by Robin Cook
“I’ll give you the script anyway,” Dr. White replied without looking up. He continued typing into his device.
• • •
Greg had never felt so helpless. Even in the last go-round of chemo he had always had hope. If hope was still alive anywhere inside him now, it was doing an excellent job of hiding. Greg’s iDoc chimed in with a short selection of Bach’s Cello Suite no. 1. The music normally had a calming effect on him, but not today. Recognizing that iDoc wanted to talk, Greg moved to a quiet corner of the hospital’s hallway and clicked ANSWER on the app. His doctor immediately appeared.
“Hello, Greg. May we talk? You are on speakerphone.”
“Yes.”
“I’ve just been apprised of your last MRI study. I am sorry to have to tell you that there were several abnormalities seen as reported by one of the more senior radiology attendings. Would you like to talk about this now or later?”
“Now,” Greg said without hesitation.
“Would you like me to be frank or just supportive?”
“Frank and supportive, if that is possible.”
“It is possible. First I have to say that on a statistical basis these lesions are most likely metastatic cancer, hardly good news, considering all that you have been through. I am so sorry about this, but we must be proactive. A biopsy has already been scheduled, which will give us the definitive answer. Once we have that result we will consider our options.
“I also know you’ve just come from a meeting with your oncologist, Dr. White. Based upon the notes that he entered in your medical record, I know you’re aware of your current situation. This is a stressful circumstance for you, Greg, as it would be for anyone, and your vitals reflect that. It would be best for you to go home. I’d like you to have a sedative, but I don’t want to administer it until I know you will not be driving. Your pulse rate is up and you’re perspiring more than—”
“Stop!” Greg said, impatient to get to the heart of the matter. “Just give me specifics about the biopsy. What are the chances that the liver lesions are in fact cancer?”
“Under the circumstances the chances are 94.36 percent. I’m terribly sorry to have to give you this information, but it is the most accurate that I can determine, considering thousands of similar previous cases.”
Greg had wanted it cut-and-dried and that’s how iDoc just gave it to him. Tears welled up in his eyes.
“Please go home and lie down!” iDoc said. “Your pulse is going up. You need to relax. Call me when you get home, and we will talk more. There are some new promising treatments available.”
“You remember that my kidneys are still not functioning up to par.”
“Of course I am taking that into consideration. Now please go home and try to relax.”
Greg clicked off his iDoc. Thank God for Dr. Williams, he thought. Dan Williams was the name he had chosen for his iDoc physician. A Dan Williams had been his football coach in high school, a man he had worshipped.
9
L.A. UNIVERSITY MEDICAL CENTER
WESTWOOD, LOS ANGELES, CALIFORNIA
MONDAY, JUNE 30, 2014, 12:05 P.M.
George hustled toward the front of the hospital, still hoping that his unauthorized departure had gone unnoticed. As he approached the main door he spotted Greg Tarkington coming out. The man was clutching his smartphone. His face had an intense, strained expression. George slowed down, debating whether he wanted to say something to the patient. He decided he would rather not; his excuse was that he was already late getting back. But Tarkington saw him as they were about to pass each other.
“Hello, Doctor uh . . . ,” Tarkington stammered. He stopped.
“Wilson,” George finished for him.
“Yeah. Sorry. A lot on my mind at the moment.” He put away his phone and stood silent.
Here was an example of what he had just been talking about with Paula. He felt an overwhelming empathy for this man but was unable to think of anything to say.
“I just learned that the MRI wasn’t good,” Tarkington managed. “I mean it wasn’t good news. Sorry for putting you on the spot earlier. Who wants to tell someone that?” He tried to smile.
George was taken aback. Tarkington felt empathy and compassion toward him, the doctor. George experienced a moment of profound guilt.
Tarkington shrugged and looked at the ground. “Life has its challenges,” he said, raising his eyes to George’s.
“It does.” George was at a loss. “You seem to me like a person who meets the challenge,” he finally added after a pause. He was awed by Tarkington’s courage and wondered if he would have the same, were the situation reversed. He also wondered if it wouldn’t have been better if the man hadn’t had the MRI.
“Well, I’m not going to roll over without a fight. It’s going to have to take me kicking and screaming.”
George found himself thinking that under different circumstances he and Tarkington could have been friends. He admired the guy, even admitted to himself that he liked him. George also wondered if he really had what it took to be a good doctor. Seeing people confront their mortality was unsettling at a very deep level.
“I’m sure your doctor has a plan of action,” George said. “There’s more than one way to beat these things.”
Tarkington nodded. “Well . . . thanks. I appreciate what you doctors do. But I need to get home and think this through.” He gave George’s arm a squeeze as he walked past. It was a melancholy sort of gesture reflecting a human need to connect.
