Vital Signs

by Robin Cook

As soon as Marissa had mentioned this shocking possibility, she regretted it. There were a number of reasons she shouldn’t have said anything, her promise to Ken foremost among them. She tried to change the subject to tuberculosis, but Robert wouldn’t let it go.

  “I think you’d better explain,” he insisted.

  Realizing her mistake, Marissa decided she had no choice but to tell the whole story. After she’d finished, Robert sat back in his chair and looked at Gustave. “You’re a doctor,” he said. “What do you think of what you just heard?”

  “Circumstantial,” Gustave said. “Personally, I think those two pathologists are letting their forensic imaginations run wild. As they said themselves, there is no concrete proof. They have a ruptured aorta. That certainly is lethal. Probably the heart was in diastole at the moment of impact, so that it was filling when it was shocked into stopping. The only bleeding came from backflow, meaning the blood that was in the aorta itself.”

  “Sounds reasonable to me,” Robert said.

  “Gustave is probably right,” Marissa agreed, glad to get off the subject. She wasn’t about to bring up her own question regarding the fact that Rebecca had hardly acted depressed in the waiting room.

  “Even so,” Marissa continued, “Rebecca’s death makes us even more eager to access the Women’s Clinic’s computer. I’d love to read what’s in her record; what she saw had to contribute to her death.”

  “Maybe we could find some whiz-kid hacker over at MIT,” Wendy said. “It would be classic if we could get at their files from off-site.”

  “That would be fantastic,” Marissa agreed. “But what’s more realistic is for you and me to sneak in there at night and just use one of the terminals. Someone could do that at the Memorial with only a little creativity.”

  “Hold on,” Robert said. “You guys are getting way out of hand. Unauthorized access of someone’s private computer files is considered grand theft in Massachusetts. If you do something crazy like that, you could find yourselves felons.”

  Marissa rolled her eyes.

  “That’s no joke,” Robert said. “I don’t know what’s in your minds.”

  “Wendy and I happen to think this TB salpingitis is extremely significant,” Marissa told him. “We think it ought to be followed up. We seem to be the only ones willing to do it. Sometimes risks have to be taken.”

  Gustave cleared his throat. “I’m afraid I’m in agreement with Robert on this one,” he said. “You can’t be serious about breaking into the clinic files. Despite your motivations, it would be a crime nonetheless.”

  “The problem is truly one of priorities,” Marissa said. “You men don’t realize how important this issue could be. By following up on it we are being responsible, not the reverse.”

  “Maybe we should change the subject,” Wendy suggested.

  “I think it should be settled before you women get into serious trouble,” Gustave said.

  “Be quiet, Gustave!” Wendy snapped.

  “These five cases may be the tip of an iceberg,” Marissa said. “As I’ve already said, it reminds me of the discovery of toxic shock syndrome.”

  “That’s not a fair comparison,” Robert said. “It’s not like anyone’s died.”

  “Oh yeah?” Marissa challenged. “What about Rebecca Ziegler?”

  7

  March 30, 1990

  8:15 A.M.

  Robert opened the mahogany-paneled door to his private office in the old City Hall building and stepped inside. He tossed his briefcase onto the couch and stepped over to the window. His view out onto School Street was marred by rivulets of water streaming across the outside of the window. He’d never experienced such a rainy March in Boston.

  Behind him he heard his private secretary, Donna, come into the room, bringing his usual morning coffee and his usual stack of phone messages.

  “Some weather!” Donna said. Her strong Boston accent made the word sound like “wethah.”

  Robert turned. Donna had seated herself to the left of his desk to go over the phone messages, which was their usual routine. Robert looked at her. She was a big girl, almost five-ten. In her heels, she practically looked him in the eye. Her hair was dyed blonde, the dark roots clearly visible. Her features were rounded but not unpleasant, and her body was toned from daily aerobic exercise. She was a great secretary: honest, devoted, and dependable. She also had simple needs, and for a moment Robert wondered why he hadn’t married someone like Donna. Life would have been so much more predictable.

