Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  "They were very positive," she said.

  "Evenat high dilutions."

  "All of them?" Cyrill asked incredulously.

  "All of them," the technician repeated.

  "That's the proof I wanted," Marissa said. When she'd first arrived at the CDC, she'd gone directly to the lab to have some blood drawn. Then she'd made arrangements for her serum to be tested with the ELISA test for BCG along with Rebecca Ziegler's and Evelyn Welles' serums.

  "I don't understand," Cyrill said.

  "How can that be?"

  "I think it is rather clear," Marissa said.

  "Evelyn Welles didn't have tuberculosis. She had disseminated BCG bacillus." Marissa reached for Welles' hospital chart and opened it to her autopsy page.

  "Look," she said, pointing to a description of the microscopic appearance of her fallopian tubes.

  "It says there was an intense, overwhelming infection in her oviducts. I'll tell you why that was the case: the fallopian tubes were the port of entry of the BCG. The fact that it disseminated was because of her immunological problem. And look here at the description of her cervix.

  It describes a recent punched-out lesion. That had to be a biopsy site." Marissa flipped through the chart until she came to the woman's last Pap smear report.

  "Now look at this. The Pap smear was normal four weeks before. Does that make any sense to you men?"

  "I think I'm beginning to get the picture," Tristan said.

  "You're suggesting that the twenty-three cases of TB salpingitis that I reported were actually BCG, not TB."

  "That's exactly what I'm suggesting," Marissa said.

  "I didn't have TB salpingitis either. I had a deliberate inoculation with BCG vaccine. I think the basis of this whole mystery is nothing but business interest. A few years ago, Female Care Australia realized that they were sitting on a potential gold mine with their IVF technology. The only trouble was that their increased success was denying them income by lowering revenue. So they decided on two courses of action to ensure increased revenues.

  One was to create more demand. The only absolute indication for IVF is hopelessly blocked fallopian tubes. Someone found out that the rural Chinese doctors had been clever enough to develop a way of cannula ting the fallopian tubes without the need for anesthesia. So they began bringing these doctors out of China to do just what they had been doing in China: sterilizing women.

  The trick was to sterilize without leaving evidence of it, or leaving evidence that could be misinterpreted. Someone must have come up with the BCG vaccine. It causes an intense immunologic reaction that seals the tubes totally and destroys the organisms in the process. That's how BCG works. On biopsy, it looks like tuberculosis. There just aren't any organisms. Obviously, they only tried this ploy on certain candidates. They chose only young, recently married, middle-class females. All they had to do was schedule these women for a minor procedure of some sort, like a cervical biopsy. I know that one ruse was to tell the patient that her Pap smear was CIN Grade #1. That's how they got me and Wendy. Neither Wendy nor I had told the clinic we were physicians. If they had known, they probably wouldn't have risked including us in the scheme. And they certainly didn't know about Evelyn Welles'immunological problem. And Rebecca Ziegler.

  She must have been clever enough to figure that something was wrong. I think they killed her and made it look like a suicide.

  "The second part of the plan to maintain revenue was to make sure that the IVF wasn't successful too quickly. At ten thousand dollars per cycle, you can see why they'd want to run their patients through as many cycles as possible. Yet ultimately, they wanted all their patients to conceive. That meant a better reputation for them. My guess is that to make failed cycles a certainty, they just added a drop or two of acid to the culture media after fertilization took place. Before my last egg transfer, I asked to see the zygotes. I remember the solution was crystal clear. The significance of the color didn't dawn on me until just recently. The usual pH indicator in tissue culture media is phenol red, which turns clear in acid. My embryos were in acid. No wonder they didn't implant."

  Cyril! cleared his throat. He looked at Marissa's flushed and angry face. He could tell she was convinced, but unfortunately he didn't share her conviction. He didn't know quite what to say.

  "I'm not sure..." he began.

  "Not sure of what?" demanded Marissa.

  "Is it just too had for you men to believe that women could be victimized to this extent?"

  "It's not that," Cyrill said.

  "It's just that it is too complicated.

  It represents too much effort, too much conspiracy. It's just too diabolical."

  "It's diabolical, all right," Marissa agreed, "but let's be clear about the motivation. This is about profit, pure and simple. I'm talking about big money. Look!" Marissa stood up and went to a small blackboard that Cyrill had in his office. Picking up a piece' of chalk, she wrote down 600,000. "This is the number of couples in the U.S. that fertility specialists estimate need IVF if they want to have a child that is genetically theirs. If we multiply that by fifty thousand dollars we get thirty billion dollars. That's billion.

  Not thirty million, thirty billion. And that's just in the United States. IVF could rival the world's illegal drug industry as a money-maker. Admittedly not all of the six hundred thousand are middle class, and not all could come up with the money necessary. But that is why FCA has gone to such lengths to create their own market."

