Error in Diagnosis (5 page)

Two minutes after he had made an incision, Crossman held Lizette's uterus cupped in his hands. Selecting an area between the engorged veins, he quickly made an incision just large enough for the baby to fit through. Working his way through the thick muscular wall, he entered the body cavity of the uterus. Carefully scooping the baby out of the organ, he clamped the umbilical cord and cut it.

“I'm right behind you,” Armbrister said, with her arms outstretched and draped with a sterile towel.

Crossman set the baby into her waiting arms. She was profoundly blue and limp as a Raggedy Ann doll. She made no sounds, not even a whisper of a cry. With the help of her nurse practitioner, Armbrister positioned the baby on a warming bed and swiftly slid a breathing tube through her graying lips and down into her trachea to assist her breathing.

“Talk to me, somebody. How's the baby doing?” Crossman inquired without lifting his eyes from the operating field.

“She's alive,” Armbrister answered, using a plastic bulb to suction out the baby's nostrils and mouth. The instant she was finished, she transferred the baby from the warming bed to an incubator. “We're out of here,” she announced.

“Does she have a chance?” Crossman asked.

“Ask me in about twenty minutes. Right now things aren't looking so good.”

During the entire time the C-section was in progress, two medical residents alternated performing CPR on Lizette. At the same moment Crossman finished stapling closed her incision, her heart suddenly stopped. Arrani and the others continued to work like madmen for the next twenty minutes to restore a heartbeat but with no success.

Finally, he looked away from the monitor. His eyes dropped and in a monotone drenched in defeat, he said, “We can stop the chest compressions. I'm calling it. Somebody note the time of death for the record please.”

By this time, the floor was littered with empty medication boxes, paper heart tracing strips and an endless assortment of used medical supplies. Allowing a full breath to flow out from his lungs, he leaned over and picked up a box. As far as he knew, Lizette Bordene was the first death from GNS in the country.

After a minute or so, he crumpled the box in his hand and tossed it into the trash. As much as he dreaded doing it, he walked over to the phone to call Lizette's mother.

The moment Jack stepped off the plane in West Palm Beach, he was struck by a squall of wind rich with the scent of ozone. Shading his eyes, he gazed to the east at the remnants of a rogue storm moving offshore.

“My car's right over there,” Mike said, gesturing to a small gravel lot protected in part by a weather-beaten chain-link fence. “It's only about a thirty minute ride to the hospital.”

•   •   •

When Mike turned his SUV into the Southeastern State University Medical Center, Jack was immediately taken back. The sprawling medical complex bore no resemblance to the small hospital he remembered. In addition to the new school of medicine, the medical center now boasted a six-hundred-bed teaching hospital, a seven-story research
center, and a children's hospital. To the west, Jack noticed a modernist building nearing completion. A large banner in front of it indicated it was the future home of Southeastern State University's Women's Cancer Hospital.

As they approached the valet parking area, Jack's attention shifted to the dozens of media vehicles amassed in a parking lot alongside the hospital. Their antennae spiraled upward like the towering masts of a flotilla of great sailing ships. Around the vans and SUVs, dozens of broadcast personnel congregated in small groups. Some were dressed casually and stood with cameras hoisted on their shoulders. Those who were more formally attired gripped microphones in their hands. The largest group jockeyed for a preferred position directly in front of the main entrance to the hospital. The GNS outbreak was an enormous story. He wasn't surprised that the prediction Helen Morales had made on the phone regarding the inevitability of a media circus at Southeastern State had come true.

Mike and Jack made the short walk from the parking lot and entered the hospital through a revolving glass door. They hadn't taken more than a few steps when a slight woman wearing a teal-colored suit approached at a brisk pace.

“Jack, I'd like you to meet Dr. Helen Morales.”

A peculiar habit of Jack's for as long as he could remember was conjuring up an image of a person's appearance based on his or her telephone voice. He smiled to himself. As usual, he was light-years off of the mark. Helen wasn't matronly, stout or on the fashion police's most wanted list. She was just the opposite.

Helen took Jack's extended hand and gave it a vigorous shake.

“Welcome back to South Florida. I can't thank you enough for accepting our invitation.”

“It's nice to meet you.”

With more than subtle apprehension in his voice, Mike asked, “How's Tess doing?”

“I just came down from the ICU. I'd say she's about the same.”

Mike pushed out a quick breath but said nothing. As well as Jack knew him, he couldn't be sure if he was encouraged or dismayed by Helen's report.

“Would it be all right if I catch up with you two a little later?” Mike asked. “I have a couple of things to take care of.” Mike took a few steps forward and gave Jack a brief hug. “I almost forgot,” he said. “I had some clothes sent over to your hotel. I figured your vacation attire might not be appropriate for the hospital. They may not fit perfectly but I think they'll be close enough.”

“Thanks. I'm sure they'll be fine,” Jack said, wondering if Mike really had something to do or if, for the moment, he just couldn't bear seeing Tess.

“I'll take you up to the ICU. We can talk on the way,” Helen said to Jack gesturing toward the elevators. “As of nine this morning, we've admitted thirty-five women with GNS. All indications are that we can expect more . . . a lot more. Our facilities are already stressed. From what I hear, the same scenario's being played out in hospitals from here to California.” The elevator doors rolled open and they stepped aboard. “The frustration amongst our
physicians is soaring. We really need a fresh pair of eyes. I can assure you, Jack, that everyone on staff is excited about collaborating with you.”

Jack smiled politely. He hoped his expression didn't betray his anxiety. He wondered if Helen Morales's expectations of him were even remotely realistic. He was a well-trained and experienced neurologist; but he wasn't bestowed with divine diagnostic or healing powers. It wasn't that he lacked confidence, but his gut feeling was that figuring out the cause of GNS and how to treat it would be the greatest challenge of his career.

