Authors: Robin Cook
CENTURY PLAZA HOTEL
CENTURY CITY, LOS ANGELES, CALIFORNIA
MONDAY, JUNE 30, 2014, 10:14
A.M.
G
eorge 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.
CENTURY PLAZA HOTEL
CENTURY CITY, LOS ANGELES, CALIFORNIA
MONDAY, JUNE 30, 2014, 10:18
A.M.
G
eorge 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 revelationâwhat could he do as a first-year residentâhe 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.