Cell

1

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.

“You okay?” Claudine asked, eyeing him.

“Yeah. Fine. Thanks.”

But he wasn’t. Burying a problem only made it fester. The clarity with which Kasey’s death face appeared in his mind’s eye scared him. In the wake of her death he had discovered she’d just been diagnosed with very aggressive stage-four, grade-three ovarian cancer found by a CT scan she’d had at Santa Monica University Hospital. The test had been performed on the Friday before her death, which was early on a Monday morning, so she hadn’t even been told yet. Since the hospital was a sister hospital to George’s, he had used his resident’s access code to view the study. It had been a violation of HIPAA regulations, but at the time he couldn’t help himself. He was lucky he hadn’t been prosecuted, due to the circumstances, yet he had been worried.

“Let’s finish the study,” George said, shaking himself free of his disturbing thoughts.

“There’s only fourteen minutes to go,” Susan said.

Returning to his chair, George forced himself to go back to flipping through the radiology journal, trying not to think. For a time no one talked. No other abnormalities were found besides the two small lesions, which were undoubtedly tumors, but the implications of that finding hung like a miasma over the control room.

“I’m afraid,” Claudine said, breaking the silence and giving voice to what they were all thinking, “that, with the patient’s history, the lesions are most likely metastases of the patient’s original pancreatic tumor.”

George nodded, and said churlishly, mostly to Claudine, “Okay, now, quick reminder: We do not say or indicate in any manner anything to the patient, beyond mentioning that the test went well, which it did. The material will be read by the senior radiology attending, and a report will be sent to the patient’s oncologist and primary-care doctor. Any ‘informing’ will be done by them. Understood?”

Claudine nodded. She certainly understood, but the admonishment and its tone came across harsher than George had intended and created an uncomfortable silence. Susan looked down, busying herself by arranging her paperwork just so.

George realized how he sounded and launched into a little damage control. “I’m sorry. That was uncalled-for. You’re doing a great job, Claudine. Not just today, but in your whole month of rotation.” He meant it, too. Claudine relaxed visibly and even smiled. George sighed as the previous awkwardness dissolved. He needed to get a grip on himself.

“What’s our schedule for the rest of the day?” he asked.

Claudine consulted her iPad. “Two more MRIs. One at eleven, the other at one thirty. Then, of course, whatever comes in from emergency.”

“Any trouble with the two scheduled MRIs, you think?”

“No. Why?”

“I have to step out for two or three hours. I want to go to a conference over in Century City. Amalgamated Healthcare, the insurance giant and our hospital’s new owner, has a presentation planned for would-be investors. It’s something about a new solution they have come up with to end the shortage of primary-care physicians. Can you imagine: a health insurance company solving the primary-care shortage? What a stretch.”

“Oh, sure! An insurance company solution to the lack of primary-care physicians,” Claudine mocked skeptically. “Now, that sounds like a fantasy if I ever heard one, especially with Obamacare adding thirty million previously uninsured into a system that was already functioning poorly.”

“You sure the presentation isn’t being held down at Disneyland?” Susan said as she prepared to go into the imaging room to see to the patient, who at the moment was being slid out of the MRI machine by an attendant.

“Might as well be,” George said. Even though they were making light of the situation, it was a serious issue. “I’m really curious what they are going to say. It would take a decade, at the very least, to train enough doctors to fill the gap, provided they can talk doctors into practicing primary care, which isn’t a given. Anyway, I’d like to go hear what they have to say, if you don’t have any problem.”

“Me?” Claudine asked. She shook her head. “I don’t have a problem. Knock yourself out!”

“Are you sure?”

“Very sure.”

“Okay. Text me if you need me. I can make it back in about fifteen minutes if I’m needed.”

“No prob,” Claudine said. “Gotcha covered.”

“We’ll review them when I get back.” He paused. “You sure you’re okay with this — my leaving?”

“Yes, of course. I’ll be working with Susan again. She doesn’t need either one of us.”

Susan grinned at the compliment.

“Okay, great. Let’s all go in and talk with the patient,” George said, motioning them toward the door.

They put on game faces and entered the imaging chamber. Tarkington was sitting on the edge of the bed, smiling nervously. He was obviously eager for some positive feedback.

The doctors were all careful not to divulge the bad news, knowing that it would most likely mean more chemotherapy, despite the man’s tenuous kidney function. Claudine spoke as reassuringly as she could while George and Susan nodded.

Then, as the attendant and Susan got the patient onto his feet, George and Claudine retreated back to the safety of the control room. Talking with a patient destined to receive very bad news underlined the fragility of life. There was no way to be detached about it.

“That sucked,” Claudine said, sinking into a chair. “I hate not being forthright and honest. I didn’t think that was going to be part of being a doctor.”

“You’ll get over it,” George said with a casualness he didn’t feel.

She looked at him, stunned.

“I didn’t mean it like that. But you will get over it.” George didn’t know why he had just said that. He hadn’t gotten over anything of the sort. He hedged a little. “To some degree, anyway. You have to, or you won’t be able to do your job. It’s not the ‘not being honest’ part that bothers me as much as the shitty situation itself. We just had a conversation with a very nice man in the prime of his life, with a family, who will in all likelihood soon die. That will always suck.” George busied himself with the files of the upcoming cases so as to not have to look directly at Claudine. “But you have to compartmentalize your feelings so you can continue to do your job, which will help save the lives of those who can be helped.”

She looked at him.

George sensed her gaze and felt bad. Repeated exposure to such cases had not deadened his own feelings. He looked up at her. “Look…,” he said, searching for the right words. “It’s part of why I went into radiology. So there would be a buffer between me and the patient. I figured if I could deal with the images rather than the patient, I would be better equipped to handle my job.” He motioned to the adjacent room, where they had just left Tarkington. “But as you can see, the buffer has holes in it.”

They both sat silent for a moment, then George moved to the door. “Well, I have to get a move on—”

“Me, too,” Claudine said softly.

George looked at her quizzically: Me, too, what?

“It’s why I went into radiology. And thanks… for the honesty.”

George gave her a melancholy smile and left the room.

2

As George walked into the presentation, he felt like a fish out of water. It was obvious to him that the event was primarily for prospective investors in Amalgamated Healthcare. The room was filled with “people of resources.” In other words, people unlike him. George was immediately struck by their custom-tailored business suits, four-hundred-dollar haircuts, and general air of superiority. He was aware that Amalgamated had recently acquired a number of health care companies and hospitals, including the medical center where he worked. The prospect of offering health insurance on a national scale rather than on a state-by-state basis had been part of their acquisition strategy. George assumed the company had thoroughly combed through the 2,700-plus pages of the Affordable Care Act — aka Obamacare — determined to exploit all of the changes mandating health insurance for everyone.

George pushed through the crowd at the back of the room, thankful he had left his white coat back at the hospital. As it was, he wouldn’t have been surprised if someone attempted to order him out, thinking he was crashing the party. As he walked down one of the aisles, someone handed him a fancy prospectus filled with spreadsheets and financial data. He felt a rush of déjà vu. It was as if he were glimpsing an alternative life he had turned his back on. When he first walked into Columbia University as an undergraduate all those years before, he had already narrowed down his career choices to going either into business or to medical school. By the end of his first year he had veered toward medicine, a choice Kasey had made him come to understand. Had he taken the alternative, he would have felt at home here. This could have been his life. He might even have some money in the bank rather than a mountain of debt. He tried to shut off such thinking; that was another life, another world, another dream. He forced himself to focus on the moment.

There was seating for several hundred people in the room. He noticed several IT barons representing Apple, Oracle, Google, and Microsoft, along with a few well-known hedge fund guys in a reserved section at the front. George frequently watched CNBC while on the treadmill, so he recognized some of the players. The gathering here was like the Fortune 500 version of an Oscar party. Attendees were being served refreshments by a flock of extremely tall and gorgeous young women in futuristic white uniforms.

On the dais at the front of the room were four stainless-steel-and-white-Ultrasuede modern club chairs. Expensive-looking, even from a distance, each one probably worth more than George’s car. Directly behind the stage was an enormous LED screen with two other equally sized screens on either side, at forty-five-degree angles. Amalgamated Healthcare was spelled on each in bold black letters. The room itself also was mostly white, with row upon row of padded Ultrasuede seats with folded writing arms. Also white, of course. George was impressed, making him wonder if the presentation had been arranged by the same consultants who handled the iPhone and iPad product releases for Apple.

George took a seat in the very last row and waited. At exactly ten o’clock the room lights dimmed, and four people appeared on the speakers’ platform: three men and one woman. At the same time, a choral group, reminding George of Celtic pop music, could be heard very faintly from hidden speakers, giving the event an ethereal atmosphere.

George’s eyes were drawn to the woman. He recognized her immediately. Her name was Paula Stonebrenner, and it was because of her that he’d been invited to this presentation. Paula was dressed in a smart business suit, with just enough white ruffles around her neck to broadcast her femininity. She was attractive in a classic, Ivy League fashion.

Paula had been George’s classmate at Columbia Medical School, and he had gotten to know her reasonably well back then. “Reasonably well,” as in they hooked up once or twice. They had been attracted to each other in the first weeks of medical school and ended up going out for drinks with some other new friends, and one thing led to another. “Another” being the roof of Bard Hall, the medical school dorm at Columbia. George still considered it the most risqué sexual episode of his life.

After the initial sparks George’s interest abruptly waned when he discovered another Columbia classmate, Pia Grazdani. Pia was dark, exotic, and an off-the-charts gorgeous mix of Italian and Albanian heritage. Her mere presence swept him off his feet. Her aloof manner captivated him. And her callousness stomped on his heart. She resisted any and all attempts at friendship, let alone romance. Throughout high school and college George had never had trouble getting women to go out with him. He had an outgoing personality and was a starter on all the right sports teams. He was used to being the one to call the shots. Not so with Pia.

Prior to Pia, George had been one to avoid commitment. He would rationalize his quick departure from relationships as his version of “compassion,” likening his exit to a girl getting stung by a bee. It hurt briefly but was quickly forgotten. And it wasn’t like he was being selfish — all through high school and college his desire to succeed, whether as a doctor or businessman, had taken precedence over social attachment, which for him had been more about entertainment than an opportunity for self-learning.

George understood all this now, even though he hadn’t in the past. And again, it was all because of Kasey and her unique understanding of interpersonal relationships. She had a natural intuition about people that had drawn George to her like a hungry mouse to cheese. Kasey was the first woman who had become a best friend and confidante to George before becoming a lover. It had been a revelation for George, a kind of rebirth that made him understand what he had been missing.

