Vital Signs

5

Dorothy Finklestein hurried under the overhead walkway and entered the brick courtyard of the Women's Clinic. As usual, she was late. She was always late. Her appointment for her annual exam had been scheduled for eleven-fifteen.

A sudden gust of wind caught the edge of her hat and lifted the brim. She reached up just in time to prevent the hat from sailing off her head. At the same time, something above caught her eye.

A high-heeled shoe was plummeting toward her. It landed near her, falling into a planter filled with rhododendrons..

Despite her haste, Dorothy stopped as her eye traveled upward, tracing the shoe's trajectory. At the very top story of the Women's Clinic, six floors up, her gaze became transfixed by what looked like a woman sitting on a window ledge, her legs dangling over, her head tilted down as if she were studying the pavement below. Dorothy blinked, hoping her eyes were deceiving her, but the image remained: it wasn't her imagination, it was a woman on the ledge-a young woman!

Dorothy's blood ran cold as she watched as the woman seemed to inch forward, then pitch headfirst in a slow somersault. The woman fell like a life-sized doll, picking up speed as she passed each successive floor. She landed in the same planter as her shoe, hitting with a dull thump like a heavy book dropped flat on a thick rug.

Dorothy winced em pathetically as if her own body had suffered the fall. Then she screamed as the reality sank in. Pulling herself together, she ran toward the planter without any idea of what she would do. As a buyer for a large Boston department store, she had scant training in emergency first aid, although she had attended a CPR course in college.

A few passersby responded to Dorothy's scream. After recovering from their initial shock, several followed her to the planter.

Someone else ducked back into the clinic to sound an alarm.

Arriving at the edge of the planter, Dorothy stared down in horror. The woman was on her back. Her eyes were open and they stared skyward, focused on nothing. Not knowing what else to do, Dorothy bent down in the bushes and started to give mouth-to mouth resuscitation. It was apparent to her that the woman was not breathing. She blew into the woman's mouth several times, but she had to stop. Turning her head, she vomited her coffee break blueberry muffin. By then, a doctor in a crisp white jacket had arrived.

"Of course I remember you," Dr. Arthur said.

"You were the woman who was so sensitive to ketamine. How could I forget?"

"I just wanted to be sure you wouldn't use it again," Marissa said. She hadn't recognized Dr. Arthur at first since he'd not treated her since the biopsy. But after he'd started her IV, something jogged her memory.

"All we need today is a little Valium," Dr. Arthur reassured her.

"And I'm going to give you a little right now. This should make you pretty sleepy."

Marissa watched him inject the drug into the side port of her IV. Then she rolled her head straight. Now that the egg retrieval was about to begin, her attitude about the procedure had changed from fifteen minutes earlier. She was no longer ambivalent.

As the Valium hit her system, Marissa's mind calmed, but she didn't sleep. She dwelt on the thought of her blocked tubes and what might have caused the blockage. Then she began to consider the different procedures she had undergone. She, remembered how she felt waking up from the general anesthesia after her laparoscopy.

As soon as she was lucid, Dr. Carpenter had told her that her tubes appeared so scarred that microsurgery was totally out of the question. He said that all he'd been able to do was take a biopsy. He let her know then that her only chance for a baby was in-vitro fertilization.

"Are we ready?" a booming voice called.

Marissa lifted her head, raised heavy eyelids, and looked up at the bearded face of Dr. Wingate. Lying back, she tried to dissociate herself from her body to cope with her anxiety. Her mind wandered back to her visit to Dr. Ken Mueller in the department of pathology at the Memorial after her laparoscopy. The Women's Clinic frequently sent some of their specimens to the Memorial to confirm their diagnoses. Marissa had been told that her fallopian tube biopsy had been forwarded there.

Hoping to maintain her anonymity, Marissa had searched for her slides herself. Shed knew that the Women's Clinic used her social security number as her case number.

Once Marissa had the slides, she sought out Ken. They'd been friends since medical school. She asked him to look at the microscopic sections for her, but didn't say they were hers.

"Very interesting," Ken said after a brief scan of the first slide.

He sat back from the microscope.

"What can you tell me about the case?"

"Nothing," Marissa said.

"I don't want to influence you. Tell me what you see."

"Sort of a quiz, huh?" Ken said with a smile.

"In a way," Marissa said.

Ken went back to the microscope.

