Error in Diagnosis (8 page)

It was just after six
P.M.
when Jack and Madison's flight touched down in West Palm Beach. With no luggage to claim, they made their way directly through the terminal and then to the same-day parking lot.

“I understand that most of the key treating physicians will be at dinner tonight,” Jack said, buckling up his seat belt. “Have you worked with Dr. Sinclair very much?”

“Our specialties don't really overlap, but we've consulted on a few cases together.”

“How have you found working with him?”

With an intrigued look on her face, she said, “That's kind of a strange question.”

“Really? In what way?”

“I'm not sure, but I'm getting the feeling you and Marc must be getting pretty chummy. So what it is that you're really asking me?”

“Nothing,” he insisted, trying to deflect her question by sounding as vague and nonchalant as possible. With Madison already having misgivings about his integrity, the last thing he wanted was to be caught flirting with the truth.

“It sounds more to me as if you already have a preconceived notion about him.”

“I wouldn't exactly put it in those terms.”

“Really? Then what terms would you put it in?”

“From what little I've heard, I get the impression he feels comfortable managing the GNS cases without a great deal of assistance.”

“Hollis Sinclair's a well-trained neurologist, and he's an excellent clinician. There are some who think he's a tad inflexible and self-important at times.” She paused just long enough to cast a cautionary glance his way. “I guess we've all been guilty of that from time to time in our careers.”

A few more minutes passed and they pulled up to the hotel. With no further mention of Dr. Sinclair, they strolled past the concierge's desk and down a carpeted hallway. The walls were decorated with grainy photographs of Boca Raton's high society and dignitaries from the turn of the twentieth century.

They reached a group of meeting suites. A cardboard announcement resting on an easel identified the dining room reserved by Helen Morales. Jack opened the door for Madison and they walked into a room heavily steeped in history. The royal blue carpet was as thick and lavish as the antique satin drapery. But the showpiece of the
room was an eighteenth-century exquisitely crafted crystal chandelier. Helen Morales greeted them immediately and began introducing Jack and Madison to the fifteen other physicians in attendance.

After a few minutes, Helen left Jack and Madison to chat with a few of the latecomers. It was at that moment that Hollis Sinclair strolled up.

“Good evening,” Madison said. “Hollis, I'd like you to meet Jack Wyatt.”

“Ah, the prophet from Ohio State,” he said, removing the two impaled olives from his martini and popping them into his mouth. Jack extended his hand. Sinclair stared at it for a few seconds before giving it a hasty shake. The limp-wristed greeting had all the warmth of a get-well card from one's worst mortal enemy.

“It's nice to meet you,” Jack said.

“I haven't had the opportunity to ask you, but when exactly did you arrive?”

“Yesterday morning,” Jack said, suspecting Sinclair already knew the answer to his question.

Appearing uninterested in Jack's answer, Sinclair held up his glass and motioned the bartender.

“Have you got it figured out yet?” he asked Jack.

“I beg your pardon?”

“Do you have any idea what's causing GNS?”

“I'm afraid not, but I'd certainly like to compliment you and your team on the way you're managing these difficult cases.”

“Speaking on behalf of all the second-stringers,” he
said with a smile that displayed thirty-two perfect teeth, “we thank you.”

Jack could recall getting off to a stilted start with a colleague a couple of times in his career, but the last two days had been unprecedented. He wasn't one to make snap judgments about people, but in the case of Hollis Sinclair he was ready to make an exception. He found his pompous and sarcastic manner repugnant. Jack had no way of being certain but he strongly suspected Sinclair had a privileged life growing up and believed pedigree trumped civility. “So, Dr. Wyatt. You were about to share your impressions of GNS with me.”

“Hollis,” Madison said, “this is supposed to be the social part of the evening. There'll be plenty of time to discuss GNS after dinner.”

The bartender walked over and handed Sinclair another vodka martini.

“Nonsense. You don't mind talking about the cases now, do you, Dr. Wyatt?” he asked, taking two swallows of the premium alcohol.

“Not at all but I'd prefer hearing your thoughts first. And please, call me Jack.”

“Okay, Jack,” he said, raising his glass in a pseudo toast. “Everybody has made two assumptions, both of which I believe to be totally erroneous and both of which have led all of the investigators down the path of misdiagnosis.”

“Interesting,” Jack said. “What assumptions are those?”

He raised his hand and with a wry smile wagged his
finger. “I'm close to finalizing my theory regarding the cause of this disease, so I'd prefer not to say anything at this time. I will mention, however, I've been speaking to some of the brightest minds on three continents. I find it interesting that nobody besides myself appears to be intrigued by the fact that there are no cases of GNS reported outside of the United States.”

“Will you be recommending a treatment plan?” Jack asked.

“Naturally.”

“I hope it doesn't include termination of the pregnancies,” Madison said.

