Error in Diagnosis (13 page)

Hollis Sinclair strolled through Southeastern State Hospital's main lobby. A choir of students from a local high school stood behind a white baby grand piano filling the lobby with melodious Christmas carols. He walked over to the Family Welcome Center and randomly reached for one of the many brochures describing the hospital's special programs. He opened the pamphlet but instead of reading about Southeastern's advanced program of knee and hip replacement surgery, he peered above it to the area in front of the hospital. As he expected, the sea of reporters that had been congregating outside all day was still there.

Replacing the brochure, he buttoned his freshly pressed white coat, straightened his tie and, finally, made sure his identification badge was in clear sight. Because of the unrelenting presence of the media, the administration had
advised all physicians to use alternative hospital exits to avoid an ambush—an advisory that Hollis Sinclair fully intended to ignore.

He gave a final tug on the lapels of his coat and then made his way out of the hospital into an early dusk. Having participated in two of the regularly scheduled hospital press briefings, he was immediately recognized by the reporters. They scampered forward en masse, gathering around him like frenetic autograph seekers at a rock concert. Above the clamoring of their questions, he held up his hand.

“I'm sorry. I would prefer not to answer any questions at this time.”

“Can you just tell us if you're still involved in the care of these women?”

“GNS is a neurologic disease. I'm the chief of neurology. Naturally, I'm involved.”

The same reporter again made his voice heard above the others. “Can you share with us your impression of the overall condition of the victims of GNS?”

“As I just mentioned, I'd prefer not to make any specific comments at this time.”

A second reporter, waving his notebook in the air, asked in a booming voice, “Are the doctors any closer to discovering the cause of GNS?”

“Without going into detail, the answer to your question is yes.”

A television anchorwoman from one of the local channels had managed to weave her way to the front and was now flanking Sinclair.

“Does that mean you're also getting closer to finding a treatment?”

“I'll make one comment because I think it's important the American people understand that there's a small group of forward-thinking doctors who are convinced GNS is a curable disease. Even as we speak, I am planning on a bold diagnostic test that will answer a great many questions about this dreaded disease and lead to a treatment plan.” Sinclair's prediction prompted an immediate cacophony of fever-pitched voices. He started forward and again raised his hand. “I'm sorry. That's all I can say at this time. If you will excuse me, I have important patient-related matters to attend to.”

Sinclair made his way slowly through the reporters, who, for obvious reasons, were not deterred by his insistence he would make no further comments. But Sinclair had already accomplished what he had set out to do. He picked up his pace and ignored all the questions being posed to him.

By the time he reached the main medical office building, the reporters had retreated. With a satisfied grin, he looked back at the group and then continued on his way toward the doctors' parking lot. His less than impromptu meeting with the press went exactly as he'd planned. He knew there would be a price to pay, and it would come in the form of an urgent summons to Dr. Helen Morales's throne room—but he didn't care. In matters with such profound life-and-death consequences, the ends always justified the means.

DECEMBER TWELFTH

NUMBER OF CASES: 2,654
NUMBER OF DEATHS: 13

Jack's first stop when he arrived at the hospital was Tess's room. He took over a half an hour examining her and reviewing her medical record. His conclusion was that there was no improvement in her neurologic condition. He was also concerned her ability to breathe on her own was deteriorating.

When he had finished his evaluation, he called Mike to give him an update. He was honest but chose his words carefully to avoid eroding the small amount of hope his friend was still clinging to. After arranging to meet him
for lunch, he started down the hall to visit Isabella Rosas. Even though she wasn't pregnant, her medical condition continued to worsen, making her no different from the other women with GNS.

“Her grandmother's in the waiting room,” Peter McLeod, the ICU nurse caring for Isabella, said. “She's been here for the past ten hours. She's pretty anxious to speak with you. Would you like me to get her now or do you need a little time?”

“Now's fine,” Jack answered.

