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This is a work of fiction. Names, characters, places, and incidents are either the product of the author’s Imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events or locales is entirely coincidental.

Titles by Robin Cook

TOXIN
CHROMOSOME 6
INVASION
CONTAGION
ACCEPTABLE RISK
FATAL CURE
TERMINAL
BLINDSIGHT
VITAL SIGNS
HARMFUL INTENT
MORTAL FEAR
OUTBREAK
MINDBEND
GODPLAYER
FEVER
BRAIN
SPHINX
COMA
THE YEAR OF THE INTERN

ACKNOWLEDGMENTS

Vital Signs could not have been written without the assistance of Jean Reeds, whose professional and personal knowledge of the human heart is matched only by her own.

This book is dedicated to the countless couples who have suffered the emotional and physical trials and tribulations of infertility and its modern treatments.

Prologue

February 16, 1988

The infecting bacteria came in a swift gush as if flushed from a sewer. In an instant, several million slender, rod-shaped microorganisms filled the lumen of the fallopian tubes. Most were grouped in small, tight clumps. They settled against the velvety convolutions of the mucosa, nestling in the warm, fertile valleys, absorbing the abundant nutrients and expelling their own foul excretions.

The delicate cells lining the interior of the oviducts were helpless in the face of the sudden invading horde. The putrid waste of the bacteria—caustic proteins and greasy fats—burned like acid, resulting in instant destruction of the fine cilia whose normal function was to move an egg toward the uterus.

The tubular cells released their defensive and messenger chemicals, signaling the body for help. Unfortunately, the defensive secretions had no effect on the bacteria, whose membranes were protected by a brownish waxy envelope of lipid.

Medical students fresh from their microbiological labs would have recognized the bacteria—or so they would have thought. The fatty bacterial cell walls were “acid fast,” capable of absorbing certain stains and resisting decolorizing with acid alcohol. The medical students would have cried in unison, “Tuberculosis,” with a self-congratulatory sense of satisfaction.

Tubercular or not, as far as the tubal cells were concerned, any kind of invading bacteria meant trouble. The messenger chemicals that the cells had released initiated the complex immunological defense against foreign invaders which had evolved over the entire billion-year evolution of earthly life.

The chemicals released initiated a change in the local blood vessels. The blood flow increased and opened up tiny fenestrations, releasing plasma into the tissue. Specialized, first-line-of-defensecells called granulocytes migrated from the bloodstream directly into the bacterial horde. These cells released more chemicals, including potent enzymes. They also combated the bacteria directly. But for them it was a kamikaze exercise—after releasing their granules, nearly all the granulocytes perished.

Soon, larger cells called macrophages answered the chemical call, mobilizing themselves from lymph nodes and the bone marrow. They too passed through the pores of the capillaries to join the melee. They were more successful than the granulocytes in engulfing some of the bacteria. They also released chemicals into the developing pus, which was now taking on a greenish cast.