Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  "We had to wait for anesthesia before we began out case."

  "It makes no difference at all," Marissa assured him. She told Robert to see what Gustave wanted to drink while she and Wendy called for the pizza.

  When the pizza arrived, they all gathered around the table in the family room off the kitchen. The men were drinking beers.

  Marissa was pleased but a little surprised that Robert was enjoying

  Gustave's company. He usually didn't get along with doctors.

  "We haven't heard about your visit to the Women's Clinic today," Robert said when there was a lull in the conversation.

  Marissa looked over at Wendy, She wasn't sure if she wanted to get into a discussion about their visit, knowing that she'd have to hear Robert's "I told you so."

  "Come on," Robert urged.

  "What happened?" Turning to Gustave, Robert explained that the women had tried to access the clinic's computer.

  "We asked and they said no," Wendy admitted.

  "I'm not surprised," Robert said.

  "Were they nasty about it?"

  "Not at all," Wendy said.

  "We had to go to the director of the clinic, the same man who runs the in-vitro unit. He said it was a policy made at the home office in San Francisco."

  "I think it is shortsighted," Marissa said, finally speaking up.

  "Although we didn't find anything out at the clinic, we did learn that there are five cases, and five cases of a rare problem in one geographical location deserves to be investigated."

  "Five cases?" Gustave questioned.

  "Five cases of what?"

  Wendy quickly filled Gustave in on the situation, explaining it involved her apparent TB of the fallopian tubes.

  "So we went back to the clinic to see if there are other cases,"

  Marissa explained.

  "But they would not let us search their files for reasons of confidentiality."

  "If you were running a clinic," Robert asked Gustave, "would you let a couple of people off the street come in and access your records?"

  Absolutely not," Gustave agreed.

  That's what I tried to explain to the ladies last night," Robert said.

  "The clinic is only operating in a reasonable, ethical, and legal fashion. I would have been shocked if they had given any information at all."

  "We are hardly 'people off the street," Wendy said heatedly.

  "We're doctors as well as patients."

  Being two of the five in your own series hardly makes you objective," Gustave pointed out.

  "Especially with the hormones you women have been taking."

  "I'll drink to that," Robert said, raising his beer bottle.

  Wendy and Marissa exchanged frustrated glances.

  After wiping his mouth with the back of his hand, Robert turned back to Marissa.

  "Five cases?" he said.

  "Last night you mentioned four."

  Rebecca Ziegler had the same problem," Marissa answered.

  :

  "No kidding," Robert said. Turning to Gustave, he said, "She was the woman who committed suicide over at the Women's Clinic. She went berserk in the waiting room just as Marissa and I arrived, the very day she jumped. I tried to restrain her but she slugged me."

  "Wendy told me about her," Gustave said.

  "You tried to restrain her before she jumped?"

  "Nothing so dramatic," Robert said.

  "She was about to attack a receptionist. Seems the receptionist wouldn't let her see her records. It wasn't until later that she jumped out of the window.

  And that was from the top floor, not the waiting room."

  Gustave nodded.

  "Tragic case," he said.

  "It may be more tragic than you think," Marissa blurted without thinking.

  "Wendy and I learned something else today. Rebecca

  Ziegler might not have committed suicide. She might have been murdered. That's how reasonable, ethical, and legal the Women's Clinic is being run."

  As soon as Marissa had mentioned this shocking possibility she regretted it. There were a number of reasons she shouldn'i have said anything, her promise to Ken foremost among them.

  She tried to change the subject to tuberculosis, but Robert wouldn't let it go.

  "I think you'd better explain," he insisted.

  Realizing her mistake, Marissa decided she had no choice but to tell the whole story. After she'd finished, Robert sat back in his chair and looked at Gustave.

  "You're a doctor," he said.

  "What do you think of what you just heard?"

  "Circumstantial," Gustave said.

  "Personally, I think those two pathologists are letting their forensic imaginations run wild. As they said themselves, there is no concrete proof. They have a ruptured aorta. That certainly is lethal. Probably the heart was in diastole at the moment of impact, so that it was filling when it was shocked into stopping. The only bleeding came from back flow, meaning the blood that was in the aorta itself."

  "Sounds reasonable to me," Robert said.

  "Gustave is probably right," Marissa agreed, glad to get off the subject. She wasn't about to bring up her own question regarding the fact that Rebecca had hardly acted depressed in the waiting room.

  "Even so," Marissa continued, "Rebecca's death makes us even more eager to access the Women's Clinic's computer. I'd love to read what's in her record; what she saw had to contribute to her death."

