by Robin Cook
“Why did the media report that he had a stuck accelerator?”
“No idea. You’d have to ask them. We guess it was because of his vehicle’s make and age and the fact that he was traveling over a hundred miles per hour, and it was the kind of accusation that would sell papers and up TV ratings. But, again, that’s just a guess.”
“You were going to have me picked up Saturday morning?” George asked.
“I was told that that had been the plan. But unfortunately when a backup team returned to your apartment, you had been arrested for hacking. That put us in a tailspin. We were very concerned you were going to tell the police, alerting the media in the process and putting the whole iDoc program in jeopardy, after all. But then things began to look up when you got out of jail so quickly, eventually leading us to Paula’s house.”
“How did you follow me to Paula’s house?”
“We personally didn’t follow you. The professionals did.”
“I thought I was being careful.”
“Well, they are, by definition, professionals. I assume they merely tracked your cell by GPS. Either that or they put a GPS tracker on your car.”
George looked at Paula, who raised her eyebrows as if to say “I told you so.”
“Now, if there are no more questions . . .” Thorn looked back and forth between Paula and George, waiting.
At first neither Paula nor George moved. Then Paula piped up: “When the, quote, ‘professionals’ invaded my house, they blew my front door off its hinges. What do you plan to do about that?”
“Already taken care of. The door is back on, restored to normal, as is the security system.”
Thorn waited a few beats before adding, “Well, then, the ball is in your court. We will leave you two alone to discuss the situation. But remember, we believe that now is not the time for the general public to hear about the ‘glitch’ issue. The public is not ready for the debate about resource allocation, and iDoc should not be made a hostage to it. That’s why you two must agree not to expose iDoc’s problem, at least in the short term, until iDoc is introduced on a national scale and included with Medicare and Medicaid. At that point, the government and Amalgamated will respect your input.”
Paula had another question. “How long do we have to make up our minds?”
Thorn shrugged. “As long as it takes. Let’s just say as soon as possible. If you have any additional questions just let the attendants know. There’s a large common room where you’ll be allowed to spend most of your time. And a dining room where you will take your meals. Nights will be spent in the rooms you occupied last night. You will not be bothered. At the moment you are the only . . .” He searched for the right word, finally adding, “Guests.” He rose from his chair. Langley and Clayton followed.
“We hope to hear from you both soon,” Thorn said with a forced smile.
With that Thorn, Langley, and Clayton filed out of the room, closing the door behind them.
George and Paula eyed each other, mouths agape.
“That was one of the weirdest experiences I’ve ever had,” George said, shaking his head.
“Agreed,” Paula responded. “I don’t know what I expected but that certainly wasn’t it. I don’t know whether to be thankful or mad or both. Hell, they could have just phoned us rather than sending in the goon squad.”
A minute later the door opened and several of the attendants reappeared. They motioned for George and Paula to follow them to the common room.
56
MENTAL HEALTH FACILITY
HOLLYWOOD HILLS, LOS ANGELES, CALIFORNIA
MONDAY, JULY 7, 2014, 10:35 A.M.
George and Paula cast their eyes around the large, very institutional-looking common room, which was furnished with several aged couches and a smattering of club chairs that faced an old TV set. The TV was tuned to a morning game show. In addition, there were four game tables and two bookcases, with a collection of dated books—mostly old Reader’s Digest condensed editions—and magazines and board games. To complete the functional decor, the windows were barred.
Standing off to the side, near the entrance to the room, were four of the original six attendants, keeping an eye on their charges. On the other side of the entrance was the hallway leading back toward the conference room, and farther on, in the same direction, were the rooms where George and Paula had spent the night.
Paula and George were not watching TV but left it on to cover their muted conversation. They were settled into a couple of the chairs, as far away from the attendants as possible.
Paula was still incensed. “I cannot believe that they are treating us like this, holding us captive in this fifties-style mental institution.”
“The whole affair defies imagination,” George stated. “But I have to say that right now I’m feeling a lot better and a lot more relieved than I expected I’d be feeling.”
“I guess I have to agree.”
“I wonder if there are any other inmates or patients here despite what Thorn said.” George looked back toward a glass-fronted nurses’ station. Inside was a desk, where one of the attendants was doing paperwork.
“If there are other people, then they must be in isolation,” Paula said, her eyes following George’s as they took in their surroundings for the hundredth time.
“Okay,” George said, turning to face Paula. “We have had time to recover from our shock at seeing Thorn, Langley, and Clayton. We have to talk! What’s your gut reaction to Thorn’s lecture?”
Paula shook her head. “I haven’t had time to completely internalize it. I still feel so shell-shocked about the whole affair that it’s hard to think clearly. All at once I have much more of an appreciation of post-traumatic stress.”
“Me, too. But we have to make an effort. I imagine they expect to hear from us fairly soon.”
