Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  While waiting for a red light, Marissa looked at the directions she'd written down when she'd spoken to Susan Walker about the Resolve meeting. She was supposed to take a right on Charles, then a left on Mt. Vernon, and another right on Walnut.

  The directions advised her to take any parking place she could find on Beacon Hill.

  When the light turned green, Marissa turned right. But before she got to Mt. Vernon, she found a parking place. She took it.

  Susan Walker's house turned out to be a cute little Georgianstyle town house nestled among several others on picturesque Acorn Street.

  The door was opened by an extremely attractive, dark-haired woman in her mid-thirties. She was exquisitely attired in a silk dress that immediately made Marissa feel underdressed. Marissa had worn wool slacks and a sweater.

  "I'm Susan Walker," the woman said, extending her hand and shaking Marissa's firmly. Marissa told her her name.

  "We're so glad you could come," Susan said as she gestured for Marissa to step into the living room.

  In the living room, between twenty and thirty people were milling about, engaging in conversation. The impression was a normal cocktail party with a slight but obvious preponderance of women.

  Playing the good hostess, Susan took Marissa around and introduced her to a number of the people present. But then the door chimed again and Susan excused herself.

  To Marissa's surprise and relief, she was immediately put at ease. She had thought she would feel out of place, but she didn't at all. All the women seemed warm and friendly.

  "And what do you do?" asked Sonya Breverton. Susan had just introduced her to Marissa before leaving to answer the door.

  Sonya had told Marissa that she was a stockbroker with Paine Webber.

  "I'm a pediatrician," Marissa replied.

  "Another doctor!" Sonya remarked.

  "It's reassuring that you professionals suffer along with the rest of us. There's another doctor here, an ophthalmologist. Wendy Wilson."

  "Wendy Wilson!" Marissa exclaimed, her eyes immediately sweeping the room. She felt a surge of excitement. Could it be the Wendy Wilson she'd gone to Columbia Medical School with?

  Her eyes stopped on a woman across the room who was not much taller than herself, with short, sandy-blonde hair.

  Marissa excused herself and began to weave her way through the people to her old friend. As she got closer, the impish, pixie like features were immediately unmistakable.

  "Wendy!" Marissa shouted, interrupting the woman in mid-sentence.

  Wendy turned her eyes to Marissa.

  "Marissa!" Wendy cried, giving her a big hug. Wendy quickly introduced Marissa to the woman with whom she'd been speaking, explaining that Marissa was an old medical school chum she'd not seen since graduation.

  After exchanging a few pleasantries, the other woman politely excused herself, suspecting they had a lot of catching up to do.

  "When did you get to Boston?" Marissa demanded.

  "I've been here for over two years. I finished my residency at UCLA, worked for several years at the hospital, then came east with my husband, who took a surgical position at Harvard. I'm at the Mass. Eye and Ear. What about you? When I first got back, I asked about you and was told you'd moved to Atlanta."

  "That was just for a two-year stint at the CDC," Marissa explained.

  "I've been back for about three years." Quickly she filled Wendy in on her marriage, her practice, where she lived.

  "Weston!" Wendy laughed.

  "We're neighbors. We live in Wellesley. Hey, you're not here as tonight's lecturer, are you?"

  "Afraid not," Marissa said.

  "How about you?"

  "I wish," Wendy said.

  "My husband and I have been trying to have a child for two years now. It's been a disaster."

  "Same with me," Marissa admitted.

  "I can't believe this. It takes being infertile to meet up with you. And here I was worried that I'd meet someone I knew."

  "Is this your first Resolve meetine." Wendy asked.

  "I've only been to five or so, but I've never heard your name."

  "First one," Marissa admitted.

  "I'd always been reluctant to come, but recently a counselor recommended it."

  "I've enjoyed it," Wendy said.

  "Problem is, I can't get my granite-headed husband here. You know how surgeons are. He hates to admit that somebody might have something to offer in the way of information or expertise."

  "What's his name?" Marissa asked.

  "Gustave Anderson," Wendy said.

  "And he's just what he sounds like: one of those white-blond Swedes from Minnesota."

  "I can't Set my husband, Robert, to get near anything that smacks of therapy," Marissa said.

  "He's no surgeon, but just as rock-headed."

  "Maybe they can talk to each other," Wendy suggested. don't know," Marissa said.

  "Robert doesn't like to think he's being manipulated. The therapist tried talking with him after my last transfer, but it only made things worse."

  "Excuse me, everybody!" Susan Walker called out over the general din.

  "If everyone could find a seat, we'll get going."