Peter left the room. For a time, Jack studied the monitors. The flashing colors of the various displays were hypnotic, and he soon found himself lost in thought. One of his favorite mantras regarding the art of diagnosis came to mind:
Focus, simplify and execute.
Each failure along the way was no different than a false start in a hundred-meter dash. The only way to deal with it was to reset yourself in the blocks, wait for the crack of the starter's gun and explode out of the gate again. He smiled when he thought about the corny poster on the wall of his college dormitory room that advised,
It's not how you fall that's important. It's how you get up
.

The sound of Peter clearing his throat snapped Jack back to the moment. Standing just inside the door was an elderly, square-chinned woman with wiry gray hair and a slight droop at the corner of her mouth.

“Dr. Wyatt. This is Audrey Phillips; Isabella's grandmother.”

Jack moved toward her and shook her hand, the back
of which was crisscrossed with a nest of tortuous veins. Her skin was craggy and furrowed from years of working in the sun caring for and training horses.

“It's nice to meet you,” he told her. “I'm one of the neurologists looking in on Isabella.”

“I know who you are, Doctor. You were brought in from Ohio to help with the GNS cases. How's my granddaughter doing today?”

“The best I can tell you is that she's stable and no worse.”

“That doesn't sound very encouraging,” Audrey said, reaching into her purse. She fished around for a few seconds and then pulled out a pair of plain black glasses with smudged lenses. She put them on and said, “To me, Isabella seems worse every day. Do you have any idea when we might start to see some improvement?”

“That's very difficult to say.”

“I was hoping she might be home in time for our big spring horse show.”

“Ms. Phillips,” Jack began slowly, suspecting Audrey was either in denial or simply didn't comprehend how sick her granddaughter was. “I'm sure you understand that Isabella's very ill. It would be impossible for me to offer an opinion as to when she might be going home.” Jack waited a few moments for her to gather herself before going on, “I know you've spoken to a great number of doctors, but I was hoping you might be willing to answer just a few more questions.”

With a tense face and a downward gaze, she nodded in agreement. “Of course, Dr. Wyatt.”

“Do you remember how Isabella first got sick?”

“She plays on her junior high school softball team. A few weeks ago they were getting ready for a Christmas tournament and she told me her stomach was hurting.”

“Where exactly?”

Isabella pointed to her own abdomen. “Down low, on the right side. I spoke to our family doctor about it. He said it was a woman thing and not to worry about it.”

“What about her mental function. Did you notice anything different?”

“Maybe she was a little forgetful. I do remember the day before she was admitted, she said something about being dizzy.”

Jack continued posing questions on a wide range of topics. To his dismay, there was nothing new or helpful in Audrey's answers. It was remarkable how similar her responses were to those of the other family members when asked about their loved ones with GNS.

His frustration was mounting rapidly. “I'm going to ask you to forget about the idea of an illness for the moment. Was there anything . . . anything at all over the last several weeks or even months regarding your granddaughter's health that was . . . out of the ordinary?”

A pensive expression came to her face. It remained there for a few seconds before the corners of her mouth lifted into a tender smile.

“There was one thing . . . but I'm not sure it matters. I hadn't thought of it until now. It was a little personal and I think Isabella was embarrassed about it.” Jack got the sense Audrey knew what she wanted to say but was
searching for the right words. “Her breasts were getting bigger way too fast.”

Jack sighed silently. “I guess at her age it's not too unusual for—”

“I raised two girls that now have kids of their own, Dr. Wyatt. Neither of them matured that quickly. It was almost like she really was pregnant. You asked if . . . well, I just thought it was a little unusual.” Peter moved forward and held a box of tissues out to her. In just above a whisper and with despair mirrored in her face, she added, “Isabella's only fourteen . . . and she's not pregnant, so there's something different about her than all of the other women. Surely, you must have some idea what might be wrong with her.”

“We have some theories but we don't have a specific diagnosis as yet.” Seeing her pained stare, he took her hands in his and added, “I promise you nobody's going to give up until we figure this thing out.”

