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

Prescott arrived at Elena's hospital room promptly at 10 a.m.

"Elena, the biopsy is scheduled for Thursday. Before that, I'd like to discuss a plan with you."

He pulled a stack of bound documents from the file folder, turned to the third page, and turned to Elena.

"We are leading a phase II clinical trial of denosumab targeting RANKL pathway-mediated aggressive osteolytic lesions."

"Based on your current imaging results, you are very likely to meet the initial screening criteria."

"Of course, the final confirmation depends on the pathology results of the biopsy. Let me first give you a brief overview of the situation."

Elena took the document but didn't look at it immediately.

"The key point is..."

Prescott raised his voice.

"As a participant, all your trial-related costs, including medication, imaging, pathology, etc., will be covered by the sponsor."

Then he chose to remain silent.

The silence was reserved for Elena, allowing her to calculate the cost of her treatment.

Prescott knew that these slum girls cared about these things the most, even if it meant climbing up a little bit.

Elena had a mental calculation:

Orthopedic ward hospitalization costs 3,200 yuan per day.

A CT scan costs 4,000 yuan, and an MRI costs 6,000 yuan.

Biopsy plus pathological analysis starts at 15,000.

……

Every extra day she lies in this hospital room, her medical loan balance, in addition to her student loan, increases.

Elena lowered her head and began flipping through the documents.

Informed consent form, 26 pages.

The first two pages provide an overview of the trial and the drug's mechanism of action.

Turn all the way to page nine, to the "Obligations of Subjects" section.

"No targeted treatment outside the protocol may be received during the trial."

She read it aloud, then looked up at Prescott. "What does this sentence mean?"

"Standard terms and conditions".

Prescott is very mild-mannered:

"To ensure the purity of the data, subjects cannot use other interventions simultaneously during the trial period. This is a basic requirement of the FDA for all clinical trials."

"So if I sign this consent form, I cannot see other doctors to treat my condition with other treatments throughout the entire trial period."

"That's one way to understand it. But you can withdraw from the experiment at any time."

"What happens after you quit?"

"After you withdraw, you will revert to being a self-paying patient. The costs incurred during the trial will still be covered by the sponsor, but you will need to pay for any subsequent treatment costs yourself."

Elena stared at the line of text for five seconds.

There are sometimes free lunches in the world, but they usually come with a pair of handcuffs.

Once she signed the document, her diagnosis, treatment plan, and follow-up schedule were all tied to Prescott's trial framework.

If she feels things are not going in the right direction and wants to change doctors, that's fine, but from the day she quits, all the bills will come crashing down on her again.

She turned a few more pages.

Page 14, Data and Intellectual Property Rights Clauses.

"Participants agree to grant the sponsor and principal investigator the right to use all clinical data and biological samples generated during the trial for academic publication and subsequent research."

Elena closed the file.

She understood.

The essence of this informed consent form is to exchange her illness, her bones... for a thesis.

And the author of that paper must be the bone tumor specialist in front of me, wearing a tie.

"I need time to finish reading it."

Prescott stood up and put his pen on the document.

"Of course. However, if you decide to enroll before Thursday, your biopsy specimen can go directly into the experimental analysis process without needing a second puncture."

He walked to the door, turned back and smiled, "You're a lawyer, I trust you'll make the most rational judgment."

Lynn doesn't have much time left...

At 3 p.m., Cassie pushed open the ward door with her tablet computer in hand.

Because of her good relationships with others, the resident physician who had previously been in charge of Elena switched shifts with her.

Elena was lying on the small table, marking the consent form with a highlighter, with a copy of the "Tabber Medical Dictionary" spread out next to her.

"What are you investigating?" Cassie approached the hospital bed.

"The boundary between irreversible bone resorption inhibition and routine care."

Elena didn't even look up. "This consent form is a fallacy."

Cassie glanced at her, said nothing, put on gloves, and lifted her hospital gown to check the amount of fluid in the drainage tube in her right shoulder and the skin tension around the incision.

The ward was so quiet that only the beeping of the monitor could be heard.

"Your accent has a South Bronx flavor," Elena suddenly said.

