Marissa had half a mind to go after him. Maybe she should try to communicate with him. Then she shook her head. She knew she could never make him understand, let alone share in her concern for the incidence of TB salpingitis. With a sigh, Marissa sat down on the love seat and began reading the article that Cyrill had given her. He was right; it was a good article.
The twenty-three cases of TB salpingitis had been seen at a Brisbane clinic that sounded similar to the Women’s Clinic. The name of the clinic was Female Care Australia, FCA for short.
Similar to the five cases Marissa knew in Boston, all the patients in the Australian series were in their twenties and early thirties.
They were middle class and married. All except one was Caucasian.
The exception was a Chinese woman of thirty-one who’d recently emigrated from Hong Kong.
The ring of the phone startled her, but she kept reading, deciding it was probably for Robert anyway.
Reading on in the article, Marissa noted that the diagnosis had been made by the histology of fallopian tube biopsy alone since no organisms had been seen or cultured. Chest X-rays and blood work had ruled out fungi and sarcoid.
In the discussion portion of the paper the author hypothesized that the problem was arising from the influx of immigrants from Southeast Asia, but he didn’t elaborate on any possible mechanism.
“Marissa!” Robert shouted.
“The phone is for you! Cyrill Dubchek!”
Marissa grabbed the phone.
“Sorry to bother you so late,” Cyrill said, “But when I returned to the CDC I got some additional information you might find interesting.”
“Oh?” Marissa said.
“These TB salpingitis cases aren’t confined to the U.S. or Australia,” Cyrill said.
“They have been showing up in Western Europe as well, with the same wide distribution pattern. There have been no clusters like the one in Brisbane. Apparently there have been no reported cases as yet in South America or in Africa.
I don’t know what to make of this, but there you have it. If I hear any more, I’ll call ASAP. But now you’ve got my interest. Let me know if you begin to develop any theories.”
Marissa thanked him again for calling and they said their goodbyes. This new bit of information was extremely significant.
It meant that the incidence of TB salpingitis could no longer be dismissed as a statistical fluke. It was occurring on an international scale. Even Cyrill’s curiosity was now piqued. For the moment Marissa forgot her grief, anger, and exhaustion.
Marissa considered the possibilities. Could TB have somehow mutated to become a venereal disease? Could it have become a silent infection in the male like some cases of chlarnydia or mycoplasma?
Should she insist that Robert be checked? Could Robert have picked it up somehow on one of his many business trips?
Marissa didn’t like this line of thinking, but she had to remain scientific.
Reaching for the telephone, Marissa called Wendy. Gustave answered.
“Unfortunately she’s not taking calls,” Gustave said.
“I understand,” Marissa said.
“Whenever it is appropriate, tell her I’ve called and ask her to call me back as soon as she feels up to it.”
“I’m worried about her,” Gustave confided.
“I’ve never seen her this depressed. I don’t know what to do.”
“Do you think she would see me if I came over?” Marissa asked.
“I think there is a chance,” Gustave said. His tone was encouraging.
“I’ll be right over,” Marissa said.
“Thanks, I really appreciate it. I know Wendy will too.”
Marissa got her coat from the laundry room and went out to her car in the garage. As she was about to get in, Robert appeared.
“Where do you think you are going at this hour?” he demanded.
“Wendy’s,” Marissa said, pushing the automatic garage-door opener.
“At least her husband is concerned about her.”
“What’s that supposed to mean?” Robert demanded.
“If you don’t know,” Marissa said, getting into her car, “I doubt if anybody could tell you.”
Marissa backed out of the garage and lowered the door. She shook her head in dismay at how far her relationship with Robert had fallen.
It only took fifteen minutes to drive to Wendy’s Victorian house. Gustave had clearly been waiting for her. He opened the door before she had a chance to ring the bell.
“I’m truly grateful for your coming out at this hour,” Gustave said. He took her coat.
“Glad to,” Marissa said.
“Where’s Wendy?”
“She’s upstairs in the bedroom. Top of the stairs, second door on the right. Can I get you anything? Coffee, tea?”
Marissa shook her head and climbed the stairs.
At the bedroom door, Marissa paused to listen. There were no sounds coming from within. She knocked lightly. When there was no answer, she called out Wendy’s name.
The door opened almost immediately.
“Marissa!” Wendy said with true surprise.
“What are you doing here?” She was dressed in a white terrycloth robe and bedroom slippers. Her eyes were still sunken and red, but otherwise she appeared better than she had in the courthouse that morning.
“Gustave said you weren’t taking any calls. He also said that he was worried about you. Really worried. He encouraged me to come over.”
“Oh, for goodness’ sake,” Wendy said.
“I’m not that bad off.
Sure I’m depressed, but part of it is I’m mad at him. He wants me to be thankful for what he calls the Women’s Clinic’s magnanimity.”
“Robert feels the same way,” Marissa said.
“I think it was a cover-up maneuver,” Wendy said.
“I agree!”
“What about your pregnancy test?” Wendy asked.
“Don’t ask,” Marissa said. She shook her head.
“How about something to drink?” Wendy difered.
