Робин Кук - Cell

“I’m afraid the MRI showed several questionable lesions in your liver. We aren’t sure they’re cancer metastases, so we will have to biopsy them, and we want to do it sooner rather than later.”

The doctor spoke calmly, as if discussing an ingrown toenail that needed treatment. At least that’s how it sounded to Greg. He was tired of being patronized. He was tired of the whole experience since he had first noticed that the whites of his eyes had turned yellow. That had been the very first symptom that started the nightmare. Then came the tests, the surgery, and the chemotherapy, which had been a torture.

“So the pancreatic cancer is back?” Greg’s voice was accusatory.

“Well...”

“Straight up, Doc! I don’t have time for equivocation.” Greg’s worst fears were materializing. He wanted it all out. Now. No more false hopes.

Dr. White sighed. “As we have discussed, it’s a very difficult cancer to treat. Its location and anatomy are... problematic. We have done the best we can. If the biopsy confirms that these new lesions are the same cancer, then we will have to be aggressive.”

“Will that mean more chemo?”

“I’m afraid it does.”

“But the chemo is killing me! It already compromised my kidneys, I’m still undergoing dialysis. On a less frequent basis than before but...”

“There are a lot of arrows left in our quiver, Greg. If more chemo is needed, we will choose agents that don’t have kidney toxicity.”

“Like what?” Greg wanted specifics. His goddamn life was on the line.

“I can’t say exactly what that might be. Not yet. Let’s wait and see what we are up against.”

“How much time do I have?” Greg pressed.

“The biopsy has yet to be done—”

“How much time if the biopsy is positive?”

“I can’t say.”

“Guess!” he demanded. Dr. White was not going to get away with hemming and hawing. Not today.

“I’ve never been right when forced to give a guess in such a situation, but let’s just say that it would be a good time to get your affairs in order. I’m sorry, Greg, but you are just going to have to buck up.”

The comment hung in the air.

“Buck up?” Greg repeated mockingly. “After all I have been through and you’re telling me to ‘buck up.’ Worse, you’re being evasive. But it’s okay. I’ll contact iDoc when I get home and get what I need.” Greg knew he was being confrontational, something he had not done up until that moment, but now he didn’t care. He was sitting on the business end of a death sentence.

“I am not being evasive. The answers to your questions are unknowns,” Dr. White replied. He was aware that Greg was part of the first cohort to use iDoc. He had been impressed with the app since the number of off-hour phone calls had dropped significantly. Emergency room visits and requests for office visits from others in the program had plummeted, too. “But let me remind you that iDoc hasn’t gotten the results of the MRI yet. I received the preliminary report by calling the radiology resident. When iDoc does receive the results, please let me know if it offers any new perspective. As I understand it, its algorithm has significant resources of knowledge available. So in the event that I’m missing anything, I would welcome hearing about it.”

He started making notes on a digital tablet. “But most important, we have to ascertain what these liver lesions are. We need to schedule a biopsy and a series of pre-biopsy clotting studies.”

“iDoc can do the clotting studies the morning of the biopsy,” Greg said.

“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.

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.