by Robin Cook
It wasn’t hard to figure out who Knox was because he was in charge. Like most of the residents, the man was dressed in blood-spattered scrubs. He looked weary and in sore need of a shave, as if he had been up all night. George waited to speak with him while he finished up with the ER paperwork.
When George explained why he wanted to talk, Knox waved for George to follow him. He said he had to hustle to the next case but that George could tag along. He led George toward Trauma Room 6, where a homeless man who had been hit by a train was going to lose both legs just below the knee. The patient needed to be stabilized before he, too, would be sent up to surgery.
“It’s about Sal DeAngelis,” George said. “You remember him, right?”
“I’ll be remembering him for a long time. What’s your question?”
“I heard about the self-inflicted wounds. Were they on the wrists like most suicides or what? And why did you feel they were self-inflicted, since the man had lacerations all over his body?”
“They were on the abdomen. Lower left.” Knox indicated the area on his own body as he spoke. “They were surgical in appearance and not at all like the other lacerations on his body from the trauma he sustained. We also found a utility knife in the vehicle with blood on the blade. That helped ID the source of the cuts. There’s no doubt the man was trying to injure himself. And it’s obvious that he succeeded.” Knox paused at the door to Trauma Room 6. “I need to get in here,” he said. “If you have any more questions, maybe we can talk later.” He then pushed open the door and disappeared into the room.
George stood for a moment in the corridor, thinking about what Sal had been doing. According to Knox there was apparently not much doubt that he had been cutting himself with a utility knife. Maybe Sal was after the reservoir. The surgical-style cuts were in the lower abdomen, where Schwarz had reportedly embedded the reservoir. Maybe in his panic Sal had decided that the reservoir was the source of his troubles, and he wanted to take it out. The thought didn’t make George feel any better. In fact it made him feel worse. Sal might have been right.
• • •
George made his way over to the emergency radiology viewing room, ducking into its peacefulness, glad to leave the chaos of the ER behind.
Carlos was working there and was surprised but glad to see George. “What the hell are you doing in here? I figured you’d be kicking back on a beach in Santa Monica right about now, which is where I’d be.”
“I wish. Maybe later.”
“Well, since you’re here, would you mind looking at some films with me? I’m not sure about a few of them. It will save me from having to take them over to radiology to find someone to check them out.”
George was glad to look at them. It would help take his mind off Kasey, Sal, and Laney.
When he and Carlos were done, George went to a free monitor and pulled up the radiological studies on Tarkington and Wong, which he had the right to do, since he had done their MRIs. What George wanted was abdominal flat plates, if they were available. They were, for both patients. And both gave full evidence of what he was looking for. Tarkington and Wong had embedded reservoirs, just as Sal, Kasey, and Chesney did. The presence of reservoirs suggested that they were part of the iDoc beta test, but were not proof. George wanted to be certain.
George glanced over his shoulder at the other people working in the room to make sure they were not paying him any attention. When he was sure no one was watching, he used his resident password to try to access both patients’ histories. Each time he tried, the computer refused him access, stating that his request violated hospital rules and that his attempts had been reported to the center’s records department. George winced. He knew this was not going to look good, especially if Schwarz followed up on his threat.
Changing tactics, George looked up Tarkington’s and Wong’s MRIs and wrote down the contact numbers of their referring oncologists. He put in a call to both, leaving his cell number. He knew that in doing so he might cause future waves for himself, but he was at a loss for what other avenue to take. If they were part of the iDoc beta test, it would further advance his theory that iDoc was either malfunctioning or being hacked. If they weren’t, then it would confirm that his paranoia was getting out of hand.
While mulling this over he decided to try the medical examiner’s office. He phoned, and after identifying himself as a doctor, was transferred to one of the forensic investigators on call.
“I was hoping for some general information on some recent deaths,” George said. “Actually, one was a few months ago, but the others are very recent. Do you think you would be able to help me?”
“That depends,” the investigator said. “Who am I speaking with?”
“I’m Dr. George Wilson, a resident in radiology at the L.A. University Medical Center,” George said. “I’ve noticed that on a number of recent terminal cases, the patients had implanted drug reservoirs. Has your office had any experience with such devices? If you have, can you tell me if they are removed in the course of an autopsy?”
“I’m afraid I don’t know anything about that, Doctor,” the forensic investigator replied. “But if you want to give me their last names, I can see if there is anything in the records.”
George was pleasantly surprised to be making headway. He imagined it was because it was a holiday, and he didn’t have to go through the ME’s public relations office. “The family names were Lynch, DeAngelis, Tarkington, Wong, and Chesney,” George said.
There was a silence on the line. All George could hear was the clicking of a computer keyboard. Finally, the investigator’s voice came back on the line.
“None of those patients needed to be autopsied.”
George was surprised. “Why is that?”
“They had terminal illnesses that were confirmed by their doctors, so the forensic autopsy was waived. It means the cause and manner of death were known for their death certificates. Pretty cut-and-dried stuff for what we’re used to.”
