Embryo 1: Embryo

by JA Schneider

  There was a pause, a long pause. He’d been going to tell her when she got back, before all this. He folded his arms and looked out at the crowd, resigned.

  “Hollins miscarried,” he said dully. “Around five o’clock.”

  Jill’s eyes widened. “Hollins? Monday’s amnio? You called me Munchkin?”

  “The same.”

  “But she was getting better!”

  “She got worse.” His troubled gaze watched a bloodied teenager being wheeled past. “Everyone in this freaking hospital has been speculating, investigating, but nothing’s connected. These patients all have different backgrounds, different treatments and problems. There’s just no common thread.”

  She thought it through before she spoke. “Do you have a few minutes? There’s something I’d like to show you.”

  He turned to her, looking pained and beyond exhausted. “No, I don’t have a few minutes. I’m behind in paper work and still haven’t finished today’s charts. Plus you’re on call tonight and you’ve had a slightly traumatic experience. Shouldn’t you be trying to get some sleep? Now?”

  “Fifteen minutes! There’s something you have to see! We can go over the charts together in my on-call room. It’ll be half the work for you and maybe they’ll make me sleepy. Sound good?”

  He looked at her. The foul mood of moments before vanished. “You strike a hard bargain.”

  “Come on,” she said.

  He frowned at the screen before him, his lips moving slightly like Peter Gregson’s. David was counting. Finally he leaned back on his stool and said, “Yep. Same as the other one. It’s unbelievable.”

  Jill said, “Trisomy 14 and a 12-17 translocation. Both of them. Little Sayers and” – she tapped the screen – “Maria Moran’s baby. Her body was flooded with fetal hemoglobin marker. Now do you see a common thread?”

  He rubbed his stubbly chin, thinking. “I see that they’re the same. But two cases don’t make a pattern. You can’t leap from two twisted chromosomes to some deadly hospital intrigue without more evidence than that. It could be just chance.”

  “David – ”

  “They could have been exposed to the same environmental pollutant. Radiation, pesticides in the water, sushi from Fukushima. Or maybe they’re distant cousins, or had the same boyfriend – a guy with a peculiar genetic makeup.”

  Jill pursed her lips. It was his logic versus her instinct. She felt frustrated, but at the same time she knew he could be right. Crestfallen, she flicked off the electron microscope. The hum of the motor ceased; the empty laboratory seemed hollow.

  He hated disappointing her. “You’ve made an important finding,” he said. “Definitely provocative but…what are you going to do with it? That’s how research goes. One aha moment leads to - okay, now what?”

  She wandered over to the window and looked out. He came to stand by her; saw that she was staring down in the direction of the Sturdevandt wing. A long row of windows on the fourth floor was brightly lit. It was Stryker’s lab.

  “They go at all hours, don’t they?” she said.

  “Yep.” David looked back at her. “By the way, how did you get the specimens up here from the morgue without incubation?”

  She told him.

  He laughed, and kissed her, and told her she was nuts.

  The desk in Jill’s on-call room was too small so they spread the day’s unfinished charts on the bed. “Hollins is on top,” he said.

  They sat, made notes, wrote orders, and whipped through the bunch in half the time it would have taken him alone.

  “I don’t believe it. We’re done thanks to you,” he said. His back ached. He turned the chair they’d pulled to the bed, and rested his head on his folded arms. “You tired yet?”

  “Getting there.” A pause. “Will Hollins be leaving in the morning?”

  “Yes.”

  “I’ll do her hemoglobin, if that’s all right. I’d like to see her again.”

  “Fine.”

  Another pause. “What are those charts you left on the desk?”

  Oh damn. Such was his fatigue that when he went for the charts, he’d forgotten to remove three older ones he’d gotten from the record room that he’d been planning to investigate himself. In the bedroom he’d pulled them out, hoping she wouldn’t notice. Fat chance. There was no stopping Jill. She would have heard about them or found them anyway – he looked up - and was already getting them and bringing them back to the bed.

  “Trouble charts, the residents are calling them.” He was cursing himself. “They’re starting to take second looks too.”

