Vital Signs

19

Between the weight of her wet clothes and the shoes she held in her hands, Marissa found swimming an effort. Although she had been at it for some minutes, she hardly seemed to have moved closer to the shore. Bentley and Tse had swum ahead, but Tristan stayed alongside Marissa.

"Just stay calm, luv," Tristan said.

"Maybe you should give me your shoes."

Marissa gladly handed them over. Tristan had tied his laces together and had strung his shoes around his neck, Taking Marissa's, he jammed them into his pockets. Without the shoes, Marissa's swimming improved.

The shock of the shooting and the panicked jump into the water had totally occupied Marissa's consciousness, but as she swam and thought about the fact that she was in the ocean, she began to think about Wendy's death. In her mind's eye she started to see the hungry gray monsters cruising silently beneath the surface. Knowing that there was a bleeding body in the water made the fear that much more poignant.

"Do you think there are sharks around here?" Marissa managed to ask between strokes. She was hoping for reassurance.

"Let's worry about one problem at a time," Tristan said.

"Of course there are sharks," Bentley called back to them.

"Thanks, mate," Tristan yelled ahead.

"That's just what we wanted to hear!"

Marissa tried not to dwell on it. Yet with each stroke, she half expected to be yanked from below. If Tristan had not been next to her, she knew she would have panicked.

"Just keep your eyes on the land," Tristan advised.

"We'll be there soon enough."

It took a long time, but gradually the trees seemed closer. Up ahead, Marissa saw that Bentley had stopped swimming. He was standing waist-deep in water. From there he walked to shore.

By the time Marissa and Tristan arrived at the same depth, Bentley and Tse were already wringing out their clothes.

"Welcome to the PRC," Tristan said as he took Marissa's hand for the last twenty feet.

The beach was sickle shaped, extending about three hundred yards between rocky promontories. Behind the beach were lush, semitropical trees bordering a swampy marsh. Seabirds and marsh birds were everywhere. Their din was constant.

Facing back to sea, Marissa gazed out over the emerald expanse dotted with tiny offshore islands. It was a peaceful, picture postcard view. Sea gulls lazily circled above. There wasn't a trace of the junk, the cigarette boat, or the patrol boat.

The group relaxed on the beach, soaking up the warm sun after having been so chilled by the cold water. Tristan took their passports out of his money belt and opened them to the sun to dry. He did the same with his Hong Kong currency, weighing down the bills with seashells.

"I don't believe the captain could kill the monk like that," Marissa said with a shudder.

"He didn't hesitate for a second."

"Life is cheap in this part of the world," Tristan said.

"I wonder if I'll ever recover from all this," she said.

"First Wendy's death, then Robert's, now this shooting. And all for nothing!"

Tristan reached out and gripped her hand.

"No one can ever say we didn't try," he said.

After the group had been resting for a half hour, they were disturbed by a distant droning noise that rapidly escalated. Having been sensitized by their recent ordeal, everyone looked at each other in puzzled consternation. The sound not only got louder, but it developed a peculiar concussive, pulsating quality.

Finally Tristan recognized it.

"It's a helicopter," Tristan cried.

"Get under the trees!"

They had barely darted beneath the branches when a large military helicopter thundered overhead, heading directly out to sea in the direction that the patrol boat had disappeared.

Emerging from the foliage, they stared at the aircraft, which was already a mere pinprick against the pale blue sky.

"Do you think they saw us?" Marissa asked.

"Nah!" Tristan said.

"But I'm surprised they didn't see all this Hong Kong money spread out on the sand."

When everyone felt rested from the cold swim, they started across the marshlands. Assuming Tse knew where he was going, the other three fell in behind him. At first an they had to do was traverse swampy grass, but eventually they had to ford some deeper streams.

"Any crocs around this part of the world?" Tristan asked nervously when he was up to his waist, holding his partially dried money belt over his head.

"No crocodiles," Bentley said.

"But we do have snakes."

"What next?" Marissa asked sarcastically.

But they didn't see any snakes. They did encounter more than a few insects. As they approached the heavily wooded higher ground, the mosquitoes came in swarms. For Marissa, this was a new fear. She asked Tse about malaria and dengue fever.