Today George had to admit that Paula looked fantastic. He also had to admit that he really didn’t know anything about her other than she was smart as a whip, fun to be with, and what he used to call a “live wire.” After being essentially dumped for Pia, Paula had acted the part of spurned lover. She wouldn’t even talk to George for the rest of that year. But by the second year, she didn’t seem to care. They happened to live in adjacent dorm rooms and had a hard time ignoring each other anyway. By their final year they were friends, or at least friendly acquaintances.

For a moment George entertained the idea of walking down to the dais and saying hello to Paula, but then chickened out. Instead he watched with growing fascination as she interacted comfortably with the three men on the stage and with some of the financial VIPs in the reserved section at the front. She took a seat in one of the club chairs with two of the accompanying men. The third man stepped forward to speak. From George’s perspective he was extremely impressive. He was meticulously dressed, standing ramrod straight with a commanding, almost military presence. His graying hair literally sparkled in the glare of the halogen spotlights. On the huge LED screen behind him appeared his name: Bradley Thorn, Amalgamated’s president and CEO.

“Welcome!” Thorn boomed with a broad smile. Without a visible microphone, his voice filled the large room. George wasn’t surprised. Everything was wireless these days.

Conversation hushed. People who had not yet found a place now rushed for a chair. George glanced back at Paula as well as the other two men seated beside her. With sudden shock George recognized one of them, and scrunched down in his seat, as if that would keep him from being seen. His pulse picked up.

“Oh, shit,” he murmured.

3

Sitting on the stage was the internationally known radiologist Dr. Clayton Hanson. He was also the chair of the residency training program at L.A. University Medical Center, someone George happened to know quite well, better than any of the other professors and attendings. He was essentially George’s boss, and George was currently playing hooky. The reason they knew each other well was because, besides being George’s superior, Clayton considered himself to be a lothario (the man was not without ego), and he had hit on Kasey even when he knew she and George were an item, although that was before the engagement.

The year before George arrived on the scene, Clayton had divorced a fading actress after twelve years of a dysfunctional marriage and was intent on making up for lost time. George had heard rumors that Clayton’s frequent transgressions had been a significant factor in his former wife’s decision to seek the divorce.

As George was one of the few unmarried residents, Clayton had initially sought him out for hints on how to meet some of the young fillies (Clayton’s word) that he assumed George would be privy to. That had never come to pass, but over time Clayton and George had established a friendship of sorts that for the most part had evolved into Clayton’s trying to fix George up with the women so that he, Clayton, could meet their friends.

George’s immediate problem was that before coming to the presentation he hadn’t bothered to get permission to leave the hospital, so he was AWOL with one of the radiology bigwigs onstage in front of him. Even though it was his last day of an easy rotation, and he had covered himself, he felt uncomfortable. He considered getting up and walking out but decided doing so would call more attention to him than just remaining in his seat. Luckily he was a good distance from the dais, and Clayton showed no sign of having spotted his resident.

George took a deep, calming breath and directed his attention back to Paula. She certainly did look terrific and impressively “together.” He found himself regretting that he hadn’t followed up with her back in medical school and wondered if reviving an acquaintance with her would fulfill his promise to Kasey.

George’s musings were interrupted by Thorn launching into a slick presentation of Amalgamated Healthcare’s spectacular growth. He explained that the company was positioned to take full advantage of the Affordable Care Act, something most other insurance companies thought impossible, given the law’s restrictions on profit, but he and his inordinately competent team had figured out a way and were leading the charge. All they needed was an infusion of more capital to continue their spectacular expansion.

“The politicians, whether they meant to or not, have put the health insurance industry in the driver’s seat to manage what will more than likely balloon to nearly twenty percent of the United States’ GDP,” Thorn continued. “Most of us know deep down that they should have passed a kind of Medicare for everyone. But they didn’t have the courage. Instead they have handed the keys to us on a silver platter. This is an unprecedented opportunity, particularly in view of what you’re going to learn today. The world, not just the United States, is on the cusp of a paradigm shift in medical care as the profession is dragged kicking and screaming into the digital age. And we, Amalgamated, are going to be leading it.”

George felt a jolt of electricity surge through his body. Thorn had hit a nerve. Over the last several years, George had become vaguely uneasy about what was happening in medicine in general and in the specialty of radiology in particular. There were somewhat fewer positions available and salaries were heading south. It wasn’t an overwhelming change but nonetheless noticeable. Consequently Thorn’s words were jarring, giving substance to a nebulous yet vexing fear that he was entering the medical profession after it had passed its zenith.

“Our country,” Thorn continued, “is going to experience a democratization of medicine that is going to catch the medical profession by surprise, but not Amalgamated. Already the general public’s main source of medical information is not doctors, as it’s been for a number of centuries: it is the Internet and social media. To illustrate my point, compare the medical profession as you know it today to another industry, dominated by the iconic Eastman Kodak Company. Kodak thought it was in the film business rather than the image business.” He paused. “We all know how well that went.”

The audience laughed. Kodak had filed for bankruptcy in 2012.

“The medical profession thinks it’s in the sickness business. It is not. It is in the health business. Preserving and maintaining health and preventing disease are the future of medicine, not treatment in the form of ever more drugs and procedures. And I’m not talking about prevention in a passive sense. I’m talking about prevention as an active process, but not wasteful, like yearly physicals and full-body CT scans. And when treatment is needed, it will be directed for the individual, not some imaginary person representing the statistical mean.

“This is important, because a third of the almost four hundred billion dollars the public pays the pharmaceutical industry is totally wasted. That’s one hundred thirty billion dollars going down the drain. The drugs involved often have no positive effect on a specific individual. If a drug trial showed that it only helps five percent of patients, that means it doesn’t help ninety-five percent, even though side effects are pretty close to one hundred percent. Bad odds!

“We at Amalgamated don’t want to waste money on useless drugs and dangerous procedures. We want to treat the individual, not a statistical construct. How will this come to pass? Through this app!” Thorn waved toward the LED screens behind him as if he were a conductor of a symphony orchestra. Coinciding with his gesture were the first thirty seconds of Beethoven’s Fifth Symphony. Simultaneously the word iDoc flashed onto the screens in foot-high bold black letters.

After pausing for effect, Thorn turned back toward the audience: “A glowing example of the failure of current medicine is the fact that the shortage of primary-care physicians has never been solved. As a result, there are too many unnecessary and expensive visits to emergency rooms, too many specialists seeing patients who don’t need to be seen by them, too many procedures on patients who don’t need them, and too many patients being prescribed unneeded drugs. All of which means a massive number of unnecessary, wasteful payouts. Well, my friends, all that is going to change; there’s a new doctor in town! The twenty-first century’s primary-care physician is an FDA conditionally approved smartphone app, and its name is iDoc!”

Thorn again gestured toward the giant LED screens as the images of three smartphones made by the world’s largest manufacturers — Apple, Samsung, and Nokia — flashed. The phones displayed a single app: a white square containing a red cross with iDoc spelled out along the horizontal arm. George caught his breath from another jolt. He’d seen the icon before.

“iDoc and its incorporation into the smartphone application platform is a result of our close working relationships with leading smartphone manufacturers and developers. The end result is a marvelous convergence of the Internet, mobile phone technology, quantum cloud computing with our state-of-the-art D-Wave quantum supercomputer, social networking, digital medical genomics, wireless biosensors, and advanced imaging. iDoc will be the doctor of tomorrow, and we have it today!

“We’ve licensed the distinctive symbol of the International Red Cross, as we felt it imperative to use a universally recognized icon. Amalgamated Healthcare will also be making an additional donation to the organization with each download of the iDoc app. And we’re not stopping there. Amalgamated will mimic the Affordable Care Act in — what else? — affordability! Enrollees with incomes of up to four hundred percent above the poverty line will either have their smartphones subsidized or given out free. Regular phone plans will stay in effect for enrollees, but data plans will be converted to unlimited. Our subsidization of the data plans will again mimic that of the ACA. All data generated by the app will be stored on our cloud services, enabling an acceptable baseline phone configuration of three-G capability with a minimum of thirty-two GB of memory. Any current enrollees who now fall below those smartphone specifications will be upgraded at our expense.”

Now George felt a chill descend his spine. He had the distinct feeling he was witnessing history in the making. With the idea of a smartphone functioning as a primary-care physician, something he had thought about in the past, he was in shock. His mental association of the Amalgamated Healthcare presentation with one of Apple’s product releases was magnified. This was a big deal. He was also amazed that Amalgamated would be able to absorb all these costs and still have a profitable business plan. What was he missing?

4

George glanced around the room at the other attendees. No one spoke. No one coughed. No one moved. The only sound was that of the faint Celtic choir in the background.

George redirected his gaze toward the dais. Thorn was still twisted around, staring up at images of the smartphones like a proud father. When he turned back the crowd burst into applause.

“Hold your excitement,” Thorn said. “There’s more. Shortly you are going to hear brief presentations from our three other speakers this morning. First will be Dr. Paula Stonebrenner.” He gestured toward Paula, and George looked over at her. She stood briefly and nodded to the audience. If she was nervous, it didn’t show. There was a smattering of applause.

Thorn continued. “Dr. Stonebrenner, I know, doesn’t look old enough to be an MD, but I assure you that she is. She will be giving a very short overview of iDoc and its capabilities. She is the best person for this task, as she is the individual who gets the credit for the idea of a smartphone functioning as a twenty-first-century primary-care physician. There have been multiple apps for smartphones configured to do various and sundry medical functions, but it was Dr. Stonebrenner who came up with the brilliant concept of putting them all together in a purposeful algorithm to create a true ersatz physician on duty twenty-four-seven for a particular individual, truly personalized medicine.”

“Holy shit!” George whispered to himself. He felt a surge of color suffusing his face. He couldn’t believe what he’d just heard and didn’t know whether to be angry or flattered. Suddenly George realized why Paula had invited him to the presentation. They’d had a conversation about this years before. She hadn’t come up with the concept. She’d gotten the idea for a smartphone primary-care physician from him!

When George had first come out to L.A. for his residency, he’d known that Paula was coming, too, not for a residency but rather for a job with Amalgamated Healthcare. They’d talked about being in the same city before graduation. She’d been in the MD-MBA program during medical school, a fact that they’d argued about on occasion. It had been George’s opinion that she shouldn’t have taken a slot to become an MD if she had no intention of ever practicing medicine. There were too many people who really wanted to be doctors who couldn’t get a spot in medical school, and that was leading to a shortage of primary-care doctors. Paula, of course, had seen the issue differently. It had been her contention that the business of medicine was so important there had to be people who understood all sides of it. Neither convinced the other.

