Cell (8 page)

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 12:05
P.M.

G
eorge 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.

•   •   •

G
eorge 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.

GEORGE'S APARTMENT

WESTWOOD, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 5:48
P.M.

G
eorge 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 time 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.

A few weeks earlier, with his promise to Kasey in mind, George had tried a couple of online dating sites, but they turned out to be a bust. As far as he could tell, no one on those sites told the truth about anything. Maybe he should see Paula as a friend. She was a known quantity. Seven years before, he had royally screwed up what could have been a rewarding relationship, which might not bode well, but at least now there was a new element. Apparently a portion of her current success stemmed from her taking his idea of using a smartphone as a primary-care doctor. They had that in common. Maybe her invitation to visit was something he should take seriously.

Out of desperation for human contact—any kind of human contact—George took another beer and went outside. He strolled over to the parking area behind his apartment complex. Earlier, when he'd arrived, he'd seen one of his neighbors, Sal DeAngelis, polishing his red vintage Oldsmobile convertible. The guy was nuts about the vehicle.

Sure enough Sal was still there, polishing away. He had his earbuds in, and as George approached he could hear the tinny jangle of doo-wop music leaking out of the tiny speakers. Sal didn't see him right off so George hung back and watched the man work. Sal lived next door and the men became acquainted from proximity more than anything else, sharing a common wall in their kitchens and living rooms. Sal was a friendly, outgoing, red-faced, stocky, retired plumber replete with a serious beer belly. He also was in the early stages of Alzheimer's, as well as a host of other medical problems, all of which he had been in the habit of discussing ad nauseam with George. Sal had never understood the fact that George was a radiology resident rather than a clinical doctor, so he constantly plied George with questions outside his specialty. Then a few months ago he had stopped. Although George had appreciated the respite from answering the same questions over and over, he was curious as to why they had suddenly stopped.

As George watched Sal work, he realized sadly that after his living in Los Angeles for three whole years, Sal might have been his closest friend. It was unfortunate, because there was little commonality and few shared interests.

As George observed his neighbor, he prepared himself to have a conversation about cars, and one car in particular. From previous interactions George was well aware that Sal's fire-engine red convertible was a 1957 Oldsmobile Golden Rocket 88 with a 371-cubic-inch displacement Rocket V8 with J2 Tri-Power carburation. He also knew that it produced 277 horsepower under the control of a Jetaway Hydramatic transmission. George didn't know the first thing about the engine or transmission in his own Jeep, but as for the vehicle in front of him, he knew everything and nothing. Finally, he reached forward and tapped Sal on the shoulder.

Sal's face lit up in a broad smile. He yanked out his earbuds.

“George! Check it out,” he said, pulling George around to his side of the car. “Just today I found a pair of original, mint-condition floor mats.” He opened the driver's door and pointed to two mats still wrapped in plastic. “They're primo! Primo!” Sal also had the habit of repeating phrases.

“Nice!” was all George could come up with. Floor mats were floor mats as far as he was concerned, but he didn't want to dampen Sal's enthusiasm. “Gonna take them out of the plastic?”

Sal hesitated. “I'd hate to mess them up,” he said as he pulled George back to the front hood, which he was about to open. “Have I showed you my new carburetor yet—”

George had seen the carburetor. At least three times, and he was not looking forward to a fourth viewing. He took a risk and steered the conversation away from the car even if it might open the proverbial floodgate. “How's it been going with your urinary tract symptoms? Still get that burning?” Suddenly George's curiosity had gotten the best of him. He also felt sorry for Sal since everyone else in the apartment complex steered clear of him so as not to have to slog through the same health-related conversations day in and day out. George knew the man had two older sisters and had even met them once during his first year in L.A., but George hadn't seen them since, though Sal often talked about them longingly. The guy was pretty much alone in the world. All he had was the Oldsmobile. And George, for whatever that was worth.

Just then the sound of a horn made both men jump. George looked around for the offending automobile. But there wasn't any. The horn was the ringtone from Sal's phone. The man snapped it up from the car's front seat and switched on the speakerphone.

“Hello, Sal, it's Dr. Wilson. You're on speakerphone. Is it all right for me to talk?”

“Yeah, sure, it's okay. Sure,” Sal responded.

“I've noticed two things over the last few minutes,” the physician said in a rich baritone. “Your blood sugar has been falling lower than I would like and your heart rate is over one hundred. Take a moment and have something healthy to drink, like orange juice, and then rest for a spell. Is that possible?”

“Can I finish polishing my car?”

“I'd rather you did not. It would be much better if you got some sugar now, along with some rest. When your pulse rate stabilizes, I'll let you know. Then you can go back to polishing the car.”

“Okay, okay.” Sal turned off the phone and glanced guiltily at George.

“What doctor was that?” George knew that Sal's primary-care doctor had been Dr. Roland Schwarz, and that clearly was not he on the phone.

