Cell (18 page)

EMERGENCY DEPARTMENT

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

THURSDAY, JULY 3, 2014, 4:05
P.M.

C
layton took the time to head back to the ER yet again, hoping he wasn't calling too much attention to himself. Once more he was on a mission for Amalgamated, at the behest of Langley and secondarily Thorn. First it had been to try to locate the drug reservoir that had been implanted in Sal DeAngelis, which was a bust. Then it had been to gauge the general reaction to DeAngelis's spectacular death, particularly from his neighbor who, by chance, happened to be Dr. George Wilson, which was ongoing. Now it was another death of an iDoc beta-test user, someone who was a Medicaid beneficiary, by the name of Laney Chesney. Clayton had recognized the name immediately, and unfortunately George Wilson was involved again.

The news of any problem with iDoc had bothered Clayton considerably. He had all his assets, including his entire IRA, tied up in the company. Inadvertent deaths with iDoc were the last thing he wanted to hear about. “Have you alerted the FDA about this problem?” Clayton had asked Thorn. Either yes or no had potentially bad implications, but Thorn had failed to answer.

Clayton reached the ER, which was as busy as he'd ever seen it. Holiday eve traffic had resulted in the expected mayhem. Six ambulances were lined up at the receiving dock, several still unloading their patients. Clayton made a beeline for the reading room, hoping to see George about the Chesney girl. He hadn't decided exactly what he was going to say, but there was no George anyway.

Checking his watch, Clayton understood why and lambasted himself for not remembering the Thursday compulsory physics lecture for all the residents. So much for confronting George. Instead he went to the main desk to see Debbie. He knew she was officially off at three, but she was so conscientious, she was always around for another hour at least. Sure enough he found her sitting at the desk with the charge nurse on duty for the three-to-eleven shift. They were still going over the patients whose cases were pending.

Clayton interrupted the conversation and took Debbie aside. She was surprised and wary to see him. Clayton didn't waste words: “I heard a young pregnant woman passed away here in the ER. I'm sorry, I know that's tough on you and everybody else.”

“Bad news travels fast,” Debbie said, eyeing Clayton suspiciously.

“How did it happen?”

“Cardiac,” Debbie said. “The patient had a long history of progressive cardiomyopathy.”

“You okay?”

“Yeah, I'm okay. But it's my own damn fault. I dropped the ball. I should have been sending people down there to continuously monitor her when I realized that the OB resident couldn't show up for several hours. But a lot of folks around here should have checked in with her without having to be told by me or by anybody. It's standard freaking procedure, for God's sake.”

Debbie paused and looked up at Clayton. “What's this sudden sympathy? It's not like you to come down here in the middle of the day, worried about my mental status.”

“Well, there is an ulterior motive. My understanding is that unfortunately George Wilson was again involved. I'm worried about his response, because the patient, like DeAngelis, was part of the iDoc beta test.”

“What the hell are you worried about? I don't understand. Do you think he's dangerous in some way?”

“Let's just say that we don't want any adverse publicity at this stage of the iDoc testing. He's a smart guy. We need to know what he's thinking in case some intervention is called for.”

“So you want me to sound him out about both Laney Chesney and Sal DeAngelis? Make sure he won't make any waves? Is that what I'm hearing?”

“Always right on the money,” Clayton said. “Sharp as a tack! I knew I could count on you.”

“Wait a second. One condition. You and me. We start going out again.”

“Absolutely. I would want that even if you weren't helping me with George Wilson,” Clayton lied. “You know that. I like you. It's just that my ex-wife was giving me such problems, I had to back off for a bit. It's better now. I know I mentioned this weekend. How about dinner at Spago Saturday night? Does that work for you?”

Debbie beamed. “Actually, it sounds wonderful. Okay, I'll do it.”

Clayton gave her a wink and a light swat on the butt with his file folder as he walked off. He was pleased, even if he'd had to agree to a Saturday-night dinner. Well, maybe he could get out of it. He checked his watch. He headed over to the hospital's parking garage. The valet raced off to retrieve his red Ferrari, which they always parked near the checkout desk. An hour earlier he had gotten a call that asked him to come to an emergency meeting with Thorn and Langley over in Century City. He loved moving among the business elites. If he had to get his shoes muddy once in a while for the privilege, so be it. The mud made him indispensable.

•   •   •

C
layton, Thorn, and Langley were gathered around a small table in Thorn's expansive corner office. The massive windows in the room looked south and west, offering a stunning view of Santa Monica Bay and the Pacific Ocean, not that Thorn noticed it anymore.

