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Larry Karp





Thursday, April 28, 1977


One last look in the hall mirror. I straightened my tie, brushed my hand over that unruly clump of hair above my right ear. Should I be suave and assured, or would I come off better as wide-eyed and enthusiastic, maybe even a little eccentric? As I glanced at the gray fabric-covered log book in my hand, I caught the reflection of my smile in the mirror. Perfect. Cool, self-possessed, yes. Suave was the way to go.

I didn't need to check my watch, but did anyway. Couple of minutes past one, almost an hour till the press conference. By five o'clock, I'd be on the local news, right at the top, and tomorrow morning, my face would be on every screen from San Francisco to Timbuktu. Well, my face and Giselle Hearn's, fair enough. I'd make sure to say I couldn't have done it without her, but there'd be no doubt who'd been the project leader, and who, the co-worker. I smiled again.

Good move, borrowing Giselle's lab log last night, then canceling my appointments and staying home this morning. My office staff would've been driving me nuts, wanting to know what all the fuss was about. Instead, I'd put in five solid hours, studying the log and my pile of reprints from Nature, Lancet, and The American Journal of Obstetrics and Gynecology. For more than a year, I'd been keeping up with that literature, but I wanted to be sure I had the material down cold, every detail. I couldn't afford a misstep.

I walked out into the corridor, took the elevator down to the lobby, clapped Albert, the doorman, on the arm. "Hey, Doc," Albert rumbled. "Them Seadogs gonna win today?"

The Emerald Seadogs, Major League Baseball's brand new representatives in the Pacific Northwest, were supposedly starting their existence under a lucky sign, double-sevens. But before the end of the first month of that auspicious 1977 season, the Seadogs were already hopelessly in the cellar, couldn't win for losing. "Don't know, Albert. I only bet on horses, but if I did bet baseball, I think I'd keep my money in my pocket on that one." The old doorman cackled.

With its long winters of short, gray, drizzly days, Emerald is the suicide capital of the country. This past season had been a prizewinner, barely a glimpse of sun between Christmas and Easter. But today, the sky was a glorious blue, not a cloud anywhere, and I threw back my head to take in the warmth of the mid-day sunlight. From this day on, that sun would shine on me, nonstop. Patients would clog my office. I'd see my photo in newspapers, magazines, on the tube. My name would be front and center in articles and popular histories; I'd get whole chapters in reproductive medicine textbooks. Rotary Club presidents and chairmen of university departments would book me for talks. It was not beyond reason to expect that one day I'd get a call to come give a speech in Stockholm. My parents would finally have to hand it to me. Their son was about to become a legend in medicine.

Most of my colleagues lived in big houses in one or another of the fancy Emerald suburbs, which entitled them to drive nearly an hour to and from work, sometimes in the middle of the night. Not for me. An easy seven-minute walk, and I was at my office in the Emerald Medical Tower, linked by skybridges to Puget Community Hospital on one side, and the new glass-and-steel Washington Public University Medical Complex on the other.

I strode into the Tower Lobby, past patients, some in wheelchairs, or making their way slowly on canes. White-coated doctors talked to white-capped nurses. Techs pushed blood-draw carts and EKG machines. For all the attention they weren't giving me, I could've been walking along a sidewalk in midtown Manhattan, but that was about to change. Tomorrow, people on all sides would stop, point, whisper to their companions, "Hey, isn't that Dr. Colin Sanford? You know, the guy..."

As I walked into my waiting room, a buzz of talk went silent. Lettie and Sally, the receptionists, Kinsey and Ruth Ellen, the nurses, Megan, the nurse-practitioner, stood in a circle in front of the reception counter. One look at me, and they froze in place, a body with five chalky faces, five open mouths and ten saucer-eyes. Barbara Renfro, the office manager, stood off from the others, stone-faced, leaning against the end of the counter. Her Adam's apple bobbed up, down, up again.

The room reeked of trouble. Had one of my patients keeled over with a pulmonary embolism? Did the pediatricians find a serious birth defect in a baby? Nah, either way, a nurse would have called my beeper. I looked past the mob to Barbara. "Got something to tell me?"

She motioned me down the hall past reception, to my consulting office.

I followed her along the corridor, into the office, closed the door. She rested a hand on my arm. "Oh, Dr. Sanford. Dr. Hearn is...dead."

