Error in Diagnosis

by Mason Lucas M.D.

Genres: Crime Fiction; Medical Thrillers; Suspense

Synopsis

Innocent lives are put in jeopardy in this terrifying new thriller that asks the question: Are we prepared for the next epidemic?

A mysterious illness with disturbing symptoms is plaguing women across the United States. It begins with memory loss and confusion and ends with the patient falling into a coma. Medical professionals are at a loss for the cause, but one thing remains constant: All of the victims are pregnant.

Called in to consult on the case of his best friend’s wife, neurologist Jack Wyatt has never seen anything like it. Now, with the nation on the brink of panic, Jack and his colleagues are in race against time to find a cure.

The disease they are calling Gestational Neuropathic Syndrome (GNS) is spreading. Patients are dying—and no one can guess what will happen next…

Release date: August 4, 2015

Publisher: Berkley

Print pages: 432

Sample

1

DECEMBER SEVENTH

West Palm Beach, Florida

Tess Ryan was lost.

Gradually maneuvering her SUV down one indistinct street after another, she bemoaned her spinning instructor, Cal’s, decision to build his new gym in a warehouse district that was more confusing than an English hedgerow maze. But in spite of the fact that every building and street appeared identical, she still couldn’t explain how she had gotten lost driving to a location she had easily found four times a week for the past eleven months.

Fearing she would miss the beginning of her class, she allowed a frustrated sigh to escape her lips. Had this morning’s dilemma been an isolated event, she might not have been so dismayed, but of late, she had been plagued with repeated mental errors and memory lapses. Earlier, she had had to look up her sister’s phone number, a call she had made a hundred times a year for as long as she could remember. A couple of days ago, she was stuck at an ATM machine struggling to remember her PIN number.

Heading west, she shaded her eyes from a sun that was settling above an endless row of flat gravel roofs. After a few more minutes of randomly creeping up and down the grid-like streets, she spotted a line of familiar cars parked in front of the gym. With an appreciative glance overhead to acknowledge the divine intervention, she pulled in behind the last car. Grabbing her gym bag, she pushed open the door. With her first step she was out of the car, and with the next she was standing in front of the gym. Curling her fingers around the knob, she took a cleansing breath, and then with a ginger push, she slipped inside.

Cal’s gym was hardly a showroom for the modern workout facility. The collection of basketball jerseys that hung randomly from the rafters did little to divert one’s eye from the grit and black smudges that tattooed the cinderblock walls. His artistic masterpiece was the wall outside of his office that he had wallpapered with dozens of collapsed Red Bull cartons. Over the relentless objections of his students, he insisted on keeping the gym oppressively hot. Normally, Tess didn’t mind but today, she felt as if she were standing in front of a wood-burning oven. Making matters worse, the pungent smell of ammonia cleaner permeating the air sent her stomach into a series of backflips.

By the sound of Paul Simon’s “Diamonds on the Soles of Her Shoes” blaring from Cal’s boom box, Tess knew the class was still in its warm-up run. She chanced an apologetic smile his way. From his bike, which sat atop a three-foot wooden platform, the ex–Navy corpsman wagged a reprimanding finger in her direction, but then with a wink and an indulgent grin, he motioned her to join in. Tess mouthed, Thank you, made her way between the first two rows, and climbed on her bike.

Long-legged with elevated cheekbones and shadowy blue eyes, she was in excellent physical condition and never had any difficulty keeping up with the class. But today, after only five minutes, she was breathless. Assuming the heat and ammonia fumes were to blame, she decided to press on. To ease her breathing, she stood up and leaned forward over the handlebars. But her performance didn’t improve, and she found herself grunting and gulping for air even more feverishly. While she struggled to figure out what was happening to her, she felt the room begin to spin. Setting her ego aside, she slowed her pace and sat back down. She waited a few seconds but the whirling sensation only got worse.

Wondering if Cal hadn’t noticed her struggling, she raised her head and looked toward the front of the gym. Instead of seeing his usual determined face pushing the class on, all she could make out was an obscure silhouette. She craned her neck forward and squinted, trying to bring his blurred image into focus, but everything around her became a shapeless convergence of oscillating gray and white shadows.

