Vital Signs

by Robin Cook

  All at once Marissa felt hurt that Robert had not been more concerned and that he had taken her at her word when she’d said she’d be perfectly fine going to the clinic by herself. Looking around the room again, Marissa saw that most of the other patients were accompanied by their spouses or boyfriends.

  “You’re being ridiculous,” Marissa silently chided herself as she tried to keep her emotions in check. She was surprised and a little embarrassed. It was not like her to be so hysterical. She liked to think she wasn’t easily upset. Besides, she knew that Robert couldn’t have come with her even if he’d wanted to. That morning he had an important meeting of the executive staff of his health care management, investment, and research company. It was a critical meeting that had been planned months in advance.

  “Marissa Blumenthal!” a nurse called.

  Marissa jumped up, placed the magazine on the side table, and followed the nurse down a long, blank white corridor. She was shown into a changing room with an inner door opening into one of the procedure rooms. From her vantage point in the changing area, Marissa could see the table with its gleaming, stainless steel stirrups.

  “Just to be on the safe side,” the nurse said as she twisted Marissa’s wrist to check her ID. Satisfied she had the right patient, she patted some clothes on a bench and added: “Slip into this johnny, slippers, and robe and hang your clothes in the closet. Any valuables can be locked in the drawer. When you’re done, go in and sit on the examining table.” She smiled. The woman was professional, but not without warmth. She closed the door to the hall behind her.

  Marissa stepped out of her clothes. The floor was cold on her bare feet. As she struggled to tie the straps of the johnny behind her, she acknowledged how much she liked the staff at the Women’s Clinic, from the receptionists to her doctor. But the main reason she patronized the clinic was because of its private status and the consequent confidentiality it had to offer. Now that she was having a biopsy, she was even more thankful for her choice. Had she gone to any one of the major Boston hospitals, especially her own hospital, the Boston Memorial, she would have undoubtedly come in contact with people she knew.

  Marissa had always been careful to keep her private life private. She never wanted personal matters like birth control, annual pelvic exams, a couple of episodes of cystitis and the like to be topics of gossip with her colleagues. And even if people didn’t talk, she did not want to worry about passing her GYN man in the hospital corridor or in the hospital cafeteria.

  The flimsy robe, the open-backed hospital johnny, and the paper slip-on slippers completed Marissa’s transition from doctor to patient. With her ill-fitting slippers flopping, she padded into the procedure room and sat on the edge of the examining table as instructed by the nurse.

  Glancing around at the usual accoutrements which included an anesthesia machine and cabinets of instruments, her panic swelled anew. Beyond her fear of the procedure, and the possible need for a hysterectomy she kept reminding herself was remote, Marissa now felt a strong intuition of disaster. She realized how much she had come to prize her life, particularly in the last few years. Between her new husband, Robert, and her recent acceptance into a fine pediatric group, her life seemed to be going almost too well. She had so much to lose; it made her terrified.

  “Hello there, I’m Dr. Arthur,” a burly man said as he entered the room with a purposeful flourish, clutching a handful of cellophane-covered packages and an IV bottle. “I’m from anesthesia, and I’ll be giving you something for your upcoming procedure. Allergic to anything?”

  “Nothing,” Marissa assured the man. She was glad for the company, relieved to have someone take her away from her own thoughts.

  “We’ll probably not need this,” Dr. Arthur said as he deftly started an IV in Marissa’s right wrist. “But it’s good to have it just in case. If Dr. Carpenter needs more anesthesia, it can be given easily.”

  “Why would he need more anesthesia?” Marissa asked nervously. She watched the droplets of fluid fall in the micropore filter. She’d never had an IV before.

  “What if he decides to do a cone biopsy rather than a punch?” Dr. Arthur replied as he slowed the IV to a mere trickle. “Or if he decides to do any more extensive procedure? Obviously we’d have to give you something in addition. After all, we want this to be as pleasant as possible.”

  Marissa shuddered at the term “more extensive procedure.” Before she could stop herself she blurted out, “I want to make it absolutely clear that I only signed a consent for a biopsy and not anything more extensive like a hysterectomy.”

