by Robin Cook
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 INH?” 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.
“I think it was blocked tubes,” Susan said after thinking for a moment. “I can’t be sure, but I believe that’s what it was.”
“Do you happen to have her phone number?” Marissa asked.
“I believe I do,” Susan said.
“Would you mind giving it to me?” Marissa asked.
Susan got the number from her study and gave it to Marissa. “You aren’t going to call Rebecca’s husband, are you?” Wendy asked when they got to the street. “The poor man is probably in shock.”
“I will if I have the courage,” Marissa said. “Besides, I was told they’d separated.”
“As if that would make much difference,” Wendy said. “If anything, I would think that would make him feel worse, even responsible.”
Marissa nodded.
On the drive home, Marissa’s excitement rose. Four cases of isolated TB salpingitis took her case out of the realm of anomaly and suggested a possible trend of public health importance.
Marissa pulled directly into the garage, then exited through the garage door to meet Wendy, who’d parked in the driveway. They entered the house through the front door.
“Nice house,” Wendy said as she followed Marissa down a corridor into her study.
“Think so?” Marissa said without enthusiasm. “It had been Robert’s house before we were married. To tell you the truth, I’ve never liked it.”
Marissa went straight to her Rolodex for Cyrill Dubchek’s home telephone number. “I’m calling one of the CDC department heads,” Marissa explained. “We were involved for a little while during my last year at the CDC. He’s quite an attractive man.”
Marissa found the number and propped the file open with a letter opener.
“Didn’t work out?” Wendy asked.
Marissa shook her head. “It was a stormy relationship from the start. The ironic part is that our major disagreement was over children. He’d had several before his wife died. He wasn’t interested in any more. Obviously that was before I knew about my fallopian tubes.”
Marissa punched the number on her telephone, then waited for the connection to go through. “It’s quite a story,” she said. “We were at loggerheads during my first couple of months at the center. Then there was romance. At the end we’d evolved into being good friends. Life is unpredictable.”
Wendy started to say something, but Marissa hushed her with a raised hand, indicating Cyrill had answered.
The first part of the call was friendly chitchat. Finally Marissa got around to the reason for her call. “Cyrill,” she said, “I have a doctor friend sitting with me and I’m going to put you on the speakerphone.” Marissa pushed the appropriate button. “Can you hear me?”
Cyrill’s voice filled the room as he responded in the affirmative.
Marissa got to the point. “Have you heard any talk around the center of TB salpingitis, like a relatively recent upswing in cases?”
“Not that I can recall offhand,” Cyrill said. “Why do you ask?”
“I have reason to believe that there are four such cases up here in Boston. All in relatively young women, and all without any apparent nidus of infection elsewhere, particularly nothing in the lungs.”
“What do you mean by ‘relatively young women’?” Cyrill asked.
“Late twenties, early to mid-thirties,” Marissa answered.
“That’s a little old for a pediatrician to be treating,” Cyrill said. “How have these cases come to your attention?”
Marissa smiled. “I should have known I couldn’t be cagey with you, Cyrill,” she said. “The fact of the matter is that I’m one of the infected. I’ve been involved with in-vitro fertilization for almost a year. Tonight I discovered three other women with the same unusual diagnosis.”
“I’m sorry to hear about your troubles,” Cyrill said. “But I haven’t heard anything about TB salpingitis in the usual CDC gossip. What I can do is ask over in bacteriology. If there has been anything at all, they’d be sure to have heard. I’ll get back to you as soon as I can.”
After appropriate goodbyes, Marissa hung up. Following a slight pause, she asked Wendy what she thought of calling Rebecca Ziegler’s number.
Wendy looked at her watch. “I’m not sure I’d have the emotional fortitude,” she said. “Besides, it’s after ten.”
“I think it’s worth the risk,” Marissa said with determination. She got the number out and dialed. The line rang seven times before someone finally picked up. Loud music could be heard in the background. It sounded like a party.
Marissa asked if she had reached the Ziegler residence.
“Just a minute,” the voice at the other end said. Marissa and Wendy could hear the man yell to others to “pipe down a sec.” Then he came back on the line.
“Are you Rebecca Ziegler’s husband?” Marissa asked.
“I was,” the man said. “Who is this?”
“I’m Dr. Blumenthal,” Marissa said. “I hope I’m not catching you at a bad time. I got your number from Resolve, the organization for infertile couples. Are you familiar with it?”
“Yeah,” the man said. “What’s up?”
“If it wouldn’t be too much of a bother,” Marissa said, “I’d like to ask a personal question about Rebecca’s condition.”
“Is this some kind of crank call?” the man asked. There was a sudden burst of laughter in the background.
