Vital Signs

10

Although Marissa and Wendy had spoken on the phone early Saturday morning, Marissa did not see her friend until Monday morning at the courthouse. As she and Robert entered the courtroom, they saw Wendy, Gustave, and their lawyer sitting in the pew like benches on the left. Robert tried to steer Marissa to an empty row on the right, but she resisted and went over to her friend.

Wendy looked awful. She stared ahead as if in a trance. Her eyes were red, rimmed, and sunken. It was obvious she'd been crying, probably a lot. Marissa touched her on the shoulder and whispered her name. Seeing Marissa, fresh tears began to streak down her cheeks.

"What's the matter?" Marissa asked. Wendy seemed more distraught than expected.

Wendy tried to speak but couldn't. All she could do was shake her head. Marissa grabbed her arm and pulled her out of her seat.

Together they walked back through the milling crowd and out of the courtroom.

Spotting a ladies' room, Marissa steered her friend into the lavatory.

"What is it?" Marissa asked.

"Is it something between you and Gustave?"

Wendy shook her head again and sobbed. Marissa hugged her tight.

"Is it this legal stuff?" she asked.

Wendy shook her head.

"It's my blood test," she said at last.

"I had it drawn on Saturday. I'm not pregnant."

"But that was only the first test," Marissa said.

"They'll have to do another to see how much the hormone goes up." She was trying to be optimistic, but she knew that if Wendy thought she wasn't pregnant, then she probably wasn't. The news sent an icicle through Marissa's heart. Just that morning before coming to the courthouse, Marissa had stopped at the Memorial for her blood to be drawn for the same test.

"The hormone level was so low," Wendy sobbed, "I can't be pregnant. I just know it."

"I'm so sorry," Marissa said.

"Do you think what happened at the clinic Friday night could have had an effect on the transfer?" Wendy asked.

"Oh, no!" Marissa said, even though the same awful thought was in her mind.

"Excuse me," said a gum-chewing woman in a tight miniskirt.

"Either of you Dr. Blumenthal?"

"I am," Marissa said with surprise.

The woman hooked a thumb over her shoulder.

"Your husband is waiting. Says he wants you out there immediately."

"They must be starting the arraignments," Marissa said to Wendy.

"We have to be there."

"I know," Wendy said, still crying. She took tissue from Marissa and wiped her eyes.

"I look terrible," she said.

"I'm afraid to look in the mirror."

"You look fine," Marissa lied.

The two women left the ladies' room together. Robert was standing right outside the door with his hands on his hips.

"What's the matter now?" he asked with exasperation after taking one look at Wendy.

"You do understand that you have to be in the courtroom when your cases are called, don't you?"

Marissa addressed him in a low, barely civil tone.

"Look, I know it's hard for you to appreciate, but Wendy is grief-stricken because her latest embryo transfer didn't take. To us, it's as bad and as real as a miscarriage."

Robert rolled his eyes.

"Come on," he said.

"She can save it for her therapist. I'm not about to let you jeopardize yourselves by missing your arraignment."

Despite Robert's concern, Marissa and Wendy weren't called for another thirty minutes. As they nervously waited, Mr. Freeborn explained that the cases were taken in the order that the involved arresting authority completed the appropriate paperwork.

So they had to wait while a parade of characters were arraigned on a variety of charges such as manslaughter, robbery, attempted rape, drug trafficking, driving under the influence, receiving stolen goods, and assault and battery. Finally, at ten-twenty, the clerk of the court called out: "Cases 9045CR-987 and 988, the Commonwealth versus BlumenthalBuchanan and Wilson-Anderson."

"Okay, that's us," Mr. Freeborn said, standing and motioning for Marissa to do the same.

Across the aisle, Marissa could see Wendy stand With her lawyer. He was a tall, thin man whose jacket sleeves were too short, making his arms and bony hands seem unnaturally long.

Together the foursome moved from the gallery section to a spot before the bench.

Judge Burano appeared disinterested. He continued to peruse the array of papers laid out in front of him. He was a heavyset man in his sixties, with wrinkled features that gave him an uncanny resemblance to a bulldog. Reading glasses pinched the end of his broad nose.

The clerk cleared his throat, then read in a loud voice for all to hear.

"Marissa Blumenthal-Buchanan, you are hereby charged by the Commonwealth of Massachusetts with breaking and entering. How do you so plead?"

"Mrs. Marissa Blumenthal-Buchanan pleads not guilty," Mr.

Freeborn said with his commanding voice.

"Marissa Blumenthal-Buchanan, you are hereby charged by the Commonwealth of Massachusetts with trespass," the clerk of the court droned on. He went through the entire list of charges, and each time Mr. Freeborn entered the same not-guilty plea.

When Marissa's charges had been read and recorded and her pleas entered, the clerk of the court repeated the same process with Wendy.

At that point a woman Marissa guessed to be an assistant district attorney stood up. With several sheets in her hand for reference, she addressed the court: "Your honor, the Commonwealth requests the re imposition of the bail previously set by the magistrate in these two cases. These are serious charges, and it is our understanding that there was significant property damage at the involved clinic."

"Your Honor, if I may," Mr. Freeborn said.

"My client, Dr. Blumenthal-Buchanan, is an esteemed physician in our state who has received national recognition for her work. I believe strongly that she should be released on her own recognizance. I would like to make a motion that the bail set by the magistrate be dropped."

"Your Honor," Wendy's lawyer said, "I would like to echo MY esteemed colleague's motion. My client, Dr. Wendy Wilson Anderson is on the staff at the renowned Massachusetts Eye and

Ear Infirmary as an ophthafinologist. She is also a property owner in the Commonwealth."

For the first time since Marissa and Wendy had come forth, the judge glanced up from his paperwork. He regarded the group before him with a cold eye.

"I will reduce bail to five thousand for each defendant," he said.

Just then, a well-dressed man in a handsome business suit approached the prosecution's table. He tapped the woman ADA on the shoulder and spoke to her at length. Once he had finished, the woman began conferring with her two colleagues.