Consumed with terror, she clutched the handlebars and closed her eyes. To her further dismay, the loss of visual cues only made her vertigo worse. She felt her body rolling and pitching as if she were in a fragile skiff on high seas. She could still hear the music and Cal’s shouts of encouragement but they were garbled and soon became distant echoes—echoes that would be the last thing her brain would process.

Tess’s head plunged forward and her body wilted. Toppling from the bike like a Raggedy Ann doll, she was moments away from her head hitting the cement floor when the woman next to her screamed. Fortunately, Cal had seen Tess falling several seconds earlier and was already racing toward her. His final stride was followed by a desperate lunge. With his arms fully extended, he snatched her up before she hit the ground. Then, with one powerful jerk, he had her safely cradled in front of him.

“Get me some water and a cold towel,” he announced to the class.

Hurrying toward the other side of the gym, he carried her past his bargain-basement artificial Christmas tree before easing her down on a sprawling canvas mat used for a women’s self-defense class. Well trained in CPR, Cal knelt down beside her and studied her breathing pattern. It was rapid but not labored. Her lips were pink—a reliable sign she wasn’t suffering from oxygen starvation. Her pulse was strong and regular. Next, he checked her pupils. They were neither pinpoint nor dilated—another good sign.

“Can you hear me, Tess?” he asked, taking note of a small pool of foamy saliva gathering at the corner of her mouth. When she didn’t answer, he repeated his question, “Tess, if you can hear me squeeze my fingers.” Still no response. He looked up at the group and in a voice that now boomed to a fever pitch said, “Somebody call nine-one-one right now.”

Just at that moment, the woman standing next to Cal gasped. With a quivering finger, she pointed at Tess’s face. Cal’s head snapped back. Seconds earlier Tess’s eyes were motionless—now they ricocheted back and forth as if they were two Ping-Pong balls in a wind tunnel. Cal had spent six months of his enlistment at the Great Lakes Naval Hospital assigned to the neurology floor. He was quite familiar with the signs of a seizure. If Tess were having one, it was unlike any he’d ever seen. His eyes remained locked on her like a laser. He felt helpless knowing the only thing he could do until the EMTs arrived was to monitor Tess’s pulse and breathing. If either faltered, he’d begin CPR immediately. He swept his clammy hand across his forehead, wiping away a few beads of sweat. And then, in a room overtaken with a deafening silence, he waited.

2

Eleven minutes after Cal’s student had called Palm Beach Fire Rescue, two paramedics were at Tess’s side. Squatting catcher-style, the first one, a slight woman whose name tag read R. PONTE, wrapped a blood pressure cuff around Tess’s upper arm. Her partner, a stubby man packing an extra fifty pounds, unraveled several feet of oxygen tubing, connected it to a mask and then fitted it squarely over Tess’s nose and mouth.

“What happened?” Ponte asked. “Was she hurt?”

“No,” Cal answered. “She was fine until about ten minutes into the workout when she . . . she just passed out and fell from her bike.”

“She didn’t hit her head?”

“No, I caught her before she hit the ground.”

“What’s her name?”

“Tess Ryan.”

“Tess, can you hear me?” Ponte asked.

Cal said, “Her eyes began darting back and forth like that a few minutes ago.”

Ponte placed a tourniquet around Tess’s biceps and waited for a suitable vein to pop up. Without looking up she asked, “Do you know if she has any serious medical conditions?”

“I don’t think so. She’s been working out with me for almost a year. She’s never had a problem.”

“When did that begin?” she asked, gesturing at Tess’s legs.

Unsure of what he was being asked, Cal’s eyes shifted to Tess’s lower body. His breath caught. Under her black leggings, her calf muscles rippled erratically as if they were being shocked by repeated bursts of an intense electric current.

“I don’t know. It . . . it must have just started,” he answered, swallowing hard against a throat that had suddenly become as dry as cotton.

