by JA Schneider
Ortega said, “Doesn’t fit anything we’ve learned. There’s gotta be something else here.”
Tricia sat. “Count me in.”
They slid the chart down the table in front of Phipps, who was in the middle, and began to discuss and shake their heads.
Moments later the door opened and Ramu Chitkara came in.
“I say,” he greeted them. “Have any of you seen the Prewitt chart?”
10
The Sturdevandt Research Wing was the pride of the medical center. Four stories high, it extended in a perpendicular from the main hospital complex to a group of older buildings. Logically, it should have served as an easy connector between the new and old parts of the med center, but it didn’t. The research building was off limits to general traffic.
Jill Raney was tense. Having bolted down a 6 a.m. breakfast, she and the other interns had rushed through two hallways, one tunnel, stepped into a designated elevator – the one patients took - and were now being carried to the one place they’d never been. All carried their notebooks. All stared at Jill as if trying to register what she was saying.
“Both women?” Tricia said. “Both exams at ovulation time?”
“It’s in their charts?” Gary Phipps asked.
Jill nodded. “Go see for yourself.”
Carole Shelton scoffed. So what? It was obviously a coincidence. Lots of women had irregular periods, hence irregular ovulation times.
Charlie ignored her. “We spent time on charts last night too. Prewitt and Burke.”
“Burke?” Jill asked.
“MacIntyre’s stillborn.”
Ramu Chitkara described the oddities they’d found in both cases.
Now it was Jill’s turn to stare.
The elevator doors opened and the group stepped into a brightly lit white foyer. Across from them was a sign with an arrow reading: FERTILITY AND GENETIC COUNSELING.
Turning right they hurried, their footsteps echoing, down a hall lined on both sides with pictures of adorable babies and closed office doors. They stopped at the door marked, Department of Obstetrics and Gynecology, Professor W.T. Stryker, M.D., Ph.D.
Chitkara raised his hand and knocked. There was no answer. Phipps whispered, “Do you think we need a password?” They broke into nervous laughter, then froze to attention as the door opened. Dr. William Stryker, thin with a sharp, narrow face, appeared.
“Come in,” he said tersely. Trading glances, they followed him through an anteroom of empty secretarial desks and flowers and more adorable baby pictures. On the right was a closed mahogany door which Jill guessed was Stryker’s inner office. To the left, down a corridor of closed doors, was a last door which Stryker threw open.
“The laboratory,” he said.
They followed him in and looked around.
It was large and sunny. The rain of the night before had stopped, and a hot, muggy brightness poured in through the east window. Three white counter tops ran nearly the length of the lab, and were crowded with sinks, gas jets, and microscopes. Shelves full of lab glassware were mounted over each of the counter tops, creating the feeling of separate alleys dividing the room.
Stryker led them down the center aisle and stopped by a mounted square incubator. It looked like a small white refrigerator. Placing his hand on it he said, “I like to personally conduct new interns around, before appointments when all is quiet.” He raised his chin, a lordly figure with silver hair, a hawk nose, and the manner of a man accustomed to command.
“The fame of this hospital,” he went on, “lies not just in the superb care extended to its patients, but also in the advanced research which is done in this room and on this floor.” His eyes probed every face. “Madison Hospital Medical Center has pioneered techniques which are now used worldwide: in helping human infertility; in the early diagnosis and treatment of birth defects and inherited disease; and in improved methods designed to manage high-risk pregnancy and fetal well-being.”
He paused for a moment. “The work never stops, of course. Consider this incubator.”
They considered it.
“This is our embryo bank,” he said, patting it. “Not human embryos. Have a look.”
Opening its door he showed them shelf after shelf of numbered flasks. “Higher vertebrates,” he said as everyone pressed closer. “Healthy, growing embryos of one chimp, two dogs, several rabbits and …mice. Many mice.”