"We will set a pre-trial conference date for May 8, 1990," the clerk of the court said.

"If it please the court, Your Honor," the assistant district attorney said, once again approaching the bench, "there has been a development in this case. Mr. Brian Pearson would like to address the court."

"And who is Mr. Brian Pearson?" Judge Burano demanded.

"I am counsel for the Women's Clinic, Your Honor," Mr.

Pearson said.

"It was within the premises of the Women's Clinic that the alleged crimes were committed by the defendants. Dr.

Wingate, the director of the clinic, has instructed me to petition the court with respect to this matter. Although the defendants' behavior is not condoned in any way, the clinic does not wish to press charges, provided the women acknowledge their liability and give their word that they will respect the property of the clinic in future and pay reasonable compensation for the repair of damages their acts caused."

"This is unusual, to say the least," Judge Burano said. He cleared his throat. Turning to the assistant district attorney, he asked: "What is the Commonwealth's opinion of this development?"

"We do not object, Your Honor," the assistant district attorney said.

"If the clinic doesn't want to press charges, then the Commonwealth won't insist."

"Well, isn't this curious," the judge said, turning his attention back to Maxissa and Wendy.

"Nolle prosequi! This certainly is a first in my court. But if no one wants to prosecute, then it behooves me to lessen the judicial burden of the Commonwealth by dropping the case. But before doing so, I intend to voice an opinion."

Judge Burano leaned forward, studying the women.

"From the material I've gone over, it suggests to me that you two adults have been acting mighty irresponsibly, especially in your capacity as physicians. I don't countenance such obvious disrespect for the law and for private property. The case is dismissed, but you two women should feel indebted to the Women's Clinic for its generosity."

Marissa felt a tug on her arm. She looked at Mr. Freeborn, who motioned for her to go. The clerk of the court was already calling out the case number for the next arraignment.

Confused but happy to be escorted out of the courtroom, Marissa waited until they'd reached the cigarette-smoke-filled hallway before speaking. Robert was directly behind her with Wendy and Gustave in tow.

"What happened?" Marissa demanded.

"Simple," Mr. Freeborn said.

"Like the judge said, the clinic decided to be magnanimous and not press charges. The ADA went along with it. Of course we'll have to negotiate the 'reasonable' compensation."

"But other than that, it's over?" Marissa asked. It seemed like the first good news she'd gotten in months.

"That's right," Mr. Freeborn said.

"What kind of compensation do you think it might involve?"

Robert asked.

"Not a clue," Mr. Freeborn said.

Wendy put her arms around Marissa and gave her a big hug.

Marissa patted her back.

"I'll call you," Marissa whispered in her ear. Even with the charges dropped, Marissa knew Wendy would still be depressed.

Wendy nodded, then left with Gustave and their lawyer.

Robert conferred with Mr. Freeborn for a few more minutes.

Then the two shook hands and Robert escorted Marissa to their car.

"You girls were mighty lucky," Robert told Marissa. as they pulled into traffic on the Monsignor O'Brien Highway.

"George had never heard of such a thing. I have to hand it to the clinic, that was pretty big of them, asking for the charges to be dropped."

"It's all a clever cover-up," Marissa said.

Robert looked at her as if he'd not heard.

"What?"

"You heard me," Marissa said.

"It was a clever trick to keep the public from finding out what kinds of beasts they employ for guards. It was also a good way to get us to drop our inquiries into this TB issue and maybe Rebecca Ziegler's death."

"Oh, Marissa!" Robert moaned.

"The judge doesn't know any of the other details," Marissa said.

"He doesn't have any idea of the dimensions of this case."

Robert beat the steering wheel with his fist.

"I don't know if I can take this anymore."

"Stop the car!" Marissa said.

"What?"

"I want you to pull over."

"Are you getting sick?" Robert asked.

"Just do it."

Robert glanced over his shoulder and pulled into the roundabout in front of the Science Museum.

Marissa opened her door, got out, and slammed the door behind her. She started walking. Confused, Robert lowered his window and called after her.

"What the hell is going on?" he demanded.

"I'm walking," Marissa said.

"I need to be by myself. You're driving me crazy."

"I'm driving you crazy?" Robert called after her in disbelief.

For a moment he was indecisive. Then he muttered, "Jesus Christ!" Rolling up his window, he drove off without looking back.

With her hands shoved deep into her raincoat pockets, Marissa walked along the Esplanade that bordered the Charles River. It was another overcast day. The color of the river was gunmetal gray. Puddles dotted the walkway.

Marissa walked as far as the Arthur Fiedler-shell, then crossed over to Arlington Street. At the corner of Arlington and Boylston she took the T out Huntington Avenue to her pediatric clinic.

Marissa entered the building through a back door. She wasn't interested in talking to anyone. With effort she climbed the fire stairs, then snaked through several exam rooms, making her way to her office. Closing her door, she didn't bother to turn on her light. She was confident no one knew she was there, and as depressed as she was, she wanted to keep it that way.

She didn't bother to check her messages for fear the results from her pregnancy test had already been called in. Instead, she sat and brooded at her desk. Never had she felt- so isolated and alone. Except for Wendy, she couldn't think of anyone to talk with.

After an hour, she began to entertain the idea of seeing some walk-in patients to take her mind off things, but then she quickly realized she was still too distraught to concentrate All she could think about was the Women's Clinic.

When the telephone rang, she lifted the receiver off the hook before the first ring had completed. It had startled her.

"Hello?" she said.

"Dr. Blumenthal?" a woman's voice asked.

"Yes," Marissa said.

"This is the lab over at the Memorial," the woman said.

"We have your beta human chorionic gonadotropin level. It was only two mg/ml. We can do another in twenty-four or thirty-six hours if you'd like, but it doesn't look good."

"Thank you," Marissa said, her voice completely flat. She wrote down the value, then hung up the phone. It was exactly as she feared: a result just like Wendy's. She wasn't pregnant!

