Vital Signs

6

Highly reactive ions called hydroniurn ions, which were nothing but hydrated protons, knifed through the delicate cell membranes of four of Marissa's developing embryos. The hydronium ions came in a sudden wave, catching the dividing cells off-guard Buffer systems were mobilized to neutralize some of the initial reactive particles, but there were too many to combat. Slowly at first, then more rapidly, the pH of the cells began to fall. They were becoming acidic. Hydronium ions inevitably resulted wherever acid was added to an aqueous medium.

Within the very depths of the embryos, molecules of DNA were in the process of replicating themselves in preparation for another division. As weak acids themselves, they were terribly susceptible to the hydronium ions that swarmed in their midst. Their replication process continued, but with some difficulty: the enzymes responsible for the, chemical reactions were also sensitive to acid. Soon replication mistakes started to occur. Affirst there were only afew errors, none that would have mattered in the long run given the redundance of genes. But as more and more of the acid particles intervened, entire gene pools found themselves replicating sheer gibberish. The cells were still dividing, but it was only a matter of time. The mistakes had become lethal.

"It's beautiful!" Marissa cried. It was hard for her to comprehend that she was looking at the barest beginning of one of her children. The embryo, now at a two-cell stage, appeared transparent in the crystal-clear culture medium. Unfortunately, Marissa could not see the chaos that was occurring on a molecular level at the very moment she was admiring the cell's microscopic appearance. She thought she was seeing the beginnings of a new human life. What she was witnessing was the first steps of its death.

"Amazing, isn't it?" Dr. Wingate said. He was standing next to Marissa. She had come in unexpectedly that morning, asking if she could see one of her embryos. At first he had questioned the wisdom of granting such a request, but, remembering she was a doctor, he realized that it would be difficult to refuse, even though at this stage he didn't like anyone handling the embryos.

"I just cannot believe that little speck could become an entire person," Marissa said. She'd never seen a live two-celled embryo before, much less her own.

"I think we'd better get the little devil back into the incubator,"

Dr. Wingate said. He carefully carried the organ-culture dish to the incubator and slid it onto the appropriate shelf. Marissa followed him, still awed. She saw that the dish had joined three others.

"Where are the other four?" she questioned.

"Over there," Dr. Wingate pointed.

"In the liquid-nitrogen storage facility."

"They've already been frozen?" Marissa asked.

"I did it this morning," Dr. Wingate said.

"Our experience has been that two-celled embryos do better than larger ones. I selected the four that I thought would tolerate the freezing and thawing the best. We'll keep them in reserve, just in case."

Marissa walked over to the liquid-nitrogen storage unit and touched its lid. The idea that four potential children were inside, frozen in a kind of suspended animation, gave her an eerie feeling.

Such high-tech intrusion reminded her a little too much of Brave New World.

"Want to see inside?" Dr. Wingate asked.

Marissa shook her head.

"I've taken too much of your time already," she said.

"Thank you."

"My pleasure," Dr. Wingate said.

Marissa hurried from the lab. She went to the elevators and pushed the Up button: What had brought her to the clinic that morning was an appointment to see Linda Moore, a psychologist.

Between the final talk with Robert the night before and his decision to sleep in the guest room, Marissa had decided to call about counseling first thing in the morning. Whether Robert went or not, Marissa. decided she needed to talk to a professional about the emotional stresses of IVF.

When she'd made the call, she thought she'd have to wait for an appointment, but Mrs. Hargrave had warned the staff psychologist that if Marissa called, she should be seen quickly.

Linda Moore's office was on the sixth floor, the very floor from which Rebecca Ziegler had jumped. The coincidence made Marissa a bit uncomfortable. As she walked down the hall, she morbidly tried to guess which window Rebecca had leaped from.

She wondered if the woman's last straw had been something she'd gleaned from her clinic record. Marissa remembered that Rebecca had left the downstairs waiting room with the express purpose of reading her record.

"Go right in," the secretary said when Marissa identified herself.

As she moved toward the door, Marissa questioned if she truly wanted to go through with the appointment. It hardly took a professional to tell her IVF was stressful. Besides, she was embarrassed to have to make excuses why Robert wouldn't come with her.

"Go right in!" the secretary repeated, seeing Marissa pause at the door.

Realizing she no longer had a choice, Marissa entered the office.

The room was soothingly decorated with comfortably upholstered furniture and muted tones of green and gray. The window, however, looked out on the stark brick courtyard six floors below. Marissa wondered what Linda Moore had been doing when Rebecca made her leap into infinity.