When George arrived in L.A. he tried to contact Paula a few times, but she never returned his calls. He didn’t have her home number or address, so he’d only left messages at Amalgamated’s main number. He never knew if she got them or not. But then, after an emotionally draining trip back home for Thanksgiving 2011, he made a more determined effort to track her down. His mother, Harriet, had died unexpectedly while he was home and, coming back to L.A., he had never felt more alone. He hadn’t been particularly close to his mother, but watching her die was one of the most painful episodes of his life.

George’s father had died when he was three and his mother remarried when George was four, but George never got along with his stepfather. On top of that, his stepfather had a son three years older than George. Then his mother and his stepfather had a daughter, and George ended up the odd man out, spending his high school years living with his grandmother, with whom he had a close relationship. During medical school his stepfather died, and his mother developed a series of health issues from smoking and obesity, which turned out to be deadly just four days short of her sixty-seventh birthday.

The day had started out routinely, but by early afternoon Harriet began wheezing and then developed chest pain. When George suggested that they call her doctor, she said she didn’t have one. Her primary-care physician had changed his practice to the concierge model, which Harriet had refused to join because she thought the yearly payment way too steep. When Harriet turned sixty-five, she tried but failed to find a doctor who would accept Medicare.

So on that fateful Thanksgiving Day there was no doctor to call or see. And she refused to go to the hospital. George pleaded with her to go but was accused of meddling. He tried to call a few of the local physicians that he could find online but wasn’t able to get anyone on the phone. He needed someone either to see her or tell her to go to the hospital. While he was making the calls, his mother became short of breath and began to perspire. He called 911. The dispatcher said the local ambulances were all occupied but that one from a distant town would be there ASAP but couldn’t give an ETA.

With growing consternation George watched his mother turn ashen. Realizing he couldn’t wait any longer, he managed to get her into the backseat of her car despite her reluctance, and rushed her to the local hospital. When he pulled up to the ER, he discovered it had been closed. “Consolidation” was what the corporation that bought the facility had called it. George drove as fast as he could to the next closest hospital, which was owned by the same corporation. It was located a half hour away, and by the time George pulled in, jumped out of the car, and opened the back door, his mother was dead. The sheer frustration of it all nearly drove George mad. He had never cried much, even as a child, but on that cold, dreary day he sat in that car and wept.

5

George reached up with both hands and rubbed his eyes to get himself under control. It always bothered him to think about his mother’s passing, and since Kasey’s death the unwelcome remembrance of the episode had become more frequent. The two episodes shared a similarity: Both had occurred in his presence.

Blinking his eyes open, George looked back at the dais. Paula had sat down and Thorn was saying, “I am also pleased to introduce to you Dr. Clayton Hanson.” Thorn pointed over to Clayton, who, like Paula, rose to his feet to acknowledge a bit of applause. From the standpoint of appearances, Clayton looked as good as Thorn, decked out in equally expensive gentlemen’s finery. Where he surpassed Thorn was his overly tanned face, accentuated by his carefully coiffed silver hair. He was old enough to appear learned and young enough to attract women of any age.

“Dr. Hanson, vice chair of academic affairs for the L.A. University Medical Center’s department of radiology, will be giving us an overview of iDoc’s advanced imaging capabilities, but before Dr. Hanson, I would like you to hear from Lewis Langley. He’ll be saying a few technical words about the unique character of the iDoc algorithm.”

Langley nodded slowly at the mention of his name but didn’t stand. He didn’t look anything like the typical software guy and was miles away from the other two men with whom he was sharing the dais, wearing shit-kicker boots with black jeans that were topped off with a huge, silver-plated Texas longhorn belt buckle. To round out the outfit, he wore a black sport jacket over an open-collared black shirt.

For the next few minutes George found it hard to concentrate on Thorn’s words. His unexpected trip down memory lane of that awful Thanksgiving Day and his mother’s death had him freaked out. On the flight back to L.A. after the funeral, he had found himself agonizing over the way the lack of primary-care physicians had contributed to the nightmare.

As fate would have it, the airplane magazine had an article about a phone app that could anticipate heart attacks. That had been the stimulus that made him think about the phone as a primary-care doctor. There were already six billion cell phones in the world and the technology was there; it just needed to be channeled. Although he didn’t do anything about this revelation — what could he do as a first-year resident — he did mention the idea to Paula when he finally did get in touch with her.

They had met for a drink, and after some small talk he told her his mom’s sad story and his idea of a cell phone functioning as a full-blown primary-care physician. He was convinced a device like that would have been a godsend to his mother and probably would have saved her life.

Paula was immediately taken by the concept and told him the idea was perfect for Amalgamated, which alarmed George. It was his belief that if anybody did it, it should be the medical profession, not an insurance company, since the smartphone, in a very real way, would be practicing medicine. Paula’s response was to laugh, pointing out that the medical profession would never get around to it, having dragged their collective feet at the idea of competition of any sort as well as their disinclination to embrace the digital world.

In the end, George’s effort in reconnecting with Paula didn’t pan out. As busy as he was with his first year of residency, he didn’t call her for months, and when he did, she declined the offer of getting together. The next time he had heard from her was just the previous week, when she texted him the invitation to the event out of the blue. The fact that the presentation was about the smartphone being a primary-care physician was a complete and total surprise.

George again considered getting up and walking out. She obviously latched on to his idea and ran with it without any attempt to connect with him even just to acknowledge his contribution. George squirmed in his seat, his mind racing to think of what to do about it. He shifted his weight to stand and leave. The man next to him even moved to let him by, but George didn’t get up. Instead he relaxed back into his seat. What purpose would it serve to walk out? Just wanting to get away was a childish response.

It ended up being a good thing that he stayed, too. Thorn still had a few surprises. “Amalgamated Healthcare is proud and will be announcing to the media that we are near the end of a very successful beta test of the iDoc algorithm and app. For almost four months, twenty thousand people here in the Los Angeles metropolitan area, who had signed strict NDAs, or nondisclosure agreements, have been using the iDoc app with truly phenomenal success. As a primary-care physician, iDoc has proven itself to be utterly reliable, far better than a flesh-and-blood general practitioner under our current health care system. And this sentiment comes directly from our participant surveys. Enrollees love it!”

George swallowed with some difficulty. His mouth had gone dry. He’d seen the iDoc app on Kasey’s phone but had not known what it was, and she hadn’t told him. She had been part of Amalgamated’s beta test! The news also gave him a queasy feeling in the pit of his stomach.

As Thorn went on to explain that iDoc would be immediately and immensely profitable, George shook his head with a mixture of disgust and admiration. iDoc was going to be performing an end run around the whole medical industry. It was about to become the doctor!

“Please!” Thorn called out after allowing the excited murmuring that had erupted to continue, obviously enjoying the moment. “Let me make one more point before I turn the floor over to Dr. Stonebrenner to provide technical details. With the success of iDoc’s beta test, Amalgamated is about to launch the program nationally. Concurrently, we will also be looking to license the program internationally, particularly in Europe. To that end we’ve been in negotiations with multiple countries, particularly those with extensive, dependable wireless infrastructure. I can confidently report that negotiations are rapidly progressing. The need for iDoc is global. Of course, this underlines how very good an investment in Amalgamated Healthcare is. We are about to conclude deals with several hedge funds, but another round of funding will be required. Our market is global. Our market is massive. Now let me turn the floor over to Dr. Stonebrenner.”

As Paula stepped forward, George did a rapid Internet search for the meaning of a beta test. He vaguely recalled hearing the term but wouldn’t be able to define it if he was pressed. He quickly found out that it’s a term for the second round of software testing in which it’s used by a limited but sizable audience to ascertain user acceptance while at the same time seeking to identify and fix glitches or problems.

As Paula began speaking George wasn’t sure how he felt about her taking over his idea without even getting in touch with him. At the same time he realized he hadn’t exactly pursued her.

“Think of iDoc as the Swiss army knife of health care,” she was saying. “Attachable sensors and independent probes that communicate wirelessly will make the phone a versatile mobile laboratory.” As Paula spoke, a slick video presentation demoed the app’s capabilities. “The property of capacitance is what enables smartphone touchscreens to sense our fingertips. But the screens also have the ability to detect and analyze much smaller things, like DNA or proteins to enable it to identify specific pathogens or particular disease markers. An Amalgamated client could simply place a saliva or blood sample directly onto the touchscreen for an analysis, and treatment would be based on the patient’s past medical history and unique genomic makeup. Recent leaps forward in nanotechnology, wireless technology, and synthetic biology make iDoc possible. With our supercomputer we will constantly monitor, in real time, a host of physiological data on all iDoc users of all vital signs. The sky is the limit. iDoc can even extend into the psychological realm because iDoc has the ability to monitor the client-patient mood, particularly in relation to depression, anxiety, or hyper states, and then communicate with the patient accordingly for on-the-spot counseling or referral to a mental health specialist.”

Paula then went on to describe how the app is able to monitor many of these functions, in particular those followed routinely only in an intensive-care unit, by the use of a bracelet, ring, or wristband with built-in sensors that communicate with the phone wirelessly. She demoed special eyeglasses that can be worn for additional monitoring of the real-time function of blood vessels and nerves in the retina of the eye, the only true window on the interior of the body. She explained that a continuous recording is made of the EKG and, if needed, the smartphone can function as an ultrasound device for studying cardiac function by merely having the patient press it against his chest.

Paula paused for a moment and stared out at the audience. From their stunned silence she knew she had their undivided attention. “Okay,” she said soothingly, switching gears, “so the question then becomes, what will iDoc do with this enormous wealth of real-time data? I will tell you. It will do what any good doctor would do and do it better, much better. Thousands of times a second all the data will be correlated via its cloud service by the Amalgamated supercomputer with the client-patient’s full medical history, the client-patient’s known genomic information, and the totality of current medical knowledge that is being updated on a continuous basis.”

Paula then gave a specific example and talked about the app’s ability to diagnose a heart attack, not only when it is happening, but also well before, so that it would have the ability to alert the patient days before the attack was going to occur. Paula then touched on iDoc’s ability to follow and treat chronic diseases like diabetes. With iDoc and an implanted reservoir of insulin, blood sugar could be tracked in real time and the correct amount of insulin could be released automatically to keep the patient’s blood sugar continually normal. In a very real way, for a diabetic, iDoc is essentially curative.