  Dr. Arthur laughed, then apologized for finding her reminder humorous. “No need to worry on that score,” he said. “We certainly don’t do hysterectomies in the minor procedure room.”

  “What will you be giving me?” Marissa asked sheepishly.

  “You want to know the specific drugs I’ll be using?” Dr. Arthur asked.

  Marissa nodded. No one at the clinic knew she was a doctor, and Marissa preferred it that way. When she’d first signed up for the clinic’s services, she’d filled out a form which only asked for her employer. She’d listed the Boston Memorial since at the time she was taking a year of fellowship in pediatric endocrinology. The fact that she was a physician wasn’t a secret and if they asked her, she’d certainly have told them. But no one had asked, a fact she took as further confirmation of the kind of confidentiality she had come to expect of the clinic.

  Dr. Arthur looked puzzled for a moment, shrugged, then replied. “I’ll be using a mixture of a small amount of Valium and a drug called ketamine.” He then cleaned up the remains of the IV paraphernalia. “It’s a good little cocktail. It’s great for pain, and it has the added appeal of occasionally providing a touch of amnesia.”

  Marissa was aware of ketamine. It was used frequently at the Boston Memorial for dressing changes with burned children. But she wasn’t aware of its use in outpatient settings. When she mentioned this to Dr. Arthur, he smiled paternalistically.

  “Been doing a little reading, huh?” he teased. Then he warned:

  “Remember, a little knowledge is a dangerous thing. Actually, the outpatient environment is the most common use for the drug.” He stared at Marissa. “My, you do seem a little tense.”

  “I’ve been trying to fight it,” Marissa admitted.

  “I’ll give you a hand,” Dr. Arthur offered. “Let’s give you a little taste of Valium and ketamine right now.” He went to fetch a syringe from the cabinet. “This biopsy stuff is a piece of cake,” he called over his shoulder.

  Marissa nodded without enthusiasm. She had already tired of the pastry metaphor. The fact was that she was nervous, and despite having felt a bit better when Dr. Arthur first appeared, now she felt decidedly worse. His offhand manner of referring to more extensive procedures had not left her feeling reassured. Again, her intuition began sending out alarms of imminent disaster. Marissa had to fight against the irrational urge to flee. “I’m a doctor,” she silently repeated to herself over and over again. “I shouldn’t be feeling like this.”

  The door to the hall burst open. In swept Dr. Ronald Carpenter dressed in surgical scrubs which included a hat and a mask. With him was a woman also in scrub clothes although her mask was draped down over her chest.

  Marissa recognized Dr. Carpenter immediately despite the mask. His bright, crystal-blue eyes and tanned skin were unmistakable. “This is only a biopsy?” Marissa questioned nervously. Dr. Carpenter was dressed for major surgery.

  “Miss Blumenthal is nervous about having a hysterectomy,” Dr. Arthur explained, snapping the side of a needle to release the air bubbles. He returned to Marissa’s side.

  “Hysterectomy?” Dr. Carpenter asked with obvious confusion. “What are you talking about?”

  Dr. Arthur raised his eyebrows. “I think our patient here has been doing a little reading.” He picked up the IV tubing and injected the contents of the syringe. Then opened the IV to flow rapidly for a moment.


  Dr. Carpenter stepped over to Marissa and put his hand on her shoulder. He looked into her dark brown eyes. “We’re only doing a simple biopsy. There’s been no talk of a hysterectomy. If you are wondering about my clothes, I’ve just come from surgery. The mask is because I have a cold and don’t want to spread it to any of my patients.”

  Marissa looked up into Dr. Carpenter’s bright blue eyes. She was about to reply when the blue brought back a memory that she’d been long suppressing: the terror of being attacked in a hotel room in San Francisco a few years earlier and the horror of having to stab a man repeatedly to save her own life. At that moment the episode came back to her with such startling clarity, she could actually feel the man’s hands around her throat. Marissa started to choke. The room began to spin and she heard a buzzing noise that gradually got louder.