“The IV’s in and her vital signs are okay. We can roll,” Ponte told her partner. Together they transferred Tess onto the stretcher, locked it into position, and hurried toward the exit.

“I’ll call her husband,” Cal said. “What hospital are you taking her to?”

“Southeastern State University.”

“Her husband’s going to ask. Do you . . . have any idea what’s wrong with her?”

“Well, if we were out in the Everglades, I’d say she’d been bitten by a rather large poisonous snake.”

Cal walked across the room and sat down at a wooden desk that was beyond restoration. The three-foot, artificial and unornamented Christmas tree standing next to the desk did little to add to the spirit of the season. He didn’t have to announce the class was over. In an awkward silence, the other students gathered their gym bags and moved toward the door. Lost in the moment, Cal rested his chin on his steepled fingers, half listening to the wail of the ambulance’s siren fading into the morning.

He tried to reassure himself that Tess Ryan would be fine, but for all his efforts he couldn’t shake the uneasy feeling that he might never see her again.

3

With a steady rain tapping against the ambulance’s windshield, Ponte eased into the receiving dock of Southeastern State University Hospital’s emergency department. Based on her en route instructions, she and her partner wheeled Tess into a critical care unit designed for the most seriously ill patients.

Much to Ponte’s surprise, there were three grim-faced doctors, two nurses, a respiratory therapist and a hospital administrator waiting for them. She exchanged a guarded look with her potbellied partner as they transferred Tess to the hospital bed. In her ten-year career, she had brought dozens of desperately ill patients to emergency rooms all over the county. Some were accident victims who were traumatized beyond recognition. Others were scarcely holding on to life from a massive heart attack or stroke. The memory of those patients was vivid in her mind. What she didn’t remember was ever being met by an entourage like the one now hovering over Tess Ryan.

The physician in charge, James Lione, stood with his arms tight against his side. As soon as the two paramedics finished and stepped back, Dr. Lione stepped forward and began his examination. Sliding his stethoscope from Tess’s left chest to the right, he threw a momentary glance in Ponte’s direction.

“Did she have a fever when you got her first set of vital signs?” he asked.

“No.”

“Any drop in blood pressure?”

“We checked it three times. They were all normal.”

Lione looked up. “Was anybody else in the class sick with similar symptoms?”

“We didn’t specifically ask, but nobody mentioned feeling ill.”

“Was she responsive at any time?”

“No.”

“Do you know if she works?”

“One of the women at the gym mentioned she works in fund-raising.”

“I don’t imagine that would pose a great risk for a toxic exposure,” Lione said.

“Have you spoken to any family members to get a more detailed history?”

Ponte shook her head at the strange question. “There were none at the scene and we wanted to transport her as quickly as possible.”

With the other two physicians flanked closely at his side, Lione completed his examination. Backing away from the bed, a restrained sigh slipped through his lips. He thumbed his ear a couple of times and then motioned the other two physicians to join him on the other side of the room. They spoke softly. Ponte tried to remain as unobtrusive as possible as she struggled to hear what they were saying.

It was at that moment that Dr. Helen Morales, the dean of the Southeastern State University School of Medicine, walked in and joined the group. Before any conversation amongst the physicians began, Lione looked over at Ponte and said, “Thanks for bringing her in. We’ll take it from here.” Becoming more perplexed with each passing moment, Ponte only nodded. Generally, paramedics were considered part of the team. Most physicians went out of their way to explain things to them regarding the patients they transported to the emergency room.

They quickly collected the rest of their equipment, left the room and walked down the hall to the staff lounge. Ponte had just grabbed a cup from the cupboard and was headed toward the coffeemaker when one of the nurses who had been present in Tess’s room walked in. Ponte knew K. P. Burnham well. She had worked with her for years, and her husband was a fellow paramedic.

“Three doctors and two nurses to meet the patient, and then we practically get thrown out of the room. What the hell’s going on . . . what’s all the mystery about?”