"My first guess is that it's a section of fallopian tube. It looks as if it's been totally destroyed by an infectious process."

"Right on," Marissa said with admiration.

"What can you say about the infection?"

For a few minutes Ken silently scanned the specimen. When he finally spoke, Marissa was stunned.

"TB!" he announced, folding his arms, "Tuberculosis?" Marissa almost fell off her chair. She'd expected nonspecific inflammation, never TB.

"What makes you say that?" she asked.

"Look in the field," Ken told her.

Marissa gazed into the scope.

"What you are looking at is a granuloma," Ken said.

"It's got giant cells and epithelioid cells, the sine qua non of a granuloma.

Not a lot of things cause granulomas. So you have to think of TB, sarcoid, and a handful of funguses. But you'd have to put TB at the head of the list for statistical reasons."

Marissa felt weak. The idea that she had any of those diseases terrified her.

"Can you do any other stains to make a definitive diagnosis?"

Marissa asked.

"Sure," Ken said.

"But it would help to have some history on the patient."

"Okay," Marissa. said.

"She's a healthy Caucasian woman, mid-thirties, with a completely normal medical history. She presented with asymptomatic ally blocked fallopian tubes."

Reliable historian?" Ken questioned as he chewed the inside of his lip.

"Completely," Marissa said.

"Negative chest X-ray'," "Completely normal."

"Eye problems?"

"None."

"Lymph nodes?"

"Negative," Marissa said with emphasis.

"Except for the blocked tubes, the patient is completely normal and healthy."

"GYN history normal?" Ken asked.

"Yup!" Marissa said.

"Well, that's weird," Ken admitted.

"TB gets to a fallopian tube via the bloodstream or the lymphatics. If it's TB, then there has to be a nidus somewhere. And it doesn't look like fungus without some hyphae or something. I'd still say TB is the leading contender. Anyway, I'll do some additional stains…"

"Marissa!" called a voice, bringing Marissa back to the present.

She opened her eyes. It was Dr. Arthur.

"Dr. Wingate is about to inject the local anesthesia. We don't want you to suddenly jump."

Marissa nodded. Almost immediately she felt a number of points of stinging pain, but they faded quickly and she went back to her musing, remembering her panicked visit to an internist the same day that she'd seen Ken. But a complete work-up had failed to find anything wrong except for a positive PPD test, suggesting that she indeed had had TB.

Although Ken tried numerous other tests on Marissa's slide, he found no organisms, TB or otherwise. But he stuck by his original diagnosis of a tuberculous infection of the fallopian tube despite Marissa's inability to explain how she could have picked up such a rare illness.

"Dr. Wingate!" a harried voice called. Marissa's attention was again brought back to the present. She turned her head. Mrs.

Hargrave was at the ultrasound-room door.

"Can't you see I'm busy, for chrissake?" Dr. Wingate snapped.

"I'm afraid there has been an emergency."

"I'm doing a bloody egg retrieval!" Dr. Wingate shouted, venting some of his frustration on Mrs. Hargrave.

"Very well," Mrs. Hargrave said as she backed out of the door.

"Ah, there we go!" Dr. Wingate said with satisfaction. His eyes were glued to the cathode-ray-tube screen.

"Want me to see what the emergency is?" Dr. Arthur asked.

"It can wait," Dr. Wingate said.

"Let's get some eggs."

For the next half hour, time seemed to crawl. Marissa was sleepy but unable to sleep under the torturous probing.

"All right," Dr. Wingate said at last.

"That's the last of the visible follicles. Let me take a look at what we've gotten."

Laying the probe aside and stripping off his gloves, Dr. Wingate disappeared with the nurse-technician into the other room to examine the aspirate under a microscope.

"Are you okay?" Dr. Arthur asked Marissa.

Marissa nodded.

Within a few minutes, Dr. Wingate came back into the room.

He had a broad smile.

"You were a very good girl," he said.

"You produced eight fine-looking eggs."

Marissa breathed out audibly and closed her eyes. Although she was happy about getting eight eggs, it hadn't been a good morning. She felt drugged and exhausted and, with the stress of the procedure gone, Marissa soon lapsed into a troubled, drugged sleep. She was only vaguely aware of being moved to a gurney and being transported across the glass-enclosed walkway to the clinic's overnight ward. She woke up briefly to help switch herself from the gurney to a bed where she at last sank into a deeper, Valium-induced sleep.

