Vital Signs

by Robin Cook

  “Ah, there we go!” Dr. Wingate said with satisfaction. His eyes were glued to the cathode-ray-tube screen.

  “Want me to see what the emergency is?” Dr. Arthur asked.

  “It can wait,” Dr. Wingate said. “Let’s get some eggs.”

  For the next half hour, time seemed to crawl. Marissa was sleepy but unable to sleep under the torturous probing.

  “All right,” Dr. Wingate said at last. “That’s the last of the visible follicles. Let me take a look at what we’ve gotten.”

  Laying the probe aside and stripping off his gloves, Dr. Wingate disappeared with the nurse-technician into the other room to examine the aspirate under a microscope.

  “Are you okay?” Dr. Arthur asked Marissa.

  Marissa nodded.

  Within a few minutes, Dr. Wingate came back into the room. He had a broad smile. “You were a very good girl,” he said. “You produced eight fine-looking eggs.”

  Marissa breathed out audibly and closed her eyes. Although she was happy about getting eight eggs, it hadn’t been a good morning. She felt drugged and exhausted and, with the stress of the procedure gone, Marissa soon lapsed into a troubled, drugged sleep. She was only vaguely aware of being moved to a gurney and being transported across the glass-enclosed walkway to the clinic’s overnight ward. She woke up briefly to help switch herself from the gurney to a bed where she at last sank into a deeper, Valium-induced sleep.

  Of all the sundry responsibilities and duties of running the Women’s Clinic, Dr. Norman Wingate’s heart rested firmly with his work associated directly with the biological part of the in-vitro fertilization unit. As an MD, PhD, cellular biology held the strongest intellectual appeal. And as he gazed at Marissa’s ova through the lenses of his dissecting microscope, he was filled with pleasure and utter awe. There, within his field of vision, was the unbelievable potential of a new human life.

  Marissa’s eggs were indeed fine specimens, attesting to the expert administering of the hormones she’d been given during the ovarian hyperstimulation period. Dr. Wingate carefully inspected each of the eight eggs. They were all quite mature. Reverently, he placed them in a previously prepared, slightly pink culture medium within Falcon organ culture dishes. The dishes were then placed in an incubator that controlled the temperature and the gaseous concentrations.

  Turning his attention to Robert’s sperm, which had been allowed to liquefy, Dr. Wingate started the process of capitation. A perfectionist, he preferred to do all the cellular biology himself. The efficacy of in-vitro fertilization was as much an art of the individual investigator as it was a science.

  “Dr. Wingate!” Mrs. Hargrave called, coming into the lab. “I’m sorry to bother you, but there’s been another development with the Rebecca Ziegler case that needs your attention.”

  Dr. Wingate looked up from his work. “Can’t you handle it?” he asked.

  “It’s the press, Dr. Wingate,” Mrs. Hargrave said. “There’s even a mobile TV news crew. You’d better come.”

  Reluctantly, Dr. Wingate looked at the flask containing Robert’s sperm. He hated it when his bureaucratic responsibilities interrupted his biological work. But as the director of the clinic, he had little choice. He glanced up at the nurse-technician. “This is your chance,” he said to her. “Go ahead and finish the capitation, the concentration, and the ‘swim up.’ You’ve seen me do it often enough, so go to it. I’ll be back as soon as I can.” Then he turned and left the room with Mrs. Hargrave.

  “Mrs. Buchanan! Hello! Mrs. Buchanan! Are you with us?” a friendly voice called.

  From the depths of a disturbing dream, Marissa became aware of the voice calling to her. She had been dreaming that she was stranded in the middle of a barren landscape. At first she tried to incorporate the voice into the dream, but the nurse was determined to rouse her.

  “Mrs. Buchanan, your husband is here!”

  Marissa opened her eyes. She was staring directly into the broadly smiling face of a nurse. The nurse’s name tag read “Judith Holiday.” Marissa blinked to bring the rest of the room into focus. It was then she saw Robert standing behind the nurse, his Burberry coat over his arm.

  “What time is it?” Marissa asked as she pushed herself up on an elbow. It felt as if she had only just gone to sleep. Surely Robert couldn’t have had time to have his meeting and get back.