"Dead? No."

"She was shot. Murdered. In her lab, a little while ago. And..."

"What, Barbara?"

"Mr. Kennett did it."

"Mr. Kennett? Why on earth would he ever -"

"And after he killed Dr. Hearn, he shot himself. A Detective Baumgartner called here not five minutes ago, looking for you. He got your name off Mr. Kennett's newborn-nursery ID bracelet. I told him we expected you any time now, and he said he wants you to go over to the lab immediately to talk to him."

I pride myself on keeping a cool head in emergencies. "I'll get over there ASAP. Would you please cancel the press conference for me?"

"Of course." She took a step away. "Dr. Sanford...did the conference have something to do with the Kennetts?"

I nodded.

As she walked out of the office, I stared at the log book in my hand. Doubly fortunate now that it wasn't sitting in a desk drawer in Giselle's office, where the cops would find it. It was my ticket to the future, but it also contained seeds for disaster, which I'd stumbled on the night before. No reporter at the press conference, rushing to get the story out, would have looked inside that log, but the scientists we'd beaten to the finish line would want to review it, and to say the least, some of the material could be embarrassing. I thought I knew what to do about it, and had figured to sit down with Giselle after the conference to get her on board. But that idea had been knocked into a cocked hat along with the conference. In any case, the log had to go someplace out of sight for the time being, absolutely-positively safe where no one would think of checking.

I scanned the room. Stash it in my desk? That'd be the first place anyone would look. Two walls of bookshelves, filled with medical textbooks, monographs, and leather-bound journals. Good camouflage, but not good enough. The faux-woodgrain metal file cabinet next to my desk? Negative. A file cabinet would be Number Two on any search, right after my desk...but wait, here's an idea. I stepped across the room, lowered a shoulder, tipped the cabinet. Below the bottom drawer was a nice little recess. Good. I tossed the log book into the cavity, gave a short silent thanks for all those after-work hours at the gym, then lowered the cabinet.

I hung my suit jacket on a hook behind the door, grabbed a white coat from an adjacent hook, shrugged it on, and rushed out, through the waiting room, into the hallway, down the corridor to the skybridge. I could deal with a little delay in my plans. First things first, and the first thing was to talk to Joyce Kennett. Going to the lab and talking to the cops would need to settle for second.



I'm a doctor, an OBGYN. I opened my office in Emerald in 1965, and by 1970, my practice was the biggest in town. Patients knew when they came to me, they'd get the best care possible, and they'd get it directly from me. No partners, no interns, no med students. I always did have an eye for the main chance — no point denying the obvious — and during the late 'sixties, I saw laparoscopy was the coming thing in my field. And why not? Would you want your surgery performed through the customary five-inch slash in the breadbasket if it could be neatly accomplished via a thin optical instrument slipped through a tiny puncture into the abdomen? So I took myself off to Philadelphia to learn the procedure from the guru, Guiseppe Allegri, and I've got to tell you, Allegri was impressed. He said he'd never seen anyone with such a knack for the procedure. When I got back home, I wangled an interview with the medical editor of The Emerald Times, to tell the city all about Band-Aid surgery, now available right in its own back yard. My office phones didn't stop ringing for days.

Then, in the mid-seventies, federal research grants began to dry up. The University faculty panicked. None of them had ever dreamed of dirtying their hands by laying them on patients, but necessity really is a mother, and the professors started promoting themselves as super-specialists, the ultimate experts. What they didn't say was that hands-on care at the U would in fact be provided by residents and med students, and the professors' role would consist of initialing trainees' chart notes. But you can sell people anything, and I started to notice a patient here, a patient there, leaving my care to go to "The Northwest's Preeminent Medical Center." Which pissed me off, royally.

You've got to keep an eye on your opposition, so I was a regular at the Wednesday morning University OBGYN Grand Rounds, where professors, fellows, and residents honed their one-upsmanship skills, pontificating on esoteric topics. At the first session after Christmas break, in January, 1976, the speaker was Dr. Giselle Hearn, a PhD embryologist. The room was packed. Dr. Hearn talked about her experiments on the behavior of chromosomes at fertilization in mice, which she hoped would shed light on factors that cause errors during that process, and produce conditions like Down Syndrome. Near the end of the hour, she said she was convinced there would be no real breakthroughs until studies being carried out in other research centers on human gametes started to yield up critical information.