Of all the sundry responsibilities and duties of running the Women's Clinic, Dr. Norman Wingate's heart rested firmly with his work associated directly with the biological part of the in vitro fertilization unit. As an MD, PhD, cellular biology held the strongest intellectual appeal. And as he gazed at Marissa's ova through the lenses of his dissecting microscope, he was filled with pleasure and utter awe. There, within his field of vision, was the unbelievable potential of a new human life.

Marissa's eggs were indeed fine specimens, attesting to the expert administering of the hormones she'd been given during the ovarian hyper stimulation period. Dr. Wingate carefully inspected each of the eight eggs. They were all quite mature. Reverently, he placed them in a previously prepared, slightly pink culture medium within Falcon organ culture dishes. The dishes were then placed in an incubator that controlled the temperature and the gaseous concentrations.

Turning his attention to Robert's sperm, which had been allowed to liquefy, Dr. Wingate started the process of capitation.

A perfectionist, he preferred to do all the cellular biology himself.

The efficacy of in-vitro fertilization was as much an art of the individual investigator as it was a science.

"Dr. Wingate!" Mrs. Hargrave called, coming into the lab.

"I'm sorry to bother you, but there's been another development with the Rebecca Ziegler case that needs your attention."

Dr. Wingate looked up from his work.

"Can't you handle it?" he asked.

"It's the press, Dr. Wingate," Mrs. Hargrave said.

"There's evena mobile TV news crew. You'd better come."

Reluctantly, Dr. Wingate looked at the flask containing Robert's sperm. He hated it when his bureaucratic responsibilities interrupted his biological work. But as the director of the clinic, he had little choice. He glanced up at the nurse technician

"This is your chance," he said to her.

"Go ahead and finish the capitation, the concentration, and the 'swim up." You've seen me do it often enough, so go to it. I'll be back as soon as I can." Then he turned and left the room with Mrs. Hargrave.

"Mrs. Buchanan! Hello! Mrs. Buchanan! Are you with us?" a friendly voice called.

From the depths of a disturbing dream, Marissa became aware of the voice calling to her. She had been dreaming that she was stranded in the middle of a barren landscape. At first she tried to incorporate the voice into the dream, but the nurse was determined to rouse her.

"Mrs. Buchanan, your husband is here!"

Marissa opened her eyes. She was staring directly into the broadly smiling face of a nurse. The nurse's name tag read "Judith

Holiday." Marissa blinked to bring the rest of the room into focus. It was then she saw Robert standing behind the nurse, his Burberry coat over his arm.

"What time is it?" Marissa asked as she pushed herself up on an elbow. It felt as if she had only just gone to sleep. Surely Robert couldn't have had time to have his meeting and get back.

"It's four-fifteen in the afternoon," Judith said as she wrapped a blood pressure cuff around Marissa's arm and blew it up.

"How do you feel?" Robert asked.

"Okay, I guess," Marissa said. She wasn't entirely sure. The Valium was still in her system. Her mouth felt as dry as the desert landscape in her dream. She was amazed that the day had passed so quickly.

"Vital signs are okay," Judith said as she removed the cuff. "if you're up to it, you're free to go on home." arissa swung her legs over the side of the bed. She felt a momentary dizzy sensation. It reoccurred when she slid off the bed and her feet touched the cold floor.

How do you feel?" Judith asked her.

Marissa said she was all right, just feeling a little weak. She took a drink from a glass on the side table. She felt better.

"Your clothes are in the closet," Judith said.

"Will you need any help?"

"I don't think so," Marissa said. She smiled weakly at the friendly and helpful nurse.

"Just yell if you do," Judith said as she backed out the door.

She closed it, but not all the way. It stood ajar by about three inches.

"Let me," Robert said as he saw Marissa start toward the closet.

Twenty minutes later, Marissa found herself walking unsteadily down the front steps of the clinic. She got into the passenger side of Robert's car. Her body felt heavy and all she could think about was getting home and climbing into bed. She looked out at the rush-hour Harvard Square traffic with a sense of detachment. It was beginning to get dark. Most of the cars already had their lights on.

"Dr. Wingate told me your egg retrieval went very well," Robert said.

Marissa nodded and looked across at him. His sharp profile was silhouetted against the evening lights. He didn't look at her.

"We got eight eggs," she said, emphasizing the "we." She studied him to assay his response. She was hoping he'd pick up on her meaning. Instead, he changed the subject.