For a moment Marissa merely stared at the figure she had written on her scratch pad. Then her vision blurred with tears of grief. She was so tired of it all. She began to think of Rebecca Ziegler again and the troubles that drove the poor woman to suicide-if it was suicide.

Suddenly the phone rang again. Marissa grabbed the receiver with the ridiculous hope that it was the lab at the Memorial calling to say they had made a mistake. Could she be pregnant after all?

"Hello?" Marissa said.

"The operator told me you were in," the receptionist explained.

"You have a visitor down here in the main reception.

Should I..

"I can't see anyone," Marissa said. She hung up the phone.

Almost immediately it rang again. This time she ignored it. After nine rings, it stopped.

A few minutes later there was a knock on her door. Marissa didn't move. There was a second knock, but she continued to ignore it, hoping whoever it was would go away. Instead, she saw the knob turn. Marissa faced the opening door, ready to snap at whoever dared disturb her. But when she saw Dr. Frederick Houser's portly figure at the threshold, she softened.

"Is there something wrong, Marissa?" Dr. Houser said. He was holding his wire-rimmed glasses in his hand.

"A few personal problems," Marissa said.

"I'll be all right.

Thank you for your concern."

Undeterred, Dr. Houser stepped into the room. Marissa could see that someone was with him. With some surprise, she immediately recognized Cyrill Dubchek.

"I hope I'm not intruding," Cyrill said.

Flustered, Marissa stood up, straightening her hair.

"Dr. Dubchek told me you and he worked together at the CDC," Dr. Houser said.

"When the receptionist called me to say that you weren't seeing visitors, I thought it was time for me to intervene. I hope I've done the right thing."

"Oh, of course!" Marissa said.

"I had no idea it was Dr.

Dubchek. Cyrill, I'm so sorry. Come in, sit down." Marissa gestured toward an empty chair. She hadn't seen Cyrill for several years, but he'd not changed one iota. As usual he was impeccably dressed and was still as handsome as ever.

Thinking of her own appearance, Marissa became acutely selfconscious.

She knew she looked as terrible as she felt, especially with all her recent bouts of tears.

"I think I'll let you two have some privacy," Dr. Houser said tactfully. With that, he quickly left and closed the door.

"He told me you've been having quite a time with this infertility treatment," Cyrill told her.

"It has been a strain," Marissa admitted. She collapsed into her desk chair.

"Only moments ago I learned that the last embryo transfer was not successful. So I'm afraid I've been cryingagain.

I've been doing more than my share of crying over the last few months."

"I'm so sorry," Cyrill said.

"I wish there was some way I could help. But you look fine."

"Please!" Marissa said.

"Don't look at me. I can't bear to imagine what I look like."

"It's a bit hard to have a conversation without looking at you," Cyrill said with a sympathetic smile.

"Although it is true you look as if you've been crying, you still look as pretty as ever to me."

"Let's change the subject," Marissa said.

"Then I'll tell you why I stopped by," Cyrill said.

"I had to fly up here on other business, but early this morning one of the people over in bacteriology came to my office with the news that there has been one other concentrated area of TB salpingitis cases like the ones you are interested in."

"Oh?"

"The location surprised me," Cyrill said.

"Would you care to guess?"

"I don't think I have the mental strength," Marissa: said.

"Brisbane," Cyrill said.

"Australia?"

"Yup, Brisbane, Australia. It's part of what they call over there the Gold Coast."

"I'm not even sure where on the Australian continent Brisbane is," Marissa confessed.

"It's in Queensland, on the east coast," Cyrill said.

"I've been there once. Charming city. Great climate. Lots of new high-rises along the beach south of the city. It's an attractive area."

"Anybody have any thoughts as to why there would be a concentration there?" Marissa asked. As far as she was concerned it might have been Timbuktu.

"Not really," Cyrill admitted.

"There has been some increase in TB in general, especially in those countries allowing significant immigration from Southeast Asia. Whether the Brisbane area has gotten more than its share of boat people, I haven't the foggiest. There has been some increase — in TB here in the U.S. above and beyond what could be expected with immigration from endemic areas, but I believe that's secondary to drugs and AIDS rather than any change in the pathogenicity of the bacteria.

At any rate, here's a paper on the cases in Australia."

Cyrill handed Marissa a reprint of an article that appeared in the Australian Journal of Infectious Diseases.

"Apparently the author is a pathologist who found twenty-three cases similar to those you've described. It's quite a good paper.), Marissa began to flip through the article. It was hard for her to get excited. Australia was halfway around the world.

"The fellow from bacteriology told me something else," Cyrill continued.

"He said that there was a case of disseminated TB at the Memorial. I mention it only because the patient is a twenty nine-year-old woman from a well-to-do Boston family. Her name is Evelyn Welles. The demographics of the case jumped out at me, I thought it might interest you as well. So there you have it."

"Thank you, Cyrill," Marissa said. She tried to smile. She was afraid she was about to start crying again. Seeing an old friend was reanimating her fragile emotions.

Cyrill stayed for another fifteen minutes before he insisted he had to leave. He had to be back in Atlanta that evening.

After Cyrill had departed, Marissa's depression returned. She sat at her desk for a long time without doing much of anything.

At least she didn't cry. She just stared out the window at the deteriorating day. But eventually she began to think of the, information

Cyrill had brought her. She glanced down at the journal article. She'd read it later. Meanwhile there were things she had to do. Picking herself up, she pulled her coat back on and forced herself to drive to the Memorial.

The patient, Evelyn Welles, was in isolation in intensive care, with a chart that reflected the difficulties of her case; it weighed five pounds. Marissa had little difficulty finding her. Nor did she have trouble finding the resident attending to her care. He was a slight fellow from New York City with intense eyes and nervous twitches. His name was Ben Goldman.

"She's in bad shape," Ben admitted upon Marissa's inquiry.

"Really bad. Moribund. I don't expect her to last much more than another day. We've got her on maximum chemo but it doesn't seem to be doing anything."

