Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  As the Valium hit her system, Marissa's mind calmed, but she didn't sleep. She dwelt on the thought of her blocked tubes and what might have caused the blockage. Then she began to consider the different procedures she had undergone. She, remembered how she felt waking up from the general anesthesia after her laparoscopy.

  As soon as she was lucid, Dr. Carpenter had told her that her tubes appeared so scarred that microsurgery was totally out of the question. He said that all he'd been able to do was take a biopsy. He let her know then that her only chance for a baby was in-vitro fertilization.

  "Are we ready?" a booming voice called.

  Marissa lifted her head, raised heavy eyelids, and looked up at the bearded face of Dr. Wingate. Lying back, she tried to dissociate herself from her body to cope with her anxiety. Her mind wandered back to her visit to Dr. Ken Mueller in the department of pathology at the Memorial after her laparoscopy. The Women's Clinic frequently sent some of their specimens to the Memorial to confirm their diagnoses. Marissa had been told that her fallopian tube biopsy had been forwarded there.

  Hoping to maintain her anonymity, Marissa had searched for her slides herself. Shed knew that the Women's Clinic used her social security number as her case number.

  Once Marissa had the slides, she sought out Ken. They'd been friends since medical school. She asked him to look at the microscopic sections for her, but didn't say they were hers.

  "Very interesting," Ken said after a brief scan of the first slide.

  He sat back from the microscope.

  "What can you tell me about the case?"

  "Nothing," Marissa said.

  "I don't want to influence you. Tell me what you see."

  "Sort of a quiz, huh?" Ken said with a smile.

  "In a way," Marissa said.

  Ken went back to the microscope.

  "My first guess is that it's a section of fallopian tube. It looks as if it's been totally destroyed by an infectious process."

  "Right on," Marissa said with admiration.

  "What can you say about the infection?"

  For a few minutes Ken silently scanned the specimen. When he finally spoke, Marissa was stunned.

  "TB!" he announced, folding his arms, "Tuberculosis?" Marissa almost fell off her chair. She'd expected nonspecific inflammation, never

  TB.

  "What makes you say that?" she asked.

  "Look in the field," Ken told her.

  Marissa gazed into the scope.

  "What you are looking at is a granuloma," Ken said.

  "It's got giant cells and epithelioid cells, the sine qua non of a granuloma.

  Not a lot of things cause granulomas. So you have to think of TB, sarcoid, and a handful of funguses. But you'd have to put TB at the head of the list for statistical reasons."

  Marissa felt weak. The idea that she had any of those diseases terrified her.

  "Can you do any other stains to make a definitive diagnosis?"

  Marissa asked.

  "Sure," Ken said.

  "But it would help to have some history on the patient."

  "Okay," Marissa. said.

  "She's a healthy Caucasian woman, mid-thirties, with a completely normal medical history. She presented with asymptomatic ally blocked fallopian tubes."

  Reliable historian?" Ken questioned as he chewed the inside of his lip.

  "Completely," Marissa said.

  "Negative chest X-ray'," "Completely normal."

  "Eye problems?"

  "None."

  "Lymph nodes?"

  "Negative," Marissa said with emphasis.

  "Except for the blocked tubes, the patient is completely normal and healthy."

  "GYN history normal?" Ken asked.

  "Yup!" Marissa said.

  "Well, that's weird," Ken admitted.

  "TB gets to a fallopian tube via the bloodstream or the lymphatics. If it's TB, then there has to be a nidus somewhere. And it doesn't look like fungus without some hyphae or something. I'd still say TB is the leading contender. Anyway, I'll do some additional stains..."

  "Marissa!" called a voice, bringing Marissa back to the present.

  She opened her eyes. It was Dr. Arthur.

  "Dr. Wingate is about to inject the local anesthesia. We don't want you to suddenly jump."

  Marissa nodded. Almost immediately she felt a number of points of stinging pain, but they faded quickly and she went back to her musing, remembering her panicked visit to an internist the same day that she'd seen Ken. But a complete work-up had failed to find anything wrong except for a positive PPD test, suggesting that she indeed had had

  TB.

  Although Ken tried numerous other tests on Marissa's slide, he found no organisms, TB or otherwise. But he stuck by his original diagnosis of a tuberculous infection of the fallopian tube despite Marissa's inability to explain how she could have picked up such a rare illness.

  "Dr. Wingate!" a harried voice called. Marissa's attention was again brought back to the present. She turned her head. Mrs.

  Hargrave was at the ultrasound-room door.

  "Can't you see I'm busy, for chrissake?" Dr. Wingate snapped.

  "I'm afraid there has been an emergency."

  "I'm doing a bloody egg retrieval!" Dr. Wingate shouted, venting some of his frustration on Mrs. Hargrave.

  "Very well," Mrs. Hargrave said as she backed out of the door.

  "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 hyper stimulation 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-vi
tro 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 evena 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." arissa 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.

  ,arissa 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 My 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 IF 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."