I didn't realize she'd flung a gauntlet until Gerry Camnitz flew to his feet, no small accomplishment given the size and weight distribution of L. Gerald Camnitz, MD. The Professor and Chairman of OBGYN had the look of an angry, red-faced walrus in a sharply-tailored gray suit, pink shirt, and narrow blue tie. "Dr. Hearn, this is not a public forum for departmental policy. It is an educational session. Kindly stick to your subject."

Hearn's face and body language told everyone in that room they were about to get a preview of the Bicentennial fireworks display. She blinked at Camnitz like a cow, offended at having gotten a gratuitous poke in the udder from a stick in the hand of a nasty little boy. "I've not gone off my topic, Dr. Camnitz. I've merely stated a matter of fact. If it happens to conflict with your prejudices, you might do well to reconsider."

I'd had no idea what was obviously running deep below the calm surface waters of the University OBGYN Department. A couple of medical students snickered. Camnitz silenced them with a glare, then turned back to Hearn. "All right, Dr. Hearn. Since you insist on pursuing this, I will restate my policy. We are not going to start down the slippery slope of experimentation on human embryos, not in my department. The ethical, moral, and legal implications are too uncertain. Would you propose to flush human beings down a sink when they're no longer of use to you? Would you be concerned even the slightest bit that attempts at in vitro fertilization might produce monstrously abnormal children?"

"I never said anything about in vitro -" Hearn began, but Camnitz shouted her down with, "This conference is over. Thank you all for coming." I thought he might follow that with an order for Hearn to go to the Dean's office and serve detention, but instead, he stormed out of the auditorium. There was a brief silence, followed by a sound like the swarming of a million angry bees. Don Gardiner, a young assistant professor, poked an elbow into my ribs. "Welcome to the halls of ivy."

I muttered, "Yeah," but I was thinking about in vitro fertilization and embryo replacement.

Not a week later, I was talking to Joyce and James Kennett, one of my infertility couples. They had what's called idiopathic infertility, which is doctor-talk for "I don't have a goddamn clue." Joyce's temperature records showed she ovulated right on schedule, every twenty-nine days plus or minus one. X-ray contrast studies indicated no blockage of her fallopian tubes. Her uterus was perfectly normal, inside and out. James' sperm were lively and quick. The couple hit the mattress at a frequency that should already have borne them a football team. Artificial insemination with James' sperm had been no more efficacious than the natural process.

They were both up tight, squirming in the chairs opposite my desk. Not unusual for infertility patients. They'd been trying for a year before they first came to see me, and I'd been working with them for an equal length of time. Two years of having every menstrual period be a disaster of dashed hopes does things to people, and in any case, this couple was predisposed to emotional problems.

James had a history of borderline paranoid schizophrenia, had been doing well for years on psychotherapy and medication, but he'd gotten himself fired from several retail clerk jobs after customers complained about what they took as insults or smart-alecky comments. This translated into endless bouts of relapsing financial pins and needles.

Joyce, a biology teacher at Emerald Community College, had the anatomy, physiology, and biochemistry of conception down pat, which made the couple's failure — her word, not mine — all the more galling. She'd tried a bunch of dietary manipulations and folk remedies, none of which were any more effective than traditional approaches.

I brought up the possibility of adoption, but the two of them shot that down in a hurry. Joyce insisted she was going to have "my own baby," no ifs, ands, or buts. "And it's going to be my baby, too," James barked. "No way some other guy's sperm is going to get her pregnant, not if I have anything to say about it."

Joyce rested a hand on his arm, something I'd seen her do before when he looked like he might be about to lose it.

Once I saw his muscles relax, I reviewed the past eleven months of investigations and treatments, and was about to launch into an explanation of a journey through the terra incognita of infertility, when Joyce gave James a look that brought me up short. It asked, "Are you ready?"

He nodded.

Joyce turned back to me. "We've decided to go to the University."

Like a slap in the face. I was stunned. "Why?"

"We thought it would be a good idea to see one of the infertility specialists there."

I shook my head. "I guess you can do that, but they don't know anything I don't know. I read the same journals they do, and attend all kinds of conferences at the U and around the country."

James pulled at the back of his collar. Joyce sat a little straighter in her chair. "They work in this field all the time, but it's only a part of your practice," she said. "Maybe there's some new research that isn't even published yet."