  “It’s four-fifteen in the afternoon,” Judith said as she wrapped a blood pressure cuff around Marissa’s arm and blew it up.

  “How do you feel?” Robert asked.

  “Okay, I guess,” Marissa said. She wasn’t entirely sure. The Valium was still in her system. Her mouth felt as dry as the desert landscape in her dream. She was amazed that the day had passed so quickly.

  “Vital signs are okay,” Judith said as she removed the cuff. “If you’re up to it, you’re free to go on home.”

  Marissa swung her legs over the side of the bed. She felt a momentary dizzy sensation. It reoccurred when she slid off the bed and her feet touched the cold floor.

  “How do you feel?” Judith asked her.

  Marissa said she was all right, just feeling a little weak. She took a drink from a glass on the side table. She felt better.

  “Your clothes are in the closet,” Judith said. “Will you need any help?”

  “I don’t think so,” Marissa said. She smiled weakly at the friendly and helpful nurse.

  “Just yell if you do,” Judith said as she backed out the door. She closed it, but not all the way. It stood ajar by about three inches.

  “Let me,” Robert said as he saw Marissa start toward the closet.

  Twenty minutes later, Marissa found herself walking unsteadily down the front steps of the clinic. She got into the passenger side of Robert’s car. Her body felt heavy and all she could think about was getting home and climbing into bed. She looked out at the rush-hour Harvard Square traffic with a sense of detachment. It was beginning to get dark. Most of the cars already had their lights on.

  “Dr. Wingate told me your egg retrieval went very well,” Robert said.

  Marissa nodded and looked across at him. His sharp profile was silhouetted against the evening lights. He didn’t look at her.

  “We got eight eggs,” she said, emphasizing the “we.” She studied him to assay his response. She was hoping he’d pick up on her meaning. Instead, he changed the subject.

  “Did you hear about the tragedy at the clinic?”

  “No!” Marissa said. “What tragedy?”

  “Remember that woman who hit me?” Robert asked, as if Marissa could have forgotten. “The one carrying on in the waiting room when we arrived? She apparently committed suicide. Took a swan dive from the sixth floor into one of the flower beds. It was on the noon news.”

  “My God!” Marissa said. She remembered too well her own vivid identification with the woman. She had understood the woman’s frustration, feeling it so frequently herself.

  “Did she die?” Marissa asked, half hoping there was a chance that the woman had not succeeded.

  “Instantly,” Robert said. “Some poor patient on her way into the clinic saw the whole thing. Said the lady was sitting on a window ledge, then just dove headfirst.”

  “That poor woman,” Marissa said.

  “Which one?” Robert asked.

  “Both,” Marissa said, although she had been referring to Rebecca Ziegler.

  “I’m sure you’ll tell me this also isn’t the right time to talk about this in-vitro protocol,” Robert said. “But having that lady go berserk like she did underlines what I was feeling this morning. Clearly we’re not the only ones to feel the pressure. I really think we should stop this infertility stuff after this cycle. Think about what it’s doing to your practice.”

  The last thing Marissa cared to think about was her pediatric practice. “I’ve spoken candidly with the director of my group and he understands,” Marissa explained, not for the first time. “He’s sympathetic to what I am going through, even if
other people aren’t.”

  “That’s fine for the director to say,” Robert said. “But what about your patients? They must be feeling abandoned.”

  “My patients are all being taken care of,” Marissa snapped. In truth, she had been concerned about them.

  “Besides,” Robert added, “I’ve had it with this ‘performing’ stuff. Going into that clinic and getting that plastic cup is demeaning.”

  “Demeaning?” Marissa echoed, as if she’d not heard correctly. Despite the Valium, she found herself once again strongly provoked. After she had suffered that very day through a painful and risky procedure, she could hardly believe that Robert was making an issue of his brief, painless contribution to the process. She tried to restrain herself, but she couldn’t help speaking her mind. “Demeaning? You find it demeaning? And how would you find spending a day flat on your back with your legs spread before an array of your colleagues while they poke and probe?”

