by JA Schneider
Jill took a curling ham and cheese sandwich, thought better of it, and settled for a plate of beef stew.
“Bad day,” she said to Tricia Donovan, who stood in line behind her.
“The worst,” Tricia said. “I heard about the Moran case. Started to cry in front of a bunch of Pathology residents.” She eyed a pyramid of grinders. “You hear about the eclampsia case too?”
“Yes. Last name Prewitt, right? You were there for that?”
A nod. “With Ramu and Charlie.”
Behind Tricia another intern named Charlie Ortega said, “We actually helped. MacIntyre was ready to drop.”
“Nice to hear one good story.” Jill looked away. She had a headache, and the depression she’d felt earlier was beginning to creep back. Ahead, further down, she saw Levine listening and nodding with grave, thoughtful eyes as MacIntyre yammered on. Levine was leaning tiredly with both elbows on the steel counter. His dark hair fell over his brow. He was about an inch taller than MacIntyre, who, in his own sandy-haired way wasn’t exactly unattractive…unless one counted his irascible temper, the white jacket that always looked slept in and the eating manners of a timber wolf.
Levine, straightening, turned to Jill and smiled at her. She smiled back, feeling her face flush.
But MacIntyre was monopolizing him. Paying the cashier, he loudly berated himself for having maybe used the wrong medications on the eclampsia patient. Or the right medications in the wrong order.
Levine turned back to his second-year resident. “You did fine.”
“Tell Mackey! He’s over there.”
“Only next time if it’s that far gone, give the Lasix and Mag Sulfate simultaneously. And give the Mag Sulfate deep IM…”
They headed off to a table where Mackey sat, looking troubled.
Jill, Tricia, and Charlie Ortega carried their trays to their usual table, on the edge of things somewhat away from the noise. They took turns bolting their food and telling each other not to bolt their food.
Jill, between swallows, said, “This morning’s done a job on me. Hard to believe when I finished med school I thought I was going to save everybody.”
Charlie shook his head. “Didn’t we all?”
Tricia said, “We thought OB was gonna be a happier place, huh?”
There was a scraping of chairs and three more interns arrived. Gary Sayers from L.A., horse-faced Carole Shelton from Minneapolis, and Ramu Chitkara, born in New Delhi and educated at Oxford. With comic primness, Ramu placed his plate of grinders distastefully on the table.
“Gee, we have a whole twelve minutes to eat,” he said in his British accent.
Between bites the ones who had been there talked about the eclampsia case. It was bad. Poor MacIntyre. Prewitt’s B.P. was already 200 over 140 when they brought her in. Rough going, but Mac got her stabilized, got the convulsions stopped.
Ramu took another mouthful, swallowed. “Now here’s the weird part. Eclampsia usually happens to overweight women with elevated blood pressure, high salt intake and albumin in the urine, right? Symptoms get worse slowly, plenty of time to treat it, right?” He reached for his Diet Coke.
Charlie said, “But Prewitt’s a thin gal into fitness and obsessive about her salt intake and – as of last week’s prenatal visit – BP okay and no albumin in the urine.”
“No antecedent toxemia symptoms at all!” Tricia said. “And they bring her in like that? It makes no sense!”
Jill looked at them all. “Boy, for a supposedly world-renowned med center, this place has had one helluva morning.”
Carole Shelton said sharply, “What do you mean, supposedly world-renowned?”
The others just looked at her. She was a school-snob type, easy to dislike.
An argument ensued. This morning was worse than most. When it rains it pours. Madison’s a magnet for the toughest cases, the high-risk patients, the ones who might get less good treatment elsewhere. Every ambulance driver knew that. No doubt that’s how the abruptio wound up here…
“Exactly!” Carole Shelton said. “And that” – she held up a finger – “is what makes Madison the unsurpassed teaching institution that it is.”
Gary Phipps broke the tension with a long, juicy burp. He rose, gallantly tossing their empty plastic plates onto a tray like Frisbees. “We’d better get going if we want good seats,” he said.
“Or any seats,” said Ramu. “Anyone for the tunnel? It’s fastest.”