“I'm a doctor. I don't have the luxury of addressing the moral and religious matters of this disease. I'm far too busy trying to cure it. I suggest we leave the spiritual issues to the clergy. The plan of treatment I'll be suggesting will be both unconventional and aggressive.” He shifted his gaze to Madison. “With respect to termination, I'm not ruling out any possibility. But I think you would have to agree that common sense would dictate there's no point prolonging a pregnancy if it means certain death for the mother and baby. In any event, termination is a matter for the families to decide, not their doctors.” The conversation was rapidly heading south. Jack had enough political savvy to remain a listener. Sinclair was acting as if he had just shared a point of profound wisdom with them that neither of them had the insight to see on their own.

“We're physicians, Hollis. There's a humanistic side to what we do. I could agree with you on your theory
of termination, but then we'd both be wrong.” Madison took a few seconds to regard him with a glassy stare. “If you'll excuse me, I'm going to join the others.”

Sinclair didn't respond to Madison's comment. Instead, he continued to hold Jack captive, droning on endlessly about his accomplishments and the inevitability that he'd be named the new chief of neurology at Southeastern State School of Medicine. Every minute or so Jack found himself glancing over at the table. Madison was seated between two colleagues, apparently involved in an amusing conversation. She never once looked in his direction.

A few more minutes passed and at Helen Morales's behest everybody began to find his or her place at the table. A young woman entered the room and handed Helen Morales a folded note. She took a moment to read it, sighed deeply and then raised her eyes.

“Excuse me,” she began, “but I'm sorry to have to report that I just received word that there's been another death. A twenty-five-year-old woman in Reno, Nevada, suffered a cardiac arrest approximately an hour or so ago. They were able to deliver the baby by C-section. The infant weighed three pounds and was transferred immediately to the neonatal ICU.” After a hushed pause, she added, “As soon as additional information becomes available, it will be posted on the National Patient Data Record.”

The dining room was noticeably quiet for the next few minutes. But eventually, the conversation picked up and Jack found himself inundated with questions from his
colleagues. He didn't particularly mind, but he was relieved when Helen stood up and reminded everybody there would be plenty of time to discuss GNS and any other medical topics of interest later. Before retaking her seat, she strongly suggested a brief moratorium on the topic of GNS in favor of lighter conversation and enjoying their dinner.

Army War College
Carlisle, Pennsylvania

Dr. Benjamin Milton was a career-hardened military physician. Holding the rank of colonel, he had served as the director of the Army's Strategic Studies Institute Center. His specific area of interest was the study of biological weapons. Having chaired numerous national and international committees, Colonel Milton had published dozens of scientific papers and had lectured all over the world. Of all the bioterrorism experts in the country, it was Milton that President Stephen Kellar wanted at this evening's meeting.

Renatta Brickell was met at the entrance to the college by two security personnel who escorted her to a small private dining room on the second floor. Glancing over
at the table, she was surprised to see it had only been set for three people. When she heard voices, she shifted her gaze to the far side of the room to a rawboned man with a grainy complexion wearing a tweed sports coat. She pushed a smile to her face, filled her lungs with a cautious breath and walked toward the man who had appointed her to the position of United States surgeon general.

“Good evening, Mr. President,” she said, extending her hand.

“Happy holidays. It's nice to see you,” he answered taking her hand in both of his with the same winning grin that had paved his way to the White House. At forty-seven and only halfway through his first term, the former governor of Rhode Island had moved from a charismatic upstart with a marginal amount of political experience to a seasoned pro. “I don't believe you've had the pleasure of meeting Dr. Milton.”

She turned toward the unimposing man with a snub nose and shook his hand.

“It's a great pleasure to meet you. I'm quite familiar with your outstanding contributions to the field.”

“Let's sit down,” the president suggested, gesturing toward the table. “I considered a larger meeting, but then I thought it might be better if just the three of us chatted.” A tall server wearing a white vest entered and placed a garden salad in front of each of them. As soon as he exited, the president continued, “I've spent most of the afternoon being briefed on certain aspects of GNS. I've spoken to several key members of the scientific community and . . . well, my sense is that these young women
are not the victims of bioterrorism.” He turned to Milton. “Do you agree?”

Milton didn't answer at once. Instead he placed his salad fork down and patted the corners of his narrow mouth with his napkin. Brickell was familiar with his reputation as an articulate man, measured in his responses and one who never presented information he couldn't back up with the facts.

With little inflexion in his voice, he answered, “GNS has an unusual and distinct set of symptoms. Considering what we know about the development of biological weapons, I'd say that the likelihood this disease is a weaponized virus or bacteria is small.”

“How small?” Kellar asked in a cautious tone.

“To manufacture a biological weapon of such sophistication is probably beyond the capability of any terrorist group we are currently familiar with.”

Kellar smiled but appeared circumspect. “You said probably, Colonel.”

“Unfortunately, sir, I can't give you an unqualified guarantee.”

The president laced his fingers behind his neck and pushed back in his chair. His salad remained untouched.

“I hope you're simply speaking with an abundance of caution, because as president, I have to know if our country could possibly be under a biological attack. You sound to me like a man with something on his mind. So, irrespective of how remote your concern is, I'd like to hear about it in detail.”

