“What you are looking at is a granuloma,” Ken said. “It’s got giant cells and epithelioid cells, the sine qua non of a granuloma. Not a lot of things cause granulomas. So you have to think of TB, sarcoid, and a handful of funguses. But you’d have to put TB at the head of the list for statistical reasons.”

Marissa felt weak. The idea that she had any of those diseases terrified her.

“Can you do any other stains to make a definitive diagnosis?” Marissa asked.

“Sure,” Ken said. “But it would help to have some history on the patient.”

“Okay,” Marissa said. “She’s a healthy Caucasian woman, mid-thirties, with a completely normal medical history. She presented with asymptomatically blocked fallopian tubes.”

“Reliable historian?” Ken questioned as he chewed the inside of his lip.

“Completely,” Marissa said.

“Negative chest X-ray?”

“Completely normal.”

“Eye problems?”

“None.”

“Lymph nodes?”

“Negative,” Marissa said with emphasis. “Except for the blocked tubes, the patient is completely normal and healthy.”

“GYN history normal?” Ken asked.

“Yup!” Marissa said.

“Well, that’s weird,” Ken admitted. “TB gets to a fallopian tube via the bloodstream or the lymphatics. If it’s TB, then there has to be a nidus somewhere. And it doesn’t look like fungus without some hyphae or something. I’d still say TB is the leading contender. Anyway, I’ll do some additional stains . . .”

“Marissa!” called a voice, bringing Marissa back to the present. She opened her eyes. It was Dr. Arthur. “Dr. Wingate is about to inject the local anesthesia. We don’t want you to suddenly jump.”

Marissa nodded. Almost immediately she felt a number of points of stinging pain, but they faded quickly and she went back to her musing, remembering her panicked visit to an internist the same day that she’d seen Ken. But a complete work-up had failed to find anything wrong except for a positive PPD test, suggesting that she indeed had had TB.

Although Ken tried numerous other tests on Marissa’s slide, he found no organisms, TB or otherwise. But he stuck by his original diagnosis of a tuberculous infection of the fallopian tube despite Marissa’s inability to explain how she could have picked up such a rare illness.

“Dr. Wingate!” a harried voice called. Marissa’s attention was again brought back to the present. She turned her head. Mrs. Hargrave was at the ultrasound-room door.

“Can’t you see I’m busy, for chrissake?” Dr. Wingate snapped.

“I’m afraid there has been an emergency.”

“I’m doing a bloody egg retrieval!” Dr. Wingate shouted, venting some of his frustration on Mrs. Hargrave.

“Very well,” Mrs. Hargrave said as she backed out of the door.

“Ah, there we go!” Dr. Wingate said with satisfaction. His eyes were glued to the cathode-ray-tube screen.

“Want me to see what the emergency is?” Dr. Arthur asked.

“It can wait,” Dr. Wingate said. “Let’s get some eggs.”