Cassie paused for a moment as she removed her gloves: "Mortehaven District."

Elena's tense shoulders relaxed slightly: "I grew up in Willis public housing on 138th Street."

The two place names are like a secret code.

The South Bronx represents poverty, shootings, drugs, and a childhood where survival is a struggle.

Cassie threw the used gloves into the medical waste bin, not in a hurry to leave as usual.

She pulled up a chair, sat down, logged into the electronic medical record system on the tablet, and updated Elena's latest blood test results.

"It must have been tough climbing out, right?" Cassie asked.

Elena put down her highlighter and gave a self-deprecating laugh.

"It took me 26 years and nearly 200,000 yuan in student loans to finally get a job with an annual salary of 195,000 yuan. In my first month at the company, I went to Whole Foods Market and bought a box of organic blueberries, but I deliberately didn't look at the price when I paid."

Her eyes were a little red.

"That was the first time in my life I bought something without looking at the price. I thought I had finally become middle class. But four months later, I'm lying here, calculating how many days of my daily wage I have left to burn."

Cassie listened attentively.

"Actually, they're all the same."

Cassie looked down at the tablet. "People think being a doctor is a high-paying and respectable job. But they don't know that a second-year resident in New York only earns $70,000 a year."

"After taxes and student loans, a single room in Manhattan costs four thousand a month. To save on rent or the two-hour commute each day, I'm still sleeping in my car."

Elena looked at the efficient young resident doctor in front of her and suddenly felt a strong sense of resonance.

The glamour they achieved through their hard work is as thin as a cicada's wing in the face of reality.

"So, when your body has problems, you don't dare to stop, right?" Cassie asked softly.

Elena leaned back against the pillow and sighed.

"I started losing weight before I even started the job, and I lost ten pounds in two or three months. I thought it was because of the stress at the law firm."

"I also have night sweats; my pajamas are soaked every morning. I share an apartment in Queens with three other girls, and the room is too small. I always thought it was a problem with the heating system."

Some details can only be recalled in moments of complete relaxation, and Cassie secretly jots them down.

"When you were in the South Bronx, did you come into contact with any particular pathogens?"

Elena recalled.

"There was an elderly Haitian woman on my floor who had a cough her whole life, and we only found out later that it was a lung problem. Who would have thought, in that kind of environment."

"How long have you had shoulder pain?"

"It's been two or three months. At first, my hand started to ache, and I thought it was from sitting at my desk for too long. But one morning, when I was wearing a shirt, I heard a 'snap' in my shoulder, and my hand was completely useless."

Elena added, "By the way, I sprained my right shoulder once when I played volleyball in college, but that was five or six years ago."

Cassie didn't understand what rare disease these symptoms, pieced together, pointed to, but she knew that Lynn needed these most authentic fragments.

"Cassie."

Elena stopped her as she was about to get up and leave, pointing to the consent form on the bedside table.

"Prescott, Garrett, and that Korean doctor...who do you think I should believe?"

This is a red line issue in hospitals.

If a resident physician privately evaluates a specialist trainee's treatment plan, and is reported, they may be severely reprimanded by the attending physician, or even have their annual evaluation affected.

Cassie loosened the doorknob and turned her head.

"The acting chief resident who came to consult on your case before."

"He was the lowest-ranking doctor, but he was also the most genuine doctor I've ever met."

After saying that, Cassie pushed open the door and left.

9:23 PM.

Cassie leaned against the wall in the blind spot of the nurses' station surveillance, took out her phone, and opened the encrypted communication software.

Sigrún has taught at the Iceland University of the Arts as a part-time lecturer since and was Dean of the Department of Fine Art from -. In – she held a research position at Reykjavík Art Museum focusing on the role of women in Icelandic art. She studied fine art at the Icelandic College of Arts and Crafts and at Pratt Institute, New York, and holds BA and MA degrees in art history and philosophy from the University of Iceland. Sigrún lives and works in Iceland.

Some readers reported that they didn't quite understand yesterday's chapter, so we've added some supplementary explanations and removed too many technical terms. If you didn't understand it, you can go back and take a look.

The modification was made at 7:09 PM on March 5th.