Cell (21 page)

EMERGENCY DEPARTMENT

L.A. UNIVERSITY MEDICAL CENTER

WESTWOOD, LOS ANGELES, CALIFORNIA

FRIDAY, JULY 4, 2014, 11:08
A.M.

G
eorge headed for the back entrance to the emergency department, stopping into the laundry to pick up a white coat. He was fretting over Schwarz's threat to call the chief of radiology. With George's previous HIPAA violation involving Kasey's records, he knew that such a call could cause serious trouble. The possibility of getting Schwarz riled up had never even occurred to him. He tried to put the thought out of his mind but couldn't. Instead he tried to think of ways to lessen the impact if the chief approached him, but nothing promising came to mind. Luckily he had other things to think about, and reasoned that nothing was going to happen until after the Fourth of July weekend no matter what. He was determined to reassure himself that Kasey's, Sal's, and Laney's deaths—as well as Tarkington's and Wong's—were coincidences and not the result of some sort of conspiracy or wireless hacking.

George heard the uproar in the ER even before he entered the public reception area. As he expected, the place was packed. With the heat wave still gripping the city, he anticipated it would be busy, especially with holiday traffic and injuries associated with celebrating the Fourth, such as burns and eye injuries from fireworks.

He spotted Debbie Waters and made a beeline for her. She was again holding court at the front desk, but this time she caught sight of him immediately.

“What the hell are you doing here?” she said in her commander-in-chief persona. “You're not on call, are you? You should be at the goddamn beach.”

“Maybe later,” George said. “Got some errands to get out of the way.”

“Like what?” Debbie demanded. “I hope to hell you aren't still agonizing over the deaths you were upset about.”

“Well, they are still on my mind. But the reason I'm here is to talk with Warren Knox. Is he in today?”

“He is, but he is acting senior resident. Why do you want to see him? The man is very, very busy.”

“I won't need much of his time. I just have a couple of questions about the DeAngelis case.”

“What kind of questions?”

George leaned over the counter so he could not be overheard. There were a lot of people about and he did not want anyone listening in. “I want to ask him about those so-called self-inflicted wounds. I have a theory about them, which doesn't have anything to do with suicidal ideation, that is if the wounds are where I suspect they might be.”

Debbie frowned. “You've got to get off this bandwagon, I'm telling you!”

“I can't. I'm convinced that DeAngelis was not suicidal.” George looked around the area. “So where can I find Knox?”

“Trauma Room Eight.” Her response was flat. She went back to barking out orders to several orderlies who had arrived with gurneys, acting as if they didn't know what to do.

“Okay, thanks,” George replied. She didn't look at him, much less acknowledge his thank-you. George shrugged. It was as if she were irritated.

George made his way down to Trauma Room 8, where he found an ER team just finishing preparations to send a bicyclist up to the OR. He had been hit by a bus and sustained massive trauma.

It wasn't hard to figure out who Knox was because he was in charge. Like most of the residents, the man was dressed in blood-spattered scrubs. He looked weary and in sore need of a shave, as if he had been up all night. George waited to speak with him while he finished up with the ER paperwork.

When George explained why he wanted to talk, Knox waved for George to follow him. He said he had to hustle to the next case but that George could tag along. He led George toward Trauma Room 6, where a homeless man who had been hit by a train was going to lose both legs just below the knee. The patient needed to be stabilized before he, too, would be sent up to surgery.

“It's about Sal DeAngelis,” George said. “You remember him, right?”

“I'll be remembering him for a long time. What's your question?”

“I heard about the self-inflicted wounds. Were they on the wrists like most suicides or what? And why did you feel they were self-inflicted, since the man had lacerations all over his body?”