"Did you hear about the tragedy at the clinic?"

"No!" Marissa said.

"What tragedy?"

"Remember that woman who hit me?" Robert asked, as if Marissa could have forgotten.

"The one carrying on in the waiting room when we arrived? She apparently committed suicide.

Took a swan dive from the sixth floor into one of the flower beds.

It was on the noon news."

"My God!" Marissa said. She remembered too well her own vivid identification with the woman. She had understood the woman's frustration, feeling it so frequently herself.

"Did she die?" Marissa asked, half hoping there was a: chance that the woman had not succeeded.

"Instantly," Robert said.

"Some poor patient on her way into the clinic saw the whole thing. Said the lady was sitting on a window ledge, then just dove headfirst."

"That poor woman," Marissa said.

"Which one?" Robert asked.

"Both," Marissa said, although she had been referring to Rebecca Ziegler.

"I'm sure you'll tell me this also isn't the right time to talk about this in-vitro protocol," Robert said.

"But having that lady go berserk like she did underlines what I was feeling this morning.

Clearly we're not the only ones to feel the pressure. I really think we should stop this infertility stuff after this cycle. Think about what it's doing to your practice."

The last thing Marissa cared to think about was her pediatric practice.

"I've spoken candidly with the director of my group and he understands," Marissa explained, not for the first time.

"He's sympathetic to what I am going through, even if other people aren't."

"That's fine for the director to say," Robert said.

"But what about your patients? They must be feeling abandoned."

"My patients are all being taken care of," Marissa snapped. In truth, she had been concerned about them.

"Besides," Robert added, "I've had it with this 'performing' stuff. Going into that clinic and getting that plastic cup is demeaning."

"Demeaning?" Marissa echoed, as if she'd not heard correctly.

Despite the Valium, she found herself once again strongly provoked.

After she had suffered that very day through a painful and risky procedure, she could hardly believe that Robert was making an issue of his brief, painless contribution to the process. She tried to restrain herself, but she couldn't help speaking her mind.

"Demeaning? You find it demeaning? And how would you find spending a day flat on your back with your legs spread before an array of your colleagues while they poke and probe?"

"My point exactly," said Robert.

"I didn't mean to suggest this has been easy for you. It's been tough on us both. Too tough.

Too tough for me, anyway. I want to call it quits. Now."

Marissa stared ahead. She was angry and she knew Robert was. They seemed to be quarreling constantly. She watched the road ahead as it sped toward her. They stopped at the toll booth on the entrance to the Mass. Pike. Robert slammed the coins into the hopper with an angry gesture.

After ten minutes of driving in silence, Marissa had significantly calmed down. She turned to Robert and told him that Mrs. Hargrave had come to visit her that afternoon.

"She was My sympathetic," Marissa said.

"And she had a recommendation."

"I'm listening," Robert said.

"She suggested that we avail ourselves of the counseling services that the clinic offers," Marissa said.

"I think it might be a good idea. As you said, others in our circumstances have been feeling the pressures. Mrs. Hargrave told me many people have found counseling to be a great help." Although she'd not been excited about the suggestion initially, the more Marissa thought about it, especially seeing how she and Robert were getting IF along, the better it sounded. They needed help; that much was obvious.

"I don't want to see a counselor," Robert said, leaving no room for discussion.

"I'm not interested in investing more time and money for someone to tell me why I'm fed up with a process that's guaranteed to make us unhappy and put us at each other's throats. We've spent enough time, effort, and money already. I hope you are aware that we've already spent over fifty thousand dollars."

They lapsed back into silence again. After a few miles, Robert broke it.

"You did hear me, didn't you? Fifty thousand dollars."

Marissa turned to him, her cheeks flushed.

"I heard you!" she snapped.

"Fifty thousand, a hundred thousand. What does it matter if it is our only chance to have our child? Sometimes I don't believe you, Robert. It's not as if we are hurting. You had enough to buy this silly expensive car this year. I really wonder about your priorities."

Marissa faced around front again, angrily folding her arms across her chest and sinking into her own thoughts. Robert's business mentality was so contrary to her own, she wondered how they had ever become attracted to each other in the first place.

"Contrary to you," Robert said as they neared the house, "fifty thousand seems like a lot of money to me. And we have nothing to show for it save for some ill feelings and a disintegrating marriage. Seems a heavy price to pay, at both ends. I'm getting to hate that Women's Clinic. I've never felt comfortable there. And being attacked by a distraught patient didn't help.