"There is always some malaria," Tse said.

"But dengue fever 19m not familiar with."

"Never mind," Marissa said. There were just so many things she could worry about at once.

"I suppose I should look on the bright side of things. We were lucky to get off the junk. Thank God for the Communist patrol boat."

"That's the attitude," Tristan said.

"And at least we still have our watches," Marissa added.

Tristan laughed, happy to hear that in spite of all that had happened, Marissa was capable of humor.

"Did you recognize the Caucasian man in the front of the powerboat?" Marissa. asked Tristan.

"He was the other man throwing chum overboard when Wendy died."

"I'd vaguely recognized him," Tristan said.

"From back when I worked for FCA."

Reaching the edge of the marsh, they next climbed up through thick vegetation. Vines hung down from the branches of the trees. It was slow going. It took some effort just to go a hundred yards. Then the trees suddenly ended at the edge of a rice paddy.

"I recognize where we are," Tse said.

"There is a small farming village ahead. Perhaps we should go there and get some food."

"How will we get food?" Tristan asked.

"Will they take credit cards?"

We'll use your money," Tse said.

"They'll take Hong Kong dollars?" Tristan questioned.

"Absolutely," Tse said.

"There is a black market for Hong Kong dollars throughout the Guangdong Province."

"Do we have to worry about the authorities in this village?"

Tristan asked.

"No," Tse said.

"There will be no police. Only in Shigi will there be police."

Turning to Bentley, Tristan asked: "What do you see as our major problem being in the PRO. After all, we have visas."

"Only two things," Bentley said.

"You have no entry stamp and no entry documents. Everyone must have a Baggage Declaration form. That is the form you must surrender when you leave the PRC."

"But no one will hassle us while we're here?" Tristan asked.

"I thought the first walloper we came across would nab us."

Everyone looked at Tristan curiously.

"What's the matter?" he asked.

"What's a walloper?" Marissa asked.

"A policeman," Tristan said.

"Am I the only one who speaks English around here?"

Ignoring Tristan, Marissa addressed Bentley.

"So we only have to be concerned about leaving the PRC?" she asked.

"I believe so," Bentley said.

"Foreign travel has become reasonably commonplace in China, especially in Guangdong Province.

So no one should bother you. But without some help, you probably will not be able to cross back into Hong Kong or Macao. Without a Baggage Declaration and also without the usual things a tourist carries, like a camera, you'll be considered smugglers and put in jail."

"At least we'll be safe," Tristan joked.

"Since we don't have anything to worry about currently, let's go to that village and get some tucker."

"Food!" Marissa translated for the others.

Tse had been right. The villagers were eager to obtain the Hong Kong dollars. For what Tristan thought was a piddling amount, he treated all four to dry clothes and a hearty meal.

Except for the rice, Marissa and Tristan did not recognize the food.

During the meal Marissa was reminded of Wendy's comment that people in the PRC liked to stare. While they ate, it seemed as if everyone in the entire village came to gawk at the four strangers eating in the village common room.

When they had finished their meal, Tristan turned to Tse.

"Do you have any suggestions for us as to how to get out of the PRO.

Maybe you know how we could get a couple of these Baggage Declaration forms?"

"I have never seen such a form," Tse said.

"And if you do not have one, I'm afraid it will be a problem for you. Our government requires forms for everything, and our officials are of a suspicious nature. But I don't think you should go to the border. I think it would be best for you to go to Guangzhou. I know there is an American consulate. I've visited it in an effort to get medical books."

"That sounds like good advice to me," Marissa said.

Tristan nodded.

"I wonder if there is an Aussie consulate as well."

"If not, I'm sure we can talk the American consul into helping you too," Marissa said.

"How do we go about getting to Guangzhou?" Tristan asked.

"I suppose it is a long walk from here."

Tse flashed a smile.

"A very long walk," he agreed.

"But it is not such a long walk to the next town, which is larger than this village. Chiang and I stayed one night in the town, and I know they have a medical dispensary similar to the one where I work.