“Coffee or tea? Or hell, since we’re not pregnant, how about a glass of wine?”
“That sounds wonderful,” Marissa admitted.
The two women descended to the kitchen. Gustave appeared but Wendy sent him away.
“He was really concerned,” Marissa said.
“Oh, let him suffer a bit,” Wendy said.
“This afternoon I was mad enough to have a go at him with one of those foot-long egg-retrieval needles. It would be good for him to get an idea of what I’ve been going through these last months.”
Wendy opened a bottle of expensive Chardonnay and led Marissa into the parlor.
“I wasn’t sure you’d be up for this,” Marissa said once they were settled, “but I brought over a journal article for you to read.”
“Just what I was hoping for,” Wendy said with sarcasm. She put her wineglass down on the coffee table, then took the reprint from Marissa. She glanced at the abstract.
While Wendy scanned the article, Marissa told her everything Dubchek had related.
“This is incredible,” Wendy admitted as she looked up from the paper.
“Brisbane, Australia! Do you know one of the things that makes Brisbane so interestine.”
Marissa shook her head.
“It’s the main gateway to one of the greatest natural wonders of the world.”
“Which is?”
“The Great Barrier Reef! A diver’s paradise.”
“No kidding?” Marissa said. Then she admitted, “It’s not something I know much about.”
“Well, it is one place in the world I’ve always wanted to visit,” Wendy said.
“Diving has been one of my passions. I started in California during my residency. I used to take all my vacations in Hawaii in order to dive. In fact, it’s how I met Gustave. Have you ever done any diving, Marissa?”
“A little. I took a scuba course in college and I’ve gone a few times to the Caribbean.”
“I love it,” Wendy said.
“Unfortunately I haven’t done it for some time.”
“What do you think of the paper?” Marissa asked, bringing the conversation back to the issue at hand.
Wendy looked down at it.
“It’s a good article. But it doesn’t say anything about transmission. The author mentions the possibility of an increase in TB due to immigration, but how is it communicated, especially to such a defined population?”
“That was my question as well,” Marissa said.
“And how does it get into the fallopian tubes? It certainly doesn’t sound like blood or lymphatic spread, which is the usual way TB gets around. I wonder if it’s venereal.”
“What about contaminated tampons?”
“That’s an idea,” Marissa said, recalling that tampons turned out to be the basis of the toxic shock syndrome.
“I certainly use tampons exclusively.”
“Me too,” Wendy said.
“Trouble is, there’s no mention of tampon use in the article.”
“I have an idea,” Marissa said.
“Why don’t we call Brisbane and talk to the author of the paper. We can quiz him about tampon use. It would also be interesting to know if there’s been any follow-up on the twenty-three cases and if there are any new ones at the Female Care Australia Clinic. After all, this paper was written almost two years ago.”
“What’s the time difference between here and Australia?”
Wendy asked.
“You’re asking the wrong person.”
Wendy picked up the phone. Calling an overseas operator, she asked about the time. Then she hung up.
“They’re fourteen hours ahead,” she said.
“So that makes it..
“About noon tomorrow,” Wendy said.
“Let’s try.”
They got the number of Female Care Australia in Brisbane from overseas information and placed the call.
Wendy put the phone on its speaker mode. They could hear the phone ring, then someone at the other end picked up. A cheerful voice with a crisp Australian accent came over the line.
“This is Dr. Wilson calling from Boston in the U.S.,” Wendy said.
“I’d like to speak with Dr. Tristan Williams.”
“I don’t believe we have a Tristan Williams here,” said the operator.
“Just a moment, please.”
Music came out of the speaker while they were put on hold.
The clinic’s operator came back.
“They tell me that there was a Dr. Williams at the clinic but I’m afraid he is no longer here.”
“Would you tell us where we can reach him?” Wendy asked.
“I’m afraid I have no idea,” the operator said.
“Do you have a personnel office?” Wendy asked.
“Indeed we do,” the operator said.
“Shall I connect you?”
“Please,” Wendy said.
“Personnel here,” a man’s voice said.
Wendy repeated her request to get in touch with Tristan Williams.
Again they were put on hold, this time for a longer period.
“Sorry,” the man apologized when he came back on the line.
“I’ve just learned that Dr. Williams’ whereabouts are unknown.
He was dismissed from the staff about two years ago.”
“I see,” Wendy said.
“Could you transfer me to pathology?”
“Surely,” the man said.
It took a full ten minutes to get one of the pathologists on the line. Wendy said her name and what she wanted.
“I’ve never met the man,” the pathologist said.
“He left before I arrived.”
“He wrote a paper while at the clinic,” Wendy explained.
“It concerned a series of patients at your clinic. We are interested in knowing if there has been any follow-up on any of the cases.
We’d also like to know if there have been any additional cases.”
“We’ve had no new cases,” the doctor said.
“As for follow-up, there hasn’t been any.”
“Would it be possible to get some of the names of the original cases?” Wendy asked.
“I’d like to contact them directly to discuss their medical histories. We have five similar cases here in Boston.”
“That would be completely out of the question,” the doctor said.