On the way out Tricia, dropping behind with Jill, said, “I’m going to research that eclampsia case on my own. It bothers me, there’s got to be more to it.”
Jill nodded in agreement. Her mind had gone back to Mary Hollins and Maria Moran.
6
The planet was violet, and floated in a bright orange sea. Whitish specks dotted the planet in odd-shaped clusters, some crowded, some sparse, suggesting civilizations of greater or lesser density – and who knew what inhabitants?
A voice, electronically amplified, floated out over the dark of the amphitheater. Computer notebooks switched on like a sudden constellation.
“What you are seeing,” intoned the voice of Dr. William Stryker, “is, I promise you, not Star Wars.”
A few chuckles came from the tiers of seats. The audience was reminded that this was, after all, a Grand Rounds conference like any other. Well, almost any other. Med students especially had arrived whispering that its title, “Latest Advances in Human Reproductive Technology,” sounded creepy, but such feelings only heightened the anticipation.
Dr. William Stryker, chief of Madison’s Obstetrics and Gynecology Department, stood to one side of the stage, leaning on a dimly illuminated lectern. The violet light from the screen gave his tall, silver-haired figure a reddish cast. Jill Raney, sitting with Tricia Donovan in the fifth row, saw his face half in shadow: a crimson mask from some ancient play.
“Nor is this a slide of outer space at all,” Stryker went on. He flicked on a light with an arrow beam, and pointed at the screen. “It is, rather, a picture of inner space: an in vitro-fertilized mouse egg, magnified three hundred times and stained for the purpose of photography. We can’t, of course, do that with a human egg.”
The arrow beam moved. “That surrounding orange area,” he said, “is the culture medium that nourishes the egg. It contains enough amino acids and glucose to nurture a mammalian egg at least to the blastocyst stage.”
The beam switched off. Soft typing sounds came from the computer notebooks.
Still leaning on the lectern, Stryker spoke briefly about the hospital’s two main methods of treating infertility. Depending on its cause, he said, a couple may choose to achieve pregnancy through either artificial insemination or in vitro fertilization – which has made amazing medical advances.
“Reviled thirty-odd years ago,” he said. “Most of you weren’t even born at the time of Louise Brown’s birth: the first so-called test-tube baby. Now, with IVF used so often, it’s hard to believe that when Brown's imminent birth was announced in 1978, many - including physicians - feared that she’d have monstrous birth defects. How, they clamored, could it be possible to tinker with eggs and sperm in a petri dish and not do some kind of serious chromosomal harm? Religious groups and ethicists warned that IVF would pave the way to abominations like artificial wombs and baby farms.”
Hushed silence in the amphitheater.
“Louise Brown,” Stryker continued, “was born beautiful and healthy. Hope was also born for millions of infertile couples.”
He pulled out the mike and walked slowly away with it from the lectern.
“Like many discoveries, IVF has opened up frontiers undreamed of in science. It has enabled us to treat genetic disorders in the newborn, and” – his voice sharpened – “has opened a Pandora’s box of new controversy: One hears silly talk of ‘embryo farms’ and ‘designer babies’ carrying preferred genes” – he turned, walked back – “but if, say, inherited disease is suspected, is it wrong to treat … preimplantation in the
uterus? Some still say yes. May I have the second slide, please?”
An overhead beam jumped, and there on the screen was a human egg, magnified two hundred times, Stryker said. It was watery, pale and mucoid. And surrounded by hundreds of iridescent sperm that seemed almost to be moving. “Only one sperm will penetrate the egg, and fertilization will occur not in the female’s body but in a glass Petri dish…a humble little saucer four inches across and one-half inch deep. Nature, always indifferent, does not care where fertilization takes place. Given correct temperature, the right egg and sperm will mate in a teaspoon!”
In her notebook Jill typed “life in a teaspoon,” and stared down at the glowing words.
Stryker was back at the screen. With a wooden pointer he tapped it.
“I’m going to show you a series of slides showing conception and the cleavage divisions – the beginning of life – of this egg as it sits and is nourished in its dish. Next!”
