“Then we’ll have tonight’s guest give her talk. We are honored to have with us Dr. Alice Mortland from Columbia Medical Center in New York. She will be talking to us about the newest aspects of GIFT, or Gamete Intra-Fallopian Transfer.”
Marissa looked at Wendy.
“Are you interested in the lecture?” she asked.
“Not in the slightest,” Wendy said.
“With both my fallopian tubes stopped up, GIFT can’t help.”
“Holy Toledo!” Marissa exclaimed.
“I’ve got the same problem: sealed tubes.”
“My word,” Wendy said with a short laugh of disbelief.
“What are we, identical twins? Let’s pretend we’re in medical school and skip the lecture. We could sneak down to hat bar with he Cheers flag and catch up.”
“Will we offend the hostess?” Marissa asked.
“Not Susan,” Wendy assured her.
“She’ll understand.”
Ten minutes later, Marissa and Wendy were seated opposite each other in low-slung vinyl chairs. They were at a large mullioned window that looked out on busy Beacon Street with the darkened Boston Garden beyond. In the light of the lamps, the grass was just starting to become green, one of the first signs of spring.
Both women ordered mineral water and laughed at each other.
“No alcohol! Well, hope springs eternal,” Wendy said.
“I had my fourth embryo transfer about a week ago,” Marissa admitted.
“Another coincidence,” Wendy said.
“So did I. Only mine was my second. What program are you involved with?”
“Women’s Clinic in Cambridge,” Marissa said.
“I don’t believe this,” Wendy said.
“I’m there as well. Dr.
Wingate?”
“Yup!” Marissa said.
“Dr. Carpenter is my regular GYN man.
I have Dr. Wingate for in-vitro fertilization.”
“I go to Megan Carter,” Wendy said.
“I’ve always preferred a woman gynecologist. But I had to go to Wingate since he runs the IVF show.”
“It’s amazing we haven’t run into each other,” Marissa said.
“But then again, they are very good about the confidentiality side of things, which is one of the reasons I started using the clinic in the first place.”
“My feelings too,” Wendy said.
“I could have gone to someone at the General, but I wasn’t comfortable with that.”
“Was it a shock to you when you discovered your fallopian tubes were sealed?” Marissa asked.
“Completely,” Wendy said.
“I’d never expected it. It was ironic, I thought, considering all the birth control precautions I took all through college and med school. Now I can’t remember what it was like not to want a child.”
“I feel the same way,” said Marissa.
“But I was even more surprised to learn the cause was TB salpingitis.”
Wendy slammed her mineral water to the table.
“These coincidences are getting spooky,” she said.
“I had the same diagnosisgranulornatous reaction consistent with tuberculosis. I even had a positive PPD skin test.”
For almost a full minute the two women stared at each other over the table. This was too much of a coincidence to be believed.
With her epidemiologic training, Marissa was instantly suspicious.
The parallels in their cases were extraordinary. And the only time their lives intersected was during medical school.
“Are you thinking what I’m thinking?” Wendy asked.
“Probably,” Marissa said.
“I’m wondering about those months we spent on that elective rotation at Bellevue. Remember those TB cases we saw, especially the drug-resistant ones? Remember they were thinking that there was an upswing in TBT’ “How could I forget?”
“Luckily my chest X-ray is perfectly clear,” Marissa said.
“So’s mine,” Wendy said.
“I wonder if we are isolated cases or part of a bigger pattern.
TB salpingitis is supposed to be rare, especially in a healthy nation like the United States.” She shook her head. It didn’t make sense.
“Why don’t we go back to the Resolve meeting and ask if there is anybody else with the same diagnosis?” Wendy suggested.
“Are you serious? The chances are so small, they’d be negligible.”
“I’m still curious,” Wendy said.
“Come on, it’s close and we have a captive audience.”
As they walked back toward Acorn Street, Marissa broached the subject of her marital situation. It was hard for her to talk about it, but she felt the need to discuss it with someone. She told Wendy that she and Robert were having serious problems.
“He’s taken to sleeping in the guest room,” Marissa. confided.
“And he refuses to see a therapist. He says he doesn’t need someone to tell him why he’s unhappy.”
“A lot of us infer tiles have marriage problems,” Wendy said.
“Especially those of us in in-vitro. It seems to go with the territory.
Of course everybody deals with it differently. My husband, Gustave, has just transferred what little attention he used to give me to his work. He’s always at the hospital. I practically never see him.”
“Robert’s doing that more and more,” Marissa said.
“Unless one of these embryos implants, I’m not all that optimistic we’ll be able to weather the storm.”
“You’ve come back!” Susan cried when she opened the door for Marissa and Wendy.
“Just in time for dessert.”
Wendy told Susan what they wanted to do. Susan took their coats, then preceded them into the living room, where guests were busily conversing in small groups as they ate chocolatt cake.
“Can I have everyone’s attention for one last time,” Susan called out. She explained that Wendy had some questions for them.
Positioning herself in the middle of the room, Wendy introduced herself in case there was anyone who wasn’t aware that she was a doctor. She then asked how many of the women present had blocked fallopian tubes as the cause of their infertility.
