"At least we know now why you haven't been making babies," he said solemnly.
"I couldn't get dye into either of your tubes, And I really pushed-as you probably felt. Both of them seem to be sealed as tight as a drum."
"How could that be?" Marissa asked with alarm.
Dr. Carpenter shrugged.
"We'll have to look into that. Probably you had some infection. You don't remember anything, do you?"
"No!" Marissa said.
"I don't think so."
"Sometimes we can find the cause of blocked tubes and sometimes we can't," Dr. Carpenter said.
"Sometimes even a high fever as a child can damage them." He shrugged and patted her on the arm.
"We'll look into it."
"What's the next step?" Marissa asked anxiously. She already felt guilty enough about being infertile. This puzzling discovery about her tubes made her wonder if she could have picked up anything from one of her former lovers. She had never been loose, not by any stretch of the imagination, but she'd had sex, especially with Roger. Could Roger have given her something?
Marissa's stomach was in knots.
"I'm not sure this is the time to talk about strategy," Dr.
Carpenter said.
"But we'll probably recommend a laparoscopy and perhaps evena biopsy. There's always the chance that the problem is amenable to microsurgery. If that doesn't work or isn't feasible, there's always in-vitro fertilization..
"Marissa!" Robert called harshly, abruptly bringing Marissa back to the present.
She lifted her face. Robert was standing in front of her.
"What are you doing?" Robert asked, his frustration all too apparent.
"I asked after you and the receptionist said you hadn't even checked in."
Marissa got to her feet. Robert was looking at his watch.
"Come on!" he said as he turned and headed over to the receptionist's desk. Marissa followed. She gazed at the sign behind the desk. That was the one that said: YOU ONLY FAIL WHEN
YOU
GIVE UP TRYING.
"I'm sorry," the receptionist said, "with all the excitement, I've been in a dither. It didn't dawn on me that Mrs. Buchanan hadn't checked in."
"Please!" Robert said.
"Just let the doctors know she is here."
"Certainly!" the receptionist said. She stood up.
"But first I want to thank you for your help earlier, Mr. Buchanan. I think that woman was about to attack me. I hope you weren't hurt badly."
"Only two stitches," Robert said, mellowing to a degree.
"I'm fine." Robert then lowered his voice and, after a furtive glance around the waiting room, asked: "Could you give me one of those, errrr... plastic containers?"
"Of course," the receptionist said. She bent down and opened a file drawer. She produced a small, graduated, red-topped plastic container and handed it over. Robert palmed it.
"Ah... this will make it all worthwhile," Robert whispered sarcastically to Marissa. Without a second glance at his wife, he strode off toward one of the doors leading into a series of cubicle like dressing rooms.
Marissa watched him go, lamenting the widening gulf separating them. Their ability to communicate, especially where their feelings were concerned, was reaching a new low.
"I'll let Dr. Wingate know you're here," the receptionist said.
Marissa nodded. Slowly she walked back to her seat and sat down heavily. Nothing was working out. She wasn't getting pregnant and her marriage was disintegrating before her eyes. She thought about all the business trips Robert had been taking of late. For the first time since she'd been married, Marissa wondered if he could be having an affair. Maybe that was the reason behind this sudden talk of not providing a sperm sample. Maybe he'd been giving samples out elsewhere.
"Mrs. Buchanan!" a nurse called from an open doorway, beckoning for Marissa. to follow her.
Marissa got to her feet. She recognized the nurse, Mrs. Hargrave.
"Are you ready to harvest those eggs?" the woman asked brightly as she got a robe, a Johnny, and slippers for Marissa. She had an English accent similar to Dr. Wingate's. Marissa had asked her about it once. She'd been surprised to learn that Mrs.
Hargrave was Australian, not English.
"An egg retrieval is just about the last thing in the world I want to do just now," Marissa admitted with dejection.
"I really don't know why I'm putting myself through this."
"Feeling a little depressed, are we?" Mrs. Hargrave asked as gently as she could.
Marissa didn't answer. She merely sighed as she took the clothes from Mrs. Hargrave and started into the changing room.
Mrs. Hargrave reached out and touched her shoulder.
"Anything you'd like to talk about?"
Marissa gazed up into the woman's face. There was warmth and sympathy in those gray-green eyes.
At first Marissa could only shake her head as she fought back tears.
"It's common for emotional problems to burden people involved with in-vitro," Mrs. Hargrave said.
"But it usually helps to talk about it. It's been our experience that part of the problem is the isolation the couples feel."
Marissa nodded in agreement. She and Robert had been isolated.
As the pressures mounted, they started avoiding friends, especially those with children.
"Has there been a problem between you and your husband?"
Mrs. Hargrave asked.
"I don't mean to pry, but we truly have found it best for people to be open."