K. P. walked over to the watercooler and shrugged. “I’m not the one to ask.”

Ponte’s stomach tensed. She raised her hands. “What’s that supposed to mean? I’m a licensed paramedic. I’d like to know what’s going on with a patient I brought to this hospital. I don’t feel like the request is out of line.”

K. P. took a swig of the ice water. After a cautious glance around the room, she started for the door. “I’ve been instructed not to discuss these cases with anybody.”

“These cases? Are there other patients with the same symptoms?”

K. P. crumpled the paper cup and tossed it into a wastebasket.

“Sorry, I’m really not supposed to say anything.”

Looking around the room as if she were searching for answers on the walls, Ponte pressed her lips into a thin line. She had great faith in the physicians and nurses who worked at Southeastern State, but if there was a method to their madness regarding their care of Tess Ryan, it was a mystery to her.

4

John F. Kennedy Center for the Performing Arts
Washington, D.C.

Since first seeing La Bohème during her freshman year at Georgetown University, Dr. Renatta Brickell, the surgeon general of the United States, had been a die-hard opera aficionado. Time had done nothing to erode her passion, and there were few things in life she coveted more than her season subscription to the opera.

With Christmas carols playing softly, she sat in her aisle seat marveling at the lavish red-and-gold silk curtain. Lost in thought, she barely noticed the light tap on her shoulder. When she looked up she saw her assistant, Julian Christakis, standing over her. His mere presence and the apologetic half smile on his baby face caused her to groan inwardly. Five years ago, she had hand-selected Julian from hundreds of applicants. Diplomatic to a fault, he had become one of her key advisors and an invaluable member of her team.

He cleared his throat and spoke in just above a whisper. “I’m sorry for disturbing you, Dr. Brickell, but there’s a . . . a situation.”

With more than an inkling her evening was in peril, she turned to her husband.

“I’m sorry, Stan. I’ll be right back.”

With a dubious look, he tapped his watch crystal. “The curtain’s about to go up, Renatta. You don’t have much time.”

She gave his hand a reassuring squeeze, came to her feet and accompanied Julian to the lobby. After scanning the area, she motioned toward a relatively secluded area in front of the donor recognition wall.

“This better be good,” she told him.

“Once you hear what’s been going on, I suspect you’ll agree it is.” He exhaled a lungful of air, scanned the lobby and then continued in a guarded voice, “I’ve been on the phone with the Centers for Disease Control for the past two hours. It seems they’ve been receiving calls all day from dozens of hospitals from Florida to California that have been treating hundreds of women with a bizarre illness that none of their doctors has ever seen before.”

“What are their symptoms?”

“Mostly neurologic: memory loss, confusion and severe muscle twitching of the legs. What’s particularly disturbing is that many of the women have developed a dancing eye syndrome.”

“I thought that only occurs in infants and children.”

“Except in rare circumstances, that’s usually the case.”

“How seriously ill are these women?”

“Some of them are unresponsive and have been admitted to intensive care units.”

“Any deaths?” she inquired, becoming more concerned with each passing second.

“None reported so far.”

“Just exactly how many cases are we talking about here, Julian?”

“The CDC’s not exactly sure. Their best guess is around four hundred, but there could be a lot more.”

She folded her arms and stared at the ceiling for a few seconds. “Has anybody considered that this may just be the beginning of some new strain of flu?”

“None of these women has a fever, sore throat or any other flu symptoms. And, none of their immediate family members is sick. Besides, why would a flu only affect women?” He lightly shrugged his shoulders. “I’ve spoken to a lot of people today. None of them has the first idea of what the hell’s going on.”

“For God’s sake, Julian, you have nine advanced degrees in health care and epidemiology.” She paused briefly to gather her thoughts and then asked, “What’s the first rule of diagnosis we all learned in medical school?”

“That’s easy. The most common things occur most frequently.”

“It’s a little corny, but it’s also very true, which leaves us with only two rational explanations: The first is this is a contagious disease. The second is we’re dealing with some type of widespread toxic exposure.”