Three people raised their hands.
Looking at these three women, Wendy asked: “Have any of you been told that your tubes were sealed by tuberculosis or what looked like TB under the microscope?”
Each made a questioning gesture, raising their eyebrows. They weren’t sure.
“Have any of you been advised to take a drug called isoniazid or INHT’ Marissa asked.
“It would have been suggested that you take it for months.”
Two of the women raised their hands. Both said that they had been sent to their internists after their laparoscopies and that a drug was mentioned that they’d have to take for an extended period of time. In both instances, however, the drug was not given, and they’d been told to come back every three months.
Marissa wrote down their names and phone numbers: Marcia Lyons and Catherine Zolk. Both promised to inquire with their family doctors to find out for certain if the drug had been isoniazid.
Utterly astonished, Marissa took Wendy aside.
“This is unbelievable.
I think we have four cases. But if these two women had TB, then our medical school rotation at Bellevue is off the hook.”
“Four cases doesn’t make a series,” Wendy cautioned.
“But it is mighty suspicious,” Marissa. said.
“Four cases of a rare disease in one geographical area. Besides, it sounds as if none of us has any signs of infection elsewhere. I think we are on to something. I’m going to follow up on it,” Marissa vowed.
“Let’s do it together,” Wendy suggested.
“Wonderful,” Marissa agreed.
“The first step will be to take advantage of my contacts at the CDC. We can start that tonight.
Where is your car?”
“It’s over at the Mass. Eye and Ear Infirmary,” Wendy said.
“Mine’s closer,” Marissa said.
“I’ll drive you to yours and you can follow me home. You game?”
“I’m game,” Wendy said.
Saying their goodbyes and thanking their hostess, Marissa suddenly had an idea. She asked Susan if she knew the cause of Rebecca Ziegler’s infertility.
“I think it was blocked tubes,” Susan said after thinking for a moment.
“I can’t be sure, but I believe that’s what it was.”
“Do you happen to have her phone number?” Marissa asked.
“I believe I do,” Susan said.
“Would you mind giving it to me?” Marissa asked.
Susan got the number from her study and gave it to Marissa.
“You aren’t going to call Rebecca’s husband, are you?”
Wendy asked when they got to the street.
“The poor man is probably in shock.”
“I will if I have the courage,” Marissa said.
“Besides, I was told they’d separated.”
“As if that would make much difference,” Wendy said.
“If anything, I would think that would make him feel worse, even responsible.”
Marissa nodded.
On the drive home, Marissa’s excitement rose. Four cases of isolated TB salpingitis took her case out of the realm of anomaly and suggested a possible trend of public health importance.
Marissa pulled directly into the garage, then exited through the garage door to meet Wendy, who’d parked in the driveway. They entered the house through the front door.
“Nice house,” Wendy said as she followed Marissa down a corridor into her study.
“Think so?” Marissa said without enthusiasm.
“It had been Robert’s house before we were married. To tell you the truth, I’ve never liked it.”
Marissa went straight to her Rolodex for Cyrill Dubchek’s home telephone number.
“I’m calling one of the CDC department heads,” Marissa explained.
“We were involved for a little while during my last year at the CDC. He’s quite an attractive man.”
Marissa found the number and propped the file open with a letter opener.
“Didn’t work out?” Wendy asked.
Marissa shook her head.
“It was a stormy relationship from the start. The ironic part is that our major disagreement was over children. He’d had several before his wife died. He wasn’t interested in any more. Obviously that was before I knew about my fallopian tubes.”
Marissa punched the number on her telephone, then waited for the connection to go through.
“It’s quite a story,” she said.
“We were at loggerheads during my first couple of months at the center. Then there was romance. At the end we’d evolved into being good friends. Life is unpredictable.”
Wendy started to say something, but Marissa hushed her with a raised hand, indicating Cyrill had answered.
The first part of the call was friendly chitchat. Finally Marissa got around to the reason for her call.
“Cyrill,” she said, “I have a doctor friend sitting with me and I’m going to put you on the speakerphone.” Marissa pushed the appropriate button.
“Can you hear me?”
Cyrill’s voice filled the room as he responded in the affirmative.
Marissa got to the point.
“Have you heard any talk around the center of TB salpingitis, like a relatively recent upswing in cases?”
“Not that I can recall offhand,” Cyrill said.
“My do you ask?”
“I have reason to believe that there are four such cases up here in Boston. All in relatively young women, and all without any apparent nidus of infection elsewhere, particularly nothing in the lungs.”
“What do you mean by ‘relatively young women’T’ Cyrill asked.
“Late twenties, early to mid-thirties,” Marissa answered.
“That’s a little old for a pediatrician to be treating,” Cyril] said.
“How have these cases come to your attention?”
Marissa smiled.
“I should have known I couldn’t be cagey with you, Cyrill,” she said.
“The fact of the matter is that I’m one of the infected. I’ve been involved with in-vitro fertilization for almost a year. Tonight I discovered three other women with the same unusual diagnosis.”
“I’m sorry to hear about your troubles,” Cyrill said.