Vital Signs

by Robin Cook

  Marissa thanked him again for calling and they said their goodbyes. This new bit of information was extremely significant. It meant that the incidence of TB salpingitis could no longer be dismissed as a statistical fluke. It was occurring on an international scale. Even Cyrill’s curiosity was now piqued. For the moment Marissa forgot her grief, anger, and exhaustion.

  Marissa considered the possibilities. Could TB have somehow mutated to become a venereal disease? Could it have become a silent infection in the male like some cases of chlamydia or myco-plasma? Should she insist that Robert be checked? Could Robert have picked it up somehow on one of his many business trips? Marissa didn’t like this line of thinking, but she had to remain scientific.

  Reaching for the telephone, Marissa called Wendy. Gustave answered.

  “Unfortunately she’s not taking calls,” Gustave said.

  “I understand,” Marissa said. “Whenever it is appropriate, tell her I’ve called and ask her to call me back as soon as she feels up to it.”

  “I’m worried about her,” Gustave confided. “I’ve never seen her this depressed. I don’t know what to do.”

  “Do you think she would see me if I came over?” Marissa asked.

  “I think there is a chance,” Gustave said. His tone was encouraging.

  “I’ll be right over,” Marissa said.

  “Thanks, I really appreciate it. I know Wendy will too.”

  Marissa got her coat from the laundry room and went out to her car in the garage. As she was about to get in, Robert appeared.

  “Where do you think you are going at this hour?” he demanded.

  “Wendy’s,” Marissa said, pushing the automatic garage-door opener. “At least her husband is concerned about her.”

  “What’s that supposed to mean?” Robert demanded.

  “If you don’t know,” Marissa said, getting into her car, “I doubt if anybody could tell you.”

  Marissa backed out of the garage and lowered the door. She shook her head in dismay at how far her relationship with Robert had fallen.

  It only took fifteen minutes to drive to Wendy’s Victorian house. Gustave had clearly been waiting for her. He opened the door before she had a chance to ring the bell.

  “I’m truly grateful for your coming out at this hour,” Gustave said. He took her coat.

  “Glad to,” Marissa said. “Where’s Wendy?”

  “She’s upstairs in the bedroom. Top of the stairs, second door on the right. Can I get you anything? Coffee, tea?”

  Marissa shook her head and climbed the stairs.

  At the bedroom door, Marissa paused to listen. There were no sounds coming from within. She knocked lightly. When there was no answer, she called out Wendy’s name.

  The door opened almost immediately.

  “Marissa!” Wendy said with true surprise. “What are you doing here?” She was dressed in a white terrycloth robe and bedroom slippers. Her eyes were still sunken and red, but otherwise she appeared better than she had in the courthouse that morning.

  “Gustave said you weren’t taking any calls. He also said that he was worried about you. Really worried. He encouraged me to come over.”

  “Oh, for goodness’ sake,” Wendy said. “I’m not that bad off. Sure I’m depressed, but part of it is I’m mad at him. He wants me to be thankful for what he calls the Women’s Clinic’s magnanimity.”

  “Robert feels the same way,” Marissa said.

  “I think it was a cover-up maneuver,” Wendy said.

  “I agree!”

  “What about your pregnancy test?” Wendy asked.

  “Don’t ask,” Marissa said. She shook her head.

  “How about something to drink?” Wendy offered. “Coffee or tea? Or hell, since we’re not pregnant, how about a glass of wine?”

  “That sounds wonderful,” Marissa admitted.

  The two women descended to the kitchen. Gustave appeared but Wendy sent him away.

  “He was really concerned,” Marissa said.

  “Oh, let him suffer a bit,” Wendy said. “This afternoon I was mad enough to have a go at him with one of those foot-long egg-retrieval needles. It would be good for him to get an idea of what I’ve been going through these last months.”

  Wendy opened a bottle of expensive Chardonnay and led Marissa into the parlor.

  “I wasn’t sure you’d be up for this,” Marissa said once they were settled, “but I brought over a journal article for you to read.”