  Marissa felt hands grabbing at her, forcing her down on her back. She tried to fight since she felt she could breathe easier if she were upright, but it was to no avail. Her head touched the examination table, and as soon as it did, the room stopped spinning and her breathing became easier. Suddenly she realized her eyes were closed. When she opened them, she was looking up into the faces of Dr. Arthur, the woman, and the masked face of Dr. Carpenter.

  “Are you okay?” Dr. Carpenter asked.

  Marissa tried to speak but her voice wouldn’t cooperate.

  “Wow!” Dr. Arthur said. “Is she ever sensitive to the anesthetic!” He quickly took her blood pressure. “At least that’s okay. I’m glad I didn’t give her the whole dose.”

  Marissa closed her eyes. At last she was calm. She heard more conversation, but it sounded as if it were someplace in the distance and didn’t involve her. At the same time she felt as if an invisible lead blanket were settling over her. She felt her legs being lifted, but she didn’t care. Then the voices in the room receded further. She heard laughter and then a radio. She felt instruments and heard the sound of metal hitting metal.

  She relaxed until she felt a cramp like a menstrual cramp. It was pain but not normal pain in that it was more alarming than uncomfortable. She tried to open her eyes but her lids felt heavy. Again she tried to open her eyes but quickly gave up. It was like a nightmare from which she could not awaken. Then there was yet another cramp, sharp enough to bring her head off the examining table.

  The room was a drug-induced blur. She could just make out the top of Dr. Carpenter’s head as he worked between her draped knees. The colposcope was pushed to the side on his right.

  The sounds of the room still came to her as if from a great distance, although now they had a peculiar, echoing quality. People in the room were moving in slow motion. Dr. Carpenter raised his head as if he could sense her eyes on him.

  A hand grasped Marissa’s shoulder and eased her back. But as she lay down, her numbed mind replayed the blurred image of Dr. Carpenter’s masked face and, despite her drugged state, a shiver of terror coursed through her veins. It was as if her doctor had metamorphosed into a demon. Instead of his eyes being crystal blue, they had become distorted. They appeared to be made of black onyx as dense as stone.

  Marissa started to scream but she held herself in check. Some part of her brain was rational enough to remind her that all her perceptions were being altered by the medication. She tried to sit up again to take another look for reassurance, but hands restrained her. She fought against the hands, and once again her mind took her back to the hotel room in San Francisco when she’d had to fight with the killer. She remembered hitting the man with the telephone receiver. She remembered all the blood.

  Unable to contain herself any longer, Marissa screamed. But no sound came out. She was on the edge of a precipice and slipping. She tried to hold on but she slowly lost her grip, falling into blackness . . . .

  February 27, 1988

  “Damn!” Marissa said as her eyes rapidly roamed her office. She could not imagine where she could have put her keys. For the tenth time she pulled open her central desk drawer, the place where she always put them. They weren’t there. Irritated, she shuffled through the contents of the drawer, then slammed it.

  “Holy Toledo!” she said as she looked at her watch. She had less than thirty minutes to get from her office over to the Sheraton Hotel where she was scheduled to receive an award. Nothing seemed to be cooperating. First she had an emergency: six-year-old Cindy Markham with a severe asthma attack. Now she could not find her keys.

  Marissa pursed her lips with frustration and tried to retrace her steps. Suddenly she remembered. She’d taken home a bunch of charts the night before. Stepping over to the file cabinet, she saw the keys immediately. She snatched them up and headed for the door.

  She got as far as her hand on the doorknob when the phone rang. At first she was tempted to ignore it, but her conscience quickly intervened. There was always a chance it involved Cindy Markham.

  With a sigh, Marissa went to her desk and leaned over to pick up the receiver. “What is it?” she asked with uncharacteristic curtness.

  “Is this Dr. Blumenthal?” the caller queried.

  “This is she,” Marissa said. She didn’t recognize the voice. She had expected her secretary, who was aware of her time constraint.

  “This is Dr. Carpenter,” said the caller. “Do you have a minute?”

  “Yes,” Marissa lied. She felt a rush of anxiety, having expected his call over the last few days. She held her breath.