  "My God!" Cyrill said.

  "I never imagined there was that kind of money involved."

  "Most people don't," Marissa said.

  "The whole infertility industry is totally unregulated and unsupervised. It's grown up in a no-man's land between medicine and business. And the government has just looked the other way. Anything to do with reproduction is politically dangerous."

  "But such a conspiracy would require so many people," Tristan said.

  "Not that many," Marissa said.

  "Maybe just one per clinic. At this point, I'm not about to hazard any guess as to the conspiracy's actual organizational design."

  "And I was so sure drugs were at the heart of it," Tristan said.

  "They still might be involved, only indirectly," Marissa said.

  "It will be interesting to see exactly how Fertility, Limited, came up with the staggering amount of capital they would have needed to expand as rapidly as they did across three continents. I have a suspicion that their stock offerings were only clever ruses. I wouldn't be surprised if they're tied up with the Wing Sin for ventures besides smuggling pairs of men out of the PRC. Fertility,

  Limited, could launder money from the Golden Triangle heroin for the Wing Sin. At least it's a possibility."

  "If this is all true," Cyrill said, "then it will take a massive effort with international cooperation to break it."

  "Precisely," Marissa said.

  "That's where the CDC comes in. I think that the Attorney General's office and the State Department have to be alerted simultaneously. If this conspiracy is to be broken, it will take their combined power, and I think they will listen to the CDC. I can tell you it won't be easy. Any organization that is as big and as wealthy as Fertility, Limited, and its subsidiaries will have significant political clout."

  "Since it is a national problem here in the United States," Cyrill said, "the FBI will have to be involved."

  "Undoubtedly," Marissa agreed.

  "And thank God for it, because

  I'm certain Tristan and I are going to need some protection for a time. We may even have to hide away someplace. I'm afraid that the Wing Sin has a global reach."

  Cyrill got to his feet'I'm going to run upstairs," he said.

  "I want to see if I can catch the director before he leaves for the day.

  Would you two mind waiting here for a moment?"

  After Cyrill left, Marissa faced Tristan.

  "What do you think?" she asked.

  "Honestly?"
<
br />   "Honestly?" Tristan repeated.

  "I think you're a spunky, knackered battler."

  "Please, Tristan," Marissa said.

  "I'm serious. Cut the Aussie babble and speak English."

  "I'm being serious too," Tristan said.

  "I think you're beautiful.

  I think you're exhausted. And I think you are amazing. In fact, you're a little intimidating. And on top of all that, I think you are right. And I can't think of anyone I'd rather go into hiding with than you."

  Epilogue

  November 22, 1990

  11:55 A.M.

  "What's that street sign over there?" Tristan asked, pointing in front of Marissa, who was sitting in the passenger seat of a Hertz rent-a-car.

  "I don't know!" Marissa sighed in exasperation.

  "I can't see it unless you pull ahead of this tree next to us."

  "Right you are, luv," Tristan said. He pulled the car ahead about a foot.

  "Cherry Lane," Marissa read.

  "Cherry Lane?" Tristan questioned. He bent over the map he'd drawn.

  "I can't figure these directions out."

  "Perhaps now we could go back down the hill and ask?"

  Marissa said. They'd passed a service station a few minutes before.

  Tristan's head shot up.

  "Listen," he said, "I can find the damn house, okay?"

  For a moment the two glared at each other. Then they both broke into easy laughter.

  "I'm sorry," Tristan said.

  "I suppose I'm a touch tense. Didn't mean to snap."

  "I didn't mean to either," Marissa said.

  "I think we're both under a bit of strain."

  "That's an understatement," Tristan said.

  "I don't even know' if Chauncey will recognize me. It's been over three years."

  "But he's six," Marissa said.

  "I think he'll recognize you. I wonder what he will think of me."

  "He's going to love you," Tristan said.

  "Mark my words."

  "If we ever get there," Marissa said.

  "Have faith," Tristan said. He looked back at his map.

  "If we could only find this Connolly Avenue."

  "We just passed that," Marissa said.

  "I'm pretty sure that was the last street we went by."

  "Then we'll just have to chuck a u-ey," Tristan said as he pulled the steering wheel all the way to the left.

  "It's always a bit confusing since you folks drive on the wrong side of the road."

  Going back a block, they found Connolly Avenue. Connolly Avenue fed into Green Street. Within fifteen minutes they were parked in front of a white clapboard house with Victorian trim.

  On the front lawn was a sign that said: OLAF SONS

  "Well, here we are," Tristan said. He gazed up at the house.

  "Yup," Marissa agreed.

  "We made it."

