Shock

THREE

I TRUST YOUR RIDE OUT FROM Boston was without incident," Dr. Donaldson said as she closed the clinic door behind the women.

"It was fine," Deborah said as she eyed a large, unoccupied waiting room. The furniture appeared to be expensive modern Scandinavian, which stood in sharp contrast to the period Victorian architectural details. A large U-shaped receptionist's desk stood empty in the center of the room. Leather upholstered chairs and couches lined the walls. A generous display of current magazines were sprinkled around on coffee and side tables.

"I realized this morning that I'd failed to give you directions," Dr. Donaldson said. "I apologize."

"No need to apologize," Deborah said. "I should have asked.

But we had no trouble. We stopped at the local pharmacy and asked."

"Very smart," Dr. Donaldson said. She clasped her hands. "Now, first things first. I trust that neither of you have had anything to eat since midnight."

Deborah and Joanna nodded.

"Excellent!" Dr. Donaldson said. "Let me give Dr. Smith, our anesthesiologist, a call. He'd like to speak with you. Meanwhile, if you'd like to take off your coats and make yourselves comfortable, we'll get things started."

While Dr. Donaldson used the receptionist's phone, Deborah and Joanna removed their coats and hung them in a cloakroom.

"Are you all right?" Deborah whispered to Joanna. In the background they could hear Dr. Donaldson on the phone.

"Yeah, I'm fine," Joanna answered. "Why do you ask?"

"You're so quiet. You're not changing your mind again, are you?"

"No! I'm just unnerved by this place," Joanna said. "Lots of little surprises like armed guards. Even that furniture out there in the waiting room bothers me."

"I know what you mean," Deborah agreed. "It looks like it cost a fortune but looks terrible in the environment."

"It's weird. Things like that usually don't bother me. I'm sorry I'm such a basket case."

"Just try to relax and think about having coffee in Piazza San Marco."

Returning to the main room, they allowed Dr. Donaldson to guide them over to a couch. Once seated, she informed them that Dr. Carl Smith was on his way down. She then asked if they had any questions.

"How long do you suppose this will take?" Joanna asked.

"A retrieval only takes forty minutes or so," Dr. Donaldson said. "Then we'll have you relax for a few hours to make sure the anesthesia has completely worn off. You'll be on your way before you know it."

"Will we be having the procedure at the same time?" Joanna asked.

"No," Dr. Donaldson said. "Miss Meissner, you'll be first since you'll be having the light general anesthesia. Of course, if Miss Cochrane would like to switch to general anesthesia, then you two could decide whom you would prefer to be first."

"I'm happy with the local anesthesia,' Deborah said.

"Whatever you prefer," Dr. Donaldson said. She looked from one woman to the other. "Any other questions for the moment?"

"Does the clinic occupy this whole building?" Deborah asked.

"Heavens no. This building is huge. It used to house a large mental institution as well as a TB sanitarium."

"So we heard," Deborah said.

"The infertility clinic takes up two floors in this wing only," Dr. Donaldson explained. "We also have a few of the offices in the tower. The rest of the facility is empty except for the old beds and a lot of the old equipment. It's almost like a museum."

"How many people work here?" Joanna asked.

"We have about forty employees presently, but the number has been steadily increasing. For the exact count, I'd have to check with Helen Masterson, the acting head of personnel."

"Forty employees is a lot," Joanna said. "It must be a godsend to a small rural community like this."

"One would think so," Dr. Donaldson said, "but in actuality we have a chronic problem recruiting help. We're forever advertising in the Boston papers, mostly for lab technicians and experienced admin people. Are you ladies interested in jobs?" Dr. Donaldson smiled teasingly.

"I don't think so," Deborah replied with a laugh.

"The only department that isn't shorthanded is the farm," Dr. Donaldson added. "We've had no problem in that arena since day one."

"The farm?" Joanna asked. "What do you mean the farm?"