Audrey didn't say anything. Jack released her hands and she walked to the head of Isabella's bed. With the tear-soaked tissue clenched in her fist, she reached down and gently stroked her granddaughter's hair as a sob escaped her lips.

Port-Menier, Anticosti Island

Located in the province of Quebec, Anticosti Island was home to 150,000 deer, a population that well outnumbered the 280 permanent residents. Called the graveyard of the Saint Lawrence, the treacherous gulf had claimed the lives of thousands of mariners over the years.

Alik Vosky sat on the end of his bed, staring at the blank screen of the television sitting atop his chest of drawers. He was pigeon-chested, and his stubby hands ended in fingernails that were buttery in color from years of smoking filterless cigarettes down to the last few millimeters. His father, an inconsequential bureaucrat whom Vosky had never come to love or admire, was completely bald. It was a fate he had managed to escape, having thick black hair that he wore combed hard against
his craggy forehead hoping to conceal a nest of crosshatching wrinkles.

The master bedroom of the small guesthouse he'd rented on the island bore little resemblance to its spartan appearance the day he'd moved in. In less than a week, he had covered all four walls with bulletin boards of various sizes and shapes. Each was cluttered to capacity with dozens of multicolored papers and documents. The papers were a hodgepodge of handwritten and printed documents ranging in size from small Post-it notes to legal pad pages. Between the bulletin boards, Vosky had thumbtacked dozens more randomly overlapping papers to the walls. The floor, covered with a dreary olive carpet stained dark from age, had become a veritable obstacle course due to the numerous stacks of textbooks and scientific journals littering the space.

Ever since he was a child, Vosky had a strong belief in God. But in spite of his prayers, the exquisite pain he would occasionally suffer had now become a daily occurrence. Beginning as a dull ache across his entire forehead, it would quickly reach a fever pitch and then settle in as a relentless ring of pain around each eye. He massaged the bridge of his nose, but he did so more as a reflex than a remedy. His gaze shifted to his night table. An unopened pill bottle sat next to his lamp. He had placed it there the same day he'd picked it up from the pharmacy. For years he took them religiously, but now the bottle served only as a reminder of his prior life and how the medication had reined in the creative processes of his
mind. It was on that same day he vowed never to push another one past his lips.

As he often did to distract himself from the endless throbbing, his thoughts drifted to his former life in Russia . . . a life he yearned to return to. But the large sum of ill-gotten money he had fled with made returning to his homeland impractical. He stood up and walked over to the small desk and sat down behind his computer. He brought up his project's main file, which was a detailed timeline of events. To date he had achieved every milestone precisely on schedule.

Earlier in the day, he had decided to spend the evening going back over all the key calculations he had made. As his mentor at Kiev University had advised him, a great scientist steps out from amongst the trees every so often to study the forest. Vosky realized it was an observation that was uninspired and hackneyed, but he overlooked it because of his tremendous admiration for his professor.

What Vosky had created from nothing, what his colleagues in Russia had told him was impossible, he had accomplished and now had taken on a life of its own. He picked up the remote control to his television and turned on his library of video recordings. Although he had already watched it countless times, he brought up the story from the United States that featured Dr. Hollis Sinclair's impromptu news conference. He watched the video twice before turning off the television.

In addition to being an insightful physician and
researcher, Dr. Hollis Sinclair possessed charisma. Other doctors working on GNS in the U.S. would look to him for guidance and leadership. That was something Vosky knew he couldn't allow. As proud as he was of what he'd accomplished on his own, he wasn't naïve enough to think he could achieve ultimate success without some obstacles and setbacks along the way. What he needed to do with respect to Dr. Sinclair first entered his mind as nothing more than an intriguing idea; now, it was a moral absolute.

He got up, walked past the iron-framed double bed and stopped in front of a night table. Opening the drawer, he pushed a few envelopes and magazines aside and removed three passports. Each had cost him a small fortune, and each was an expert forgery. With a confident grin, he selected one. He then walked back to his computer and brought up his preferred travel website.