"It's definitely TBT' Marissa asked as she peered through the glass of the woman's intensive-care cubicle. She'd been intubated and was on assisted respiration. A fully gowned and masked nurse was in the cubicle giving moment-to-moment care. Multiple

IV lines snaked down from clusters of bottles above her head.

"No question," Ben said.

"We've gotten acid-fast bacilli from everyplace we've tried: stomach washings, blood, evena bronchial biopsy. It's TB all right."

"Any idea of the epidemiology of the case?" Marissa asked.

"Oh, yeah," Ben said.

"Some interesting facts have turned up.

Apparently she visited Thailand about a year ago and stayed there for several weeks. That might be a factor. But more important, we've picked up a heretofore unrecognized immunodeficiency condition. The blood boys are working on it. So far it's thought to be secondary to an undefined collagen disease. A combination of the travel and her depressed immune response could be the explanation."

"Have you been able to talk to her at all?" Marissa asked.

"Nope," Ben said.

"She was comatose when she was brought in. Probably got some brain abscesses. We haven't felt it worth the risk to take her to the NMR or the CAT scan."

Marissa absently flipped through the thick chart. Despite these reasonable explanations of the patient's condition, she had a feeling that Evelyn Welles' TB could be related to the TB salpingitis cases. As Dubchek had suggested, maybe it was her age and social status.

Has much of a GYN history been obtained?" Marissa asked.

"Not much," Ben admitted.

"In view of her overwhelming infection, parts of the work-up have been left superficial. What we got on systems review, we got from the husband."

"Do you know if she's ever been seen at the Women's Clinic in Cambridge?" Marissa asked.

"Sure don't," Ben said.

"But I'll be happy to ask the husband when he returns. He comes in every night around ten."

If she has been seen at the clinic, it would be great if you could ask the husband to get a copy of her record," Marissa said.

"And one other thing. Could you manage to do a smear of her vaginal secretions to see if there are any TB organisms there as well?"

"Sure," Ben said with a shrug of his narrow shoulders.

Marissa paid the taxi driver while sitting in the backseat, shoving the money through the Plexiglas divider. It was dark and raining harder now than it had been earlier so that when she emerged from the cab, she ran in an effort to keep from getting soaked.

Inside her house she took off her damp coat and hung it in the laundry room. Avoiding the kitchen, she went directly to her study. Although she hadn't eaten all day, she wasn't the least bit hungry. And though she was exhausted, she wasn't about to sleep. The visit to the hospital and the plight of Evelyn Welles had renewed her terror as much as it had reawakened her curiosity.

"It's almost nine," Robert said, surprising Marissa by his presence.

She had not heard him. He was standing in the doorway, comfortably dressed, arms crossed. His tone and expression reflected his usual irritation of late, "I'm perfectly aware of the time," Marissa said as she sat down and turned on her reading lamp.

"You could have called," Robert said.

"The last I saw of you was when you jumped out of the car in front of the Science Museum. I was about to call the police."

"Your concern is touching," Marissa said. She knew she was being confrontational, but she couldn't help it.

"In case you are interested, I'm not pregnant."

"I guess I didn't expect you'd be," Robert said, his voice softening. He shrugged his shoulders.

"Well, no one can fault us L31 for not trying. Unfortunately it's another ten thousand dollars down the drain."

"Give me strength!" Marissa whispered to herself "Are you hungry?" Robert asked.

"I'm famished. What about going out for some dinner Maybe it will do us some good. After all, we should celebrate your legal victory. I know it doesn't make up for your not being pregnant, but at least it's something."

"Why don't you go by yourself," Marissa said. She was in no mood to celebrate. Besides, she was certain her "legal victory," as he put it, was nothing but a clever cover-up. She also wanted to lash back at his reference to the ten thousand dollars. But she didn't have the strength to quarrel.

"Suit yourself," Robert said. He disappeared from the doorway.

Marissa got up and closed the door to her study. A few minutes later she heard the muted sounds of Robert in the kitchen making himself something to eat.

Marissa had half a mind to go after him. Maybe she should try to communicate with him. Then she shook her head. She knew she could never make him understand, let alone share in her concern for the incidence of TB salpingitis. With a sigh, Marissa sat down on the love seat and began reading the article that Cyrill had given her. He was right; it was a good article.

The twenty-three cases of TB salpingitis had been seen at a Brisbane clinic that sounded similar to the Women's Clinic. The name of the clinic was Female Care Australia, FCA for short.

Similar to the five cases Marissa knew in Boston, all the patients in the Australian series were in their twenties and early thirties.

They were middle class and married. All except one was Caucasian.

The exception was a Chinese woman of thirty-one who'd recently emigrated from Hong Kong.

The ring of the phone startled her, but she kept reading, deciding it was probably for Robert anyway.

Reading on in the article, Marissa noted that the diagnosis had been made by the histology of fallopian tube biopsy alone since no organisms had been seen or cultured. Chest X-rays and blood work had ruled out fungi and sarcoid.

In the discussion portion of the paper the author hypothesized that the problem was arising from the influx of immigrants from Southeast Asia, but he didn't elaborate on any possible mechanism.

"Marissa!" Robert shouted.

"The phone is for you! Cyrill Dubchek!"

Marissa grabbed the phone.

"Sorry to bother you so late," Cyrill said, "But when I returned to the CDC I got some additional information you might find interesting."

"Oh?" Marissa said.

"These TB salpingitis cases aren't confined to the U.S. or Australia," Cyrill said.

"They have been showing up in Western Europe as well, with the same wide distribution pattern. There have been no clusters like the one in Brisbane. Apparently there have been no reported cases as yet in South America or in Africa.

I don't know what to make of this, but there you have it. If I hear any more, I'll call ASAP. But now you've got my interest. Let me know if you begin to develop any theories."

Marissa thanked him again for calling and they said their goodbyes. This new bit of information was extremely significant.

