'When? On whom? ' There was some excitement in Engleson's voice. D. K. Bartholomew, MD, Fellow of the American College of Surgeons and Diplomate of the American College of Obstetrics and Gynecology, shook his head. 'I… I'm afraid I don't remember, ' he said. 'What are you talking about?'
'It was surgery for something else. Maybe removal of a fibroid tumor.
The ovaries felt like this woman's did today, but there was no one around to consult, and I think I had another case or two left to do and …'
'So you just ignored them and closed?'
'I felt they were probably a normal variant.'
'Yeah, sure. Did you mention them on your operative note?'
'I… I don't remember. It might have been years ago.'
The wall telephone began ringing. 'Dr. Bartholomew, ' Engleson said, allowing the jangle to continue. 'I don't think you should operate anymore.' With that he turned and snatched up the receiver. 'Dr.
Engleson, it's Denise. I called pathology.'
'Yes?'
'I couldn't find out who the resident is on surgicals, but the staff person is Dr. Bennett.'
C'Good.'
'Excuse me?'
'I just said that's good. Thanks, Denise.'
'Thank you for what you did in there, Doctor. You made my day.'
Kate's back was arched over the pillows beneath her hips as Jared knelt between her legs and used her buttocks to pull himself farther inside her. Again and again he sent jets of pleasure and pain deep into her gut and up into her throat. Her climax grew like the sound of an oncoming train-first a tingle, a vibration, next a hum, then a roar. With Jared helping, her body came off the pillows until only her heels and the back of her head were touching the carpet. Her muscles tightened on him and seemed to draw him in even deeper. He dug his fingers into the small of her back and cried out in a soft, child's voice. Then he came, his erection pulsing in counterpoint to her own contractions. 'I love you,' he whispered. 'Oh, Katey, I love you so much.' Gently, he worked his arms around her waist, and guided her onto her side, trying to stay within her as long as possible. For half an hour they lay on the soft living room carpet, their lover's sweat drying in the warmth from the nearby wood stove. From the kitchen, the aroma of percolating coffee, forgotten for over an hour, worked its way into the sweetness of the birch fire. A cashmere blanket, one of the plethora of wedding gifts from Jared's father, lay beside them. Kate pulled it over her sleeping husband and then slipped carefully from underneath. For a time, she knelt there studying the face of the man who had, five years before, arranged to have himself and a dozen roses wheeled under a sheet into her autopsy suite in order to convince her to reconsider a rebuffed dinner invitation. Five years. Years filled with so much change-so much growth for both of them. She had been a nervous, overworked junior faculty member then, and he had been the hotshot young attorney assigned by Minton/Samuels to handle beleaguered Metropolitan Hospital. The memory of him in those days-so eager and intense brought a faint smile.
Kate reached out and touched the fine creases that had, overnight it seemed, materialized at the corners of her husband's eyes. 'A year, Jared? ' she asked silently. 'Would a year make all that much difference? You understand your own needs so well. Can you understand mine?'
Almost instantly another, far more disturbing question arose in her thoughts. Did she, in fact, understand them herself?
Silently, she rose and walked to the picture window overlooking their wooded backyard. Superimposed on the smooth waves of drifted snow was the reflection of her naked body, kept thin and toned by constant dieting and almost obsessive exercise. On an impulse, she turned sideways and forced her abdomen out as far as it would go. Six months, she guessed, maybe seven. Not too bad looking for an old pregnant lady.
Fifteen minutes later, when the phone rang, Kate was ricocheting around the kitchen preparing brunch. The edge of her terry-cloth robe narrowly missed toppling a pan of sweet sausages as she leapt for the receiver, answering it before the first ring ended. Nevertheless, through the door to the living room, she saw Jared stir from the fetal tuck in which he had been sleeping and begin to stretch. 'Hello, ' she answered, mentally discarding the exotic plans she had made for awakening her husband. 'Dr.
Bennett, it's Tom Engleson. I'm a senior resident on the Ashburton Service at Metro. Do you remember me?'
'Of course, Tom. You saw me at the Omnicenter once. Saved my life when Dr. Zimmermann was away.'
'I did? ' There was a hint of embarrassment in his voice. 'What was the matter?'
'Well, actually, I just needed a refill of my birth control pills. But I remember you just the same. What can I do for you? ' Her mental picture of Engleson was of a loose, gangly man, thirty or thirty-one, with angular features and a youthful face, slightly aged by a Teddy Roosevelt moustache. 'Please forgive me for phoning you at home on Sunday.'
'Nonsense.'
'Thank you. The reason I'm calling is to get your advice on handling a surgical specimen. It's one you'll be seeing tomorrow, a wedge section of a patient's left ovary, taken during a hypogastric artery ligation for menorrhagia.'
'How old a woman? ' Reflexively, Kate took up a pen to begin scratching data on the back of an envelope. So doing, she noticed that Jared was now huddled by the wood stove with Roscoe, their four-year-old almost-terrier and the marriage's declared neutral love object. 'Thirty,
' Engleson answered. 'No deliveries, no pregnancies, and in fact, no ovaries.'
'What?'
'Oh, they're there. But they're unlike any ovaries I've ever seen before. Dr. Bartholomew was with me-the woman is his patient-and he has never seen pathology like this either.'
Kate pulled a high stool from beneath the counter and wrapped one foot around its leg. 'Explain, ' she said. 'Well, whatever this is is uniform and symmetrical. We took a slice from the left ovary, but it could just as well have been the right. Shrunken, the consistency of… of a squash ball-sort of hard but rubbery. The surface is pockmarked, dimpled.'
'What color? ' Kate had written down almost every word. 'Gray. Grayish brown, maybe.'
'Interesting, ' she said. 'Does what I've described ring any bells?'
'No. At least not right off. However, there are a number of possibilities. Any idea as to why this woman was having menorrhagia?'
'Two reasons. One is a platelet count of just forty-five thousand, and the other is a fibrinogen level that is fifteen percent of normal.'
'An autoimmune phenomenon? ' Kate searched her thoughts for a single disease entity characterized by the two blood abnormalities.
An autoimmune phenomenon, the body making antibodies against certain of its own tissues, seemed likely. 'So far, that's number one on the list,
' Engleson said. 'The hematology people have started her on steroids.'
'Was she on any medications?'
'Hey, Kate.' It was Jared calling from the living room. 'Do you smell something burning?'
'Nothing but vitamins, ' Engleson answered. Kate did not respond.
Receiver tucked under her ear, she was at the oven, pulling out a tray of four blackened lumps that had once been shirred eggs-Jared's favorite. 'Shit, ' she said. 'What? ' Both Jared and Tom Engleson said the word simultaneously. 'Oh, sorry. I wasn't talking to you.' A miniature cumulonimbus cloud puffed from the oven. 'Jared, it's all right, ' she called out, this time covering the mouthpiece. 'It's just … our meal. That's all.'
'Dr. Bennett, if you'd rather I called back…'
'No, Tom, no. Listen, there's a histology technician on call. The lab tech on duty knows who it is. Have whoever it is come in and begin running the specimen through the Technichron. That way it will be ready for examination tomorrow rather than Tuesday. Better still, ask them to come into the lab and call me at home. I'll give the instructions myself. Okay?', Sure. Thanks.'
'No problem, ' she said, staring at the lumps. 'I'll speak to you later.'
'Shirred eggs? ' Jared, wrapped in the cashmere blanket, leaned against the doorway. Roscoe peered at her from between his knees. Kate nodded sheepishly. 'I sort of smelled the smoke, but my one track brain was focused
