Vital Signs

by Robin Cook

  Marissa wasn’t hungry, but she accompanied Tristan, who polished off a sizable slab of meat and a number of beers. Marissa ordered a chicken dish, but she hardly touched it except to move it around her plate. They talked about going to the consulate in the morning with the story that they had hired a junk to take them to Guangzhou but that the captain had taken their money and forced them to jump off the boat.

  “It’s the best we can do,” Tristan said. “And it’s close enough to the truth.”

  Marissa said that she would try to get some State Department intervention through the CDC.

  Several hours later, Marissa made her call. Knowing Cyrill’s schedule, she timed the call to catch him before he left for the lab.

  Although there was some static as well as a peculiar echo, Marissa could understand him easily. Marissa told Cyrill that she was calling from Guangzhou, in the People’s Republic of China.

  “With other people, I might be surprised to get an unexpected call from the PRC,” Cyrill said. “But with you, Marissa, nothing surprises me.”

  “There’s a rational explanation.”

  “I didn’t doubt it for a moment.”

  Marissa quickly explained how she and a colleague had inadvertently entered the PRC without going through proper immigration. She told him she was afraid she would have trouble getting out. She emphasized that the colleague was the Australian doctor who’d written the paper Cyrill had given her.

  “You’re with the author?” Cyrill said. “I’d say that is going directly to the primary source.”

  “Back when I was at the CDC, you once told me that you hoped you could make it up to me for what I went through in cracking the Ebola outbreaks. Well, Cyrill, you now have your chance.”

  “What can I do?” he asked.

  “First, I’d like you to use CDC connections to pressure the State Department to get me and Dr. Williams out of the PRC. I was told that there is a U.S. consulate here. We’ll go to the consulate in the morning, about ten hours from now.”

  “I’ll be happy to see what I can do,” Cyrill said. “But they may ask why the CDC is intervening.”

  “There is a very good reason,” Marissa said. “It’s extremely important that I get back to the CDC immediately. It can be considered legitimate CDC business. Tell that to the State Department and let them tell it to the PRC.”

  “What kind of business?” Cyrill asked.

  “It concerns the TB salpingitis,” Marissa said. “And that leads me to my next request. I need the CDC to get success rate statistics concerning in-vitro fertilization for all the Women’s Clinics around the U.S. I want statistics about efficacy per patient as well as per cycle. And if possible, I would like data on the specific causes of infertility among the women the Women’s Clinics treat with IVF.”

  “How many months do I have?” Cyrill asked wryly.

  “We need this as soon as possible,” Marissa said. “And there’s more: remember that case you told me about, the young woman with the disseminated tuberculosis in Boston?”

  “I do,” Cyrill said.

  “Find out what happened to her,” Marissa said. “If she died, which I’m afraid she must have by now, get a serum sample and her autopsy report as well as a copy of her chart. Then there is a patient by the name of Rebecca Ziegler—”

  “Hold on,” Cyrill complained. “I’m trying to write this down.”

  Marissa paused for a moment. Once Cyrill gave her the okay, she continued: “Rebecca Ziegler supposedly committed suicide. She was autopsied at the Memorial. Get a serum sample from her as well.”

  “My God, Marissa!” Cyrill said. “What’s this all about?”

  “You’ll know soon enough,” Marissa said. “But there’s still more. Is there an ELISA test for BCG bacillus?”

  “Offhand, I don’t know,” Cyrill said. “But if there isn’t, we can have it made up.”

  “Do it!” Marissa said. “And one last thing.”

  “Jesus, Marissa . . .” Cyrill sighed.

  “We’ll need an emergency U.S. visa for Dr. Tristan Williams.”

  “Why don’t I just call President Bush and have him take care of all this?” Cyrill said.

  “I’m counting on you,” Marissa said.

  She knew she was asking a lot of Cyrill, but she was convinced it was vitally important. After exchanging goodbyes, they each hung up.

