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

Two days later, in the conference room on the 12th floor of the orthopedics department.

A weekly multidisciplinary discussion on bone tumors.

The projector screen displayed Elena's shoulder 3D CT reconstruction, with the bones separated and presented individually, making every abnormality impossible to hide.

"Invasive giant cell tumor of bone, or atypical chondrosarcoma."

Prescott stood in front of the screen, his laser pointer precisely outlining the edges of the lesion.

"Look here, everyone. The bone has been gnawed like wood eaten by worms, and the outer bone shell has been penetrated. The negative biopsy result from the other hospital is only because the sample was taken too superficially; the needle didn't even reach the core of the lesion."

"I insist on surgery to take samples, and if necessary, I will cut off part of my scapula."

Garrett sat in the corner, holding his thermos, and sighed.

"Surgery is too invasive. What if it's a benign lesion? I still recommend conservative observation for two months."

"Her arm was ruined two months later!"

Park Jung-woo suddenly stood up.

His eyes were bloodshot, his eyelids twitched slightly uncontrollably, and the extra-large iced Americano beside him was empty.

He has been working non-stop for 36 hours straight in order to secure this rare case that could lead to a top position after his specialist training.

Extreme sleep deprivation left him on edge, and his emotional control was practically nonexistent.

"On angiography, several thick and dense blood supply arteries grew around the lesion, and this area also appeared bright white on the contrast-enhanced MRI scan."

"This is a typical case of osteolysis caused by high-velocity vascular malformation! The blood vessels are in the wrong place, frantically eroding the bone, causing the bone to gradually disappear."

"We must first perform interventional embolization, using a catheter to block these abnormal blood vessels and cut off their blood supply, before we can proceed with surgery to remove the lesions!"

Park Jung-woo became increasingly agitated as he spoke, his gaze sweeping over Lin En, who was sitting at the end of the long table. His suppressed anger and sense of crisis instantly found an outlet.

"By the way, why is an acting chief resident from the emergency department sitting here? Dr. Lin, can you understand these MRI sequences?"

Lynn looked at her precarious Korean colleague.

As an Asian woman who inherited the original owner's memories, Lynn knew all too well what Park Jung-woo was going through.

In this white-dominated healthcare system, Asian Americans without connections can only do the hardest and most tiring jobs, sacrificing their health to gain a little prestige on their resumes.

Park Jung-woo dared not sleep, because if he closed his eyes, the opportunity would be snatched away by someone else.

Obtaining this case will greatly enhance one's resume after completing specialist physician training, potentially leading to a direct appointment as an attending physician at Metropolitan Hospital.

But he was so tired that he developed a fatal tunnel vision, his eyes could only see one spot, and everything in his peripheral vision disappeared.

Lynn slowly opened the folder in front of him, stood up, and walked to the projector.

"Dr. Park, the premise of your entire plan is that the lesion is supplied with blood from a high-velocity arterial system. Let's verify this step by step."

Lynn switched to the angiography image.

"The first step is angiography. We can indeed see multiple thickened blood vessels around the lesion."

He then switched back to the MRI-enhanced image.

"The second step is an enhanced MRI scan. After the contrast agent is injected, the lesion area becomes significantly brighter. At this point, you conclude that the blood supply is abundant, and both pieces of evidence point in the same direction, which is logically sound."

"but……"

Lynn retrieved another set of MRI sequences and placed the laser pointer at the center of the lesion.

"There is a basic principle of MRI: the faster the blood flow, the weaker the signal. Real high-speed blood flow will appear as black tubular cavities in this image because the blood is flowing so fast that the machine simply cannot capture the signal."

He paused for a moment, giving the others time to process it.

"Look everyone, there are no black holes here. Not a single one."

"Those thickened blood vessels seen on angiography are not arteries that rapidly erode bones, but rather low-speed reactive congestion caused by the body's response to the lesion."

"Just like redness and heat around a wound, it's the tissue responding to stress, not the arteries supplying blood. Increased brightness on an MRI is just the leakage of contrast agent at the capillary level, which is completely different from arterial-level blood supply."

Lynn turned her head and looked at Park Jung-woo, whose expression had suddenly changed.

"If embolic agents are used to block this slow-moving microvascular network, they will diffuse into the microcirculation of the surrounding normal tissues, blocking the capillaries that should be supplying blood normally. This leads to large-scale ischemia and necrosis of muscles and nerves."

"Simply put, embolization not only won't cure the disease, it will also ruin her entire arm."

Park Jung-woo had seen that sequence.

But at the time, his attention was entirely focused on assessing the lesion's boundaries. The two pieces of evidence, angiography and contrast-enhanced scan, had convinced him of his point of view, and he never even considered going back to do reverse verification.

A brain that hasn't slept for 36 hours has lost its ability to self-correct.

"Dr. Park worked non-stop for 36 hours. Both tests pointed in the same direction, so it's understandable that there would be an anchoring effect."

Lynn's voice was not sarcastic. "But medicine doesn't believe in fatigue."

Park Jung-woo's lips trembled twice, and he couldn't utter a single word.

Although both are Asian, Lynn was there, and she was organized and at ease.

He tried his best, working tirelessly day and night, in an attempt to defy fate, but due to the collapse of his physical limits, he made a wrong step and lost everything.

Park Jung-woo silently closed his laptop and picked up the empty coffee cup.

The exhaustion from working non-stop finally broke his back. He lowered his head, pushed open the door, and left the conference room.

Lynn looked away and turned to Prescott.

"Dr. Prescott's tumor diagnosis appears to be the most rigorous at present."

Lynn offered timely affirmation, then changed the subject, "However, during rounds yesterday, the patient himself raised a guess."

She suspects she has Gorham-Stout syndrome, an extremely rare form of "disappearing bone disease".

"The bone is gradually eroded and absorbed by the abnormally proliferating lymphatic vessels, eventually disappearing as if it has melted away. There are fewer than three hundred recorded cases worldwide."

Prescott frowned. "A rare disease found by a layman using Google? The odds are too low."

"That's what I told her too."

Lynn smiled and closed the folder.

"But the patient is very anxious. Of course, the final conclusion will depend on Dr. Prescott's subsequent biopsy pathology. I'm just mentioning this for your reference."

After the meeting, Prescott walked down the hallway back to his office.

With Park Jung-woo out of the picture and Garrett backing down, this rare case is now entirely under his control.

Even Lynn, who's been riding high lately, had to admit that his plan was the most rigorous.

Prescott pushed open the office door, sat down at the computer, but Lynn's casual remark kept replaying in his mind.

Loss of bone disease.

He genuinely believed it to be nonsense.

But what if?

If it is indeed one of those rare diseases with fewer than 300 cases worldwide, once the bone tumor is removed according to the treatment plan, all that will be cut open are abnormally proliferating lymphatic vessels, which could lead to massive bleeding and complications that would be catastrophic.

Conversely, if he could diagnose and cure the disease, it would be a top case report that would easily be published in the New England Journal of Medicine.

Prescott accessed the pathology department's system.

He decided to proceed with caution.

While preparing for surgery to take samples, he checked an additional item on the pathology request form:

D2-40, a specific marker of lymphatic endothelial cells.

A reagent specifically for labeling lymphatic endothelial cells.

Normal bone tumor specimens should not contain a large number of lymphatic vessels. If this staining is positive, it means that the bone is full of lymphatic vessels that should not be there, and the diagnosis of disappearing bone disease will be a certainty.

Prescott pressed Enter to confirm the additional pathology request.

As one of the top bone tumor specialists at Metropolitan Hospital, he would never allow any flaws in his diagnosis.