“Okay. Thank you.” George hung up, discouraged. Then another idea hit him. He was going to pay another visit to the morgue.
• • •
George rode the elevator down to the lower basement. He was alone in the car again and, indulging in a bit of morbid humor, he guessed that not too many people needed to visit the dead on the Fourth of July.
As he neared the morgue he was struck by the disagreeable odor emanating from the place. It seemed worse than on his previous visit. It made him wonder how someone could work there day in and day out.
On this occasion, the diener was at his desk, but it was a different man. George introduced himself and said, “I’m here to talk about drug reservoirs embedded in patients. Are they routinely removed?”
The diener’s face was a complete blank. He had no idea what George was talking about.
George probed the man on the subject of drug reservoirs from various angles, but it was apparent that the morgue as a general rule took no notice of them. In fact, George learned that the dieners were instructed not to remove or handle any medical devices whatsoever, particularly on those cases slated for the medical examiner’s office. “We don’t remove anything,” the diener said. “And that includes endotracheal tubes, IVs, nasogastric tubes, embedded catheters.”
George cut the man off. It was obvious he was getting nowhere fast. George thanked the diener and beat it out of there. So much for that idea.
• • •
George returned to the emergency radiology viewing room and took one of the chairs off to the side. As he was mulling over his options his cell phone rang, jarring him from his thoughts.
“Hello.”
“This is Dr. White. Is this Dr. George Wilson?”
“Yes,” George replied, straightening up in his chair. This call just might mean progress. “Thank you for returning my call. I’m a resident radiologist at L.A. Univers
ity Medical Center, and I have a question about a former patient of yours. Greg Tarkington.”
“You’re a resident in radiology?” Dr. White asked. His voice reflected a mixture of disbelief and irritation. “I’m a busy man and this is a holiday. Why—?”
“I performed the last MRI on Mr. Tarkington.”
The oncologist seemed to calm down a degree. “Okay. What’s your question?”
“Was Mr. Tarkington taking part in the iDoc beta test? I’m helping Amalgamated with their testing. I’ve agreed to submit a couple of standardized forms whenever a beta-test subject dies. I thought I remembered Mr. Tarkington saying that he was, but I can’t locate any documentation. I thought you might be able to help me.” George lowered his voice in the hope of conveying an us-versus-them bond. “It’s easier to talk doctor to doctor than to try calling Amalgamated, especially on a holiday.” George held his breath. It was a fairly weak explanation for the call, but he hoped it might just get him the information he wanted.
“Tarkington was part of the study,” Dr. White said without hesitation, his attitude changing for the better. “And you can tell Amalgamated that iDoc made his life much easier and mine too by fielding many of his questions. I wish more of my patients had it.”
“Did you know that he had a drug-releasing implant?”
“Of course, although it wasn’t for any of the drugs I prescribed. The implant was for his diabetes. He mentioned more than once that it handled his blood sugar levels better than he had been able to. It was one less issue for him to deal with in a very trying time.”
“Thanks for your time. I appreciate your calling back.”
“Glad to be of help. Keep up the good work!”
George ended the call and wondered if Dr. White, while advocating iDoc for his patients, had any idea of the extent to which medicine was about to change. But be that as it may, George was appreciative of the man’s cooperativeness. George now knew for sure that Tarkington, like Kasey, Sal, and Laney, had been part of the iDoc beta test: four known iDoc users with drug implants . . .
George’s phone rang again almost immediately. It was a call back from Wong’s oncologist, a Dr. Susan Jefferson! George was surprised and pleased that both doctors had gotten back to him so quickly, especially on a holiday. He was also impressed, guessing that both doctors were conscientious about their professional responsibilities in a very emotionally demanding specialty.
George gave him the same story he’d given Dr. White. Dr. Jefferson was equally forthcoming, and confirmed that Wong was part of the iDoc beta test as well. So now George had confirmation that all five deaths in his cohort used iDoc and had implanted drug reservoirs.
George’s suspicions ratcheted upward. While he was still inclined to believe that a glitch was responsible, or that a malicious hacker was involved, a new possibility occurred to him: What if iDoc was intentionally serving as a “death panel”? It would certainly help Amalgamated’s bottom line, either as a company policy, which was an extreme thought, or more likely as the work of a rogue programmer sitting on a lot of Amalgamated stock options. But almost as soon as the idea occurred to George, he dismissed it out of hand. He couldn’t imagine anyone doing such a thing during the beta test. If someone were thinking of such an awful thing, he’d certainly wait for iDoc to go national before unleashing it.
As George was thinking in this vein, he remembered a few high-profile cases recently in which doctors or nurses had taken it upon themselves to relieve patients of what they thought were to be their final months of painful treatment. Maybe these health care professionals were motivated by nothing other than compassion. On the other side of the coin were those bean-counter professionals who thought about resource allocation, which meant freeing up beds for patients who would be returning to society to lead productive lives rather than having them occupied by people who were terminal. George remembered a case in which a Brazilian doctor had been responsible for the deaths of over three hundred patients.