  Her delicate hands flipped through one, with the other two placed near the pillow. Reluctantly he reached for a second one and gave it to her.

  “They go together, Warner and Tarasov,” he said. “Two miscarriages from two and three weeks ago.” Then figuring, hell, she’ll read it anyway, he reached for the third chart.

  “Another miscarriage?”

  “No. It happened the week before you came. Name’s Sheri Chang. Her child was stillborn.” He looked at the chart for a long moment, remembering. Then handed it to her.

  Jill rubbed her eyes and said, “Oh boy, suddenly I’m seeing double.” She got out her notebook and, squinting, copied each of the three patients’ names, numbers and diagnoses. Then closed her notebook and dropped her head in her hand.

  David carried the pile out to the hall, where she heard him stop a nurse and ask her to return the charts to the OB floor. When he returned he found Jill straightening the sheets and fluffing the pillow.

  He closed and locked the door, looking grave. “Jill,” he said. “I beg you. Let me look into Warner, Tarasov and Chang. Or we can do it together. This thing has turned dangerous.”

  She came to him and helped him pull off his shirt. “Stryker said what I do could wreck your career. I’ll be sneakier and more careful, promise.”

  “No – ”

  “We’re both too tired to argue. I can’t see straight and you’re falling off your feet. Tomorrow we’ll talk about it, okay?”

  “Tomorrow’s now. Your phone could ring any minute.” He pulled her into his arms. “In your shape – what if you have to deliver twins? I’ll go with you…”

  “And we both show up all sleepy-eyed and tousled? Ganon never sleeps, I hear. Come to bed…”

  They were lucky. The phone didn’t ring till five hours later.

  23

  All through patient rounds Jill was tense, and tried to get Greenberg and Donovan to move faster. They loved making small talk with the patients, and seemed puzzled by her fidgeting. They were more puzzled still when she asked to do Hollins alone.

  “Suit yourself,” Woody said. “Check her hemoglobin. She lost a fair amount of blood.”

  “Don’t discharge her till you get the report back,” Tricia said. “Holler if you need us.”

  Jill said yes and watched them go. From a supply closet she loaded a sterile table and wheeled it toward room 828. She knocked on the partially opened door. “Mrs. Hollins?”

  In a blue robe, Hollins looked up tearfully. Jill was surprised to see her setting out her clothes on a bedside armchair – black yoga pants and a plum-colored top.

  “My getaway outfit,” she said, continuing her packing.

  Jill pushed in the sterile table, frowning slightly. She hated lame, consoling clichés that never made anyone feel better. “You’ll be back,” she said. “Before you know it you’ll be back for prenatal care. There are women here – ”

  “No, I’m done.” Hollins sat heavily on the bed, as if merely laying out clothes had left her exhausted. Her eyes were red-rimmed. “I’m just tired of feeling like a walking laboratory.”

  Walking laboratory?

  Jill gestured to her sterile table. “Can we do a predischarge exam? I promise I’ll be brief.”

  Hollins took off her robe and sank sorrowfully back against the pillows.

  Putting the stethoscope to her ears, Jill listened to the heart and lu
ngs, checked the abdomen and palpated the uterus. Hollins showed no reaction until she saw Jill reaching for a syringe.

  “What’s that?” she said, looking alarmed.

  “Hemoglobin test,” Jill said, already snapping the rubber tourniquet onto the woman’s arm. “You lost some blood. We can’t discharge you until we’re sure you’re not anemic.”

  “No! Not another needle! I’ll lose my sanity!”

  Jill peered sweetly at the patient. “No, you won’t.”

  “I can’t watch,” Hollins whimpered, turning her head away.

  The tourniquet was tightly in place. “Open and close your fist,” Jill said. The veins on the inside of Hollins’ elbow bulged. Jill swabbed the area with an alcohol sponge, and placed the needle on the skin surface. The patient’s body stiffened. “Easy now,” Jill breathed. She gave a deft push; the needle flashed and popped its way in. The syringe and the vial inside it began filling with dark venous blood.