  "Maybe we could find some whiz-kid hacker over at MIT," Wendy said.

  "It would be classic if we could get at their files from offsite."

  "That would be fantastic," Marissa agreed.

  "But what's more realistic is for you and me to sneak in there at night and just use one of the terminals. Someone could do that at the Memorial with only a little creativity."

  "Hold on," Robert said.

  "You guys are getting way out of hand. Unauthorized access of someone's private computer files is considered grand theft in Massachusetts. If you do something crazy like that, you could find yourselves felons."

  Marissa rolled her eyes.

  "That's no joke," Robert said.

  "I don't know what's in your minds."

  "Wendy and I happen to think this TB salpingitis is extremely significant," Marissa told him.

  "We think it ought to be followed up. We seem to be the only ones willing to do it. Sometimes risks have to be taken."

  Gustave cleared his throat.

  "I'm afraid I'm in agreement with

  Robert on this one," he said.

  "You can't be serious about breaking into the clinic files. Despite your motivations, it would be a crime nonetheless."

  "The problem is truly one of priorities," Marissa said.

  "You men don't realize how important this issue could be. By following up on it we are being responsible, not the reverse."

  "Maybe we should change the subject," Wendy suggested.

  "I think it should be settled before you women get into serious trouble," Gustave said.

  "Be quiet, Gustave!" Wendy snapped.

  "These five cases may be the tip of an iceberg," Marissa said.

  "As I've already said, it reminds me of the discovery of toxic shock syndrome."

  "That's not a fair comparison," Robert said.

  "It's not like anyone's died."

  "Oh yeah?" Marissa challenged.

  "What about Rebecca Ziegler?"

  March 30, 1990

  8:15 A.M.

  Robert opened the mahogany-paneled door to his private office in the old City Hall building and stepped inside. He tossed his briefcase onto the couch and stepped over to the window. His view out onto School Street was marred by rivulets of water streaming across the outside of the window. He'd never experienced such a rainy March in Boston.

  Behind him he heard his private secretary, Donna, come into the room, bringing his usual morning coffee and his usual stack of phone messages.

  "Some weather!" Donn
a said. Her strong Boston accent made the word sound like wet hah

  Robert turned. Donna had seated herself to the left of his desk to go over the phone messages, which was their usual routine.

  Robert looked at her. She was a big girl, almost five-ten. In her heels, she practically looked him in the eye. Her hair was dyed blonde, the dark roots clearly visible. Her features were rounded but not unpleasant, and her body was toned from daily aerobic exercise. She was a great secretary: honest, devoted, and dependable,

  She also had simple needs, and for a moment Robert wondered why he hadn't married someone like Donna. Life would have been so much more predictable.

  "Would you like sugar in your coffee?" she asked pleasantly.

  Coffee sounded more like caw fee

  "No, I don't want coffee," Robert said sharply.

  Donna looked up from her notes.

  "Aren't we testy this morning," she said.

  Robert rubbed his eyes, then came around and sat down at his desk.

  "I'm sorry," he said to Donna.

  "My wife is driving me crazy."

  "Is it that infertility stuff?" Donna asked timidly.

  Robert nodded.

  "She began to change just about the time we admitted that we might have a problem," he said.

  "Now, between this in-vitro fertilization rigmarole and all the hormones she's on, she is truly out of control."

  "I'm sorry," Donna said.

  "To make matters worse, she's met up with an old medical school friend who's in the same situation and who is behaving equally irrationally," Robert said.

  "They seem to be feeding off each other. Now they are threatening to break into a health care clinic to get into their records. Unfortunately, I have to take her seriously in the state of mind she's in. I wouldn't put anything past her. But what can I do? And, on top of everything, this clinic has guards armed with Colt Pythons. I'm really worried about her."

  "They have snakes at this clinic?" Donna asked, wide-eyed.

  "Huh? No, not snakes. A Colt Python is a revolver capable of stopping a black rhino."

  "I can give you some advice," Donna said.

  "If you're really worried about what Marissa might do, you should hire a private investigator for a few days. He could keep her out of trouble if she is really inclined in that direction. And I happen to know someone who is very good. I used him to follow my former husband. The bum was having an affair with two women at the same time."

  "What's this investigator's name?" Robert asked. The idea of having Marissa followed hadn't occurred to him, but it had some merit.

  "Paul Abrums," Donna said.