Their discussion was about what they were now officially calling “the glitch.” Langley brought the others up to date on all the latest aspects, including specific details on the position taken by CMS and the Independent Payment Advisory Board. While Langley spoke he kept puffing on an e-cigarette, which irritated the hell out of Thorn. He was convinced that whatever Langley was blowing around the room was going to get trapped there and he'd be smelling it later. When things were not going smoothly, which they clearly weren't, Thorn was less tolerant of people's foibles.

“As I have said, my major fear is word getting out,” the tech genius was saying. “The media—”

“Will blow it all out of proportion,” Thorn finished. “We are all on the same page in this regard. No disagreement whatsoever.”

“Then why not disable it?” Clayton asked. “Is that still a possibility?”

“We tried once when it first appeared,” Langley said, “before CMS was in the picture. But getting rid of it is not as easy as it sounds. The basic program learns almost too quickly. To totally get rid of it would require rewriting huge sections of the code, a time-consuming endeavor, to say the very least.”

“What's the current situation in the trenches?” Thorn asked impatiently, looking at Clayton. By “trenches” he meant the people dealing directly with patients: doctors and nurses and the like.

“As far as I can tell there is no suspicion at the facilities where the events originated,” Clayton said. “Santa Monica and Harbor, no problem whatsoever. It has also been okay at the L.A. University Medical Center, except for some mild concern about a resident radiologist under my supervision, as I have informed Langley.”

Langley nodded.

“But other than that, nothing,” Clayton continued. “Also, I'm happy to report no problems coming from the medical examiner's office, either, which I have been monitoring. There's not been a blip on the the radar screen. No one has requested an autopsy on a deceased iDoc beta participant. The beauty of it is that everyone
expects
these people to die, given their medical histories. Of course it helps that the medical examiner's resources are stretched as thin as they are, so their forensic examiners are encouraged to sign off on terminal cases with few questions asked.”

“Back up a minute. Who is this radiologist?” Thorn asked.

“His name is George Wilson,” Clayton said. “It's an unfortunate convergence of events. He was engaged to one victim, friend to another, and did radiological studies on three others, one of whom he had a bit of a bond with. She died this morning. At this point he's only aware that three of the five are iDoc users, including the one today. But still, even three . . . I mean, what are the odds?”

“Odds aren't worth shit when it comes to reality,” Thorn retorted. “We can't make even one mistake. Our whole game plan could be undermined.” He paused and looked directly at the others to be sure they were taking this in. “And our careers.” He turned to Langley. “These clustered episodes show that the algorithm will have to be tweaked. If iDoc identifies a termination case in the future, before it takes action, have it spit out the name and case number. Then have it look at the proximity of other terminations and factor in the relationships of the health care professionals who are involved. LinkedIn, Facebook, Instagram, Tumblr—you can use those sites and others to find the connections. Once we have them, we'll develop protocols for the number of connections and how frequent they are to be acceptable within a set period of time. Are you following me?”

“Yes, I am.” Langley smiled. “I know exactly what you're looking for and I will have my team deliver.”

Clayton felt a little dizzy after Thorn's impassioned monologue. He didn't understand a word.

“Good,” Thorn said, clapping his hands together. “Now, moving on to the situation at hand . . . what do we do, if anything, about this resident radiologist?”

“Well,” Clayton said, “I don't think we should do anything yet. But I have arranged to keep him on a short leash and monitor him closely. I've engaged an attractive and effective fifth column, if you will, who has already informed me that although he is impressed with iDoc, he's not buying the generally accepted theory that his neighbor was suicidal, which in his mind is iDoc case number two. I'm afraid he might be compelled to look into the case a bit more. What we don't want to do is anything that arouses his suspicions that iDoc has anything to do with the deaths. Unfortunately something did happen that made him more suspicious, and that's that he saw me down in the morgue when I went and tried to retrieve that reservoir for Mr. Langley.” Clayton leveled an accusatory gaze on the techie.

“We were hoping for a material confirmation of what actually happened,” Langley said in his defense. “Obtaining the reservoir would have been helpful to ascertain that the insulin was the determining factor in the death.”

“I can't believe that! You already knew,” Clayton shot back. He was angry that his going down to the morgue had put him and the program at potential risk at a time when he hadn't been made fully aware of the situation and its seriousness.

“Enough!” Thorn interrupted. “We're all on the same page. I want to know more about this George Wilson fellow.”

