American Medicine: I survived the death knell thanks to the devil.

When Ah-Jung was ten years old, his father took all the money in the house and left without even closing the door.

His mother sat on the kitchen floor, coughing so hard she couldn't speak.

The radiators in that apartment in Jackson Heights only blow cool air in winter, and get hot in summer.

My aunt took a 40-minute bus ride from Queens, carrying a pot of lentil paste and a bag of cough syrup she bought from a discount counter at a pharmacy.

She helped his mother to bed and pulled him to the sink to wash his face, without saying a single unnecessary word.

For the next eleven years, every time his mother was hospitalized, it was his aunt who came.

Sign the papers, pay the fees, pick him up from school, pick Ravi up from daycare, and the two children are crammed onto the same sofa bed and covered with the same blanket.

When he was studying pharmacy at the City University of New York, his aunt would take the subway to bring him meals every week after get off work at the sewing factory in Flushing.

An aluminum foil lunchbox, wrapped in a layer of newspaper to keep it warm.

The day he passed his pharmacist exam, his aunt didn't say anything, but tied a silver chain that his grandmother had left him to his wrist.

His mother was forty-seven years old when she passed away.

Sickle cell disease.

She was at Lebanon Hospital in the Bronx, in the same building where her own sister later died.

My aunt passed away three years ago.

The same disease.

He searched through every drug that could delay hemolysis, including hydroxyurea, L-glutamylamine, and folic acid, and used the most expensive original drugs for his aunt.

Useless.

After receiving the death certificate, he went outside and sat on a concrete block in the parking lot, smoking a whole pack of cigarettes with his cousin.

Ravi is his aunt's son.

They were one of his few remaining relatives...

Arjun removed his thumb from Ravi's carotid artery.

He put his hands into the pockets of his surgical gown.

His pockets were empty, but his hands needed somewhere to rest.

The silence lasted for a long time.

Arjun pulled his hand out of his pocket and took out a pack of cigarettes.

He scratched at the foil seal with his thumb, his fingernails making a soft, rustling sound.

This action lasted for a long time.

He took out a cigarette, but didn't light it; he just held it in the corner of his mouth.

"I don't have many relatives left."

It paused for a moment.

"Cure him."

Without Arjun's interference.

Lynn resumed stitching.

The suture used was 5-0 Prilin suture.

The internal jugular vein has a three-centimeter tear with irregular edges, requiring trimming before suturing.

Eleven consecutive eversion sutures.

Lynn loosened the hemostat.

Blood flow to the vein was restored, the sutures withstood the pressure, and there was no leakage.

Sachi's rhythm of passing and cutting the string has improved a lot.

Then the neck incision was closed layer by layer.

Lynn paused when she got to the deeper layers of the stitching.

In the area where the bullet passed, there was a nerve that controls the movement of the vocal cords: the left recurrent laryngeal nerve, which had turned grayish-black.

The ballistic shockwave caused damage first, the hematoma compression caused damage again, and the traction during surgical separation was the final blow.

This nerve is dead.

This means that Ravi will most likely never be able to speak normally again.

Lynn looked at it for two seconds.

A witness who cannot speak normally.

Although it's easy to testify even if you can't speak in this era, it always makes people feel more at ease.

The suturing is complete.

Arjun turned around and extended her right hand to Lynn.

Lynn shook hands with him.

Arjun's hands were dry and strong, with abrasions from the punches he'd received earlier that day still visible at the base of his knuckles.

There was a trace of dark brown powder stuck in my fingernail; it was from when I was preparing the medicine.

Arjun gripped the handshake quite firmly, much more forcefully than her previous polite handshake.

"Don't let him move for two weeks, don't let him try to speak out, and don't let him contact anyone outside the industry."

Lynn released her grip. "I'll come back every other day to change the dressing."

"I'll arrange it."

Arjun tore off her disposable surgical gown, crumpled it up, stuffed it into a medical waste bag, and picked up her jacket from the ground to put it back on.

He patted one of his underlings on the shoulder and whispered a few words in Hindi.

The two carefully transferred Ravi from the operating table to a folding chair with its legs removed, and carried it into the car wash.

Arjun walked to the steps at the back door of the RV and glanced back at the clean area one last time.

The deformed warhead is still inside the curved disc.

Three instrument bags were missing from the cabinet, and a few specks of brownish-red, misty blood were splattered on the PVC shelf.

"Your car," he said, "is well modified. If you need any equipment, feel free to contact me."

Then he jumped.

"Come over to my house for dinner when Ravi recovers."

Ravi's wound healed faster than expected.

The body is still young and has a good foundation.

Lynn went to the car wash the next day to have her dressing changed, and she had it changed five times in a row.

Each time he takes a different route, Sachi arrives at the location 20 minutes in advance to scout it out and only sends out the signal after confirming that there are no unfamiliar vehicles.

The neck drainage tube was removed on the fourth day, and the sutures were removed on the tenth day.

There was no sign of recovery of the recurrent laryngeal nerve.

Ravi tried to speak; his lips moved, and his Adam's apple moved along with them, but the sound he made was like a deflated tire.

He typed on his phone to communicate with Ah-Qiong.

Ah-Jung stared at the words on the screen, her face expressionless.

On the twelfth day, Lynn finished her final dressing change and left the car wash.

Ah-Jung followed him to the parking lot and handed him a brown paper bag.

Inside were two boxes of propofol injection made in India, a box of bupivacaine, fifty disposable syringes, and a folded piece of paper.

The note contained an address: a bankrupt veterinary equipment wholesaler in New Jersey, along with a contact number.

"Laparoscope lenses and insufflator," Arjun said, "Find this person, give me my name, and I'll give you the cost price."

Lynn put the note into her pocket.

"Consider it a debt I owe you," Ah-Jung added, then turned and left.

He walked with his left shoulder slightly higher than his right, and he had cigarettes in his jacket pocket, but he didn't take them out to smoke.

Lynn got into the RV.

Satchel was flipping through a pocket-sized English translation of "The Art of War" in the driver's seat. Lynn had bought it for Dawson in Chinatown the previous week, and Satchel was quite interested in it.

Cassie squatted down next to the storage compartment behind the operating area, using a marker to sketch the installation location on the packaging box of the insufflator.

"Arjun brought some anesthetic." Lynn placed the brown paper bag on the worktable.

Cassie immediately put down her pen and leaned over to look through it.

"Propofol, 200 ml each, two boxes."

She picked it up and looked at the batch number in the light from the car window. "Produced in January 2026, shelf life until 2028. No problem."

"We'll have enough bupivacaine for a while."

Kashi categorized the medicines and placed them into different compartments of the car refrigerator.

Memorize the numbers.

……

Wednesday morning at 7:00 AM.

In the lecture hall on the fourth floor of Metropolitan Hospital, more than fifty people were seated in seventy seats.

The resident physicians occupied the first three rows, while the attending physicians and specialist trainees were scattered in the middle and back sections, with the aisle seats reserved for latecomers.

Projected on the screen:

Blunt dissection of the fingertip during emergency bullet removal surgery: a case report and technical overview

《外科学年鉴》，2026; 283(4): 912-919

First author: Dr. Lynn

Corresponding author: Julian Cabot, MD