  “First I’d like to congratulate you on your award today,” Dr. Carpenter said. “I didn’t even know you were a physician, much less an award-winning researcher. It’s kind of embarrassing to find out about your patients in the morning paper.”

  “Sorry,” said Marissa. “I guess I could have said.” She looked at her watch.

  “How on earth did a pediatrician get involved doing research on Ebola Hemorrhagic Fever?” Dr. Carpenter asked. “It sounds pretty esoteric. Let me see, I have the newspaper right here. ‘The Peabody Research Award goes to Dr. Marissa Blumenthal for the elucidation of the variables associated with the transmission of Ebola virus from primary to secondary contacts.’ Wow!”

  “I spent a couple of years at the CDC in Atlanta,” Marissa explained. “I got assigned to a case where Ebola virus was being intentionally spread in HMOs.”

  “Of course!” Dr. Carpenter said. “I remember reading about that. My God, was that you?”

  “Afraid so,” Marissa said.

  “As I recall, you almost got killed!” Dr. Carpenter said with obvious admiration.

  “I was lucky,” Marissa said. “Very lucky.” She wondered what Dr. Carpenter would have said if she told him that during her biopsy his blue eyes had reminded her of the man who had tried to kill her.

  “I’m impressed,” Dr. Carpenter admitted. “And I’m glad to have some good news for you. Usually my secretary makes these calls, but after reading about you this morning, I wanted to call myself. The biopsy specimens were all fine. It was merely a mild dysplasia. As I told you that day, the culdoscopy suggested as much, but it is nice to be a hundred percent certain. Why don’t you schedule a follow-up Pap smear in four to six months? After that, we can let you go for a year at least.”

  “Great,” said Marissa. “I will. And thanks for the good news.”

  “My pleasure,” Dr. Carpenter said.

  Marissa shifted her feet. She was still embarrassed by her behavior at the biopsy. Gathering her courage, she apologized again.

  “Hey, don’t give it another thought,” Dr. Carpenter said. “But after your experience I’ve decided I don’t like that ketamine stuff. I told anesthesia not to use it on any more of my cases. I know the drug has some good points, but I’ve had a couple of other patients with bad trips like yours. So please don’t apologize. But tell me, have you had any other problems since the biopsy?”

  “Not really,” Marissa said. “The worst part of the whole experience was the drug-induced nightmare. I’ve even had the same dream a couple more times since the biopsy.”


  “I’m the one who should be apologizing,” Dr. Carpenter said. “Anyway, next time we won’t give you ketamine. How’s that for a promise?”

  “I think I’ll be steering clear of doctors for a while,” Marissa said.

  “That’s a healthy attitude,” Dr. Carpenter said with a laugh. “But as I said before, let’s see you back in four months or so.”

  Hanging up the phone, Marissa rushed from her office. She waved hastily to her secretary, Mindy Valdanus, then repeatedly hit the Down elevator button. She had fifteen minutes to get to the Sheraton, an impossible feat given Boston traffic. Yet she was pleased with her conversation with Dr. Carpenter. She had a good feeling about the man. She had to chuckle when she thought about the sinister creature he had been transformed into in her nightmare. It amazed her what drugs could do.

  At last the elevator arrived. Of course the best thing about the phone conversation was learning that the cervical biopsy was normal. But then a stray thought cropped up as the elevator descended to the garage. What would she do if the next Pap smear proved to be abnormal?

  “Damn!” she said aloud, dismissing the gloomy thought. There was always something!

  1

  March 19, 1990

  7:41 A.M.

  Marissa stopped in her tracks in the middle of the elegant Oriental carpet that dominated the master bedroom. She was on her way to her walk-in closet to retrieve the dress that she had chosen the night before. The TV was on in the massive French armoire set against the wall opposite the king-sized bed; its doors were propped open by books. The television was tuned to Good Morning America. Charlie Gibson was joking about baseball spring training with Spencer Christian. Weak winter sunlight spilled into the room through half-open curtains. Taffy Two, Marissa and Robert’s cocker spaniel, was whining to be let out.

  “What did you say?” Marissa called to her husband, who was out of sight in the master bath. She could hear the shower running.