  “Would you like sugar in your coffee?” she asked pleasantly. Coffee sounded more like “cawfee.”

  “No, I don’t want coffee,” Robert said sharply.

  Donna looked up from her notes. “Aren’t we testy this morning,” she said.

  Robert rubbed his eyes, then came around and sat down at his desk. “I’m sorry,” he said to Donna. “My wife is driving me crazy.”

  “Is it that infertility stuff?” Donna asked timidly.

  Robert nodded. “She began to change just about the time we admitted that we might have a problem,” he said. “Now, between this in-vitro fertilization rigmarole and all the hormones she’s on, she is truly out of control.”

  “I’m sorry,” Donna said.

  “To make matters worse, she’s met up with an old medical school friend who’s in the same situation and who is behaving equally irrationally,” Robert said. “They seem to be feeding off each other. Now they are threatening to break into a health care clinic to get into their records. Unfortunately, I have to take her seriously in the state of mind she’s in. I wouldn’t put anything past her. But what can I do? And, on top of everything, this clinic has guards armed with Colt Pythons. I’m really worried about her.”

  “They have snakes at this clinic?” Donna asked, wide-eyed.

  “Huh? No, not snakes. A Colt Python is a revolver capable of stopping a black rhino.”

  “I can give you some advice,” Donna said. “If you’re really worried about what Marissa might do, you should hire a private investigator for a few days. He could keep her out of trouble if she is really inclined in that direction. And I happen to know someone who is very good. I used him to follow my former husband. The bum was having an affair with two women at the same time.”

  “What’s this investigator’s name?” Robert asked. The idea of having Marissa followed hadn’t occurred to him, but it had some merit.

  “Paul Abrums,” Donna said. “He’s the best. He even got photos of my ex in bed with both girls. Separately, of course. My husband wasn’t that kind of guy. And Paul’s not that expensive.”

  “How do I get in touch with him?” Robert asked.

  “I’ve got the number in my address book in my purse,” Donna said. “I’ll get it.”

  Marissa peered into the otoscope to try to catch a glimpse of the eardrum of the writhing infant on the examination table. The mother was attempting to hold the baby but was doing a miserable job. Annoyed, Marissa gave up.

  “I can’t see anything,” Marissa said. “Can’t you hold the child, Mrs. Bartlett? She’s only eight months. She can’t be that strong.”

  “I’m trying,” the mother said.

  “Trying isn’t good enough,” Marissa told her. She opened the examination room door and called for one of the nurses.

  “I’ll send someone in as soon as I can,” Muriel Samuelson, the head nurse, shouted.

  “For heaven’s sake,” Marissa muttered to herself. She was finding work exasperating. Everything was an effort, and it was difficult to concentrate. All she could think about was the pregnancy test she’d have after the weekend.

  Stepping out of the examination room to get away from the shrieking infant, Marissa massaged the back of her neck. If she was this anxious already, what would it be like on Monday when she was waiting for the result?

  The other topic on her mind was what she and Wendy were going to do about the Women’s Clinic. They had to get into their records. That morning she’d gone t
o the medical records department at the Memorial and gotten one of the women to start a search for cases of granulomatous obstruction of the fallopian tubes. There’d been no problem. If only the Women’s Clinic could be so cooperative.

  “Dr. Blumenthal, you have a call on line three,” Muriel yelled to her over the sound of crying babies.

  “What now?” Marissa muttered under her breath. She went into an empty examination cubicle and picked up the extension. “Yes?” she snapped, expecting Mindy Valdanus to be on the other end.

  “Dr. Blumenthal?” a strange woman’s voice questioned. It was the operator.

  “Yes?” Marissa repeated.

  “Go ahead,” the operator said.

  “You sound harried,” Dubchek said.

  “Cyrill!” Marissa answered. “You’re a pleasant surprise in the middle of a bad day. This place is a zoo!”

  “Can you talk for a sec or do you want to ring me back?” Dubchek asked.

