Error in Diagnosis (6 page)

Poised to begin rounds, an anxious group of residents and students congregated in front of the nursing station. As a frequent visiting professor, Jack had seen the same scene play out at a dozen different medical schools. While some of the aspiring doctors feverishly paged through pocket-size manuals, others shuffled index cards packed with medical information, preparing to present their assigned patients to the group.

Marc raised his hand, signaling to a petite-framed woman in a knee-length white coat who was talking on her cell phone. She gestured back and a few seconds later, she slipped her phone into her coat and walked over.

“Dr. Wyatt. This is Madison Shaw.”

“Dr. Wyatt,” she said.

“Please call me Jack.” He smiled, extending his hand. Even though his social life was in the doldrums, it would
have been difficult for him not to notice she was an attractive woman. She had willowy fingers, a thinly pointed nose and the neck of a ballet dancer. “It's nice to meet you. Dr. Morales had a lot of nice things to say about you.”

“That was kind of her,” she responded, stone-faced with a clipped handshake. “If you need anything, please let Marc know.” She looked at the assembled group and then motioned to one of the residents who walked over. “Go ahead and get started with rounds. Have J. C. present the first case. I'll join you in a couple of minutes.” Madison turned back to Jack. “As I said, if there's anything you need, just let Marc know. Please excuse me. I have to get back to rounds.”

“Of . . . Of course,” he answered.

With a stiffened posture, he watched Madison start to walk away. Just at that moment, Helen Morales approached. She motioned for Madison to return.

“I'm glad to see you two have had a chance to meet. I just got off the phone with the Office of the Surgeon General. There's an emergency meeting tomorrow in Atlanta at the CDC. I think it would be an excellent idea for the both of you to attend.” Her gaze turned to Jack. “Do you think you can make the trip?”

“Of course.”

“It's a three-hour meeting. It's scheduled to begin at eleven. I'll have my assistant make the travel arrangements and e-mail you the information. You should make it back in plenty of time for our dinner.” She looked down at her watch. “Just once I'd like to be on time for a meeting. I'll speak with you both later.”

“Will you be attending the dinner tomorrow evening?” Jack asked Madison.

“It's not voluntary, Dr. Wyatt. Dean Morales expects all of us to be there.”

Madison returned to the group, leaving Jack's head nodding like the Woody Hayes bobblehead doll that sat on his desk in Columbus. After an awkward few seconds, he had the sudden urge to feel his checks to make sure the flesh hadn't completely melted from his face.
So much for the warm greeting and heartfelt expression of gratitude for agreeing to serve as a guest professor
, he thought to himself. He chanced a look in Marc's direction.

“Did I miss something here?” he inquired, scratching the back of his head, unable to remember the last time somebody had taken such an instant disliking to him.

“I'm not sure. Do you frequently have this effect on women?”

“From time to time, but it usually takes a little longer. Is she always like that?”

Marc couldn't contain a short laugh. “Actually, she's one of the most easygoing, pleasant people I've ever worked with.”

“All evidence to the contrary,” Jack said with a huff.

“You probably just caught her at a bad moment. Things have been pretty tense around here the past couple of days. I'm sure she'll be in a better mood the next time you meet.”

“Well, you've certainly honed your diplomatic skills,” Jack responded as if Marc were somebody trying to sell
him enough life insurance for three people. Jack was still wondering what he'd done to deserve such an ungracious welcome when one of the interns rushed up.

Between clipped breaths, she said, “Marc, Dr. Shaw wants you stat. Tess Ryan's crashing.”

Tess's room was generous in size but not designed to accommodate twelve crane-necked medical students and residents, all struggling to see what was going on.

Jack followed Marc as he cut a path through the group. When he reached the head of Tess's bed, his gaze instantly fixed on her face. Her eyes were hollow, glazed and frozen open. Her skin was the color of a clamshell, and at the corners of her mouth, filmy puddles of saliva lightly bubbled.

“What's going on?” Marc asked John Fuller, the ICU physician on duty.

“About half an hour ago, she developed sudden bursts of non-purposeful movement and arching of her back. Her pulse went crazy but it's slowing down now.” He then gestured toward her upper body. “At about the same
time, a facial rash appeared.” Jack took a moment to study the brightly speckled crimson rash on Tess's cheeks.

“Does she have a fever?” Madison asked.