  “Done.” Jill first removed the tourniquet, then the syringe, and placed them on the sterile table.

  Hollins turned back to her and inhaled with relief.

  “Now there’s just one more thing I have to do,” Jill said.

  “What? I thought you were – ”

  “No biggie. I just want to look at your throat.”

  “Whew. Is that all?” Hollins was relieved.

  Tongue depressor in hand, Jill told the woman to say “Ah,” and peered in. “Hmm,” she said, and then, “hmm” again.

  As she withdrew the tongue depressor, she gently scraped the edge of the wooden blade against the inside of the cheek. Then casually slid the blade into a transport pack – a thin, plastic envelope about eight inches long. She did not place it on the sterile table, but continued to hold it in her fist.

  She gave a warm good-bye. Then pushed the sterile table to the doorway, where she turned, smiled, and gave a thumbs up to Mary Hollins.

  She dropped off the blood sample in its vial, then raced up to Pathology. No Peter Gregson there, but she knew the ropes. Took a culture plate off the rack, removed the lid, and dragged the tongue depressor still wet with mucosal cells across the amber-colored nutrient.

  She replaced the lid, labeled it and put the plate into the incubator, next to the skin specimens of Sayers and Moran.

  With trembling fingers, she closed the door.

  Inside, the living cells of Mary Hollins responded to their new environment by stepping up their metabolism. Several, when taken from their donor, had already been primed for cell division.

  Before Jill even left the room, their chromosomes began to move.

  Sam MacIntyre called to Jill when she reached the OB floor. He looked stressed.

  “How’s your forehead?” he said in a rush. “Listen, go down to X ray for me? There’s a hysterosalpingogram I want you to check, the right Fallopian especially.” He pushed a scrawled-on paper at her. “Here’s the order.”

  “Can’t do it,” Jill said.

  “What?” MacIntyre looked as if he hadn’t heard right.

  She raised her hands. “Sam, please understand. There’s something else I have to do. Can’t you get someone else to go?”

  “No!” His face reddened. “What’s so important you can’t take ten minutes to run down to X ray?”

  “I have to go over some charts.”

  “They’ve already been gone over!”

  “Different charts.”

  “In a different hospital, right?” MacIntyre’s voice rose. “What in Hell’s Bells are you up to now? And where by the way were you ten minutes ago? You left the floor. We had an admission!”

  Jill looked at him fondly. “And you covered for me, right?”

  He wagged his finger at her. “Ba-a-d intern.”

  “I’ll make it up to you. And if I’m bad why did you rate my performance to the Genetic Committee as superior? I heard you did that when they were checking up on me.”

  She let the question hang as she gave a little wave and headed off.

  MacIntyre watched her, still red-faced, then hollered, “I lied!”

  The nurses, fortunately, were overwhelmed and hadn’t gotten to replace last night’s charts in their rack. Jill slid the three she wanted out of the stack and nobody noticed. Pure luck. Within minutes their old dates would have been noticed and they’d have been sent back down to the record room.

  In the doctors’ lounge she looked like anyone going over charts, with coffee and a donut to look extra casual. She had two charts lying side by side; flipped pages of both as she read.

  Tarasov and Warner – both second semester miscarriages – seemed random and unconnected. The women had healthy medical histories. Neither smoked or used drugs. They came from different social backgrounds; had had different physicians.

  Different delivering physicians, that is.

  Jill flipped two pages; dug deeper.

  Tarasov had been a clinic patient, Warner a private patient in the Sturdevandt wing. For what? It didn’t say. Well, the fact that a woman was a patient of the Genetic Counseling bunch didn’t necessarily mean anything. Those doctors saw regular patients as well as infertile and high-risk ones.

  Something caught Jill’s eye in the Tarasov report. A messy scrawl on the bottom of a green page reporting that in late March Tarasov had come in “demanding” – that was the word – a pregnancy test.

  Jill stared at the page. Why would anyone demand a pregnancy test?

  Unless she’d tested at home? Again and again…and couldn’t believe the results?

