Nali: Li Yun, I heard you are in the area. Can I ask you for a favor?

Li Yun didn’t expect Wen Nali to message him. After the breakup, they hadn’t talked much other than the occasional emojis on their social page. When she posted her engagement, he had even posted a couplet on her announcement page. 

Li Yun: Sure.

Nali: My fiance’s mother is here to consult with a doctor on her condition. They say it’s a chronic disorder, and can’t be cured. I am not that knowledgeable about what the doctor is advising, and I thought since you’re here you may be able to assist.

He didn’t have a concrete plan and saw no reason to refuse. Nali wouldn’t request his help unless it was a last resort. After agreeing to help her, she sent him the location of a hospital cafe.

“Weigh General Hospital?” Li Yun glanced at the location, and didn’t think it was unusual for them to consult with the leading hospital in the country. Some of the researchers Li Yun had met were naturally associated with Weigh GH to some extent.

The following afternoon, Li Yun arrived at the hospital complex. It took some time to navigate, but he had planned to come early to tour the hospital briefly before meeting with Wen Nali. Inside the cafeteria, there were a few people sitting around to eat. Most people hated hospital food, but Li Yun thought it was decent. It was the mentally draining atmosphere that made the food taste horrendous.

“Sorry for asking you to come at the last minute,” Nali said as she arrived a bit late.

“It’s fine,” Li Yun replied. It looked like she had lost some weight since the last time they had met. “How are you?”

“Busy,” Nali sighed. “I’m still trying to get tenure, research is going nowhere, and I’m in the middle of planning my wedding,” Nali was someone who stressed out by every little thing and always on her feet.

“Do you have the file?” asked Li Yun.

Nali nodded her head. “This is all the information I have gathered,” Nali gave Li Yun a manila envelope.  “I was chatting with Beibei the other day, and she said you're really good at diagnosing illness.”

Li Yun nodded as he continued listening. “What’s her overall medical history?”

”She has been experiencing pain for many years, and the doctor had diagnosed her with mild rheumatoid arthritis. Since last year, her pain had gotten worse, the doctor thought it was brain cancer, but after the biopsy, it came back negative. We have consulted with a lot of doctors, and many believe it is a neuroinflammatory disorder.”

Li Yun reviewed Ms. Vetter’s medical report, x-rays, and MRIs, but he couldn’t draw any conclusion other than what the doctors had suggested in the report. There was a list of possible illnesses, most were neuroinflammatory disorders. 

“From what I have heard, she had been experiencing mild back and leg pain for many years,” Nali explained. “However, the pain had gotten progressively worse since she was hospitalized last year. She has difficulty standing up for a long period of time. Nick had been trying to find a doctor that could treat her pain. Most medicines work initially, but lose their effect after a few years. Now, she has a daily prescription of opioids to manage her pain.”

“Are they performing genetic testing?” Li Yun asked.

“One of the hospitals submitted her information, but they are still analyzing the data.”

Li Yun saw that she had been treated with a paraspinal injection of analgesic drugs and corticosteroids for cauda equina neuroinflammation. “When is her next appointment?”

“She has an appointment in a few minutes. They are in the waiting room area, I’ll take you up there.”

Li Yun carefully closed the file and returned it back to Nali. They headed up the elevator and arrived at the suite where everyone was waiting. 

“Hi, you must be a friend of Nali?” Nali’s fiancé, Nick, asked as they shook hands. 

“Yes, are you also a professor at the university?” Li Yun asked as he returned the greeting. He had seen Nick’s pictures online, but he was rather smaller in person. His most prominent feature was his high forehead with a widow’s peak.

“Yes, I teach sociology,” said Nick. “My students call me Dr. V.” Nick seemed like someone well-loved by his students and charismatic despite not being traditionally handsome. It was likely he was very good with words. “I heard you are a surgeon?”

There was some skepticism in his question. It wasn’t just Li Yun’s age, but his training in China was often viewed as inadequate. 

“On some days,” Li Yun couldn’t help but joke as he turned his attention to Ms. Vetter, a rather harsh-looking woman. “Ms. Vetter is also a professor?”