And did you see that guard?"

"What guard?" Marissa asked.

"The guard who came in with the doctors when the lady was carrying on. The Asian guy in the uniform. Did you notice he was armed?"

"No, I didn't notice he was armed!" Robert had an infuriating way of changing the subject with insignificant details. Here they were struggling with their relationship and their future, and he was thinking about a guard.

"He had a .357 Colt Python," Robert said.

"Who does he think he is, some kind of Asian Dirty Harry?"

Switching on the light, Dr. Wingate entered his beloved lab * It was after eleven P.M. and the clinic was deserted. Across the street in the overnight ward and in the emergency room there was staff, but not in the main clinic building.

Taking off his coat, Dr. Wingate slipped on a clean white lab coat, then washed his hands carefully. He could have waited for morning, but after getting the eight superb mature eggs from Marissa that day, he was eager to check on their progress.

That afternoon, after having dealt with the unfortunate Rebecca

Ziegler affair as best he could, he'd returned to the lab to find that the nurse-technician had done a fine job preparing the sperm. By two P.M. all eight eggs had been placed in a meticulously prepared insemination medium contained in separate organ culture dishes. To each dish Dr. Wingate had carefully added roughly 150,000 capita ted mobile sperm. The eggs and the sperm had then been co-incubated in 5 % CO, with 98 % humidity at 37 degrees Centigrade.

Turning on the light for his dissecting microscope, Dr. Wingate opened the incubator and removed the first dish. Placing it under the scope, he looked in.

There, in the middle of the microscopic field, was the beautiful egg, still surrounded by its corona cells. Looking more closely as he deftly handled a micro pipette Dr. Wingate experienced the thrill of creation as he observed two pro nuclei within the ooplasm of the egg. The egg had fertilized and looked entirely normal.

Repeating the procedure with the other dishes, Dr. Wingate was extremely pleased to see that all the eggs had fertilized nor many. There had been no polyspermic: fertilization, in which more than one sperm penetrates the egg.

Working deliberately, Dr. Wingate transferred the fertilized oocytes to fresh growth medium containing a higher concentration of serum. Then all the fertilized eggs went back into the incubator.

When he was finished, Dr. Wingate went to the phone. Despite the hour, he called the Buchanan residence. He reasoned it was never too late to relay good news. After the fifth ring, he wondered if he'd made a mistake. By the sixth ring, he was about to hang up when Robert answered.

"Sorry to be calling so late," Dr. Wingate said.

"No problem," Robert said.

"I was in my study. This is my wife's line."

"I have some good news for you folks," Dr. Wingate said.

"We can use a bit of that," Robert said.

"Hold on, IT wake Marissa."

"Maybe you shouldn't wake her," Dr. Wingate said.

"You can tell her in the morning or I'll call back then. After what she's been through today, perhaps we should let her sleep."

"She'll want to hear," Robert assured him.

"Besides, she can go right back to sleep. That's never been one of her problems.

Hang on."

A few moments later, Marissa's tired voice came over the line as she picked up an extension.

"Sorry to wake you up," Dr. Wingate said, "but your husband assured me you wouldn't mind."

"He said you had some good news?"

"Indeed," Dr. Wingate said.

"All eight eggs fertilized already.

It was very quick, and I'm optimistic. Usually only eighty percent or so fertilize at best. So you got a particularly healthy crop."

"Wonderful," Marissa said.

"Does this suggest the transfer is more likely to be successful?"

"I'll have to be honest," Dr. Wingate said.

"I don't know if there is any association. But it can't hurt."

"What made it different this time?" Marissa asked. In the last cycle none of the eggs had fertilized.

"I wish I knew," Dr. Wingate confided.

"In some respects, fertilization remains a mystifying process. We don't know all the variables."

"When will we do the transfer?" Marissa asked.

"In forty-eight hours or so," Dr. Wingate said.

"I'll check the embryos tomorrow and see how they are progressing. As you know, we like to see some divisions."

"And you'll be transferring four embryos?"

"Exactly," Dr. Wingate said.

"As we've already discussed, experience has shown that more than four has a higher risk of resulting in a multiple pregnancy without significantly raising the efficacy of the transfer. The other four embryos we'll freeze. With this many good eggg, you can have two transfers without having to undergo another hyper stimulation

"Let's hope this transfer is successful," Marissa said.