As George watched the man walk away, he wondered if he could have offered more support. Then he turned and entered the hospital, thinking how much easier it was to spend time with Tarkington’s MRI printout than with the man himself. It was so much less emotional, so much more scientific, and so much more an intellectual exercise. Yet ultimately it was about another human being, and in this situation it was like being responsible for the man’s getting a death sentence. George shuddered. That was the part he really didn’t want to think about. Maybe even radiology wasn’t safe enough for him. What if he had taken the same MD-MBA course that Paula had taken? If he had, he might be living in a Santa Monica house with a pool and driving a new Porsche Carrera without ever having to be touched, however obliquely, by something like pancreatic cancer.
• • •
George walked into the MRI control room, where Claudine and another technician, Mark Sands, were in the midst of a study. Mark was an African American with whom George had spent a lot of time. Of all the technicians, Mark understood the MRI best in all its technological subtleties. Under his guidance images progressively wiped across the screen, generating anatomical slices of a human body in a fashion that never failed to astound George. Claudine glanced up and gave George a thumbs-up, which George interpreted to mean that things had gone well during his absence.
George raised his eyes and glanced through the observation window at the huge, doughnut-shaped magnet. He could see the feet and lower legs of a woman protruding from the MRI. He guessed from the woman’s position that it was another abdominal study.
With the equipment on autopilot under the watchful eye of Mark, Claudine took a moment to quickly review what had transpired during George’s absence. It was confirmed that there had not been any problems and no one had come looking for him, which eased George’s residual anxiety. Soon he was feeling entirely relieved about having been out. Clearly he had not been missed.
Using a monitor, Claudine went through the images of a torn ACL, which had been the first case she’d done with Susan’s assistance after George had left. Next she showed George a bothersome lower back done with Mark’s help. In both cases the tests were diagnostic and well done.
“What’s up with this current case?” George asked, nodding toward the patient in the adjacent room.
“Her name is Claire Wong. She’s forty-three years old and
has a history of lobular breast cancer. She’s been treated with a mastectomy and chemotherapy combined with radiation. Although she’s currently asymptomatic, her oncologist wanted the abdominal MRI, just to be certain there aren’t any additional problems. So far it looks good.”
George nodded again, feeling an uptick from the unease the encounter with Tarkington had generated. The idea of another cancer case made him feel superstitiously uneasy. Moving over to Mark, he looked over the man’s shoulder at the most recently formed image. To his chagrin he immediately noticed something that Claudine had missed. “Uh-oh! That doesn’t look so good. It seems that there is some definite retroperitoneal thickening. Can you guys see it?”
“I think so, now that you’ve pointed it out,” Claudine said. She took a laser pointer from her pocket and outlined what she thought George was referring to.
“That’s it. Let’s review some of the previous slices,” George suggested.
Mark pulled them up. George studied them closely, then pointed at a portion of the small intestine. “There’s thickening of the bowel wall as well.” George used his finger to trace along the problem segment.
Again Claudine and the technician could see the condition after George pointed it out.
George shuddered inwardly. This case was as bad as Greg Tarkington’s in terms of its implications for the patient, but George’s thoughts were interrupted. Suddenly the door opened and Clayton Hanson poked his head in.
“Can I have a word, George?”
“Sure,” George replied as he felt a quickening of his pulse. He could only guess that Clayton had seen him at the presentation after all. As George headed for the door he tried to think of a plausible excuse for having left the hospital without getting permission and without formally signing out. Nothing came to mind. He knew he was considered one of the best radiology residents. Clayton himself had said so. Was he ever going to grow up about facing authority figures? After all it had been a medically oriented event, he had covered his responsibilities, and Clayton had been there himself.
“I noticed you over at the Amalgamated event,” the older doctor said sotto voce as George joined him in the hall. There were a number of passersby.
“Yeah. I saw you, too,” George said. At least Clayton wasn’t saying it in a confrontational manner. That was a surprise. And a relief.
“What did you think?”
“Well, it’s quite a bit to digest.” George searched his mind for a diplomatic response since he hadn’t decided exactly what his feelings were. And he had no idea why Clayton would ask him such an open-ended question.
As George hesitated Clayton went on. “Well, let me tell you what I think. Amalgamated wouldn’t be a bad stock for a young man to invest in, if that was why you were there.”
Rather than respond, since Clayton knew full well that George had no money, George said, “What’s your involvement?”
Clayton studied George a moment before answering. “I have a sizable investment position in Amalgamated. I was involved with an earlier generation of iDoc, helping them look at it from the imaging perspective.”
“That got you onstage?” It was a bold question. Clayton could easily take offense. But the question was nagging at George.
Clayton paused before answering, as if measuring his response. “Thorn and I have come to know each other well over the years. Actually, he’s my brother-in-law. He’s married to my younger sister. After all the family time spent together and the inevitable health-care-related discussions, he’s come to trust my medical instincts.” Clayton studied George’s face for a reaction. George gave none. He wasn’t going to intimate, even with his expression, that nepotism was the reason that Clayton had such a prestigious seat at the event. George was a realist. The guy could seriously impair George’s radiology career if he chose to do so.
“What’s your relationship with Paula Stonebrenner?” Clayton asked. He was looking at George with raised eyebrows. “It looked like she made a beeline for you at the reception. You banging her?”