“They were on the abdomen. Lower left.” Knox indicated the area on his own body as he spoke. “They were surgical in appearance and not at all like the other lacerations on his body from the trauma he sustained. We also found a utility knife in the vehicle with blood on the blade. That helped ID the source of the cuts. There's no doubt the man was trying to injure himself. And it's obvious that he succeeded.” Knox paused at the door to Trauma Room 6. “I need to get in here,” he said. “If you have any more questions, maybe we can talk later.” He then pushed open the door and disappeared into the room.

George stood for a moment in the corridor, thinking about what Sal had been doing. According to Knox there was apparently not much doubt that he had been cutting himself with a utility knife. Maybe Sal was after the reservoir. The surgical-style cuts were in the lower abdomen, where Schwarz had reportedly embedded the reservoir. Maybe in his panic Sal had decided that the reservoir was the source of his troubles, and he wanted to take it out. The thought didn't make George feel any better. In fact it made him feel worse. Sal might have been right.

•   •   •

G
eorge made his way over to the emergency radiology viewing room, ducking into its peacefulness, glad to leave the chaos of the ER behind.

Carlos was working there and was surprised but glad to see George. “What the hell are you doing in here? I figured you'd be kicking back on a beach in Santa Monica right about now, which is where I'd be.”

“I wish. Maybe later.”

“Well, since you're here, would you mind looking at some films with me? I'm not sure about a few of them. It will save me from having to take them over to radiology to find someone to check them out.”

George was glad to look at them. It would help take his mind off Kasey, Sal, and Laney.

When he and Carlos were done, George went to a free monitor and pulled up the radiological studies on Tarkington and Wong, which he had the right to do, since he had done their MRIs. What George wanted was abdominal flat plates, if they were available. They were, for both patients. And both gave full evidence of what he was looking for. Tarkington and Wong had embedded reservoirs, just as Sal, Kasey, and Chesney did. The presence of reservoirs suggested that they were part of the iDoc beta test, but were not proof. George wanted to be certain.

George glanced over his shoulder at the other people working in the room to make sure they were not paying him any attention. When he was sure no one was watching, he used his resident password to try to access both patients' histories. Each time he tried, the computer refused him access, stating that his request violated hospital rules and that his attempts had been reported to the center's records department. George winced. He knew this was not going to look good, especially if Schwarz followed up on his threat.

Changing tactics, George looked up Tarkington's and Wong's MRIs and wrote down the contact numbers of their referring oncologists. He put in a call to both, leaving his cell number. He knew that in doing so he might cause future waves for himself, but he was at a loss for what other avenue to take. If they were part of the iDoc beta test, it would further advance his theory that iDoc was either malfunctioning or being hacked. If they weren't, then it would confirm that his paranoia was getting out of hand.

While mulling this over he decided to try the medical examiner's office. He phoned, and after identifying himself as a doctor, was transferred to one of the forensic investigators on call.

“I was hoping for some general information on some recent deaths,” George said. “Actually, one was a few months ago, but the others are very recent. Do you think you would be able to help me?”

“That depends,” the investigator said. “Who am I speaking with?”

“I'm Dr. George Wilson, a resident in radiology at the L.A. University Medical Center,” George said. “I've noticed that on a number of recent terminal cases, the patients had implanted drug reservoirs. Has your office had any experience with such devices? If you have, can you tell me if they are removed in the course of an autopsy?”

“I'm afraid I don't know anything about that, Doctor,” the forensic investigator replied. “But if you want to give me their last names, I can see if there is anything in the records.”

George was pleasantly surprised to be making headway. He imagined it was because it was a holiday, and he didn't have to go through the ME's public relations office. “The family names were Lynch, DeAngelis, Tarkington, Wong, and Chesney,” George said.

There was a silence on the line. All George could hear was the clicking of a computer keyboard. Finally, the investigator's voice came back on the line.

“None of those patients needed to be autopsied.”

George was surprised. “Why is that?”

“They had terminal illnesses that were confirmed by their doctors, so the forensic autopsy was waived. It means the cause and manner of death were known for their death certificates. Pretty cut-and-dried stuff for what we're used to.”