I imagine they have transportation to Shigi, where the district hospital is located. From there we can go to Forshan, which is a big city."

"That sounds good to me," Tristan said.

"What do you think, Marissa?"

"Sounds almost too good to be true," Marissa said.

"I like the idea of having a U.S. official deal with the Communist bureaucracy.

As Tse says, it's a much better idea than going to the border and trying our luck. With everything that has happened, I don't feel very lucky."

"What about you, Bentley?" Tristan asked.

"I think I will go back via Macao," Bentley said.

"I have a hui shen jing, which entitles me multiple visa-free entries into the PRC. I shouldn't have much trouble. Maybe a short delay; but I'll go with you as far as Forshan."

The walk from the tiny village to the next town took only about an hour. First they passed by small plots of vegetables, then through rice paddies being worked by peasants with water buffalo. Whenever any peasants spotted them, they stopped and stared until the strange group passed from view. Marissa imagined they made for a curious sight: two gwedos and all four dressed in ill fitting clothing.

Entering the town, Tse conversed briefly with a man pushing a wheelbarrow. During the entire conversation, the peasant didn't take his eyes off Marissa.

"He says the dispensary is just a little way ahead," Tse reported.

Most of the buildings in the town were either wood or brick, but the health clinic was a concrete whitewashed structure with a roof made of sunbaked tile. They entered through a low door.

Both Tristan and Bentley had to duck to get in.

The first room was a waiting room. It was filled mainly with older women, a few accompanied by young children. One middleaged man had a cast on his leg.

"Please," Tse said.

"If you would wait here I will introduce myself to the doctor."

There was no space on the crude wooden benches that circled the room's periphery, so Marissa, Tristan, and Bentley stood.

None of those waiting uttered a single word. They merely gawked at the trio as if they were extraterrestrial beings. The children were especially curious.

"Now I know how cinema stars feel," Tristan said.

Tse reappeared, escorted by a tall, gaunt Chinese man dressed in a short-sleeved Western-style shirt.

"This is Dr. Chen Chi-Li," Tse said. He then introduced ChiLi to Marissa, Tristan, and Bentley.

Chi-Li bowed. Then he smiled, revealing large, yellow teeth.

He spoke quickly in guttural Cantonese.

"He welcomes you to his clinic," Tse said.

"He thinks it is an honor to have an American and an Australian doctor visit. He asks if you would care to see his facility."

"What about the transportation?" Tristan asked.

"The clinic has a van," Tse said.

"The van will take us to Shigi.

From Shigi he said that we can take a bus to Forshan, then a train to Guangzhou."

"How much will he charge for the van?" Tristan asked.

"There will be no charge," Tse said.

"We will go with several patients being sent to the district hospital."

"Fine," Tristan said.

"Let's see the bugger's clinic."

With Chi-Li and Tse leading, the group toured the clinic. The rooms were essentially bare except for crude furniture here and there. The procedure room was especially stark, with a rusted steel table, a porcelain sink, and one ancient glass cabinet full of instruments.

Seeing that Marissa seemed interested in the instrument cabinet,

Chi-Li went over and opened the door for her.

Marissa winced when she looked into a tin of non disposable needles that had become dull from overuse. It made her realize how much she took for granted in her office and at the Boston Memorial. As her eyes wandered to the upper shelf, she saw packages of vaccines, including a cholera vaccine made in the United States. Then she noticed some vials of BCG. She remembered

Tse's having mentioned their use in tuberculosis inoculations.

Marissa was curious about BCG, particularly since it had never been proven to be effective in the United States. She reached into the cabinet and lifted one of the vials. Reading the label, she discovered it had been made in France.

"Ask Chi-Li if he sees much tuberculosis," Marissa asked as she replaced the BCG vial. She glanced at the other contents of the cabinet while Tse spoke with the man.

"He sees about the same as I," Tse reported.

Marissa closed the cabinet door.

"Ask him if he ever sees TB as a female problem," she asked. She watched Chi-Li's face as Tse translated. There was always the chance she could hit on something unexpected. But Chi-Li's expression reflected a negative response to the question. Tse translated that Chi-Li had seen nothing of the kind.