George took a step back. Clayton was known for blunt, even vulgar, comments but they were usually unintentionally inappropriate. This one seemed deliberate. George assumed Clayton was taking a shot at him for forcing him to reveal the family connection to Thorn.
“We were at Columbia Medical School together.”
“And . . . ?” Clayton wasn’t letting up.
“We dated a little our first year,” George admitted, feeling a little like Clayton was taking advantage of George’s subordinate role. “We’re just friends now. Maybe even that’s too strong a word. We’re acquaintances.”
“Sorry, I shouldn’t have asked,” Clayton said, backing off. “It’s none of my business.” Clayton knew about George’s fiancée’s recent death and had been lately encouraging George to be more social. He had even invited George to a couple of parties at his home, which George had respectfully declined. George imagined Clayton meant well, but he had always been put off by Clayton’s treatment of women, as if their existence were solely for his enjoyment. Kasey had been harsher in her assessment. As a radiologist, George truly admired the man, but as a person, it was another story.
“Paula is an impressive woman,” Clayton offered. “I’ve gotten to know her a bit while working on the iDoc project. Maybe you should think about sparking that fire again.”
“She is impressive, I agree. But as far as dating again . . . I don’t know.”
“I know you’re still trying to work things out . . . about Kasey. Things like that never really go away. You just find a way to live with it. Paula’s attractive, considerate, incredibly bright, and on the fast track to professional stardom. That’s something to think about.”
George stared at the floor, nodding his head. What Clayton was saying about Paula was both accurate and kind. He was demonstrating his ability to flip from crass to considerate. That was his saving grace, from George’s perspective.
“Just make sure you sign out properly next time,” Clayton said as he turned to leave.
George was stunned. Clayton was switching directions again, this time from personal to professional.
“I had everything covered,” George said, stumbling over an excuse.
“No matter,” Clayton said, “I won’t say anything to the chief of radiology, but from now on do us both a favor and follow protocol whenever you leave the hospital. I don’t want you screwing up at this point in your career. You’ve been doing so well.”
“I will,” George assured Clayton. “And thanks, I appreciate it.”
“No problem. And think about some Amalgamated stock. It’s worth mortgaging an apartment to free up some cash if need be.” He headed off down the hallway with a wave over his shoulder before George could respond.
George watched him disappear down the hall. Clayton had managed to get one last zing in before leaving. George had to hand it to him; the guy was way ahead of George in manipulating people. George wanted to yell out that in case Clayton had forgotten, he didn’t have a pot to piss in or a window to throw it out of. He didn’t own his apartment. He rented. And that was a struggle. With his salary, he’d have to go out as far as San Bernardino in order to find something affordable to buy, and the commute would kill him. Clayton knew all this. He just enjoyed screwing with George.
10
GEORGE’S APARTMENT
WESTWOOD, LOS ANGELES, CALIFORNIA
MONDAY, JUNE 30, 2014, 5:48 P.M.
George drove his aging Jeep Cherokee up behind his apartment complex and parked. He was very much out of sorts, having been reminded by Clayton of his impecunious circumstances in the middle of a very expensive, money-worshipping city. Once inside his tiny apartment, he went into his closet and pulled down the cardboard box in which he stored Kasey’s things. There wasn’t much, since she had not finished moving in with him. Just a few clothes and personal items. For some t
ime he had avoided looking in the box, but now he wanted to see something specific.
He rooted through the box and found Kasey’s cell phone under a small stack of sweaters. Always cold, she was a firm believer in layering, and had sweaters handy at all times. One of George’s fondest memories of her was her throwing one on and cuddling up against him on the couch to watch a movie. George pushed such thoughts out of his head and plugged her phone into his charger. Once it powered up, he punched in her passcode. He wanted to make sure she had had an iDoc app. She did. It was in the dock section for apps at the very bottom of the display face, so no matter which screen she was on, it was always available. He had seen it but had never asked her about it, and she had never offered an explanation. Now he knew why: the nondisclosure agreement she’d had to sign to become part of the iDoc beta test.
George pressed the icon, curious to see what might happen. It opened, but the screen was blank except for an icon similar to the one on the app. Apparently iDoc had been wiped clean, as Paula had mentioned. He wasn’t surprised. It made sense to protect the privacy of her health information. He put the phone back and set the box on the closet shelf. Then he grabbed a beer from the fridge before retreating to his threadbare sofa, where he was enveloped by the black hole sensation of Kasey’s loss. When he allowed himself to think about it, he marveled at just how much he missed her. At the same time he recognized that he had to pull himself out of the hole that fate had cast him into, as he had promised her.
The trouble was, knowing what he had to do and actually doing it were two entirely different things.
From his perspective, being in L.A. didn’t help. Some people fantasized it was a hedonistic center, but that hadn’t been George’s experience. He had found L.A. could be a cold city to outsiders, and with the busy schedule of a resident, he didn’t have a lot of time to meet any new people other than fellow medical center employees, like nurses. Meeting Kasey in the hospital had been a total but wonderful fluke.