Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  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 capita ted mobile sperm. The eggs and the sperm had then been co-incubated in 5% CO,. 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 micro pipette Dr. Wingate experienced the thrill of creation as he observed two pro nuclei 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 nor many. 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, IT 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 see 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 eggg, you can have two transfers without having to undergo another hyper stimulation

  "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 counseling, 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.

  After hanging up the phone, Marissa was glad for having brought up the topic of the suicide. Merely having talked about it eased the impact to a degree.

  Getting out of bed, Marissa pulled on her robe, and went down the hall to Robert's study. She found him seated at his computer console. He glanced up as Marissa
came into the room.

  "They all fertilized," Marissa said as she sat on a love seat below a wall of built-in bookshelves.

  "That's encouraging," Robert said. He was looking at her over the top of his half-glasses.

  "That's the first hurdle," she said.

  "Now all they have to do is to get one of the embryos to stick in my uterus."

  "Easier said than done," Robert said. He was already looking back at his computer screen.

  "Can't you be just a tiny bit supportive?" Marissa asked.

  Robert looked back at her.

  "I'm starting to think that my being supportive and not telling you what I'm thinking has just encouraged you to keep beating your head against a wall. I've still got serious questions about this whole process. If it works this time, fine; but I don't want to see you setting yourself up for another disappointment." He turned back to his screen.

  For a moment Marissa didn't say anything. As much as she hated to admit it at the moment, Robert was making sense. She was afraid of getting too hopeful herself.

  "Have you thought any more about the idea of counseling?"

  Marissa asked.

  Robert turned to Marissa a third time.

  "No," he said.

  "I told you, I'm not interested in going to a counselor. There has already been too much interference in our lives. Part of the problem for me is that we have lost our private life. I feel like a fish in a fishbowl."

  "Dr. Wingate told me that one of the reasons the woman who killed herself today did so was because she and her husband did not seek counseling."

  "Is this some kind of not-so-veiled threat?" Robert asked.

  "Are you telling me you're thinking of diving off the roof of the Women's Clinic if I don't agree to see one of their counselors?"

  "No!" Marissa said heatedly.

  "I'm just telling you what he told me. The woman and her husband were having difficulties. Counseling was recommended. They didn't go. Apparently they broke up, which is one of the things that made the woman so upset."

  "And counseling would have solved everything?" Robert asked sarcastically.

  "Not necessarily," Marissa said.

  "But I doubt it would have hurt. I'm beginning to think that we should seek counseling whether we continue with the IVF or not."

  K

  "What do I have to say to you?" Robert asked.

  "I'm not interested in spending time and money on a counselor. I know why I'm upset and unhappy. I don't need someone else to tell me."

  "And you don't want to try to work on it?" asked Man*ssa. She hesitated to say "together."

  "I don't think a counselor is the way to work on it," Robert said.

  "You don't have to be a rocket scientist to know what is wrong. Anyone would feel stressed out by what we've been through in the past few months. Some things in life you have to deal with. Others you don't. And we don't have to deal with this infertility therapy anymore, if we so choose. At this point, I'd prefer to put it out of our lives."

  "Oh, for goodness' sake!" Marissa said with disgust. She got up from the love seat and left Robert to his beloved computer and spreadsheets. She wasn't up to having another argument.

  Marissa stomped down the hall and into the bedroom, slamming the door behind her. It seemed that instead of getting better, everything was getting a whole lot worse.

  March 20,1990

  8:45 AM.

  Highly reactive ions called hydroniurn ions, which were nothing but hydrated protons, knifed through the delicate cell membranes of four of Marissa's developing embryos. The hydronium ions came in a sudden wave, catching the dividing cells off-guard Buffer systems were mobilized to neutralize some of the initial reactive particles, but there were too many to combat. Slowly at first, then more rapidly, the pH of the cells began to fall. They were becoming acidic. Hydronium ions inevitably resulted wherever acid was added to an aqueous medium.