"The Wingate Clinic has a large animal farm,' Dr. Donaldson explained. "It's an integral part of our research efforts. We're interested in basic reproductive research in species besides homo sapiens."

"Really?" said Joanna. "What other species are you looking at?"

"Any species that are economically significant," Dr. Donaldson said. "Cattle, pigs, poultry, horses. And, of course, we're also very much involved with the reproduction of domestic pets such as cats and dogs."

"Where is this farm?" Joanna asked.

"On the property directly behind this main building, which we affectionately call the 'monstrosity, and past a dense stand of white pine. The setting is rather idyllic. There's a pond, a dam, and even an old mill in addition to the barns, cornfields, hayfields, and paddocks. The Cabot Institution sat on over two hundred acres, with housing for its professional staff and its own farm to make it largely self-sufficient foodwise. Having the farm on the premises was one of the major reasons we leased the property. It makes our research a lot more efficient to have the farm adjacent to the laboratory, not to mention the housing."

"You have a laboratory here?" Deborah asked.

"Absolutely," Dr. Donaldson said. "A major lab. I'm particularly proud of it, probably because I'm mainly responsible for setting it up."

"Could we have a tour?" Deborah asked.

"I imagine that could be worked out," Dr. Donaldson said. "Ah, here comes Dr. Smith."

The women turned to see a large, heavyset man dressed in surgical scrubs enter the room carrying a clipboard. Just then, the front door opened and a throng of employees swarmed in, abuzz with conversation. One woman headed for the receptionist's desk while the rest crowded into the hall that Smith had just exited.

Joanna felt herself stiffen. Seeing the anesthesiologist's operating room garb made the reality of the upcoming procedure more difficult to suppress.

After introducing himself and shaking hands with both women, Dr. Smith sat down, crossed his legs, and positioned the clipboard on his lap. "Now then," he said as he took one of the many pens from his breast pocket. "Miss Cochrane, I understand your preference is local anesthesia."

"Correct," Deborah said.

"May I ask why?" Dr. Smith questioned.

"I just feel more comfortable with it," Deborah answered.

"I assume you've been informed that we prefer light general anesthesia for egg retrievals."

"Dr. Donaldson said as much," Deborah said. "She also said the decision was mine."

"That's very true," Dr. Smith said. "At the same time, I'd like to tell you why we prefer to have you asleep. Under light general anesthesia, we do the retrieval under direct laparoscopic observation. With local, paracervical anesthesia the retrieval is done with an ultrasound-guided needle. Comparatively speaking it's like working in the dark." Dr. Smith paused and smiled. "Any questions about what I've said so far?"

"No," Deborah said simply.

"There's one more issue," Dr. Smith said. "Under local anesthesia we don't have the control of pain coming from intra-abdominal manipulation. In other words, if we have any trouble getting to either ovary and have to do some maneuvers to make it possible, you might experience some discomfort."

"I'll take my chances," Deborah said.

"Even considering the pain issue?"

"I think I can handle it," Deborah said. "I prefer to be awake."

Dr. Smith glanced briefly at Dr. Donaldson, who shrugged. He then went through a brief medical history with both women. When he was finished he stood. "That's all I need for now. I'll have you two get changed, and I'll see you upstairs."

"Will I be getting a sedative?" Joanna asked.

"Absolutely," Dr. Smith said. "It will be administered as soon as you get your IV. Any other questions for the moment?"

When neither woman responded, Dr. Smith smiled and left. Dr. Donaldson then escorted the women down the main hall and into a separate, smaller waiting room. On one side were several changing cubicles with louvered doors and on the other a bank of lockers. A rack of hospital johnnies, paper slippers, and bathrobes was next to the lockers. A pleasant-faced, petite nurse was restocking the patient apparel. Several gurneys were parked by the double swinging entry doors. In the middle of the room were a grouping of chairs, a couch, and a coffee table littered with magazines.