“All have been in vitro fertilized,” he said, closing the door quickly, explaining that maintaining the correct warmth and moisture was vital. “The easy part is bringing sperm and egg together. The hard part involves the embryo transfer; that is, successfully transferring the embryo or embryos into the female’s womb. Our success rate with human embryo transfer is forty percent. We’d like to make it higher. Hence our experiments using animals as research subjects. Alright, follow me.”
He led them around, pointing to where a team of second-year residents was running hormone assays on women who were habitual aborters; then showed another counter lined with bottles of whiskey, packs of cigarettes, a multi-tiered-and-labeled bin full of pills, cleaning solvents and other substances. Cages of mice stacked near were research subjects to study the causes of defective ovulation.
“Other projects are over here.” Across an intersecting aisle they trooped and past an array of condensers and distillation changers, liquid nitrogen containers and more cages of mice.
Jill dropped behind to look. Some of the mice were painted blue. Control groups with stripes of green or purple or orange running down their backs scratched around in adjoining cages.
Then she caught up. Stryker had stopped by a lab counter and was gesturing dramatically. “This,” he said, “is one of the most important studies going on. It involves the forefront of DNA research, and is the work of Thomas Ganon.”
Jill and Tricia traded looks. Tom Ganon was the hospital Nasty. Having played his politics well, he had intrigued his way to the top – the position of fourth-year chief resident of OB/GYN. People felt that Ganon was as obnoxious a medical ego as ever swung a stethoscope. People called him Stryker’s deputy, Stryker’s spy, Stryker’s hatchet man…
“He’s kept this rabbit embryo alive ex utero for eight days,” said Stryker. “The embryo’s mother has cystic fibrosis, as does her offspring we suspect, since it’s inherited in both mammals and humans. If Tom has one more day to examine the embryo’s chromosomal structure, he might …” A pause. “Well, don’t want to push our luck. But imagine being able to remove problematical DNA from embryos. Being able to remove other inherited diseases.”
He asked if there were any questions.
Carole Shelton asked what would happen if the rabbit embryo expired.
“We’ll farm another embryo,” Stryker said curtly.
Farm another embryo? Jill and Tricia traded chilled looks.
“It’s 7:25,” Stryker said. “No doubt you’re all due for rounds, but there’s more to show you.”
Jill took one last look at the lab. She was both impressed and spooked. Ganon, Stryker, the others who work here - the thought came unbidden…
Bet they’d love to put women in those cages.
David Levine paced in front of the nurses’ station, looking at his watch every thirty seconds.
“Where are they?” he complained. “We have to start rounds.”
A petite nurse behind the counter checked her watch and shrugged. “Stryker’s got them,” she said, as if that were explanation enough. She smiled but he missed it; he was too busy scowling at the chart rack before him. So many patients to see and not enough time!
Woody Greenberg came hurrying through the morning commotion and David said hi; spoke briefly about a Fallopian reconstruction Woody was rushing to, and bitched about the interns being late.
“Stryker’s got ‘em? Fugheddaboudit,” Woody hooted, comparing watch times with David’s - Woody’s was a minute slow – then tearing off like the White Rabbit late for an appointment.
&n
bsp; More minutes passed. Levine paced.
The nurse looked up from something she was writing. “Not back yet, huh?”
“Nope.” David was silent a minute or two, then shook his head. “I hope they’re minding their manners, at least.”
“Hah!” she said. “Interns? You kidding?”
A bit more hurriedly Stryker showed them the rest of the floor, including the sonography room, the patients’ recovery room with regular hospital beds and pastel blankets, and the Special Procedures Room – identical to the one on the OB floor – where amniocentesis, laparoscopies, artificial insemination, and IVF transplants were performed.
“And this,” he said, throwing open another door, “is a lab devoted to in vitro research in humans.”
The long room looked identical to the mammal research lab.
No time now, but Jill wondered the same questions the others must have wondered: fertility drugs produce extra eggs; how many eggs do you implant; do you freeze the extras and for how long; what about multiple births?