  Within the very depths of the embryos, molecules of DNA were in the process of replicating themselves in preparation for another division. As weak acids themselves, they were terribly susceptible to the hydronium ions that swarmed in their midst. Their replication process continued, but with some difficulty: the enzymes responsible for the, chemical reactions were also sensitive to acid. Soon replication mistakes started to occur. Affirst there were only afew errors, none that would have mattered in the long run given the redundance of genes. But as more and more of the acid particles intervened, entire gene pools found themselves replicating sheer gibberish. The cells were still dividing, but it was only a matter of time. The mistakes had become lethal.

  "It's beautiful!" Marissa cried. It was hard for her to comprehend that she was looking at the barest beginning of one of her children. The embryo, now at a two-cell stage, appeared transparent in the crystal-clear culture medium. Unfortunately, Marissa could not see the chaos that was occurring on a molecular level at the very moment she was admiring the cell's microscopic appearance. She thought she was seeing the beginnings of a new human life. What she was witnessing was the first steps of its death.

  "Amazing, isn't it?" Dr. Wingate said. He was standing next to Marissa. She had come in unexpectedly that morning, asking if she could see one of her embryos. At first he had questioned the wisdom of granting such a request, but, remembering she was a doctor, he realized that it would be difficult to refuse, even though at this stage he didn't like anyone handling the embryos.

  "I just cannot believe that little speck could become an entire person," Marissa said. She'd never seen a live two-celled embryo before, much less her own.

  "I think we'd better get the little devil back into the incubator,"

  Dr. Wingate said. He carefully carried the organ-culture dish to the incubator and slid it onto the appropriate shelf. Marissa followed him, still awed. She saw that the dish had joined three others.

  "Where are the other four?" she questioned.

  "Over there," Dr. Wingate pointed.

  "In the liquid-nitrogen storage facility."

  "They've already been frozen?" Marissa asked.

  "I did it this morning," Dr. Wingate said.

  "Our experience has been that two-celled embryos do better than larger ones. I selected the four that I thought would tolerate the freezing and thawing the best. We'll keep them in reserve, just in case."

  Marissa walked over to the liquid-nitrogen storage unit and touched its lid. The idea that four potential children were inside, frozen in a kind of suspended animation, gave her an eerie feeling.

  Such high-tech intrusion reminded her a little too much of Brave New World.

  "Want to see inside?" Dr. Wingate asked.

  Marissa shook her head.

  "I've taken too much of your time already," she said.

  "Thank you."

  "My pleasure," Dr. Wingate said.

  Marissa hurried from the lab. She went to the elevators and pushed the Up button: What had brought her to the clinic that morning was an appointment to see Linda Moore, a psychologist.

  Between the final talk with Robert the night before and his decision to sleep in the guest room, Marissa had decided to call about counseling first thing in the morning. Whether Robert went or not, Marissa. decided she needed to talk to a professional about the emotional stresses of IVF.

  When she'd made the call, she thought she'd have to wait for an appointment, but Mrs. Hargrave had warned the staff psychologist that if Marissa called, she should be seen quickly.

  Linda Moore's office was on the sixth floor, the very floor from which Rebecca Ziegler had jumped. The coincidence made Marissa a bit uncomfortable. As she walked down the hall, she morbidly tried to guess which window Rebecca had leaped from.

  She wondered if the woman's last straw had been something she'd gleaned from her clinic record. Marissa remembered that Rebecca had left the downstairs waiting room with the express purpose of reading her record.

  "Go right in," the secretary said when Marissa identified herself.
<
br />   As she moved toward the door, Marissa questioned if she truly wanted to go through with the appointment. It hardly took a professional to tell her IVF was stressful. Besides, she was embarrassed to have to make excuses why Robert wouldn't come with her.

  "Go right in!" the secretary repeated, seeing Marissa pause at the door.