Dr. Donaldson introduced the women to the nurse, whose name was Cynthia Carson. She in turn supplied the women with sets of the in-patient hospital garb, gave each of them a key to a locker along with advice to pin the keys to their johnnies, and opened the doors of two adjacent changing cubicles. At that point Dr. Donaldson took her leave. A few moments later Cynthia also left, to get the IV supplies. She said she'd be right back.

"That was a rather hard sell for general anesthesia," Joanna called out from her stall.

"You can say that again," Deborah agreed.

The women stepped out from their respective changing rooms, each holding her thin bathrobe closed with one hand and clutching her street clothes with the other. They burst out laughing when they saw each other.

"I hope I don't look as pathetic as you," Joanna managed.

"I hate to break it to you,' Deborah responded, "but you do."

They went to the lockers to secure their belongings.

"Why didn't you give in and take the general anesthesia?" Joanna asked.

"You're not going to start in on me, too, are you?" Deborah asked.

"The anesthesiologist's points made a lot of sense to me," Joanna said. "Especially when he explained about pain from intra-abdominal manipulation. It was enough to make me feel lightheaded. Don't you think you should reconsider?"

"Listen!." Deborah said as she slammed the locker door and yanked out the key. She faced her friend. Her cheeks had a sudden flush. "You and I have already had this discussion. I have this thing about being put to sleep. Call it a phobia. You don't like needles, and I don't like anesthesia, okay?"

"Okay!" Joanna said. "Jeez, calm down! I'm the one who's supposed to be unnerved by this, not you."

Deborah sighed. She closed her eyes briefly and shook her head. "I'm sorry. I didn't mean to snap at you. I suppose I'm on edge, too."

"No need to apologize," Joanna said.

At that moment Cynthia reappeared with an armload of paraphernalia, which she dumped on one of the gurneys. In her other hand she had an IV bottle, which she proceeded to hang on the gurney's IV pole. "Which one of you is Miss Meissner?" she called out.

"Joanna raised her hand.

Cynthia patted the gurney's padded surface covered with a fresh bedsheet. "How about hopping up here on this contraption so I can start an IV? Then I'm going to be giving you a cocktail that will make you feel like it's New Year's Eve."

Deborah reached out and gave her friend's arm a squeeze as they exchanged a compassionate glance. Joanna then did as she was told. Deborah came around to stand on the other side of the gurney.

Cynthia went through the preparations of starting the IV with a practiced economy of motion. At the same time she kept up a distracting stream of conversation about the weather, and before Joanna had a chance to work herself up into a dither, Cynthia was already putting a tourniquet around Joanna's left arm just below the elbow.

Joanna averted her face and grimaced as the needle broke the skin. The next instant the tourniquet was gone, and Cynthia was applying tape.

"There, at least that's done," Cynthia said.

Joanna turned. Her face reflected her surprise. "Is the IV in already?"

"Yup," Cynthia said cheerfully as she drew up medication in two syringes. "Here comes the fun part. But, just to be one-hundred-percent sure: You have no allergies to any medication, isn't that right?"

"That's right," Joanna said.

Cynthia bent over the IV port and took the cap off the first syringe.

"What am I getting?" Joanna asked.

"You really want to know?" Cynthia asked. She finished with the first and started with the second.

"Yes!"

"Diazepam and fentanyl."

"How about in English?"

"Valium and an opioid analgesic."

"I've heard of Valium. What's the other stuff?"

"It's in the morphine family," Cynthia said. The nurse quickly cleaned up the wrappers and other debris and threw it all into a special receptacle. While she made an entry onto the clipboard that she'd pulled from beneath the gurney's pad, the door opened to the hallway and another patient walked in. She smiled at the women, went to the clothes rack for a set of the hospital patient clothes, then disappeared into one of the changing rooms.

"Do you think she's another donor?" Joanna asked.

"I've no idea," Deborah said.

"That's Dorothy Stevens," Cynthia said in a hushed voice as she went around to the head of the gurney and unlocked the wheels. "She's a Wingate client who's here for yet another embryo transfer. The poor dear has suffered a lot of disappointment."