Marissa nodded again. She looked at Mrs. Hargrave's understanding face. She did want to talk, and with a few tears that she wiped away with the back of her hand, she told her about Robert's initial refusal to cooperate that morning, and their consequent quarrel. She told Mrs. Hargrave she was beginning to think they would have to stop the infertility treatments.
"It's been pure hell for me," Marissa admitted.
"And for Robert."
"I think it is safe to say that something would be wrong with you both if it weren't," Mrs. Hargrave said.
"It's stressful for everyone, even the staff. But you've really got to learn to be more open. Talk to other couples. That will help you learn to talk to each other and to be aware of each other's limitations."
"We are ready for Mrs. Buchanan," another nurse called through the door to the ultrasound room.
Mrs. Hargrave gave Marissa a comforting squeeze on her shoulder.
"You'd better get on with this," she said.
"But afterwards
I'll come back and we'll talk some more. How about it?"
"Okay," Marissa said, trying to muster some enthusiasm.
Fifteen minutes later, Marissa again found herself on her back in the ultrasound room, facing yet another painful and potentially risky procedure, She was lying supine with her legs straight out. In a few minutes her legs would be put up in the all-too familiar stirrups. Then there would be the disinfectant, followed by the local anesthetic. She cringed at the thought.
The room itself seemed scary. It was a cold, forbidding, futuristic environment filled with electronic instruments, some of which Marissa recognized and some she didn't. Multiple cathode-ray screens were set into the instrumentation. Mercifully, the foot-long egg-retrieval needle was kept out of sight.
The nurse-technician who had brought Marissa into the room was busy with preparations for the procedure. Dr. Wingate, who performed most of the clinic's infertility procedures including the in-vitro fertilization, had not yet arrived.
A knock on the door got the attention of the nurse-technician, who stepped over and opened it. Marissa turned her head to see Robert standing in the threshold.
Although the procedure room made him feel even more uncomfortable than it made Marissa feel, he forced himself to step into the high-tech room. He pointed over his shoulder for the nurse technician benefit.
"Mrs. Hargrave said I could come in for a moment," he explained.
<
br /> The nurse-technician nodded, motioned toward Marissa, then went back to her preparations.
Robert gingerly walked over to the ultrasound unit and looked down at his wife. He was careful not to touch any of the delicate instrumentation, or Marissa herself, for that matter.
"Well, I did it," he said as if he had accomplished some major task.
"And now that my part's over, I'll be heading to the office.
Unfortunately, because of the stitches, I'm later than I planned.
So I've got to run. But I'll come back after the meeting and pick you up. If it looks like the meeting is going to run over, I'll call and leave word with Mrs. Hargrave. Okay?"
"Okay," Marissa said.
"Thanks for providing a sample. I appreciate it."
Robert wondered if Marissa was being sarcastic. He couldn't detect any irony in her tone.
"You're welcome," he said finally.
"Good luck with the egg retrieval. Hope you get a full dozen."
With a tentative pat on her shoulder, he turned and left the room.
Marissa felt tears welling up again, but she didn't know if they were from sadness or anger. She felt so terribly alone. Lately Robert had been so businesslike, even when it came to her. She was hurt that he could leave her to face such an ordeal alone.
The Robert of today seemed so different from the man she had married so blissfully only a few years ago. in so many ways he was telling her that business came first; it was his identity and his escape. A single tear ran down into her ear. She closed her eyes tightly, hoping to block out the whole world. It seemed that her life was falling apart and there was nothing she could do to stop it.
"Excuse me, Dr. Wingate," Mrs. Hargrave said, stopping the doctor on his way into the ultrasound room.
"Could I have a brief word with you?"
"Is it. important Dr. Wingate asked.
"I'm late for Mrs. Buchanan."
"It's Mrs. Buchanan I want to discuss," Mrs. Hargrave said.
She held her head back. She was a tall woman herself, almost six feet. Even so, she looked slight next to Dr. Wingate's impressive bulk.
"Is it confidential?" Dr. Wingate asked.
"Isn't everything confidential?" Mrs. Hargrave said with a sly smile.
"True enough," Dr. Wingate said. He briskly walked down the hallway to his office. They entered a back door directly from the corridor, bypassing his secretary. Wingate closed the door behind them.
"I'll be brief," Mrs. Hargrave said.
"It's come to my attention that Mrs. Buchanan... actually, I should say Dr. Buchanan.
You do remember that she is a doctor, don't you?"
"Yes, of course," Dr. Wingate said.
"Dr. Carpenter told me that two years ago. It was a surprise, I recall. Dr. Carpenter only knew through reading it in the Globe.
"I think the fact that she is a physician herself should be kept in mind," Mrs. Hargrave said.
"As you know, doctors can be difficult patients at times."
