got out of bed and walked over to the coffeemaker. Reaching for a cup, he thought about his conversation with Fuller. He was just about to hit the Brew button when it suddenly struck him. He closed his eyes and threw back his head. It wasn't a revelation or realization born of careful thought. It was like a crack of thunder followed by somebody shaking him to wake up and see the obvious.

“Shit,” he muttered, as he grabbed for his phone to call Madison.

“I think I screwed up,” he told her.

“What are you talking about?”

“Tess isn't going to get better. I missed something. I'm certain of it.”

“What makes you think that?” she asked.

“I just got off the phone with Dr. Fuller a few minutes ago. It was something he said. He wanted to let me know he was putting Tess on a blood thinner. He mentioned he was going to use heparin. He reminded that it would take care of new clots but not the old ones.”

“And that comment made you realize you had overlooked some critical piece of information? Excuse me for saying this, Jack, but you're starting to sound like somebody who's ready to stick his head in an oven.”

“What's your point?”

“My point is you're panicking. It's only been a couple of days since Tess's surgery. You need to give this more time.”

“I'm not saying we should have seen a complete recovery. I'm saying we should have seen at least some subtle signs of improvement by now.”

After a quiet few moments, Madison said, “I'm not trying to be harsh or unfeeling, but do you think it's just possible your relationship with Tess and Mike is clouding your objectivity, and that you're becoming a little desperate? Jack, we've done everything we can. Helen told us it's over the morning of the twenty-sixth. She's not going to change her mind. If Tess doesn't start to improve pretty soon . . . well, I guess we're both going to have to get on board with what the hospital officially recommends.”

“I'm not going to worry about politics and deadlines right now, he said.”

“What are you going to do then?” she asked.

“One of our assumptions has to be wrong. I have to make another phone call. Then I'm going to get back on the computer. I have a suspicion . . . no, call it an inkling, of where I went wrong.”

An hour later, Jack had again reviewed most of the scientific articles he had accumulated on autoimmune diseases. He continued to be plagued by a vague recollection of one of the articles, but the more he prodded his memory to recall which one, the further he found himself from remembering. As he approached the end of his review, his confidence that he would find the article was waning.

It was at that moment, when he brought up the next article, that he knew he'd found what he was after. The article was written by a group from the University of Texas in Galveston discussing novel new therapies for patients with autoimmune diseases. The author mentioned a group at the Rockefeller University in New York that was conducting exciting new research on treating the neurologic symptoms of autoimmune diseases. The article then went
on to mention the work was under the leadership of Dr. Jessica Tau.

Raising his eyes from the screen, Jack drummed the desktop. He brought up Rockefeller University's website. Moving to the faculty tab, he was able to locate Dr. Jessica Tau. Her bio was impressive. Not only did she hold an M.D. and a Ph.D. in immunology, but she had also been awarded several NIH grants. It was still early, but he dialed her office number anyway, assuming he'd be prompted to her voice mail.

To his great surprise a woman answered on the second ring.

“This is Dr. Tau.”

Jack stood up. “Dr. Tau. My name is Jack Wyatt. I'm a neurologist at Southeastern State working on the GNS cases. I apologize for the early hour, but I was hoping you might have a few minutes to speak with me.”

“It seems everybody's arriving at work early these days, Dr. Wyatt. I'd be delighted to speak with you. By the way, I'm quite familiar with your extensive work and contributions in the area of difficult neurologic diagnoses.”

“Thank you. I recently became aware of the innovative work you're doing on the neurologic symptoms of some of the autoimmune diseases. I was wondering if you had published any of your findings as yet?”

“Actually, we received notification a few days ago from the
New England Journal of Medicine
that they intend to publish our first manuscript in the fall.”

“Congratulations.”

“I would be happy to e-mail you a copy of the manuscript if you'd like to review it.”

“I'd greatly appreciate that.”

“If you'll give me your e-mail address, I'll send it right now.”

Jack proceeded to ask Tau a number of questions regarding her work. She was more than cooperative, answering all of them in extreme detail.

“I look forward to reading your manuscript. In the event I have further questions, would you mind if I call you back after I have a look at it?”

“Of course not. I'll give you my cell number.”

Jack provided Dr. Tau his e-mail address and entered her number into his electronic phone book.

“Thank you again, Dr. Tau. I look forward to speaking with you again.”

He walked over to his nightstand to grab his legal pad and pen. By the time he returned to his computer, Tau's manuscript had arrived.

For the next hour Jack drank coffee, read and then reread every word of it. It was an incredible piece of scientific work, a true research marvel. Finally, he lifted his eyes from the screen. His mind was doing backflips. When he finally snapped back to the here and now, he reached for his phone and located Lisa's number.

“Good morning. This is Dr. Wyatt. I apologize for the early hour, but I have something rather important to ask you.” He nodded a few times as Lisa assured him he had
not awakened her. “You mentioned that Sherry had her tonsils out but you didn't.”

“That's right. I think we were about six at the time.”

“Have they ever given you any trouble?”

“I've had strep throat a few times over the years. It always got better right away with antibiotics. I asked my internist about having them taken out, but she said it wasn't necessary.”

“Do you recall when you last had strep throat?”

“Let me think a moment,” she answered. “It was right before I got pregnant. I took antibiotics for a week and I was fine.” Before the words were out of her mouth, Jack felt his stomach drop.

“Thank you, Lisa. I apologize again for calling you so early.” He found Marc's number and dialed it. The phone rang several times before kicking over to voice mail.

“C'mon, Marc,” Jack said out loud as he ended the call and then hit the Redial button. “Pick up your damn phone.” While the phone rang, Jack paced the carpet. He assumed he was one ring away from getting his voice mail again when Marc answered.

“Good morning, Dr. Wyatt.”

“I need some information from the National Data Record as soon as possible. It's urgent.”

“Sure. Just tell me what you need.”

Jack paused to gather his thoughts. He then took the next few minutes to tell Marc in very specific terms the patient information he was interested in, and that he'd meet him in the ICU within the hour. Jack set his phone
down on the nightstand and started getting dressed. His hands were shaking and he could feel drops of perspiration creeping down his brow. Although it was a rare experience for him, Jack Wyatt recognized an overwhelming adrenaline rush when he felt one.