Robin Cook - Foreign Body

Jennifer slammed the locker closed, and as she ran for the door, she put her phone on vibrate and slipped it into her scrub pants pocket along with the safety pin and the key. She was truly worried. Being late was not the way to begin a new rotation, especially with a compulsive surgeon, and from her experience in third-year surgery, they were all compulsive.

October 15, 2007

Monday, 11:05 a.m.

New York, USA

(Simultaneous with Jennifer’s Being Chided for Being Late by Her New Preceptor)

“Can you see them?” Dr. Shirley Schoener asked. Dr. Schoener was a gynecologist who had specialized in infertility. Although she’d never admitted it, she’d gone into medicine as a way of superstitiously dealing with her fear of disease, and she went into infertility for fear of suffering it herself. And it had worked on both fronts. She was currently healthy and had two great kids. She also had a thriving practice, as her statistics for successful pregnancies were superb.

“I suppose,” Dr. Laurie Montgomery said. Laurie was a medical examiner who worked at the Office of the Chief Medical Examiner for the city of New York. At forty-three, she was a contemporary of Dr. Schoener’s. They’d gone to medical school together and had even been friends and classmates. The difference between them, other than their professional specialties, was that Shirley had married relatively early — at age thirty, just after completing her residency — and kids had come in due course, with Shirley popping out one after the other. Laurie had waited until age forty-one, two years ago, before marrying a fellow medical examiner, Jack Stapleton, and stopping what she’d come to call the “goalie,” which was a euphemism for various methods of contraception she’d employed over the years. Without contraception, Laurie had assumed that she would promptly become pregnant with the child she always knew she would have. After all, she had mistakenly become pregnant while relying on the rhythm method by merely cutting things a bit too close. Unfortunately, the pregnancy turned out to be ectopic and had to be terminated. But now that conception was supposed to happen, it hadn’t, and after the requisite year of unprotected “goalie”-free sex, she’d come to the unpleasant conclusion that she had to face reality and be proactive. At that point she’d contacted her old friend Shirley and started treatments.

The first stage had involved finding out if there was something wrong anatomically or physiologically with either Jack or herself. The answer had turned out to be no. It had been the only time in her life that she’d hoped medical tests would find something wrong so it could be fixed. They did find, as was expected, that one of her fallopian tubes was nonfunctional from her ectopic pregnancy, but the remaining fallopian tube and its apparent function were entirely normal. Everyone felt one tube shouldn’t have been a problem.

At that point Laurie had tried the drug Clomid along with intrauterine insemination, whose old name, artificial insemination, had been changed to make it sound less unnatural. After the requisite Clomid cycle attempts, all of which were unsuccessful, they’d gone on to the follicular-stimulating hormone injections. Laurie had now begun her third cycle of injections, and if this was unsuccessful, as the two earlier ones had been, Laurie was scheduled for in vitro fertilization as the last hope. Consequently, she was understandably on edge and even a touch clinically depressed. She had never guessed how stressful infertility treatments were going to be or the emotional burden they were going to entail. She was frustrated, let down, angry, and exhausted. It was as if her body was toying with her after she had made so much effort over so many years not to get pregnant.

“I don’t know why you can’t see them,” Dr. Schoener said. “The follicles are very apparent, at least four of them, and they look terrific. They are a good size: not too big, not too small.” Grabbing the ultrasound screen with her free hand, she turned it forcibly to make it more perpendicular to Laurie’s line of sight. She then pointed to each follicle in turn. With her right hand under a modesty sheet, she was directing the ultrasound wand into the left vertex of Laurie’s vagina.

“Okay, I see them,” Laurie said. She was propped up on the examining table with her feet in stirrups and her legs apart. The first time she’d experienced a fertility-style ultrasound she’d been mildly taken aback, since she’d expected the sensor to be placed externally on her abdomen. But now, having had the procedure every couple of days through the first half of five cycles, she took it in stride. It was mildly uncomfortable but certainly not painful. The biggest problem was that she found it humiliating, but then again, she found the whole infertility rigmarole humiliating.

“Do they look any better than they have in earlier cycles?” Laurie asked. She needed encouragement.

“Not remarkably,” Dr. Schoener admitted. “But what I particularly like is that the majority in this cycle are in the left ovary rather than in the right. Remember, it’s your left oviduct that is patent.”

“Do you think that’s going to make a difference?”

“Am I detecting some negativity here?” Dr. Schoener said, as she removed the wand and pushed the ultrasound screen out of Laurie’s way.

Laurie let out a short mocking laugh while she removed her feet from the stirrups, swung her legs over the side of the exam table, and sat up. She was clutching the sheet around her midsection.

“You have to stay positive,” Dr. Schoener went on. “Are you having some hormonal symptoms?”

Laurie repeated her sham laugh with a touch more forcefulness. She also rolled her eyes. “When I started all this, I promised myself I wouldn’t let it get to me. Was I wrong! You should have heard me yesterday bawl out an octogenarian who tried to cut in front of me at the checkout line at Whole Foods. As the saying goes, it would have made a sailor blush.”

“How about headaches?”

“Those, too.”

“Hot flashes?”

“The whole shebang. And what bothers me the most is Jack. He acts like he’s not even part of this. Every time I get my period and feel crushed that I’m not pregnant, he just blithely says, ‘Well, maybe next month,’ and goes about his business. I feel like hitting him over the head with a frying pan.”

“He does want children, doesn’t he?” Dr. Schoener asked.

“Well, to be truthful, he’s probably going through this mostly on my behalf, although once we have them, if we have them, he’ll be the world’s greatest dad. I’m convinced. Jack’s problem in this regard is that he had two lovely daughters with his late wife, but the wife and the kids were all tragically killed in a commuter plane crash. He suffered so he’s afraid of making himself vulnerable again. It was even hard to get him to commit to marriage.”

“I didn’t know,” Dr. Schoener said, with true sympathy.

“Very few people know. Jack’s not forthcoming with his personal emotional issues.”

“There’s nothing strange about that,” Dr. Schoener said, as she snatched up the paper debris from the ultrasound test and stuffed it into the wastebasket. “Unless the male is demonstrably the source of the infertility, which he then takes very seriously, he deals with infertility and its treatment very differently than a woman.”

“I know, I know,” Laurie said insistently. She stood up, still keeping the sheet wrapped around her. “I know it, but it still bugs me that he doesn’t act more committed and understanding of what I’m going through. All this ain’t easy by any stretch of the imagination, especially with the threat of hyperstimulation hanging over my head. The trouble is as a doctor I know what to be afraid of.”