by Robin Cook
For a moment Marissa didn't say anything. As much as she hated to admit it at the moment, Robert was making sense. She was afraid of getting too hopeful herself.
"Have you thought any more about the idea of counseling?"
Marissa asked.
Robert turned to Marissa a third time.
"No," he said.
"I told you, I'm not interested in going to a counselor. There has already been too much interference in our lives. Part of the problem for me is that we have lost our private life. I feel like a fish in a fishbowl."
"Dr. Wingate told me that one of the reasons the woman who killed herself today did so was because she and her husband did not seek counseling."
"Is this some kind of not-so-veiled threat?" Robert asked.
"Are you telling me you're thinking of diving off the roof of the Women's Clinic if I don't agree to see one of their counselors?"
"No!" Marissa said heatedly.
"I'm just telling you what he told me. The woman and her husband were having difficulties. Counseling was recommended. They didn't go. Apparently they broke up, which is one of the things that made the woman so upset."
"And counseling would have solved everything?" Robert asked sarcastically.
"Not necessarily," Marissa said.
"But I doubt it would have hurt. I'm beginning to think that we should seek counseling whether we continue with the IVF or not."
"What do I have to say to you?" Robert asked.
"I'm not interested in spending time and money on a counselor. I know why I'm upset and unhappy. I don't need someone else to tell me."
"And you don't want to try to work on it?" asked Man*ssa. She hesitated to say "together."
"I don't think a counselor is the way to work on it," Robert said.
"You don't have to be a rocket scientist to know what is wrong. Anyone would feel stressed out by what we've been through in the past few months. Some things in life you have to deal with. Others you don't. And we don't have to deal with this infertility therapy anymore, if we so choose. At this point, I'd prefer to put it out of our lives."
"Oh, for goodness' sake!" Marissa said with disgust. She got up from the love seat and left Robert to his beloved computer and spreadsheets. She wasn't up to having another argument.
Marissa stomped down the hall and into the bedroom, slamming the door behind her. It seemed that instead of getting better, everything was getting a whole lot worse.
6
March 20,1990
8:45 AM.
Highly reactive ions called hydroniurn ions, which were nothing but hydrated protons, knifed through the delicate cell membranes of four of Marissa's developing embryos. The hydronium ions came in a sudden wave, catching the dividing cells off-guard Buffer systems were mobilized to neutralize some of the initial reactive particles, but there were too many to combat. Slowly at first, then more rapidly, the pH of the cells began to fall. They were becoming acidic. Hydronium ions inevitably resulted wherever acid was added to an aqueous medium.
Within the very depths of the embryos, molecules of DNA were in the process of replicating themselves in preparation for another division. As weak acids themselves, they were terribly susceptible to the hydronium ions that swarmed in their midst. Their replication process continued, but with some difficulty: the enzymes responsible for the, chemical reactions were also sensitive to acid. Soon replication mistakes started to occur. Affirst there were only afew errors, none that would have mattered in the long run given the redundance of genes. But as more and more of the acid particles intervened, entire gene pools found themselves replicating sheer gibberish. The cells were still dividing, but it was only a matter of time. The mistakes had become lethal.
"It's beautiful!" Marissa cried. It was hard for her to comprehend that she was looking at the barest beginning of one of her children. The embryo, now at a two-cell stage, appeared transparent in the crystal-clear culture medium. Unfortunately, Marissa could not see the chaos that was occurring on a molecular level at the very moment she was admiring the cell's microscopic appearance. She thought she was seeing the beginnings of a new human life. What she was witnessing was the first steps of its death.
"Amazing, isn't it?" Dr. Wingate said. He was standing next to Marissa. She had come in unexpectedly that morning, asking if she could see one of her embryos. At first he had questioned the wisdom of granting such a request, but, remembering she was a doctor, he realized that it would be difficult to refuse, even though at this stage he didn't like anyone handling the embryos.
"I just cannot believe that little speck could become an entire person," Marissa said. She'd never seen a live two-celled embryo before, much less her own.
"I think we'd better get the little devil back into the incubator,"
Dr. Wingate said. He carefully carried the organ-culture dish to the incubator and slid it onto the appropriate shelf. Marissa followed him, still awed. She saw that the dish had joined three others.
"Where are the other four?" she questioned.
"Over there," Dr. Wingate pointed.
"In the liquid-nitrogen storage facility."
"They've already been frozen?" Marissa asked.
"I did it this morning," Dr. Wingate said.
"Our experience has been that two-celled embryos do better than larger ones. I selected the four that I thought would tolerate the freezing and thawing the best. We'll keep them in reserve, just in case."
Marissa walked over to the liquid-nitrogen storage unit and touched its lid. The idea that four potential children were inside, frozen in a kind of suspended animation, gave her an eerie feeling.
Such high-tech intrusion reminded her a little too much of Brave New World.
"Want to see inside?" Dr. Wingate asked.
Marissa shook her head.
"I've taken too much of your time already," she said.
"Thank you."
"My pleasure," Dr. Wingate said.
