Chapter 11: A Medical Family (part 2 of 3)

  Dressed in my best business changshan, I paced the garden outside my father's office as I waited for the most important meeting of my life.

  Michael had settled himself on a bench next to a mossy pond. He too was sharply dressed in a dark blue changshan with black trims. Presently, he had his eyes shut in a slight frown as he muttered something under his breath—no doubt reciting the pitch back to himself. My brother seemed nervous, perhaps more so than was warranted for our father's favourite child. As for me, being the least favourite as well as the root cause of our recent drama, the stakes were orders of magnitudes higher.

  It was very much in character for our father to have placed his office atop a quiet hill a few minutes' hike away from the main hospital—and to have built himself a Buddhist garden to surround it. He still saw patients on the rare occasion, usually elderly ones he'd already looked after for many years. But ever since he took on the role of Chief Medical Officer at Sembawang General, most of his time went toward travelling around the city, attending one meeting or another. The rest was spent here in near-total seclusion, with only his secretary acting as a channel to the goings-on in the hospital.

  I guessed that very few people at Sembawang felt comfortable enough to pay Father a visit in his office. We also wouldn't have chosen to if we had our way. Michael and I—mostly I, as Michael still wasn't allowed into the Central—had already pestered many a colleague and senior staff at our own hospital. We weren't completely without allies—Dr Malhotra surprisingly the most vocal among them—but having the interest and support of a few surgeons and department heads didn't translate to the hospital brass signing off on our project. The Central was headed by a committee rather than a single authority figure, and the gist of their consensus was that it was simply too risky. Too many unknowns, too much potential cost and fallout. It wasn't that the Central was averse to leading the charge on practice-changing experiments—quite the contrary under normal circumstances. But the fact that the experiment entailed inserting a Maladous organ into a patient was what gave everyone pause; even I had to admit that was fair enough.

  So our next port of call was the second largest hospital in Temasek. This one was more or less run by one big boss, and that boss happened to be our esteemed father, Ruijie 'Ricky' Tao. I could feel in my bones that this meeting would turn out to be more stressful than any of the ones I've had at the Central. My one consolation, oddly enough, was that Michael would be allowed to tag along.

  Even knowing that I'd never be truly ready, it still felt too soon when the doors to the office folded open and a portly man emerged from within. Mr Lau was Father's secretary, a former theatre nurse who had worked closely with him for decades before trading in smocks for the business changshan. Michael and I knew him well since we were kids, and he looked over at us now with a familiar paternal smile. "Sorry to have kept you waiting. Your father's ready to see you now."

  Before I could react, Michael shot up from his bench and repositioned himself directly in front of Mr Lau. He then bowed, his left hand clasped over his right fist in a sign of respect. "Uncle Lau, long time no see. I hope you're in good health."

  I quickly stumbled over to my brother's side and copied the gesture, though I was too startled to come up with something appropriate to say. Mr Lau chuckled warmly as he stepped over and clapped us both on our shoulders. "Boys, boys, there's no need for that. Come in, quick. Don't tell him I told you this, but your father's been complaining that you haven't visited in ages."

  I shot a look at Michael, intending to convey mild accusation. I myself was resigned to being a lost cause, but I expected Michael at least to have maintained a semblance of cordiality with Father. If this were to be the first time since Lucy's injury that either of us spoke to Father, our meeting was already off to a bad start.

  Oblivious to my rising trepidations, Mr Lau pushed us brothers into the building. This was my first time in here and I was immediately struck by the discovery that Father had managed to create nearly an exact replica of his own house, down to the layout of the rooms and the finish on the wooden trims. Even some of the ink paintings looked identical to the ones that hung in our lounge. If anyone needed proof of just how set in his ways Ricky Tao was, here it was in its full glory.

  I groaned inwardly and repeatedly as Mr Lau led us across a courtyard to a door that matched the one to Father's own study at home. He gave each of us a genial pat on the back, then disappeared into the room next door. Michael and I exchanged one last look and an unconvincing nod, then pushed our way in.

  In the back of an immaculately presented study—again instantly familiar to us both—Father sat precisely centred in his desk, a fine-tip calligraphy brush moving fluidly in his hand. He had never been a physically imposing man, even in his younger days, yet his perfectly straight back and constant scowl demanded that he be taken seriously at all times. His writing hand paused as we stepped in noisily, and he turned up one eyebrow as he glared at us both.