“Actually, you've met him,” Clayton said.

“How? Where, for Christ's sake?”

“At the investor presentation at the Century Plaza Hotel. He's a friend of Paula Stonebrenner's. I saw her introduce you to him.”

Thorn was shocked. “Seriously? Jesus, it's a small world sometimes. Okay, continue.”

Clayton gave them some background on George, including his having been involved to a degree in exposing a conspiracy at Columbia Medical School while he was a student there. On hearing this, Thorn's face darkened. Clayton also described George as one of his best residents, conscientious to a fault, a hard worker and bright.

“How are you going to monitor him?” Thorn asked.

“As I've said, I've arranged for a friend to keep George under surveillance over the next few days, which I feel are critical. If he calms down, then we're good. If he doesn't, I'll let you know. I imagine you can best handle it at that point.”

Thorn nodded, deciding if push came to shove to turn the situation over to his security department as a code-red emergency. The security department's entire hierarchy was composed of former mercenaries. He was confident they could handle doing whatever was necessary.

“You know, it's a good thing this is happening,” Langley said, interrupting.

Thorn and Clayton looked at him, puzzled.

“We didn't plan on this ‘glitch,' but all the same that is what a beta test is for, to identify and resolve this kind of unexpected phenomenon. It's a lot better than finding out about it after we go national. In a way, this situation in and of itself is a mini beta test.”

“I wish I could feel as optimistic as you,” Thorn said. “I don't like threats that could possibly derail our program.”

“Well, I like looking on the bright side,” Langley said. “We might learn some really important lessons from this radiology resident, depending on how his involvement unfolds. And with Clayton keeping tabs on him, we can intervene if need be, which lowers the risk to an acceptable level. I think this situation is a blessing in disguise. It has created a nice controlled environment to get some potentially helpful data about security for iDoc in the future.”

GEORGE'S APARTMENT

WESTWOOD, LOS ANGELES, CALIFORNIA

THURSDAY, JULY 3, 2014, 8:30
P.M.

G
eorge had been moping since he'd gotten home. Compared to Kasey's, Sal's, Tarkington's, Wong's, and now Laney's, George's life was a walk in the park, since he was still alive. But he was unable to shake a sense of complicity in all their deaths. Talking with Kelley earlier made him feel better by getting it out in the open, but not for long.

He was sitting on his couch in the dark, mindlessly TV channel surfing, when his doorbell rang. He ignored it, hoping whoever it was would go away. But it rang again. Then again. Reluctantly George got up and opened the door, thinking it could only be either Zee or his drunk-ass building superintendent. It was neither. He stood dumbstruck staring at Debbie Waters.

“Aren't you going to invite me in?” she said. “If you're entertaining, though, I can come back another time.”

George found his voice. “No! No! Let me get a light.”

Debbie came in and looked for a place to sit as George turned on a floor lamp and turned off the TV. She had to make a conscious effort not to comment on the state of George's apartment.

“I was driving by and thought of you,” she said, deciding the best place to sit was in a vinyl club chair. She wanted to avoid the couch so as not to give mixed signals. “I hope you don't mind my stopping by, but I needed to talk with someone. I'm still weirded out about the Chesney girl dying during my watch.”

“I can understand,” George said. “Her death bothered everyone. She was a sweet girl who hadn't had a lot of chances in life. Before you came I was just sitting in here in the dark, trying to make sense of her passing.”

“How exactly does it bother you?” Debbie asked. She wanted to get this mission for Clayton over with as fast as possible. “It certainly wasn't your fault.”

George started to reply, then paused. It was a bit of an odd question, since the answer was so intuitive. “I don't think it was anyone's fault, Debbie, if that's what you're worried about. I think it was more of a confluence of errors and oversights. What bothers me is the fact that she was dealt such a bad hand throughout her short life. I don't know if you are aware of the details, but suffice it to say she had multiple major health issues, some of which I helped to define. Add in her train wreck of a childhood, and it's just tragic, at all levels.”

“That's it?” Debbie asked.

George regarded her closely. He suddenly had the sense that she was interrogating him rather than having a real discussion. He was glad he hadn't shared his thoughts about his own sense of responsibility. He sensed he should hold his cards close to his chest. His subconscious picked up something a bit off about Debbie. And until he could identify what that something was, he'd play it safe.

“So you're okay?” Debbie asked, studying his face. “I thought maybe this episode on top of DeAngelis and then of course your fiancée . . . I don't know . . . I was worried about you.”