"Why don't you close the door?" Linda suggested, gesturing with her free hand. She was young; Marissa guessed, in her late twenties. She also had an accent, just like Mrs. Hargrave.

"Have a seat and I'll be with you in a moment," Linda said.

She was on the phone.

Marissa sat down on a dark green chair facing Linda's desk.

The woman was rather petite, with short reddish hair and a sprinkling of freckles across the bridge of her nose. Her phone conversation was obviously with a patient, and it made Marissa uncomfortable. She tried not to listen. But it was soon over, and Linda turned her full attention to Marissa.

"I'm glad you called," she said with a smile.

Almost immediately, Marissa felt glad too. Linda Moore struck her as being both competent and warm. Encouraged by Linda, Marissa. soon began to open up. Although Linda saw patients with a wide variety of problems at the Women's Clinic,

Marissa learned that a good portion of her practice involved IVF. She understood exactly what Marissa had been going through, perhaps better than Marissa did herself.

"Basically, the problem is a Sophie's choice," Linda said halfway into the hour.

"You have two equally unsatisfactory possibilities: you can accept your infertility without further treatment as your husband is suggesting and thereby live a life that is contrary to your expectations, or you can continue with the IVF which will lead to continued stress on yourself and on you; relationship, continued cost as your husband has pointed out, and continued stress for you both with no guarantee of success."

"I've never heard it put so succinctly," Marissa said.

"I think it is important to be clear," Linda said.

"And honest.

And being honest starts with yourself. You have to understand what your choices are so you can make rational decisions."

Gradually, Marissa began to feel more comfortable about revealing her feelings, and the surprising part was that by doing so, she became more self-aware.

"One of the worst problems I have is that I can't fix things myself."

"That's true," Linda said.

"With infertility it doesn't make any difference how hard you try."

"Robert used the term 'obsessed,"

" Marissa admitted.

"He's probably right," Linda agreed.

"And it's only made worse by the emotional ups and downs of IVF: the recurrent flip flop from hope to despair, grief to rage, and envy to self reproach

"What do you mean by envy?" Marissa asked.

"The envy you feel toward women who have children," Linda said.

"The pain you might experience seeing mothers with kids in the grocery store. That kind of stuff."

"Like the anger I have at the mothers in my practice," Marissa said.

"Especially those who I think are neglecting their kids in some way."

"Exactly," Linda said.

"I can't think of a worse practice for an infertile woman than pediatrics. Why couldn't you have specialized in something else?" Linda laughed and Marissa laughed with her. Pediatrics was a particularly cruel field for someone in her circumstances. It probably was one of the reasons she'd been avoiding going to work as much as possible.

"Anger and envy are okay," Linda said.

"Let yourself feel them. Don't try to bottle them up just because you feel they are inappropriate."

Easier said than done, Marissa thought to herself.

"Before we break," Linda continued, "there are a couple of important points I want to make. We'll be going over all of this in more detail in future sessions, and I hope we can get Robert in here for one or two of them. But I want to warn you against letting this longed-for child become the embodiment of all your hope. Don't persuade yourself everything will be different if only you have this baby, because it doesn't work that way. What I want to suggest is that you set a realistic time frame for IVF attempts. As I understand it, you are on your fourth. Is that correct?"

"That's right," Marissa said.

"Tomorrow I'll have the embryo transfer. " "Statistically, four is probably not enough," Linda said.

"Perhaps you should think of setting eight tries as a cutoff. Here at the Women's Clinic we have a very high success rate around the eighth attempt. If after eight you haven't achieved pregnancy, then you should stop and consider other options."

"Robert is talking about other options now," Marissa countered.

"He will be more willing to be cooperative if he knows you've established a cutoff point-that this ordeal won't go on forever," Linda said.

"That's been our experience. In every couple there is one who is more committed to the process than the other. Give him a little time. Respect his limitations as well as your own."

"I'll see what I can do," Marissa said. Considering Robert's latest words on the subject, she wasn't optimistic.

"Are there any other issues you'd like us to concentrate on?"

Linda asked.

Marissa hesitated.

"Yes," she said at last.

"We mentioned guilt briefly. That's a big problem for me. Perhaps because I'm a doctor, it has bothered me that I haven't been able to find out how I got the infection that blocked my fallopian tubes."

"I can understand," Linda said.

"It's natural to think that way. But we'll have to try to change your thinking. The chance that any past behavior was the cause is infinitesimally small. It's not as if it were VD or anything."