Dr. Wingate nodded.
"At any rate," Mrs. Hargrave continued, "I believe she is suffering from a certain amount of depression."
"That's not unexpected," Dr. Wingate said.
"Almost all of our in-vitro patients experience depression at one time or another."
"There is a suggestion of marital discord as well," Mrs. Hargrave said.
"Even some talk about stopping after this cycle."
"Now that would be unfortunate," Dr. Wingate agreed, interested at last.
"Depression, marital problems, and the fact that she is a physician make me think we should perhaps alter the treatment protocol."
Dr. Wingate leaned against his desk, hooking a thumb under his chin and resting his nose on an index finger while he pondered Mrs. Hargrave's suggestion. She definitely had a point, and flexibility had always been an approach he'd advocated.
"She also witnessed the scene with Rebecca Ziegler," Mrs.
Hargrave added.
"That can only have contributed to her emotional distress. I'm very concerned about her."
"But she has been stable up until now," Dr. Wingate said.
"That's true," Mrs. Hargrave replied.
"I suppose it is the problem of her being a physician that makes me feel uneasy."
"I appreciate your concern," Dr. Wingate said.
"It's attention to detail that makes the Women's Clinic so successful. But I think it will be safe to continue as usual with Dr. Blumenthal-Buchanan.
She'll tolerate another couple of cycles, but perhaps it would be wise to recommend some in-house counseling for both her and her husband."
"Very well," Mrs. Hargrave said.
"I'll suggest it to her. But as a physician, she might be resistant to such an idea."
With the matter decided, Dr. Wingate moved to the door and opened it for Mrs. Hargrave.
"Speaking of Rebecca Ziegler," said Mrs. Hargrave, "I trust she's being well taken care of?"
"She's reading her records as we speak," Dr. Wingate said, following Mrs. Hargrave into the hallway.
"Unfortunately, it will be upsetting for her."
"I can well imagine," Mrs. Hargrave said.
March 19,1990
11:37 A.M.
Dorothy Finklestein hurried under the overhead walkway and entered the brick courtyard of the Women's Clinic. As usual, she was late. She was always late. Her appointment for her annual exam had been scheduled for eleven-fifteen.
A sudden gust of wind caught the edge of her hat and lifted the brim. She reached up just in time to prevent the hat from sailing off her head. At the same time, something above caught her eye.
A high-heeled shoe was plummeting toward her. It landed near her, falling into a planter filled with rhododendrons..
Despite her haste, Dorothy stopped as her eye traveled upward, tracing the shoe's trajectory. At the very top story of the Women's Clinic, six floors up, her gaze became transfixed by what looked like a woman sitting on a window ledge, her legs dangling over, her head tilted down as if she were studying the pavement below. Dorothy blinked, hoping her eyes were deceiving her, but the image remained: it wasn't her imagination, it was a woman on the ledge-a young woman!
Dorothy's blood ran cold as she watched as the woman seemed to inch forward, then pitch headfirst in a slow somersault. The woman fell like a life-sized doll, picking up speed as she passed each successive floor. She landed in the same planter as her shoe, hitting with a dull thump like a heavy book dropped flat on a thick rug.
Dorothy winced em pathetically as if her own body had suffered the fall. Then she screamed as the reality sank in. Pulling herself together, she ran toward the planter without any idea of what she would do. As a buyer for a large Boston department store, she had scant training in emergency first aid, although she had attended a CPR course in college.
A few passersby responded to Dorothy's scream. After recovering from their initial shock, several followed her to the planter.
Someone else ducked back into the clinic to sound an alarm.
Arriving at the edge of the planter, Dorothy stared down in horror. The woman was on her back. Her eyes were open and they stared skyward, focused on nothing. Not knowing what else to do, Dorothy bent down in the bushes and started to give mouth-to mouth resuscitation. It was apparent to her that the woman was not breathing. She blew into the woman's mouth several times, but she had to stop. Turning her head, she vomited her coffee break blueberry muffin. By then, a doctor in a crisp white jacket had arrived.
"Of course I remember you," Dr. Arthur said.
"You were the woman who was so sensitive to ketamine. How could I forget?"
"I just wanted to be sure you wouldn't use it again," Marissa said. She hadn't recognized Dr. Arthur at first since he'd not treated her since the biopsy. But after he'd started her IV, something jogged her memory.
"All we need today is a little Valium," Dr. Arthur reassured her.
"And I'm going to
give you a little right now. This should make you pretty sleepy."
Marissa watched him inject the drug into the side port of her IV. Then she rolled her head straight. Now that the egg retrieval was about to begin, her attitude about the procedure had changed from fifteen minutes earlier. She was no longer ambivalent.
Robin Cook 1990 - Vital Signs Page 5
