Робин Кук - Vital Signs

Marissa hurried past a trio of street musicians playing for commuters’ donations and quickly went up the stairs to the street. It was still raining so she paused briefly to raise her folded umbrella.

Marissa buttoned her trench coat and held her umbrella tight as she traversed the square and headed up Mount Auburn Street. Sudden gusts of wind foiled her attempt to stay dry; by the time she reached the Women’s Clinic at the end of Nutting Street, a plethora of raindrops were sprinkled across her forehead like beads of perspiration. Beneath the glass-enclosed walkway that spanned the street and connected the main building of the clinic to its overnight ward and emergency facilities, Marissa shook her umbrella and folded it closed.

The clinic building was a postmodern structure, built of red brick and mirrored glass, which faced a bricked courtyard. The main entrance was off the courtyard and was reached by a wide run of granite steps.

Taking a deep breath, Marissa climbed the front steps. Although as a physician she was accustomed to entering medical facilities, this was the first time she was doing so as a patient, coming in not just for an examination but for surgery. The fact that it was minor surgery had less of a mitigating effect than she’d imagined. For the first time Marissa realized that from a patient’s point of view, there was no such thing as “minor” surgery.

Only two and a half weeks earlier Marissa had climbed the same steps for a routine annual Pap smear only to learn a few days later that the results were abnormal, bearing the grade CIN #1. She’d been genuinely surprised, having always enjoyed perfect health. Vaguely she’d wondered if the abnormality had anything to do with her recent marriage to Robert Buchanan. Since their wedding, they had certainly been enjoying the physical side of their relationship a great deal.

Marissa grasped the brass handle of the massive front door and stepped into the lobby. The decor was rather stark although it reflected good taste and certainly money. The floor was surfaced in dark green marble. Ficus trees in large brick planters lined the windows. In the middle of the room was a circular information booth. Marissa had to wait her turn. She unbuttoned her coat and shook the moisture from her long brown hair.

Two weeks previously, having received the surprising result of the Pap smear, Marissa had had a long phone conversation with her gynecologist, Ronald Carpenter. He had strongly recommended the colposcopy-biopsy procedure.

“Nothing to it,” he’d said with conviction. “Piece of cake, and then we know for sure what’s going on in there. It’s probably nothing. We could wait for a while and do another smear, but if it were my wife, I’d say do the colposcopy. All that means is looking at the cervix with a microscope.”

“I know what a colposcopy is,” Marissa had told him.

“Well, then, you know how easy it is,” Dr. Carpenter had added. “I’ll give the old cervix a good look, snip out a tiny piece of anything suspicious, and that will be it. You could be outta here in an hour. And we’ll give you something in case there’s any pain. In most centers they don’t give any analgesia for biopsies, but we’re more civilized. It’s really easy. I could do it in my sleep.”

Marissa had always liked Dr. Carpenter. She appreciated his offhand, easygoing manner. Yet his attitude about a biopsy made her appreciate the fact that surgeons viewed surgery in a fundamentally different way than patients did. She wasn’t concerned about how easy the procedure was for him. She was concerned about its effect on her. After all, above and beyond the pain, there was always the possibility of a complication.

Yet she was reluctant to procrastinate. As a physician, she was well aware of the consequences of putting off a biopsy. For the first time, Marissa felt medically vulnerable. There was a remote but real possibility that the biopsy might prove to be positive for cancer. In that case, the sooner she knew the answer, the better off she’d be.

“Day surgery is on the third floor,” the receptionist said cheerfully in response to Marissa’s question. “Just follow the red line on the floor.”

Marissa looked down at her feet. A red, a yellow, and a blue line ran around the information booth. The red line led her to the elevators.

On the third floor, Marissa followed the red line to a window with a sliding glass panel. A nurse dressed in a standard white uniform opened the panel as Marissa approached.

“I’m Marissa Blumenthal,” Marissa managed. She had to clear her throat to get it out.

The nurse found her folder, glanced at it briefly to see if it was complete, then extracted a plastic ID bracelet. Reaching across the countertop, the nurse helped Marissa secure the bracelet.

Marissa found the procedure unexpectedly humiliating. From about the third year in medical school, she’d always felt in control in a hospital setting. Suddenly the tables were turned. A shiver of dread passed through her.

“It will be a few minutes,” the nurse intoned. Then she pointed to some double doors. “There’s a comfortable waiting room just through there. Someone will call you when they are ready.” The glass panel slid shut.

Dutifully Marissa went through the doors into a large, square room, furnished in a nondescript modern style. About thirty people were waiting. Marissa felt the stare of silent eyes as she self-consciously hurried to an empty seat at the end of a couch.

There was a view of the Charles River across a small green park. Silhouetted against the gray water were the leafless skeletons of the sycamore trees that lined the embankment.

By reflex, Marissa picked up one of the glossy-covered magazines from the side table and absently flipped through the pages. Surreptitiously she glanced over the top of the magazine and was relieved to see that the eyes of the other people in the room had gone back to their own magazines. The only sound was of pages being turned.

Marissa stole quick glances at some of the other women, wondering what they were there for. They all seemed so calm. Surely she couldn’t be the only one who was nervous.

Marissa tried to read an article on upcoming summer fashion trends, but she couldn’t concentrate. Her abnormal Pap smear seemed like a hint of internal betrayal: a warning of what was to come. At thirty-three years old, she had been having the barest exterior reminders of getting older, like the fine lines appearing at the outer corners of her eyes.

Focusing for the moment on the many ads that filled the women’s magazine in her hands, Marissa gazed at the faces of the sixteen- and seventeen-year-olds who populated them. Their youthful, blemish-free faces seemed to mock her and make her feel old beyond her years.

What if the biopsy was positive? What if she had cancer of the cervix? It was rare but not unknown in women her age. Suddenly the possibility bore down on Marissa with a crushing intensity. My God! she thought. If it was cancer, she might have to have a hysterectomy, and a hysterectomy would mean no children!

A dizzy feeling spread through Marissa, and the magazine in her hands momentarily blurred. At the same time her pulse began to race. The thought of not having children was anathema to her. She’d married only six months previously, and although she hadn’t planned on starting a family immediately, she had always known that children would eventually be a big part of her life. If it turned out that she could not have children, she hated to consider the consequences, both for herself and for her husband. And until that very moment, waiting for the biopsy that Dr. Carpenter said would be “a piece of cake,” she’d never given the possibility serious thought.

All at once Marissa felt hurt that Robert had not been more concerned and that he had taken her at her word when she’d said she’d be perfectly fine going to the clinic by herself. Looking around the room again, Marissa saw that most of the other patients were accompanied by their spouses or boyfriends.