  “My point exactly,” said Robert. “I didn’t mean to suggest this has been easy for you. It’s been tough on us both. Too tough. Too tough for me, anyway. I want to call it quits. Now.”

  Marissa stared ahead. She was angry and she knew Robert was. They seemed to be quarreling constantly. She watched the road ahead as it sped toward her. They stopped at the toll booth on the entrance to the Mass. Pike. Robert slammed the coins into the hopper with an angry gesture.

  After ten minutes of driving in silence, Marissa had significantly calmed down. She turned to Robert and told him that Mrs. Hargrave had come to visit her that afternoon. “She was very sympathetic,” Marissa said. “And she had a recommendation.”

  “I’m listening,” Robert said.

  “She suggested that we avail ourselves of the counseling services that the clinic offers,” Marissa said. “I think it might be a good idea. As you said, others in our circumstances have been feeling the pressures. Mrs. Hargrave told me many people have found counseling to be a great help.” Although she’d not been excited about the suggestion initially, the more Marissa thought about it, especially seeing how she and Robert were getting along, the better it sounded. They needed help; that much was obvious.

  “I don’t want to see a counselor,” Robert said, leaving no room for discussion. “I’m not interested in investing more time and money for someone to tell me why I’m fed up with a process that’s guaranteed to make us unhappy and put us at each other’s throats. We’ve spent enough time, effort, and money already. I hope you are aware that we’ve already spent over fifty thousand dollars.”

  They lapsed back into silence again. After a few miles, Robert broke it. “You did hear me, didn’t you? Fifty thousand dollars.”

  Marissa turned to him, her cheeks flushed. “I heard you!” she snapped. “Fifty thousand, a hundred thousand. What does it matter if it is our only chance to have our child? Sometimes I don’t believe you, Robert. It’s not as if we are hurting. You had enough to buy this silly expensive car this year. I really wonder about your priorities.”

  Marissa faced around front again, angrily folding her arms across her chest and sinking into her own thoughts. Robert’s business mentality was so contrary to her own, she wondered how they had ever become attracted to each other in the first place.

  “Contrary to you,” Robert said as they neared the house, “fifty thousand seems like a lot of money to me. And we have nothing to show for it save for some ill feelings and a disintegrating marriage. Seems a heavy price to pay, at both ends. I’m getting to hate that Women’s Clinic. I’ve never felt comfortable there. And being attacked by a distraught patient didn’t help. And did you see that guard?”

  “What guard?” Marissa asked.

  “The guard who came in with the doctors when the lady was carrying on. The Asian guy in the uniform. Did you notice he was armed?”

  “No, I didn’t notice he was armed!” Robert had an infuriating way of changing the subject with insignificant details. Here they were struggling with their relationship and their future, and he was thinking about a guard.

  “He had a .357 Colt Python,” Robert said. “Who does he think he is, some kind of Asian Dirty Harry?”

  Switching on the light, Dr. Wingate entered his beloved lab. It was after eleven P.M. and the clinic was deserted. Across the street in the overnight ward and in the emergency room there was staff, but not in the main clinic building.

  Taking off his coat, Dr. Wingate slipped on a clean white lab coat, then washed his hands carefully. He could have waited for morning, but after getting the eight superb mature eggs from Marissa that day, he was eager to check on their progress.

  That afternoon, after having dealt with the unfortunate Rebecca Ziegler affair as best he could, he’d returned to the lab to find that the nurse-technician had done a fine job preparing the sperm. By two P.M. all eight eggs had been placed in a meticulously prepared insemination medium contained in separate organ culture dishes. To each dish Dr. Wingate had carefully added roughly 150,000 capitated, mobile sperm. The eggs and the sperm had then been co-incubated in 5% CO2 with 98% humidity at 37 degrees Centigrade.

  Turning on the light for his dissecting microscope, Dr. Wingate opened the incubator and removed the first dish. Placing it under the scope, he looked in.

  There, in the middle of the microscopic field, was the beautiful egg, still surrounded by its corona cells. Looking more closely as he deftly handled a micropipette, Dr. Wingate experienced the thrill of creation as he observed two pronuclei within the ooplasm of the egg. The egg had fertilized and looked entirely normal.

