Saving Meghan(56)

Dr. Levine’s leg stopped bouncing, and his fidgety fingers went still as a trace of a smile came to his boyish face. Even the opposing attorney looked pleased. A pang struck Zach as he realized Leers might have made her first mistake of the day.

“That’s why we’re careful in how we word the questions,” Dr. Levine replied with an almost cocky grin. “And why my medical training isn’t, as you put it, unsophisticated.”

Becky cupped her mouth with her hands. Carl went rigid. He had to know, as did Becky, that even more damage had been done. The question was, how much?





CHAPTER 26


It was Zach’s turn to testify.

This was not Zach’s first time on the witness stand. He’d been an expert witness in malpractice cases before, but this time felt more nerve-racking, either because his job could be on the line, or because he did not want to fail the Gerards—Becky, especially, whom he viewed as a deeply devoted yet shattered mother. Even Carl, who’d shown him nothing but contempt, had his deep sympathies.

“What makes you think Meghan has mitochondrial disease?” Attorney Leers began.

“The main symptoms of mitochondrial myopathy are muscle fatigue, weakness, and exercise intolerance, also called ‘exertional fatigue,’ which refers to the unusual feelings of exhaustion brought on by physical exertion,” Zach began. “The mitochondria contain DNA with some of the genes needed for mitochondrial function. There are other genes needed for proper mitochondrial function found on chromosomes in the nucleus of the cell. Meghan’s cells have a deficiency in processing mitochondria. Her lack of endurance and declining skills as a soccer player, I believe, are attributed to her cells’ inability to produce the required energy as a result of a genetic deficiency.”

For the record, Zach recounted Meghan’s fainting episode that had led to Becky’s embarrassing removal from the airplane. The opposing attorney had already cited that incident as an example of Becky’s instability.

“How did you come to your mito diagnosis?”

“There are no published consensus-based practice parameters for clinicians to initiate diagnosis or patient management,” Zach said. “Instead, I rely on a set of internally established guidelines and personal anecdotal experience.”

“Which is why this disease is notoriously difficult to diagnose?” Attorney Leers asked.

“Yes.”

“And even if you do certain lab tests, such as a muscle biopsy or electromyogram, or EMG, to detect abnormal muscle electrical activity, many cases still do not receive a specific diagnosis?”

“That’s correct,” Zach said. “This is a very wily disease to pin down.”

“But you have a lot of experience in this area, don’t you?”

Zach listed his credentials: medical school at Case Western Reserve. Residency at University of Massachusetts Memorial Medical Center. Fellowship in pediatric neuro-oncology at New England Medical Center. Board-certified in child neurology. Membership in the Mitochondria Research and Medicine Society. Attorney Leers did not bring up his numerous publications in respected journals.

“And, in your opinion, was there any harm in treating Meghan with the mito cocktail that you had prescribed?”

As Zack looked over at Singer and Nash, a cold feeling swept over him.

“No. But we didn’t give her enough time on the treatment to properly assess the effectiveness.”

“By removing the child from the parents’ care and stopping treatment, it’s your opinion that Meghan’s health and well-being are being jeopardized?”

“It is, strongly,” Zach said.

Strongly.

He guessed what Singer was thinking: Zach felt strongly about every mito case he diagnosed.

“No further questions.”

Attorney Leers returned to her seat as the opposing attorney came out from behind her table to face off with Zach.

“Dr. Fisher, you have a personal history with mitochondrial disease, do you not?”

Zach braced himself. He knew this was coming. He and Attorney Leers had prepped for it. But that was in the abstract. It was different when the question was being asked of him in court.

“Yes, I do,” Zach said solemnly.

“Can you tell us about it?”

You know damn well about it, he seethed.

“My son, William, had the disease. He died from it.”

“How long ago?”

Screw you, thought Zach as he tried to rein in his emotion.

“He died five years ago.”

“That must have been devastating for you.”

Attorney Leers was on her feet in a flash. “Objection, Your Honor. This is not about Zach’s son. This is about Meghan Gerard.”

The judge sent a stern look to the opposing attorney.

“Your Honor,” she said, “I intend to show a predictable pattern with Dr. Fisher of frequently diagnosing cases of mitochondrial disease that may have origins in his tragic past.”

The judge thought for a beat. “Objection sustained,” the judge said. “Limit your questions to the topic.”

“Yes, Your Honor,” the attorney responded demurely. “Dr. Fisher, how many cases of mitochondrial disease have you diagnosed since your tenure at White began?”

“Maybe two, three dozen,” Zach said.