  “I can talk,” Marissa said. “Actually, at the moment I’m standing and waiting for a nurse before I look at a child with an ear infection. So you got me at a good time. What’s up?”

  “I’m finally getting back to you on those questions you raised about TB salpingitis,” Dubchek said. “Well, I have some interesting news. There have been sporadic reports of a condition that’s consistent with TB salpingitis from all around the country, although mostly on the West and East coasts.”

  “Really!” Marissa exclaimed. She was astounded. “Has anybody been able to culture it?”

  “No,” Dubchek said. “But that’s not unusual. Remember, it’s hard to culture TB. In fact, no one has, to my knowledge, seen an actual organism in any of these cases.”

  “Now that’s strange,” Marissa said.

  “Yes and no,” Dubchek said. “It’s frequently hard to find the TB bug in tuberculosis granuloma. At least that’s what my bacteriology colleagues tell me. So don’t make too much of that either. What’s more important, from an epidemiologic point of view, is that there are no areas of concentration. The cases seem to be widely scattered and unrelated.”

  “I now have five cases in Boston,” Marissa said.

  “Then Boston gets the prize,” Dubchek said. “San Fran is second with four. But no one has actually looked into it. There have been no studies launched, so these cases represent haphazard reporting. If somebody looked, he’d probably find more. Anyway, I’ve got a few people checking into it here at the Center. I’ll be back to you if anything interesting turns up.”

  “The five cases I’ve come across are all at one clinic,” Marissa said. “I’ve started to search at the Memorial just this morning. What I’d really like to do is get access to the clinic’s records. Unfortunately they turned me down. Could the CDC help?”

  “I don’t see how,” Dubchek said. “It would take a court order, and with the paucity of details and low danger level to society, I doubt seriously a judge would grant it.”

  “Let me know if you hear anything else,” Marissa said.

  “Will do.”

  Marissa hung up the phone and leaned against the wall. The idea that tuberculous granuloma of the fallopian tube had been reported from around the country made her more curious than ever. There had to be some interesting epidemiological explanation behind it. And by a quirk of fate, not only was she suffering from the illness herself, she was part of what was the largest concentration. She had to get into the clinic’s records. She had to find more cases if there were more to find.

  “Dr. Blumenthal,” Muriel said, stepping into the room, “I don’t have anybody to help you at the moment, but I can myself.”

  “Wonderful,” Marissa said. “Let’s go to it.”

  • • •

  The sliding glass door opened automatically as Marissa strode into the lobby level of the Massachusetts Eye and Ear Infirmary. Despite the cool late-afternoon temperature she had on only her thin doctor’s white jacket. After a quick inquiry at the information booth, she veered right into the emergency area. She asked for Dr. Wilson at the emergency desk.

  “She’s in the back,” the secretary said. She pointed through a pair of swinging doors that were propped open.

  Marissa continued her search. Beyond the propped-open swinging doors were several ophthalmologic examining rooms, each with its barberlike chair and attached slit lamp. A lone patient sat in the first room Marissa went by. In the second, the room light was out and two figures were bent over a reclining patient. Allowing her eyes to adjust, Marissa recognized one of them as Wendy.

  “Now press down gently and look where you are pressing,” Wendy said, guiding a junior resident through a specialized exam. “You should see the tear at the periphery of the retina.”

  “I see it!” the resident cried.

  “Good,” Wendy said. She caught sight of Marissa and waved. Turning back to the resident, she said, “Write it up and call the senior resident.”

  Wendy came out of the darkened room, blinking in the raw fluorescent light of the main part of the emergency room. “This is a surprise,” she said. “What’s up?”

  “I got a very interesting call from the CDC,” Marissa said. Then she lowered her voice. “Where can we talk?”

  Wendy thought for a minute, then took Marissa around the back of the emergency area into an empty laser room. She shut the heavy door behind them. “You look positively mischievous. What’s going on?”

  “You’re not going to believe this,” Marissa began. She then told Wendy the gist of Dubchek’s call indicating that they were dealing with a problem that had national scope.