“No, which surprises me a little because this disease is starting to look more and more like a virus every hour.”

“Do any of the other patients have similar findings?” she inquired.

“Not yet,” he answered, unfastening the top button of his white coat. “But Tess was one of our first patients, and since they've all had identical symptoms to this point, I suspect the others will follow suit soon enough.”

“Has she had a recurrence of dancing eye syndrome?” Jack asked.

Fuller gazed over at him. A curious look crossed his face.

“I'm sorry,” Marc said. “This is Dr. Jack Wyatt. He's chief of neurology at Ohio State. Because of his special expertise in elusive diagnoses, he's serving as a guest professor and consultant on the GNS cases.”

Fuller took a couple of steps forward and shook Jack's hand. “Welcome. I think we've got her dancing eye syndrome under control, but she's becoming less responsive with each passing hour. I've ordered another MRI but I'm not sending her up to radiology until I'm sure she's stable.”

“Has Dr. Sinclair been informed?” Madison inquired.

“I spoke with him a little while ago. He's in a lengthy budget meeting, but he agreed with ordering an MRI. He also wanted to repeat an EEG to see if there's been
any change in her brain wave pattern. He said he'd be down to see her as soon as the meeting was over.” From the tone of his voice, Jack suspected Fuller was miffed that Sinclair didn't share his sense of urgency regarding the abrupt change in Tess's condition. Jack was in agreement: No budget meeting should take priority over a patient in trouble. Fuller continued, “Her blood pressure and pulse are okay for now. So, apart from an assessment of the baby's condition, which I'll leave to you and Marc, I can't think of anything else to do at the moment except keep a close eye on things.”

“Have we notified her husband?” Madison asked.

“No, but I was just about to do that. I'll give him a call in the next few minutes.”

Madison stepped up to Tess's bed and slowly began an examination of her abdomen. While she was still feeling her lower belly, she turned to Marc. “Find an ultrasound machine and get it in here stat. When you're ready to go, come and get me. I want to have another look at the baby.” She pulled the covers back up and then led the group out of the room. Jack and Marc were a few steps behind them.

“As soon as we're done with the ultrasound, I'll give you a ride over to your hotel,” Marc said.

“That won't be necessary. I'll be happy to take him,” came a voice from behind them. Jack recognized it instantly. It was Mike Ryan.

“What's all the excitement about?” Mike asked, peering into Tess's room. The forced calmness in his tone did little to mask his anxiety.

“We were just about to call you,” Marc said. “There's been a change in Tess's condition. She's developed some new neurologic symptoms and a facial rash.”

Mike took a hard look at Jack before turning back to Marc. “What does all that mean?”

“We can't be completely sure. There are several possibilities we're looking into.”

“It sounds like you're saying Tess is getting worse, and you don't know why.”

“Dr. Shaw and I are looking after the baby, so it would probably be better if you spoke with Dr. Fuller directly.”

With his eyebrows drawn together, Mike said, “If Tess had suddenly improved, I suspect you'd be more than
happy to share the news with me.” Mike was not one to become easily unhinged or forget his manners. Jack suspected the pure weight of the stress he was under was to blame.

“Take it easy, Mike,” Jack said in a calming voice. “The new symptoms don't necessarily mean things are worse. It may just be the natural course of the disease. Marc and Dr. Shaw are going to do an ultrasound of the baby to make sure she's okay.”

“I don't think you're as convinced as you're trying to sound.”

Before Jack could respond, Mike turned and walked toward the nursing station. With his back to them, he shook his head slowly. Jack was tempted to join him but thought better of the idea and decided to give him a few moments alone to regain his composure.

As Jack suspected, after a minute or so, Mike walked back down the hall.

His words were measured. “Ever since Tess was admitted I've listened to one learned medical opinion after another. The only thing I know for sure is that none of the doctors has the first damn clue of what to do to help Tess or our baby. I'm not naïve and I don't believe in miracles, so I wasn't expecting you to breeze in here and instantly tell me what's wrong with her, but I was hoping you'd . . . you'd at least have some—”

“We're only a few days into this illness. The only thing I can tell you for certain is this will be an hour-to-hour process. Right now, nobody can say when the pieces will start coming together.”

“Or if they ever will,” Mike stated.