George found himself nodding. It was apparent to him immediately that iDoc had handled Kasey’s diabetes and why she didn’t talk about it. Kasey’s word was her bond, and she had obviously signed a nondisclosure agreement. He remembered how pleased she was at the time, being free of her usual burdensome monitoring. George even knew she had had some sort of implanted device. Now he knew what it had been. It had been a reservoir just as Paula was describing.

Paula concluded by saying that embedded reservoirs have been and would be used for various ailments, and not just for chronic diseases, noting that it would be the answer to the problem of poor compliance that a number of patients demonstrate when it comes to taking medications as instructed.

Despite his irritation at having been, in his words, ripped off on the concept, George became progressively impressed by what he was hearing. He could tell everyone else in the room felt the same. Paula was offering understandable specifics, and everyone was listening with rapt attention. George could easily see why iDoc would make a superb primary-care doctor, especially when the doctor was available 24/7 to answer a patient’s questions without the inconvenience of having to make an appointment, travel to an office, and wait to be seen by someone who might be rushed, distracted, or not able to find the appropriate patient records, and, worse yet, might have forgotten half of what he or she learned in medical school.

“From the outset,” Paula continued after another astutely planned pause, “we wanted to make iDoc extremely personable. The client-patient can choose the gender of his doctor avatar as well as his or her attitude in relation to being paternal or maternal in tone. So far there is also a choice between forty-four languages and several accents. There are also choices available regarding how the patient would like to be notified when his iDoc doctor wants to have a chat when stimulated by a change in the client-patient’s constant physiological or mental monitoring.

“I want to emphasize that iDoc never has a memory lapse, never gets tired, never gets angry, is never on vacation, and never has a drink, pain reliever, or sedative. And lastly, client-patients can select a name for their avatar doctor, either made up or from a preset list. If they don’t want to be bothered, a name will be selected for them with a choice of ethnicities. For privacy concerns, if a client-patient’s speakerphone is activated, iDoc will ask patients if they are alone and if it’s okay to have an open audio conversation. iDoc will strictly guard patient confidentiality, using the full gamut of biometric identifiers.

“What I have just given is a rapid, superficial overview of iDoc. It uses an extraordinarily versatile algorithm. As Mr. Thorn mentioned, the reception by our client-patients throughout the beta test has been exceptionally positive far beyond our expectations and hopes. People love iDoc and already are telling us they don’t want to give it up at the conclusion of the test period and are eager to share their experience with family and friends, which they have been strictly forbidden to do. iDoc has already saved lives as well as time and inconvenience for the patients that have it, and it has saved money, too.” Paula paused on that note, letting the audience absorb the information. When everyone realized she was done, applause erupted. Paula waited a few beats, acknowledging the audience’s response, then said a quick thank-you.

George marveled at why other people had not come up with the iDoc idea. After Paula’s presentation it seemed intuitive, given current technology. He watched Paula return to her seat as the third speaker approached the front of the stage. George hoped he might catch her eye, but she didn’t look in his direction.

Lewis Langley addressed the audience for only a couple of minutes. Even from where George was sitting he could see his cowboy-style fitted shirt had snaps instead of buttons. With his hair that was cut long, giving Langley a rather wild, artsy look, George got the impression he was the right-brain, creative type in contrast to his left-brain colleagues.

“I’m not going to take much of your time,” Langley said with a discordant New York accent. “There are only three things I want to convey above and beyond what you have already heard from Mr. Thorn and Dr. Stonebrenner. First off, and most important, the iDoc algorithm was written to be heuristic so that it would improve itself by learning on its own over the course of time. This has already proven to be the case to a marked degree during the beta test. As a backup to iDoc, Amalgamated has employed a large group of internists, surgeons, and other specialists who rotate through a twenty-four-seven state-of-the-art call center. At any given time there are at least fifty of them on hand.

“These doctors assist iDoc’s automated decision making as a default mechanism whenever there is the slightest problem. At first, at the outset of the beta test, there were quite a few calls, maybe as often as twenty percent of the episodes. But that changed rapidly, and during the course of the three-month beta-test period, the number of calls coming into the center dropped by eleven percent, meaning the iDoc logarithm is indeed learning.

“The second issue I want to explain is that important subjective issues have been meticulously researched and included in the iDoc algorithm, such as pain and suffering associated with treatment options and possible outcomes, something traditional medicine has always had great difficulty considering. Cost was another issue taken into consideration in the iDoc algorithm. For example, generic drugs are prescribed, provided the efficacy between the generic and the brand-name drug is equal. If the brand-name drug is superior, it is prescribed.

“The third and last issue I want to mention is that it is my firm belief that iDoc will bring about a miraculous democratization of medicine, somewhat akin to what the Gutenberg Bible did for religion. iDoc will free the general public from the clutches of doctors and the medical profession just as the Bible freed the public from the clutches of priests and organized religion. iDoc will be making the paradigm of the practice of medicine personal, meaning that if a drug is prescribed, it will be prescribed because iDoc knows that it will benefit the specific patient rather than knowing it will benefit five percent of patients with the hope that the specific patient will be part of that five percent. Because of this democratization of medicine, I believe the introduction of iDoc will prove to be on par with or more important than other major technological milestones, such as the development of the computer, the Internet, the mobile phone, and DNA sequencing.”

Dr. Clayton Hanson was the final speaker to address the audience. Despite acknowledging to himself that he was acting ridiculous, George flattened himself down in his chair throughout Hanson’s brief talk. His remarks, in contrast to those of the other speakers, were pedestrian. He talked briefly about the medical imaging capabilities of iDoc, particularly ultrasound in conjunction with a wireless handheld transducer. He listed as an example the cardiac function tests that could be performed from the privacy of the patient’s home. Until now these tests required multiple hospital visits and thousands of dollars. His point was that not only was iDoc a better primary-care physician than a flesh-and-blood individual, it was also going to save society a significant amount of money immediately and over the long haul.

Thorn stepped forward again as soon as Clayton finished and took his seat. “Thank you all for attending. And before I open the floor to questions, I want to remind you that we’ll be having a reception and buffet lunch in the restaurant on the first floor of this tower immediately following our presentation, so we all have a chance to speak personally. Okay, who’s first?” A number of hands shot up. The excitement in the room was palpable.

6

George took the elevator down to the first floor and walked toward the restaurant’s entrance with a number of the other attendees. He was deep in thought, debating what to do next. He knew he should head back to the hospital but couldn’t let the opportunity to confront Paula pass, even if he risked being seen by Clayton. He rationalized that he wouldn’t be long, and he hadn’t received any texts or calls from Claudine Boucher, so things were undoubtedly fine in the MRI unit. George wasn’t surprised, since Claudine was one of the more accomplished residents on her last day on an MRI rotation; she knew the ropes in spades.

He walked into the restaurant, which was reserved for Amalgamated, leaned on the bar, and ordered a Diet Coke. Again, the caffeine was a slight risk, considering he had already had coffee, but, hey, he was rolling the dice today. With his drink in hand he moved to a corner of the room, waiting for Paula to appear. He wanted to avoid any conversations with strangers, if possible. The truth was George couldn’t shake the feeling of inferiority to these successful market warriors. They were a part of the real world, an arena outside the hospital in which he had limited experience.

He spotted her as she strolled in with the other speakers. There was a smattering of applause. It was apparent that the presentation had elicited a very positive reaction. Luckily for George, Clayton immediately veered off, zeroing in on an attractive female in an expensive business suit. George gathered up his courage and walked over toward Paula. Eyeing the situation, looking for an opportunity to present himself, he saw she looked even better up close and was obviously totally at ease in what was to George an alien environment. He wondered what might have happened between them during their first year of medical school if he hadn’t been such an immature ass. Just then she looked up and caught sight of George and smiled broadly. Encouraged by her grin, he headed straight for her.

“George!” Paula exclaimed. “You made it!”

“Hello, Paula.” George put out his hand to shake but she disarmed him by pulling him toward her and kissing him on the cheek. She seemed genuinely happy to see him.

She looked around, still holding on to his hand, and spotted Bradley Thorn shaking hands just behind her. “Bradley, excuse me, this is a dear friend of mine from Columbia Medical School, George Wilson.”

Thorn peered at George over his half glasses. He was holding one of Amalgamated’s spreadsheets.

“George, this is Bradley Thorn, my boss. George is a radiology resident over at L.A. University Medical Center. Which makes him one of our new employees!”

“My pleasure,” Thorn replied. “Excuse me.” He turned from George, his sights set on a big-name CNBC host standing nearby.

Paula smiled at George and shrugged. “Sorry. He’s in ‘biz’ mode.” She aimed another beaming smile at George; she was obviously still on a high after the excitement of the presentation.

“Hey, no problem. I get it.” George didn’t want her to feel defensive.

“I really am glad you came,” she said. “Thanks!”

“Me, too. It was lucky that I could get away,” George said, feeling a bit nervous and less confrontational now that he was actually talking with Paula. “It’s the last day of this month’s rotation, so the resident I’m supervising is entirely comfortable working alone. Tomorrow will be a different story. July first. I’ll be shepherding one or more first-year residents. You know what that means.”

She gave him a blank look.

“July first. The first day of residency, nationwide, for freshly minted medical school grads?” He was trying to help her remember all the requirements to becoming a full-fledged specialist.

“Oh, right. Aka, the deadliest month of the year for patients.” She chuckled, although there was truth in the statement. Both knew that hospital deaths spiked in July, when thousands of new residents began attending patients.

“I’ll be in the ER next month… well, tomorrow, actually,” George said. “Supervising a few first-years there. It’s my last year as a resident. Finally I will make some real money.” He had meant to say it in jest, but it didn’t come out that way. The look on Paula’s face was confirmation.

Paula regarded him for a beat, sensing his nervousness. “Thanks again for coming, George. I really wanted you to be here. So… what do you think of iDoc?”

“I think the app is amazing. A real paradigm shifter, just as it’s being billed. Wish I had thought of it.” His eyes stayed close on her.

“And, of course, you did. Don’t think I’ve forgotten. It’s why I wanted you to be here for our announcement, so you would see it was becoming a reality, not just an idea no one acted upon. It’s actually happening!”

George was taken aback. He had not expected such honesty.

“It was a huge amount of work,” she continued. “Tens of thousands of man-hours. Millions upon millions of dollars. But we did it. And it works. It works better than we ever imagined. It’s the answer, George. Better care. Lower costs. That’s something the ACA will never do on its own.”