Marissa hurried from the lab. She went to the elevators and pushed the Up button: What had brought her to the clinic that morning was an appointment to see Linda Moore, a psychologist.
Between the final talk with Robert the night before and his decision to sleep in the guest room, Marissa had decided to call about counseling first thing in the morning. Whether Robert went or not, Marissa. decided she needed to talk to a professional about the emotional stresses of IVF.
When she'd made the call, she thought she'd have to wait for an appointment, but Mrs. Hargrave had warned the staff psychologist that if Marissa called, she should be seen quickly.
Linda Moore's office was on the sixth floor, the very floor from which Rebecca Ziegler had jumped. The coincidence made Marissa a bit uncomfortable. As she walked down the hall, she morbidly tried to guess which window Rebecca had leaped from.
She wondered if the woman's last straw had been something she'd gleaned from her clinic record. Marissa remembered that Rebecca had left the downstairs waiting room with the express purpose of reading her record.
"Go right in," the secretary said when Marissa identified herself.
As she moved toward the door, Marissa questioned if she truly wanted to go through with the appointment. It hardly took a professional to tell her IVF was stressful. Besides, she was embarrassed to have to make excuses why Robert wouldn't come with her.
"Go right in!" the secretary repeated, seeing Marissa pause at the door.
Realizing she no longer had a choice, Marissa entered the office.
The room was soothingly decorated with comfortably upholstered furniture and muted tones of green and gray. The window, however, looked out on the stark brick courtyard six floors below. Marissa wondered what Linda Moore had been doing when Rebecca made her leap into infinity.
"Why don't you close the door?" Linda suggested, gesturing with her free hand. She was young; Marissa guessed, in her late twenties. She also had an accent, just like Mrs. Hargrave.
"Have a seat and I'll be with you in a
moment," Linda said.
She was on the phone.
Marissa sat down on a dark green chair facing Linda's desk.
The woman was rather petite, with short reddish hair and a sprinkling of freckles across the bridge of her nose. Her phone conversation was obviously with a patient, and it made Marissa uncomfortable. She tried not to listen. But it was soon over, and Linda turned her full attention to Marissa.
"I'm glad you called," she said with a smile.
Almost immediately, Marissa felt glad too. Linda Moore struck her as being both competent and warm. Encouraged by Linda, Marissa. soon began to open up. Although Linda saw patients with a wide variety of problems at the Women's Clinic,
Marissa learned that a good portion of her practice involved IVF. She understood exactly what Marissa had been going through, perhaps better than Marissa did herself.
"Basically, the problem is a Sophie's choice," Linda said halfway into the hour.
"You have two equally unsatisfactory possibilities: you can accept your infertility without further treatment as your husband is suggesting and thereby live a life that is contrary to your expectations, or you can continue with the IVF which will lead to continued stress on yourself and on you; relationship, continued cost as your husband has pointed out, and continued stress for you both with no guarantee of success."
"I've never heard it put so succinctly," Marissa said.
"I think it is important to be clear," Linda said.
"And honest.
And being honest starts with yourself. You have to understand what your choices are so you can make rational decisions."
Gradually, Marissa began to feel more comfortable about revealing her feelings, and the surprising part was that by doing so, she became more self-aware.
"One of the worst problems I have is that I can't fix things myself."
"That's true," Linda said.
"With infertility it doesn't make any difference how hard you try."
"Robert used the term 'obsessed,"
" Marissa admitted.
"He's probably right," Linda agreed.
"And it's only made worse by the emotional ups and downs of IVF: the recurrent flip flop from hope to despair, grief to rage, and envy to self reproach
"What do you mean by envy?" Marissa asked.
"The envy you feel toward women who have children," Linda said.
"The pain you might experience seeing mothers with kids in the grocery store. That kind of stuff."
"Like the anger I have at the mothers in my practice," Marissa said.
"Especially those who I think are neglecting their kids in some way."
"Exactly," Linda said.
"I can't think of a worse practice for an infertile woman than pediatrics. Why couldn't you have specialized in something else?" Linda laughed and Marissa laughed with her. Pediatrics was a particularly cruel field for someone in her circumstances. It probably was one of the reasons she'd been avoiding going to work as much as possible.
"Anger and envy are okay," Linda said.
"Let yourself feel them. Don't try to bottle them up just because you feel they are inappropriate."
Easier said than done, Marissa thought to herself.
"Before we break," Linda continued, "there are a couple of important points I want to make. We'll be going over all of this in more detail in future sessions, and I hope we can get Robert in here for one or two of them. But I want to warn you against letting this longed-for child become the embodiment of all your hope. Don't persuade yourself everything will be different if only you have this baby, because it doesn't work that way. What I want to suggest is that you set a realistic time frame for IVF attempts. As I understand it, you are on your fourth. Is that correct?"
"That's right," Marissa said.
"Tomorrow I'll have the embryo transfer. " "Statistically, four is probably not enough," Linda said.