  Again, Michael was the first to stride forward and bow, and I hastily lined up beside him to follow suit. None of us said anything. After a few seconds of keeping my head bowed, I started to straighten before noticing that Michael was still holding his posture. I lowered my eyes again, wondering how long this charade would last.

  "Ruihong," Father finally called out in a stern voice, and I tentatively looked up. He was the only person who still insisted on calling me by my full Luoyangese name, and I had long given up on trying to correct him. His glare never softened as he continued. "What are you rostered for today? I trust you're not missing work to be here."

  Never change, Father. I hadn't spoken to him in months, the last stilted meeting taking place outside the ICU after his daughter had one of her legs amputated. But of course, the first thing out of his mouth was to check if I were bludging. This is my work, I would have said were I in a braver mood, but I settled for something more diplomatic. "I've got shifts this weekend, and this is my rostered day off," I probably should have left it there, but I couldn't stop myself. "Good to see you too, Father."

  He scoffed softly, a somewhat milder reaction that I would have expected. There were two empty chairs laid out in front of his desk—possibly having been placed there by Mr Lau—but Father did not appear interested in inviting us to sit. Also, for whatever reason, he kept his eyes trained on me alone.

  "You're nearing the end of your third year in Radiology," he mused, apparently still determined to drill me on my vocational status before delving into anything else. "I expect your revision for the fellowship exam is coming along without difficulty?"

  I froze. Honestly, I had forgotten all about it. How much time did I have left—two weeks? Three? Outside of actual work, almost all of my time and energy had been poured into refining the prosthesis in preparation for Lucy's implant operation. Just maybe, if I didn't wish to repeat a whole year of training with no pay rise, it would do me good to open a textbook or two.

  "Yeah, of course," I coughed out a reply, and now felt Michael's eyes on me as well. "I'm always good with exams. You know that."

  Father narrowed his eyes. "What are the criteria for a type B aortoiliac lesion according to the Inter-Hub Concensus classifications?"

  Really, Father? Father was of the same specialty as Michael, and he was annoyingly astute about what Angiology-related questions might come up on a Radiology exam. As absurd as this was, my mind began searching frantically for the textbook definitions, and I broke into a cold sweat. I was about relive my worst childhood memories were it not for Michael cutting in to set things on track.

  "Father, if I may, I'd like to get this meeting started."

  Thankfully, Father turned his glare to my brother. His expression did not change much, but I thought I detected a subtle deflated sag of the shoulders. "I would ask about the end of your training, Ruiming, but we all know how that's turned out."

  Suddenly, it made sense that Michael hadn't kept in more frequent contact with Father. He never confided in me about it, but he must have been the bigger target of Father's ire the past few months. His suspension, which wouldn't expire until well into the next clinical year, likely meant that he had to repeat his sixth and final year of Angiology training. Not to mention the damage the whole ordeal had inflicted on the family's carefully cultivated reputation among the medical elites of Temasek...

  Michael did not react to Father's snide remark, and instead waited dispassionately for a response to the original query. After a few more tense moments, Father scoffed again and put down his brush, careful not to spill any ink. Then, back still straight as a board, he crossed his arms and stared at us in turn. "Well, go on, then. Let's hear this proposal of yours."

  By way of introduction, Michael stepped toward Father's desk and placed a packet of handwritten notes. He then carefully laid down a black leather case and unfastened it, revealing the third iteration of our prosthetic leg. Father did not reach for either item, and instead kept his eyes needled on my brother.

  "Two years ago," Michael began, slipping into his academic diction, "a team at Pr-Ankh Institute in Memphis managed to partially restore sensorineural hearing loss in an Aurum-attuned individual. They achieved this by harvesting the Apparatus from a Crocuta, a canine Malady endemic to Kemet and parts of Tamazgha. These Crocutae usually aren't very dangerous on their own, but they have an exceptionally well-developed sense of hearing with which they seek out and stalk injured prey. The Apparatus that's endogenous to the Crocutae are geared toward enhancing audition; they could be described as an evolved variant of the mammalian cochlea.