The entire sixth floor of Southeastern State University Hospital was a designated critical care area consisting of four separate intensive care units. After walking down a wide corridor, Helen and Jack arrived at ICU 3. She tapped on a metal plate and the two frosted glass doors swung open.

The unit was laid out in a circular configuration with the nursing station and all of its monitoring equipment in the middle. The patient rooms ran the entire circumference of the spacious unit like the spokes of a wheel. Similar to the lobby, it was obvious to Jack no money had been spared on its design and construction. It was always amazing to him that irrespective of what state he was in, all intensive care units had the same mineral scent.

“Tomorrow night we've arranged a dinner at your hotel,” Helen said. “It will be mostly social but we'd like
to spend some time discussing the GNS cases if you're amenable.”

“Of course,” Jack said. “I understand Dr. Sanchez recently stepped down as your chief of neurology. Have you named his successor?”

“Not yet, but our search committee has already interviewed a few promising candidates. In the meantime, Hollis Sinclair is serving as interim chief. He's an excellent clinician and teacher.” She paused briefly. From her expression, Jack got the feeling she was collecting her thoughts and had something to add. “At times, Hollis can seem a little proud and single-minded, but I assure you he always has the best interests of his patients at heart. I'm sure you two will work well together.”

Helen's comments struck an immediate cautionary note in Jack's mind. He assumed in the interest of diplomacy, they had been understated. He'd never met Sinclair, nor did he know of him by reputation, but when somebody was easy to work with, it generally wasn't necessary to point it out.

“I fully understand your close friendship with Mike may complicate matters,” Helen mentioned. “If there's anything I can do to help, please don't hesitate to ask.”

“Thank you,” he said, thinking to himself it was nice to hear Helen acknowledge that she was keenly aware of his predicament.

Helen motioned to a young man working on a laptop. He returned the wave, stood up and walked over. Appearing sleep deprived and skeletal, his Brillo-y black hair and Ringo Starr mustache were both screaming for a
grooming. An iPod was hitched to his frayed brown belt right next to a standard-issue hospital phone. The pockets of his white coat overflowed with an assortment of folded papers and medical manuals.

“I'd like you to meet Marc Jaylind,” Helen said. “He's our senior fellow in perinatology. He's been working very closely with our division chief, Madison Shaw, on these cases. He'll get you acquainted and answer any questions you may have.”

Marc extended his hand, “Welcome to Southeastern State, Dr. Wyatt.”

“I appreciate the invitation. It's a pleasure to be here.”

“I have a meeting so I'll let you two get started,” she said above the shrill alarm of one of the cardiac monitors.

“Dr. Morales mentioned you'd probably want to begin by being briefed on Tess Ryan before we discussed the other patients.” Marc pointed toward the nursing station. “There's a physician's conference room over there.”

“How did you get interested in perinatology?” he asked Marc as they made their way past a portable X-ray machine.

“I saw a lot of high-risk pregnancies at Northwestern during my OB residency. Most of the other residents hated complicated obstetrics. I really liked it.”

“Well, if Southeastern State's perinatology fellowship's anything like Ohio State's, I'm sure you've been working your tail off.”

“It hasn't exactly been a pajama party, I'll give you that. I was an optometrist for five years before I decided to go to med school, so I'm a little older than most of
the other residents and fellows.” He grinned and held up a hand. “I know. It sounds kind of strange.”

“Not really. I did a year of vet school before switching into medicine.”

“Any regrets?” Marc inquired with a sidelong glance.

“From time to time, I guess,” he answered. “Are you coming to dinner tomorrow night?”

“I'm afraid not. No bottom-feeders. Only the elite are invited.”

Jack chuckled. “Well, at least you can take comfort in the fact that you're only a few months from the promised land. If it makes you feel any better, we all had to pay our dues.”

The main part of the ICU was visible from the physician conference room through a large glass window. In the center of the room was a table with six chairs around it. Marc sat down, extending his legs and crossing them at the ankles. Jack took the seat directly across from him.

“I heard you've spent quite a bit of time with these patients. I guess that makes you the GNS expert.”

“I'm afraid GNS expert would be a strong contender for the oxymoron of the month.”

Jack smiled. “How are the babies doing?”

“They seem to be holding their own—at least to this point. Two quad screens have been done on each of them, which have all been normal. The other hospitals are reporting the same thing. We are planning on—”

Jack held up his hand. “Quad screen? My perinatology's a little rusty. You'll have to refresh my memory.”

“Beginning at eighteen or nineteen weeks, we measure
four hormones levels in the mother's blood. If any of them is abnormal, it can be an indication of fetal distress or the development of a serious malformation. We've also done ultrasounds and amniocenteses on almost all of the patients, and they've all been normal.”

Jack would be the first to admit he suffered from his fair share of professional shortcomings, but being completely clueless regarding a medical case had never been one of them. But at the moment, that's exactly how he felt. Just then, the door opened and the unit secretary poked her head in.

“Everybody's looking for you, Marc. They're ready to start rounds.”

He stood up, removed his stethoscope from around his neck and shoved it into his back pocket.

“C'mon, I'll introduce you to Dr. Shaw. I'm sure she's looking forward to meeting you.”

Jack followed Marc out of the room. He had always relied heavily on first impressions. Marc struck him as bright, personable and mature. Spending a great deal of time with the residents and fellows at Ohio State, he often wondered how a particular one would fare in the real world after his or her training was over. In the case of Marc Jaylind, he had little doubt a promising career awaited him.