"Perhaps you should think of setting eight tries as a cutoff. Here at the Women's Clinic we have a very high success rate around the eighth attempt. If after eight you haven't achieved pregnancy, then you should stop and consider other options."
"Robert is talking about other options now," Marissa countered.
"He will be more willing to be cooperative if he knows you've established a cutoff point-that this ordeal won't go on forever," Linda said.
"That's been our experience. In every couple there is one who is more committed to the process than the other. Give him a little time. Respect his limitations as well as your own."
"I'll see what I can do," Marissa said. Considering Robert's latest words on the subject, she wasn't optimistic.
"Are there any other issues you'd like us to concentrate on?"
Linda asked.
Marissa hesitated.
"Yes," she said at last.
"We mentioned guilt briefly. That's a big problem for me. Perhaps because I'm a doctor, it has bothered me that I haven't been able to find out how I got the infection that blocked my fallopian tubes."
"I can understand," Linda said.
"It's natural to think that way. But we'll have to try to change your thinking. The chance that any past behavior was the cause is infinitesimally small. It's not as if it were VD or anything."
"How do I know?" Marissa asked.
"I feel as if I have to find out. It's become an increasingly important issue for me."
"All right, we'll be sure to talk more about it." Opening up the scheduling book on her desk, Linda made a second appointment for Marissa. Then she stood up. Marissa did the same.
"I'd like to make one more suggestion," Linda said.
"I've got the distinct impression that you've been experiencing a good deal of isolation as a result of your infertility."
Marissa nodded, this time in genuine agreement.
"I'd like to encourage you to give Resolve a call," Linda continued. She handed a card with a telephone number to Marissa.
"You might have heard of the organization. It's a self-help support group for people with infertility problems. I think you would benefit from the contact. They talk about the same issues you and I have been discussing. It will be reassuring to realize that you are not alone in all this," Leaving the psychologist's office, Marissa felt pleased that she'd made the effort. She felt a hundred times better about the session than she'd imagined she would. She looked at the card with the Resolve phone number on it. She even felt positive about calling the organization. She'd heard about it before, but had never seriously thought of calling, in part because she was a physician. She had always assumed that the main purpose of the group was to explain the scientific aspects of infertility to lay people. That Resolve dealt with emotional aspects of infertility was news.
Riding down in the elevator, Marissa realized she'd forgotten to ask Linda about Rebecca Ziegler. She made a mental note to do it at their next session.
From the Women's Clinic, Marissa. went to her pediatric group. Robert had been right. Her practice was in disarray.
Given her frequent absences, her secretary, Mindy VaIdanus, was being used as a "float" to cover for other secretaries who were on vacation. Marissa wasn't surprised to find Mindy's desk empty when she passed by on her way to her office.
On her own desk, Marissa found a pile of unopened mail as well as a fine layer of dust. Hanging up her coat, Marissa called Dr. Frederick Houser, the senior partner of the group. He could see her, so she went directly up to his office.
"I have an embryo transfer scheduled for tomorrow," Marissa told her mentor once they were seated in the conference room.
"It might be the last cycle if my husband has his way."
Dr. Houser was an old-school physician. He was a large, portly man, mostly bald save for a ring of silver hair that ran around the back of his head. He wore wire-rimmed glasses and an everpresent bow tie. He had a warm, generous air about him that made everyone feel comfortable in his presence, from patients to colleagues.
"But if it is not successf
ul," Marissa continued, "and if I can smooth things out with Robert, we'll try a few more. But no more than eight. So one way or another, I'll be back to normal within half a year at most."
"We wish you the best," Dr. Houser said.
"But we will have to lower your salary again. Of course that will change as soon as you start contributing significantly to the group's income."
"I understand," Marissa said.
"I appreciate your patience with me."
Back in her office, Marissa took out the card Linda had given her and called the number. A friendly female voice answered.
"Is this Resolve?" Marissa asked.
"Sure is," the woman answered.
"I'm Susan Walker. What can I do for you?"
"It was suggested I give you people a call," Marissa said.
"I'm involved with the in-vitro fertilization unit at the Women's clinic."
"Staff or patient?" Susan asked.
"A patient," Marissa said.
"I'm on my fourth cycle."
"Would you and your husband like to come to our next meeting?"
Susan asked.
"My husband probably will refuse to come," Marissa said, a bit embarrassed.
"Sounds familiar," Susan said.
"It happens with most couples.
Husbands are reluctant until they come for one session. After that, most of them love it. That's what happened with my own husband. He'll be happy to call your husband to talk to him. He's fairly persuasive."
"I don't think that would be a good idea," Marissa said quickly. She could just imagine Robert's response if a stranger called up about a self-help infertility group.
"I'll speak with him myself. But if he doesn't come, would it be awkward if I came by myself?"
"Heavens, no!" Susan said.
"We'd love to have you. You'll have plenty of company. There are a number of women currently going through lVF. Several of them will be solo as well." Shethen gave Marissa the date and the directions.
Hanging up the phone, Marissa hoped the experience would be as rewarding as the session with Linda Moore. Although she had her doubts, she was willing to give it a try, mainly because of