  "In any case, the team in Memphis was able to isolate the sensory relay mechanism of the Crocuta Apparatus and implant it in their subject via partial mastoidectomy. Over the next several days, the subject was instructed to feed the Apparatus a steady course of Aurous input. From the outset, the subject reported sensing a kind of feedback from the Apparatus, and an augmentation to his own ability to sense background Aurous Quintessences. On day three, he reported the first instance of perceiving auditory signals since his hearing loss."

  At this, Father finally uncrossed his arms and reached for the notes in front of him. As his eyes darted over the page, he waved for Michael to continue.

  "By the end of the first week, hearing had recovered enough for the subject to discern spoken words and engage in conversation. At that time, they also found Radiological evidence of new fibrous connections between the Apparatus and the host anatomy. In other words, the subject was able to condition the Crocuta Apparatus into performing a version of its previous functions within a new system. Unfortunately for this patient, the hearing never recovered fully to the pre-injury state and he couldn't return to adventuring, but at the very least, this case is a proof of concept. That as long as we can keep an Apparatus alive within a human body, an attuned subject could learn to incorporate Maladous Magic. Maybe it won't perfectly emulate how it was used by the Malady itself, but who's to say, really? That's partly what we want to find out."

  Father didn't look up as Michael wound down his spiel. He continued to flip through the notes slowly, scanning the pages with his patented glare. I cleared my throat before launching into my portion of the pitch.

  Stolen content alert: this content belongs on Royal Road. Report any occurrences.

  "The procedure we're planning is a Barong Apparatus implantation as a bridging device to leg prosthesis in an above-knee amputee. As you know, Barongs are Ignis-attuned and so is... the subject we've lined up. The Barong's particular brand of Maladous Magic is based in locomotion and acrobatics—powerful, agile movements driven by their hindlegs. Similar to what the Memphian team did, we want to use an Apparatus to restore lost function, in this case the loss of limb. Our patient is a young Field Medic in her early twenties. If the operation is successful, she could regain decades of what would otherwise be disability and lost income."

  I watched my father during my speech and saw that he looked up ever so briefly at the mention of the patient profile. Michael and I both knew there was no big secret about who this proposal was really about, but knowing Father, we thought it best to keep the presentation as neutral and impersonal as possible. As I watched, Father put put down the packet of notes and grabbed the prosthesis. He then started to turn it this way and that, occasionally peering into the bamboo casing.

  "The prosthesis in question has already been developed by Paragon Biomedical Engineering down in Jurong, pro bono. It is a remarkably functional model of human leg anatomy but requires Quintessential input to power its movements. This is where the Barong Apparatus comes in. By pairing with the subject's attunement, it will act as a kind of channel. The interface will allow the subject to power the prosthesis at minimal cost to her own energy reserve and in the virtual absence of a physical Ignis source. As we saw in the case of the hearing aid, the Apparatus would enhance the user's ability to sense and draw upon environmental Quintessences. We've also done extensive testing to show that it has highly efficient amplificatory properties. In fact, at least in the early stages, the patient may have to learn to tune down her input to achieve just the desired effect."

  I paused, hesitating over the next portion of my speech. The exciting part with the promises of scientific advancement—of the betterment of my sister's life—was done and dusted. The next part with all the practical and logistical concerns was where I had hit the first snag with the powers that be at the Central. I honestly had no guesses as to how Ricky Tao might receive the news.

  "Try as we might, we couldn't extend the viability of a devascularized Barong Apparatus beyond a maximum of 46 minutes and a median of 35. Considering the time it takes for the surgeon to establish return of circulation in the new host, and also allowing for the shorter end of the viability window, we've concluded that the Barong we harvest from must be brought as close to the operative field as possible without breaking sterility—and alive. A trained adventurer will have to put down the Barong on site. A secondary surgeon will then excise the Apparatus and disinfect it before it is passed to the primary surgeon for implantation. Silver Crane Agency, also of Jurong, has already agreed to perform the live capture and transport of the Barong, as well as to assist in harvesting the Apparatus. They too are doing this pro bono.

  "So... Dr Tao, that's a summary of our planned procedure, and we seek your approval for it to go ahead at Sembawang General. We have the theory, the prosthesis, and a technique that's been rigorously tested. We will also provide the implant itself and any additional training that's required. All we ask for is the venue and the staff to make it happen."

