Error in Diagnosis (17 page)

At the president's request, the conference room aboard Air Force One was always kept at sixty-eight degrees. Set upon a plush alabaster carpet, eight beige leather armchairs were positioned with geometric precision around a rectangular conference table. One wall of the room contained a series of windows that were typical of any commercial airliner, while the opposite one was lined with a row of thick-cushioned window-bench-type seating. Holiday instrumentals played softly in the background. As he was being escorted to his seat, Jack detected the telltale aroma of a recently smoked cigar, an indulgence the president was well-known for.

Kellar, dressed in his personalized Air Force One crew jacket and khaki pants, warmly greeted each of them. Before formally beginning the meeting, he introduced Jack, Madison and Helen to the only other person in the
room, Mitchell Kincaide, his principal advisor on health care issues.

Once they were all seated, Kellar glanced down over the top of his glasses at a few loose pages of paper in front of him.

“I want to begin by assuring each of you that you have your country's and my heartfelt thanks for your tireless efforts in trying to cure this disease.” He paused briefly before going on. “I'd like to ask the surgeon general to bring me up to speed on the most recent developments.”

“Of course, Mr. President,” Brickell began. “We are treating patients in forty states. Ninety medical centers are participating. Our official case count won't be finalized until tomorrow at six a.m. but it's likely to exceed three thousand. To date, there have been no cases reported outside of the continental United States. It's the general impression of the physicians caring for these women that their conditions are gradually deteriorating. Fortunately, the mortality rate from the disease is still low but we have to assume it's going to climb.”

“Thank you, Renatta,” the president said, interlacing his fingers behind his neck.

“The specific reason I requested to meet with all of you this evening was to discuss the young lady at Southeastern State with GNS who isn't pregnant. Are we absolutely convinced she has GNS?”

“There's no doubt, sir,” Helen answered.

“I understand she's already been operated on.”

“The procedure took place a few hours ago. We removed a tumor from her ovary.”

“How did she come through the surgery?”

“Very well.”

“That's good to hear. What's the young lady's first name?”

“Isabella.”

“I'm sure everyone appreciates that the care of this young lady raises some very difficult and . . . sensitive questions.” Lifting his chin and cutting his eyes toward Helen, he asked, “Am I correct in assuming if Isabella should recover, it would be fairly strong evidence that termination of the pregnancy either by C-section, induction . . . or other means, would result in a cure of GNS?”

“That's what we believe, Mr. President,” Madison said.

Glancing overhead, he asked, “Would we then recommend all women who are beyond their twenty-sixth week undergo a C-section or induction of labor?”

“That would seem to make the most sense,” she said.

“What about those women who are less than twenty-six weeks pregnant?”

The president's eyes shifted to Jack, who had the presence of mind to gather his thoughts before responding to the booby-trapped question. He swallowed against a throat that had suddenly become as dry as a swath of burlap.

“If we prove termination cures GNS, and we can't find an alternative effective treatment for mother and baby, I expect it would become a viable option for consideration.”

“A viable option for consideration,” the president said with an easy grin. “You should have been a politician, Dr. Wyatt. Do you feel we are any closer to that alternative cure?”

“I'm sorry, sir. I don't.”

“The reason I ask is that I saw Dr. Sinclair's impromptu press conference. He's certainly not shy in front of the cameras. I asked a member of the surgeon general's office to speak with him personally. He seems convinced GNS is a viral illness and there's an FDA-approved drug that can cure it.” Kellar paused, looked around the table and asked, “Do any of you agree?”

Helen Morales answered, “Dr. Sinclair's an excellent physician and doesn't generally shoot from the hip. He's done extensive research and has presented some interesting evidence, which lends merit, but not proof, to his viral theory.”

“What I'm asking is if any of you believe there's a significant chance his theory's correct and that . . . that this wonder drug will cure GNS?”

“It's possible,” Madison said. “But what concerns all of us is that Vitracide is extremely toxic to both mother and fetus. I think we're all in agreement that we don't have nearly enough hard evidence to recommend its use.”

Kellar shifted in his chair, directing his next question at Helen Morales. “Hard evidence,” he repeated, seemingly in distant thought. “How many people at Southeastern State are aware of Isabella's . . . special situation?”

“That's difficult to say with certainty but there have been many people involved in her care.”

“Have the details of her surgery been posted in the National GNS Data Record as yet?”

“We decided not to post any further details until we had something definite to report,” Helen responded.

“I think that was a wise decision,” he said, standing up and moving to the back of his chair. He faced the group. “I'm not breaching national security when I share with you that over the past two days I've met with several highly concerned religious groups and other organizations on both sides of the aisle of the abortion issue. I'm sure it comes as no surprise that there are those who vehemently oppose any governmental agency advocating termination under any circumstances.” He paused for a moment, placing his hands on the chair. “And that would remain true even if there's convincing medical evidence it would result in a cure for the mother.

“As the president, I have grave concerns regarding the impact the details of Isabella's condition could have on the nation. Even if she should recover, I'm not sure it would be advisable to make sweeping medical recommendations based on her case alone. If we should advocate termination and it turns out there was an alternative way to cure the disease . . . well, the outcry will be heard around the world.”

Kellar pressed his palms together and continued, “Let me assure all of you that from a political standpoint, Dr. Sinclair's treatment plan is far more appealing than anything I've heard here tonight. He has communicated to my staff that he believes if we don't begin therapy soon, we'll lose our window of opportunity and that it's quite likely we'll start seeing hundreds more deaths of both mothers and babies.” Jack was hanging on every word Kellar was saying. He had a strong suspicion where he was leading them. “Therefore, until I authorize otherwise, I am
directing that all medical information regarding this young woman's care remain sealed and strictly confidential.” Speaking in a voice that could leave no doubts, he added, “I consider the details of her medical condition to be a matter of national security.” He returned to his seat and looked out over the group. “I welcome your comments.”