“No,” Marissa said. “I can assure you it isn’t. I just wanted to ask if Rebecca’s problem had anything to do with her fallopian tubes. Those are the tubes that transport the eggs to the uterus.”
“I know what fallopian tubes are,” the man said. “Just a minute.” Then to his guests, the man yelled: “Come on, you guys, shut up! I can’t hear!” Coming back on the line he apologized for the commotion. “My friends,” he explained. “They’re a bunch of animals.”
“About Rebecca?” Marissa questioned, rolling her eyes for Wendy’s benefit.
“Yeah,” the man said. “She had blocked tubes.”
“Do you happen to know how they became blocked?” Marissa persisted.
“I just know they were blocked. More than that, you’ll hav
e to ask her doctor.” There was a crash in the background, and the shatter of broken glass. “Jesus!” the man said. “Hey, I gotta go.” Then the line went dead.
Marissa pushed the disconnect button.
They stared at each other. Finally Wendy broke the silence. “So much for the grieving widower.”
“At least we don’t have to feel guilty about calling,” Marissa said. “And she had blocked tubes. I think it will be worth looking into the cause. If by any chance her tubes were blocked in the same way as ours, it could put a whole new spin on this affair.”
Wendy nodded.
“Wait a second!” Marissa cried.
“What’s the matter?” Wendy asked.
“We forgot to ask those other two women where they are being treated. I know Rebecca was at the Women’s Clinic.”
“You have their numbers,” Wendy said. “Give them a call.”
Marissa quickly dialed. Both women were available and both gave the same answer: they were being treated at the Women’s Clinic.
“This is getting interesting,” Wendy said.
“That’s an understatement,” Marissa said. “I think we’d better make a visit to the Women’s Clinic, the sooner the better. Like tomorrow morning. Are you with me?”
“I wouldn’t miss it for the world,” Wendy said.
“Hello,” a voice called. Both Marissa’s and Wendy’s eyes were drawn to the doorway. It was Robert, dressed in a V-necked sweater, tan chinos, and loafers without socks. His reading glasses were in his hand.
Marissa stood up from her desk chair and introduced Wendy to Robert, explaining that they’d met at the Resolve meeting. She told him that Wendy was involved with in-vitro fertilization with Dr. Wingate too. Robert shook Wendy’s hand.
“I was on my way to the kitchen to make some tea,” Robert said. “Can I interest anyone else?”
“I’d love some,” Wendy said.
Robert turned and disappeared toward the kitchen. “Wow,” Wendy said. “And I thought Gustave was handsome.”
Marissa nodded. “I do love him,” she admitted. “We’re just going through a particularly rough time.” She shrugged. “At least that’s what I tell myself.”
By the time they got to the kitchen, Robert already had the kettle on the stove and boxes of different teas on the table along with three mugs.
“So how was the meeting?” Robert asked as he got out the sugar and honey.
Marissa described the meeting, emphasizing how pleasant it was and how many husbands were in attendance.
“Was your husband there?” Robert asked Wendy.
“He was in surgery and couldn’t make it,” Wendy answered evasively. She neglected to say that he probably wouldn’t have attended even if he’d been free. But Robert was a good cross-examiner.
“Has he been to any of the others?” he asked. Just then, the kettle began to whistle. Robert went to get it.
Marissa answered for Wendy. “He hasn’t been able to make any of the meetings.”
“I see,” Robert said as he poured boiling water into each of the mugs. He had one of those half-smiles that galled Marissa.
“I’m certain you’d feel differently about the meetings if you had an open enough mind to attend one,” Marissa said.
“Maybe I should talk with Wendy’s husband,” Robert said. “He sounds like a kindred soul.” He took the kettle back to the stove.
“Great idea,” Wendy agreed.
“All I can say is that the meeting was extremely rewarding for me,” Marissa said. “Not only did I meet Wendy, we happened to learn that four of us have the same odd diagnosis.”
“Are you talking about the TB stuff?” Robert asked.
“Exactly,” Wendy said. “I’m one of the four.”
“No kidding?”
Marissa launched into breathless explanation of exactly how unusual the number of cases was. “It’s so unexpected, we have to look into it. Tomorrow we’ll go to the Women’s Clinic to launch our official investigation.”
“What do you mean your ‘official investigation’?” Robert asked.
“We want to know how many cases like ours have been seen. We want to find out if Rebecca Ziegler had the same problem. We already know she had blocked tubes.”
“The Women’s Clinic is not going to give you that kind of information.”
“Why not? It could be important,” Marissa said. “For all we know it might have serious public health consequences. We could really be on to something . . . something along the lines of toxic shock syndrome.”
Robert looked at Marissa, then at Wendy. He found their ardor unsettling, especially in view of Marissa’s recent outburst at the Chinese restaurant. No doubt Wendy was strung out on the same hormones.