Just at that moment, Julian’s cell phone rang. He plucked it from the leather case and checked the display. “It’s the CDC,” he told her, raising the phone to his ear. “This is Julian Christakis,” he answered, pacing in a tight circle while he listened. He suddenly stopped, and then with a solemn nod added, “You’re absolutely sure. There’s no chance of an error? I see. Thanks very much for calling, Dr. Emerson. No, that won’t be necessary. I’m with the surgeon general now. I’ll brief her immediately.”

Julian slid his car keys from the inside pocket of his black blazer. He was generally unflappable but at the moment his expression was ominous. He leaned back against the wall.

“There’s obviously something else,” Renatta stated in a guarded tone.

“I’m afraid so. Not only are the hospitals reporting more new cases every hour but most of the women who were admitted earlier are getting worse. I don’t have the exact numbers but quite a few are now in a near coma.” He paused long enough to push his hand through his curly blond hair. Renatta was familiar with the habit, which was a sure sign of his uneasiness. “Emerson also confirmed something we suspected earlier.”

“I’m listening.”

“All of the affected women are pregnant.”

With his words seemingly suspended in midair, Renatta could feel the color drain from her face.

The lobby lights flickered.

“Give me a minute,” she told him. “I’ll let Stan know I have to leave. You can drive us to the office.”

Renatta made her way back into the opera hall. Clutching her rolled-up program, she descended the center aisle. With her stomach clenched and plagued by a rising sense of urgency, it occurred to her that perhaps the most sensible thing to do was skip the trip to her office and have Julian drive her directly to the White House.

5

DECEMBER EIGHTH

The Island of Nevis, West Indies

NUMBER OF CASES: 823

Dr. Jack Wyatt’s plan to spend a relaxing week at a plush Caribbean hideaway had fallen well short of his expectations. After a punishing two-hour tennis lesson with a fanatic pro, he limped back to his oceanfront casita. Dumping his gear on the floor, he resisted the temptation to collapse on the canopied four-poster bed in favor of watching another spectacular sunset.

With one brief stop to pluck a chilled imported beer from the refrigerator, he made his way out onto the veranda and flopped into a wicker love seat. With his angular legs outstretched and the fading warmth of the afternoon sun on his freckled arms and shoulders, he gazed out to sea. A couple hundred yards from the beach, two WaveRunners with their engines whining sliced across the water in tandem.

Since his divorce nine months earlier, Jack had done little to kick-start a new social life. It had been a process, but he finally admitted to himself that his wife had stopped loving him long before she’d asked him to move out. The ink had barely dried on their divorce decree when she packed up her belongings and their daughter and moved to France, where she had been born and raised. He never pined for her, but he missed Nicole terribly.

He had never given serious thought to vacationing alone, and it was only at the insistence of a few concerned friends that he needed some time off that he finally caved in and booked the trip. Unfortunately, the change of surroundings did little to improve his emotional indifference.

A few days after he arrived, he gave serious consideration to cutting his vacation short and returning to Columbus. But his grueling schedule of teaching and patient care as chief of neurology at the medical school left him precious little time off. In spite of the disappointment with his vacation, the meager two weeks he could manage each year were far too precious to give up.

It wasn’t long before the rigors of his tennis lesson, the premium beer and the light tropical wind levied their full effect. With the droning of the WaveRunners disappearing to the north, Jack closed his eyes and yielded to the inevitable.

It wasn’t more than a few minutes later, when the shrill alert of his phone snapped his eyes open, that his tranquil nap came to an abrupt end.

“Hello,” he muttered, assuming it was the concierge confirming his dinner reservation.

“Jack. It’s Mike. I’m sorry to bother you on vacation but something’s happened to Tess.” Jack pulled his legs in and shook the fuzz from his head. “She’s pretty sick. The doctors put her in the intensive care unit at Southeastern State.”

Jack was unaccustomed to the trepidation in his best friend’s voice. Having grown up in Fort Lauderdale across the street from each other, Jack and Mike had been inseparable from their first day of kindergarten until high school graduation in spite of diametrically opposed personalities. Even though they had attended different colleges, time and distance had done nothing to erode their friendship. They spoke frequently and still shared an inviolate golf trip to Arizona every September.