Stryker closed the door and moved away. Standing in the hall, he pointed out the offices of the other members of the Genetic Counseling Committee. “Doctors Simpson and Rosenberg are there,” he said, pointing to their marked doors. “And Dr. Arnett is there, just two doors down from my own office. All of them will be glad to answer your questions. All have their own independent research, and together they combine expertise in the areas of perinatology, embryonic epidemiology, high risk obstetrics, and genetics. I truly doubt if you would find a better research faculty in the country.”
He scanned their faces. “Are there any questions for now?”
For once Jill decided not to jump in first…but the others did.
“About yesterday…” said Phipps hesitantly.
“We were concerned about some cases,” said Ortega.
“Strange cases,” said Tricia.
“The eclampsia, for one,” said Chitkara. “That Prewitt case didn’t present at all like eclampsia…”
Stryker stiffened. “Of course it didn’t.”
They looked at him.
He folded his arms. “We had a near tragedy because some fool of a student nurse gave the patient the wrong medication. Prewitt had been getting penicillin for an ear infection. The nurse injected her with norepinephrine by mistake. Sent her blood pressure through the roof.”
They stared at him, unable to believe what they were hearing.
“The girl denies it, of course. The nursing supervisor is dealing with her. And we didn’t have the answers until eleven last night, when our review committee finally sorted out what happened.”
He looked at Tricia. “You said ‘cases’ plural, I believe. Was there something else?”
Tricia paled and opened her mouth. “I…” she managed.
Phipps said, “The Burke infant. Shouldn’t that baby had made it because he was full term and seemed normal – ”
“He wasn’t,” Stryker snapped. “The child had a heart defect. I received results of the post last night.”
“Who did the post?” Ortega asked belligerently.
Stryker glared at him, at all of them. “That is quite enough! Doctors,” he said coldly. “I appreciate your concern, but I must remind you that minds vastly more highly trained than yours have the responsibility for dealing with these things. Your job is to learn, not question.”
The interns looked humiliated, embarrassed. Jill Raney was the only one who met Stryker’s glare.
“Why Doctor Raney, you’ve been so quiet. Your friends seem to be such experts. Tell me, do you have something on your mind too? Some terrible instance of bad medicine and misdiagnosis which you have uncovered?”
Tricia’s eyes were sending out frantic messages of “No! Save it!” Jill went cold and took a deep gulp of air.
“Just a simple question.” Her voice shook. “Do you and other members of the Genetic Counseling Committee ever do routine physicals in the outpatient clinic?”
“Of course. Everyone volunteers whatever time they can.”
“And among your patients were there two women by the names of Sayers and Moran? I was wondering if you or anyone here in the research group ever treated them.”
Stryker’s pale eyes narrowed at her, then swept the others. “It is now 7:36,” he announced. “The rest of you may continue on to your ward duties. I will have a talk with Dr. Raney.”
Tricia’s mouth turned down at the corners. Gary Phipps said, “We can wait, sir. It’s really all right if we’re a little late. Dr. Levine knows – ”
“Now, please,” said Stryker.
At a loss, sending last glances to Jill, they turned to go. As the door closed behind them she found Stryker studying her.
“Now,” he said coldly. “Sayers and Moran. Continue.”
Her heart hammered. “I found something curious in their charts.”
“And?”
“When they arrived at the hospital yesterday, it was the impression of the doctors treating them that they had been brought off the streets, so to speak. Because there were no records of their having received prenatal care here.”
Stryker watched her. His silence prodded her.
“It turns out that neither was a stranger to this hospital. In fact, each was here five or six months ago respectively for a routine GYN checkup. The date of each exam coincides exactly with the time that they conceived. And each pregnancy ended in tragedy.” She fumbled in her pocket and pulled out her black notebook. “I’ve written it all down if you’d care to check their ovulations dates with the time of their deliveries.” She held up the little notebook.