George didn’t quite know what to say. He had been so sure that he was going to have to argue to get the credit for giving her the idea.

“Do you have any free cash?” Paula inquired.

“Pardon me?” George was thrown by the question.

“Sorry. I didn’t mean it like that. What I meant to say was that whatever you have, invest it in Amalgamated stock. It’s going to go through the roof. And that’s not insider trading advice. Maybe if I had told you yesterday, but not after today’s presentation to the investor community at large. I’m leveraged to the hilt with stock options and—”

“I’m a medical resident, Paula,” George replied in an even tone. “I make a bit less than fifty-five thousand dollars a year putting in eighty-hour workweeks and trying to pay down my med school debt while subsidizing my grandmother’s assisted-living expenses. Stock options are not an option for me. I’m sure they are fine for you with what I’m sure is a significantly higher salary, but not for me.”

Paula took a step back as if he had just thrown a splash of cold water in her face. “Hey, I’m just trying to be a friend, an appreciative one at that. I’m certainly not going to apologize for my compensation package, if that is what you are implying. I work hard for what I earn, and my work is valuable, as time is going to prove. Not just to my employers, but to the general public. Because of that, our company’s stock will rise. Considerably.” She paused. “We all make choices in life, George. I’m happy with mine. You should be with yours, too.”

George didn’t quite know how to respond. He had been feeling outclassed by Paula’s success and then annoyed by her hubris, but her frank response disarmed him.

“Hey! Remember our old argument about how wasteful you thought it was for me to be doing the combined MD-MBA program?” Paula asked. Her tone had changed again. It was now nostalgic and teasing.

“You’ve won that one, obviously,” George conceded.

She laughed, visibly relaxing as she took him by the arm, leading him to a quiet corner of the room. “Listen, no more of this. We’re friends. Why don’t you come over to my house for a visit? We can catch up some — in a more personal environment.”

“Well…,” George stammered. She had him off balance again.

“Come on. I bought a house not too long ago and have barely had time to try out the pool.”

“I’m not sure that we should—”

“What? Catch up on old times? Truth is, George, I don’t have a lot of friends out here. Colleagues, yeah, I got plenty of those. But I have been working nonstop, twenty-four-seven — we both know what that’s all about. I’m realizing I need people I can relax around, where there is no competition to get a particular project done. I don’t have too many such friends here.” She laughed again. “Actually, I don’t have any at the moment. So, what do you say? No pressure.”

George studied her face. As far as he could tell she was sincere, which was sad in one way. It sounded as if she didn’t have much of a life. But he was in that same sad boat. “Sure,” he replied. Her vulnerability was not only appealing, it was her saving grace.

“Great! I’ll text you my address. It’s in Santa Monica. How about Saturday? One o’clock okay?”

“Well… I am off Saturday,” George conceded.

“Keep it in mind. A friend date. We’ve been down that other road, and it didn’t work. And… there’s one more caveat. You cannot mention Pia Grazdani. I do not want to even hear her name. Deal?” She smiled. A genuine warm smile.

“Deal,” George said. Her warmth was infectious. It made George want to be around her.

“I can even pick you up if you want. The company has, in their infinite wisdom, bequeathed me a brand-sparkling-new Porsche Carrera to show their iDoc gratitude.” She smiled again.

George shuffled his feet and changed the subject. “Is iDoc really that good? I mean, there were some pretty bold statements made in your presentation. Were you exaggerating a bit for the sake of the potential investors?”

“We were not exaggerating in the slightest. iDoc is truly fantastic. Maybe even better than we explained. To be perfectly honest, we actually held back to a degree.”

“In what way?”

“Well, for instance… and how is it that you can turn me into a shameless blabbermouth?” She wasn’t looking for an answer to her question, and George noticed that she had grasped his arm again. “Our beta-test group is using smartphones just like the one you have in your hand, Mr. Nomophobe.”

“Nomophobe?” George questioned. “What the hell is that?”

“It’s the fear of being out of mobile phone contact.”

George did have his phone in his hand. He had the ringer off but wanted to be sure to feel the vibration if Claudine texted him.

“What we could have added to the presentation was a solution that we have come up with during the iDoc beta test. The problem with the smartphone is… well, it’s not a problem so much as an inconvenience that has the potential to become a problem… is the battery. iDoc runs constantly with its vast array of wireless sensors. Batteries run down, fast. Our beta testers need to recharge all the time. Three times a day plus charging it overnight while asleep. While that isn’t a deal breaker, it is an inconvenience.”

“So what’s the solution to that?”

“Graphene,” she whispered.

“Graphene?” George replied, matching her hushed tone. “Never heard of it.”

“It’s been around since the sixties. It’s not like it’s a secret, even though I’m trying to keep this between us because we’re presenting iDoc to investors as it will run today, not tomorrow. Anyway, it’s also not a secret that we’ve established close relationships with the world’s major smartphone manufacturers. We became aware of graphene’s potential by accident. UCLA discovered a process to make a nontoxic, highly efficient energy-storage medium out of pure carbon. Graphene. It’s a ridiculously simple technology and Amalgamated helped fund their efforts in finding a way to mass-produce it with small embedded electrodes.”

“You lost me.”

“It’s a supercapacitor. It charges much more rapidly than a chemical battery. It’s high density, in that it can hold a lot of electrons, and we can make it one atom thick. Long story short, the technology will have the capability to charge a smartphone from zero percent to one hundred percent in one second. Flat.”

“Seriously?”

“Absolutely. Smartphone models with graphene-based batteries will begin rolling out this fall.” She looked around; still, no one was within earshot. “Now, that is a secret of sorts. As co — patent holders in the technology, we’ve asked manufacturers to not release any information about it until we go wide with iDoc. We want to overwhelm the public’s perception that iDoc is revolutionary. The new battery technology coinciding with iDoc’s release will reinforce investors’ assessment that a new paradigm has been entered. And it will also help serve to get any non-smartphone users into stores to buy new ones.”

“And if you can’t afford a new phone?”

“We’ll subsidize it. Or, more accurately, Obamacare will subsidize it. That’s another bit of holdback, too.”

“How can—”

“Everyone in the beta test loves iDoc, George. It’s better than a real doctor. For all the little things patients want to talk to their doctor about and can’t because that doctor is unavailable. The acceptance of iDoc was immediate. It will change medicine. We’re talking health care, not sick care, as Bradley alluded to during the presentation. Let me give you a personal example of how this works. Recently I woke up with a sore throat. My first concern was strep, as a friend of mine had been diagnosed with it. I dropped a saliva sample onto the designated location of my phone’s touchscreen and asked iDoc for an analysis. Within so many seconds, strep was detected in the flora of my mouth. iDoc emailed a script to my local pharmacy and the prescription was waiting for me when I arrived. I was subsequently contacted by iDoc at later intervals, unprompted, asking to monitor my saliva again. Might have forgotten, but iDoc did not.”

“But what about this call center? Isn’t that cheating? Because real doctors are the backup?”

“Not at all. iDoc has been learning. Learning fast. Just as Lewis Langley reported. iDoc is using the ‘real doctor’ backup at a significantly lower rate now than at the beginning of the beta-test period.”

“Where is this call center located?”

“Upstairs on the seventh floor of the neighboring building, which houses Amalgamated’s home office. Would you like to see it? I’d be happy to show it to you.” She was enjoying this. Her tendency to show off was taking over.

“You can leave here?” George motioned to the crowd of investors.

“Yeah. The sad reality for me is that when it gets to crunch time, these hedge fund guys would rather talk to a man than a woman. They’re more than happy to make small talk and hit on me, but serious investment talk is reserved for Bradley. I think they believe that I’m some sort of a PR front man.”

George scrutinized her. If she resented the sexism, she wasn’t showing it. She just seemed to be acknowledging a fact.

“Okay. Why not? Let’s check it out,” George said.

George followed Paula into the Century Towers. The building was sleek, modern, high-tech, and oozed prestige. Paula reminded him that it also had an unfortunate nickname, the Death Star, a reference to Star Wars and the ultimate weapon in the Galactic Empire’s arsenal. The name had nothing to do with Amalgamated. The building was bestowed the moniker because its lobby bore a striking resemblance to the interior of the film series’ Death Star and because Hollywood’s top talent agency, so secretive and powerful that it literally terrified everyone, including many of its clients, had taken up residence in the tower. Paula said that Thorn didn’t mind the nickname. In fact he hoped its suggestive powers would cause employees and vendors to pledge their loyalty to him. A fantasy, of course, but Thorn liked to indulge in them from time to time.

Paula led George through the massive white marble lobby and over to a concierge desk, where she arranged visitor credentials for George. With the proper guest pass in hand, they approached the bank of elevators, where the IDs were scrutinized by two large and intimidating guards.

“They take security seriously here,” George said under his breath as they entered an elevator.

“You don’t know the half of it,” Paula replied.

After they exited the elevator they had to show their credentials to another couple of guards at the entrance to the call center. Even though they obviously knew Paula, they checked her ID and scanned it into a reader along with George’s. Paula and George walked into what looked like a call center on steroids. It was a massive open space divided into comfortable cubicles with six-feet-tall, thick glass partitions serving as walls. Each office was occupied by a single, carefully groomed, white-smocked man or woman. Each cubicle also held a sleek glass table and ergonomic chair. And that was it. Nothing else. There were no computers, no monitors, no headphones, no papers or pens visible. Nothing, save an occasional insulated coffee mug. What astounded George was that the glass walls acted as computer monitors. The keyboards were virtual impressions on the glass desktops. George could see images of medical files flashing by. FaceTime-style chats with patients were projected as well. The operators were zooming in on this or that by touching their desktops. George noticed that a few doctors were using some sort of 3D hologram while viewing MRI and X-ray images of internal organs and bone structure. They could manipulate and rotate these images as well. Some of the pictures were going from one doctor to another with texted voice-recognition messages. George was stunned.

Paula could tell George was impressed.

“What the…?”

“Pretty sweet, huh? We combined cutting-edge technology with a couple of Hollywood set designers and… voilà!”

“Tony Stark.”

“Pardon me?”

“Iron Man. It reminds me of the movie.” George felt as if he had been literally transported into the future.