It meant that the incidence of TB salpingitis could no longer be dismissed as a statistical fluke. It was occurring on an international scale. Even Cyrill's curiosity was now piqued. For the moment Marissa forgot her grief, anger, and exhaustion.

Marissa considered the possibilities. Could TB have somehow mutated to become a venereal disease? Could it have become a silent infection in the male like some cases of chlarnydia or mycoplasma?

Should she insist that Robert be checked? Could Robert have picked it up somehow on one of his many business trips?

Marissa didn't like this line of thinking, but she had to remain scientific.

Reaching for the telephone, Marissa called Wendy. Gustave answered.

"Unfortunately she's not taking calls," Gustave said.

"I understand," Marissa said.

"Whenever it is appropriate, tell her I've called and ask her to call me back as soon as she feels up to it."

"I'm worried about her," Gustave confided.

"I've never seen her this depressed. I don't know what to do."

"Do you think she would see me if I came over?" Marissa asked.

"I think there is a chance," Gustave said. His tone was encouraging.

"I'll be right over," Marissa said.

"Thanks, I really appreciate it. I know Wendy will too."

Marissa got her coat from the laundry room and went out to her car in the garage. As she was about to get in, Robert appeared.

"Where do you think you are going at this hour?" he demanded.

"Wendy's," Marissa said, pushing the automatic garage-door opener.

"At least her husband is concerned about her."

"What's that supposed to mean?" Robert demanded.

"If you don't know," Marissa said, getting into her car, "I doubt if anybody could tell you."

Marissa backed out of the garage and lowered the door. She shook her head in dismay at how far her relationship with Robert had fallen.

It only took fifteen minutes to drive to Wendy's Victorian house. Gustave had clearly been waiting for her. He opened the door before she had a chance to ring the bell.

"I'm truly grateful for your coming out at this hour," Gustave said. He took her coat.

"Glad to," Marissa said.

"Where's Wendy?"

"She's upstairs in the bedroom. Top of the stairs, second door on the right. Can I get you anything? Coffee, tea?"

Marissa shook her head and climbed the stairs.

At the bedroom door, Marissa paused to listen. There were no sounds coming from within. She knocked lightly. When there was no answer, she called out Wendy's name.

The door opened almost immediately.

"Marissa!" Wendy said with true surprise.

"What are you doing here?" She was dressed in a white terrycloth robe and bedroom slippers. Her eyes were still sunken and red, but otherwise she appeared better than she had in the courthouse that morning.

"Gustave said you weren't taking any calls. He also said that he was worried about you. Really worried. He encouraged me to come over."

"Oh, for goodness' sake," Wendy said.

"I'm not that bad off.

Sure I'm depressed, but part of it is I'm mad at him. He wants me to be thankful for what he calls the Women's Clinic's magnanimity."

"Robert feels the same way," Marissa said.

"I think it was a cover-up maneuver," Wendy said.

"I agree!"

"What about your pregnancy test?" Wendy asked.

"Don't ask," Marissa said. She shook her head.

"How about something to drink?" Wendy difered.

"Coffee or tea? Or hell, since we're not pregnant, how about a glass of wine?"

"That sounds wonderful," Marissa admitted.

The two women descended to the kitchen. Gustave appeared but Wendy sent him away.

"He was really concerned," Marissa said.

"Oh, let him suffer a bit," Wendy said.

"This afternoon I was mad enough to have a go at him with one of those foot-long egg-retrieval needles. It would be good for him to get an idea of what I've been going through these last months."

Wendy opened a bottle of expensive Chardonnay and led Marissa into the parlor.

"I wasn't sure you'd be up for this," Marissa said once they were settled, "but I brought over a journal article for you to read."

"Just what I was hoping for," Wendy said with sarcasm. She put her wineglass down on the coffee table, then took the reprint from Marissa. She glanced at the abstract.

While Wendy scanned the article, Marissa told her everything Dubchek had related.

"This is incredible," Wendy admitted as she looked up from the paper.

"Brisbane, Australia! Do you know one of the things that makes Brisbane so interestine."

Marissa shook her head.

"It's the main gateway to one of the greatest natural wonders of the world."

"Which is?"

"The Great Barrier Reef! A diver's paradise."

"No kidding?" Marissa said. Then she admitted, "It's not something I know much about."

"Well, it is one place in the world I've always wanted to visit," Wendy said.

"Diving has been one of my passions. I started in California during my residency. I used to take all my vacations in Hawaii in order to dive. In fact, it's how I met Gustave. Have you ever done any diving, Marissa?"

"A little. I took a scuba course in college and I've gone a few times to the Caribbean."

"I love it," Wendy said.

"Unfortunately I haven't done it for some time."

"What do you think of the paper?" Marissa asked, bringing the conversation back to the issue at hand.

Wendy looked down at it.

"It's a good article. But it doesn't say anything about transmission. The author mentions the possibility of an increase in TB due to immigration, but how is it communicated, especially to such a defined population?"

"That was my question as well," Marissa said.

"And how does it get into the fallopian tubes? It certainly doesn't sound like blood or lymphatic spread, which is the usual way TB gets around. I wonder if it's venereal."

"What about contaminated tampons?"

"That's an idea," Marissa said, recalling that tampons turned out to be the basis of the toxic shock syndrome.

"I certainly use tampons exclusively."

"Me too," Wendy said.

"Trouble is, there's no mention of tampon use in the article."

"I have an idea," Marissa said.

"Why don't we call Brisbane and talk to the author of the paper. We can quiz him about tampon use. It would also be interesting to know if there's been any follow-up on the twenty-three cases and if there are any new ones at the Female Care Australia Clinic. After all, this paper was written almost two years ago."

"What's the time difference between here and Australia?"

Wendy asked.

"You're asking the wrong person."

Wendy picked up the phone. Calling an overseas operator, she asked about the time. Then she hung up.

"They're fourteen hours ahead," she said.

"So that makes it..

"About noon tomorrow," Wendy said.

"Let's try."

They got the number of Female Care Australia in Brisbane from overseas information and placed the call.