“Okay. Thank you.” George hung up, discouraged. Then another idea hit him. He was going to pay another visit to the morgue.

•   •   •

G
eorge rode the elevator down to the lower basement. He was alone in the car again and, indulging in a bit of morbid humor, he guessed that not too many people needed to visit the dead on the Fourth of July.

As he neared the morgue he was struck by the disagreeable odor emanating from the place. It seemed worse than on his previous visit. It made him wonder how someone could work there day in and day out.

On this occasion, the diener was at his desk, but it was a different man. George introduced himself and said, “I'm here to talk about drug reservoirs embedded in patients. Are they routinely removed?”

The diener's face was a complete blank. He had no idea what George was talking about.

George probed the man on the subject of drug reservoirs from various angles, but it was apparent that the morgue as a general rule took no notice of them. In fact, George learned that the dieners were instructed not to remove or handle any medical devices whatsoever, particularly on those cases slated for the medical examiner's office. “We don't remove anything,” the diener said. “And that includes endotracheal tubes, IVs, nasogastric tubes, embedded catheters.”

George cut the man off. It was obvious he was getting nowhere fast. George thanked the diener and beat it out of there. So much for that idea.

•   •   •

G
eorge returned to the emergency radiology viewing room and took one of the chairs off to the side. As he was mulling over his options his cell phone rang, jarring him from his thoughts.

“Hello.”

“This is Dr. White. Is this Dr. George Wilson?”

“Yes,” George replied, straightening up in his chair. This call just might mean progress. “Thank you for returning my call. I'm a resident radiologist at L.A. University Medical Center, and I have a question about a former patient of yours. Greg Tarkington.”

“You're a resident in radiology?” Dr. White asked. His voice reflected a mixture of disbelief and irritation. “I'm a busy man and this is a holiday. Why—?”

“I performed the last MRI on Mr. Tarkington.”

The oncologist seemed to calm down a degree. “Okay. What's your question?”

“Was Mr. Tarkington taking part in the iDoc beta test? I'm helping Amalgamated with their testing. I've agreed to submit a couple of standardized forms whenever a beta-test subject dies. I thought I remembered Mr. Tarkington saying that he was, but I can't locate any documentation. I thought you might be able to help me.” George lowered his voice in the hope of conveying an us-versus-them bond. “It's easier to talk doctor to doctor than to try calling Amalgamated, especially on a holiday.” George held his breath. It was a fairly weak explanation for the call, but he hoped it might just get him the information he wanted.

“Tarkington was part of the study,” Dr. White said without hesitation, his attitude changing for the better. “And you can tell Amalgamated that iDoc made his life much easier and mine too by fielding many of his questions. I wish more of my patients had it.”

“Did you know that he had a drug-releasing implant?”

“Of course, although it wasn't for any of the drugs I prescribed. The implant was for his diabetes. He mentioned more than once that it handled his blood sugar levels better than he had been able to. It was one less issue for him to deal with in a very trying time.”

“Thanks for your time. I appreciate your calling back.”

“Glad to be of help. Keep up the good work!”

George ended the call and wondered if Dr. White, while advocating iDoc for his patients, had any idea of the extent to which medicine was about to change. But be that as it may, George was appreciative of the man's cooperativeness. George now knew for sure that Tarkington, like Kasey, Sal, and Laney, had been part of the iDoc beta test: four known iDoc users with drug implants . . .

George's phone rang again almost immediately. It was a call back from Wong's oncologist, a Dr. Susan Jefferson! George was surprised and pleased that both doctors had gotten back to him so quickly, especially on a holiday. He was also impressed, guessing that both doctors were conscientious about their professional responsibilities in a very emotionally demanding specialty.

George gave him the same story he'd given Dr. White. Dr. Jefferson was equally forthcoming, and confirmed that Wong was part of the iDoc beta test as well. So now George had confirmation that all five deaths in his cohort used iDoc and had implanted drug reservoirs.