by Robin Cook
“I don’t know why you can’t see them,” Dr. Schoener said. “The follicles are very apparent, at least four of them, and they look terrific. They are a good size: not too big, not too small.” Grabbing the ultrasound screen with her free hand, she turned it forcibly to make it more perpendicular to Laurie’s line of sight. She then pointed to each follicle in turn. With her right hand under a modesty sheet, she was directing the ultrasound wand into the left vertex of Laurie’s vagina.
“Okay, I see them,” Laurie said. She was propped up on the examining table with her feet in stirrups and her legs apart. The first time she’d experienced a fertility-style ultrasound she’d been mildly taken aback, since she’d expected the sensor to be placed externally on her abdomen. But now, having had the procedure every couple of days through the first half of five cycles, she took it in stride. It was mildly uncomfortable but certainly not painful. The biggest problem was that she found it humiliating, but then again, she found the whole infertility rigmarole humiliating.
“Do they look any better than they have in earlier cycles?” Laurie asked. She needed encouragement.
“Not remarkably,” Dr. Schoener admitted. “But what I particularly like is that the majority in this cycle are in the left ovary rather than in the right. Remember, it’s your left oviduct that is patent.”
“Do you think that’s going to make a difference?”
“Am I detecting some negativity here?” Dr. Schoener said, as she removed the wand and pushed the ultrasound screen out of Laurie’s way.
Laurie let out a short mocking laugh while she removed her feet from the stirrups, swung her legs over the side of the exam table, and sat up. She was clutching the sheet around her midsection.
“You have to stay positive,” Dr. Schoener went on. “Are you having some hormonal symptoms?”
Laurie repeated her sham laugh with a touch more forceful-ness. She also rolled her eyes. “When I started all this, I promised myself I wouldn’t let it get to me. Was I wrong! You should have heard me yesterday bawl out an octogenarian who tried to cut in front of me at the checkout line at Whole Foods. As the saying goes, it would have made a sailor blush.”
“How about headaches?”
“Those, too.”
“Hot flashes?”
“The whole shebang. And what bothers me the most is Jack. He acts like he’s not even part of this. Every time I get my period and feel crushed that I’m not pregnant, he just blithely says, ‘Well, maybe next month,’ and goes about his business. I feel like hitting him over the head with a frying pan.”
“He does want children, doesn’t he?” Dr. Schoener asked.
“Well, to be truthful, he’s probably going through this mostly on my behalf, although once we have them, if we have them, he’ll be the world’s greatest dad. I’m convinced. Jack’s problem in this regard is that he had two lovely daughters with his late wife, but the wife and the kids were all tragically killed in a commuter plane crash. He suffered so he’s afraid of making himself vulnerable again. It was even hard to get him to commit to marriage.”
“I didn’t know,” Dr. Schoener said, with true sympathy.
“Very few people know. Jack’s not forthcoming with his personal emotional issues.”
“There’s nothing strange about that,” Dr. Schoener said, as she snatched up the paper debris from the ultrasound test and stuffed it into the wastebasket. “Unless the male is demonstrably the source of the infertility, which he then takes very seriously, he deals with infertility and its treatment very differently than a woman.”
“I know, I know,” Laurie said insistently. She stood up, still keeping the sheet wrapped around her. “I know it, but it still bugs me that he doesn’t act more committed and understanding of what I’m going through. All this ain’t easy by any stretch of the imagination, especially with the threat of hyperstimulation hanging over my head. The trouble is as a doctor I know what to be afraid of.”
“Luckily, there doesn’t seem to be any threat of hyperstimulation in this cycle or those in the past, so I want you to continue with the same dosage with your injections. If your hormone level is too high in the blood sample we drew today, I’ll call and make the necessary adjustments. Otherwise, stay the course. You’re doing terrific. I feel good about this cycle.”
“That’s what you said last month.”
“I did say that because I did feel good last month, but I feel better this month with that left ovary of yours getting more into the act.”
“What is your guesstimate in terms of my taking the trigger injection and having the intrauterine insemination? Jack likes a little warning about when he’s going to be required to step up to the plate.”
“Considering the current size of the follicles, I’d say maybe five or six days. Have the front desk schedule another ultrasound and estradiol for two or three days from now, whatever’s most convenient. I’ll be able to give you an even better estimate.”
“And one other thing,” Laurie said, as Dr. Schoener was about to leave. “Last night I was lying in bed unable to go back to sleep when the question dawned on me about my job. Do you think that there could be any environmental issues at the morgue that could be contributing to this infertility problem, like fixatives for tissue samples or something like that?”
“I doubt it,” Dr. Schoener said without hesitation. “If pathologists had more infertility than other docs, I think I would have heard of it. Remember, I see a lot of docs around the med center, including a few pathologists.”
Laurie thanked her friend, gave her a quick hug, and then ducked into the changing room where she’d left her clothes. The first thing she did was get out her watch. It was not quite eleven-thirty, which was perfect. It meant she’d be getting back to the medical examiner’s office just about noon, the time she gave herself her daily hormone shot.