“How do you know about my fiancée?” George asked.

“Clayton filled me in,” Debbie said without blinking an eye. “That's why I'm worried about you.”

“Thanks. I appreciate it.” And he did. Other than Kasey, he hadn't had a woman in Los Angeles express much concern about his well-being. As a consequence, his guard dropped a little. Maybe he had misjudged her.

“You look troubled,” she said. “What are you thinking about?”

“Well, I did—do—have this crazy idea about death stalking me. I know that sounds paranoid. I mean, these patients all had serious illnesses, particularly considering what you told me about Sal.”

“Pardon?” She looked confused.

“The prostate cancer.”

“Oh. I forgot I had mentioned it.”

“How did you know?”

“I'm not sure.”

“Really?” George asked, his guard back up.

“Oh, I remember now. His accident was so freaky. When the crash happened, his phone rocketed out of the car and literally landed in my lap.”

George felt a twinge of guilt for having essentially swiped the phone from her desk. Of course he thought it was going to be thrown in the trash.

“Even though it looked worse for wear, I hooked it up to one of the handhelds that Amalgamated gave us for their iDoc clients. It can retrieve their medical histories and recent vital signs data to help us make an initial diagnosis. His phone was jammed from the impact of the accident, but I was able to get some of the latest data downloaded into the reader before it completely crashed. And that included the results of a recent prostate biopsy. It was the last entry in his medical history.”

“That's fascinating,” George said with obvious interest. “Do you think he knew? Is that information still in the hospital computer?”

“It never got that far,” Debbie said. “And he probably didn't know about the diagnosis.” George's sudden eagerness scared her a little. She was certain that getting him riled up was not what Clayton had in mind. He just asked her to gauge George's state of mind about the deaths, hoping he had put them behind him, and here she was aggravating the situation. “It was obvious pretty quickly that the guy was dead, so there was no need for further medical history. I just read it off the handheld. I never uploaded it.”

“Interesting,” George commented as all the disparate facts swirled around in his brain. If Sal didn't know about the prostate diagnosis, then there was an interesting parallel with Kasey. Suddenly he blurted out: “I wonder if Greg Tarkington and Claire Wong were iDoc users? If they were, that would be an odd coincidence.”

“Who are Greg Tarkington and Claire Wong?” Debbie's warning bell was dinging. Clayton was not going to be happy.

“They are two patients I did MRIs on who have also recently shown up as DOAs in your ER.” George moved to the edge of the couch. “I have a favor to ask. Would you see if you can find out if they were part of the iDoc beta test?”

Debbie was about to beg off, but George didn't give her a chance. “Sorry,” he said. “I'm just thinking out loud, but there is something else.” He could see her stiffen up, but he went on anyway. “There is the issue about an implanted reservoir. My fiancée had one to control her diabetes. Sal had one, too—or at least he thought he had one. He showed me a scar on his abdomen. Laney? I don't know if she had one, but it stands to reason that she did since she had diabetes, too. I suppose I should have noticed when the ultrasound was done, but I was distracted by showing Carlos the ropes. I can find out about Sal to be one hundred percent certain, since I know the name of his former primary-care doctor. Sal had me call him a couple of times. I'll see if he has a record of it. Sal had said that he had put it in. Sal and Laney must have had one because, like Kasey, iDoc was controlling their diabetes. The only way for that to happen was for them to have implanted reservoirs.”

“What are you talking about?” Debbie demanded. She was becoming progressively alarmed. “Implanted reservoirs?” He had completely lost her, and his sudden enthusiasm was scary. She had a feeling that she had somehow made things worse for Clayton.

George stared at Debbie. “What about it?” he asked. “Can you get this kind of information about Tarkington and Wong for me from the ER records?”

“Absolutely not!” Debbie stated categorically. “None of these people were my patients. I'm the charge nurse. One thing that the hospital admin has driven home to us is the sanctity of individual health records. My accessing patient records would be a clear violation of HIPAA, which I remind you is taken very seriously at the medical center. You know that. Anytime someone tries to access a medical record who is not directly involved in the patient's care on an ongoing basis, a red flag goes up in the medical records department.”

“You're right,” George said. He had been severely reprimanded after he had accessed Kasey's records without authorization, even though he was engaged to her. At the time he'd been surprised at how quickly he'd been caught.

“Listen,” Debbie said, trying to do some damage control. “This thought you have that death is stalking you is ridiculous. I'm sorry, but it is crazy. As your friend I must tell you that you have to just let it go. You have been a victim of coincidence. Believe me, if you persist, you're risking getting yourself in trouble.” She thought about saying it was a certainty but didn't dare, thinking he'd smell a rat.