  Neither moved to get out of the car.

  Marissa was particularly nervous. The Olafsons, Tristan's in laws had been caring for Tristan's son, Chauncey, for the past three years. Marissa had never met them and had never seen Chauncey. While Marissa and Tristan had been hiding out under the auspices of the FBI, it had been deemed unwise for them to meet until now, Thanksgiving day.

  The months since their return from the Orient had passed slowly. The government had placed them in Montana, where they shared a house in a small town. Neither of them were permitted to work as physicians.

  At first it had been very difficult for Marissa. It took her a long time to adjust to Robert's death. She felt responsible for it for a long time. That he had died when they were still on such bad terms only added to her pain.

  Tristan helped a lot. To a degree, he'd been through the same thing. It gave him a special empathy. He'd known when to talk with her and when to leave her alone.

  On top of Robert's death, she had to contend with Wendy's.

  It had taken months before the nightmares of the sharks had stopped their nightly visit. She felt responsible for her friend's death as well.

  Ultimately, time had been the great healer, as it was said to be.

  Gradually Marissa had begun to feel more like herself. She even started back to her usual exercise routine of jogging several miles a day. Losing the weight she'd gained through the fertility treatments proved a boost to her morale.

  "I guess we'd better go inside," Tristan said. But no sooner had he voiced the words than the front door to the house opened, and out stepped a couple with a child.

  Tristan got out of the car. Marissa did the same. They slammed their doors shut. For a moment, no one said anything or moved.

  Marissa looked at the child. She could see sZ s of Tristan in his hair and the shape of his little face. Next s e looked to the couple. They were younger than Marissa had anticipated. The man was tall and slight, his features sharp. The woman was short.

  Her bobbed hair had a sprinkling of gray. She was clutching a tissue. Marissa realized that she was crying.

  The introductions were awkward, especially with Elaine Olafson struggling through tears.

  "I'm sorry," she apologized.

  "But seeing Tristan brings back the pain of losing Eva. And we have gotten so attached to Chauncey."

  For the moment, Chauncey was holding on to Elaine's leg. His eyes darted from Marissa to his father.

  Marissa couldn't help but sympathize with Elaine. The woman had lost her only child and was now about to lose the grandson she had been caring for for three years.

  As they entered the house, Marissa smelled the wonderful aroma of a roasting turkey. She had always loved Thanksgiving.

  Her memories of Thanksgiving dinners in Virginia were warm and wonderful. It had always been a comfortable, secure time.

  Tristan and Eric soon retired to the den to watch football, cans of beer in hand. Marissa and Elaine went into the kitchen. After some initial shyness, Chauncey attempted to straddle both rooms, moving back and forth from the kitchen to the den every few minutes. Tristan had decided not to force anything. He wanted Chauncey to have the chance to get used to him.

  "Put me to work," Marissa told Elaine. She knew for a dinner like this there would be much to do.

  Elaine told Marissa to relax, but Marissa insisted. Soon she found herself rinsing the salad greens. They chatted about the journey that morning from Butte, Montana, to San Francisco.

  But as Elaine calmed, they moved to more personal issues.

  "Tristan told Eric on the phone that you and he are planning to be married?" Elaine said.

  "That's the current plan," Marissa said. It was hard for her to believe it herself. Only months previously she never would have imagined that she'd be capable of such a major step. But the transition from friendship to romance had started slowly. It had grown steadily through their months in hiding. Then, to Marissa's surprise, their budding romance had flowered with sudden and intense passion.

  "And you are going to adopt Chauncey?" Elaine asked. She opened the oven and basted the turkey.

  "Yes," Marissa said. She watched Elaine, waiting for the woman to look at her.

  "I know this is very difficult for you " Marissa said.

  "I can imagine how much you will miss the boB ut there is something you should know. Tristan and I plan to move here to Berkeley so that Chauncey won't have to change schools. But also so that he will be nearby. You and Eric will see him as often as you like. We know the change will be as difficult for Chauncey as it will be for you. We want to do the most we can to make it easier."

  "That's wonderful," Elaine said. She smiled for the first time since they'd arrived.

  "I had no idea. I thought you would be moving back to Australia."

  "No," Marissa said.

  "For now it will be better for us both here.

  We have a lot we'd like to put behind us. We want a fresh start."

  Elaine's mood was much improved with the unexpected news about the intended move to Berkeley.

  "Eric
and I saw you and Tristan on Good Morning America and on 60 Minutes. When we heard what those clinics were doing, we were appalled. What some people will do for money!"

  Marissa nodded.

  "I had to laugh at what Charlie Gibson said," Elaine continued.

  "That comparison he made between the closing of the chain of Women's Clinics and the jailing of Al Capone."