Chapter 3
OCTOBER 15, 2007
MONDAY, 9:30 A.M.
LOS ANGELES, USA
(20 MINUTES AFTER LAURIE GIVES HERSELF HER HORMONE INJECTION)
The cell phone’s vibration caught Jennifer completely off guard because she’d totally forgotten she’d slipped it into the pocket of her scrub pants instead of leaving it in her locker. As a consequence she jumped, and it was enough to catch her new preceptor’s attention. His name was Dr. Robert Peyton. Since he’d made her adequately aware that she’d started on the wrong foot in his estimation when she’d been almost four minutes late on the first day, the vibrating phone, which could be heard faintly, was a potential disaster. She shoved her hand into her pocket to try to calm the insistent device, but she couldn’t. Unable to determine quickly enough the phone’s orientation, she couldn’t connect with the appropriate button.
Jennifer, along with Dr. Peyton, who was an elegant man with marquee good looks, and seven of Jennifer’s classmates who’d signed up for the same elective, was standing in the mausoleum stillness of the anesthesia supply room situated between operating rooms number eight and ten, discussing the coming month’s schedule. The eight-person group was to be divided into four pairs and assigned weeklong rotations in various surgical specialties, including anesthesia. To Jennifer’s chagrin, she and another student had been assigned to anesthesia. She felt that if she’d wanted anesthesia, she would have chosen it for the whole rotation. But because of the bumpy start she’d had from being late, she’d not complained.
“Is there something the young lady would like to share with the group in reference to her very apparent startle and her apparent need to bring her cell phone into the OR?” Dr. Peyton questioned, with a taunting tone and with what seemed to Jennifer an uncalled-for hint of sexism. She was tempted to give the man an appropriate response but thought better of it. Besides, the continuing vibration of the phone dominated her thoughts. She could not imagine who could be calling her unless it had something to do with her grandmother. Impulsively and despite everyone’s attention directed at her, she pulled the phone from her pocket, mainly to quiet
it, but in the process glanced at the LCD screen. Instantly, she could see it was an international call, and having called the number so recently, she knew it was the Queen Victoria Hospital.
“I beg everyone’s pardon,” Jennifer said. “I have to take this call. It’s about my grandmother.” Without waiting for a response from Dr. Peyton, she rushed out through the door into the OR’s central corridor. Sensing that even having a phone in the OR might have been considered a major no-no as she flipped it open and put it to her ear, she said, “Hold the line for a moment!” Then she ran toward the double bidirectional entrance doors. It wasn’t until she got to her earlier location in the locker room that she tried to have a conversation. She started by apologizing.
“It is no bother,” a rather high-pitched Indian voice said. “My name is Kashmira Varini, and you left a message on my voicemail. I am Maria Hernandez’s case manager.”
“I did leave a message,” Jennifer admitted. She could feel her abdominal muscles tense as to why the woman was calling. Jennifer knew it wasn’t a social call, since it must have been close to midnight in New Delhi.
“I’m calling you as you instructed. I have also just finished speaking to your father, and he advised me to call as well. He said you should be in charge.”
“In charge of what?” Jennifer asked. She knew she was playing dumb to an extent and postponing the unthinkable. The call had to be about Maria’s condition, and there was little chance of it being good news.
“In charge of arrangements. I’m afraid Maria Hernandez has passed away.”
For a moment Jennifer couldn’t speak. It seemed impossible that her grandmother could be dead.
“Are we still connected?” Kashmira questioned.
“I’m still here,” Jennifer answered. She was thunderstruck. She could not believe a day that had started out so promising was turning out so disastrous. “How can this be?” she complained irritably. “I just called your hospital maybe an hour and a half ago and was assured by the operator that my grandmother was doing just fine. I was told she was even eating and had been mobilized.”
“I’m afraid the operator did not know. All of us here at the Queen Victoria Hospital are terribly sorry about this most unfortunate state of affairs. Your grandmother was doing splendidly, and the operation to replace her hip was a complete, unqualified success. No one expected this outcome. I hope you will accept our most sincere sympathies.”
Jennifer’s mind was in a near paralysis. It was almost as if she’d been hit on the head.
“I know this is a shock,” Kashmira continued, “but I want to assure you that everything was done for Maria Hernandez that could have been done. Now, of course—”
“What did she die of?” Jennifer suddenly demanded, interrupting the case manager.
“I’m told by the doctors it was a heart attack. With no warning whatsoever of any problems, she was found in her room unconscious. Of course a full resuscitation attempt was made, but unfortunately with no response.”
“A heart attack doesn’t seem to me to be particularly likely,” Jennifer said, as her raw emotions spilled over into anger. “I happen to know she had low cholesterol, low blood pressure, normal blood sugar, and a perfectly normal cardiogram. I’m a medical student. I made sure she’d had an A-plus physical here at the UCLA Medical Center only months ago when she visited me.”
“One of the doctors mentioned she’d had a history of a heart arrhythmia.”