  “Just what I was hoping for,” Wendy said with sarcasm. She put her wineglass down on the coffee table, then took the reprint from Marissa. She glanced at the abstract.

  While Wendy scanned the article, Marissa told her everything Dubchek had related.

  “This is incredible,” Wendy admitted as she looked up from the paper. “Brisbane, Australia! Do you know one of the things that makes Brisbane so interesting?”

  Marissa shook her head.

  “It’s the main gateway to one of the greatest natural wonders of the world.”

  “Which is?”

  “The Great Barrier Reef! A diver’s paradise.”

  “No kidding?” Marissa said. Then she admitted, “It’s not something I know much about.”

  “Well, it is one place in the world I’ve always wanted to visit,” Wendy said. “Diving has been one of my passions. I started in California during my residency. I used to take all my vacations in Hawaii in order to dive. In fact, it’s how I met Gustave. Have you ever done any diving, Marissa?”

  “A little. I took a scuba course in college and I’ve gone a few times to the Caribbean.”

  “I love it,” Wendy said. “Unfortunately I haven’t done it for some time.”

  “What do you think of the paper?” Marissa asked, bringing the conversation back to the issue at hand.

  Wendy looked down at it. “It’s a good article. But it doesn’t say anything about transmission. The author mentions the possibility of an increase in TB due to immigration, but how is it communicated, especially to such a defined population?”

  “That was my question as well,” Marissa said. “And how does it get into the fallopian tubes? It certainly doesn’t sound like blood or lymphatic spread, which is the usual way TB gets around. I wonder if it’s venereal.”

  “What about contaminated tampons?”

  “That’s an idea,” Marissa said, recalling that tampons turned out to be the basis of the toxic shock syndrome. “I certainly use tampons exclusively.”

  “Me too,” Wendy said. “Trouble is, there’s no mention of tampon use in the article.”

  “I have an idea,” Marissa said. “Why don’t we call Brisbane and talk to the author of the paper. We can quiz him about tampon use. It would also be interesting to know if there’s been any follow-up on the twenty-three cases and if there are any new ones at the Female Care Australia Clinic. After all, this paper was written almost two years ago.”

  “What’s the time difference between here and Australia?” Wendy asked.

  “You’re asking the wrong person.”

  Wendy picked up the phone. Calling an overseas operator, she asked about the time. Then she hung up. “They’re fourteen hours ahead,” she said.

  “So that makes it . . .”

  “About noon tomorrow,” Wendy said. “Let’s try.”

  They got the number of Female Care Australia in Brisbane from overseas information and placed the call.

  Wendy put the phone on its speaker mode. They could hear the phone ring, then someone at the other end picked up. A cheerful voice with a crisp Australian accent came over the line.

  “This is Dr. Wilson calling from Boston in the U.S.,” Wendy said. “I’d like to speak with Dr. Tristan Williams.”

  “I don’t believe we have a Tristan Williams here,” said the operator. “Just a moment, please.”

  Music came out of the speaker while they were put on hold. The clinic’s operator came back. “They tell me that there was a Dr. Williams at the
clinic but I’m afraid he is no longer here.”

  “Would you tell us where we can reach him?” Wendy asked.

  “I’m afraid I have no idea,” the operator said.

  “Do you have a personnel office?” Wendy asked.

  “Indeed we do,” the operator said. “Shall I connect you?”

  “Please,” Wendy said.

  “Personnel here,” a man’s voice said.

  Wendy repeated her request to get in touch with Tristan Williams. Again they were put on hold, this time for a longer period.

  “Sorry,” the man apologized when he came back on the line.

  “I’ve just learned that Dr. Williams’ whereabouts are unknown. He was dismissed from the staff about two years ago.”

  “I see,” Wendy said. “Could you transfer me to pathology?”

  “Surely,” the man said.

  It took a full ten minutes to get one of the pathologists on the line. Wendy said her name and what she wanted.

  “I’ve never met the man,” the pathologist said. “He left before I arrived.”