“With all due respect, Mr. President,” Madison began with a measure of hesitancy in her voice. “I'm not sure as physicians we can guarantee—”

“Dr. Shaw,” Kellar began, “as I'm sure you're aware, approximately six million women a year become pregnant in this country. About four million of those pregnancies result in a live birth. Even as we speak, thousands upon thousands of obstetricians' offices are being flooded with frantic calls from families wondering if they should terminate their first trimester pregnancies as a precaution.” He pushed forward in his chair and placed his hands flat on the table. “I'm asking you not to discuss any of this information with anyone until we're absolutely convinced we can't cure this disease by some means other than termination.”

Helen Morales said, “Let me assure you, sir, that the administration and medical staff at Southeastern State will do everything in their power to comply fully with your request.”

“It's not my intent to place anybody in a difficult position but until we can get a better understanding of Dr. Sinclair's claims, I feel as if there's no other way. A cure for this dreaded disease without resorting to termination would be the preferred scenario by far.”

For the next thirty minutes, the president asked Jack and Madison a number of pointed questions. Jack felt he was legitimately interested in the specifics of the GNS cases, but that he had already addressed the main reason he had requested the meeting.

The president was beyond cordial in thanking each of them for disrupting their busy schedules to speak with him. Jack and Madison returned to their seats. It was another fifteen minutes before either of them uttered a word.

Twenty minutes after they had arrived at Andrews, Jack and Madison were airborne on their way back to West Palm Beach. The much smaller military jet had few of the comforts of Air Force One but it didn't matter. Both of them were overwhelmed by their encounter with the president and hardly in the mood to discuss it any further.

Madison finished the last sip of her sparkling water and then asked, “How long ago was your divorce?”

“I don't recall mentioning I've ever been divorced.” She looked at him as if he were trying to persuade her the world was flat. He shrugged and said, “Nine months ago.”

“Any children?”

“I have a five-year-old daughter.”

“What's her name?”

“Annis.”

“Pretty. Do you see her often?”

“Four times.”

“A week or a month?” she asked.

“Since the divorce. My ex-wife's French. She had an excellent attorney who persuaded the judge to allow her to move back to Paris. So, since our divorce, I've made two trips to France, and twice, Nicole's brought Annis to New York.”

“Which one of you wanted the divorce?”

“I'd say we both did.”

“That's crap. It's always one person who wants out more than the other. Let me guess. You were never home and when you were, you had your head glued to your computer screen writing a paper or another chapter for the latest textbook in neurology. Your wife was going through life alone, you were insensitive to her needs and you had long forgotten how to enjoy your marriage.”

“That . . . and Nicole was sleeping with her boss.”

Madison chuckled but quickly covered her mouth. “I'm sorry, I shouldn't laugh. It was just the way you said it. How did you find out?”

With a slight head shake, he asked, “Are you sure you want to hear this?”

“Pretty sure.”

“We used to eat out a lot, but every Thursday we would stay home and order pizza. Well, I had just finished my third slice and was working on my second glass of Chianti when Nicole took my glass from me and set it down. I thought she was going to tell me how much she adored
me but, instead, she used the tender moment to inform me she had never really loved me the way a married person should. Before I could get a rational explanation, she confessed she'd been horribly lonely for a long time and that she was in love with someone else.” He spun the ice cubes in the bottom of his empty glass before going on. “She then told me the best thing for the both of us would be a divorce. The whole thing was very well prepared and took all of two minutes.”

“You really had no clue how unhappy she was?”

“Nope. I guess she viewed being married to me as a little bit worse than residing in the seventh circle of Hell.”

“Did you know him?”

“Her boss?”

“Yeah.”

“No, and, not that it's important, but him was a her.”

“Actually, that makes things a lot easier. You had what my laser club calls a no-brainer divorce.”

“What's your laser club?”

“A group of my friends, mostly doctors, one of whom is a plastic surgeon, get together every couple of months for dinner at somebody's house. We spend the evening bitching, drinking margaritas and lasering off anything that might make us look older.”

“And the no-brainer divorce?”

“Simple. Once you had the information about your wife, you had to get a divorce. You didn't have to waste six months beating yourself up wondering why your marriage failed or how you could have saved it.”

“Why did you get divorced?” Jack asked.

With a bemused grin, she said, “I guess I finally figured out he just wasn't worth fighting for.”

“Any kids?”

“Only him. Our breakup was one of the great legal olympiads in modern history. The worst part was that a couple of months into it, we talked seriously about reconciliation. By an incredible act of stupidity, I got pregnant. Two months later, I lost the baby. I always blamed it on the stress.”

“What did you do?”

“After a few months of self-loathing, I went into a complete emotional free fall. I wound up taking some time off and getting a lot of help.” She sighed and added, “It was a struggle but I finally put my life back together.”

“I . . . I'm sorry. I wasn't really trying to . . .”

“No need to apologize, Jack. People recover. It was a long time ago and I'm fine now. It doesn't matter what happens to you or who's to blame. If you can't figure out how to get comfortable in your own skin . . . well, life winds up being intolerable.”

Jack was surprised how candid Madison was being with him. It was the human side of her he hadn't seen a particle of until this moment. Nothing further was mentioned about either of their divorces. Instead, they covered a host of much less depressing topics. He enjoyed speaking with her and it made the rest of the flight seem like it only lasted a few minutes.

It was just after eleven when their driver pulled up to
the hospital. Instead of heading back to his hotel, Jack decided to stop by the ICU to check on Tess and Isabella. Finally seeming like a mere mortal, Madison told him she was too exhausted to join him and would meet him first thing in the morning in the ICU.