“It’s funny you say that, because, as I said, we actually did hire some Hollywood set designers to help with the design.” She pointed to various features as she spoke. “Each cubicle is wired for sound so there’s no need for headsets. Cameras are embedded in the glass walls for doctor-to-patient face-to-face chats. That’s why they wear the smocks. Professionalism is key to our patients’ having confidence in the system. We even have a hair and makeup room, and the doctors, they’re all board certified and work only four-hour shifts to ensure that they remain fresh and on top of their game. Overhead air systems suppress the sound of the conversations so there’s no background noise and privacy is protected. Medical records and current vital signs are displayed on the walls, as you can see. Whatever image or file a doctor cares to view is controlled by desktop touch controls. The doctors can also enlarge and highlight and make notes on any image they choose simply by touching their desktops. Three-D holographic technology enables the doctors to better view and evaluate a condition and then diagnose it.”

George noticed a young man and woman in white futuristic outfits similar to those he had seen at the presentation carrying beverages into various cubicles. Paula followed his eyes.

“We want to make the doctors’ experience as pleasant as possible, too,” Paula said, “so, among other things, they can order drinks whenever they want. No food is allowed, though. For that, we have a dining hall. Wolfgang Puck handles the food for us. It’s quite good.”

“I can imagine.”

“The doctors can take breaks whenever needed. There’s no punching the clock here. They earn, on average, twenty-three percent more income on a per-hour basis than that of a typical medical specialist. Their stress levels are much lower, too, because they don’t have to worry about running an office.”

George scanned the room. “You said these are all board-certified doctors?” He noticed that they did appear cheerful. The ones treating patients were doing so with a smile.

“Yep. They’re mostly internists, along with some pediatricians and ob-gyns. We have a few general surgeons, orthopedists, ENTs, ophthalmologists, and dermatologists, too. Questions from iDoc users are routed by specialty after being handled first by a general internist.”

George was upset. Even though the room was beyond impressive, it seemed as if doctors were being reduced to glorified call-center operators. “iDoc isn’t going to work,” George blurted before he even had time to process exactly why he said it.

“Why?” Paula asked, startled. The outburst came across like a dose of sour grapes.

George immediately regretted having said it, but he couldn’t take it back. But now that it was out there… in for a penny, in for a pound. “There are two major problems as I see it,” George said, thinking it through out loud. “First, there’s the lack of human touch, which, in spite of this here”—he waved his arm around the room—“can’t be replaced by what is essentially a robot that is acting as the first responder. Second, there’s the issue of confidentiality, which is huge. People will be carrying around their complete medical histories, which could be hacked or compromised even in an unintended way.”

“Human touch is not an issue,” Paula said, shaking her head. “That’s been proven by the reaction of twenty thousand people during the beta test. Hardly a small sample. iDoc’s acceptance has been extraordinary. And it has cut down regular doctor appointments and emergency room visits by an astounding forty-five percent. No one in the beta-test group complained about the human-touch issue. They did say over and over again how much they appreciated the ease of use on a twenty-four-seven basis. Being able to talk with their iDoc doctor when it suited them and for as many times as they felt the need to trumped any other issue. Think about it, the average person gets less than an hour of face time with their primary-care physician in an entire year. You call that a human touch? I call that missing in action. Availability trumps all other issues. Doctors over the years have made themselves progressively harder and harder to reach. Email has helped, but not enough doctors have embraced it to make a difference.”

George opened his mouth to respond but couldn’t think of any rational comeback.

Paula sensed she won the point and pressed forward. “As for hacking, iDoc has the most advanced firewall technology available. And we don’t see privacy as the issue it once was. In an era when one hundred percent of the population has health insurance available to them and preexisting conditions can no longer preclude getting insurance, privacy diminishes in importance. As to your last point about accidental access, the iDoc app is biometrically accessed. It will only open for access when the intended user presses his fingerprint on the app. Access closes after sixty seconds of nonuse. And that’s just the first level. iDoc uses voice recognition in answering questions or divulging personal information. It also uses Eye-Verify, which analyzes the blood vessels in a user’s iris to verify authenticity. Its accuracy is on par with that of a fingerprint. Also, since iDoc monitors vital signs, it always knows where the user is in relation to the phone. Finally, iDoc is quantum cloud based. Very little actual personal medical information is stored on the phone itself. What data is stored we encrypt. So, if someone’s phone is stolen, there’s not much anyone can get off it. We can also wipe a phone clean remotely if a patient notifies us of a lost or stolen phone or in the event of death, when iDoc recognizes that vital signs have ceased.”

George was silent. They seemed to have all the bases covered, and covered well. He still didn’t want to believe it was all so nice and tidy, but there was little he could say that would sound reasonable.

“A doctor working here in the call center isn’t all that different from a radiologist like yourself. You’re both just interpreting data generated by technology.”

George ignored the comment and moved to firmer ground. “You’re blurring the line of what a doctor is by cutting the primary-care physician out of the equation and acting as one yourself. ‘Yourself’ being Amalgamated, an insurance company. When did their executives go to medical school?”

Paula stared at George with her lips pursed. “A blue-ribbon team of the nation’s top doctors contributed their knowledge and experience to the development of our algorithm. iDoc also has all known and recorded medical knowledge at its disposal — textbooks, lab studies, journal articles. In short, it is the most knowledgeable doctor in the world, and it forgets nothing and is constantly updated. On top of that, it has the added benefit of continuous, real-time vital signs. It can compare that data against the patient’s complete medical history in less than two-tenths of a second. It can take any new information, such as test results, and compare it to the patient’s historical data and all known medical knowledge and make a diagnosis in less than half a second. I don’t mean to offend you, George, but with a choice of being treated between you or iDoc, I choose iDoc.”

“Well…,” George said, clearing his throat. “I appreciate your candor. Point taken.” He wasn’t offended so much as surprised at her frankness. If iDoc was half as good as they claimed, she was right. He decided to ask how iDoc would affect him if he were sick, thinking of his stint in the ER beginning the next day. “How does it work when someone has to go to the emergency room?”

“It’s simple. If the hospital is owned by Amalgamated Healthcare, which is a distinct possibility, since we’ve bought up a number of hospital chains, we’ll soon have an integrated and automatic wireless hookup. iDoc will know when a client-patient enters one of our hospitals, and it will alert the staff because iDoc will have sent the patient to the hospital in the first place. Theoretically, client-patients will not even have to approach anyone on staff; they can just take a seat. The appropriate personnel will be alerted to their presence and can locate them by both GPS and facial recognition. Staff will know why that individual is there, if not by iDoc vital sign readings and known medical history, then by having been told why the patient asked to go to the ER. iDoc will forward that information through the appropriate channels. Basically, you will be triaged immediately upon entering the facility. If it is not an Amalgamated hospital, the iDoc physician will consult directly with the emergency room physician, explaining why the patient needed emergency care, or the patient’s medical history and vital stats can be downloaded by a licensed handheld device provided to the ER by Amalgamated. The information can then be uploaded into the hospital’s computer system and accessed by the ER staff. Handheld downloads are how our beta testers are operating now.”

George tried to think of other reasons why he thought iDoc wouldn’t work as well as Paula believed, but he couldn’t come up with any. He wasn’t sure exactly why he hoped the system would fail, although he guessed it had something to do with his viewing it as competition. He changed the subject: “Are you really an iDoc user or was that story you told about strep for effect?”

“I absolutely am an iDoc user, and I love it like everyone else.”

“Let me see it?”

“Not concerned about HIPAA, huh?” Paula teased as she pulled out her phone and opened the app. She held the phone up a foot away with the screen facing her and asked: “How are my vital signs today?”

A crisp but caring woman’s voice responded in a slight English accent. “Hello, Paula. Your phone is on speaker. May I proceed?”

“Yes. Speakerphone is fine.” She glanced at George and turned the phone so that he could see the screen. On it was an animated image of an attractive woman in a white doctor’s coat. Speaking to George, Paula whispered: “I always loved English accents. They seem so authoritative and reassuring.”

“Excellent,” Paula’s iDoc doctor responded to Paula’s giving permission to proceed. “Your vital signs are entirely normal, but about an hour earlier, there was the suggestion of anxiety, not enough to warn you about but enough to alert me that something out of the ordinary was happening. I also noticed that your sleep was interrupted last night. Your periods of deep sleep were shorter than usual. How are you feeling?”

“Much better. I was anxious about a big presentation I had to give this morning. I should have given you warning.”

“I do appreciate as much information as possible in advance.”

“Okay. Bye.” Paula closed the app.

George grinned, impressed. The short interaction was uniquely personable. “Nice. Much better than I imagined.”

“The program is heuristic, too, like you heard at the presentation. So much so that my iDoc avatar has been learning to relate to me in the manner I like to be talked to. I can’t say that any of my primary-care doctors ever bothered to.”

“You have a point there.” George checked his watch. “I have to get back to the hospital.”

“I’ll go out with you. I have to get back to the potential investors.”

She accompanied George to the elevator. After the doors closed Paula said softly, “I wish your mother had had iDoc.”

The comment startled him. “Thanks! Me, too.” George realized his mother might still be alive today if she had had such a device.

“During the development process, I included a test that I named ‘Harriet.’ For your mom.”

George turned and studied Paula’s face. He didn’t know what to say in response, as it was truly a generous gesture. Paula was full of surprises today.

“Also, I insisted that an anti-addiction program be included for specific drugs, alcohol, and particularly cigarettes, such that iDoc knows immediately when any are ingested. iDoc will interrupt and initiate a conversation with the patient. Not like after one glass of wine or anything, but if certain levels are reached or heavy habits established, it will take action.”

While George was touched by her thinking of his mother, he couldn’t shake an underlying resistance to the app. “Won’t that be just plain irritating? Sounds like it could be viewed as Big Brother.”

“I’m sure it is irritating to some people, and they can decline the conversation. If they do that, it won’t continue to hector them. But that is not what has happened in the beta test. In fact a number of our smokers have been able to quit. Immediate intervention with every episode seems to help a lot of people. Patients can’t hide their habit from iDoc because it constantly searches for offending agents.”

“I guess that might be helpful,” he said, wondering if it might have gotten his mother to stop smoking, but he doubted it. She would have just turned the app off.

“Well, thanks for the tour,” George said as they walked across the lobby. “And for inviting me to the presentation.” He thought briefly about bringing up the fact that Kasey had been part of the iDoc beta study and had died possibly because her phone had been charging, but he couldn’t do it. He didn’t want to think about Kasey, much less talk about her with Paula.

“You okay? With all of this?” Paula sensed George was a little overwhelmed.

“Would it matter if I wasn’t?”

“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.

7

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.

8

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.

“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.

9

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.

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.

George 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.

10

George 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.