All these thoughts gave George an unpleasant shiver. It was a scary side to the concept of digitalized medicine and an awful distortion of the idea of the smartphone becoming an ersatz physician. iDoc was undoubtedly going to prove itself a fantastic idea and the wave of the future, and to have it hijacked for whatever reason would be a colossal tragedy. This realization brought George back to the importance of the embedded reservoir in the execution of any kind of death panel. As Sal had apparently sensed, if iDoc was killing people, it had to be done with the help of the reservoir. George felt he needed to focus on that.
Suddenly an idea struck him. It was a crazy idea, but possibly a good one. He remembered that Sal’s funeral service was set for that afternoon. If he could only remember where.
George pulled out his cell and Googled local funeral homes. He only got to the Cs before hitting upon Carter’s Funeral Home. As soon as he saw the name, he remembered it was the one Clarence had mentioned. While he may not have been able to examine Sal’s body in the morgue, he just might be able to do so at the funeral home. Or at least talk to the embalmer. He didn’t know how they might react, but it would be worth a try. Worst case, he would get a chance to pay his respects to Sal.
With sudden resolve, George leaped out of his seat and bolted for the exit, startling two ER residents.
He dashed out into the ER proper, pulling off his white coat as he ran. His first stop was an empty exam room, where he grabbed a pair of surgical gloves just in case. Then he headed for the parking garage.
“George! Hey! Over here!”
George pulled himself to a halt. To his astonishment, Debbie was waving him back.
“I meant to ask you earlier,” she said, “are you up for Whiskey Blue again tonight? I’m thinking of heading over. I’m going to need a break after today. It’s a circus here.”
“I don’t know,” he said, a little out of breath. Her constant switch from hot to cold bewildered him. The last thing he wanted to do was go back to the bar. At the same time he didn’t want to burn any bridges. “I’ll text you when I get home.”
“Where the hell are you going in such a hurry?”
“Believe it or not, I’m heading off to a local funeral home.”
“A funeral home? What on earth for?”
“Sal DeAngelis’s service is today.” He leaned close to Debbie and whispered, “To be honest, since I can’t imagine many people are going to show up, I’m hoping I’ll have the opportunity to inspect the body. I have a new theory about his self-inflicted abdominal wounds. I think there is a good chance that he was trying to remove his drug reservoir. What I’d like to do is find out if he had been successful.”
Debbie eyed him as if she thought he was going off the deep end. “You’re crazy! You have to stop this shit!”
“I know, it sounds ridiculous, but I’m committed. Let me put it this way: I’m beginning to think that ‘something is rotten in the state of Denmark’ when it comes to Amalgamated Healthcare.”
“I have no idea what you are talking about,” Debbie said irritably.
“Amalgamated Healthcare, or at least somebody in the company, might not be as ethical as the Amalgamated front office wants us to believe.”
“Isn’t it a little cliché to blame the health insurance company?” She glanced down, seeing what he had in his hands. “What are you doing with surgical gloves?”
“Just in case.” He waved them at her as he headed for the main entrance.
“In case of what?” she called after him.
“I’ll text you later about tonight,” he said, ignoring the question. A moment later he was in the connector, half power-walking, half jogging on the way to the garage.
33
CLAYTON HANSON’S HOME
BEL AIR, LOS ANGELES, CALIFORNIA
FRIDAY, JULY 4, 2014, 12:20 P.M.
Clayton was lounging by his pool, enjoying lunch at
a table under a yellow-and-white-striped umbrella. He was in the company of a bikini-clad young woman who was twenty-five years of age, while a mister system puffed out sprays of cool vapor to combat the heat. He’d had her over the night before, and although she left in a huff while he was off on his command visit to Debbie Waters’s apartment, Clayton had managed to patch things up that morning.
Just then Clayton’s cell phone rang. He leaned over and stared at its display. He wasn’t on call and couldn’t imagine who would be phoning. It was Debbie. He frowned, debating whether to answer.
“Excuse me,” Clayton said, deciding he had little choice but to talk with her. “I need to take this.” He moved away from the table to talk privately. “What?” he demanded, a little harsher than he had planned.
“Is that any way to say hello? Especially to someone who’s going out of her way to help you?”
“I’m sorry. I’m just in the middle of something.”
“I hope you’re having a wonderful time,” Debbie said sarcastically. “I’m slogging it out here in the ER.”
“Did you have something to tell me? If so, out with it. I told you I was busy.”
“I can only imagine. But you better be nice to me or I won’t share the important information I just learned, smart-ass.”
“I am being nice. I answered, didn’t I?”
“Are we still on for Spago on Saturday night?”
“Of course we are! I’m looking forward to it.” Clayton rolled his eyes.
“I just had a word with your favorite resident. Seems he is on a fucking crusade.”
Clayton winced. “You’d better explain.”
“He is still focused on those deaths because, as he said, ‘something is rotten in Denmark,’ whatever the hell that means.”
“It’s a quote from Shakespeare, which is pretty damn famous.”
“Careful, buddy. You’re on thin ice with me.”
Ignoring the comment he said, “Do you have any idea what he was referring to?”