Michael Palmer - Side Effects

"When did Sandy leave?"

"A couple of hours ago. Did you get done whatever it is you wanted to?"

Kate nodded. His expression was as flat and as drained as his words. No surprise, she realized. First his wife stalks out of the house with no real explanation, then he has to listen to the agonies of the breakup of his best friend's marriage. "I… I guess I owe you an apology for the way I acted earlier. Some sort of explanation." Jared shrugged. "I'll take the apology. The explanation's optional."

"I'm sorry for leaving the way I did."

"I'm sorry you left the way you did, too. I could have used some help-at least some moral support."

"Sorry again." The three feet separating them might as well have been a canyon. "Anything decided?"

"He went home to tell Ellen and to move out, I guess. It got awful quiet here after you left. Neither of us was able to open up very well. We each seemed to be wrapped up in our own bundle of problems."

"Three I'm sorries. That's my limit." She unsnapped her barrette, shook her hair free, and combed it out with her fingers. The gesture was natural enough, but at some level she knew she had done it because it was one Jared liked. "After what happened this morning-in the car, I mean-I couldn't listen to Sandy just brush off Ellen and their marriage the way he did. I mean, here I am, scrambling to do a decent job with my career and to be a reasonably satisfying friend and wife to you, and there's Ellen able to do both of those so easily and raise three beautiful, talented children to boot, and…"

"It's not right what you're doing, Kate."

"What's that?"

"You're comparing your insides to Ellen's outsides, that's what. She looks good. I'll give you that. But don't go and cast Sandy as the heavy just because he's the one moving out. There are things that are missing from that relationship. Maybe things too big to overcome. What's that got to do with our discussion this morning, anyway?"

"Jared, you know perfectly well what it has to do. Having children is a major responsibility. As it is, I feel like a one-armed juggler half the time. Our lives, our jobs, the things we do on our own and together…

Toss in a baby at this point, and what guarantee is there I won't start dropping things?"

"What do you want me to say? I'm almost forty years old. I'm married. I want to have children. My wife said she wanted to have children, too.

Now, all of a sudden, having children is a threat to our marriage."

"Christ, Jared, that's not what I mean… and you know it. I didn't say I won't have children. I didn't say it's a threat to our marriage. All I'm trying to say is there's a lot to think about-especially with the opportunities that have arisen at the hospital. It's not the idea I'm having trouble with so much as the timing. A mistake here and it's a bitter, unfulfilled woman, or a neurotic, insecure kid, or… or a twenty-six-year-old stewardess. Can you understand that?"

"I understand that somewhere inside you there are some issues you're not facing up to. Issues surrounding me or having children or both."

"And you've got it all together, right? " Kate struggled to stop the tears that seemed to be welling from deep within her chest. "I know what I want."

"Well, I don't. Okay?

And I'm the one who's going to have to pass up a chairmanship and go through a pregnancy and change my life so that I don't make the same horrible mistakes with our child that my mother made with us. I…

Jared, I'm frightened." It was, she realized, the first time she had truly recognized it. "Hi, Frightened. I'm Perplexed. How do you do?"

"You know, you could use a little better sense of timing yourself."

"Okay, folks, here we go. It's time once again to play let's-jump-all over-everything-Jared-says. Well, please, before you get rolling, count me out. I'm going to bed."

"I'll be in in a while."

"Don't wake me."

The section from Beverly Vitale's left ovary was unlike any pathology Kate had ever encountered. The stroma-cells providing support and, according to theory, critical feminizing hormones-were perfectly normal in appearance. But the follicles-the pockets of nutrient cells surrounding the ova-were selectively and completely destroyed, replaced by the spindle-shaped, deep pink cells of sclerosis-scarring. Assumin'g the pattern held true throughout both ovaries-and there was no reeison to assume otherwise-Beverly Vitale's reproductive potential was as close to zero as estimate would allow. For nearly an hour, Kate sat there, scanning section after section, taking notes on a yellow legal pad. Why couldn't Jared understand what it all really meant to her? Why couldn't he see what a godsend medicine had been to a life marked by aimlessness and a self-doubt bordering on self-loathing. "My God, woman, if I didn't know better, I'd swear you were a model the Zeiss Company had hired to plug their latest line of microscopes."

"Aha, " Kate said melodramatically, her eyes still fixed on the microscope, "a closet male chauvinist pig. I expected as much all. along, Dr. Willoughby." She swung around and, as always, felt a warm jet of affection at the sight of her department head. In his early sixties, Stan Willoughby was egg bald save for a pure white monk's fringe. The pencil-thin moustache partially obscured by his bulbous nose was a similar shade. His eyes sparkled from beneath brows resembling endstage dandelions. In all, Jared's likening him to the wise imp Yoda was, though inappropriate, not inaccurate. Willoughby packed his pipe and straddled the stool across the table from Kate. "The young lady on Ashburton Five? " he asked. Kate nodded. "This a good time for me to take a look-see?"

Although Willoughby's primary area of interest was histochemistry, thirty-five years of experience had made him an expert in almost every phase of pathology. Every phase, that is, except how to administer a department. Willoughby was simply too passive, too nice for the dogmaim-dog world of hospital politics, especially the free-for-all for an adequate portion of a limited pool of funds. "Stan, I swear I've never seen, or even heard of, anything like this."

The chief peered into the student eyepieces on the teaching microscope-a setup enabling two people to view the same specimen at the same time.

"All right if I focus? " Kate nodded. Ritualistically, he went from low power magnification to intermediate, to high, and finally to thousand-fold oil-immersion, punctuating each maneuver with a "hmm" or an "uh huh." Through the other set of oculars, Kate followed. They looked so innocent, those cells, so deceptively innocent, detached from their source and set out for viewing. They were in one sense a work of art, a delicate, geometrically perfect montage that was the antithesis of the huge, cluttered metal sculptures Kate had built and displayed during her troubled Mount Holyoke years. The irony in that thought was immense. Form follows function. The essential law of structural design.

Yet here were cells perfect in form, produced by a biologic cataclysm tantamount to a volcano. A virus? A toxin? An antibody suddenly transformed?

The art of pathology demanded that the cells and tissues, though fixed and stained, never be viewed as static. "Did you send sections over to the electron microscopy unit? " Willoughby asked. "Not yet, but I will."

"And the young woman is bleeding as well? "

"Platelets thirty thousand. Fibrinogen fifteen percent of normal." 7. all "Ouch!"

"Yes, ouch. I spoke with her at some length last night. No significant family history, no serious diseases, nonsmoker, social drinker, no meds …"

"None?"

"Vitamins and iron, but that's all. No operations except an abortion at the Omnicenter about five years ago." The two continued to study the cells as they talked. "She's a cellist with the Pops."