  Marissa and Wendy sat down on a nearby couch. Marissa was still full of questions for her old friend and had to force herself to be patient. She and Wendy had been quite close during medical school. The fact that they had lost touch was purely a function of geography and their busy careers. After the long forced isolation of infertility, Marissa was overjoyed to find such a former friend in whom she could confide.

  But Marissa's patience paid off, and she soon found herself mesmerized by the meeting. A number of the women stood up and addressed the group, telling their own stories.

  It was an emotional experience for Marissa as she heard story after story with which she could identify. When one woman confessed to screaming at a shopper in a grocery store who she thought was neglecting her children, Marissa nodded, remembering the teenage mother with the dirty child.

  Even one of the husbands got up to talk, making Marissa particularly sorry that she'd been unable to get Robert to come.

  He talked about the stress from the male point of view, giving Marissa, a slightly better appreciation of what Robert had been trying to tell her about his response to "performing."

  One woman lawyer stood up and spoke of the need for couples going through unsuccessful IVF to grieve for their lost potential children. After eloquently outlining such couples' predicaments, she added quietly, "If there were formal supports for the inferm tiles' grief, maybe my friend and colleague Rebecca Ziegler would be with us tonight."

  For a few moments, after the lawyer sat down, the room maintained a respectful silence. Clearly many had been touched by mention of the dead woman. When the next speaker got up, Marissa turned to Wendy.

  "Was Rebecca Ziegler a frequent attendee of these meetings?" she asked.

  "Yes, poor thing," Wendy said.

  "I even spoke with her at the last meeting. It was a shock to hear she'd killed herself."

  "Had she been very depressed?" Marissa asked.

  Wendy shook her head.

  "I never saw signs of it."

  "I saw her the day she died," Marissa said.

  "In fact, she hit my husband."

  Wendy looked at Marissa in surprise.

  "It was at the Women's Clinic. She was out of control," Marissa explained.

  "Robert was trying to restrain her. The curious thing was that she didn't act depressed then either. She was angry, yes, but not depressed. Was she pretty calm in general?"

  "Seemed to be every time I saw her," Wendy said.

  "Weird," Marissa said.

  "Time for a coffee break," Susan Walker announced after the final speaker.

  "Then we'll have tonight's guest give her talk. We are honored to have with us Dr. Alice Mortland from Columbia Medical Center in New York. She will be talking to us about the newest aspects of GIFT, or Gamete Intr
a-Fallopian Transfer."

  Marissa looked at Wendy.

  "Are you interested in the lecture?" she asked.

  "Not in the slightest," Wendy said.

  "With both my fallopian tubes stopped up, GIFT can't help."

  "Holy Toledo!" Marissa exclaimed.

  "I've got the same problem: sealed tubes."

  "My word," Wendy said with a short laugh of disbelief.

  "What are we, identical twins? Let's pretend we're in medical school and skip the lecture. We could sneak down to hat bar with he Cheers flag and catch up."

  "Will we offend the hostess?" Marissa asked.

  "Not Susan," Wendy assured her.

  "She'll understand."

  Ten minutes later, Marissa and Wendy were seated opposite each other in low-slung vinyl chairs. They were at a large mullioned window that looked out on busy Beacon Street with the darkened Boston Garden beyond. In the light of the lamps, the grass was just starting to become green, one of the first signs of spring.

  Both women ordered mineral water and laughed at each other.

  "No alcohol! Well, hope springs eternal," Wendy said.

  "I had my fourth embryo transfer about a week ago," Marissa admitted.

  "Another coincidence," Wendy said.

  "So did I. Only mine was my second. What program are you involved with?"

  "Women's Clinic in Cambridge," Marissa said.

  "I don't believe this," Wendy said.

  "I'm there as well. Dr.

  Wingate?"

  "Yup!" Marissa said.

  "Dr. Carpenter is my regular GYN man.

  I have Dr. Wingate for in-vitro fertilization."

  "I go to Megan Carter," Wendy said.

  "I've always preferred a woman gynecologist. But I had to go to Wingate since he runs the IVF show."

  "It's amazing we haven't run into each other," Marissa said.

  "But then again, they are very good about the confidentiality side of things, which is one of the reasons I started using the clinic in the first place."

  "My feelings too," Wendy said.

  "I could have gone to someone at the General, but I wasn't comfortable with that."

  "Was it a shock to you when you discovered your fallopian tubes were sealed?" Marissa asked.

  "Completely," Wendy said.

  "I'd never expected it. It was ironic, I thought, considering all the birth control precautions I took all through college and med school. Now I can't remember what it was like not to want a child."

