Robin Cook 1990 - Vital Signs

by Vital Signs(lit)

  "Get him away from me," yelled Marissa. She leaped to her feet and tossed the menu aside.

  "Don't let him touch me. No!" she screamed, as illusion and reality merged.

  In her mind's eye, Marissa saw the face of Dr. Carpenter come up between her sheet-draped knees, having been transformed into a demon. His eyes were no longer blue. They were distorted and shiny, like cold, black onyx.

  "Marissa!" Robert shouted, feeling a mixture of concern, shock, and embarrassment. Other diners had paused to cast startled looks in Marissa's direction. Robert stood and reached for her.

  "Don't touch me!" she shouted again. She knocked Robert's hand away from her. Spinning on her heels, she fled from the restaurant, banging open the door.

  Robert chased after her, practically tackling her outside the door. Grabbing her by the shoulders, he shook her hard.

  "Mafissa, what's wrong with you?"

  Marissa blinked several times as if waking from a trance.

  "Marissa?" Robert yelled.

  "What's going on? Talk to me!"

  "I don't know what happened," Marissa said groggily.

  "All at once I was back at the clinic having a biopsy. Something keyed off a replay of the bad trip I'd had from ketamine." She glanced back into the restaurant. People were at the window, staring out at her. She felt foolish and embarrassed as well as scared. It had been so real.

  Robert put his arms around her.

  "Come on," he said. "]Let's get out of here."

  He walked her to the car. Marissa held back, her mind frantically trying to find some answers. She'd never lost control to such a degree. Never. What was happening to her? Was she going crazy?

  They climbed into the car. Robert didn't start it immediately.

  "Are you sure you're all right?" he asked. The episode had unnerved him.

  Marissa nodded.

  "At this point I'm just scared, 9'she said.

  "I've never experienced anything like that. I don't know what set it off.

  I know I've been overly emotional lately, but that hardly seems like an explanation. I was hungry, but I certainly can't blame it on that. Maybe it was that pungent smell in there. The nerves of smell connect directly with the limbic system in the brain." Marissa was searching for a physiological explanation so she wouldn't have to probe for a psychological one.

  "I'll tell you what it says to me," Robert said.

  "It tells me you've been taking too many drugs. All those hormones can't be good for you. I think it is just one more sign we should stop this in-vitro nonsense. Pronto."

  Marissa didn't say anything. She was scared enough to think that perhaps Robert was right.

  March 21,1990 7:47 Am.

  "Want to flip to see who does the incision?" Ken Mueller said to Greg Hommel, the junior pathology resident who had been assigned to him for a month's rotation doing postmortems.

  Ken was particularly pleased with Greg. The kid was eager and smart as a whip. Ken smiled to himself calling Greg a kid; the guy was only five years younger than himself.

  "Heads I win, tails you lose," Greg said.

  "Flip," Ken said, already engrossed in the chart. The patient was a thirty-three-year-old woman who'd fallen six stories into a rhododendron planter.

  "Tails!" Greg called out.

  "You lose." He laughed happily.

  Greg loved doing posts. Whereas some of the other junior residents hated it, he thought it was a gas; a detective story wrapped up in the mystery of a body.

  Ken didn't share Greg's enthusiasm for posts, but he accepted his teaching responsibilities with equanimity, especially with a resident like Greg. Yet looking at the patient's chart, he felt a little irritated. It had been well over twenty-four hours since the patient's death, and Ken liked to do posts as soon as possible. He thought he was able to learn more.

  The patient in this case had been brought to the Memorial by ambulance for a brief resuscitation attempt but the woman had been declared DOA. Then the body had sat in cold storage. It was supposed to have been sent to the medical examiner's office, but between a rash of shootings and other trauma, the ME had been swamped. Finally, a request had come through for them to do the post at the Memorial and Ken's chief had gladly agreed.

  It was always politically wise to stay on the ME's good side. You I never knew when a return favor would be needed.

  With his gloved. left hand providing counter traction Greg was about to make the typical Y-shaped autopsy incision when Ken told him to hold up.

  "Have you gone over the chart?" Ken asked.

  "Of course," Greg said, almost hurt by the implication.

  "So you know about this infertility stuff?" Ken asked while he was still reading.

  "The in-vitro attempts and the blocked tubes."

  Blocked tubes had rung a bell, and Ken recalled Marissa's visit.

  "Yup, and she looks like a pincushion because of it," Greg said.

  Ken glanced at the body as Greg pointed to the multiple hormone-injection sites as well as the multiple bruises where blood had been drawn to measure estrogen levels.

  "Ouch," Ken said, looking down.

  "And here's a fresh one," Greg said, pointing to the crook of the left elbow.

  "See the heme staining under the skin? She had blood drawn within hours of her jumping out the window.

  Couldn't have been from our ER. She was dead when she arrived."