Leaving the procedure room, they walked into an examining room. A female patient was sitting on a chair in the corner. She stood and bowed as the group entered.

Marissa bowed back, sorry to have intruded. Suddenly Marissa stopped. In the center of the room was a relatively modern examining table, complete with stainless steel stirrups.

Seeing the table brought back all the unpleasant procedures she'd endured over the last year in the course of her fertility treatments. She was surprised to see such a modern piece of equipment at the clinic; nearly everything else she'd seen was quite dated and rudimentary.

Stepping over to the table, Marissa absently fingered one of the stirrups.

"How did this examining table get here?" she asked.

"The same way all the other equipment got here," Tse said.

"Most of the rural health clinics have such a table."

Marissa nodded as if she understood. But she didn't. Of all the pieces of modern equipment to be sent to rural clinics, it seemed strange for them to choose an examining table with stirrups. But having read of the bureaucratic mismanagement problems of

Communist governments, she assumed this was just another case in point.

"We use such a table frequently," Tse said.

"Birth control has been gi vena high priority by the government."

"I see," Marissa said. She was about to walk on when she looked back at the table. She was puzzled.

"What type of birth control do you favor?" she asked.

"Intrauterine devices?"

"No," Tse said.

"Diaphragms?" Marissa asked, even though she knew they couldn't use diaphragms since they were too expensive and not effective enough. Yet why a table equipped for internal exams?

"We use sterilization," Tse said.

"After one child the woman is often sterilized. Sometimes we perform sterilization even before the woman has a child if there is a request or if the woman should not have a child."

Tristan called to Marissa from the next room, but Marissa ignored him. Although she had remembered hearing that sterilization was used for birth-control in the PRC, she hated to hear a doctor speaking so coldly about it. She wondered who got to make the decision of who could bear a child and who couldn't.

The issue offended her feminist sensibilities.

"How do you sterilize these women?" she asked.

"We cannulate the fallopian tubes," Tse said matter-of-factly.

"Under anesthesia?" Marissa asked.

"No need for anesthesia," Tse said.

"How can that be?" Marissa asked. She knew that to cannulate the fallopian tubes, the cervix had to be dilated, and dilating the cervix was excruciatingly painful.

"It is easy for us rural doctors," Tse explained.

"We use a very small catheter with a wire guide. It is done by feel. We do not need to see. It is not painful for the patient."

"Marissa!" Tristan called. He had come back to the threshold of the examining room.

"Come out here and see the garden. They grow their own medicines!"

But Marissa waved Tristan away. She stared at Tse, her mind racing.

"Can Chi-Li perform this technique as well?" she asked.

"I'm sure," Tse said.

"All rural doctors are taught it."

"Once you cannulate the fallopian tube," Marissa said, "what do you use to sterilize?"

"Usually a caustic herbal solution," Tse said.

"It is like a kind of pepper."

Tristan left the doorway and approached Marissa.

"What's the matter, luv?" he asked.

"You look like you've just seen a ghost."

Without saying a word, Marissa. hurried back to the procedure room and walked up to the cabinet. She studied the shelf of vaccines.

Tristan followed her, wondering what she was thinking.

"Marissa," he said, as he reached out and grabbed her shoulders, swinging her around to face him.

"Are you okay?"

"I'm fine," Marissa said.

"Tristan, I think I just figured it all out. All of a sudden I think I understand-and if I'm right, the truth is much worse than we imagined."

The health clinic van took the four of them to Shigi and dropped them off at the Shigi bus station. Since there was frequent service to Forshan, they had only a short wait. During the trip, Marissa sat next to Tristan while Bentley sat with Tse.

"I've never seen anybody spit more than these Chinese," Tristan said to make conversation. It was true. At any given moment someone on the bus was either preparing to spit or was in the process of spitting out the window.

"What the hell is wrong with these blokes?"

"It's a national pastime," Bentley said, hearing Tristan's comment.

"You see it all over China."

"It's disgusting," Tristan said.

"It reminds me of that foolish American game of baseball."

Everyone on the bus seemed to be busy talking except Marissa and Tristan. Tristan had finally given up after Marissa persisted in meeting his every question with only one-word replies. She seemed to be deep in thought.