Rounding a sad-looking palm tree, George started toward his door. Besides Sal, George was friendly with only one other tenant. His name was Zee, and George really didn’t know him all that well. He wasn’t even sure if Zee was his real name or not. He was in his mid-twenties and used to work for a computer gaming company. He had gotten laid off when a major new product bombed upon its release. According to Zee, he had nothing to do with that particular product, but since he was the low man on the totem pole, he was one of the employees who got their walking papers. Now he supported himself playing poker on the Internet, a career choice George never knew existed until Zee gave him the 411 on it.

George knew Zee to be incredibly computer savvy and capable of fixing anything and everything associated with hardware and software. That talent had come in handy on occasion. Zee had helped George with a number of iPad and iPhone issues. George was also aware that Zee was an accomplished hacker since he had regaled George with hacking stories while fixing whatever computer device wasn’t working. It seemed to George that Zee hacked secure sites just for the fun of it. Zee bragged that he could hack into anything.

Slamming the door behind him as he entered his apartment, George was in a strange mood. iDoc had invaded his world without his even having been aware of it. And it was an idea he had supplied to one of its creators! He wasn’t sure if he was depressed or just pissed off about the whole thing. The distinction probably didn’t matter.

“Shit!” George shouted while glancing at the bare shelves in his refrigerator. He had forgotten to stop at Ralph’s grocery on his way home. The empty fridge underscored how sad and devoid of pleasure his life was.

He looked around the room. He had no pictures on the walls and no photos. There had been a few of Kasey, but after she died he put them away. They were too painful to look at every day. His only addition to the furniture that had come with the apartment was the flat-screen TV and a bunch of radiology textbooks. Sad. Very sad indeed.

11

George entered the radiology main conference room, checking messages on his phone while balancing a cup of coffee on his iPad. For a small gaggle of first-year residents it was the first day of residency. He was still in a blue funk from the previous day and still couldn’t decide how he felt about Paula and iDoc.

Feeling decidedly antisocial, George took a seat in the very last row. He liked a lot of his fellow residents and some of them were very accomplished, but he wasn’t close to any of them. For the most part, they were married, some with kids and living a completely different life from George’s. In truth he felt envious, and it made him miss Kasey that much more.

George sipped his coffee and tuned out the welcoming speeches. He had heard them all, ranging from the warm to the threatening. George stifled a yawn as he eyed the first-year residents. There were more women than men this time around, and all appeared eager to go. They were scrubbed up in crisp, freshly laundered and pressed white coats. He had made it a point to look over the list of the first-year residents a few days before and noticed they were all married.

George’s mind wandered as the meeting droned on. Over the last few months he was supposed to have been dreaming up some sort of research project for his fourth year, but he hadn’t given it much serious thought. He wondered about the possibility of doing a year of subspecialty radiology as a way of putting off the decision about what he was going to do after he graduated from the program. After the previous day’s presentation at Amalgamated, he wasn’t as sanguine about his professional future as he had been prior to it. Would he end up working for Amalgamated or its equivalent? Unfortunately he thought the chances were depressingly possible.

At the conclusion of the department’s welcoming conference there was a modest spread of doughnuts and coffee to encourage mingling. George watched it all from the periphery, feeling disassociated. Just then Clayton caught sight of him and sidled over before George could escape.

“The women are getting better looking every year,” Clayton whispered.

“It’s just that we’re getting older,” George replied. “Plus they’re all married, so it doesn’t matter.”

Clayton glanced over at George. “Someone got up on the glass-half-empty side of the bed this morning. What’s your first rotation this year?”

“Supervising emergency imaging in the ER.”

“Good!” Clayton said, pleased. “I had told scheduling to assign you there, but you never know. Can’t count on anyone anymore. Listen: I heard through the grapevine that there’s a knockout first-year ER resident from Stanford. Single, since that seems to be a prerequisite for you. Her name is Kelley something or other. Check her out. I’m always thinking about you, buddy.”

“Okay,” George said. He wasn’t interested, but he didn’t want to get into it with Clayton; better to let him think all was well with his clumsy efforts to fix George up. George definitely wanted to stay on the man’s good side. George saw Carlos Sanchez, the first-year that he was scheduled to supervise. It was an excellent opportunity to ditch Clayton. “Excuse me, that’s my newbie over there. Better go get him situated.”

“Go to it.” Clayton smacked George on the butt with his folder. He had once confided that carrying a folder around always made you appear busy, and even better, you could end any conversation instantly just by waving it and saying you had to go. The guy was a superb radiologist and a great teacher, George thought, but he had his fair share of idiosyncrasies.

George approached Carlos, a bright, eager Mexican American whose record George had perused when he’d gotten the assignment. Carlos had breezed through UCLA Medical School with stellar grades. With radiology being one of the more desirable specialties, all of the department’s residents had done extremely well in medical school, George included. When George first met the young man a few days earlier he’d been impressed with his eagerness. He had already read several of the main texts written about emergency imaging, but reading textbooks about what to do was one thing, actually doing it was another.

“Hey, Carlos!” George said, offering his hand.

“Dr. Wilson,” Carlos replied, grabbing George’s hand and giving it an eager pump.

“Just George will be fine. I’m about to head out but wanted to let you know I’ll see you over in the ER after the reception.”

“I’ll go with you,” Carlos said, setting down his coffee.

“No! Stay and try to meet as many of the staff members as you can! It’s important for you to get the lay of the land. See you in a few!” George headed for the exit, waving over his shoulder in a fair imitation of Clayton.

“Okay, boss,” Carlos called after him.

12

George leaned back and stretched in his chair. Carlos did likewise in unconscious imitation. George glanced at him, making sure Carlos wasn’t messing with him. Apparently not. They were in the ER’s radiology reading room, where most of the light came from the viewing monitors. They had just finished going over all the X-rays taken the night before in preparation for their conference with the ER staff. George had found three X-ray cases that had been misread by the emergency medicine residents in the current batch.

“Would you like to present the details?” George asked.

“No!” Carlos replied, shocked. “It’s my first day. I’d make a fool of myself.”

“You would do fine. But I’ll leave that up to you. If you change your mind, let me know,” George said, remembering his own reluctance to speak when he was a first-year resident.

The door opened and a shaft of daylight pierced the reading room.

“Dr. Wilson?” one of the ER secretaries called out. “Dr. Hanson is at the main ER desk and wants to see you.”

George rolled his eyes and pushed himself out of his chair. “Start going through this morning’s X-rays,” he said to Carlos.

George stood outside the reading room, waiting for his eyes to adjust to the sunlight streaming through the floor-to-ceiling windows. The place was packed with patients who had not been deemed true emergencies, illustrating the chronic problem caused when the general public used the ER as primary care.

George spotted Clayton chatting up Debbie Waters, the charge nurse known for being a no-nonsense taskmaster and for her excellent work keeping the ER running smoothly. On seeing George, Clayton immediately broke off and walked over to him.

“Did you meet that first-year ER babe yet?” he asked, seemingly unconcerned about being overheard. “You know, the one I mentioned earlier, from Stanford.”

“That’s why you pulled me out of the reading room?” George’s tone of mild admonishment had no effect on Clayton.

“Someone has to look out for you, my friend,” Clayton said. “It’s time you left the past behind you, where it belongs. Tell me! Have you at least laid eyes on her?”

“No, I don’t believe I have. It was a busy night last night. Lots of films.”

Extending a hand, Clayton motioned for George to be quiet and nodded toward a young woman who had just come out of one of the enclosed cubicles. She was fashion-model tall and seriously attractive in a healthy, vibrant way. Even in scrubs it was obvious to George that she had a rocking-hot body. She walked past them, tapping away on her tablet.

“Now you have,” Clayton whispered. “What a sight. Agreed?”

George turned away from Clayton and rolled his eyes. Dutifully he watched the first-year ER resident approach the main desk to drop off paperwork before taking the next clipboard from the to-be-seen rack.

“They don’t get much better than that,” Clayton said.

“She’s definitely attractive,” George admitted, although at this point he was watching Clayton, not Kelley. The man was shameless.

Clayton watched as she stopped to go over a chart. “You better get busy before some surgical resident gets all up in that. But if it doesn’t work out, I can put in a good word for you with Debbie Waters.”

“The Queen of Mean?” George was shocked. He could feel his face redden as he briefly glanced over at Debbie.

“Hey, she said she was interested in getting together with you,” Clayton protested. “And you need to get out more. I’m worried about you. You have to have some balance in your life. You work too hard. Seriously. Invite her to have a drink at the W Hotel! She likes it there. I happen to know.”

George stole another glance at her. Luckily Waters’s attention was directed elsewhere. He had always admired how well she kept the ER on an even keel even when all hell was breaking loose.

“She’s a lot of fun, even though she can be a bit bossy,” Clayton said. “She’s very entertaining when she is taken out of her element here in the ER trenches. Believe me! Work is work. Fun is fun. She’s a pistol. Don’t judge a book by its cover!”

George knew everybody was intimidated by Debbie Waters. He had seen her give more than one tongue-lashing to unprepared surgeons all the way down to janitors. She didn’t discriminate.

“Debbie would be perfect for you,” Clayton persisted. “Hell, you don’t have to marry her. Come on! I’ll break the ice.”

“No way. It’s not that I don’t find her attractive. It’s just that she’s so damn… domineering.” He realized Clayton wasn’t about to drop the subject. George added, “I’ll talk to her when she isn’t quite so busy.”

Clayton shrugged. “It’s your call.” He glanced down at his watch. “I have to get back to work. I hope to hear you made some progress on one of these young fillies soon. You need to be entertained to pull you out of your funk.”

George shook his head in disbelief as Clayton walked off. In a way it was touching that Clayton was concerned about him. He had also heard rumors that Clayton and Debbie had been more than good friends.

Despite his misgivings George was intrigued. If Debbie Waters really had said she’d like to get together, he’d be a fool to not follow up. When you worked in the ER it was best to have her in your corner.

Reaching the main desk, George pretended to look through the to-be-seen charts while watching Debbie out of the corner of his eye. As usual she was juggling about ten different tasks. As George waited to see if she would even acknowledge him, one of the orderlies dropped a sheaf of paperwork on the countertop in front of him.

“The patient in Trauma Room Six is dead on arrival,” the orderly stated.

“And do you have a name, or are you going to make me weed through all of this to find out?” Debbie demanded. She aimed her pen toward the clipboard in front of her.

“Tarkington,” the orderly replied.

George’s head shot up.

“Thank you. That wasn’t so hard, was it?” Debbie said dismissively as she crossed out a name on the master sheet in front of her.