  "I feel the same way," said Marissa.

  "But I was even more surprised to learn the cause was TB salpingitis."

  Wendy slammed her mineral water to the table.

  "These coincidences are getting spooky," she said.

  "I had the same diagnosisgranulornatous reaction consistent with tuberculosis. I even had a positive PPD skin test."

  For almost a full minute the two women stared at each other over the table. This was too much of a coincidence to be believed.

  With her epidemiologic training, Marissa was instantly suspicious.

  The parallels in their cases were extraordinary. And the only time their lives intersected was during medical school.

  "Are you thinking what I'm thinking?" Wendy asked.

  "Probably," Marissa said.

  "I'm wondering about those months we spent on that elective rotation at Bellevue. Remember those TB cases we saw, especially the drug-resistant ones? Remember they were thinking that there was an upswing in TBT' "How could I forget?"

  "Luckily my chest X-ray is perfectly clear," Marissa said.

  "So's mine," Wendy said.

  "I wonder if we are isolated cases or part of a bigger pattern.

  TB salpingitis is supposed to be rare, especially in a healthy nation like the United States." She shook her head. It didn't make sense.

  "Why don't we go back to the Resolve meeting and ask if there is anybody else with the same diagnosis?" Wendy suggested.

  "Are you serious? The chances are so small, they'd be negligible."

  "I'm still curious," Wendy said.

  "Come on, it's close and we have a captive audience."

  As they walked back toward Acorn Street, Marissa broached the subject of her marital situation. It was hard for her to talk about it, but she felt the need to discuss it with someone. She told Wendy that she and Robert were having serious problems.

  "He's taken to sleeping in the guest room," Marissa. confided.

  "And he refuses to see a therapist. He says he doesn't need someone to tell him why he's unhappy."

  "A lot of us infer tiles have marriage problems," Wendy said.

  "Especially those of us in in-vitro. It seems to go with the territory.

  Of course everybody deals with it differently. My husband, Gustave, has just transferred what little attention he used to give me to his work. He's always at the hospital. I practically never see him."

  "Robert's doing that more and more," Marissa said.

  "Unless one of these embryos implants, I'm not all that optimistic we'll be able to weather the storm."

  "You've come back!" Susan cried when she opened the door for Marissa and Wendy.

  "Just in time for dessert."

  Wendy told Susan what they wanted to do. Susan took their coats, then preceded them into the living room, where guests were busily conversing in small groups as they ate chocolatt cake.

  "Can I have everyone's attention for one last time," Susan called out. She explained that Wendy had some questions for them.

  Positioning herself in the middle of the room, Wendy introduced herself in case there was anyone who wasn't aware that she was a doctor. She then asked how many of the women present had blocked fallopian tubes as the cause of their infertility.

  Three people raised their hands.

  Looking at these three women, Wendy asked: "Have any of you been told that your tubes were sealed by tuberculosis or what looked like TB under the microscope?"

  Each made a questioning gesture, raising their eyebrows. They weren't sure.

  "Have any of you been advised to take a drug called isoniazid or INHT' Marissa asked.

  "It would have been suggested that you take it for months."

  Two of the women raised their hands. Both said that they had been sent to their internists after their laparoscopies and that a drug was mentioned that they'd have to take for an extended period of time. In both instances, however, the drug was not given, and they'd been told to come back every three months.

  Marissa wrote down their names and phone numbers: Marcia Lyons and Catherine Zolk. Both promised to inquire with their family doctors to find out for certain if the drug had been isoniazid.

  Utterly astonished, Marissa took Wendy aside.

  "This is unbelievable.

  I think we have four cases. But if these two women had TB, then our medical school rotation at Bellevue is off the hook."

  "Four cases doesn't make a series," Wendy cautioned.

  "But it is mighty suspicious," Marissa. said.

  "Four cases of a rare disease in one geographical area. Besides, it sounds as if none of us has any signs of infection elsewhere. I think we are on to something. I'm going to follow up on it," Marissa vowed.

  "Let's do it together," Wendy suggested.

  "Wonderful," Marissa agreed.

  "The first step will be to take advantage of my contacts at the CDC. We can start that tonight.

  Where is your car?"

  "It's over at the Mass. Eye and Ear Infirmary," Wendy said.

  "Mine's closer," Marissa said.

  "I'll drive you to yours and you can follow me home. You game?"

  "I'm game," Wendy said.

  Saying their goodbyes and thanking their hostess, Marissa suddenly had an idea. She asked Susan if she knew the cause of Rebecca Ziegler's infertility.