  Slowly, the doctors' eyes met. They were thinking the same thought. The patient certainly wasn't a drug addict.

  "Maybe we should extend the toxicology screen," Greg said ominously.

  "Just what I was about to suggest," Ken said.

  "Remember, we're being paid to be suspicious."

  " You're being paid," Greg laughed.

  "As a resident, my salary is more like alms."

  "Oh, come on!" Ken said.

  "When I was at your stage..

  "Spare me," Greg said, holding the knife aloft. He laughed.

  "I've already heard what medicine was like in medieval times."

  "What about the evidence of the trauma from the faUT' Ken asked.

  Rapidly, Greg ticked off the external signs of impact. It was apparent that both legs were broken, as was the pelvis. The right wrist was also bent at an abnormal angle. The head, however, was intact.

  "All right," Ken said, "cut away."

  With a few deft strokes, Greg used the razor-sharp knife to cut through the skin, exposing the omentum-covered intestines.

  Then, with large clippers, he cut through the ribs.

  "Uh-oh!" Greg said, lifting off the manubrium, or breastbone.

  "We got some blood in the chest cavity."

  "What does that suggest?" Ken asked.

  "I'd say aortic rupture," Greg said.

  "Six stories could have generated the two thousand pounds of force necessary."

  "My, my," Ken teased, "you must be doing some extracurricular reading."

  "Occasionally," Greg admitted.

  Carefully, the two men extracted the blood from both lung cavities.

  "Maybe I'm wrong about the aortic rupture," Greg said, staring at the graduated cylinder when they were done.

  "Only a few hundred cc's."

  "I don't think so," Ken said. He withdrew his hand from inside the chest cavity.

  "Feel along the aortic arch."

  Looking up at the ceiling as he concentrated on feel, Greg palpated along the aorta. His finger slipped inside. It was an aortic rupture, all right.

  "You have promise as a pathologist after all," Ken said.

  "Thanks, all-seeing, all-knowing Karnak the Magnificent," Greg joked, though he was obviously pleased with the compliment.

  He turned his attention to the evisceration of the corpse.

  But as he worked, his forensic mind was beginning to set off alarm bells in his head. There was something wrong with this case; something very wrong.

  Having gone through an embryo transfer before, Marissa knew what to exp
ect. There wasn't much pain involved, especially in comparison with the myriad procedures she'd been enduring over the year, but it was still an uncomfortable and humiliating exercise. To keep her uterus in a dependent position, she had to lie prone with her knees raised to her chest and with her rear end sticking up in the air. Although she had a sheet draped over her, Marissa felt completely exposed. The only people present were Dr. Wingate, his nurse-technician, Tara MacLiesh, and Mrs. Hargrave. But then the door opened and Linda Moore came in. The fact that people could come in and out was part of the reason Marissa felt so vulnerable.

  "It's important for you to be relaxed," Linda said, positioning herself near Marissa's head. She patted Marissa's shoulder.

  "I want you to think relaxing thoughts."

  Marissa knew the therapist meant well, but telling her to think relaxing thoughts seemed absurd. She hardly saw how it would help. And it was particularly hard to relax knowing Robert was outside waiting. Marissa had been surprised he'd come with her that morning since he'd slept in the guest room again.

  "Everything is ready," Dr. Wingate said, keeping Marissa informed, as usual.

  "And just like we did last time, the first thing we have to do is assure asepsis."

  Marissa felt the sheet drawn back. Now she was literally exposed.

  She closed her eyes as Linda continued to drone on about relaxing. But Marissa couldn't relax. So much was riding on this transfer, maybe even her marriage. Robert had accompanied her to the clinic, but neither of them had said a single word through the entire drive from Weston to Cambridge.

  "First the sterile speculum," Dr. Wingate said. A few seconds later, she felt the instrument.

  "Now I will be rinsing with the culture medium," Wingate continued.

  Marissa felt the rush of fluid inside her. Then she felt a hand on her shoulder. Opening her eyes, she saw that Linda Moore's freckled face was inches from her own.

  "Are you relaxed?" Linda asked her.

  Marissa nodded, but it was a lie.

  "We're ready for the embryos now," Dr. Wingate told Tara.

  Tara went back into the lab. Then to Marissa, Dr. Wingate said:

  "You might feel a tiny bit of cramping with the insertion, but don't worry. It will be just like last time."

  Marissa. would have preferred he'd not made the comparison: last time the transfer had not worked. She heard Tara come back into the room. Marissa could picture the Teflon catheter, called a Tomcat.

  "This is it," Dr. Wingate continued.

  "Remember to relax," Linda said.

  "Think of a fine, healthy baby," Mrs. Hargrave said.

  Marissa felt a strange deep sensation like a pain, but not strong enough to be called a pain.

  "We should be within one centimeter of your uterine fundus," Dr. Wingate said.

  "I'm injecting now."