“Of course, sir. As soon as the first cases of GNS were
reported, we began looking into the possibility we were facing an act of bioterrorism. In conducting that review, we came across several political groups and individuals of interest. We were able to dismiss most of them fairly quickly, but there was one who stood out. His name's Alik Vosky. He was a Russian scientist.”

“The Russian biological weapons research program was dismantled in the 1970s. How does Vosky tie into GNS?”

“As you know, the Russian research program into biological weapons was by far the most extensive and sophisticated of its time. Because of the political upheaval surrounding its termination, we've never had more than a hazy understanding of just how far their research had taken them, and if any of their technology might have fallen into the wrong hands.” Milton stopped for a few seconds. Before continuing he took a couple of breaths and fiddled with one of his gold cuff links. “Several years ago, information reached us via the Canadian authorities that prior to its closing, a research facility in the Ukraine had been working on selective acts of biological warfare.”

“What do you mean by selective acts?” the president asked.

“It's a term that describes biological weapons that target a specific segment of the population.”

“Such as pregnant women.”

“I'm afraid so, sir.”

“Is there reliable information that such a weapon was ever developed?”

“None that's definitive.”

“What else to you know about Vosky?”

“It appears he was a brilliant scientist. Before he reached the age of twenty-five, he had already earned both an M.D. and Ph.D. from Kiev University. He then served three years in the military before being recruited into the biological weapons program. After the program was shut down, he spent almost a year in North Korea before moving to the Middle East. We don't have a lot of information about the time he spent there, but we do know that he became rather wealthy, and he adopted some radical political views. The intelligence we have is a little sketchy, but it seems probable that he didn't acquire this sudden wealth by legitimate means. Eventually, he left the Middle East and made his way to Canada.”

“Did the Canadian authorities have any idea who he was?”

“Not at first, but when his prior employment history came to the attention of the Royal Canadian Mounted Police, they invited him in for a chat. A copy of the transcript of that interview was forwarded to our office this morning. In a nutshell, Vosky confirmed there was a pilot program investigating a biological weapon which would control populations. He told the Canadians that the project had a number of start-up delays, but after two years, they had made progress. It was the interviewer's impression that Vosky was probably more knowledgeable than he was letting on.”

With a pained stare, Kellar asked, “Just how high up on the food chain was Dr. Vosky?”

“We don't think he served in a supervisory role. He was probably an upper-level scientist on the project.”

“What about his mental state?”

“We've asked ourselves the same question. Unfortunately, the interviewer didn't cover that area very well. So, the best we can say is that Vosky was mentally impaired. Where he might fall on the spectrum from mild depression to frank schizophrenia is impossible to say.”

“What about the research itself? Did Vosky reveal any of the specifics?” the president asked.

“He disclosed that the program focused on several areas,” Milton answered as he set his fork down. “One of the main areas was targeting pregnant women. Their theory was that only a relatively small percentage of the population needed to be affected because such an outbreak would cause a major societal disruption.”

Kellar slid his glasses down and looked over the rims. “I suggest we contact the Mounted Police and ask them to get Comrade Vosky back in for another chat.”

“That may be a little difficult. They've already made some preliminary inquiries. It seems Mr. Vosky went missing about six months ago.”

“How hard has anybody looked for him?” the president asked.

“Not very, but until today there wasn't really a reason to.”

“I certainly hope all that's about to change.”

“The director of the RCMP asked me to assure you personally that locating Vosky is now on their short list of highest priorities.”

“I'd like to see a copy of the original transcript, Colonel.”

“It will be on your desk by nine
A.M.,
sir.”

The server cleared the salad plates and began serving the main course. Renatta didn't even have to look. Having had many dinners with the president, she was quite familiar with the aroma of pine nut pesto, his favorite sauce.

“I'm not a scientist, Colonel, but wouldn't thirty years give somebody or some group ample time to bring almost any biological weapon to fruition?”

“It seems like a long time but when you consider the necessary brain power and resources . . . well, I still think it's unlikely.”

The president smiled knowingly. “One of the first things I learned after winning the election was to be mindful of the word
unlikely
. My predecessor, a man of uncommon wisdom, told me the road to presidential hell is bricked with similar words. A better way to look at all things is that they're all fifty-fifty. Either they'll happen or they won't. As a result of our meeting tonight, I'm far from convinced GNS is a mere act of God.”

“Yes, sir.”

The president reached for his fork. “As soon as you're notified Vosky has been found, I'd like to know about it.”

For the next hour, both the president and Dr. Brickell asked Milton a number of tough questions regarding the possibility that GNS was an act of bioterrorism. He was informative, but measured in his responses. After coffee and dessert, Kellar thanked Brickell and Milton and ended the meeting.

“May I offer you a ride back to Washington?” he asked her. Brickell had made the trip to the War College by car with two of her aides. She would have preferred to ride back with them, but for reasons far too numerous to count, turning down the president of the United States' offer to accompany him back to Washington was definitely not an option.