  Father did not shift in his seat as he finished inspecting the leg. When he was done, he carefully restored it to its original position and put it back into the leather case. When he finally did look up to settle his gaze on me, I was startled to see... emotion on his face. His frown had deepened and his eyes appeared to be more bloodshot. The corners of his jaw shook slightly, as if he were trying to contain himself.

  "This proposal," when he spoke, he was back to his usual dignified self. "I assume you've already run it by the administrative board at Central Temasek?"

  "Yes," Michael and I answered simultaneously.

  "And their reasons for rejecting the proposal?"

  I glanced at Michael uneasily. He gave me a slight nod and the go-ahead to take this one myself. I needed a way to keep things tactful while also not casting our ideas in too negative a light.

  "Budgetary concerns," I suggested with none of my earlier confidence, then cleared my throat again. "Logistical issues with bringing a live Malady into the hospital, and potential public relations challenges stemming from that as well. Erm, there were also questions as to the ethics of introducing a Maladous component into a human subject, though they did acknowledge the scientific value of—"

  "Expand on that," Father cut me off, seeming to have hit upon the crux of his question. "How do you ensure the subject's safety in receiving an Maladous implant?"

  I nearly let out a sigh of relief before catching myself. It felt like one of those rare occasions where the questions on an exam came precisely from the only third of the textbook I had time to skim the night before. Except, of course, Michael just had to cut in first and steal my thunder.

  "This question is actually addressed fairly extensively in a case series that was published by the same Memphian team. We can provide a supplement with additional literature, if you wish. The short of it is we can minimize risk in a very similar fashion to organ transplant procedures. Via animal models, the Memphian team was able to show that an intra- and post-operative course of immunosuppressive modification reduced the incidence of adverse outcomes to negligible levels. The same technique adjusted for dose and duration proved efficacious for the man that received the hearing implant. We've already briefed a select group of Endologists, Haemologists, and Pharmacologists at the Central on adapting this therapy to our patient. Although, if you wish to recruit doctors at Sembawang for this, I'm sure we could provide—"

  Father put up a hand, palm facing Michael, and my brother stopped talking abruptly. Ricky Tao wasn't one to suffer prattle once he deemed the conveyed information to be sufficient to his needs. Presently, he crossed his arms again and frowned at his desk, looking lost in thought. When he spoke his next question, he took on a musing, almost furtive tone, as though he were in a on secret plan. "How long do you think it would take to train a team to anaesthetize a Barong?"

  "Excuse me?" I blurted out, then looked to Michael. He looked back with mouth hanging slightly open, his first show of emotion during the entire meeting.

  "I refuse to turn my operating rooms into an abattoir," Father continued, apparently content to answer his own question. "Also, we need to extend the Apparatus's viability window as much as possible. If we're going to cut Ruixi open again, we'd damn better be sure we get it right this time."

  He said this with such force and anguish that my brother and I exchanged another look, this time tinged with surprise and rising hope.

  "Does this mean—" Michael began to say, but Father cut him off again with further instructions; he seemed to gain more steam as he kept up with his own ideas.

  "Ruihong, round up your associates at Silver Crane to work with Anaesthetists among my staff. Your task is to devise and test a safe and reproducible method of putting a Barong under general anaesthesia. This would allow us to maintain circulation for as long as possible before we excise the Apparatus, thus ensuring we have the maximum available window of viability. And this way, we also have access to a second Apparatus as back-up in case something goes wrong. I assume Barongs have one on each hindleg?"

  "Uh, yes. You're right, they do," I stammered, racing to get the words out, and in the process, throwing decorum out the door. "But Father, does this mean you're going to—"

  "And Ruiming," Father turned to Michael, ignoring my attempt at getting a straight answer, "I will put you in contact with surgeons of my choosing. You are to relay everything you know about the Memphian procedure as well as everything you've learned about the prosthesis and the Barong Apparatus. You will train them until you are satisfied that any one of them could perform the procedure as quickly and safely as you could."

  I stole a glance at my brother, who kept his eyes on Father, his face a mask of impassivity again. We had finally come upon an issue I'd been skirting around for weeks. In this room, Michael was the only one who still believed that he would be the primary surgeon for Lucy's operation.

  "Father," he said slowly, almost carefully, "of course I can train your surgeons. We would need them to assist with the procedure. But you make it sound as though you expect one of them to be the primary surgeon?"