Suddenly she turned to him.

"Do you know the pH indicator phenol red?"

"Vaguely," Tristan said, surprised by er sudden inquiry.

"When does it turn red?" Marissa asked.

"In an acidic or an alkaline solution?"

"I think alkaline," Tristan said.

"In an acid solution it's clear."

"I thought so," Marissa said. Then she lapsed back into silence.

They rode for another mile. Finally, Tristan could no longer contain his curiosity.

"What's with you, Marissa?" he asked.

"Why won't you tell me what you're thinking?"

"I will," Marissa said.

"But not yet. We have to get out of the PRC. There are a couple of things I have to check to be sure first."

From Forshan they were able to get hard seats on a train to Guangzhou. Bentley and Tse left them at the Forshan bus station.

By the time they got to Guangzhou it was dark. They took a taxi from the train station. On the recommendation of the driver, they went to the White Swan Hotel. During the short trip both Marissa and Tristan remarked that the city looked more Western than they'd expected, although even at night the bicycles far outnumbered the motor vehicles in the streets.

The hotel turned out to be a surprise as well. The lobby was impressive, with a waterfall. The rooms had all the modern conveniences, including TVs, refrigerators and, more importantly, direct-dial telephones. They booked a suite with two bedrooms and a view over the Pearl River.

Marissa was exhausted. She eyed the bed with longing, hoping that she would at last get a good night's rest. But even before bed, what she was interested in most was the telephone. After calculating the time on the East Coast of the United States, she decided to put off her call for a few hours. She knew it wouldn't help to wake Cyrill Dubchek from his sleep.

"They have a Western-style restaurant," Tristan said with excitement, coming into Marissa's bedroom with the hotel directory in his hand.

"What do you say to a nice big steak!"

Marissa wasn't hungry, but she accompanied Tristan, who polished off a sizable slab of meat and a number of beers. Marissa ordered a chicken dish, but she hardly touched it except to move it around her plate. They talked about going to the consulate in the morning with the story that they had hired a junk to take them to Guangzhou but that the captain had taken their money and forced them to jump off the boat.

"It's the best we can do," Tristan said.

"And it's close enough 4 to the truth."

Marissa said that she would try to get some State Department intervention through the CDC.

Several hours later, Marissa made her call. Knowing Cyrill's schedule, she timed the call to catch him before he left for the lab.

Although there was some static as well as a peculiar echo, Marissa could understand him easily. Marissa told Cyrill that she was calling from Guangzhou, in the People's Republic of China.

"With other people, I might be surprised to get an unexpected call from the PRC," Cyrill said.

"But with you, Marissa, nothing surprises me."

"There's a rational explanation."

"I didn't doubt it for a moment."

Marissa quickly explained how she and a colleague had inadvertently entered the PRC without going through proper immigration.

She told him she was afraid she would have trouble getting out. She emphasized that the colleague was the Australian doctor who'd written the paper Cyrill had given her.

"You're with the author?" Cyrill said.

"I'd say that is going directly to the primary source."

"Back when I was at the CDC, you once told me that you hoped you could make it up to me for what I went through in cracking the Ebola outbreaks. Well, Cyrill, you now have your chance."

"What can I do?" he asked.

"First, I'd like you to use CDC connections to pressure the State Department to get me and Dr. Williams out of the PRC. I was told that there is a U.S. consulate here. We'll go to the consulate in the morning, about ten hours from now."

"I'll be happy to see what I can do," Cyrill said.

"But they may ask why the CDC is intervening."

"There is a very good reason," Marissa said.

"It's extremely important that I get back to the CDC immediately. It can be considered legitimate CDC business. Tell that to the State Department and let them tell it to the PRC."

"What kind of business?" Cyrill asked.

"It concerns the TB salpingitis," Marissa said.

"And that leads me to my next request. I need the CDC to get success rate statistics concerning in-vitro fertilization for all the Women's Clinics around the U.S. I want statistics about efficacy per patient as well as per cycle. And if possible, I would like data on the specific causes of infertility among the women the Women's Clinics treat with VF."

