“I think you’d better have it looked at,” she said.
“You might even need a stitch. A butterfly, maybe,” Dr. Wingate said as he tipped Robert’s head back to get a better view of his lip.
“Come on, I’ll take you.”
“I don’t believe this,” Robert said with disgust, looking at the bloodstains on his handkerchief.
“It won’t take long,” Marissa urged.
“I’ll sign in and wait here.”
After a moment’s hesitation, Robert allowed himself to be led from the room.
Marissa watched the door close behind him. She could hardly blame Robert if this morning’s episode added to his reluctance to proceed with the infertility treatment.
Marissa was suddenly overwhelmed by a wave of doubt about her fourth attempt at in-vitro fertilization. Why should she dare hope to do any better this time around? A feeling of utter futility was beginning to bear down on her.
Sighing heavily, Marissa fought back new tears. Looking around the waiting room, she saw that the other patients had calmly retreated to the pages of their magazines. For some reason,
Marissa just couldn’t force herself back in step. Instead of approaching the receptionist to check in, she went over to an empty seat and practically fell into it. What was the use of undergoing the egg retrieval yet again if the failure was so certain?
Marissa let her head sink into her hands. She couldn’t remember ever feeling such overwhelming despair except when she’d been depressed at the end of her pediatric residency. That was when Roger Shulman had broken off their long-term relationship, an event that ultimately led her to the Centers for Disease Control.
Marissa’s mood sank lower as she remembered Roger. In late spring their relationship had still been going strong, but then out of the blue he had informed her he was going to UCLA fora fellowship in neurosurgery. He wanted to go alone. At the time she’d been shocked. Now she knew he was better off without her, barren as she was. She tried to shake the thought. This was crazy thinking, she told herself.
Marissa’s thoughts drifted back a year and a half, back to the time she and Robert decided to start their family. She could remember it well because they had celebrated their decision with a special weekend trip to Nantucket Island and a giddy toast with a good Cabernet Sauvignon.
Back then they both thought conceiving would take a matter of weeks, at the most a couple of months. Having always guarded so carefully against the possibility of becoming pregnant, it never occurred to her that conceiving might be a problem for her. But after about seven months, Marissa had begun to become concerned.
The approach of her period became a time of building anxiety, followed by depression upon its arrival. By ten months she and Robert realized that something was wrong. By a year they’d made the difficult decision to do something about it.
That’s when they’d gone to the Women’s Clinic to be seen and evaluated in the infertility department.
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 gi vena 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 para cervical 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 evena 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.
Marissa watched him go, lamenting the widening gulf separating them. Their ability to communicate, especially where their feelings were concerned, was reaching a new low.
“I’ll let Dr. Wingate know you’re here,” the receptionist said.
Marissa nodded. Slowly she walked back to her seat and sat down heavily. Nothing was working out. She wasn’t getting pregnant and her marriage was disintegrating before her eyes. She thought about all the business trips Robert had been taking of late. For the first time since she’d been married, Marissa wondered if he could be having an affair. Maybe that was the reason behind this sudden talk of not providing a sperm sample. Maybe he’d been giving samples out elsewhere.
“Mrs. Buchanan!” a nurse called from an open doorway, beckoning for Marissa. to follow her.
Marissa got to her feet. She recognized the nurse, Mrs. Hargrave.
“Are you ready to harvest those eggs?” the woman asked brightly as she got a robe, a Johnny, and slippers for Marissa. She had an English accent similar to Dr. Wingate’s. Marissa had asked her about it once. She’d been surprised to learn that Mrs.
Hargrave was Australian, not English.
“An egg retrieval is just about the last thing in the world I want to do just now,” Marissa admitted with dejection.
“I really don’t know why I’m putting myself through this.”
“Feeling a little depressed, are we?” Mrs. Hargrave asked as gently as she could.
Marissa didn’t answer. She merely sighed as she took the clothes from Mrs. Hargrave and started into the changing room.
Mrs. Hargrave reached out and touched her shoulder.
“Anything you’d like to talk about?”
Marissa gazed up into the woman’s face. There was warmth and sympathy in those gray-green eyes.
At first Marissa could only shake her head as she fought back tears.
“It’s common for emotional problems to burden people involved with in-vitro,” Mrs. Hargrave said.
“But it usually helps to talk about it. It’s been our experience that part of the problem is the isolation the couples feel.”
Marissa nodded in agreement. She and Robert had been isolated.
As the pressures mounted, they started avoiding friends, especially those with children.
“Has there been a problem between you and your husband?”
Mrs. Hargrave asked.
“I don’t mean to pry, but we truly have found it best for people to be open.”
Marissa nodded again. She looked at Mrs. Hargrave’s understanding face. She did want to talk, and with a few tears that she wiped away with the back of her hand, she told her about Robert’s initial refusal to cooperate that morning, and their consequent quarrel. She told Mrs. Hargrave she was beginning to think they would have to stop the infertility treatments.
“It’s been pure hell for me,” Marissa admitted.
“And for Robert.”
“I think it is safe to say that something would be wrong with you both if it weren’t,” Mrs. Hargrave said.
“It’s stressful for everyone, even the staff. But you’ve really got to learn to be more open. Talk to other couples. That will help you learn to talk to each other and to be aware of each other’s limitations.”
“We are ready for Mrs. Buchanan,” another nurse called through the door to the ultrasound room.
Mrs. Hargrave gave Marissa a comforting squeeze on her shoulder.
“You’d better get on with this,” she said.
“But afterwards
I’ll come back and we’ll talk some more. How about it?”
“Okay,” Marissa said, trying to muster some enthusiasm.
Fifteen minutes later, Marissa again found herself on her back in the ultrasound room, facing yet another painful and potentially risky procedure, She was lying supine with her legs straight out. In a few minutes her legs would be put up in the all-too familiar stirrups. Then there would be the disinfectant, followed by the local anesthetic. She cringed at the thought.
The room itself seemed scary. It was a cold, forbidding, futuristic environment filled with electronic instruments, some of which Marissa recognized and some she didn’t. Multiple cathode-ray screens were set into the instrumentation. Mercifully, the foot-long egg-retrieval needle was kept out of sight.
The nurse-technician who had brought Marissa into the room was busy with preparations for the procedure. Dr. Wingate, who performed most of the clinic’s infertility procedures including the in-vitro fertilization, had not yet arrived.