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.