Робин Кук - Cell

“It would matter to me. As I admitted, our talk those few years ago was my initial inspiration to pursue it.”

“Thanks. I appreciate that, but to be honest, I’m not sure how I feel. It’s a lot to get my head around. You guys — an insurance company — are assuming a lot of responsibility.” He put his hand out to shake. “It’s been an interesting morning. Thanks.”

“Thanks for coming. It meant a lot to me.”

George smiled and turned to leave. Paula called after him.

“Why radiology?”

George turned back. “What?”

“Why radiology? I always meant to ask you. After all the grief you gave me in medical school about the MD-MBA program and taking up space in medical school while never intending to practice medicine on real human beings — and here you end up in a residency program that, for the most part, avoids patient contact. It’s ironic. iDoc uses avatar doctors and you apparently prefer patient avatars in the image form of X-ray, MRI, and PET scans.”

It was her second reference to his chosen specialty. Was she picking on him? Her tone didn’t sound like it, but he wasn’t sure. “There is definitely some truth in what you say.”

“I always had you pegged for a GP or an internist. I never suspected radiology. What motivated you?”

“I don’t think anything really happened,” George said. Suddenly he could hear Kasey’s voice in his head. She had helped him understand his career motivations, namely that he had gone into medicine in order to feel worthy of people’s respect. The issue stemmed from a vain attempt to gain his stepfather’s respect. He wasn’t sure he was up to sharing that now with Paula.

“Well, it is a big difference from the way you talked in our second year.”

“To be truthful, the farther along in medicine I went, the less tolerance I had for direct patient contact. It was a surprise. Actually, at first I wondered if I was really that shallow. Maybe it was because I got the feeling I was coming down with every disease I encountered.”

“That happened to all of us, even if we didn’t talk about it.”

“It happened to you, too?”

“Absolutely. It’s human. Your interest in radiology had to come from something else. When we were first introduced to it, I was intimidated,” Paula said. “Were you?”

“I liked it from the word ‘go’!” George said. “I was intrigued by its definitiveness. It could make a real diagnosis that could lead to definitive treatment, especially with radiology becoming more interventional.”

“Well, there you go,” Paula said. “That makes sense.”

“To be completely honest, someone told me that I have too much empathy and that I needed a specialty that distanced me a little from my patients so I could be objective. Like, I don’t know how people can become oncologists. All the more power to them. I couldn’t do it. No way.”

“That I can relate to as well, even more than the hypochondriasis. Thanks for being honest.”

“You’re welcome,” George said. He checked his watch and winced. “Well, thanks again for inviting me to this presentation. Now I have to get back to the hospital for sure.”

She gave him a brief hug good-bye before he headed for the door.

“Keep the idea open of your coming over to my house on Saturday, Dr. Honesty,” she called after him.

CENTURY PLAZA HOTEL

CENTURY CITY, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 11:42 A.M.

Lewis Langley terminated the call and pocketed his phone. He was troubled. He scanned the room, looking for Bradley Thorn. He spotted him holding court with two hedge fund managers whose faces he recognized from their frequent appearances on financial shows. He knew Thorn would be pissed but Langley didn’t want to waste any time. He pushed his way through the crowd until he reached the CEO’s side. Thorn reluctantly turned to him, irritated at the interruption.

“I need a moment,” Langley whispered in Thorn’s ear.

“Now? In case you haven’t noticed, I’m busy.”

Langley just stared at him, raising a single eyebrow.

Thorn hesitated. The last thing he wanted to do was step away from the potential investors standing in front of him, but Langley looked upset. In private Thorn joked that his dealings with Langley were similar to Pope Julius II’s dealings with Michelangelo. Langley was a genius but could be a pain in the ass.

“Excuse me, gentlemen, I’ll be right back,” Thorn said, following his tech manager.

“It better be good,” Thorn said quietly. “They were eating out of my hand.”

“I just became aware of something. I don’t want to rain on our parade, but my IT head just reported that a bug seems to have appeared in the iDoc application. Reappeared, actually.”

Thorn’s face turned hostile. Langley could tell that this was the last thing his boss wanted to hear, especially in the present company. But Langley didn’t care. Diplomacy was not his concern, nor was Thorn’s reaction. But the success of iDoc was. “This newest incident happened at Santa Monica University Hospital, same place as the first. We thought it had been a fluke at the time but apparently not.”

“What kind of a bug are we talking about?” Thorn asked, though he wasn’t sure he wanted to hear. “Something serious?”

“I would qualify it as serious. Especially if the media or the FDA became aware of it. Two patients involved in the beta test have died.”

Thorn swallowed hard. “How many people know about it?”

“Just the IT supervisor. Me. And now you.”

“No, I don’t know about it. Just you and your IT man do. This is your responsibility. Deal with it, and do it quietly and effectively! That’s your job.” Thorn looked around, making sure no one was within earshot. “And if we need to have a conversation this sensitive, this would not be the time or place for it. Don’t be such a goddamn cowboy, even though you look the part. Furthermore, fix your errors, Langley! Or I’ll get someone who can.” He turned to head back to his guests.

“You don’t understand,” Langley snapped, grabbing Thorn’s arm. Thorn stared at Langley’s hand until it was dropped. “My take is that it’s not an error. At least technically speaking. Rather, the program is working too well. We might not want to fix it. In fact, this kind of bug may appeal to certain parties we’re currently negotiating with, namely Centers for Medicare and Medicaid Services. It might be just what will get CMS to take iDoc for all its beneficiaries.”

“Explain yourself!”

“My sense is that the IPAB set up by the ACA might find this bug entirely to their liking. If they do, and force CMS’s hand, that’s eighty-seven million potential client-patients in the plus column.” Langley had the habit of lapsing into geek-speak punctuated with acronyms, but it didn’t trouble Thorn. He knew Langley was referring to the Independent Payment Advisory Board and the Affordable Care Act, but he was still confused. “All right! All right! You are going to have to explain in more detail. But not now, for Chrissake!” He straightened his tie and plastered a broad smile on his face before walking off to rejoin the waiting hedge fund managers.

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 11:45 A.M.

Greg Tarkington entered the office of his oncologist, Dr. Peter White. Greg was nervous. He had noticed that the MRI technician had been reluctant to make eye contact at the conclusion of the procedure earlier that morning. The resident, Dr. Boucher, did the same. Greg sensed it meant bad news. After everything that Greg had been through, he knew the ground rules regarding ancillary personnel: divulge nothing. But Dr. White couldn’t hide behind that dictum, and finally he spilled the beans.