“Are we ready?” a booming voice called.
Marissa lifted her head, raised heavy eyelids, and looked up at the bearded face of Dr. Wingate. Lying back, she tried to dissociate herself from her body to cope with her anxiety. Her mind wandered back to her visit to Dr. Ken Mueller in the department of pathology at the Memorial after her laparoscopy. The Women’s Clinic frequently sent some of their specimens to the Memorial to confirm their diagnoses. Marissa had been told that her fallopian tube biopsy had been forwarded there.
Hoping to maintain her anonymity, Marissa had searched for her slides herself. Shed knew that the Women’s Clinic used her social security number as her case number.
Once Marissa had the slides, she sought out Ken. They’d been friends since medical school. She asked him to look at the microscopic sections for her, but didn’t say they were hers.
“Very interesting,” Ken said after a brief scan of the first slide.
He sat back from the microscope.
“What can you tell me about the case?”
“Nothing,” Marissa said.
“I don’t want to influence you. Tell me what you see.”
“Sort of a quiz, huh?” Ken said with a smile.
“In a way,” Marissa said.
Ken went back to the microscope.
“My first guess is that it’s a section of fallopian tube. It looks as if it’s been totally destroyed by an infectious process.”
“Right on,” Marissa said with admiration.
“What can you say about the infection?”
For a few minutes Ken silently scanned the specimen. When he finally spoke, Marissa was stunned.
“TB!” he announced, folding his arms, “Tuberculosis?” Marissa almost fell off her chair. She’d expected nonspecific inflammation, never
TB.
“What makes you say that?” she asked.
“Look in the field,” Ken told her.
Marissa gazed into the scope.
“What you are looking at is a granuloma,” Ken said.
“It’s got giant cells and epithelioid cells, the sine qua non of a granuloma.
Not a lot of things cause granulomas. So you have to think of TB, sarcoid, and a handful of funguses. But you’d have to put TB at the head of the list for statistical reasons.”
Marissa felt weak. The idea that she had any of those diseases terrified her.
“Can you do any other stains to make a definitive diagnosis?”
Marissa asked.
“Sure,” Ken said.
“But it would help to have some history on the patient.”
“Okay,” Marissa. said.
“She’s a healthy Caucasian woman, mid-thirties, with a completely normal medical history. She presented with asymptomatic ally blocked fallopian tubes.”
Reliable historian?” Ken questioned as he chewed the inside of his lip.
“Completely,” Marissa said.
“Negative chest X-ray’,” “Completely normal.”
“Eye problems?”
“None.”
“Lymph nodes?”
“Negative,” Marissa said with emphasis.
“Except for the blocked tubes, the patient is completely normal and healthy.”
“GYN history normal?” Ken asked.
“Yup!” Marissa said.
“Well, that’s weird,” Ken admitted.
“TB gets to a fallopian tube via the bloodstream or the lymphatics. If it’s TB, then there has to be a nidus somewhere. And it doesn’t look like fungus without some hyphae or something. I’d still say TB is the leading contender. Anyway, I’ll do some additional stains…”
“Marissa!” called a voice, bringing Marissa back to the present.
She opened her eyes. It was Dr. Arthur.
“Dr. Wingate is about to inject the local anesthesia. We don’t want you to suddenly jump.”
Marissa nodded. Almost immediately she felt a number of points of stinging pain, but they faded quickly and she went back to her musing, remembering her panicked visit to an internist the same day that she’d seen Ken. But a complete work-up had failed to find anything wrong except for a positive PPD test, suggesting that she indeed had had
TB.
Although Ken tried numerous other tests on Marissa’s slide, he found no organisms, TB or otherwise. But he stuck by his original diagnosis of a tuberculous infection of the fallopian tube despite Marissa’s inability to explain how she could have picked up such a rare illness.
“Dr. Wingate!” a harried voice called. Marissa’s attention was again brought back to the present. She turned her head. Mrs.
Hargrave was at the ultrasound-room door.
“Can’t you see I’m busy, for chrissake?” Dr. Wingate snapped.