"Am I going already?" Joanna asked as the gurney began to move.

"Yes, indeed," Cynthia said. "I was told they were eagerly awaiting your arrival when I went out to get the IV material."

"Can I go along?" Deborah asked. She'd taken hold of Joanna's hand.

"I'm afraid not," Cynthia said. "You stay and relax. You'll be going up yourself before you know it."

"I'll be all right," Joanna said with a smile to Deborah. "I already feel that opioid stuff. It's not half bad, either."

Deborah gave Joanna's hand a final squeeze. Before the doors swung shut Deborah caught a glimpse of Joanna merrily waving to her over her shoulder.

Deborah turned back to the room. She walked over to the couch and sat down heavily. She was hungry from not having eaten anything since before going to bed the night before. She picked up several magazines but found she could not concentrate, not with her stomach growling. Instead she tried to picture where they were taking Joanna in the huge, old, white elephant of a building. Tossing the magazines aside, she glanced around the room. There was the same jarring disjuncture between the elaborate crown molding and trim and the furniture as there had been out in the main waiting room. Joanna had been right: The Wingate was a place filled with contrasts that were vaguely unsettling. As much as Joanna, Deborah was looking forward to having the egg retrieval procedures behind them.

One of the changing room doors opened and Dorothy Wash-burn emerged clutching her clothes. She smiled at Deborah before heading over to the lockers to store them. Deborah watched her and wondered what it was like to contend with continued infertility treatment and continual disappointment.

Dorothy locked the locker, then came over to the sitting area while pinning the locker key to her johnny en route. She picked up a magazine, sat down, and began to flip through the pages. Apparently sensing Deborah's stare, she raised her strikingly cerulean eyes. This time it was Deborah's turn to smile. She then introduced herself, and Dorothy did the same. For a few minutes the two women indulged in light conversation. After a pause, Deborah asked Dorothy if she'd been a patient of the Wingate Clinic for some time.

"Unfortunately, I have," Dorothy said.

"Has it been a pleasant experience?"

"I don't think pleasant is the right word," Dorothy said. "It's not been an easy road by any stretch of the imagination. But to the Wingate's credit, they did warn me. Anyway, my husband and I are not about to give up, at least not yet or at least not until we've used up all our credit."

"You're having an embryo transfer today?" Deborah asked. She was reluctant to admit she already knew.

"My ninth," Dorothy said. She sighed and then held up crossed fingers.

"Good luck," Deborah said sincerely.

"I could use some."

Deborah imitated the crossed-fingers gesture.

"Is this your first time to the Wingate?" Dorothy asked.

"It is," Deborah admitted. "For both myself and my roommate."

"I'm sure you'll be satisfied with your choice," Dorothy said. "Are you both doing in vitro?"

"No," Deborah said. "We're egg donors. We responded to an ad in the Harvard Crimson."

"That's wonderful," Dorothy said with unabashed admiration. "What a loving gesture. You are going to give hope to some desperate couples. I applaud your generosity."

Deborah suddenly felt uncomfortably venal. She hoped to change the subject before her true motive for donating was revealed. Luckily she was saved by Cynthia's abrupt return. The nurse burst through the swinging doors without warning.

"Okay, Dorothy!" Cynthia called out with great enthusiasm. "You're on! Get yourself down there to the transfer room. They're all ready for you."

Dorothy stood, took a deep breath, and then headed out the door.

"She's quite a soldier," Cynthia remarked as the door swung shut. "I sure hope this turns out to be a successful cycle. If anyone deserves it, she does."

"How much does a cycle cost?" Deborah asked. Concern about her venality had brought the issue of economics to the fore.

"It varies quite a bit depending on what procedures are involved," Cynthia said. "But on average it's around eight to ten thousand dollars."

"Oh, my goodness," Deborah commented. "That means Dorothy and her husband have spent nearly ninety thousand dollars!"