“You’re probably right.” She reached out and touched his hand reassuringly. “Listen! I don’t know how I feel about it all, but at least there are some compelling aspects to their offer.”
“What do you mean?”
“I mean the part about needing some kind of rationing of health care for the last months of life. Ironically it has always existed, but behind the scenes. I mean, the demand for health care, or should I say sick care, is near infinite. Rationing has always been around in this country. And I must say it’s been unfair, since it has been based on ability to pay or celebrity status. People with money and power have always gotten the health care they needed or desired. I don’t know for sure, but maybe Mickey Mantle’s liver transplant is a case in point. Possibly the same for Steve Jobs’s.”
“Are you buying Thorn’s premise to let sleeping dogs lie?”
Paula shrugged. “I’m not buying anything. I’m just thinking out loud. I was blown away by Langley’s explanation that iDoc actions were responsible for the deaths. Like you, I thought for sure it had to be hackers. It never occurred to me that it came from the iDoc algorithm itself. I mean, I did know about all the subjective aspects Langley mentioned regarding cost control and quality of life that had been taken into consideration when the iDoc program was designed, but I never would have made the leap to think that iDoc would be analyzing these considerations and making the decision that it’s best to get rid of people. Yet rationing has always been around. Maybe there is something to letting an algorithm, which is completely nondiscriminating, handle the matter. What could be more fair?”
“It sounds like you have made up your mind.”
“No, but I have to say, talking about it does help. When I think about the individual cases, I mean, there is no way that they should have been murdered, because that is what happened. Yet at the same time they may not have wanted to be tortured with any more drugs that wouldn’t have cured them and might have had horrific side effects. Maybe there is a place for assisted suicide or at the very least for expanded hospic
e care.”
George nodded. He could see Paula’s point. “I have to admit that I have never given much thought to the issue.”
“Well, maybe it is an issue that can no longer be swept under the rug.”
George ran a nervous hand through his hair. “Health care is changing so fast with Washington mandating private health insurance. What the government should have done is make health care a function of government alongside education and defense, like medicine for everyone.”
“That was never going to happen,” Paula said. “That unfortunately got mislabeled as ‘socialized’ medicine way back when none of our politicians had enough courage to take it on.”
“Well, we doctors should have been for it, but we were too afraid of losing control of the profession, which now is going to happen via the digital revolution. Maybe we deserve it, having tried to support the fee-for-service paradigm for so long.”
“I couldn’t agree more,” Paula said. “Doctors certainly have been dragging their feet about informational technology in general. It is just another reason why iDoc is going to be a huge plus.”
“It’s not going to be a huge plus if, as you say, it murders people.”
“Let’s put that behind us for a few minutes,” Paula said. “I’m inclined to do as they wish. I committed the last three years to developing iDoc. Maybe you should feel the same, since it was your germ of an idea that started it all.” With raised eyebrows she looked over at him and studied his face.
George was taken aback. “I hope you are not suggesting that you and I bear some of the responsibility for these deaths.”
“Hardly. But I am beginning to think that they are, as Thorn has suggested, an unfortunate consequence or growing pain of a new and improved system that is going to have an enormous positive effect on the health of the public. A few people die in all sorts of medical studies, particularly drug trials. As long as the unintended killing has stopped, I think I can live with keeping quiet about this glitch, at least in the short run. What about you?”
George sighed. “You know, I have a real problem because one of these murdered souls was someone I loved, and another was one I cared about as a friend. That makes it hard to think of them as unfortunate ‘growing pains’ or statistics. What would I have paid to have had six more months with my fiancée. But maybe she would have wanted to avoid the pain and suffering. Still, I would much rather that the decision had been hers and not an algorithm’s. . . . Jeez!” George lifted his hands in a gesture of frustration and confusion.
“These issues are a thousand times more troublesome when they are imbued with emotion. I can understand. And I’m sorry.” She touched his hand again, this time leaving her hand resting on his.
George glanced at the attendants, then leaned closer to Paula. “Thorn also said that the government doesn’t want the glitch to go away.”
“But the killing has stopped.”
“But it is only a click away if the glitch, as they euphemistically call it, remains.”
Paula removed her hand from George’s. “I see your point.”
“This Independent Payment Advisory Board is a scary behind-the-scenes organization. Its members are appointed, not elected, and this Universal Resource Initiative is even more of an enigma.”
“Agreed. But Thorn said that what the government does with the glitch is an open question and that our input will be respected.”
“True. But the secrecy worries me. And when you get down to it, the federal government is going to do what the federal government wants to do. If our input doesn’t line up with their intentions, who do you think wins?”
“Well, we can agree not to let it remain a secret. Meanwhile, I think we should get out of this place. We can tell Thorn that we agree in principle to what he’s asking, meaning we won’t go running off to the media. That will get us out of here, and we can continue talking at my place, which will be a hell of a lot more pleasant.”
