Робин Кук - Vital Signs

Marissa pointed to the statistics spelled out on the computer printout she was holding in her hands.

“That’s not so surprising,” Tristan said. “In every clinic, most patients have to go through several attempts before they conceive. What are you getting at?”

A knock on Cyrill’s door interrupted them before Marissa could reply. It was one of the technicians from the lab.

“We have the results on those ELISA tests,” she said.

“That was fast,” Cyrill commented.

“They were very positive,” she said. “Even at high dilutions.”

“All of them?” Cyrill asked incredulously.

“All of them,” the technician repeated.

“That’s the proof I wanted,” Marissa said. When she’d first arrived at the CDC, she’d gone directly to the lab to have some blood drawn. Then she’d made arrangements for her serum to be tested with the ELISA test for BCG along with Rebecca Ziegler’s and Evelyn Welles’ serums.

“I don’t understand,” Cyrill said. “How can that be?”

“I think it is rather clear,” Marissa said. “Evelyn Welles didn’t have tuberculosis. She had disseminated BCG bacillus.” Marissa reached for Welles’ hospital chart and opened it to her autopsy page. “Look,” she said, pointing to a description of the microscopic appearance of her fallopian tubes. “It says there was an intense, overwhelming infection in her oviducts. I’ll tell you why that was the case: the fallopian tubes were the port of entry of the BCG. The fact that it disseminated was because of her immunological problem. And look here at the description of her cervix. It describes a recent punched-out lesion. That had to be a biopsy site.” Marissa flipped through the chart until she came to the woman’s last Pap smear report. “Now look at this. The Pap smear was normal four weeks before. Does that make any sense to you men?”

“I think I’m beginning to get the picture,” Tristan said. “You’re suggesting that the twenty-three cases of TB salpingitis that I reported were actually BCG, not TB.”

“That’s exactly what I’m suggesting,” Marissa said. “I didn’t have TB salpingitis either. I had a deliberate inoculation with BCG vaccine. I think the basis of this whole mystery is nothing but business interest. A few years ago, Female Care Australia realized that they were sitting on a potential gold mine with their IVF technology. The only trouble was that their increased success was denying them income by lowering revenue. So they decided on two courses of action to ensure increased revenues. One was to create more demand. The only absolute indication for IVF is hopelessly blocked fallopian tubes. Someone found out that the rural Chinese doctors had been clever enough to develop a way of cannulating the fallopian tubes without the need for anesthesia. So they began bringing these doctors out of China to do just what they had been doing in China: sterilizing women. The trick was to sterilize without leaving evidence of it, or leaving evidence that could be misinterpreted. Someone must have come up with the BCG vaccine. It causes an intense immunologic reaction that seals the tubes totally and destroys the organisms in the process. That’s how BCG works. On biopsy, it looks like tuberculosis. There just aren’t any organisms. Obviously, they only tried this ploy on certain candidates. They chose only young, recently married, middle-class females. All they had to do was schedule these women for a minor procedure of some sort, like a cervical biopsy. I know that one ruse was to tell the patient that her Pap smear was CIN Grade #1. That’s how they got me and Wendy. Neither Wendy nor I had told the clinic we were physicians. If they had known, they probably wouldn’t have risked including us in the scheme. And they certainly didn’t know about Evelyn Welles’ immunological problem. And Rebecca Ziegler. She must have been clever enough to figure that something was wrong. I think they killed her and made it look like a suicide.

“The second part of the plan to maintain revenue was to make sure that the IVF wasn’t successful too quickly. At ten thousand dollars per cycle, you can see why they’d want to run their patients through as many cycles as possible. Yet ultimately, they wanted all their patients to conceive. That meant a better reputation for them. My guess is that to make failed cycles a certainty, they just added a drop or two of acid to the culture media after fertilization took place. Before my last egg transfer, I asked to see the zygotes. I remember the solution was crystal clear. The significance of the color didn’t dawn on me until just recently. The usual pH indicator in tissue culture media is phenol red, which turns clear in acid. My embryos were in acid. No wonder they didn’t implant.”

Cyrill cleared his throat. He looked at Marissa’s flushed and angry face. He could tell she was convinced, but unfortunately he didn’t share her conviction. He didn’t know quite what to say.

“I’m not sure...” he began.

“Not sure of what?” demanded Marissa. “Is it just too hard for you men to believe that women could be victimized to this extent?”

“It’s not that,” Cyrill said. “It’s just that it is too complicated. It represents too much effort, too much conspiracy. It’s just too diabolical.”

“It’s diabolical, all right,” Marissa agreed, “but let’s be clear about the motivation. This is about profit, pure and simple. I’m talking about big money. Look!” Marissa stood up and went to a small blackboard that Cyrill had in his office. Picking up a piece of chalk, she wrote down 600,000. “This is the number of couples in the U.S. that fertility specialists estimate need IVF if they want to have a child that is genetically theirs. If we multiply that by fifty thousand dollars we get thirty billion dollars. That’s billion. Not thirty million, thirty billion. And that’s just in the United States. IVF could rival the world’s illegal drug industry as a money-maker. Admittedly not all of the six hundred thousand are middle class, and not all could come up with the money necessary. But that is why FCA has gone to such lengths to create their own market.”

“My God!” Cyrill said. “I never imagined there was that kind of money involved.”

“Most people don’t,” Marissa said. “The whole infertility industry is totally unregulated and unsupervised. It’s grown up in a no-man’s land between medicine and business. And the government has just looked the other way. Anything to do with reproduction is politically dangerous.”

“But such a conspiracy would require so many people,” Tristan said.

“Not that many,” Marissa said. “Maybe just one per clinic. At this point, I’m not about to hazard any guess as to the conspiracy’s actual organizational design.”

“And I was so sure drugs were at the heart of it,” Tristan said.

“They still might be involved, only indirectly,” Marissa said.

“It will be interesting to see exactly how Fertility, Limited, came up with the staggering amount of capital they would have needed to expand as rapidly as they did across three continents. I have a suspicion that their stock offerings were only clever ruses. I wouldn’t be surprised if they’re tied up with the Wing Sin for ventures besides smuggling pairs of men out of the PRC. Fertility, Limited, could launder money from the Golden Triangle heroin for the Wing Sin. At least it’s a possibility.”

“If this is all true,” Cyrill said, “then it will take a massive effort with international cooperation to break it.”

“Precisely,” Marissa said. “That’s where the CDC comes in. I think that the Attorney General’s office and the State Department have to be alerted simultaneously. If this conspiracy is to be broken, it will take their combined power, and I think they will listen to the CDC. I can tell you it won’t be easy. Any organization that is as big and as wealthy as Fertility, Limited, and its subsidiaries will have significant political clout.”