"Probably more," Cynthia said. "That doesn't include the initial infertility workup or any ancillary treatments that might have been indicated. Infertility is an expensive undertaking for couples, especially since insurance doesn't usually cover it. Most couples have to come up with the cash somehow."

Two more patients entered, and Cynthia's full attention immediately turned to them. She took the women's paperwork, glanced at it briefly, got them apparel, and directed them into changing rooms. Deborah was surprised at the apparent age of one of them. She couldn't be sure, but she thought the woman looked old, like she was in her middle to late fifties.

Feeling restless, Deborah got to her feet. "Excuse me, Cynthia," Deborah said. The nurse was reading the patients' paperwork more thoroughly. "Dr. Donaldson mentioned that I could have a tour of the laboratory. Who should I see about it?"

"That's a request I haven't had before," Cynthia said. She thought for a moment. "I guess you could try Claire Harlow in public relations. She gives tours to prospective patients, although I don't know if that includes the lab or not. If you don't mind walking around in your robe, you can go out to the receptionist in the main waiting room and have her page Miss Harlow. You don't have a lot of time so I wouldn't go far. I imagine they'll be calling for you in another fifteen minutes or so."

Despite the warning about time, Deborah had to do something. Following Cynthia's suggestion, she retraced her steps out to the main waiting room and had the public relations person paged. While she waited for the page to be returned, she noticed that quite a few patients had arrived since she and Joanna had passed through. There was not much conversation. Most of the women were reading the magazines. A few were blankly staring ahead.

Claire Harlow was a soft-spoken, gentle, accommodating woman who seemed pleased to take Deborah up a floor and show her the main lab. As Dr. Donaldson had suggested, it was huge, extending along the back of the building for almost the entire wing occupied by the Wingate.

Deborah was duly impressed. Having spent many hours in biology labs, she knew, for the most part, what she was looking at. The equipment was the newest and best available and included surprising things like automated DNA sequencers. The other surprise was how few people were in the mammoth room.

"Where is everybody?" Deborah asked.

"The doctors are all doing various clinical procedures at the moment," Claire answered.

Deborah strolled along a long countertop supporting more dissecting microscopes than she'd seen in any one place before. They were also more powerful than the microscopes Deborah had had the pleasure of using.

"An army could work in here," Deborah said…

"We're always looking for qualified people," Claire said.

Deborah came to the end of the lab bench and glanced out the window. It faced out the back of the building and offered an impressive view. It was particularly expansive because the building sat on the spine of a hill, with lawn sloping away in both the front and the back. Northward through a tangle of orange oaks and red maples Deborah could make out stone buildings similar to the gatehouse but with white trim.

"Are those buildings part of the farm?" Deborah asked.

"No, those are some of the living quarters," Claire explained. Pointing off to the right in a southeastern direction to where the property sloped down even more dramatically than elsewhere, she directed Deborah's attention to a shimmering of light just visible through old-growth pines. "That sparkle is sun reflecting off the surface of the mill pond. The farm buildings are grouped around it."

"What's the story with the brick chimney spewing smoke?"

Deborah questioned, gesturing toward a smokestack rearing up above the trees even farther to the right. "Is that part of Wingate complex as well?" The smoke was white as it left the chimney but faded to a dark purplish-gray as it trailed off in the distance toward the east.

"It certainly is," Claire said. "That's the old power plant for heat and hot water. It's a rather interesting structure. It was also the crematorium for the Cabot Institution."

"Crematorium?" Deborah sputtered. "Why on earth did they have a crematorium out here?"

"Out of necessity, I guess," Claire said. "Back in the olden days I think a lot of the patients were essentially abandoned by their families."

Deborah cringed at the thought of an isolated mental hospital with its own crematorium, but before she could ask another question, Claire's pager went off. The woman checked the LCD window. "That's for you, Miss Cochrane. They're ready for your procedure."

Deborah was pleased. She was eager to get it over with so she and Joanna could be on their way.