“Do you think Thorn will buy it?”
“I do! I’m taking him at his word. We have no other choice if we want to walk out of here.”
“Letting the glitch persist makes me feel I have taken the first step on a slippery slope. It’s like the beginning of herding up the weakest among us for a future cull.”
“That may be, but as long as no more people are murdered, we can afford to continue thinking about it. I have to get the hell out of here. And you need to finish your residency instead of going to prison.”
“Okay!” George said. “Okay!”
“Okay what?” Paula asked.
“Okay, I guess it is worth a try. I hope I can make it sound convincing.”
“All we are promising is not to go to the media right now. We can sound convincing because that is exactly what we are doing, and for the moment at least, it’s all they’re asking.”
57
MENTAL HEALTH FACILITY
HOLLYWOOD HILLS, LOS ANGELES, CALIFORNIA
MONDAY, JULY 7, 2014, 2:30 P.M.
Just when Paula and George were beginning to despair that Thorn might not return that day after they had sent word that they had agreed to his offer and wished to see him, he walked into the common room. They had returned there following their lunch. They had been the only people in the dining room, and the isolation of the place, its pervading silence, and its vintage fifties decor were beginning to wear on them.
Thorn dismissed the attendants and brought a chair over to where Paula and George were sitting.
“I must tell you that I was ecstatic to hear the good news!” Thorn said. He was clearly pleased that his speech had had the desired result.
As George and Paula had decided prior to Thorn’s arrival, Paula spoke while George stayed silent. It had been her idea because she knew Thorn best and was also more confident she and George were making the right decision. She didn’t waste words: “We have talked it over and agree that the iDoc program should not be held up by the glitch, which we understand would occur if the media happened to get ahold of the story. So we will not be alerting the media, or anyone else, for that matter, despite, should we say, our continued misgivings.”
“I’m pleased to hear this,” Thorn said with a contented smile. “Can I ask what your misgivings are, specifically?”
Paula glanced briefly at George in the hope that he would indeed stay silent and let her answer. “Our biggest concern is that the glitch has not been eliminated, or should we say dismantled, from the iDoc program.”
Thorn looked at George. “I trust that these are your feelings as well.”
George nodded.
Paula added, “We would also like to impress upon you our desire to be included in the ongoing discussions vis-à-vis CMS’s response.”
“Excellent! I can assure you of that. In fact, we welcome your input.” Thorn turned back to George. “I want to be absolutely certain that Ms. Stonebrenner is speaking for you.”
George nodded. “She is.”
“Excellent,” Thorn repeated, slapping his thighs. “I consider this welcome news, as you can well imagine. Now, you can leave this facility, but we feel it would be best if neither of you goes back to your work routines for, let’s say, at least a week. I would also prefer that you stay together during the upcoming week so that you can continue your discussions. We would be happy to put you up in a hotel.”
“I don’t think that’s necessary,” Paula said. “Our plan is to stay in Santa Monica.”
“You wouldn’t prefer, say, the Four Seasons in Maui?”
Paula turned to George with a questioning expression. The idea had some merits.
He shrugged. “I think Santa Monica will be just fine.” He was not interested in becoming beholden to Amalgamated, which he thought would be the case if they accepted a paid vacation in Hawaii.
“Excellent,” Thorn said yet again. He turned to George. �
��Just so you are aware, I’ll be telling Clayton to reinstate you at the medical center. As for the stock options, I will bring them up at our next board meeting.”
“I think I’ll pass on the options,” George said.
Thorn gave him a look, suggesting that was not what he wanted to hear. “I will put in the request just the same,” he said, standing. “I will make the arrangements for you folks to leave. If you change your minds about Maui, let us know.”
Thorn stuck out his hand to Paula, who took it and shook. He then did the same with George, saying in the process: “Once again, let me apologize to you both for last night.”
Both Paula and George just nodded.
58
MENTAL HEALTH FACILITY
HOLLYWOOD HILLS, LOS ANGELES, CALIFORNIA
JULY 7, 2014, MONDAY, 3:15 P.M.
As promised, in less than an hour two attendants accompanied Paula and George out to a waiting black SUV. Two muscular-appearing men in black suits and short, military haircuts were in the front seat. Although Paula and George didn’t recognize the men from the previous night, they decided that they were of the same ilk, “professionals.”
As they left the facility, George was surprised to see how close they were to Laurel Canyon Boulevard. There was no sign identifying the place.
The drive home was a quiet one. Paula and George didn’t want their conversation to be overheard by their drivers, and the drivers did not speak to them or each other. The SUV pulled to the curb in front of Paula’s house, and George and Paula stepped out, still wearing the blue institutional clothing they had been given. Paula said thank you to the drivers, but there was no response.