"How many months do I have?" Cyrill asked wryly.

"We need this as soon as possible," Marissa said.

"And there's more: remember that case you told me about, the young woman with the disseminated tuberculosis in Boston?"

"I do," Cyrill said.

"Find out what happened to her," Marissa said.

"If she died, which I'm afraid she must have by now, get a serum sample and her autopsy report as well as a copy of her chart. Then there is a patient by the name of Rebecca Ziegler-"

"Hold on," Cyrill complained.

"I'm trying to write this down."

Marissa paused for a moment. Once Cyrill gave her the okay, she continued: "Rebecca Ziegler supposedly committed suicide.

She was autopsied at the Memorial. Get a serum sample from her as well."

"My God, Marissa!" Cyrill said.

"What's this all about?"

"You'll know soon enough," Marissa said.

"But there'd still more. Is there an ELISA test for BCG bacillus?"

"Offhand, I don't know," Cyrill said.

"But if there isn't, we can have it made up."

"Do it!" Marissa said.

"And one last thing."

"Jesus, Marissa…" Cyrill sighed.

"We'll need an emergency U.S. visa for Dr. Tristan Williams."

"Why don't I just call President Bush and have him take care of all this?" Cyrill said.

"I'm counting on you," Marissa said.

She knew she was asking a lot of Cyrill, but she was convinced it was vitally important. After exchanging goodbyes, they each hung up.

"Did I hear that a trip to the States is in the offing?" Tristan said as he peeked through the door.

"I hope so," Marissa said.

"The sooner the better."

The following morning both Marissa and Tristan were pleasantly surprised by their reception at the U.S. Consulate. As soon as Marissa gave her name, they were shown into Consul David Krieger's office.

During the night, communications had been received from the State Department and from the U.S. ambassador in Beijing.

"I don't know who you people are," David told them, "but I'm certainly impressed by the behind-the-scenes flurry your being here has stirred up. It's not often I'm given instructions to issue an emergency U.S. visa. But I'm pleased to say I have one for Dr. Williams."

David Krieger himself accompanied Marissa and Tristan to the Public Security Bureau on Jeifong Bei Lu Street in front of Yuexiu Park. Although the police had been advised of the case, they still insisted on interrogating Marissa and Tristan, but did so in David Krieger's presence. They proceeded to check Marissa's and Tristan's story by dispatching several officers by helicopter to the two villages Marissa and Tristan claimed to have passed through.

During the interview, it was apparent to Marissa that the Chinese authorities associated their presence with the cigarette boat incident. Marissa was quick to say that it was at the appearance of the powerboat and the patrol boat that the captain of the junk had made them jump overboard.

When they returned to the consulate, David Krieger was optimistic that the problem would be resolved swiftly. He graciously invited Marissa and Tristan to have lunch with him. After lunch, the consul arranged for Marissa and Tristan to get some Westernstyle clothes. By the time they returned to the consulate, word had already arrived that Marissa and Tristan were free to leave the PRC whenever they cared to.

"If you are in a hurry," the consul said, "we can make arrangements for you to fly to Hong Kong this afternoon."

"No, not Hong Kong," Marissa said quickly.

"Are there other foreign destinations available directly from Guangzhou?" She didn't like the idea of returning to Hong Kong even if only in transit. She didn't want to risk any more run ins with the thugs from the FCA or the Wing Sin.

"There is a daily flight to Bangkok," David Krieger said.

"That would be much better," Marissa said.

"But it's out of your way if you're heading back to the States," David Krieger said.

Marissa smiled innocently.

"Regardless, I think we'd both rather spend a little more time flying than going back through Hong Kong. Do you agree, Tristan?"

"Right you are, luv," Tristan said.

"Here are all the statistics we could get on such short notice," Cyrill Dubchek said, handing computer printout pages to Marissa.

Marissa, Tristan, and Cyrill were sitting in Cyrill's office at the Centers for Disease Control in Atlanta, Georgia. Marissa and Tristan had just arrived that afternoon from their grueling flight across the Pacific, flying from Bangkok to Honolulu to L.A. to Atlanta.