  “He wrote a paper while at the clinic,” Wendy explained. “It concerned a series of patients at your clinic. We are interested in knowing if there has been any follow-up on any of the cases. We’d also like to know if there have been any additional cases.”

  “We’ve had no new cases,” the doctor said. “As for follow-up, there hasn’t been any.”

  “Would it be possible to get some of the names of the original cases?” Wendy asked. “I’d like to contact them directly to discuss their medical histories. We have five similar cases here in Boston.”

  “That would be completely out of the question,” the doctor said. “We have strict confidentiality rules. I’m sorry.” The next thing they heard was a click.

  “He hung up!” Wendy said indignantly. “The nerve!”

  “The old confidentiality obstacle,” Marissa said, shaking her head in frustration. “What a pity! Twenty-three cases is probably enough to draw some reasonable inferences.”

  “What about talking in greater detail with the two women we found at the Resolve meeting?” Wendy asked.

  “I suppose,” Marissa said, losing some of her enthusiasm. It seemed impossible to get information. “What I’d like to do more is get at those eighteen cases the computer suggested there were at the Women’s Clinic.”

  “Obviously that’s out of the question,” Wendy said. “But I wonder how these people at the Female Care Australia would treat us if we showed up on their doorstep?”

  “Oh, sure!” Marissa said. “Why don’t we wander over there in the morning and ask?”

  “It doesn’t sound so preposterous to me,” Wendy said, her eyes alight. “I’m curious as to what they would do if we visited the clinic. I think they’d be flattered that we’d come halfway around the world to see their facility.”

  “Are you serious?” Marissa asked in disbelief.

  “Why not?” Wendy said. “The more I think about the idea, the better it sounds. God knows we both could use a vacation. We’d have a better shot at tracking down this Tristan Williams. Someone in the clinic’s pathology department is bound to know where he went. You have to admit, it would be a lot easier than trying to do it by telephone.”

  “Wendy,” Marissa said with a tired voice, “I’m not up to traveling eighteen zillion miles to look for a pathologist.”

  “But it will be fun for us.” Her eyes seemed to brighten. “If nothing else, we could fit in a visit to the Great Barrier Reef.”

  “Oh, now I’m beginning to understand your motive. Visiting the FCA clinic is the excuse for a diving expedition.”

  “No law against having a little fun when the work is done,” Wendy said with a smile. “You look as bad as I do.”

  “Thanks, good friend,” Marissa said wryly.

  “I’m serious,” Wendy said. “The two of us have had PMS for six months. We’ve been crying like babies. We’ve both put on weight. When was the last time you did any jogging? I remember you used to jog every day.”

  “You’re really hitting below the belt.”

  “The point is we both could use a vacation,” Wendy said. “And we’re both fascinated by this string of TB salpingitis cases but we’re stymied here. The way I see it, we’re killing two birds with one stone.”

  “We might hear about some cases from the Memorial and the General,” Marissa said. “We haven’t exhausted our possibilities here.”

  “Are you going to tell me you couldn’t use a vacation?” Wendy insisted.

  “A little time away does have some appeal,” Marissa admitted.

  “Thank you for your admission,” Wendy said. “You can be pretty stubborn.”

  “But I don’t know how Robert will take it. We’ve been having enough trouble lately. I can just imagine his response if I suggest I want to go to Australia alone.”

  “I’m sure Gustave will go for the idea,” Wendy said. “I know he could use the break.”

  “You mean our husbands would go too?” Marissa asked, puzzled.

  “Hell, no,” Wendy said. “Gustave needs a break from me! Let’s see if I’m right.”

  Wendy shocked Marissa by shouting for Gustave. Her voice echoed through the high-ceilinged house. “I usually can’t get away with this kind of behavior,” she admitted to Marissa. She took another drink from her wineglass.

  Gustave came at a run. “Something the matter?” he asked nervously.

  “Everything is fine, dear,” Wendy said. “Marissa and I were thinking it might be good for the two of us to take a little holiday. What do you think of that?”

  “I think it’s a great idea,” Gustave said. He clearly seemed relieved at the change in Wendy’s mood.