"How do I know?" Marissa asked.

"I feel as if I have to find out. It's become an increasingly important issue for me."

"All right, we'll be sure to talk more about it." Opening up the scheduling book on her desk, Linda made a second appointment for Marissa. Then she stood up. Marissa did the same.

"I'd like to make one more suggestion," Linda said.

"I've got the distinct impression that you've been experiencing a good deal of isolation as a result of your infertility."

Marissa nodded, this time in genuine agreement.

"I'd like to encourage you to give Resolve a call," Linda continued. She handed a card with a telephone number to Marissa.

"You might have heard of the organization. It's a self-help support group for people with infertility problems. I think you would benefit from the contact. They talk about the same issues you and I have been discussing. It will be reassuring to realize that you are not alone in all this," Leaving the psychologist's office, Marissa felt pleased that she'd made the effort. She felt a hundred times better about the session than she'd imagined she would. She looked at the card with the Resolve phone number on it. She even felt positive about calling the organization. She'd heard about it before, but had never seriously thought of calling, in part because she was a physician. She had always assumed that the main purpose of the group was to explain the scientific aspects of infertility to lay people. That Resolve dealt with emotional aspects of infertility was news.

Riding down in the elevator, Marissa realized she'd forgotten to ask Linda about Rebecca Ziegler. She made a mental note to do it at their next session.

From the Women's Clinic, Marissa. went to her pediatric group. Robert had been right. Her practice was in disarray.

Given her frequent absences, her secretary, Mindy VaIdanus, was being used as a "float" to cover for other secretaries who were on vacation. Marissa wasn't surprised to find Mindy's desk empty when she passed by on her way to her office.

On her own desk, Marissa found a pile of unopened mail as well as a fine layer of dust. Hanging up her coat, Marissa called Dr. Frederick Houser, the senior partner of the group. He could see her, so she went directly up to his office.

"I have an embryo transfer scheduled for tomorrow," Marissa told her mentor once they were seated in the conference room.

"It might be the last cycle if my husband has his way."

Dr. Houser was an old-school physician. He was a large, portly man, mostly bald save for a ring of silver hair that ran around the back of his head. He wore wire-rimmed glasses and an everpresent bow tie. He had a warm, generous air about him that made everyone feel comfortable in his presence, from patients to colleagues.

"But if it is not successful," Marissa continued, "and if I can smooth things out with Robert, we'll try a few more. But no more than eight. So one way or another, I'll be back to normal within half a year at most."

"We wish you the best," Dr. Houser said.

"But we will have to lower your salary again. Of course that will change as soon as you start contributing significantly to the group's income."

"I understand," Marissa said.

"I appreciate your patience with me."

Back in her office, Marissa took out the card Linda had given her and called the number. A friendly female voice answered.

"Is this Resolve?" Marissa asked.

"Sure is," the woman answered.

"I'm Susan Walker. What can I do for you?"

"It was suggested I give you people a call," Marissa said.

"I'm involved with the in-vitro fertilization unit at the Women's clinic."

"Staff or patient?" Susan asked.

"A patient," Marissa said.

"I'm on my fourth cycle."

"Would you and your husband like to come to our next meeting?"

Susan asked.

"My husband probably will refuse to come," Marissa said, a bit embarrassed.

"Sounds familiar," Susan said.

"It happens with most couples.

Husbands are reluctant until they come for one session. After that, most of them love it. That's what happened with my own husband. He'll be happy to call your husband to talk to him. He's fairly persuasive."

"I don't think that would be a good idea," Marissa said quickly. She could just imagine Robert's response if a stranger called up about a self-help infertility group.

"I'll speak with him myself. But if he doesn't come, would it be awkward if I came by myself?"

"Heavens, no!" Susan said.

"We'd love to have you. You'll have plenty of company. There are a number of women currently going through lVF. Several of them will be solo as well." Shethen gave Marissa the date and the directions.

Hanging up the phone, Marissa hoped the experience would be as rewarding as the session with Linda Moore. Although she had her doubts, she was willing to give it a try, mainly because of

Linda's recommendation. Donning a short white coat, Marissa went down to the main walk-in clinic area to try to cam some of the small salary she was still receiving.

After seeing a handful of children with runny noses, middle ear infections, and sore throats, Marissa found herself in an examination cubicle with an eight-month-old infant and a disinterested teenage mother.

"What's the problem?" Marissa asked, even though she could see well enough herself. The child had a number of suppurating sores on his back and arms. In addition, he was filthy dirty.