George edged along the countertop, angling for a look at the paperwork, though he wasn’t sure he wanted to know that his patient had died. He glimpsed the given name Gregory before Debbie snatched away the chart. As her eyes met his there wasn’t an ounce of recognition.

So much for Clayton’s good word, George thought. He turned and headed down to Trauma Room 6. The dead patient was lying on a gurney, his clothes torn open, revealing a bare chest. An ER doctor was off to the side typing on a tablet. A male nurse was busy detaching the EKG leads from the individual’s chest. A crash cart with a defibrillator stood off to the side.

George looked at the dead man’s face. He just wanted to be sure it was the Tarkington whose MRI George had supervised the day before.

“What was the cause of death?” George asked the ER doctor.

The resident glanced up and shrugged. “Don’t know. If I had to guess, probably a heart attack. Whatever it was, he was long gone by the time he got here. He was as cold as an ice cube.”

“Was there a resuscitation attempt?” George asked, looking over at the defibrillator.

“No. Like I said, the guy was already cold.” He gave George a look of “what can you do” and left.

“Are you okay, Doctor?” one of the orderlies asked as he came in to retrieve the crash cart.

“Yeah, I’m fine. Thanks,” George mumbled. Yesterday he had assumed Tarkington was in for a rough time, but he didn’t think the man would be dead within twenty-four hours! George couldn’t shake the feeling that the episode was directed at him to remind him yet again that life was fragile, unpredictable, and unfair, and that he better squeeze what he could out of it while he was able. Worse yet, he felt a strange and irrational complicity, as if he were somehow responsible. Had it not been for him, the lesions in the man’s liver might have been overlooked, and had they been overlooked, the man might be alive, happy, and unsuspecting while enjoying life with his family.

George wondered again if medicine had been an appropriate career choice. Maybe he didn’t have the emotional strength necessary.

Just then an orderly poked his head into the trauma room. “Excuse me? Are you Dr. Wilson?”

“Yes?”

“Dr. Sanchez asks that you return to the image-reading room to view a possible hip fracture.”

“Okay, thanks,” George said. He looked back at Tarkington’s lifeless body, then began walking back to Carlos. Passing the central desk, he paused to take another look at Debbie Waters. She was still at it, barking out orders. It might be interesting to find out what made her tick. And he did need to get out of his rut.

13

Sal DeAngelis glanced up at the clouds scudding across the sky. What a great day, he thought. He was dressed in a red T-shirt that had I LOVE MY OLDSMOBILE emblazoned across the front in white lettering. It was a gift from his oldest sister, Barbara, and happened to be his favorite piece of clothing. It was the same red as the exterior of his ride, and the off-white lettering matched the upholstery.

Sal carried a can of car wax in one hand and a toolbox in the other in case he came across something that needed repair. He had washed the car, and now it was time for a wax. He had only a vague sense of when it had last been waxed and couldn’t pin the exact date down. The reality was it had been the day before and the day before that.

He started on the grillwork, intending to proceed to the hood and front fenders. But he would never make it that far. All of a sudden an unpleasant feeling spread through his body. It was a sensation he used to experience frequently before iDoc entered the picture, when he would forget to eat on a regular basis. Since iDoc, such episodes had been a thing of the past. But now the sensation was back, and back with a vengeance.

He put down the can of car wax, tossed the polishing rag onto the hood of the car, and made a beeline for his apartment. Inside he went directly to the refrigerator and grabbed the half-gallon container of orange juice he had just bought. With shaking hands, he filled a glass and gulped it down. He stood still, waiting for the dizziness to recede.

Unfortunately he didn’t feel any better. With some difficulty he poured another glass of OJ. When that had no effect, he panicked, especially since he had begun to sweat profusely.

Dashing into the bathroom, he stared at his reflection. Perspiration was now literally drenching his face, and he could feel his pulse in his temples thumping rapidly. This was bad.

He dashed back out to the car, where he had foolishly left his phone. Even before he got to the car he heard his phone’s honk. Relieved at having his doctor available, he held the phone in front of his face. His hands were so sweaty that iDoc couldn’t make a biometric read of his fingerprints, so it automatically switched to visual verification. Finally, his iDoc doctor avatar appeared on-screen.

“Sal, we’re on speakerphone again,” Dr. Wilson said. “Can I speak openly?”

“Yes!” Sal shouted at the phone.

“I can tell you’re very anxious. I suggest you lie down.”

“Something’s wrong! My blood sugar is out of whack.”

“Nothing is wrong,” Dr. Wilson answered in his calm, reassuring voice. “You’re agitated. You need to lie down.”

“I need sugar,” Sal shouted back at the phone.

“Your sugar levels are normal,” iDoc stated soothingly. “Please, Sal. Go inside, lie down, and close your eyes.”

“Screw that!” Sal blurted. He knew he was getting worse, despite the orange juice. Dang it all, iDoc wasn’t working right. Damn computer glitches! Maybe he even screwed it all up himself. He might have broken that thing they put in him when he was bending over waxing the car. Sal pulled his T-shirt up to inspect the small, narrow pink scar on the left side of his lower abdomen. His anxiety growing, he tossed his phone onto the front seat of the Oldsmobile and massaged the pink scar with his fingertips. He’d always been afraid to touch the area, but now he pinched it, feeling the square, waferlike object implanted under his skin.

With sudden resolve, he bent down and opened his toolbox, rifling through his collection and sending screwdrivers and wrenches clattering to the concrete floor of the carport. There it was! His utility knife. He extended the razor-sharp blade, then looked back down at the thin scar, evaluating it. Abruptly changing his mind, he turned and ran. George!

Sal pounded hard on George’s front door, nearly shaking it off its hinges. There was no response. Sal’s anxiety level shot off the scale. He gasped for breath. On top of everything else, his COPD was acting up, causing him to wheeze.

“George! George! Open up, it’s an emergency!” George’s door didn’t open but the door to the adjacent apartment did.

“What the fuck, dude!” An angry, sleepy Joe stood in his doorway, sporting a pair of paisley boxers and nothing else. He looked at Sal: wild-eyed and clutching an open utility knife. “Whoa!” Joe immediately took a step back into his apartment, pulling the door halfway closed. “I’m trying to sleep, you crazy old fart!”

Unlike George, Joe had never found Sal worthy of sympathy and, having been awakened after a night of wild sex, he regarded Sal with irritation and disgust.

A naked tattooed young woman had come up and was peeking over Joe’s shoulder.

“What the hell are you doing disturbing everybody!” she yelled at Sal.

Sal didn’t respond. Instead he sprinted away, tearing down the path to his Olds. He yanked open the driver’s-side door. For a moment the world spun. He was forced to wait until the vertigo passed. As the sensation subsided, he climbed behind the steering wheel, still clutching the knife in his right hand. Securing the lap belt he’d retrofitted in the vintage vehicle didn’t cross his mind. He turned the key and the engine roared to life. At least the Olds wasn’t going to let him down. He was vaguely aware of the muffled voice of iDoc Dr. Wilson, still trying to get him to go into the house and relax.

Sal threw the car into reverse and backed up too fast, colliding with the trash cans lined up opposite his parking space. Unconcerned, he put the car in drive and careened down the street. His mental capacity was deteriorating quickly as he tried to get to the L.A. University Medical Center. They had an ER and would help him. George would be there, too. Without thinking about what he was doing, Sal hiked up his T-shirt and used the utility knife to try to cut open the scar on his left side. He had to get the damn device out!

Sal had been told what they were embedding in the fatty tissue just under the skin of his abdomen, but he didn’t really understand. He was leery of all things high-tech but had trusted that the doctors knew what they were doing. Now something had gone wrong. What he sensed on an intuitive level was that the damn thing in his belly was killing him, and he wanted it out. He felt no pain as he cut into his tissue.

Irrational as it was, a part of his compromised brain was horrified by the narrow jets of blood spurting onto the Oldsmobile’s white leather upholstery. But he had no choice. Gritting his teeth, Sal pushed the blade in as far as it would go and then drew it laterally. He could feel the tip scrape across plastic or metal.

Sal knew the route to the medical center by heart. He sped up. Suddenly there was a sickening sound of metal against metal, and he felt the shudder of his car as it ricocheted off a vehicle parked along the street. Jesus! He used the back of his right hand to try to wipe the sweat from his eyes while still holding the utility knife. Suddenly he was bouncing along the sidewalk without knowing how he got there. He wrenched the steering wheel to the left, sending the Olds careening back onto the street, clipping the back end of a parked Mercedes. Now he was driving into oncoming traffic; horns blasted as Sal yanked the car back into his own lane.

Sal thrust his index finger inside the four-inch gaping wound, feeling for the implant. Just as the tip of his finger touched the edge of the object he glimpsed the red blur of a traffic light. Its message no longer registered in his brain, and he sailed through the light and onto Wilshire Boulevard. He was totally oblivious to the cacophony of metal slamming into metal.

“Hey! Watch out!”

The loud yell came from less than a foot away. Sal jerked his head up. He had arrived at the hospital. A man on crutches, crossing the street, whom he had almost hit, had just screamed at him. Sal slumped his weight to the right. At that point it was all he could manage to do, using his body weight to turn the wheel in that direction. The car swerved and jumped the curb, crashing through a privet hedge, still moving at over forty miles per hour.

Sal’s foot no longer responded to the feeble messages sent from his brain and remained heavy on the accelerator. Shocked parking valets dived out of the way as the Oldsmobile plowed across a patch of grass on a direct path toward them. Their abandoned valet stand exploded into a mass of flying wooden shrapnel as the car-turned-ballistic-missile blasted through it on its way toward the floor-to-ceiling windows of the contemporary-designed ER.

The Olds knifed through the plate-glass wall and bounced across the ER’s marbled foyer, barely missing the department’s stunned concierge greeter, frozen in her tracks, digital tablet in hand. The car zipped by Debbie Waters’s command post and smashed into a massive LED screen displaying a slide show of the medical center. The vehicle crashed into the screen’s supporting concrete, its back end rearing up in the air before slamming back down onto the marble floor.

The old car was not equipped with an airbag. Sal was launched through the car’s disintegrating windshield like a rocket-propelled grenade. Headfirst his body buried itself into the display board. He was killed instantly.

Sal’s smartphone followed him through the windshield, deflecting off a shard of glass that sent it skidding across the sign-in desk and into the lap of a shocked Debbie Waters.

For a split second no one in the emergency department moved. Then, as if a television image had suddenly been un-paused, all hell broke loose.