"We'll all be hoping for the best."

"I was sorry to hear about the woman who killed herself," Marissa said. The tragedy had been on her mind all evening. She wondered how many cycles the poor Ziegler woman had endured.

Having identified with the woman, she was already anticipating the psychological effect of yet another failure. Since there had been so many in the past, she had trouble being optimistic.

Would another failure push her beyond her limits?

"It was a terrible tragedy," Dr. Wingate said. His previously enthusiastic tone became somber.

"We were all crushed. The staff is usually adept at picking up such symptoms of depression. Until her outburst yesterday, we had no indication Rebecca Ziegler was so distraught. Apparently she and her husband had separated.

We'd tried to get them into counseling, but they wouldn't go."

"How old was she?" Marissa asked.

"Thirty-three, I believe," Dr. Wingate said.

"A tragic loss of a young life. And I'm concerned about its effect on other patients.

Infertility is an emotional struggle for everyone involved. I'm sure it didn't help your state of mind seeing Mrs. Ziegler's outburst in the waiting room."

"I identified with her," Marissa admitted. Especially now, Marissa thought, hearing about the woman's marital problems. She and Rebecca were even close in age.

"Please don't say that," Dr. Wingate said.

"On a happier note, let's look forward to a successful embryo transfer. It's important to stay positive."

"I'll try," Marissa said.

After hanging up the phone, Marissa was glad for having brought up the topic of the suicide. Merely having talked about it eased the impact to a degree.

Getting out of bed, Marissa pulled on her robe, and went down the hall to Robert's study. She found him seated at his computer console. He glanced up as Marissa came into the room.

"They all fertilized," Marissa said as she sat on a love seat below a wall of built-in bookshelves.

"That's encouraging," Robert said. He was looking at her over the top of his half-glasses.

"That's the first hurdle," she said.

"Now all they have to do is to get one of the embryos to stick in my uterus."

"Easier said than done," Robert said. He was already looking back at his computer screen.

"Can't you be just a tiny bit supportive?" Marissa asked.

Robert looked back at her.

"I'm starting to think that my being supportive and not telling you what I'm thinking has just encouraged you to keep beating your head against a wall. I've still got serious questions about this whole process. If it works this time, fine; but I don't want to see you setting yourself up for another disappointment." He turned back to his screen.

For a moment Marissa didn't say anything. As much as she hated to admit it at the moment, Robert was making sense. She was afraid of getting too hopeful herself.

"Have you thought any more about the idea of counseling?"

Marissa asked.

Robert turned to Marissa a third time.

"No," he said.

"I told you, I'm not interested in going to a counselor. There has already been too much interference in our lives. Part of the problem for me is that we have lost our private life. I feel like a fish in a fishbowl."

"Dr. Wingate told me that one of the reasons the woman who killed herself today did so was because she and her husband did not seek counseling."

"Is this some kind of not-so-veiled threat?" Robert asked.

"Are you telling me you're thinking of diving off the roof of the Women's Clinic if I don't agree to see one of their counselors?"

"No!" Marissa said heatedly.

"I'm just telling you what he told me. The woman and her husband were having difficulties. Counseling was recommended. They didn't go. Apparently they broke up, which is one of the things that made the woman so upset."

"And counseling would have solved everything?" Robert asked sarcastically.

"Not necessarily," Marissa said.

"But I doubt it would have hurt. I'm beginning to think that we should seek counseling whether we continue with the IVF or not."

"What do I have to say to you?" Robert asked.

"I'm not interested in spending time and money on a counselor. I know why I'm upset and unhappy. I don't need someone else to tell me."

"And you don't want to try to work on it?" asked Man*ssa. She hesitated to say "together."

"I don't think a counselor is the way to work on it," Robert said.

"You don't have to be a rocket scientist to know what is wrong. Anyone would feel stressed out by what we've been through in the past few months. Some things in life you have to deal with. Others you don't. And we don't have to deal with this infertility therapy anymore, if we so choose. At this point, I'd prefer to put it out of our lives."

"Oh, for goodness' sake!" Marissa said with disgust. She got up from the love seat and left Robert to his beloved computer and spreadsheets. She wasn't up to having another argument.

Marissa stomped down the hall and into the bedroom, slamming the door behind her. It seemed that instead of getting better, everything was getting a whole lot worse.