Error in Diagnosis (9 page)

Jack was accustomed to boring medical dinners. When the crème brûlée and hazelnut coffee were finally served, the conversation shifted from informal and innocuous to a discussion of Southeastern State's enigmatic group of GNS patients.

Jack was asked several general questions, which he answered with a mixture of caution and guarded optimism. The participation was excellent, so when Sinclair didn't utter a single word, it left Jack wondering at first. But as he gave it more thought, he understood. Sinclair believed he had the solution to GNS. To contribute to a conversation held by a group of bumbling, less-enlightened physicians than he would be intellectually beneath him. Jack had little doubt that when Sinclair felt the time was right, he wouldn't hesitate to move center stage and announce he had discovered the cause of GNS and how to cure it.

After another thirty minutes had passed, most of the guests had left. A few, including Sinclair and Madison, remained.

“We've scheduled you to host our noon conference tomorrow,” Helen informed Jack. “The residents have prepared a couple of cases to present to you. I should warn you, they're pretty tough ones.”

“I'll look forward to it.”

She took a sip of her red wine and added, “Under the circumstances, I thought it might be better if we didn't discuss the GNS cases at the conference. We've already had a problem with some members of the press sneaking into the hospital. There will be a large number of people there and I'm not sure our security department has the resources to monitor everybody entering the auditorium.”

At that moment, Madison approached with an ominous look on her face.

“Excuse me for interrupting but I've just had a call regarding a new patient with GNS.”

“We should check with the ICU to make sure we have a bed available,” Helen suggested. Sinclair, who was seated a few feet away, turned in his chair but said nothing.

“Actually, she's in the children's hospital emergency room. She was transferred down from Cocoa Beach about two hours ago.”

“How old is she?” Helen asked.

“She'll be fourteen next month,” Madison answered, hoisting her purse on her shoulder. “I'm going over there.”

“Any doubt about the diagnosis?” Helen asked.

“It doesn't sound like it. She has all the symptoms.”

“I guess I should go as well,” Sinclair grumbled without coming to his feet.

In addition to the two vodka martinis he'd seen Sinclair drink before dinner, Jack had also noted he had consumed several glasses of wine with his meal. He scanned the faces of those around him. It was obvious the only person amongst them who felt Sinclair was in any shape to see a patient was the acting chief of neurology himself.

Madison stepped forward. “There's no reason for both of us to go, Hollis. I'll make sure everything's taken care of. I'll fill you in first thing in the morning and give you a thorough briefing.”

Sinclair shook his head and smiled sardonically. “Why do any of us need to see her tonight? Is there some pressing reason she needs to be seen urgently? The children's hospital has an intensive care unit and neurologists on staff.”

“She's a child,” Madison replied. “I'd feel more comfortable if I examined her tonight.”

“Seems ludicrous. There are a couple of thousand other pregnant women in the country just as sick. The problem's that teenage pregnancy is rampant in this country. If her parents had done their job, she wouldn't be in a hospital.”

After a few moments of silence Jack asked, “Would you mind if I tagged along?”

“I don't think that's such a good idea,” Sinclair was quick to say.

“That's very kind of you to offer,” Helen said, ignoring
Sinclair's objection. She looked over at Madison. “I assume that's okay with you.”

“Of course,” she answered the dean's rhetorical question without hesitation.

“She'll be the youngest patient we've cared for,” Helen said.

“Actually, I suspect she's the youngest patient in the country.”

Helen removed her purse from the back of her chair. “I'll walk you two to the lobby,” she said, pointing in the direction of the door. Jack anticipated Helen would offer a third-party apology for Sinclair's remarks but she said nothing as she escorted him and Madison to the hotel exit. “If you had asked me a half-hour ago if it were possible for the mood of the country to be any worse, I would have said no. But if we are on the verge of discovering that GNS is capable of attacking children, there's no telling what the catastrophic consequences might be. For starters, we may see every school in the country closed.” Her eyes dropped for a moment. “Please call me as soon as you've assessed this young lady's condition.”

“We will,” Madison assured her.

