Робин Кук - Cell

“My God... Kasey!” George shrunk back in horror. She was going into rigor mortis. She was dead! His fiancée — his world — had died during the night and he, a doctor no less, had slept right through it!

George collapsed onto the floor, his back against the wall, and wept. It was twenty minutes before he could manage to call 911.

NEARLY THREE MONTHS LATER

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 8:35 A.M.

It was George’s last day as a third-year radiology resident at L.A. University Medical Center. Tomorrow would mark the beginning of his fourth and final year in the hospital’s residency program, and then he could start making some real money. After all his years of medical training and two hundred thousand plus dollars’ worth of debt, the light at the end of the tunnel was finally visible. His focus on moneymaking was his way of surviving the devastating loss of the woman he loved, the only woman he had really loved. Although he knew it wasn’t exactly the healthiest way to begin the healing, it was all he could come up with at the moment. Getting paid, and paid well, would at least be a vindication that all his years of education had been well spent, and he could begin to pay back the money he owed. At least his professional life was on track.

Over the past three grueling months, George had pretended an amenable camaraderie with his coworkers, but the truth was that he had become a hermit. Anyone who tried to dig under the genial surface scraped up against a strongbox in which he kept his feelings. It was what held his demons at bay, or so he had thought. Actually he knew that he was going back on a sacred promise he had made to Kasey. When he had asked her to marry him, she had demurred, saying that it was unfair for him to tie himself down with someone with substantial medical issues. To George’s consternation, she had been extremely serious and had agreed to marry him only when he had finally said that if something were to happen to her, he would not shut himself off from his friends and would ultimately find another relationship. Kasey had even made him give her a written statement to that effect.

George sighed. He was exhausted. The previous night he had not been able to fall asleep until almost morning, overcome with guilt at having broken his promise and for the greater guilt at having slept through her death. He would never know if she had suffered or if she had died in her sleep. That was a question that would haunt him for the rest of his life. It kept him from sleeping well since her death, and his insomnia was getting worse.

He looked at his watch. It was 8:35 in the morning. George was in the MRI unit, supervising second-year resident Claudine Boucher. The radiology department in general and the MRI unit in particular were large revenue generators, and their reward from the administration was an excellent location on the center’s ground floor immediately adjacent to the emergency department. Claudine had been on her current rotation under George’s tutelage for the past month, and at this point George’s presence was superfluous.

George was sitting off to the side, glancing through a radiology journal. Every so often he’d look up at the monitor as the computer generated image slices. He was too far away to see any detail, but all seemed in order. He continued sipping on a cup of his favorite Costa Rican coffee. He loved coffee. The taste. The smell. Its stimulative and euphoric effect. But he was highly susceptible to caffeine; his body didn’t seem to metabolize it like those of other people. One cup in the morning was his limit. Otherwise, he would be bouncing off the walls into the early-morning hours with a crash-down throbbing headache rounding out the ride. In his present state of mind, indulging himself with even one cup was life on the edge. But George didn’t mind since he felt as if he had already fallen off.

A large thermo-paned window let the doctors see into the adjacent room, where the enormous MRI machine did its work. Only the legs of the current patient were visible as they protruded from the multimillion-dollar testament to advanced technology. A highly efficient radiology technician, Susan Fournier, was monitoring the progress of the scan. All was going smoothly. Claudine was seated next to Susan, looking at the horizontal slices of the liver as they appeared. Except for the muffled clunks of the machine coming through the insulated wall, the room was quiet. Inside the MRI room itself, the noise level was horrendous, requiring the patient to wear earplugs.

The patient, Greg Tarkington, was a highly successful forty-eight-year-old hedge fund manager. All three of the medical professionals in the room were aware of this patient’s history of pancreatic cancer. They were also well acquainted with the details of the extensive surgeries and chemotherapy he had undergone. The surgeries had made the man diabetic, while the side effects of the chemo had caused his kidneys to fail temporarily. At present, he was relying on dialysis to stay alive. Tarkington’s referring physician, an oncologist, was particularly concerned with making sure the liver was normal.

“How’s it look?” George asked, breaking the silence.

“Good to me,” Susan responded softly. Even though there was no chance the patient could hear, the doctors and technicians tended to whisper when a procedure was under way.

“To me, too,” Claudine said, turning to George. “Take a peek?”

George heaved himself to his feet and stepped closer to the monitor. He took his time, staring in silence as the images emerged. Susan was rerunning the film starting at the base of the liver and moving cephalically, or toward the head.

“Stop there,” George suddenly ordered. “Freeze it.”

The technician paused the frame as instructed.

“Let me see the previous slice,” George said, leaning in for a better look. Most people, George included when he had first started, thought radiology was a hard science, meaning the sought-after lesion was either there or not there, but over the previous three years George had learned differently. There was a lot of room for interpretation, especially with small irregularities.

George sensed something abnormal in the image, just to the right of center. He rubbed his eyes and looked again.

“Give me the slice one centimeter lower!” He studied the requested image and suddenly he was sure. There were two small irregularities present. “Go back to the original image you had up, the one that’s still being formed.”

“Coming up,” the technician responded.

The irregularities were in this image, too. George took a laser pointer from the pocket of his white coat and lit up the irregularities.

“That doesn’t look good,” he said.

Claudine and the technician studied the frame. Out of the various shades of gray they could now see the two lesions.

“My goodness,” Claudine said. “You are right.”

“It’s pretty damn subtle,” Susan said.

George stepped over to a hospital computer monitor and called up Tarkington’s previous MRI, quickly locating slices from the same location in the liver. They had been normal. The lesions were new. George paused a moment to think about what that could mean. On one level, their discovery meant George was doing his job well. But to the anxious man in the adjacent room with his head stuffed into a 3.0-tesla-strength magnet — a magnetic field 60,000 times the strength of the Earth’s — it meant something quite different. The incongruity of such a situation never failed to discomfit George. It also brought up his raw emotions about Kasey’s sudden death. The image of her face in its mask of death — its frozen pallor, the staring eyes, the dilated pupils — confronted him.