  Repeating the procedure with the other dishes, Dr. Wingate was extremely pleased to see that all the eggs had fertilized normally. There had been no polyspermic fertilization, in which more than one sperm penetrates the egg.

  Working deliberately, Dr. Wingate transferred the fertilized oocytes to fresh growth medium containing a higher concentration of serum. Then all the fertilized eggs went back into the incubator.

  When he was finished, Dr. Wingate went to the phone. Despite the hour, he called the Buchanan residence. He reasoned it was never too late to relay good news. After the fifth ring, he wondered if he’d made a mistake. By the sixth ring, he was about to hang up when Robert answered.

  “Sorry to be calling so late,” Dr. Wingate said.

  “No problem,” Robert said. “I was in my study. This is my wife’s line.”

  “I have some good news for you folks,” Dr. Wingate said.

  “We can use a bit of that,” Robert said. “Hold on, I’ll wake Marissa.”

  “Maybe you shouldn’t wake her,” Dr. Wingate said. “You can tell her in the morning or I’ll call back then. After what she’s been through today, perhaps we should let her sleep.”

  “She’ll want to hear,” Robert assured him. “Besides, she can go right back to sleep. That’s never been one of her problems. Hang on.”

  A few moments later, Marissa’s tired voice came over the line as she picked up an extension.

  “Sorry to wake you up,” Dr. Wingate said, “but your husband assured me you wouldn’t mind.”

  “He said you had some good news?”

  “Indeed,” Dr. Wingate said. “All eight eggs fertilized already. It was very quick, and I’m optimistic. Usually only eighty percent or so fertilize at best. So you got a particularly healthy crop.”

  “Wonderful,” Marissa said. “Does this suggest the transfer is more likely to be successful?”

  “I’ll have to be honest,” Dr. Wingate said. “I don’t know if there is any association. But it can’t hurt.”

  “What made it different this time?” Marissa asked. In the last cycle none of the eggs had fertilized.

  “I wish I knew,” Dr. Wingate confided. “In some respects, fertilization remains a mystifying process. We don’t know all the variables.”

  “When will we do the transfer?” Marissa asked.

  “In forty-eight hours or so,” Dr. Wingate said. “I’ll check the embryos tomorrow and se
e how they are progressing. As you know, we like to see some divisions.”

  “And you’ll be transferring four embryos?”

  “Exactly,” Dr. Wingate said. “As we’ve already discussed, experience has shown that more than four has a higher risk of resulting in a multiple pregnancy without significantly raising the efficacy of the transfer. The other four embryos we’ll freeze. With this many good eggs, you can have two transfers without having to undergo another hyperstimulation.”

  “Let’s hope this transfer is successful,” Marissa said.

  “We’ll all be hoping for the best.”

  “I was sorry to hear about the woman who killed herself,” Marissa said. The tragedy had been on her mind all evening. She wondered how many cycles the poor Ziegler woman had endured. Having identified with the woman, she was already anticipating the psychological effect of yet another failure. Since there had been so many in the past, she had trouble being optimistic. Would another failure push her beyond her limits?

  “It was a terrible tragedy,” Dr. Wingate said. His previously enthusiastic tone became somber. “We were all crushed. The staff is usually adept at picking up such symptoms of depression. Until her outburst yesterday, we had no indication Rebecca Ziegler was so distraught. Apparently she and her husband had separated. We’d tried to get them into counselling, but they wouldn’t go.”

  “How old was she?” Marissa asked.

  “Thirty-three, I believe,” Dr. Wingate said. “A tragic loss of a young life. And I’m concerned about its effect on other patients. Infertility is an emotional struggle for everyone involved. I’m sure it didn’t help your state of mind seeing Mrs. Ziegler’s outburst in the waiting room.”

  “I identified with her,” Marissa admitted. Especially now, Marissa thought, hearing about the woman’s marital problems. She and Rebecca were even close in age.

  “Please don’t say that,” Dr. Wingate said. “On a happier note, let’s look forward to a successful embryo transfer. It’s important to stay positive.”

  “I’ll try,” Marissa said.