The egg was now twelve hours after fertilization, beginning to rearrange itself. “Examine for defects.” The pointer moved. “Look for injury to the cell wall; deterioration of the nucleus; disintegration of any cellular details. Next!”
Luminous, stroboscopic stages of the cell now splitting into two cells, which in turn split – “Next!” – into four cells; then – “Next!” eight cells, big enough now to be re-implanted in the mother’s uterus.
“And so,” concluded Stryker, returning to his lectern, “to the joy or dismay of many, we create life in the lab. Lights please! Are there any questions?”
The recessed lights came on and several questions were asked, including a female med student who said, “Dare I ask what happened to that egg?”
Stryker smiled, placing his hands on each side of the lectern. “She’s in pre-school.”
Loud laughter. Stryker seemed to enjoy it, and as the amphitheater buzzed he stepped down to confer with some older doctors in the front row. Madison’s genetic counseling team, Jill knew.
Tricia leaned to her and said in a lecherous whisper, “I was conceived in a Honda.”
Jill burst out laughing, and quickly covered her mouth. Stryker was back at the lectern, waiting. The audience quieted.
“Since some of you are new to the hospital, I would like to introduce you to our vice-chairman of the Genetic Counseling Committee, Dr. Clifford Arnett. Dr. Arnett is deeply involved in reproductive endocrinology and infertility research. He also gives most generously of his time to our clinics, and is an invaluable member of our obstetrical teaching program. I give you, therefore, Dr. Clifford Arnett.”
A ripple of applause had already begun as a large, white-coated figure mounted the podium. Clifford Arnett had thin ginger hair, a broad toothy smile, and wore an open-collared purple sport shirt under his lab coat. Jill had admired him since med school. He could be volatile but colorful, and was popular as a teacher. For two years Jill had dreamed of one day being invited to join Arnett’s research team, although you had to be high up the ladder to qualify for that.
Arnett waved high a thick sheaf of papers. “Last week I prepared a wonderful and highly technical lecture to give to you. Unfortunately, medicine is changing so fast that everything in here is already obsolete!”
He tossed his papers aside in a helpless gesture and waited for the nervous laughter to subside. It was hard to stay current in medicine; everyone knew that.
“DNA and genetic engineering,” Arnett said, stating his real topic. “Awful expression, isn’t it? Most scientists feel that not enough research has been done on lab rats to make these concepts applicable to human beings. That is certainly the position of the National Institutes of Health, and they’re regular fuddy-duddies when it comes to overseeing our research and handing out grants.”
Soft typing sounded in notebooks as he argued for incubating embryos longer in the lab – “at least to Day 5;” talked about improvements in culture mediums, and how to recognize the most viable embryo(s) in the batch, selecting those first for fresh transfer.
“Now I’m going to show you some marvelous slides. Technicolor DNA molecules taken from fifth-day cells of a variety of lower organisms. Lights off, please?”
The amphitheater went dark again – and a sudden, beeping noise filled the room. All eyes looked stage right to a flashing red light and, below it, an illuminated screen. Digital code figures marched across the monitor: 117-61-Ch8.
David Levine’s call number was 117; the rest of the code meant emergency in Obstetrics, Chapin Eight. Levine’s available interns would also have to respond.
“Hell,” Jill muttered as she and Tricia made their way out. Ortega and Levine joined them higher up the aisle.
In the darkness behind them Arnett’s voice announced the first dazzling slide.
“Attempts to insert DNA into the in vitro-fertilized embryos of mice have met with highly photogenic results, as you’ll see…”
The others were already out the swung-closed doors. Jill hesitated, staring at the brilliantly lit screen. She saw, as if they were floating, two tall, intertwined spirals jammed with hundreds of multicolored balls.
DNA. The amazing double helix. One could hallucinate looking at something like that.
She was aware of the door re-opening behind her, and a hand on her arm.
“Don’t want to go,” she told Levine.
“Nobody does. Come on.”
Jill hurried after him across the foyer, leaving behind the big, darkened room with its entranced students, all of them relieved that they hadn’t been called.