Sal glanced around to make sure no one else was within earshot. He shielded his face with his hand and spoke in a low voice. “I'm not supposed to tell anyone but you are a doctor, so it probably doesn't matter. My new doctor is something called iDoc. It's a—”

“I know what it is,” George said. He was shocked.
iDoc again!
“When did you start using the app?”

“It's been a month or two now, I guess. Month or two. I can't remember exactly.”

George was taken aback. After a presentation that day heralding a new paradigm for medicine based on digital technology, he found out his neighbor was part of the Amalgamated beta test. It was a shock, not as much as ascertaining his deceased fiancée was part of the program, but a shock nonetheless.

“Can I see your phone?” George asked.

“Sure. Sure.” Sal handed it over, pleased that George was taking an interest.

George turned the phone over in his hand. The phone's protective case was a startling electric orange. “Quite a shocking color,” George said.

“I picked that out myself. I was always misplacing the damn thing. Now it's hard to miss.”

George turned the phone over to look at the screen. He stared at the iDoc icon on the screen, just like the one on Kasey's phone and just like the one on the huge LED screen at the Amalgamated presentation. “How long did you say you've had it?”

“Can't remember exactly. My mind isn't sharp as a marble anymore.” He laughed at his own joke. “A couple of months or so, I guess.”

George suddenly understood why Sal's medical questions had stopped. He had a 24/7 doctor in his pocket who didn't mind being asked the same questions over and over. “Do you like having a doctor to talk with whenever you want?”

“Love it. I use it all the time. Love it,” Sal said. “I used to have trouble remembering to take my meds, but not now. iDoc tells me whenever I need to take something. And it'll remind me if I forget. But most important, I don't have to think about the insulin anymore. It's automatic. Auto—”

“What about Dr. Schwarz?” George interrupted. “You used to see him quite a bit.”

“Not anymore. Nope. Not anymore. He put the reservoir thing in, but that was the last time I saw him.” Sal raised the waistband of his T-shirt to show George a thin, nearly invisible scar on his left lower abdomen.

George's reaction was complicated, adding to his general unease.

“But you're by far the best doctor I've ever met. The nicest, too,” Sal said. He seemed to have sensed George's not-so-positive reaction.

“And the name, Dr. Wilson?” George asked. “Where did that come from?”

Sal blushed. “I hope you don't mind. I had to pick a name . . .” Sal didn't finish his sentence.

“It's okay. Really! Thanks, Sal. I'm flattered. But I gotta go. Make sure you follow iDoc's advice and rest up.” George handed Sal back his phone. “Catch you later, buddy.”

“Later, Doc. Later,” Sal said, watching George walk off. He pocketed his phone and started to put away his polishing kit.

George headed back toward his apartment, going through the back gate. He took in the relative rundown condition of the complex, which didn't improve his mood. With a wry smile he imagined how it must compare to Paula's home. Although he'd never been to her house, he knew Santa Monica had become a high-end neighborhood loaded with celebrities and studio executives living in multimillion-dollar homes.

George's apartment complex, likely built in the sixties from the look of it, was an eyesore. It was a poorly constructed U-shaped structure, just like a gazillion other apartment buildings strewn across the greater Los Angeles area. Inside the U was a small, unappetizing pool ringed by a few scraggly palm trees and other plantings fighting for life. The building was two stories high with mostly one-bedroom units, although there were a few studios and two-bedroom apartments as well. The building manager lived in a ground-floor studio next to the back gate. His contribution to the building was a bad joke, as George had come to learn over the years. At exactly 3:00
P.M.
every day the guy began drinking. If he made an on-site inspection of an apartment past 3:00
P.M.
, a drink was always in hand. And since he was hungover every morning, he was MIA before noon.

The ground-floor units of the complex had small fenced-in patios facing the pool. George estimated that the rickety fences hadn't seen a coat of paint in at least ten years. George occupied a one-bedroom unit, as did Sal. Sal's apartment was just to the left of George's, and on the other side a wannabe actor slash waiter. His name was Joe. George didn't know the last name, and he didn't want to.

The actor's apartment, like Sal's, was the mirror image of George's but, unfortunately for George, their bedrooms shared a shoddily constructed common wall without insulation. Consequently, George already knew quite a bit about the actor, since he could hear the man's conversations as clearly as if he were in George's apartment. Joe worked at a nearby Beverly Hills restaurant and had lots of one-nighters that he picked up at the dive bars on Sunset over in West Hollywood. These sexual escapades often woke George up. A few times, desperate to get back to sleep, George pounded on the common wall, but it had never done any good. It was apparent that Joe's attitude toward women was not all that different from Clayton's.

Since George had so many nights that required him to stay in the hospital on call, he'd tolerated the Joe the Actor issue, but now that he was about to begin his final year of residency, which had no scheduled night call, he knew he was going to have to do something.

George skirted the pool, glancing over at two inked-up twenty-something girls floating on rafts. They lived in one of the upstairs units. They were drinking PBR beers from tallboy cans and didn't acknowledge George as he passed. He assumed his lack of body art combined with his somewhat combed hair was a factor.