Wendy put the phone on its speaker mode. They could hear the phone ring, then someone at the other end picked up. A cheerful voice with a crisp Australian accent came over the line.

"This is Dr. Wilson calling from Boston in the U.S.," Wendy said.

"I'd like to speak with Dr. Tristan Williams."

"I don't believe we have a Tristan Williams here," said the operator.

"Just a moment, please."

Music came out of the speaker while they were put on hold.

The clinic's operator came back.

"They tell me that there was a Dr. Williams at the clinic but I'm afraid he is no longer here."

"Would you tell us where we can reach him?" Wendy asked.

"I'm afraid I have no idea," the operator said.

"Do you have a personnel office?" Wendy asked.

"Indeed we do," the operator said.

"Shall I connect you?"

"Please," Wendy said.

"Personnel here," a man's voice said.

Wendy repeated her request to get in touch with Tristan Williams.

Again they were put on hold, this time for a longer period.

"Sorry," the man apologized when he came back on the line.

"I've just learned that Dr. Williams' whereabouts are unknown.

He was dismissed from the staff about two years ago."

"I see," Wendy said.

"Could you transfer me to pathology?"

"Surely," the man said.

It took a full ten minutes to get one of the pathologists on the line. Wendy said her name and what she wanted.

"I've never met the man," the pathologist said.

"He left before I arrived."

"He wrote a paper while at the clinic," Wendy explained.

"It concerned a series of patients at your clinic. We are interested in knowing if there has been any follow-up on any of the cases.

We'd also like to know if there have been any additional cases."

"We've had no new cases," the doctor said.

"As for follow-up, there hasn't been any."

"Would it be possible to get some of the names of the original cases?" Wendy asked.

"I'd like to contact them directly to discuss their medical histories. We have five similar cases here in Boston."

"That would be completely out of the question," the doctor said.

"We have strict confidentiality rules. I'm sorry." The next thing they heard was a click.

"He hung up!" Wendy said indignantly.

"The nerve!"

"The old confidentiality obstacle," Marissa said, shaking her head in frustration.

"What a pity! Twenty-three cases is probably enough to draw some reasonable inferences."

"What about talking in greater detail with the two women we found at the Resolve meeting?" Wendy asked.

"I suppose," Marissa said, losing some of her enthusiasm. It seemed impossible to get information.

"What I'd like to do more is get at those eighteen cases the computer suggested there were at the Women's Clinic."

"Obviously that's out of the question," Wendy said.

"But I wonder how these people at the Female Care Australia would treat us if we showed up on their doorstep?"

"Oh, sure!" Marissa said.

"Why don't we wander over there in the morning and ask?"

"It doesn't sound so preposterous to me," Wendy said, her eyes alight.

"I'm curious as to what they would do if we visited the clinic. I think they'd be flattered that we'd come halfway around the world to see their facility."

"Are you serious?" Marissa asked in disbelief.

"Why not?" Wendy said.

"The more I think about the idea, the better it sounds. God knows we both could use a vacation. We'd have a better shot at tracking down this Tristan Williams. Someone in the clinic's pathology department is bound to know where he went. You have to admit, it would be a lot easier than trying to do it by telephone."

"Wendy," Marissa said with a tired voice, "I'm not up to traveling eighteen zillion miles to look for a pathologist."

"But it will be fun for us." Her eyes seemed to brighten.

"If nothing else, we could fit in a visit to the Great Barrier Reef."

"Oh, now I'm beginning to understand your motive. Visiting the FCA clinic is the excuse for a diving expedition."

"No law against having a little fun when the work is done," Wendy said with a smile.

"You look as bad as I do."

"Thanks, good friend," Marissa said wryly.

"I'm serious," Wendy said.

"The two of us have had PMS for six months. We've been crying like babies. We've both put on weight. When was the last time you did any joggine. I remember you used to jog every day."

"You're really hitting below the belt."

"The point is we both could use a vacation," Wendy said.

"And we're both fascinated by this string of TB salpingitis cases but we're stymied here. The way I see it, we're killing two birds with one stone."

"We might hear about some cases from the Memorial and the General," Marissa said.

"We haven't exhausted our possibilities here."

"Are you going to tell me you couldn't use a vacation?" Wendy insisted.

"A little time away does have some appeal," Marissa admitted.

"Thank you for your admission," Wendy said.

"You can be pretty stubborn."

"But I don't know how Robert will take it. We've been having enough trouble lately. I can just imagine his response if I suggest I want to go to Australia alone."

"I'm sure Gustave will go for the idea," Wendy said.

"I know he could use the break."

"You mean our husbands would go too?" Marissa asked, puzzled.

"Hell, no," Wendy said.

"Gustave needs a break from me! t Let's see if I'm right."

Wendy shocked Marissa by shouting for Gustave. Her voice echoed through the high-ceilinged house.

"I usually can't get away with this kind of behavior," she admitted to Marissa. She took another drink from her wineglass.

Gustave came at a run.

"Something the matter?" he asked nervously.

"Everything is fine, dear," Wendy said.

"Marissa. and I were thinking it might be good for the two of us to take a little holiday.

What do you think of that?"

"I think it's a great idea," Gustave said. He clearly seemed relieved at the change in Wendy's mood.

"Marissa's afraid Robert might not be so agreeable," Wendy said.

"What's your opinion?"

"Obviously I don't know him well," Gustave said.

"But I do know he is fed up with the in-vitro protocol. I think he'd like a break. Where were you girls thinking of going" "Australia," Wendy said.

Gustave visibly swallowed.

"Why not the Caribbean?" he asked.

Later, when Marissa drove home, her mind was in disarray. It had been a strange day with roller-coaster emotions and unexpected happenings. Within minutes of leaving an excited Wendy, she began to question the reasonableness of going to Australia at the present time. Although the concept of getting away had a lot of appeal, the idea of considering such a journey was a fitting end to a mad day. Besides, she wasn't sure she could manage Robert as handily as Wendy managed Gustave.