“Thanks for your advice,” George said, but his mind was churning. He had another idea. Suddenly he thought Paula might be able to answer his questions. Amalgamated had to have a master list of iDoc beta-test participants. Then he thought of something else: “I remember the names of Tarkington's and Wong's oncologists. I wonder if I call them, if they might be willing to tell me if the two patients were with iDoc. It wouldn't be divulging their medical histories per se.”

“I don't know. I doubt it. Listen! I'm going to say it again. You have to let this drop. You are letting your imagination run away with itself, and you are going to get yourself in deep shit if you're not careful.” Debbie stood up. Suddenly she wanted to get out of there as quickly as possible. Clayton was not going to like it. She didn't know exactly why she felt that way, but she did. “I gotta run,” she said as she headed for the door.

George was snapped out of his reverie. He appreciated Debbie's unexpected visit, as it had focused his thinking. “Are you sure you have to go? I really appreciate your dropping by. I can get out the Jack Daniel's again.”

“No. Thanks. I really have to go. I feel better having spoken with you. Thanks, George.”

“Sure. Anytime. Should we call a taxi?”

“No, I drove.”

“Then I'll walk you out to your car.”

“It's not necessary. I'm a big girl!”

“I insist,” George said. “I really do appreciate your coming by.”

He walked her out to her car in front of his apartment building. He gave it one last shot to get her to stay or even go out to a local bar, but she was intent on leaving. He waved as she pulled out into the traffic.

He headed back into his apartment complex, perplexed by her hot-and-cold behavior. The light was on in Sal's apartment. Good. It must be the sisters. He debated whether or not to say hello and extend his sympathies, but he wasn't sure they would even remember him.

He got to his front door and changed his mind. He decided he should make the effort to say hello and find out if there were any plans for a service. As he approached the apartment he could see into Sal's living area. There weren't two older women inside, but two men. Thirtyish, in dark suits and ties! They seemed pretty damn busy, too, whatever they were doing.

George glanced at the super's door, thinking about inquiring exactly who was in Sal's apartment. But imagining that the man was drunk as usual, he decided to just see what he could learn on his own. He went out to the rear of the building to check out Sal's parking place. In it he saw a large, late-model black SUV with dark tinted windows. He doubted it was another tenant's. More confused than ever, he returned to Sal's patio fence.

George hunched down to avoid being seen from inside Sal's apartment. At the same time he glanced around the complex hoping no one was watching him. He didn't want to risk another run-in with the police, which must have been precipitated by someone seeing him climbing over Sal's fence.

Through the sliding glass door he could see all of the living area and the kitchen. The men in the suits were seemingly searching the apartment, as he had done. One was actually vacuuming Sal's faux oriental carpet with a handheld DustBuster. Weird! George wondered what, if anything, he should do.

For lack of an alternative plan, he decided to check in with the super, drunk or not. With some reservation, he rang the bell. When the super opened the door, George saw that, as expected, the man was plastered. Having come as far as he had, George plowed ahead. “I thought you might want to know that there are two men in DeAngelis's unit searching the place.”

“I know. I gave them a key.”

“Who are they?”

“Police. Or something or other,” the super replied, scratching his head. He looked as if he hadn't shaved for a week. He was holding on to the door frame for support and still wobbling.

“They don't look like police.”

“They had badges. And a paper that was some kind of warrant.”

“What are they looking for?”

“No idea.”

George was confused. “You didn't ask?”

The super, whose name was Clarence, had to think that one over. “I might have. Can't remember.”

George realized this was hopeless and turned to leave. “Okay, thanks.”

“Sal's sisters are in town,” Clarence yelled, as if he just remembered it. “There's a memorial service they got planned for tomorrow. Hang on.” He reached to a table just inside his door and grabbed a piece of paper. He held it as far away from himself as he could while attempting to read it. “Carter's Funeral Home. Two o'clock. If you want to go. Said they wanted to bury him as quick as can be and skedaddle out of town.”

“Thanks, Clarence.” George walked off. He was amazed that the service was scheduled to take place on the Fourth of July, not that he imagined too many people would want to show up.

George headed back to his apartment, still curious as to who exactly was searching Sal's. If they were government agents of some sort, as Clarence thought, he'd have to guess they were FBI. But why in thunder would the FBI be searching Sal's apartment?