7
Down the stairs Levine plunged, with the others close behind.
“Dammit,” Tricia called. “We missed the important part of that lecture!”
“Crappy luck,” Jill breathed.
At the next landing Tricia caught up. “When I have a child,” she huffed, “I’m going to write its whole genetic code. It will have brown eyes and hair like my grandfather, who was handsome but dumb, and an IQ of 150 like my uncle, who’s smart but really ugly.”
“Like a shopping list,” Jill said.
“Yeah! Wouldn’t that be cool?”
“Stop, you’re scaring me.”
“Sorry!”
There was a loud clang as Levine opened the steel door that led to the tunnel. A decrepit labyrinth was the sole inside connection between the old med school and the complex of modern structures, four blocks long, that made up the city within a city that was Madison Hospital.
Levine held the heavy door for the two women. “Gotta get you two running shoes,” he said.
“I used to run before this place crippled me,” Jill said.
Fortunately they only needed a short stretch of musty, white-tiled tunnel. Within minutes they’d reached the main bank of elevators and were tearing down the fifth-floor corridor to Delivery Room Number 3.
Outside, an OB nurse was wheeling away a table piled with instruments. “Unbelievable,” she told them, shaking her head.
“What is?” Levine said.
She kept shaking her head. “Go see.”
Into the anteroom for a quick scrub, then they entered the delivery room.
George Mackey’s surgical gown was blood-spattered. He had a tiny blue infant on a draped side table, and was struggling with a suction tube to resuscitate it. The newborn appeared to be of about twenty-one weeks’ gestation, and could not have weighed more than two pounds.
“Broke our necks to get here…” Levine began, his voice muffled as one of the nurses tied on his surgical mask. He looked down at the infant, turning bluer by the second and making sucking sounds at the rate of about seventy respirations per minute. The young mother moaned, groggy from medication. Jill, Charlie, and Tricia stared down too, slack-faced.
“It’s Sayers. Remember her?” Mackey shook his head. “Sweet girl. She – she was going to name him Christopher if it was a boy.”
Over his shoulder Levine said, “Nurse, get more sterile towels, medium, and an incubator.”
M
ackey stopped what he was doing and stepped back. Levine moved in. With his gloved left hand he lifted the baby’s rump and tilted him head down to promote drainage from the trachea. His right hand reached for Mackey’s suction bulb, and with both elbows up he tried to clear the infant’s breathing passage.
The baby gave a tiny cough; everybody cheered.
“No, not yet…” said Levine in a low voice. “I don’t know…” He was breathing rapidly.
Forgetting sterile procedure, Jill raised one of her gloved hands to her mouth and pressed hard.
“Can’t be Thalidomide,” Ortega said. “Nobody’s used that in a million years.”
“God only knows.” Levine’s hands were working furiously; his voice suddenly rose. “Oh Christ. The kid’s retracting. Look at his ribs. Oh Jesus – ”
Jill helped push the incubator into place. The infant’s form was darkening rapidly; his almost inaudible gasps were now coming faster and more shallowly. Its features were nearly indistinct. At two pounds it was like a tiny doll…a doll with four little stubs where there should have been arms and legs.
Overcome, Jill looked away; steadied herself watching the sweeping hand of the wall clock.
“Drugs?” Ortega asked. “The mother took drugs?”
Levine watched Tricia wrap the newborn in a little blanket. “Mother is a PhD candidate in anthropology,” he said. “Straight-arrow as they come.”
He started to move the gasping bundle into the incubator, and suddenly stopped, stiffening.
“Forget it,” he said. “Kid’s had it.” He looked down at the infant he cradled. Respiration had stopped. The lips and eyelids were blue, the miniscule nostrils which only seconds before had been flaring desperately were now still.
Tiny Christopher Sayers had spent just fourteen minutes on earth.
Faces fell and there was silence. Gently the baby with stubs instead of arms and legs was placed on a gurney.
Jill Raney backed slowly away, feeling tears well up painfully.
No, she decided. Obstetrics was not a happy place.