“I'm not going to paint a rosy picture for you. Figuring out what's wrong with Tess isn't going to be easy. I understand that right now you're a little frantic, but every disease leaves footprints. We need more time to find them, and then see where they take us.”

For the moment, Mike guarded his silence, looking at Jack through a barely perceptible veil of tears. “Tess isn't going to die. It's not her time. There are thousands of people out there with sick kids she hasn't met yet who are going to desperately need her.” Without waiting for Jack to answer, Mike turned around and walked into Tess's room.

Jack's instincts were telling him a cure was possible. But he suspected they didn't have a lot of time, and in the absence of swift treatment options, GNS would turn out to be a fatal disease. Jack felt his resolve strengthening. He thought to himself that irrespective of how discouraging things appeared at the moment, he was light-years away from taking a knee on saving Tess Ryan's life.

DECEMBER TENTH

NUMBER OF CASES: 1,606
NUMBER OF DEATHS: 1

After a night plagued by restless sleep, Jack threw back the covers and got out of bed. Last evening, when he returned from dinner, there was a voice message from Madison informing him she would pick him up at seven fifteen to drive him to the airport. For obvious reasons, he assumed her offer was not the result of his charming personality but came at the behest of Helen Morales.

Jack telephoned the ICU and spoke with the nurse taking care of Tess. She reported she'd had a stable night but was still unresponsive. Her rash was still present, but her muscle spasms had improved with heavy sedation. She
also mentioned that as Dr. Fuller had predicted, almost all of the other women with GNS were showing the same new symptoms that Tess had exhibited. Word of the first GNS death had reached him the night before. The news only served to heighten the urgency of a situation that was already a ticking time bomb.

While he finished getting dressed Jack flipped on the TV and did a quick lap. Every morning news program was featuring coverage of the outbreak with special attention to the first death. Feeling more and more discouraged with each story, he turned off the television and went downstairs. Having some time to spare, he walked through the lobby's expansive atrium and exited the back of the hotel onto a terrace that overlooked a private marina. He strolled past an endless line of yachts, one more spectacular than the next. Some were already adorned with lights and other elaborate Christmas decorations for the yearly holiday boat parade on the Intracoastal Waterway due to take place in a couple of days. A sudden frenetic squawking pierced the air. Although he hadn't lived in Florida for many years, he had no difficulty identifying the sound. Looking up, he watched a flock of wild parrots diving and climbing in synchronicity as if they were tethered together with a clear fishing line.

After a few minutes, Jack headed back to the terrace and found a seat at a wrought iron table. Gazing without purpose across the waterway, his thoughts turned to Tess. His pulse quickened while in his mind's eye he found himself intensely studying her disease, personifying it as
if it were his sworn enemy, a phenomenon common amongst physicians. When an elderly couple engaged in a heated conversation strolled past, Jack was suddenly snapped back to the here and now. He glanced down at his watch. He stood up and headed back toward the front of the hotel to meet Madison.

Standing under the arched stone entranceway, Jack watched the piercing rays of the sun streaming through the palm trees. He wasn't paying particular attention when a black Mini Cooper convertible pulled up. It was only when he heard two quick taps of the horn that he bent over and looked in the passenger-side window.

“Good morning,” he said.

“It's open,” Madison told him.

The parking attendant, his lips pressed tightly together to stave off a smile, opened the door.

“You don't happen to have a shoehorn on you?” Jack whispered to him.

After a series of maneuvers that would have made even the most seasoned Cirque du Soleil contortionist stand up and applaud, Jack managed to work his way into the passenger seat.

“Great car,” he said. Madison didn't smile or say anything. Undaunted, Jack went on, “I called the ICU when I got up. The nurse taking care of Tess told me she had a relatively stable night.”

“I know. I called too.”

“I assume you heard about the woman in Spokane who died.”

“I did. Since then, two more have been reported. One
from New Jersey and the other from New Mexico. Both the babies were delivered by emergency C-section and are alive.”

Jack's stomach rolled. “No, I hadn't heard. I guess we can assume the topic will come up at today's meeting.”

During the ride to the airport, the conversation remained civil but strained. Waiting for their flight in the gate area, Madison continued to answer Jack's questions with chopped answers and rare eye contact. The flight was more of the same. By the time they landed in Atlanta, whatever hope he had had that Madison was just having a bad day when they had first met had long evaporated.