Five minutes after they'd boarded Marine One, Kellar and Brickell were airborne. They sat across from each other in wide leather chairs. They barely had time to review the events of the meeting when the helicopter settled on the south lawn of the White House. With the sound of its engine fading into the evening sky, they walked across the lawn.

“How fast do you think we'll see the death rate escalate?” he asked her.

“It's impossible to say, but in the continued absence of any real progress, I would expect it will be pretty rapid.”

“My understanding is there haven't been any infant deaths as yet.”

“That's correct, sir. All of the women we've lost underwent urgent C-sections and the babies were saved. They're
obviously all very ill, but it's impossible to tell whether they have GNS or just severe prematurity.”

The president shook his head slowly as he looked overhead at a full moon that had just emerged from behind a stack of clouds. For the first time since she'd met him, his face was painted with anguish.

“Have you been watching much TV of late?” he asked.

“Excuse me, sir?”

“It may not be what most people imagine their president does in his limited leisure time, but I enjoy watching a little TV at night. I especially like it this time of year because of all the holiday specials.” Renatta smiled, wondering where one of the brightest and most insightful men she'd ever met was going with this. “Since the GNS outbreak, there hasn't been too much else on except the coverage. Most of it is understandably depressing. The tearful interviews with grieving friends and family members betray the terrified mood of the country. Millions of Americans, whether they have a loved one with GNS or not, are in mourning.” Kellar's face went slack, and after a weighty sigh, he said, “Good night. Let's talk in the morning.”

She watched as the slump-shouldered chief executive made his way across the lawn and past the Rose Garden. She suspected there were things Kellar had left unsaid because that was his style when facing difficult problems. But she knew the events of the meeting at the War College weighed heavily upon him. She was also sure they shared the same dreaded fear: If GNS was an act of biological terror, it could easily become the greatest medical catastrophe in modern history.

Although it had only been four years since the ribbon-cutting ceremony, the Stenson Family Children's Hospital had matured into an outstanding facility. An eight-story architectural triumph, the hospital incorporated multiple inspirational themes that successfully captured what modern children's hospitals strove to achieve. Its construction would not have been possible without the efforts of Southeastern State University's charitable foundation, which had raised ninety million dollars for the project. Although Madison served on many hospital committees, she was most proud of being asked to serve on the foundation's board of directors.

Avoiding the packed waiting room, Madison led Jack into the emergency room through the staff entrance. Having been there several times to consult on teenage high-risk pregnancies, she was familiar with the ER's
layout. Jack, on the other hand, could barely remember the last time he'd been in a children's hospital. The voices of harried personnel barking orders while wailing children clutched at their parents was a stark reminder to Jack why he never gave serious thought to going into pediatrics.

Following Madison down a hallway crowded with equipment and staff, he glanced back and forth into the examination rooms. Not a single one was empty, and the patients spanned the gamut from infancy to adolescence. Approaching the nursing station, they walked past a six-bed pod specially designed for the treatment of asthma. Even from the hall, his eyes fixed on the anxious face of a father cradling his squirming daughter. He struggled to hold a plastic mask that spewed a medicated aerosol over her mouth and nose.

Just as they reached the central station, Linda Haise, a veteran nurse with a skeletal frame and a pair of tortoiseshell reading glasses that teetered on the tip of her nose, emerged from the trauma treatment area.

“Hi, Dr. Shaw. I heard they called you to come to see Isabella Rosas.”

Madison nodded. “How's she doing?”

“Not great. Her vital signs have been all over the place and she's pretty out of it. When the paramedics first brought her in we thought she had suffered an unwitnessed head injury, but when we saw the dancing eye syndrome . . . well, it didn't take too long to figure out she was the first case of pediatric GNS.”

“Is Dr. Effratus still in there?”

“Yeah,” she said, brushing a few obstinate strands of
auburn hair from her forehead. “When I left the room a few minutes ago, he was still scratching his head. Sam's been in there with her for a while,” she said. A nurse's aide walked up and handed Linda a printout of lab results. “I gotta go. I have a two-year-old who decided to eat his toy soldiers and their cannons for dinner. I think it's affecting his digestion.”