Ms. Vetter shook hands with Li Yun and nodded. “Yes, but at Columba University for Literature.”

The woman was sitting in a wheelchair, but otherwise looked healthy. The anesthesia made her look more relaxed, but he couldn’t imagine what it was like when she wasn’t medicated.  The nurse directed them to the exam room and gathered Ms. Vetter’s physical information. They waited another fifteen minutes. Nick was increasingly growing irritated, but as he had been in and out of the hospital with his mother, he knew it would be long, but still complained to the nurse.

In the meanwhile, Li Yun used the time to look up the internet what possible illness Ms. Vetter may have. Based on what they told him, it was likely to be adhesive arachnoiditis, or AA, a neuroinflammatory disease that caused scarring to the arachnoid lining at the lumbar spine.

Dr. Pale walked down the hallway and overheard the patient arguing with the nurse. Despite the patient’s irate tone, Dr. Pale didn’t pick up his speed. It was an all too common occurrence for him.

“Good evening Ms. Vetter,” said Dr. Pale as though he knew the patient for a long time.

“Dr. Vetter,” the woman corrected in a joking manner, but she didn’t spend an additional six years in college for nothing. 

“Ah, Dr. Vetter, I stand corrected,” Dr. Pale replied.

Nick cooled down seeing Dr. Pale's appearance. No matter how irritated he was, he was much more interested to learn what was going on with his mother. Everyone in the room suddenly forgot about the long wait for him.

“Doctor, what’s wrong with my mother?” Nick asked.

“The kidneys are not performing well and there are elevated levels of SAA and CRP. There’s still a lot of uncertainty, and we have already ruled out epidural abscess, but I suggest a biopsy to clear our spinal cord tumor.”

“Another biopsy?” Ms. Vetter frowned. The previous biopsy had caused her an infection, and she didn’t want to be dissected again if there were no clear results.

“Unfortunately, it’s the only way to confirm the diagnosis,” Dr. Pale responded.

“Can I suggest something?” Li Yun asked. “It’s possible that during the process of myelograms, it triggered arachnoiditis?”

Dr. Pale turned to look at Li Yun and wondered if this was another relative? They called him Dr. Li, but he had assumed it was another non-medical type degree. It annoyed him whenever patients filled the room with relatives, but even more when they bring along someone who thinks they know anything about the medical profession.

Dr. Vetter had a problem from her previous biopsy, but most doctors would still recommend a biopsy as it carried a very small risk and was the definitive method to confirm cancer and many infections. Li Yun may be the only doctor in the world who would sign off against having a biopsy. He would if she had cancer, but he knew for certain that she didn’t.  The advantage of a biopsy vastly outweighs any potential side effects, such as positive confirmation that she didn’t have cancer. However, there was no progress in determining the diagnosis.

“While myelograms may cause arachnoiditis, it is a rare occurrence,” Dr. Pale replied. “The MRIs look normal, so it’s unlikely to be the case.”

“But what happens if there is a flaw in the MRI?” asked Li Yun; he rather trusted his ability than machines, surprisingly. He wondered when he had become so sure that everything he saw with his ability was accurate.

“That’s a possibility, but you’re grasping at straws,” Dr. Pale responded in a condescending tone as he assumed Li Yun was a resident. Error in the MRI scan was rare, and there were 5 different axial scans from vertebrae L1 to L5.

Li Yun held his tongue. The only way to confirm was to perform another MRI with myelogram, which may exacerbate the problem. If they were at Qinbei, Li Yun would have used his own judgment to waive the test. However, he didn’t have any authority at Weigh General Hospital and it would be difficult to convince the doctor and the patient of the diagnosis.

Even with a confirmed diagnosis, AA was incurable and could only be treated to manage the pain. However, the current treatment had reached a point where its effectiveness was slowly deteriorating. Huifu was likely the best effective treatment, but it was still under the F&DA review, which may take months to process.

Judging by everyone’s bias, it would be difficult to convince Ms. Vetter to take a TCM medicine. However, there was a way, but it would involve Wen Nali convincing the in-laws.