Робин Кук - Vital Signs

Robert’s sperm analysis had been the first hurdle, but he passed with flying colors. Marissa’s first tests were more complicated, involving X-ray study of her uterus and fallopian tubes.

As a physician Marissa knew a little about the test. She’d even seen some pictures of the X-rays in textbooks. But photographs in books had been no preparation for the actual experience. She could remember the test as if it had been yesterday.

“Scoot down a little farther,” Dr. Tolentino, the radiologist, had said. He was adjusting the huge X-ray fluoroscopy unit over Marissa’s lower abdomen. There was a light in the machine, projecting a grid onto her body.

Marissa wriggled farther down on the rock-hard X-ray table.

An IV was hooked into her right arm. She’d been given a bit of Valium and was feeling lightheaded. In spite of herself she was mildly apprehensive that she might suffer a second drug-induced nightmare.

“Okay!” Dr. Tolentino said. “Perfect.” The grid was centered just south of her umbilicus. Dr. Tolentino threw a few electrical switches and the cathode tube monitor of the fluoroscopy unit gave off a light-gray glow. Going to the door, Dr. Tolentino called for Dr. Carpenter.

Dr. Carpenter entered along with a nurse. The two of them were wearing the same sort of heavy lead apron Dr. Tolentino had on to shield his body from ambient radiation. Seeing such heavy protective gear made Marissa feel all the more exposed and vulnerable.

Marissa could feel her legs being lifted and parted to be placed in stirrups. Then the end of the table dropped away so that her backside was perched on the very edge.

“You’ll feel the speculum now,” Dr. Carpenter warned.

Marissa clenched her teeth as she felt the instrument slip inside of her and spread.

“Now you are going to feel a prick,” Dr. Carpenter said. “I’m going to put in the local anesthetic.”

Marissa bit her lip in anticipation. True to Dr. Carpenter’s warning, she felt a sharp stab localized somewhere in her lower back.

“And again,” Dr. Carpenter said.

He injected her in several locations, explaining to her that he was giving her a paracervical block to anesthetize the cervix.

Marissa breathed out. She hadn’t realized she’d been holding her breath. All she wanted at that moment was for the study to be over.

“Just a few minutes more,” Dr. Carpenter said as if reading her mind.

In her mind’s eye Marissa could see the long, scissor-shaped instrument with its jaws shaped like two opposing fangs. She knew those fangs were about to bite through the delicate tissue of her cervix.

But Marissa felt no pain when she heard the sharp metallic sound of the instrument handles lock, just a sensation of pressure and a pulling. She could hear Dr. Carpenter talk to both the nurse and Dr. Tolentino. She heard the X-ray machine go on and could just barely see part of an image that had appeared on the fluoroscopy screen.

“Okay! Marissa,” Dr. Carpenter said, “as I explained earlier, the Jarcho cannula is now in place and I’m about to inject the dye. You’ll probably feel this a bit.”

Marissa held her breath again, and this time the pain came. It was like a severe cramp that built to the point that she could not keep from moving.

“Hold still!” Dr. Carpenter commanded.

“I can’t,” Marissa moaned. Just when she thought she couldn’t bear the pain for a moment longer, it abated. She let her breath out with relief.

“The dye didn’t go anyplace,” Dr. Carpenter said with surprise.

“Let me take a spot film,” Dr. Tolentino said. “I think I can just make out the dead ends of the tubes here and here.” He was pointing at the screen with a pencil.

“Okay,” Dr. Carpenter said. He then told Marissa they were going to take an X-ray and for her to stay still.

“What’s wrong?” Marissa asked with concern. But Dr. Carpenter ignored her or didn’t hear. All three people disappeared behind the screen. Marissa looked up at the huge machine suspended over her.

“Don’t move,” Dr. Tolentino called out.

Marissa heard a click and a slight buzz. She knew that her body had just been bombarded by millions of tiny X-rays.

“We are going to try again,” Dr. Carpenter said as he returned. “This might hurt a little more.”

Marissa gripped the sides of the X-ray table.

The pain that followed was the worst she’d ever experienced. It was like a knife thrust into her lower back and twisted. When it was over she looked at the three people grouped around the fluoroscopy screen.

“What did you find?” Marissa questioned. She could tell from Dr. Carpenter’s face that something was abnormal.

“At least we know now why you haven’t been making babies,” he said solemnly. “I couldn’t get dye into either of your tubes. And I really pushed — as you probably felt. Both of them seem to be sealed as tight as a drum.”

“How could that be?” Marissa asked with alarm.

Dr. Carpenter shrugged. “We’ll have to look into that. Probably you had some infection. You don’t remember anything, do you?”

“No!” Marissa said. “I don’t think so.”

“Sometimes we can find the cause of blocked tubes and sometimes we can’t,” Dr. Carpenter said. “Sometimes even a high fever as a child can damage them.” He shrugged and patted her on the arm. “We’ll look into it.”

“What’s the next step?” Marissa asked anxiously. She already felt guilty enough about being infertile. This puzzling discovery about her tubes made her wonder if she could have picked up anything from one of her former lovers. She had never been loose, not by any stretch of the imagination, but she’d had sex, especially with Roger. Could Roger have given her something? Marissa’s stomach was in knots.

“I’m not sure this is the time to talk about strategy,” Dr. Carpenter said. “But we’ll probably recommend a laparoscopy and perhaps even a biopsy. There’s always the chance that the problem is amenable to microsurgery. If that doesn’t work or isn’t feasible, there’s always in-vitro fertilization...”

“Marissa!” Robert called harshly, abruptly bringing Marissa back to the present.

She lifted her face. Robert was standing in front of her.

“What are you doing?” Robert asked, his frustration all too apparent. “I asked after you and the receptionist said you hadn’t even checked in.”

Marissa got to her feet. Robert was looking at his watch. “Come on!” he said as he turned and headed over to the receptionist’s desk. Marissa followed. She gazed at the sign behind the desk. That was the one that said: YOU ONLY FAIL WHEN YOU GIVE UP TRYING.

“I’m sorry,” the receptionist said, “with all the excitement, I’ve been in a dither. It didn’t dawn on me that Mrs. Buchanan hadn’t checked in.”

“Please!” Robert said. “Just let the doctors know she is here.”

“Certainly!” the receptionist said. She stood up. “But first I want to thank you for your help earlier, Mr. Buchanan. I think that woman was about to attack me. I hope you weren’t hurt badly.”

“Only two stitches,” Robert said, mellowing to a degree. “I’m fine.” Robert then lowered his voice and, after a furtive glance around the waiting room, asked: “Could you give me one of those, errrr... plastic containers?”

“Of course,” the receptionist said. She bent down and opened a file drawer. She produced a small, graduated, red-topped plastic container and handed it over. Robert palmed it.

“Ah... this will make it all worthwhile,” Robert whispered sarcastically to Marissa. Without a second glance at his wife, he strode off toward one of the doors leading into a series of cubicle-like dressing rooms.