77 – Karma

"Guiying, you have to be reasonable, there isn't a way to save Little Yan unless we move him," Xia Hong pleaded, but he felt like he was wasting his breathe. He had been arguing with his daughter for quite some time regarding the best treatment for his grandson.

"I disagree, we have the best facility in Imperial City, there is no reason to fly to the States for the surgery," the young mistress Xia Guiying disagreed with the plan to move her son. "We can hire the best doctors and bring them here."

"We have already discussed this, no one is willing to operate on Little Yan with his conditions."

"Sister, listen to father, this is for the best," said another woman in the room.

"Shut up, this isn't your son we are talking about," Xia Guiying only had one son, and she would do anything to save him.

"Xia Guiying, don't talk to my wife like that," Xia Lihou barked back.

The once quiet room quickly turned into a screaming match. Although they were both siblings, Xia Guiying was from the first marriage and Xia Lihou was from the second marriage. They grew up in separate villas and raised by their respective mothers; they were no better than strangers.

"Quiet," a voice, neither loud nor hasty, emerged from the hallway, silencing everyone in the room.

Xia Yong walked into the room with assistance from his personal secretary. He was the patriarch of the Xia family. As the man who had expanded the family wealth to greater expanse than any previous generation, no one dared to speak a word if Xia Yong had not finished his statement. Even his son, Xia Hong, paled in comparison.

The old man walked inside with a commanding atmosphere that suppressed everyone in the room. It was difficult to tell that the man was nearing his 80s.

"Who's the leading expert in thoracic surgery?" Xia Yong asked as he looked at his great-grandson.

In the room, there were two doctors, Professor Yuan Yu, a general surgeon and Doctor Chang, a TCM doctor. Naturally, the question was posed for Professor Yuan Yu.

"Professor Shao Shan from Magic City and Professor Ma Zong from Imperial City,"  Professor Yuan Yu replied.

"What is their response?" asked Xia Yong.

"They both believe a TEVAR is only a temporary fix and there may be complications in the future, but they would like to see the patient first before making a final recommendation."

"Are they both coming here?"

"Yes, I have also invited Doctor Mori from Eternal City."

"Then it is settled," Xia Yong responded.

Meanwhile, at the Magic City University Hospital, Professor Shao Shan was looking at the case.

"An aortic arch replacement on a five years old boy?" Professor Shao Shan read through the profile of a patient in Imperial City. 

The details were blanked out, so it was obviously someone from the upper echelon. On his history, yhe boy suffered from a fall nearly a year ago. However, an aneurysm was not discovered until recently after complaints of chest pain and coughing.

The initial consultation called for an open aortic repair, but there was some disagreement due to the boy's frail health. A second opinion called for a less invasive procedure, the thoracic endovascular aortic repair (TEVAR.)

There were two problems with TEVAR. One was finding an appropriate stent. Only the Inoue Stent was considered a proper replacement for an arch replacement, but it was rarely used. Second problem, TEVAR was not typically recommended for people under the age of 18.  It made sense as the heart would change drastically from toddler to adulthood. Most pediatric cases opted for an open aortic aneurysm repair because there were better results in the long run. If it was a descending aortic replacement, it wasn't a problem, but this was a complete aortic arch replacement.

ProfessorSS: Doctor Li, are you interested in seeing a case in Imperial City?

DocLi: Depends, who is it?

ProfessorSS: 5-years old boy who needs an aortic arch replacement.

Li Yun thought it was sad that the boy had to suffer so early in his life, but since he was still young, it was possible to manage both illness and live a relatively normal life. He wondered why the Professor needed his assistance for an open aortic surgery.

ProfessorSS: If you're wondering why I need you, it's because the family wants a minimally invasive surgery. I do not blame them, the boy is in poor health. The only technique I know available is using the Inoue Stents, but I've only seen it performed on elderly patients. I do not know if it is feasible in pediatric cases.

At Qinbei hospital, Li Yun looked at the incoming text. Triple branch Inoue stent was so rare that Li Yun had to search it up on the internet. After reading the case, Li Yun agreed that Professor Shao Shan was really in a bind. Even if Li Yun successfully installs it, there will  be complications in the future. A regular aortic stent was not approved by the States FDA for pediatric use, much less the more complex triple branch version.

<credit: Tazaki, J., MD, et al>

Li Yun decided to check out the little boy the following week. It helped that Professor Shao Shan was willing to pay for the trip and medical expenses. Although, it was probably the patient's family who was paying for the added expenses.

At around noon, Bu Tao gave him a call.

"What happened with the organ harvesting case?" Bu Tao wondered.

"It's pretty much settled," Li Yun replied.

"Meaning?"

"I couldn't get him to confess, so that's it."

"Should I bring him in for interrogation?"

"Sure, up to you, but I'm going to be pretty busy. I'm heading to Imperial City for a week."

"Ah dammit you punk," Bu Tao figured out from Li Yun tone that he was letting go of the case. "You're just going to let him go?"

"I think he's going to suffer a bit more, but it's up to karma to decide."

"I thought Taoist don't believe in karma."

"It's a metaphor." Li Yun thought karma sounded better than yin spirits.

When Li Yun left Caoben street, he had asked Doctor Tsang about the informant who had died. He was missing a kidney and a part of his liver. The original contract only stated the kidney. It was the reason why the prosecutior started the investigation.

"The informant?" Doctor Tsang thought back, it was one of the last people he had operated on. "He had originally wanted to sell his liver, but we told him he couldn't because of the cancer cells."

"He had cancer?" Li Yun thought most patients would sell their organs to the black market if they were dying.

"He was sick and knew he was dying. He didn’t go to the hospital because he didn't want to pay for it. When I told him, he asked me to cut it off. Thinking back, I shouldn't have agreed."

"Doctor Tsang?" Li Yun spoke as Doctor Tsang was about to leave.

Doctor Tsang wondered if there were police already waiting for him. He had decided that if they weren't waiting for him at the entrance of Caoben, he would turn himself in. He was tired.

"Your punishment is better served in the hospital," Li Yun said.

"You think so?" Doctor Tsang placed both hands in his pocket. "You're not here to address me?"

"I represent the victims, not the police. It's not my call, but there are spirits who think having you in prison is a waste." Li Yun wasn't sure what the yin spirits were thinking, but if they were exorcised, it meant that their souls were resting in a better place.

Doctor Tsang nodded, and left.

Since there was nothing left in the well, Li Yun also decided to leave.

"Oh hey, are you going to buy this place or not?" Pao Lie asked. He was confused by their conversations, but it didn't matter to him. He just wanted to sell the place.

"250k, if you agree, give me a call," Li Yun replied as he walked away.