Marissa. pulled into the garage, not sure how to proceed. For a few moments she sat behind the steering wheel and tried to think. Without a specific plan, she finally got out of the car and entered the house. She took off her coat and hung it in the hall closet.

The house was still. Robert was up in his study; she could just barely hear the click of his computer keys as he typed. She paused again in the darkness of the dining room.

"This is ridiculous!" Marissa said finally. She'd never had so much trouble making up her mind. With a new but fragile sense of resolve, she mounted the stairs and walked into Robert's study.

"Robert, I'd like to talk to you about something."

Robert turned to face her.

"Wendy and I have been thinking," she continued.

"Oh?"

"It may sound a little crazy..

"These days, I'd expect as much."

"We thought that perhaps it would do us good to get away for a short time," Marissa said.

"Like a vacation."

"I can't take time off now," Robert said.

"No, not you and I," Marissa said, "Wendy and I. Just us girls."

Robert thought for a moment. The idea had some merit. It would give him and Marissa time to cool down.

"That doesn't sound so crazy. Where were you thinking of going?"

"Australia," Marissa said. She winced as the word came out of her mouth.

"Australia!" Robert exclaimed. He snatched off his reading glasses and tossed them on top of his correspondence.

"Australia!" he repeated as if he'd not heard correctly.

"There is an explanation," Marissa said.

"We didn't just pull Australia out of a hat. I found out today that the only concentration of cases of TB of the fallopian tubes like Wendy and I have is in Brisbane, Australia. So we could do a little research as well as have some fun. It was Wendy's idea. She's a diving enthusiast and the Great Barlier Reef-" "You were right!" Robert said, interrupting her.

"This sounds very crazy. This is the most ridiculous thing I've ever heard. Your practice is in a shambles and you want to fly halfway around the world to continue a crusade that came close to landing you in jail.

I thought you meant a little vacation, like a weekend in Bermuda.

Something reasonable."

"You don't have to overreact," Marissa said.

"I thought we could talk about this."

"How can I not overreact?" Robert demanded.

"It's not that unreasonable," Marissa said.

"I also learned today that this odd form of TB has been showing up on an international scale. Not only in Australia, but in Europe as well.

Someone should be looking into it."

"And you are that someone?" Robert asked.

"In your state, you think you are appropriate?"

"I think I am very qualified."

"Well, I think you're wrong," Robert said.

"There's no way you could be objective. You're one of the cases yourself. And if you care about my opinion, I think your going to Australia is preposterous. That's all I have to say."

Robert reached for his reading glasses and slipped them on.

Looking away from Marissa, he turned his attention back to his computer screen.

Seeing that he really didn't intend to discuss it any further, Marissa turned and walked out the door.

The problem with going to Australia was that for the most part Marissa thought Robert was right. It seemed an extravagant idea, in time as well as expense, not that finances were her top consideration. Still, she couldn't shake the feeling: it seemed unreasonable to suddenly fly halfway around the world.

Reaching for the phone, she called Wendy. Wendy answered on the first ring, as if she were waiting by the phone.

"Well?" Wendy asked.

"It doesn't look good," Marissa said.

"Robert is very much against the idea, at least of going to Australia. He likes the vacation part."

"Damn!" Wendy said.

"I'm disappointed. I was practically packing my bag. I could just feel that hot Australian sumner sun."

"Another time," Marissa said.

"Sorry to be such a drag."

"Sleep on it," Wendy said.

"Maybe tomorrow you and Robert will feel differently. I'm sure we'd have a ball."

Marissa hung up the phone. Suddenly sleep sounded good to her. She climbed the stairs, wishing that Robert would surprise her and join her for a change.

Marissa opened her eyes and immediately knew she'd overslept.

The light in the bedroom was brighter than it should have been. Rolling to the side, she glanced at the clock. She was right, it was almost eight-thirty, an hour later than usual. She wasn't surprised. Having awakened at four A.M. and unable to fall back asleep, she'd taken a piece of one of Robert's Valiums.

Pulling on her robe, she went down to the guest room and peered inside. The bed was empty and unmade. Going to the top of the stairs, she called down for Robert. If he was there, he didn't reply.

Descending the stairs, Marissa made a quick tour of the kitchen, eventually checking the garage. Robert's car was gone.

Going back inside, she looked on the planning desk for a message.

There was none. Robert had just left for work without so much as a note. Every time she'd thought their relationship had reached its nadir, it sank a little lower.

"Thanks for nothing," Marissa said aloud as she fought back tears. Then she shook herself.

"God, I've only been awake for ten minutes and already I'm crying." She made a cup of instant coffee and carried it upstairs to drink while she got dressed.

"A note wouldn't have been asking too much," she said as she stepped into the bathroom to shower.

While she was dressing and applying her makeup, Marissa decided she had to try to get her life back to some semblance of normality. For one thing, she conceded that Robert was right: her practice was in a shambles. Maybe she should start going to work on a more regular basis. Maybe then her relationship with Robert would improve. With that idea in mind, Marissa decided to head straight for her clinic.

Checking herself in the full-length hall mirror before going to her car, Marissa muttered, "I'll even start exercising again. It would be great to get back to my old weight."

With a new sense of resolve, Marissa strode down the main corridor on her floor and turned into her office. In contrast to the other waiting rooms, hers was empty. She found Mindy Valdanus at the reception desk, opening the mail.

"Dr. Blumenthal!" Mindy exclaimed.

"Don't act so surprised," Marissa said.

"Bring the scheduling book in. We have some planning to do."

"You just had a call from the intensive care unit at the Memorial,"

Wendy said. She handed Marissa a phone message slip.

"Dr. Ben Goldman asked you to return his call."

There was a stab in Marissa's heart. Her first thought was that Evelyn Welles had died.

"Hold up on the scheduling book," Marissa said. She opened the door to her office and went inside.

After hanging up her coat, Marissa rang Dr. Goldman. One of the intensive care unit nurses answered and put her on hold while she went to get the man. Marissa played with a paper clip while she waited.