“I think you guys ought to calm down,” Robert told them. “Even if you get to the bottom of this, it’s not like it’s going to reverse your condition. And I seriously doubt you’ll get very far with the clinic. It would be highly unethical, even illegal, for them to disclose information about their patients without the patients’ consent.”
But Marissa would hear none of it. “This TB issue has bothered me from the start. I mean to get to the bottom of it. I don’t care what it takes. I just talked to Cyrill Dubchek and he can put the authority of the CDC behind it.”
Robert just shook his head. He clearly disapproved. “Well then,” he said curtly, “I’ll leave you two sleuths to your plotting.”
With that, he picked up his mug and walked away.
Wendy broke the uncomfortable silence once his steps were out of earshot. “He is right,” she said. “We may have a problem getting access to those medical records.”
“We have to give it a try. Maybe we can muster some authority as doctors. You know, take the professional approach. If that doesn’t work, we’ll just think of something else. You are with me, aren’t you?”
“Absolutely,” Wendy said. “United we stand.”
Marissa smiled. She could hardly wait for morning.
6
March 29, 1990
9:30 A.M.
Struggling with their umbrellas in the wind, Marissa and Wendy passed into the courtyard of the Women’s Clinic.
Entering the front door, they shook water from their coats. Their rain-slicked hair was plastered to their foreheads.
“Do you know where the medical records department is?” Marissa asked Wendy.
“I haven’t the faintest idea,” Wendy said. “I’ll ask.”
While Marissa fought to close her umbrella, which had turned inside out in the wind, Wendy made her inquiries at the information booth. She motioned for Marissa to follow her to the elevators. “Sixth floor,” she said when Marissa joined her.
“I should have guessed,” Marissa said. “Rebecca Ziegler jumped from the sixth floor right after reading her records.”
“Makes you wonder what she could have read.”
Marissa nodded.
Once on the sixth floor, it was easy to find the department. The clatter of typewriters could be heard immediately outside the elevators. Marissa was relieved it was in the opposite direction from Linda Moore’s office. For the moment, Marissa did not want to run into someone she knew.
There was no mistaking the medical records department. Dozens of file cabinets lined the room. There were three secretaries with headphones, typing dictation. A woman occupying the desk to the right of the entrance greeted Marissa and Wendy. “Can I help you?” she asked. The woman, who was about fifty, Marissa guessed, had a name tag: Helen Solano, Medical Records Librarian. In front of her was a computer terminal.
“I’m Dr. Blumenthal,” Marissa said professionally. “And this is Dr. Wilson.”
Wendy nodded. Mrs. Solano smiled.
“We have a question for you,” Wendy said. “We’re curious if the Women’s Clinic record system is such that cases of a specific diagnosis such as fallopian tube blockage can be printed out.”
“Absolutely,” Mrs. Solano said.
“How about granulomatous blockage?” Marissa asked.
“That specific category I’m not certain of,” Mrs. Solano said.
“I’d have to look it up in our diagnostic code. Let me see.” She swiveled in her chair to face a bookcase filled with looseleaf manuals. She pulled one out and began flipping through.
“We do have a code for granulomatous infections of the fallopian tubes,” Mrs. Solano said, glancing up from the manual.
“Wonderful,” Marissa said with a smile. “If it wouldn’t be too much trouble, we’d like to get a printout with that diagnosis.”
“No trouble at all,” Mrs. Solano said.
Marissa and Wendy exchanged a satisfied glance.
“Where is your authorization requisition?” Mrs. Solano asked.
“We didn’t think we needed one for research purposes,” Wendy said.
“You need one for any purpose,” Mrs. Solano explained.
“Fine,” Marissa said. “Who do we see to get the proper authorization?”
“There is only one person who can issue such a requisition,” Mrs. Solano said. “And that is Dr. Wingate, the director of the clinic.”
Back at the elevators, Marissa shook her head at Wendy. “Damn,” she said. “I thought we were home free when she told us they had the granulomatous diagnostic category.”
“Me too,” Wendy said. “But now I’m thinking that your husband was right. I don’t think we’ll be able to persuade Wingate to give us the authorization.”
“Let’s not get discouraged so soon,” Marissa said as they boarded the elevator.
Dr. Wingate’s offices were on the second floor. He had one office as the director of the clinic and another as director of the in-vitro fertilization unit. Marissa and Wendy went to the first but were directed to the second. Dr. Wingate, they learned, was busy in the lab.
“I’ll tell the doctor that you are here,” the receptionist said.
Marissa and Wendy sat down. “It’s nice not to be here for another procedure,” Wendy whispered. Marissa smiled in agreement.
“Dr. Wingate can see you now,” the receptionist called out about a half hour later. She directed them down a long hall to the third door on the right.