As soon as Jack arrived back in his hotel room, he got on his computer. He wanted to get some further information on what Marc had told him regarding the distribution of the chimera cells in the women with GNS. He hadn’t been at work for more than a few minutes when he realized he was exhausted. He was just about to wrap things up and climb into bed when his phone rang. He checked the caller ID. It was Lucien from Orlando Memorial calling.
“Hi, Jack. I’m sorry to call you so late, but do you have a few minutes to talk about the biopsy slides?”
“Of course,” he answered, instantly feeling as alert as if he had just awakened from a solid eight-hour sleep.
“I made a new set of slides using alternative staining techniques, and I have to tell you that a number of the slides bear a very subtle resemblance to the brain tissue of patients with some of the rarer forms of autoimmune diseases.”
Jack was instantly reminded of his team meeting when the possibility that the women suffering from GNS were all chimeras was first raised. He specifically remembered Carolyn, the medical student, informing the group that women with chimerism have a greater chance of having one of the autoimmune diseases.
In a guarded tone he said, “I’m sure you’re aware that all of the GNS patients have had a complete set of blood tests to see if they have an autoimmune disease. They’ve all come up negative.”
“I wasn’t aware of that, but it doesn’t surprise me. The slides I prepared are not diagnostic of any specific disease in the autoimmune family. All I can say is they have a vague resemblance to the brain tissue of patients with diseases like lupus. If GNS does turn out to be an autoimmune illness, it’s going to be a new one that’s never been described or seen before, which would account for why all of your blood tests have come up negative.”
“Almost all of the women who died were autopsied. I’ve read the reports. None of them even hinted at the possibility of an autoimmune disease.”
“I’m not surprised,” Lucien said. “The special techniques and stains we used to look at the young woman’s brain biopsy would never be part of a routine autopsy. Plus, the pathologists who did the autopsies were dealing with dead tissue while we studied specimens from viable brain.” He shook his head a few times. “There’s no way our findings would have been observed at any of the autopsies done on the GNS victims.”
Like most physicians, Jack was well aware that one of the most poorly understood groups of diseases known to medical science were the autoimmune ones. Normally, the body makes antibodies to fight off harmful bacteria and viruses. In patients with autoimmune diseases, this important process goes completely haywire. The individual’s antibodies, for unknown reasons, are defective and instead of fighting off infection, they attack and severely damage normal tissue. In spite of an enormous amount of sophisticated research, medical science had never figured out why the body attacks its own normal tissues. No cure had ever been found. Various treatments such as chemotherapy and steroids had been tried but the results had been far from encouraging.
Jack stood up and started in a slow pace around his room.
“Do you have a theory why the pathologists at Southeastern didn’t make the same observation you did?”
“I don’t know. What I’m seeing is the furthest thing from obvious, or maybe they weren’t looking for it,” Lucien offered. Jack knew what he was thinking and saw no reason to ask him to explain his comment. “The other reason could be that the findings I’m talking about are extremely thin. It’s not unreasonable to theorize that they could have gone unnoticed, or noticed and rejected as a possibility.”
“I know you’re a superb pathologist, Lucien, and please take this with the spirit it’s intended. Did you consider asking another pathologist to have a look at the slides?”
Lucien chuckled. “As a matter of fact, I did. I called Jacob Shoemaker in Tampa for a second opinion. He’s considered a national authority on autoimmune diseases. I assumed you wanted to keep this matter highly confidential, so I didn’t tell him the slides were from a GNS patient. He called me an hour or so ago and agreed with my findings.”
“Well, that’s certainly a fascinating observation you two have made.”
“Hopefully this will lead somewhere. It’s been a pretty lousy Christmas for a lot of people. Let me know if I can be of any further help.”
“Thanks, Lucien. I owe you one.”
Jack stopped pacing and sat on the end of his bed. He was already quite knowledgeable on the neurologic problems one sees in the autoimmune diseases. Lucien was right about one thing: If GNS was a new autoimmune disease, it certainly didn’t resemble any of the others and may not be detectable with the standard diagnostic tests available.
After a few minutes, he went out on his balcony. Looking across the Intracoastal Waterway and out to the Atlantic, he went over every detail of his conversation with Lucien. Even though he had promised Helen to stop all of his team’s efforts to discover the cause of GNS, Jack reached for his phone and called Marc.
“Are you still in the hospital?”
“Yeah,” Marc answered with a sigh. “We’ve been slammed with six new admissions. I’ll be here for a while.”
“Do you think you can find some time to check something out for me in the Patient Data Record?”
“Sure…but I thought we were no longer…”
“This is unofficial…and confidential.”
“I understand. What do you need me to do?”
“I want to repeat the autoimmune testing on all of the GNS patients just to make sure we haven’t missed something.”
“No problem I’ll take care of it right away,” he told Jack. “I assume you heard that Tess Ryan is scheduled for a C-section tomorrow.”
“I heard. I’ll see you in the morning.”
Jack tossed his phone on the bed. He then walked over to the desk, turned his computer on again and brought up his preferred medical information website. The website was a convenient resource for finding all the most recent scientific publications on any disease or medical topic. It was the same website he had used to educate himself on chimerism.
Jack would have gone to the hospital himself and done the research he’d asked Marc to do, but he had far more important plans for the next several hours. He continued to face countless uncertainties, but there was one thing that was unshakably true—by sunup he’d know everything that medical science knew about autoimmune diseases.