“Arrhythmia my ass,” Jennifer snapped. “Oh, she had a few PVCs way back when, but it was found to be due to ephedrine in an over-the-counter cold remedy she was taking. The important thing is that the PVCs disappeared as soon as she stopped the med, and never came back.”
It was now Kashmira’s turn to be silent, necessitating for Jennifer, after a pause, to question if the call had been dropped.
“No, I’m still here,” Kashmira intoned. “I’m not quite sure I know what to say. I’m not a doctor; I only know what the doctors tell me.”
A touch of guilt softened Jennifer’s response to the horrid news. Instantly, she felt a slight embarrassment about blaming the messenger. “I’m sorry. I’m just so upset. My grandmother was very special to me. She was like a mother.”
“We are all truly sorry for your loss, but there are decisions to be made.”
“What kind of decisions?”
“Mainly concerning disposition of the body. With a signed death certificate, which we already have, we need to know if you plan to have the body cremated or embalmed and whether you plan to ship it back to the States or have it remain here in India.”
“Oh! Good God,” Jennifer murmured under her breath.
“We know it’s hard to make decisions under the circumstances, but these decisions must be made. We asked your father, since he is listed in the contract as next of kin, but he said you, as a near doctor, should handle it, and he’s faxing us a statement to that effect.”
Jennifer rolled her eyes. Such a trick to avoid responsibility was so typical of Juan. He was shameless.
“Considering this awful circumstance, we had expected Mr. Hernandez to come here to India forthwith at our expense, but he said he was unable to travel because of a back injury.”
Yeah, sure, Jennifer silently mocked. She was well aware that every November he could drive all the hell up to the Adirondacks to hunt and climb over mountains with his other worthless buddies with no trouble at all.
“We will surely extend the same invitation to you as the new next of kin. The contract your grandmother signed included airfare and lodging for a relative to accompany her, but she had said it was not needed. Anyway, funds are still available.”
Jennifer felt herself getting choked up, imaging her grandmother dying in far-off India, and her body alone on some cold slab in a mortuary cooler. With travel, room, and board available, she knew instinctively she could not let her granny down, never mind the inconvenience of her personal responsibilities—namely, medical school and her new surgical rotation. She’d never forgive herself, despite the fact that her grandmother had not conveyed to Jennifer that she was going in the first place.
“Arrangements could be made through the American embassy and documents signed from afar, but your presence is definitely preferable. It is safer under such circumstances when a family member is present to avoid any mistakes or misunderstanding.”
“Alright, I’ll come,” Jennifer said abruptly, “but I want to come immediately. That means today if possible.”
“That should not be a problem if there are seats on the late-afternoon Singapore flight through Tokyo. We’ve had American patients from the L.A. area before, so I’m familiar with the schedule. The bigger problem will be the visa, but I should be able to arrange that through the Indian health ministry for a special emergency M visa. We can let the airline know from this end. I will need your passport number just as soon as possible.”
“I’ll head to my apartment and call you with it,” Jennifer promised. She was glad she had one, and the only reason she did was because of her grandmother. Maria had taken her and her two brothers to Colombia to meet relatives when she was nine. She was also glad she’d made the effort to renew it.
“Perhaps I’ll have most of the arrangements done by the time you call back. Despite the hour here in India, I will do it right now. But before I let you go, I want to ask again whether you want your grandmother’s body cremated, which we recommend, or embalmed.”
“Don’t do either until I get there,” Jennifer said. “Meanwhile, I’ll ask my two brothers what they think.” Jennifer knew that was a lie. She and her brothers had gone in opposite directions in life, and they rarely talked. She didn’t even know how to get a hold of them, and for all she knew they were still in prison for dealing drugs.
“But we need an answer. The death certificate is already signed. You must decide.”
Jennifer hesitated answering. As a matter of habit whenever someone pushed her, she pushed back. “I assume the b
ody is in a cooler.”
“It is, but our policy is to take care of it immediately. We don’t have the proper facilities, as Indian families claim their deceased kin immediately to cremate or bury, but mostly cremate.”
“A good part of the reason I’m coming is to see the body.”
“Then we can have it embalmed for you. It will be far more presentable.”
“Look, Ms. Varini,” Jennifer said. “I’m coming halfway around the world to see my grandmother. I don’t want her disturbed until I arrive. I certainly don’t want her sliced and diced by an embalmer. I’ll probably have her cremated, but I don’t want to decide until I see her one last time, okay?”
“As you wish,” Kashmira said, but with a tone that suggested she strenuously disagreed with the decision. She then gave Jennifer her direct-dial number with the insistence that Jennifer get her passport details back to her just as soon as possible.
Jennifer flipped her phone closed. Her perplexity and annoyance at the case manager’s inappropriate and continued insistence that she make a decision about what to do with her grandmother’s body, when she clearly indicated she didn’t yet know, at least had the effect of taking the edge off her grief. But then Jennifer shrugged her shoulders. The situation was probably just another example of how some people lacked common sense in regard to social skills.. Kashmira Varini was probably one of those midlevel administrators who had a box next to “dispose of body” that needed to be checked off.