Even though they were exhausted, Marissa insisted on going directly to the CDC.

Marissa studied the pages carefully. Tristan looked at Cyrill and shrugged. Tristan was still in the dark as to Marissa's suspicions.

"Just as I thought," Marissa said, raising her eyes from the computer paper.

"These statistics mirror those that I found in Australia with the FCA data. They show that the Women's Clinics around the country have a high rate of pregnancy per patient in their in-vitro fertilization program but a low success rate per cycle. In other words, most IVF patients at Women's Clinics get pregnant but it takes multiple cycles before they're met with success. Look how the success rate shoots up after the fifth lVF attempt."

Marissa pointed to the statistics spelled out on the computer printout she was holdin in her hands.

"That's not so surprising," Tristan said.

"In every clinic, most patients have to go through several attempts before they conceive.

What are you getting at?"

A knock on Cyrill's door interrupted them before Manissa could reply. It was one of the technicians from the lab.

"We have the results on those ELISA tests," she said.

"That was fast," Cyrill commented.

"They were very positive," she said.

"Evenat high dilutions."

"All of them?" Cyrill asked incredulously.

"All of them," the technician repeated.

"That's the proof I wanted," Marissa said. When she'd first arrived at the CDC, she'd gone directly to the lab to have some blood drawn. Then she'd made arrangements for her serum to be tested with the ELISA test for BCG along with Rebecca Ziegler's and Evelyn Welles' serums.

"I don't understand," Cyrill said.

"How can that be?"

"I think it is rather clear," Marissa said.

"Evelyn Welles didn't have tuberculosis. She had disseminated BCG bacillus." Marissa reached for Welles' hospital chart and opened it to her autopsy page.

"Look," she said, pointing to a description of the microscopic appearance of her fallopian tubes.

"It says there was an intense, overwhelming infection in her oviducts. I'll tell you why that was the case: the fallopian tubes were the port of entry of the BCG. The fact that it disseminated was because of her immunological problem. And look here at the description of her cervix.

It describes a recent punched-out lesion. That had to be a biopsy site." Marissa flipped through the chart until she came to the woman's last Pap smear report.

"Now look at this. The Pap smear was normal four weeks before. Does that make any sense to you men?"

"I think I'm beginning to get the picture," Tristan said.

"You're suggesting that the twenty-three cases of TB salpingitis that I reported were actually BCG, not TB."

"That's exactly what I'm suggesting," Marissa said.

"I didn't have TB salpingitis either. I had a deliberate inoculation with BCG vaccine. I think the basis of this whole mystery is nothing but business interest. A few years ago, Female Care Australia realized that they were sitting on a potential gold mine with their IVF technology. The only trouble was that their increased success was denying them income by lowering revenue. So they decided on two courses of action to ensure increased revenues.

One was to create more demand. The only absolute indication for IVF is hopelessly blocked fallopian tubes. Someone found out that the rural Chinese doctors had been clever enough to develop a way of cannula ting the fallopian tubes without the need for anesthesia. So they began bringing these doctors out of China to do just what they had been doing in China: sterilizing women.

The trick was to sterilize without leaving evidence of it, or leaving evidence that could be misinterpreted. Someone must have come up with the BCG vaccine. It causes an intense immunologic reaction that seals the tubes totally and destroys the organisms in the process. That's how BCG works. On biopsy, it looks like tuberculosis. There just aren't any organisms. Obviously, they only tried this ploy on certain candidates. They chose only young, recently married, middle-class females. All they had to do was schedule these women for a minor procedure of some sort, like a cervical biopsy. I know that one ruse was to tell the patient that her Pap smear was CIN Grade #1. That's how they got me and Wendy. Neither Wendy nor I had told the clinic we were physicians. If they had known, they probably wouldn't have risked including us in the scheme. And they certainly didn't know about Evelyn Welles'immunological problem. And Rebecca Ziegler.

She must have been clever enough to figure that something was wrong. I think they killed her and made it look like a suicide.