  “Did I hear that a trip to the States is in the offing?” Tristan said as he peeked through the door.

  “I hope so,” Marissa said. “The sooner the better.”

  The following morning both Marissa and Tristan were pleasantly surprised by their reception at the U.S. Consulate. As soon as Marissa gave her name, they were shown into Consul David Krieger’s office.

  During the night, communications had been received from the State Department and from the U.S. ambassador in Beijing.

  “I don’t know who you people are,” David told them, “but I’m certainly impressed by the behind-the-scenes flurry your being here has stirred up. It’s not often I’m given instructions to issue an emergency U.S. visa. But I’m pleased to say I have one for Dr. Williams.”

  David Krieger himself accompanied Marissa and Tristan to the Public Security Bureau on Jeifong Bei Lu Street in front of Yuexiu Park. Although the police had been advised of the case, they still insisted on interrogating Marissa and Tristan, but did so in David Krieger’s presence. They proceeded to check Marissa’s and Tristan’s story by dispatching several officers by helicopter to the two villages Marissa and Tristan claimed to have passed through.

  During the interview, it was apparent to Marissa that the Chinese authorities associated their presence with the cigarette boat incident. Marissa was quick to say that it was at the appearance of the powerboat and the patrol boat that the captain of the junk had made them jump overboard.

  When they returned to the consulate, David Krieger was optimistic that the problem would be resolved swiftly. He graciously invited Marissa and Tristan to have lunch with him. After lunch, the consul arranged for Marissa and Tristan to get some Western-style clothes. By the time they returned to the consulate, word had already arrived that Marissa and Tristan were free to leave the PRC whenever they cared to.

  “If you are in a hurry,” the consul said, “we can make arrangements for you to fly to Hong Kong this afternoon.”

  “No, not Hong Kong,” Marissa said quickly. “Are there other foreign destinations available directly from Guangzhou?” She didn’t like the idea of returning to Hong Kong even if only in transit. She didn’t want to risk any more run-ins with the thugs from the FCA or the Wing Sin.

  “There is a daily flight to Bangkok,” David Krieger said.

  “That would be much better,” Marissa said.

  “But it’s out of your way if you’re heading back to the States,” David Krieger said.

  Marissa smiled innocently. “Regardless, I think we’d both rather spend a little more time flying than going back through Hong Kong. Do you agree, Tristan?”

  “Right you are, luv,” Tristan said.

  “Here are all the statistics we could get on such short notice,” Cyrill Dubchek said, handing computer printout pages to Marissa.

  Marissa, Tristan, and Cyrill were sitting in Cyrill’s office at the Centers for Disease Control in Atlanta, Georgia. Marissa and Tristan had just arrived that afternoon from their grueling flight across the Pacific, flying from Bangkok to Honolulu to L.A. to Atlanta.

  Even though they were exhausted, Marissa insisted on going directly to the CDC.

  Marissa studied the pages carefully. Tristan looked at Cyrill and shrugged. Tristan was still in the dark as to Marissa’s suspicions.

  “Just as I thought,” Marissa said, raising her eyes from the computer paper. “These statistics mirror those that I found in Australia with the FCA data. They show that the Women’s Clinics around the country have a high rate of pregnancy per patient in their in-vitro fertilization program but a low success rate per c
ycle. In other words, most IVF patients at Women’s Clinics get pregnant but it takes multiple cycles before they’re met with success. Look how the success rate shoots up after the fifth IVF attempt.”

  Marissa pointed to the statistics spelled out on the computer printout she was holding in her hands.

  “That’s not so surprising,” Tristan said. “In every clinic, most patients have to go through several attempts before they conceive. What are you getting at?”

  A knock on Cyrill’s door interrupted them before Marissa could reply. It was one of the technicians from the lab.

  “We have the results on those ELISA tests,” she said.

  “That was fast,” Cyrill commented.

  “They were very positive,” she said. “Even at 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 cannulating 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.”

  Cyrill 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 hard 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?”

  “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.”