  "Of course that's what I'm saying," Father's reply was prompt and stern, his brow furrowing into his meanest glare. "Did you expect anything else?"

  "I thought... seeing as how Rui and I have done nearly all of the testing and operative planning, I would be best suited for the job."

  "Have you taken leave of your senses?"

  I flinched as Father raised his voice for the first time in the meeting. Back in the operating room on the night Lucy became an amputee, my mind had been in a haze of fear and self-loathing. I had watched with numb befuddlement as my brother waged a war of words against seemingly everyone in the room. Here, in the clear light of day, I hoped that he had gained perspective. At least for now, it seemed he wouldn't easily lose his temper as he stared back at Father with steadfast calm. "On the contrary, Father, it only seemed appropriate to me that the operator with the most sophisticated insight and specified experience should take on the responsibility. In this particular case, I don't believe I'm in the wrong to say that would be me. Father, I can do this. You know that I—"

  "Then you presume too much, Ruiming Tao." Father interrupted again, though he had reined in his anger considerably. "Do not mistake your brilliance for certitude. You are a surgeon of Temasek. Ours is a tradition built on centuries of scholarship, integrity, and above all, trust. Trust in the institution that brought all of us up, trust in our colleagues, and trust in the team. I won't belabour any argument about the merits of management decisions that already transpired in Ruixi's case, but the fact is you flew in the face of that trust, and my daughter lay in an ICU bed for 18 days."

  I thought a slight tremor had crept into his voice, but if it were there, it had been nearly imperceptible. I also noticed that I had balled my own hands into fists, and tried to loosen them. Michael did not avert his gaze for a second, but he kept quiet, waiting for Father to finish. Father sighed and rubbed his eyes before continuing.

  "You must remember, both of you. For the rest of your careers and long after, there will be more doctors who grieve loved ones. There will be more adventurers who lose life and limb. Through it all, we must never lose sight of what had brought us here, and what our duties are, to ourselves and to this city. This implant... if it works in the way you proposed, it could very well revolutionize Medicine. Irrevocably. Be that as it may, you two are still part of something much greater than yourselves. You must never forget that," his voice had grown softer, more tired. It was rare to see Father in this mood. Elements of our conversation had invigorated him, yet at the same time, had taken something out. "You will meet with my surgeons and you will bring them up to speed. If you claim that you couldn't entrust this to fully trained Angiologists on my staff... then perhaps your procedure isn't worth a damn after all."

  An awkward silence fell over the room. By then, I was convinced that even Michael was in agreement. But the vulnerability Father had shown made both of us unsure how to proceed. Throughout our lives, we'd known Father to occupy exactly two states: the stern and quietly menacing authority figure when he was in control, and the acerbic tyrant when he wasn't. This muted, contemplative figure that sat before us was something entirely unfamiliar. But... that wasn't true, was it? Hadn't I known at least one other occasion where Father had seemed to lose control but not his temper?

  "Go on, pay your respects to Nai Nai." Father says in a shaking voice. His voice never shook.

  I leaned down and grabbed my right thigh in surprise. A flash of pain had shot through the intangible depth of my leg, the kind of pain that was awfully familiar to me from all the times I've had to Reduct during an imaging procedure. My sudden movement seemed to bring Father out of his rumination, and he broke the silence.

  "Of course, all of this can wait until Ruihong is finished with his exams," he said with a sense of finality, eyeing me with his usual glare again. "There's no real benefit to rushing into this. We'll get more hands on deck and take our time with planning and training. If we're going to do this, we shall get it right on the first try, agreed?"

  "Yes, Father," my brother and I replied in unison, subconsciously straightening our postures. Father, in contrast, seemed to relax and leaned back into his seat.

  "Have you eaten?"

  Michael and I looked at each other again, and it was all I could do to stop myself from bursting out in laughter. Perhaps there was nothing quite like the traditional Luoyangese greeting of affection to break up the tension of discussing a risky and unprecedented medical procedure. It was late afternoon, and now that Father mentioned it, I was starting to feel hungry.

  "I still need to finish up here," he grumbled as he launched into his final set of instructions for the day. "You two are to proceed to the house. Stop by Old Kwok's on the way to pick up some braised duck. Your mother should be home by the time you get there. Help her with dinner until I arrive. And next time, for Buddha'a sake, bring Emily and Robbie."