“Was she in an accident?” he asked Mike with a mixture of alarm and uncertainty.

“No, nothing like that. I got a call yesterday that she had passed out during her spinning class. Her instructor called nine-one-one and the paramedics took her to Southeastern State.”

“Is she still unconscious?”

“No . . . not exactly. I . . . I guess you’d call it more like a daze. Her eyes were going crazy, so they called in a specialist. As soon as he saw her, he had her admitted to the intensive care unit.”

“Is the baby okay?”

“They told me she’s okay . . . but I’m not sure anybody . . .” Mike paused for a few moments. “I need you to come up here, buddy. I’m scared shitless. I guess I didn’t realize how bad things were until a few hours ago. The ICU doctor told me she’s . . . she’s not sure Tess is going to make it.”

“I’ll call the airlines as soon as we get off the phone,” Jack said, pushing his sunglasses atop his head. “I’ll be there tomorrow.”

“Don’t bother calling the airlines. I’ll fly down tomorrow and get you. Just come to the general aviation center at the Saint Kitts airport at around ten.”

“Has Tess had an MRI or CT scan of her head?”

“Both,” he answered. “Look, I’m calling from Dr. Helen Morales’s office. She’s the dean of the medical school. She can fill you in a lot better than I can.”

Although they had never met, Jack recognized the name immediately. Helen Morales was a trained radiologist but for the past fifteen years, she had been a nationally recognized innovator in medical education. Two years ago, she had left her position at Dartmouth to become dean of Southeastern State University’s medical school.

It wasn’t hard for Jack to connect the dots why Mike was calling from her office. In addition to Tess and Mike being alumni of Southeastern State, they both had an undying passion for philanthropy. Mike was a dorm-to-empire techno-genius. By the time he was thirty, he had made his fortune designing and producing video games. Last year he had been named to Southeastern State University’s board of trustees. Soon after the appointment, he pledged five million dollars toward construction of the new business school, an architectural marvel that would bear his name.

“Dr. Wyatt?” came a pleasant voice. “This is Helen Morales. Let me begin by adding my apology to Mike’s for disturbing you on vacation, but we’re all very concerned about Tess.”

“Mike and Tess are family, Dr. Morales. You’re not disturbing me.”

“He obviously feels the same way about you. As Mike mentioned, Tess was brought to ER early yesterday morning with a major alteration in her mental status. We ran two complete urine and blood toxicology panels thinking she might have accidentally ingested something, but they were completely negative. She’s had both an MRI and a CT scan of her brain, both of which were normal.” Even as she spoke, Jack was racking his brain trying to recall any neurologic illness that fit Tess’s symptoms. “So, as you can see, in spite of a rather extensive evaluation, we don’t have a diagnosis.”

Jack was well aware that Dr. Morales’s call was a courtesy briefing only. Being a family friend and not a treating physician, he was mindful not to step across the line of professional ethics by making any suggestions regarding Tess’s care.

“It certainly sounds like you’ve done everything by the book,” he told her.

“Coming from a neurologist of your preeminence, I’ll take that as a compliment. All of us here are quite familiar with your outstanding work on elusive neurologic diagnoses. Your book chapters and scientific publications are required reading for our neurology residents.”

“That’s kind of you to say.”

“As I’m sure you’re aware, we consider Tess and Mike extremely important members of the Southeastern State family. When Mike mentioned to me that you two were extremely close friends . . . well, I encouraged him to call you. I understand your main reason for coming here tomorrow is to support Mike, but I was hoping I might be able to persuade you to make your visit a little more formal. I’d like to extend you an invitation to serve as a visiting professor of neurology at Southeastern State. That way you’d be able to formally consult on Tess’s case.”

Jack was quite familiar with visiting professorships. It was a common practice amongst medical schools to invite faculty members of other schools to spend time with their residents and students in order to expose them to different medical insights and perspectives. Over the years, Jack had been invited to serve as a guest professor on many occasions. His s