  “My word! We’re on the brink of some major discovery,” Wendy said, catching Marissa’s enthusiasm.

  “I don’t think there is any doubt,” Marissa said. “And there is only one minor barrier to the whole denouement.”

  “Wingate,” Wendy said.

  “Exactly!” Marissa said. “We have to see if there are more cases. I’m sure there are. There have to be. Once we have them all, we can begin to look for areas of commonality in all the subjects in terms of life-style, work, health history, all that. I’m sure if we do that with enough cases we’ll come up with a theory as to the source of the TB and how it is being transmitted. Usually TB is airborne. But if no one has any lung lesions, maybe it’s traveling by some other means.”

  “So what do you propose?” Wendy asked.

  “It’s Friday night. I think we should go over to the Women’s Clinic and act as if we own the place. I wore my white coat over here just to try it. No one questioned me. I walked right in as if I were on the staff.”

  “How soon do you want to do this?” Wendy asked.

  “When are you off?” Marissa asked.

  “I can leave anytime now,” Wendy answered.

  “Get a white coat and pens and a stethoscope,” Marissa said.

  “The more medical paraphernalia, the better.”

  Half an hour later, Marissa and Wendy slowly drove beneath the overhead walkway and past the opening into the courtyard of the Women’s Clinic. They had started out the drive with excited chatter, but now, within sight of the clinic, they had fallen silent. Both felt nervous, tense, and a little fearful. Although Marissa tried not to think about it, Robert’s comments concerning the felonious nature of what they were about to attempt were preying on her mind.

  “The place is still hopping,” Wendy said.

  “You’re right,” Marissa agreed. People were entering and exiting. The windows were ablaze with lights.

  “I suggest we go someplace and cool our heels for a couple of hours,” Wendy said. “How about a bar?”

  “I wish we could drink,” Marissa said. “A glass of wine might calm me down. That reminds me, when do you have your blood test?”

  “Tomorrow,” Wendy said.

  “You must be nervous about that too,” Marissa said.

  “I’m a wreck,” Wendy agreed.

  Paul Abrums rummaged in his right front pocket for a dime. It was
still one of the bargains of Boston that if you could find an ATT phone, a local call was still only ten cents.

  He let the coin drop into the slot and dialed Robert’s office. It was before eight, and he was confident Robert would be there. Robert had told him earlier in the day that he’d be in his office until nine. Then he’d be at home after that. He’d given Paul both numbers.

  As the phone rang, Paul turned to keep his eye on the Viceroy Indian Restaurant in Central Square. Marissa had entered with her companion over an hour ago. If she happened to come out, Paul wanted to know.

  “Hello,” Robert answered. He was the only one in the office.

  “Paul Abrums here,” Paul said.

  “Is there a problem?” Robert asked, somewhat alarmed.

  “Not a big problem,” Paul said. He spoke slowly and deliberately. “Your wife is with a short blonde woman who must also be a doctor.”

  “That’s Wendy Wilson,” Robert said.

  “They’re eating at an Indian restaurant as we speak,” Paul said. “They drove past the Women’s Clinic. I thought they were about to stop but they didn’t.”

  “That’s odd,” Robert said.

  “But there is something else,” Paul added. “Can you think of any reason why an Asian guy in a gray suit would be following your wife?”

  “Heavens no!” Robert said. “Are you sure?”

  “About ninety percent sure,” Paul said. “He’s been on her tail too long for it to be coincidence. I noticed him when your wife left her pediatric clinic. He’s a young guy, I think. Sometimes I can’t tell with Asians. He’s dressed in a good suit.”

  “That’s very odd,” Robert said, already glad he’d taken Donna’s suggestion about hiring Abrums.

  “I won’t take any more of your time,” Paul said. “But it was curious enough for me to ask.”

  “Find out who that guy is,” Robert said. “And why he’s following my wife. God, I’m glad you are there.”

  “I don’t mean to upset you,” Paul said. “Everything is under control. You relax, I’ll find out . . . Uh oh! Your wife is just coming out of the restaurant. I gotta go.”