Chapter 62

Leland swatted Marsha's hand aside. His eyes, wild and sharp, burned with rage that had been bottled up too long. "You want proof? Look at my brother's leg. That so-called miracle drug you gave him turned a small ache into full-blown necrosis."

A wave of uneasy chatter filled the room. Some of the senior doctors leaned toward one another,exchanging looks that said more than words could.Evita's expression hardened. She moved fast, pulling her granddaughter close. "Marsha, leave him be.There are better things for you to spend your time on."

Marsha clenched her jaw but stayed still. Her forehead pulsed with fury, and her fists curled at her sides as she fought the urge to lash out.

Rylie stood nearby, arms folded, quietly observing the chaos like someone watching rodents in a cage.A faint smirk tugged at her lips. Marsha caught it.

Marsha turned to her. "Wipe that smile off your face.You'll get yours soon enough."

As Marsha turned to leave, Leland instantly regretted his impulsive outburst.

The Kirks weren't doing well, and now he had offended the Wilde family. Once the seminar was over, he was afraid that the VitaLink Hospital would likely fire him.

Leland trailed behind Rylie toward the consultation room, doubting everything about her credentials. He muttered, "With Ms. Wilde in the room, the winner's already been picked. We just have to pretend we've still got a shot."

Rylie didn't respond, Instead, she leaned over the first patient and began her assessment. Her voice was steady when she finally spoke. "The problem with the Kirk family is that you only trust people who shine. You never look at what's hiding in the shadows."

Leland narrowed his eyes. "You really think you can do this?"

Rylie didn't answer. She focused on the report,flipping through pages until she found what she needed.

She scribbled notes and pieced together a treatment plan. It included three different approaches, each with unique meds and costs, all tailoredto fit the patient's budget.

He wrote his own version but frowned deeper with each side-by-side review. Every part of hers made his look half-baked.

Then he spotted something. His finger tapped the third section. "Are you serious? You're mixing ketamine with pregabalin? That doesn't even follow the treatment protocol for neuroimmune disorders."

Still writing, she replied without lifting her head,"Protocols stay the same. Patients don't."

He raised his voice. "That mix is neurotoxic. And you've thrown in an experimental NMDA receptor

blocker too-"

"It's the only thing that's stopping his neurons from dying off," she interjected. Rylie finally lifted her head, her clear eyes meeting Leland's gaze. "Did you even read the spinal fluid report? His glutamate levels are quadruple the normal count. That kind of spike points straight to neurotoxic overload."

Leland froze. He snatched up the report and flipped through it with trembling fingers. Buried in all the technical language, the glutamate levels were clearly flagged as dangerously high.

He stammered, "'But... this treatment just feels too extreme."

"I'd rather gamble with recovery than watch him waste away in a coma," she said. Rylie clicked her pen shut. "Typical immunosuppressants won't work this time. There's over seventy percent damage to his blood-brain barrier. What matters now is bringing back protection for his neurons, not dragging out more immune suppression."

Leland mouth opened, but no sound followed.There was nothing that he could say to counter her logic.That was when it hit him. He'd been clinging to textbook answers for too long, forgetting that every patient carried their own puzzle.

He pointed at one of the drugs in her second plan."Why would you even use doxycycline? That's not for neurological stuff."

Rylie's lips curved, just slightly. "You really should keep up with Frontiers in Neuroimmunology. The latest volume has a wvhole piece on this." She pulled up the study on her tablet. "Silvercrest University found that this class of antibiotics helps regulate neuroinflammation. Especially when it stems from something like a mycoplasma infection. Just like in his case."

Leland took the tablet from her and read the summary. His brows drew together as he tried to absorb the findings. Those studies had always felt outside his lane. He'd skipped over them.

"I'll need time to look through these properly," he said, struggling to admit it.

"We're out of time." Rylie closed the tablet. "Let's move to the next one."

Their second patient wasn't any easier to figure out.

Leland stared at the brain scans. Diffuse lesions stretched across the cortex. Sweat gathered on his brow as he leaned in closer. "This almost resembles prion disease, but something doesn't line up."

Rylie was already pulling on gloves. She stepped over to the patient and began checking his skin. "It's not prion-related." She pointed to a patch on the arm."These tiny rashes? Capillary dilation." Then she gently opened one eyelid. "See this? The blood vessels in the conjunctiva are abnormal."

He leaned over to inspect them himself. She was right. The signs were clear now that he looked closer."What does that mean, exactly?"he asked.

"Brain ischemia from vasculitis," Rylie answered,jotting notes on the plan. "We'll still need imaging to confirm it, but this points to a rare form of ANCA- related vasculitis."

"Hold on!" Leland cut in. "If this really is vasculitis,then why didn't the others catch it? The standard ANCA results were negative!"

Rylie exhaled sharply. "Because all they did was run the usual panel. This strain doesn't show up there.You need a specialized ELISA test to trace antibodies that target membrane protrusion proteins." Rylie turned the results toward him as she added, "Look at this. His complement levels are way below normal.That's a major indicator."

The room tilted slightly as Leland processed it. His vision wavered. Those same numbers had been in front of him. He just hadn't connected the pieces.Rylie had a way of cutting through noise. It was as if she could see the disease bare and unfiltered.

He cleared his throat. "Your protocol- it includes rituximab and pulse doses of cyclophosphamide?"

"Exactly." Rylie nodded once. "We need high-intensity immunosuppression. Add plasma exchange,and it's our best shot at halting the damage before it spreads."

He blinked hard. "But the death rate - it's nearly thirty percent."

"If we don't treat it, the mortality jumps to one hundred." Her tone stayed even. "But I've adjusted the frequency and dosage. The risk drops to under fifteen now."

It clicked for Leland right then. Her approach wasn't guesswork. She had built it on firm science and lived experience. What seemed like reckless choices at first were backed by clear knowledge of how each drug behaved and what the illness demanded.

So by the time they moved on to the next patient, he found himself hesitating before pushing back. This man's symptoms were even stranger. A burning fever that wouldn't quit. Weakness in the limbs. But there were no signs of infection or swelling anywhere.

Rylie glanced at the older man's face, mostly hidden under the blanket, and let out a soft chuckle. "Out of all three, he's the easiest one to figure out."

Leland stared at her, stunned. He'd combed through this chart more than once. Still, nothing had made sense. "Really? But I don't see it. I really don't.