Stryker ignored it. “Is that all?”
Jill stared at him. “Is that all! Dr. Stryker, two ill-fated horrendous pregnancies almost look as if they got started in this hospital, and you dismiss it just like that? I can’t believe there wouldn’t be at least some investigation launched or – ”
“Doctor Raney,” he said icily. “As an intern barely into training you are to be commended for having the beginning – note, I said beginning – of a research mind. You have found a common denominator between two vastly different obstetrical mishaps. However, to have the audacity to stand here demanding an investigation, as you so offensively put it, is both irresponsible and intolerable on your part.”
“But – ”
“No buts!” Stryker shouted. Jill stepped back, frightened, and he abruptly lowered his voice.
“It is in your interest that I’m telling you this, so listen and listen carefully. First, it is common nowadays for women to update their GYN status before initiating a pregnancy; you’ll find plenty of babies born nine months give or take after their mothers’ exams. Second, you can be sure that these cases are being thoroughly investigated.” His tone turned more menacing. “You have the privilege of training in a superior institution. And you are well on your way to jeopardizing your place in it.”
He stormed into his office and closed the door.
Jill left, her cheeks aflame with anger and humiliation. She walked back past the adorable baby pictures and secretaries just arriving, trying to control the tears that threatened.
11
Levin was ready with a box of Kleenex. “Another day begins well, huh?” he said, offering the tissues.
Jill gave him a stony look. “Don’t need ‘em.” She slammed her notebook down on the chart rack. “Something’s rotten around here. Stryker’s an icicle. Blames mishaps on nurses and has pat answers for appalling cases.”
“Yeah, a real charmer. Let’s go.” David gave the chart rack a shove, explaining that today he’d switched his keep-the-interns-sane approach. The others were shook. He’d told them to go observe some surgery. “Two of us alone can move faster anyway.”
They walked the busy corridor. Sullen, Jill listened as he told her that Cliff Arnett was going to repeat the end of yesterday’s DNA lecture. Too many people had missed it: others had been called too after they left. “Today at 9:00 in the co
nference room. Don’t miss it.”
An odd thought popped into her head.
“David, I’ve heard people say you’re a crack shot. Is that true?”
He kept pushing the rack. “Sort of.”
“How sort of?”
He looked at her, wondering if he should send her again to sedate herself on paper work. “Well,” he said, “I’m from Denver, and out there they give prizes to kids for marksmanship. That’s how it started, anyway. Then when I was sixteen my folks sent me to an Israeli kibbutz – a summer camp kind of thing to toughen up spoiled geeks.”
She nodded, interested.
He grinned. “Everyone else picked grapefruits all day. I made friends at an army base nearby, spent the whole time there doing target practice.”
“And you’re still in practice?”
“Why? Who do you want me to shoot?”
They’d reached room 808. David pulled out that chart. “Once,” he said, “back home I was camping out with friends. Shot off a rattler’s head at forty feet.”
“Mm,” Jill said. “No wonder you think Madison’s so tame.”
He gave her a look. Then flipped open the chart, tilted his head toward the room and said, “Shall we?”
Fidgeting, she watched as he greeted Mrs. somebody Edwards. Asked the patient how she felt. Did the physical, checking the pulse and blood pressure, then felt the belly to make sure the uterus was contracting on schedule, which it wasn’t, so he wrote an order for Ergotrate (light green sheet), and clamped it to the outside of the chart.
And all the while, as his eyes scanned lab reports, he cracked jokes with the patient. Told her she’d been a real tiger in the delivery room; promised her a bullet to bite on for the next time; said “Oh? Factory closed?” when she said there wasn’t going to be a next time. Mrs. Edwards smiled at Jill. Jill smiled back.
They left. Did the rest of the even numbers, and those patients were easy. At the far end of the hall they stood, writing up notes together before crossing to the odd numbers.
Outside room 819, David looked up and frowned.