They were going, no question. Infertility patients are like trains with disabled brakes. They wanted the benefit of new research. Were they thinking of in vitro fertilization? They weren't about to get that at the U, though, were they?

But they couldn't get it from me, either. I swallowed bile, got up, and extended my hand. "I wish you luck," I said. "Keep in touch. If they help you conceive, I'll certainly want to know the details."

James nearly fell over his feet, thanking me for trying to help. He pumped my hand as if he expected to see water gush out of my mouth. Joyce was cooler, but still cordial. "I'll definitely let you know," she said. "And if we're successful, I'd like to come back and have you take care of my pregnancy and delivery."

Knick-knack, paddy-whack, toss the dog a bone. "It would be my pleasure," I said.

For the rest of the afternoon, I had to force myself to keep my mind on business at hand. After the office closed and I'd written up the charts for the day, I walked across the skybridge to the University Medical Complex, stopped by the cafeteria, grabbed some dinner, and picked at it. This was my personal Pearl Harbor, and I was not about to lie down and let those hypocritical University bastards wipe out my practice. I had an idea, which, I'll admit, made me more than a little nervous. If it didn't work out, things could get ugly.

But what if it did work out?

I left my tray with most of the food uneaten, no great loss, hustled out of the cafeteria, and down the hall to the Med Center Library.

The library closed at midnight, and that's when I left, stepping lively, carrying a fistful of copied journal articles from medical centers around the world. The papers described the scientific and clinical procedures which one day might produce babies through in vitro fertilization, and discussed the ethical and religious arguments that swirled around those procedures. Catholics were opposed, no surprise, but the secular ethicists were split into two camps. One group was as strongly opposed as the Catholics, claiming that since there was no way to tell in advance whether the procedure was safe and would produce normal children, it constituted unethical experimentation on the unborn, or even on the unconceived. The other group insisted the work was right and proper, because it might both alleviate the human misery of infertility, and give life to individuals who otherwise never would exist.

It was clear a race was on to be first to the finish line, and that the leaders were a team in England, consisting of Robert Edwards, a physiologist who'd spent some time doing research at Johns Hopkins, and Patrick Steptoe, a clinical gynecologist. Edwards seemed to have gotten a good handle on the protocol for fertilizing human eggs and culturing embryos. Steptoe's expertise? He was a leading laparoscopist who'd published a book, "Laparoscopy in Gynaecology," which I'd read hot off the press in 1967. In the journal articles, he'd described his approach to recovering human eggs from ovaries just before ovulation, and I had no trouble seeing that with a little practice, it would be a piece of cake for me. The question was whether Giselle Hearn could pick up on Edwards' reports, and do the laboratory side of the work as well as I could do the clinical.

Once I set my mind to an idea, I never waste time. Next day, after I finished with my morning patients, I hustled across the skybridge to the Department of Obstetrics and Gynecology, then down the hallway to the research wing, and into Dr. Hearn's lab area. Hearn was standing in a corridor, talking to a young woman in a white coat, probably a tech. I waited until the girl smiled, nodded, and walked away; then, before her boss could move on to whatever she had in mind to do next, I walked up to her. "Dr. Hearn."

She had no idea who I was. "I'm Colin Sanford. I practice OBGYN at Puget Community."

Her face said, "Then why don't you go off and practice a little OBGYN?"

"I need to talk to you," I said.

"About what?"

"I have an idea I'm pretty sure will interest you." Then, I added, "I was at your conference last week." I looked around to make sure no one was close. "Gerry Camnitz is not only a pompous ass, he's a stupid man. You should be able to extend your work to humans, and I know how you can do it."

She didn't know what to make of me, and I couldn't blame her.

"We can't talk about it here," I said. "Let me take you to dinner tonight."

That earned me a world-class fish eye.

"Dr. Hearn, I'm not trying to mash on you, and I'm not playing games. I'm as serious as I've ever been. I don't think you'll want to walk away from my proposal. Meet me at Charley's Boathouse, seven o'clock, and I'll tell you about it."

She didn't say yes, she didn't say no. Just stood there, trying to sort me out.

"What can you lose?" I added. As it turned out, only her life, but how could I know?



End of the Opening Scenes of A PERILOUS CONCEPTION