Робин Кук - Vital Signs

“You’re being ridiculous,” Marissa silently chided herself as she tried to keep her emotions in check. She was surprised and a little embarrassed. It was not like her to be so hysterical. She liked to think she wasn’t easily upset. Besides, she knew that Robert couldn’t have come with her even if he’d wanted to. That morning he had an important meeting of the executive staff of his health care management, investment, and research company. It was a critical meeting that had been planned months in advance.

“Marissa Blumenthal!” a nurse called.

Marissa jumped up, placed the magazine on the side table, and followed the nurse down a long, blank white corridor. She was shown into a changing room with an inner door opening into one of the procedure rooms. From her vantage point in the changing area, Marissa could see the table with its gleaming, stainless steel stirrups.

“Just to be on the safe side,” the nurse said as she twisted Marissa’s wrist to check her ID. Satisfied she had the right patient, she patted some clothes on a bench and added: “Slip into this johnny, slippers, and robe and hang your clothes in the closet. Any valuables can be locked in the drawer. When you’re done, go in and sit on the examining table.” She smiled. The woman was professional, but not without warmth. She closed the door to the hall behind her.

Marissa stepped out of her clothes. The floor was cold on her bare feet. As she struggled to tie the straps of the johnny behind her, she acknowledged how much she liked the staff at the Women’s Clinic, from the receptionists to her doctor. But the main reason she patronized the clinic was because of its private status and the consequent confidentiality it had to offer. Now that she was having a biopsy, she was even more thankful for her choice. Had she gone to any one of the major Boston hospitals, especially her own hospital, the Boston Memorial, she would have undoubtedly come in contact with people she knew.

Marissa had always been careful to keep her private life private. She never wanted personal matters like birth control, annual pelvic exams, a couple of episodes of cystitis and the like to be topics of gossip with her colleagues. And even if people didn’t talk, she did not want to worry about passing her GYN man in the hospital corridor or in the hospital cafeteria.

The flimsy robe, the open-backed hospital johnny, and the paper slip-on slippers completed Marissa’s transition from doctor to patient. With her ill-fitting slippers flopping, she padded into the procedure room and sat on the edge of the examining table as instructed by the nurse.

Glancing around at the usual accoutrements which included an anesthesia machine and cabinets of instruments, her panic swelled anew. Beyond her fear of the procedure, and the possible need for a hysterectomy she kept reminding herself was remote, Marissa now felt a strong intuition of disaster. She realized how much she had come to prize her life, particularly in the last few years. Between her new husband, Robert, and her recent acceptance into a fine pediatric group, her life seemed to be going almost too well. She had so much to lose; it made her terrified.

“Hello there, I’m Dr. Arthur,” a burly man said as he entered the room with a purposeful flourish, clutching a handful of cellophane-covered packages and an IV bottle. “I’m from anesthesia, and I’ll be giving you something for your upcoming procedure. Allergic to anything?”

“Nothing,” Marissa assured the man. She was glad for the company, relieved to have someone take her away from her own thoughts.

“We’ll probably not need this,” Dr. Arthur said as he deftly started an IV in Marissa’s right wrist. “But it’s good to have it just in case. If Dr. Carpenter needs more anesthesia, it can be given easily.”

“Why would he need more anesthesia?” Marissa asked nervously. She watched the droplets of fluid fall in the micropore filter. She’d never had an IV before.

“What if he decides to do a cone biopsy rather than a punch?” Dr. Arthur replied as he slowed the IV to a mere trickle. “Or if he decides to do any more extensive procedure? Obviously we’d have to give you something in addition. After all, we want this to be as pleasant as possible.”

Marissa shuddered at the term “more extensive procedure.” Before she could stop herself she blurted out, “I want to make it absolutely clear that I only signed a consent for a biopsy and not anything more extensive like a hysterectomy.”

Dr. Arthur laughed, then apologized for finding her reminder humorous. “No need to worry on that score,” he said. “We certainly don’t do hysterectomies in the minor procedure room.”

“What will you be giving me?” Marissa asked sheepishly.

“You want to know the specific drugs I’ll be using?” Dr. Arthur asked.

Marissa nodded. No one at the clinic knew she was a doctor, and Marissa preferred it that way. When she’d first signed up for the clinic’s services, she’d filled out a form which only asked for her employer. She’d listed the Boston Memorial since at the time she was taking a year of fellowship in pediatric endocrinology. The fact that she was a physician wasn’t a secret and if they asked her, she’d certainly have told them. But no one had asked, a fact she took as further confirmation of the kind of confidentiality she had come to expect of the clinic.

Dr. Arthur looked puzzled for a moment, shrugged, then replied. “I’ll be using a mixture of a small amount of Valium and a drug called ketamine.” He then cleaned up the remains of the IV paraphernalia. “It’s a good little cocktail. It’s great for pain, and it has the added appeal of occasionally providing a touch of amnesia.”

Marissa was aware of ketamine. It was used frequently at the Boston Memorial for dressing changes with burned children. But she wasn’t aware of its use in outpatient settings. When she mentioned this to Dr. Arthur, he smiled paternalistically.

“Been doing a little reading, huh?” he teased. Then he warned:

“Remember, a little knowledge is a dangerous thing. Actually, the outpatient environment is the most common use for the drug.” He stared at Marissa. “My, you do seem a little tense.”

“I’ve been trying to fight it,” Marissa admitted.

“I’ll give you a hand,” Dr. Arthur offered. “Let’s give you a little taste of Valium and ketamine right now.” He went to fetch a syringe from the cabinet. “This biopsy stuff is a piece of cake,” he called over his shoulder.

Marissa nodded without enthusiasm. She had already tired of the pastry metaphor. The fact was that she was nervous, and despite having felt a bit better when Dr. Arthur first appeared, now she felt decidedly worse. His offhand manner of referring to more extensive procedures had not left her feeling reassured. Again, her intuition began sending out alarms of imminent disaster. Marissa had to fight against the irrational urge to flee. “I’m a doctor,” she silently repeated to herself over and over again. “I shouldn’t be feeling like this.”

The door to the hall burst open. In swept Dr. Ronald Carpenter dressed in surgical scrubs which included a hat and a mask. With him was a woman also in scrub clothes although her mask was draped down over her chest.

Marissa recognized Dr. Carpenter immediately despite the mask. His bright, crystal-blue eyes and tanned skin were unmistakable. “This is only a biopsy?” Marissa questioned nervously. Dr. Carpenter was dressed for major surgery.

“Miss Blumenthal is nervous about having a hysterectomy,” Dr. Arthur explained, snapping the side of a needle to release the air bubbles. He returned to Marissa’s side.

“Hysterectomy?” Dr. Carpenter asked with obvious confusion. “What are you talking about?”