  "He's the best. He even got photos of my ex in bed with both girls. Separately, of course. My husband wasn't that kind of guy. And Paul's not that expensive."

  "How do I get in touch with him?" Robert asked.

  "I've got the number in my address book in my purse," Donna said.

  "I'll get it."

  Marissa peered into the otoscope to try to catch a glimpse of the eardrum of the writhing infant on the examination table. The mother was attempting to hold the baby but was doing a miserable job. Annoyed, Marissa gave up.

  "I can't see anything," Marissa said.

  "Can't you hold the child, Mrs. Bartlett? She's only eight months. She can't be that strong."

  I'm trying," the mother said.

  "Trying isn't good enough," Marissa told her. She opened the examination room door and called for one of the nurses.

  "I'll send someone in as soon as I can," Muriel Samuelson, the head nurse, shouted.

  "For heaven's sake," Marissa muttered to herself. She was finding work exasperating. Everything was an effort, and it was difficult to concentrate. All she could think about was the pregnancy test she'd have after the weekend.

  Stepping out of the examination room to get away from the shrieking infant, Marissa massaged the back of her neck. If she was this anxious already, what would it be like on Monday when she was waiting for the result?

  The other topic on her mind was what she and Wendy were going to do about the Women's Clinic. They had to get into their records. That morning she'd gone to the medical records department at the Memorial and gotten one of the women to start a search for cases of granulomatous obstruction of the fallopian tubes. There'd been no problem. If only the Women's Clinic could be so cooperative.

  "Dr. Blumenthal, you have a call on line three," Muriel yelled to her over the sound of crying babies.

  "What now?" Marissa muttered under her breath. She went into an empty examination cubicle and picked up the extension.

  "Yes?" she snapped, expecting Mindy Valdanus to be on the other end.

  "Dr. Blumenthal?" a strange woman's voice questioned. It was the operator.

  "Yes?" Marissa repeated.

  "Go ahead," the operator said.

  "You sound harried," Dubchek said.

  "Cyrill!" Marissa answered.

  "You're a pleasant surprise in the middle of a bad day. This place is a zoo!"

  "Can you talk for a see or do you want to ring me back?"

  Dubchek asked.

  "I can talk," Marissa said.

  "Actually, at the moment I'm standing and waiting for a nurse before I look at a child with an ear infection. So you got me at a good time. What's up?"

  "I'm finally getting back to you on those questions you raised about TB salpingitis," Dubchek said.

  "Well, I have some interesting news. There have been sporadic reports of a condition that's consistent with TB salpingitis from all around the country, although mostly on the West and East coasts."

  "Really!" Marissa exclaimed. She was astounded.

  "Has anybody been able to culture it?"

  "No," Dubchek said.

  "But that's not unusual. Remember, it's hard to culture TB. In fact, no one has, to my knowledge, seen an actual organism in any of these cases."

  "Now that's strange," Marissa said.

  "Yes and no," Dubchek said.

  "It's frequently hard to find the TB bug in tuberculosis granuloma. At least that's what my bacteriology colleagues tell me. So don't make too much of that either.

  What's more important, from an epiderniologic: point of view, is that there are no areas of concentration. The cases seem to be widely scattered and unrelated."

  "I now have five cases in Boston," Marissa said.

  "Then Boston gets the prize," Dubchek said.

  "San Fran is second with four. But no one has actually looked into it. There have been no studies launched, so these cases represent haphazard reporting. If somebody looked, he'd probably find more.

  Anyway, I've got a few people checking into it here at the Center.

  I'll be back to you if anything interesting turns up."

  "The five cases I've come across are all at one clinic," Marissa said.

  "I've started to search at the Memorial just this morning.

  What I'd really like to do is get access to the clinic's records.

  Unfortunately they turned me down. Could the CDC help?"

  "I don't see how," Dubchek said.

  "It would take a court order, and with the paucity of details and low danger level to society, I doubt seriously a judge would grant it."

  "Let me know if you hear anything else," Marissa said.

  "Will do."

  Marissa hung up the phone and leaned against the wall. The idea that tuberculous granuloma of the fallopian tube had been reported from around the country made her more curious than ever. There had to be some interesting epidemiological explanation behind it. And by a quirk of fate, not only was she suffering from the illness herself, she was part of what was the largest concentration. She had to get into the clinic's records. She had to find more cases if there were more to find.

  "Dr. Blumenthal," Muriel said, stepping into the room, "I don't have anybody to help you at the moment, but I can myself"

  "Wonderful," Marissa said.

  "Let's go to it."
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