“That sounds terrible,” Madison said.

“There are a lot worse things. I'm sure if we wait a day or so the entire army and their artillery will come out in the wash.”

Madison and Jack made their way down to Isabella's room. When they were a few feet away, they noticed a sign on the door indicating isolation precautions. They each slipped on latex gloves, a yellow paper gown and a mask.

Dr. Samuel Effratus was hunched over the bed listening to Isabella's heart. He was a placid man who maintained an optimistic outlook on most things and who waged a never-ending war to keep his weight down. If asked, he'd be the first to admit he'd lost the last few battles. His usual engaging smile absent from his face, he glanced up at Madison and shook his head.

“Sam, this is Jack Wyatt,” Madison said. “He's a visiting professor of neurology from Ohio State.”

“Nice to meet you,” he said, strolling over to shake his hand.

“How's she doing?” Madison asked, glancing up at the cardiac monitor.

“I'd say fair at best. Her blood pressure and pulse are
finally okay. She's still conscious but she's not responding to verbal commands. She has muscle twitching in both legs and dancing eye syndrome.”

“Doesn't sound like there's much doubt about the diagnosis. Are her parents here?”

“Unfortunately her father's been MIA for the past five years and mom's been in and out of rehab so many times the court awarded permanent custody to the grandmother. She brought her in. She seems very concerned. She needed a break so I sent her out to the waiting room.”

“Have you done a CT scan of her head yet?” Jack inquired.

“It was normal,” Effratus answered. He then turned to Madison and added, “I spoke with a pediatric neurologist and went over the case with him in detail. Because you guys have all the experience dealing with GNS, he suggested we transfer Isabella to the main hospital. He slung his stethoscope around his neck. “What do you think?”

“I think it's a good idea,” Madison said. “When were you planning on sending her over?”

“I wanted to get your approval first. I'll give our transport team a call. They'll have her over there within the hour.”

Madison walked up to the head of the bed. She reached under the covers and gently palpated Isabella's tummy. She looked over at Marc. “Pretty normal abdomen. What did her ultrasound show?”

After a brief silence, Marc said, “We didn't do one.”

“Why not? What are you waiting for?” she asked with an impatient huff.

“Her physical examination shows no signs of her being pregnant. We sent off both urine and blood. They both came back normal, so we repeated them and they both came back normal again.” With a furrowed brow, he turned away and covered his mouth for a few seconds. Finally, he said, “There's no way she's pregnant.”

Madison took a step back from the bed.

“The only factor these patients have in common is that they're all pregnant. It's the only damn clue we have . . . or should I say, had.” She gazed overhead with disbelief fixed on her face. “Now what the hell do we do?” She exhaled sharply and, then, in a more controlled voice said, “Thanks for everything you've done, Sam. We'll check on her as soon as she gets over to Southeastern State.”

Jack could well appreciate Madison's mounting frustration. He'd been in the same situation many times himself, chasing an elusive diagnosis. The problem was that Madison was right. In a clinical investigation already fraught with one dead end after another, losing the one glimmer of hope that could lead to a major breakthrough was hardly a trivial setback. They retraced their steps out of the emergency room. This time Jack was lost in thought and oblivious to the commotion around him. They stepped outside and continued in silence toward the parking lot. They waited for a minute while an ambulance with its red and green lights flashing backed into one of the four bays.

“This may not be as bad as it looks,” Jack said, trying not to dampen her resolve any more than it already had been.

“For God's sake, Jack. The only clue we had just evaporated in front of our eyes. From where I sit, we're back to square one. How much worse could this be?”

“It's just a matter of expanding the possibilities. Even though Isabella's not pregnant, there still has to be one or more factors she shares with the other GNS patients.”

“Your optimism is commendable, but if you look at things objectively, you don't have to be a Jedi Master to see we're screwed. You'll have to excuse me for not breaking into a victory dance over the events of the evening.”

Madison picked up her pace, leaving Jack a few steps behind. He sensed any further pep talks would be as useful as shouting at the rain. He reached the car a few seconds after she did, climbed in and sat in silence.