  The door opened and horse-faced Carole Shelton came in. “Well hello!” she said, pouring herself coffee. “Where have you been?”

  “On a cruise,” Jill said.

  If Shelton had planned on staying, she didn’t.

  The door closed behind her, and Jill breathed again. Leafed back through the pages and found the date of a routine exam - sure enough – right at her ovulation time.

  She breathed shallowly.

  Another surprise: Tarasov’s report said she’d undergone - a cervical mucous test? But that was a prefertility test! Presumably not requested, tucked in with routine tests where nobody would notice…

  Tarasov and Sayers had both been clinic patients.

  Jill opened the chart of Sheri Chang, who’d been a private patient.

  It was a jumble. Several pages were out of order, and lab tests ordered had not come back.

  Or had they come back? And been removed?

  The Chang infant had died stillborn on June 20, after a seven month and seemingly normal pregnancy. Jill flipped back, and there on November 24 Sheri Chang had undergone…something, but no telling what since the rest of the line had been inked out.

  The addresses and phone numbers of all three patients were already in Jill’s notebook. Warner lived on Fifth Avenue, Tarasov in Brooklyn, and Sheri Chang lived in Chinatown.

  Jill started to carry the charts back, and saw Tom Ganon chewing out Gary Phipps further down the hall.

  She hurried to the nurses’ station, where a student nurse was helping.

  “Will you take these back to the record room?” Jill asked her. “Please hurry. They’re waiting for them.”

  “Sure!” the girl said and scampered off.

  Amazing, Jill thought. Nobody ever asks who “they” are.

  Annie Smith didn’t show up for her clinic appointment, and Luisa Vega did – in hard labor. She had to be rushed up to delivery, which left Jill with two unexpected empty time slots.

  From outside the building she called the Fifth Avenue residence of Caroline “Sunny” Warner. She wasn’t surprised when a butler-sounding voice answered. “Wohnah residence.”

  Jill identified herself. “May I speak with Mrs. Warner?”

  The nasal voice informed her that madame was resting; would the caller care to speak –

  “I’ve got it, Phillip,” came a sudden, rasping voice. Another extension had been picked up. The butler voice murmured something and hung up
.

  Jill hesitated. “Is this Mrs. Warner?”

  “Sometimes,” said the voice, and let loose with a wild bray of laughter. Jill was taken aback. The laughter subsided, and the voice resumed its tipsy decorum.

  “I was eavesdropping. You’re calling from Madison Hospital and you’re Dr. who?”

  “Raney,” said Jill. “I wanted – ”

  “Well, aren’t you the dear heart! Called to see how poor little me is doing?”

  “Mrs. Warner, I’m hoping you’ll be able to help me. I’ve been doing a follow-up study of your miscarriage, and I find that the information on your chart is incomplete.”

  “Incomplete? Of course it’s incomplete.”

  Jill stared ahead at nothing. “I don’t understand,” she said.

  Warner was silent for a moment, then said, “Oh, what the hell. That’s how Dr. Stryker protects his patients. Their privacy, I mean. It’s nobody’s business if James has a low sperm count and I had artificial insemination. I’m sick of getting hounded by his side who thinks it’s my fault – ”

  Jill was stunned. Warner had artificial insemination? It was nowhere in her records. Throughout her training she’d been taught to believe what she read in charts; to assume that all objective data had been collected and was there.

  She closed her eyes. How many other prenatal records left things out?

  “…so you know what that dear man does? He even meets with his patients after hours – you know, at night. There’s a private entrance and it’s nobody’s business who comes and goes.”

  “That certainly is dedication,” Jill said.

  “Frankly, I’m overdue for a little TLC in my life. I divorced two jocks because they were skirt chasers. Well, hah, husband number three leaves the girls alone, but he’s firing blanks! He - ”

  “Another question,” Jill interrupted. “In the course of your treatment were you seen by other members of the Genetic Counseling Committee?”

  “Of course.” A pause. Time out for what must have been a long pull, a swallow, then: “They all have a go at you, at your artificial insemination I mean. It took four damn tries.”