"I dunno," the mother said as she cracked her gum and stared around the room.

"The kid cries all day long. He never shuts up."

"When was the last time you bathed this infant?" Marissa demanded as she looked at the pustules. She guessed it was staph.

"Yesterday," the mother said.

"Don't give me that," Marissa snapped.

"This child hasn't been bathed in a week, if then."

"Maybe it was a few days ago," the mother admitted.

Marissa was livid. She was tempted to tell the girl she wasn't fit to be a mother. Resisting the impulse, she buzzed one of the nurses and asked her to come to the examination room.

"What's up?" Amy Perkins asked.

Marissa could not bring herself to look at the mother. She only gestured in her direction.

"This child needs to be bathed," she told Amy.

"Also, these open sores need to be cultured. I'll be back."

Stepping from the examination room, Marissa went into the deserted supplies closet. She put her face in her hands, fighting back tears. She was disgusted with her lack of control. It was scary to be this close to the edge. She could have hit that girl. It made the discussion she'd just had with Linda Moore seem a lot less academic.

For the first time she wondered if she should continue seeing patients in this hyper emotional state.

"Why don't we go out for dinner?" Robert suggested after coming home late as usual from his office.

"Let's go to that Chinese restaurant. We haven't been there for months."

Marissa thought it was a fine idea to get out of the house. She wanted to talk to Robert, particularly after he'd slept in the guest room the night before. That had been a disturbing first. Besides, she was starved and Chinese food sounded particularly appetizing to her.

After he'd taken a quick shower, they climbed into Robert's car and headed into town. Robert seemed in good spirits, which Marissa thought was a good sign. He was pleased about a deal that he'd struck that day with European investors concerning building and managing retirement-nursing homes in Florida.

Marissa listened with half an ear.

"I went to see the counselor at the Women's Clinic today," Marissa said when Robert's story came to an end.

"She was even more helpful than I'd anticipated."

Robert didn't respond. Nor did he look at her. Marissa could sense immediate resistance to her turning the subject of their conversation to their infertility problems.

"Her name is Linda Moore," Marissa persisted, "and she's very good. She's hopeful that you will come in for at least one session."

Robert glanced at Marissa, then back at the road.

"I told you yesterday, I'm not interested," he said.

"It might be helpful for us," Marissa added.

"One thing that she suggested was deciding in advance how many cycles we are willing to try before giving up. She says it is less stressful knowing that the process is not open-ended."

"How many did she suggest?" Robert asked.

"Eight," Marissa answered.

"Four isn't enough to take advantage of the statistics."

"That's eighty thousand dollars," Robert said.

Marissa couldn't answer. Was money always on his mind?

How could he reduce a child to a simple dollar value?

They traveled in silence for a while. Marissa's interest in talking with Robert cooled, yet she still wanted to bring up the issue of his sleeping in the guest room. She had to say something.

Nearing the restaurant, Robert had no trouble finding a parking place. As Marissa opened her door, she found the courage to ask him about it. She discovered Robert wasn't in the mood to discuss it.

"I need a vacation from all this," he said irritably.

"I've been telling you that this in-vitro stuff is driving me crazy. If it's not one thing, then it's something else. Now it's this counseling garbage!"

"It is not garbage!" Marissa snapped "There you go again," Robert said.

"Lately I can't talk to you without you flying off the handle."

They stared at each other over the top of Robert's car. After a moment of silence, Robert changed the subject again by saying, "Let's eat."

Disgusted, Marissa followed him into the restaurant.

The China Pearl was run by a family who had recently moved from Chinatown to Boston's suburbs. The restaurant's decor was typical: simple Formica-topped tables and a couple of ceramic red dragons. By that late hour only four or five of the twenty or so tables were still occupied.

Marissa sat down in a chair facing the street. She felt horrible.

All of a sudden she wasn't hungry anymore.

"Good evening," said the waiter as he handed' them menus.

Marissa glanced up at the man as she took the long, plastic coated menu.

Robert asked her if she'd like to split an appetizer. But before she could respond, Marissa felt cold sweat break out all over her body. In a flash, she was back at the Women's Clinic having her cervical biopsy. The vision was starkly vivid, as if she were actually there again.

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

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

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

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

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

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

"Mafissa, what's wrong with you?"

Marissa blinked several times as if waking from a trance.

"Marissa?" Robert yelled.

"What's going on? Talk to me!"

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

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

Robert put his arms around her.

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

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

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

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

Marissa nodded.

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

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

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

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

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

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