A minute later, Dr. Goldman came on the line.

"I called about Evelyn Welles," he said, wasting no time.

"How is she doing?" Marissa asked, afraid to hear the answer.

"Clinically, not much change," Dr. Goldman said.

"But we did some smears of her vaginal secretions like you suggested, and they were loaded with acid-fast bacilli. I mean, loaded with TB.

My chief was impressed, but I didn't take credit for it. I have to admit I was tempted. How did you guess they'd be there?"

"It would take me an hour to explain," Marissa said.

"What about the Women's Clinic? Did you remember to ask the husband?"

"Sure did," Dr. Goldman said.

"The answer was yes. She'd been a patient there for several years."

"What about the record?" Marissa asked.

"That I don't know," Dr. Goldman admitted.

"But I asked the husband to try to get us a copy. I'll let you know if anything turns UP."

"The record could be key," Marissa said.

"I'd be very interested to have a look at it. Please call me back if you get it."

"Sure will," Dr. Goldman said.

"And thanks for the tip about looking for TB in the vagina. I've got a GYN consult coming in sometime today."

It was getting to the point where Marissa wasn't surprised to see her suspicions borne out. It was almost gratifying to have the pieces of the puzzle begin to fall so neatly into place. If Goldman didn't come through with that record, she resolved to contact Evelyn Welles' husband herself.

There was a knock on her door, then her secretary appeared.

She had Marissa's scheduling book in hand.

"Do you want to go over the scheduling book now?" she asked.

"No, not now," Marissa said.

"I've had a slight change of plans. I've got to go out for a little while. We'll do it as soon as I come back."

Marissa got her coat. She'd made a snap decision. The salpingitis problem was too important to ignore. She had to follow up on it. Robert had to understand. What she needed to do was have a real talk with him. No more of these halfhearted attempts. She decided to go to his office. Now that they'd both had a good night's sleep, maybe they would be in better shape to discuss their problems.

Getting into her car, and pulling out of the clinic's garage, Marissa already felt better than she had for months. She was doing something she should have done long ago. She had to explain to Robert what her feelings were and listen to his. They had to stop the downward spiral.

Parking was at a premium in downtown Boston. Marissa left her car with the doorman at the Omni Parker House Hotel, slipping him a five-dollar bill. When his expression didn't change, she gave him another five. She wasn't in a position to bargain.

Crossing School Street, she entered the elegant, refurbished old City Hall building that housed Robert's office. She took the elevator to the fourth floor, making her way to a door with HEALTH RESOURCE CORPORATION etched on the glass. Taking a deep breath, she opened the door and walked in.

The reception area of the office was handsomely decorated with rich mahogany paneled walls, leather seating, and Oriental rugs. The main receptionist recognized Marissa and smiled. She was on the phone.

Marissa passed the receptionist's desk. Familiar with the office, she walked straight back to Robert's corner office. His secretary, Donna, wasn't at her desk but the steaming cup of coffee in the middle of the blotter indicated she couldn't be far away.

Marissa went to Robert's door. She glanced back at Donna's telephone to see if any of the extension lines were lit. She didn't want to interrupt Robert if he was in the middle of a call. Seeing that no one was on the phone, Marissa knocked softly and entered.

Marissa was first aware of a flurry of activity with Donna straightening up and Robert coming half out of his chair. Robert quickly sat back down. Donna self-consciously smoothed her short skirt toward her knees and adjusted a string of pearls around her neck. Her hair, which she usually wore in a chignon, had partially come undone on the side.

Stunned, Marissa stared at her husband. His tie was loosened and the top two buttons of his shirt were undone. His sandy hair, usually so neatly combed, was mussed. On the carpet by Robert's desk, Marissa spotted two high-heeled shoes.

The scene was so trite, Marissa didn't know whether to laugh or cry.

"Maybe I should wait outside for a few minutes," she said at last.

"It'll give you two time to finish your dictation." With that, she started to back out of the office.

"Marissa!" Robert said.

"Wait! This is not what you are thinking.

Donna was merely rubbing my shoulders. Tell her, Donna!"

"Yes!" Donna said.

"I was just rubbing his shoulders. He's been so tense."

"Whatever," Marissa said with a false smile.

"I think I'll be leaving. In fact, I've just reconsidered that idea I mentioned last night. I think I'll be going to Australia for a few days after all."

"No!" Robert said.

"I forbid you to go to Australia!"

"Oh, really?" Marissa said.

With that, Marissa spun on her heels and walked out of Robert's office. She heard him call after her, insisting she come back immediately, but she ignored him. The receptionist looked up at her with a quizzical expression, having heard her boss's cry, but Marissa merely smiled and kept moving. She went directly to the elevators and punched the Down button, refusing to so much as glance back at Robert's office door.

Inside the elevator, Marissa was glad to be alone. In spite of her rage, she felt a few hot tears slide down her face.

"Bastard!" she muttered.

Crossing School Street, Marissa ducked into the Omni Parker House and used a pay phone to call the airlines. Then, after picking up her keys from the doorman, she made a loop through downtown Boston and headed out Cambridge Street. She parked in the parking lot of the Massachusetts Eye and Ear Infirmary and went into the emergency area.

After checking both eye emergency rooms, she found Wendy helping a junior resident with a procedure in one of the minor surgical rooms.

When Wendy was through, Marissa took her out by the emergency room desk.

"Are you still up for the Australian trip?" Marissa asked.

"Sure!" Wendy said.

"You look kind of tense. Everything okay?"

Marissa ignored her question.

"How soon could you leave?"

"Pretty much anytime," Wendy answered.

"When do you want to go?"

"How about today," Marissa said.

"There's a United flight that leaves at five-fifteen that can get us to Sydney with connections to Brisbane. I think we may need visas, too. I'll call the Australian consulate to check."

"Wow!" Wendy said.

"I'll see what I can do. Why the rush?"

"So I don't change my mind," Marissa said.

"I'll explain once we're on our way."