Within seven hours lymphocytes began to accumulate, marking the beginning of another level of immunological defense. Since this particular type of bacteria had not been encountered before, there were no specific antibodies circulating. But the process to make them had begun. T-lymphocytes massed and underwent chemical-induced alterations. They also stimulated the arrival of more macrophages which in turn stimulated more T-cell aggregation in an ever-increasing spiral of cellular activity.

After twenty-four hours, the balance of the struggle had already tipped away from the bacteria. The tubular cells were winning but the victory was Pyrrhic. Vast areas of the delicate mucosal lining of the fallopian tubes had been destroyed by the immunological reaction. Extensive scarring was inevitable. Interference with the blood flow added to the injury. And on top of that, the remaining bacteria and their waste continued to stimulate the immune system’s response. The body persisted in amassing more cellular troops, unaware that the battle had been won. Macrophages continued to arrive, and their activity caused more destruction. In their frenzy, some of the cells underwent nuclear division without subsequent cellular division, resulting in giant cells with multiple nuclei.

Again, the medical students would have smiled knowingly if they’d had a chance to view this sequence through the lens of a microscope. They would have nodded with appreciation at the distorted architecture of the developing granuloma.

This cellular drama continued to play out over several weeks within the dark recesses of thirty-one-year-old Rebecca Ziegler’s womb. Rebecca herself had no idea of frantic chemical battles being waged within her body, nor of the resultant cellular destruction. There had been a few hints: subtle changes in her vital signs in the form of a low-grade fever and a mildly elevated pulse. She had even experienced some cramps, lower abdominal tenderness, and a mildvaginal discharge, but none of these signs and symptoms seemed cause for concern. Even a mildly abnormal Pap smear which had caused her momentary worry had been proven to have been perfectly normal after all.

Rebecca ignored these petty maladies. After all, everything else in her life was wonderful. Six months earlier she’d married, to her mother’s relief, and her life had taken on new meaning. She’d even accepted a new job as one of the youngest litigators for a prestigious Boston law firm. Everything was perfect, and she was not about to let some mild physical complaints mar her mood.

Yet there was more to this episode than Rebecca could have known. The bacteria had started a chain of events that went beyond the immunological. The consequences were destined to come back to haunt her, to rob her of her happiness, and eventually, indirectly, to kill her.

February 21, 1988