Cell (3 page)

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.

CENTURY PLAZA HOTEL

CENTURY CITY, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 9:51
A.M.

A
s 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.

CENTURY PLAZA HOTEL

CENTURY CITY, LOS ANGELES, CALIFORNIA

MONDAY, JUNE 30, 2014, 10:02
A.M.

S
itting 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?