  “Marissa’s afraid Robert might not be so agreeable,” Wendy said. “What’s your opinion?”

  “Obviously I don’t know him well,” Gustave said. “But I do know he is fed up with the in-vitro protocol. I think he’d like a break. Where were you girls thinking of going?”

  “Australia,” Wendy said.

  Gustave visibly swallowed. “Why not the Caribbean?” he asked.

  Later, when Marissa drove home, her mind was in disarray. It had been a strange day with roller-coaster emotions and unexpected happenings. Within minutes of leaving an excited Wendy, she began to question the reasonableness of going to Australia at the present time. Although the concept of getting away had a lot of appeal, the idea of considering such a journey was a fitting end to a mad day. Besides, she wasn’t sure she could manage Robert as handily as Wendy managed Gustave.

  Marissa pulled into the garage, not sure how to proceed. For a few moments she sat behind the steering wheel and tried to think. Without a specific plan, she finally got out of the car and entered the house. She took off her coat and hung it in the hall closet.

  The house was still. Robert was up in his study; she could just barely hear the click of his computer keys as he typed. She paused again in the darkness of the dining room.

  “This is ridiculous!” Marissa said finally. She’d never had so much trouble making up her mind. With a new but fragile sense of resolve, she mounted the stairs and walked into Robert’s study.

  “Robert, I’d like to talk to you about something.”

  Robert turned to face her.

  “Wendy and I have been thinking,” she continued.

  “Oh?”

  “It may sound a little crazy . . .”

  “These days, I’d expect as much.”

  “We thought that perhaps it would do us good to get away for a short time,” Marissa said. “Like a vacation.”

  “I can’t take time off now,” Robert said.

  “No, not you and I,” Marissa said, “Wendy and I. Just us girls.”

  Robert thought for a moment. The idea had some merit. It would give him and Marissa time to cool down. “That doesn’t sound so crazy. Where were you thinking of going?”

  “Australia,” Marissa said. She wince
d as the word came out of her mouth.

  “Australia!” Robert exclaimed. He snatched off his reading glasses and tossed them on top of his correspondence. “Australia!” he repeated as if he’d not heard correctly.

  “There is an explanation,” Marissa said. “We didn’t just pull Australia out of a hat. I found out today that the only concentration of cases of TB of the fallopian tubes like Wendy and I have is in Brisbane, Australia. So we could do a little research as well as have some fun. It was Wendy’s idea. She’s a diving enthusiast and the Great Barrier Reef—”

  “You were right!” Robert said, interrupting her. “This sounds very crazy. This is the most ridiculous thing I’ve ever heard. Your practice is in a shambles and you want to fly halfway around the world to continue a crusade that came close to landing you in jail. I thought you meant a little vacation, like a weekend in Bermuda. Something reasonable.”

  “You don’t have to overreact,” Marissa said. “I thought we could talk about this.”

  “How can I not overreact?” Robert demanded.

  “It’s not that unreasonable,” Marissa said. “I also learned today that this odd form of TB has been showing up on an international scale. Not only in Australia, but in Europe as well. Someone should be looking into it.”

  “And you are that someone?” Robert asked. “In your state, you think you are appropriate?”

  “I think I am very qualified.”

  “Well, I think you’re wrong,” Robert said. “There’s no way you could be objective. You’re one of the cases yourself. And if you care about my opinion, I think your going to Australia is preposterous. That’s all I have to say.”

  Robert reached for his reading glasses and slipped them on. Looking away from Marissa, he turned his attention back to his computer screen.

  Seeing that he really didn’t intend to discuss it any further, Marissa turned and walked out the door.

  The problem with going to Australia was that for the most part Marissa thought Robert was right. It seemed an extravagant idea, in time as well as expense, not that finances were her top consideration. Still, she couldn’t shake the feeling: it seemed unreasonable to suddenly fly halfway around the world.

  Reaching for the phone, she called Wendy. Wendy answered on the first ring, as if she were waiting by the phone.