"The second part of the plan to maintain revenue was to make sure that the IVF wasn't successful too quickly. At ten thousand dollars per cycle, you can see why they'd want to run their patients through as many cycles as possible. Yet ultimately, they wanted all their patients to conceive. That meant a better reputation for them. My guess is that to make failed cycles a certainty, they just added a drop or two of acid to the culture media after fertilization took place. Before my last egg transfer, I asked to see the zygotes. I remember the solution was crystal clear. The significance of the color didn't dawn on me until just recently. The usual pH indicator in tissue culture media is phenol red, which turns clear in acid. My embryos were in acid. No wonder they didn't implant."

Cyril! cleared his throat. He looked at Marissa's flushed and angry face. He could tell she was convinced, but unfortunately he didn't share her conviction. He didn't know quite what to say.

"I'm not sure…" he began.

"Not sure of what?" demanded Marissa.

"Is it just too had for you men to believe that women could be victimized to this extent?"

"It's not that," Cyrill said.

"It's just that it is too complicated.

It represents too much effort, too much conspiracy. It's just too diabolical."

"It's diabolical, all right," Marissa agreed, "but let's be clear about the motivation. This is about profit, pure and simple. I'm talking about big money. Look!" Marissa stood up and went to a small blackboard that Cyrill had in his office. Picking up a piece' of chalk, she wrote down 600,000. "This is the number of couples in the U.S. that fertility specialists estimate need IVF if they want to have a child that is genetically theirs. If we multiply that by fifty thousand dollars we get thirty billion dollars. That's billion.

Not thirty million, thirty billion. And that's just in the United States. IVF could rival the world's illegal drug industry as a money-maker. Admittedly not all of the six hundred thousand are middle class, and not all could come up with the money necessary. But that is why FCA has gone to such lengths to create their own market."

"My God!" Cyrill said.

"I never imagined there was that kind of money involved."

"Most people don't," Marissa said.

"The whole infertility industry is totally unregulated and unsupervised. It's grown up in a no-man's land between medicine and business. And the government has just looked the other way. Anything to do with reproduction is politically dangerous."

"But such a conspiracy would require so many people," Tristan said.

"Not that many," Marissa said.

"Maybe just one per clinic. At this point, I'm not about to hazard any guess as to the conspiracy's actual organizational design."

"And I was so sure drugs were at the heart of it," Tristan said.

"They still might be involved, only indirectly," Marissa said.

"It will be interesting to see exactly how Fertility, Limited, came up with the staggering amount of capital they would have needed to expand as rapidly as they did across three continents. I have a suspicion that their stock offerings were only clever ruses. I wouldn't be surprised if they're tied up with the Wing Sin for ventures besides smuggling pairs of men out of the PRC. Fertility,

Limited, could launder money from the Golden Triangle heroin for the Wing Sin. At least it's a possibility."

"If this is all true," Cyrill said, "then it will take a massive effort with international cooperation to break it."

"Precisely," Marissa said.

"That's where the CDC comes in. I think that the Attorney General's office and the State Department have to be alerted simultaneously. If this conspiracy is to be broken, it will take their combined power, and I think they will listen to the CDC. I can tell you it won't be easy. Any organization that is as big and as wealthy as Fertility, Limited, and its subsidiaries will have significant political clout."

"Since it is a national problem here in the United States," Cyrill said, "the FBI will have to be involved."

"Undoubtedly," Marissa agreed.

"And thank God for it, because

I'm certain Tristan and I are going to need some protection for a time. We may even have to hide away someplace. I'm afraid that the Wing Sin has a global reach."

Cyrill got to his feet'I'm going to run upstairs," he said.

"I want to see if I can catch the director before he leaves for the day.

Would you two mind waiting here for a moment?"

After Cyrill left, Marissa faced Tristan.

"What do you think?" she asked.

"Honestly?"

"Honestly?" Tristan repeated.

"I think you're a spunky, knackered battler."

"Please, Tristan," Marissa said.

"I'm serious. Cut the Aussie babble and speak English."

"I'm being serious too," Tristan said.

"I think you're beautiful.

I think you're exhausted. And I think you are amazing. In fact, you're a little intimidating. And on top of all that, I think you are right. And I can't think of anyone I'd rather go into hiding with than you."