Robin Cook – Vital Signs

The other topic on her mind was what she and Wendy were going to do about the Women’s Clinic. They had to get into their records. That morning she’d gone to the medical records department at the Memorial and gotten one of the women to start a search for cases of granulomatous obstruction of the fallopian tubes. There’d been no problem. If only the Women’s Clinic could be so cooperative.

“Dr. Blumenthal, you have a call on line three,” Muriel yelled to her over the sound of crying babies.

“What now?” Marissa muttered under her breath. She went into an empty examination cubicle and picked up the extension.

“Yes?” she snapped, expecting Mindy Valdanus to be on the other end.

“Dr. Blumenthal?” a strange woman’s voice questioned. It was the operator.

“Yes?” Marissa repeated.

“Go ahead,” the operator said.

“You sound harried,” Dubchek said.

“Cyrill!” Marissa answered.

“You’re a pleasant surprise in the middle of a bad day. This place is a zoo!”

“Can you talk for a see or do you want to ring me back?”

Dubchek asked.

“I can talk,” Marissa said.

“Actually, at the moment I’m standing and waiting for a nurse before I look at a child with an ear infection. So you got me at a good time. What’s up?”

“I’m finally getting back to you on those questions you raised about TB salpingitis,” Dubchek said.

“Well, I have some interesting news. There have been sporadic reports of a condition that’s consistent with TB salpingitis from all around the country, although mostly on the West and East coasts.”

“Really!” Marissa exclaimed. She was astounded.

“Has anybody been able to culture it?”

“No,” Dubchek said.

“But that’s not unusual. Remember, it’s hard to culture TB. In fact, no one has, to my knowledge, seen an actual organism in any of these cases.”

“Now that’s strange,” Marissa said.

“Yes and no,” Dubchek said.

“It’s frequently hard to find the TB bug in tuberculosis granuloma. At least that’s what my bacteriology colleagues tell me. So don’t make too much of that either.

What’s more important, from an epiderniologic: point of view, is that there are no areas of concentration. The cases seem to be widely scattered and unrelated.”

“I now have five cases in Boston,” Marissa said.

“Then Boston gets the prize,” Dubchek said.

“San Fran is second with four. But no one has actually looked into it. There have been no studies launched, so these cases represent haphazard reporting. If somebody looked, he’d probably find more.

Anyway, I’ve got a few people checking into it here at the Center.

I’ll be back to you if anything interesting turns up.”

“The five cases I’ve come across are all at one clinic,” Marissa said.

“I’ve started to search at the Memorial just this morning.

What I’d really like to do is get access to the clinic’s records.

Unfortunately they turned me down. Could the CDC help?”

“I don’t see how,” Dubchek said.

“It would take a court order, and with the paucity of details and low danger level to society, I doubt seriously a judge would grant it.”

“Let me know if you hear anything else,” Marissa said.

“Will do.”

Marissa hung up the phone and leaned against the wall. The idea that tuberculous granuloma of the fallopian tube had been reported from around the country made her more curious than ever. There had to be some interesting epidemiological explanation behind it. And by a quirk of fate, not only was she suffering from the illness herself, she was part of what was the largest concentration. She had to get into the clinic’s records. She had to find more cases if there were more to find.

“Dr. Blumenthal,” Muriel said, stepping into the room, “I don’t have anybody to help you at the moment, but I can myself”

“Wonderful,” Marissa said.

“Let’s go to it.”

The sliding glass door opened automatically as Marissa strode into the lobby level of the Massachusetts Eye and Ear Infirmary.

Despite the cool late-afternoon temperature she had on only her thin doctor’s white jacket. After a quick inquiry at the information booth, she veered right into the emergency area. She asked for Dr. Wilson at the emergency desk.

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