  "Breathe deeply," Mrs. Hargrave said.

  "Relax," Linda suggested.

  Despite her hopes, Marissa didn't feel optimistic.

  "Perfect," Dr. Wingate said.

  "I'm coming out now."

  Marissa held her breath as she experienced an extremely mild cramp' Now don't move until we ascertain that the embryos have all been extruded from the catheter," Dr. Wingate said. He and Tara disappeared into the lab.

  "You feel okay?" Mrs. Hargrave asked.

  "Fine," said Marissa, as self-conscious as ever, always concerned someone else was about to barrel through the door, "Now that it's over," Linda said, giving Marissa's shoulder another pat, "I'll be going. I think I'll have a word with your husband on my way out."

  Good luck, Marissa thought. She didn't think her husband would be approachable that day.

  Dr. Wingate returned just as Linda was departing.

  "All the embryos were planted," Dr. Wingate said. Marissa felt the speculum being removed. He tapped her gently on the top of her rump.

  "Now you can lower yourself to your tummy. But don't roll over. Just like the previous transfer: I want you to remain on your stomach for three hours, then you can roll over on your back for an hour. Then you'll be free to go." He pulled the sheet over Marissa's lower half.

  Mrs. Hargrave released the brakes on the gurney and started pushing. Tara held open the door to the hallway. Marissa thanked Dr. Wingate.

  "You're very welcome, love," he said, his Australian accent suddenly more pronounced.

  "We'll all be keeping our fingers crossed."

  As they came abreast of the waiting room, Marissa heard Mrs.

  Hargrave call out Robert's name. The conversation with Linda must have been brief, as she was already gone.

  Robert fell in beside them as Mrs. Hargrave pushed Manissa across the glassed walkway to the overnight ward.

  "I was told everything went smoothly," he said.

  "We're very optimistic," Mrs. Hargrave said.

  "They were fine eggs and fine embryos."

  Marissa didn't say anything. She could tell Robert wasn't happy. Linda had no doubt irritated him, The room that Marissa was placed in for her four-hour wait was pleasant enough. There were yellow curtains over windows that looked out onto the Charles River. The walls were a restful light green color.

  Marissa was gingerly transferred from the gurney to the bed.

  Following orders, she lay quietly on her abdomen, her head to the side. Robert sat in a vinyl chair facing her.

  "You feel okay?" he asked.

  "As well as can be expected," Marissa said evasively.

  "You'll be all right?" he asked.

  Marissa could tell he was impatient to go.

  "AN I'm doing is lying here," she told him.

  "If you have things to do, please, go do them. I'll be fine."

  "You're sure?" Robert stood up.

  "I suppose if you are comfortable, there are some things I ought to attend to."

  Marissa could tell he was grateful to be excused. Before he left he gave her a quick peck on the cheek.

  The way she'd been feeling lately, Marissa was initially more comfortable left alone. But as the hours crawled by, she started to feel lonely, even abandoned She began to look forward to the infrequent visits by one of the Women's Clinic staff who dropped by to check on her every now and then.

  When four hours had passed, Mrs. Hargrave came back to help her dress. At first, Marissa was reluctant to stand up, fearing she would spoil the transfer, even though the prescribed time had gone by. Mrs. Hargrave was nothing but encouraging.

  Before Marissa left the clinic, Mrs. Hargrave advised her to take it easy for the next few days. She also told her to avoid sex for a little while.

  No problem there, Marissa thought forlornly, especially if Robert continued to sleep in the guest room. She couldn't remember the last time the two of them had had sex.

  Marissa arranged for a cab to come pick her up. The last thing she wanted to do was call Robert for a ride.

  She spent the remainder of the day resting. At seven o'clock she watched the news, keeping an ear out for the sound of Robert's car in the driveway. By eight o'clock she began eyeing the phone. At eight-thirty she broke down and called his office.

  Marissa let the phone ring twenty-five times, hoping that he was there by himself and would eventually hear it even if it wasn't ringing in his private office. But no one picked up.

  Hanging up the receiver, Marissa stared at the clock, wondering where Robert could be. She tried to tell herself he was probably on his way home. Marissa had promised herself she wouldn't cry. She was afraid it might somehow jeopardize the embryos.

  But as she sat alone in the dark waiting for Robert to come home at last, loneliness overcame her. Despite her best intentions, tears began to slide down her cheeks. Even if she was pregnant, at this point she wasn't sure it would be enough to save her marriage.

  With deepening despair, she wondered what was going to happen to her life.

  Marissa exited from Storrow Drive onto Revere Street at the base of Beacon Hill. As usual, she felt anxious. It ha
d been almost a week since her embryo transfer, and it was difficult for her to think of anything other than the question of whether she was pregnant or not. In just a few days she was scheduled to return to the Women's Clinic to have blood drawn for a test that would indicate whether or not the transfer had been successful.