Chapter 247: Milo (4)
‘Unbelievable.’
My survival rate, as listed on the death notice, had just dropped.
In other words—
‘Milo’s IL-6 treatment will directly affect my chances of survival…
If he responds well to the first treatment?
Then Milo will continue using that drug and will never have any connection to me again.
Which means my survival rate will no longer be influenced by him.
However—
Milo did change my survival rate.
Which strongly suggests that he might be a Russian Roulette patient.
That would mean the standard treatment likely wouldn’t work on him.
‘How many rounds of trial and error can Milo possibly endure in his current condition…?’
Milo was just a fragile little three-year-old, like a piece of bubble gum.
So I couldn’t just stand by and let them go through with a treatment that was likely to fail.
That’s why I had tried to persuade the hospital…
But instead, they retreated behind the shield of the “patient’s choice.”
“Then we’ll follow the patient’s decision. We’ll begin re-administering the IL-6 inhibitor tomorrow at 2 p.m.”
The attending physician said this, shot me a quick glance, and quickly left the room.
‘What now…?’
Obviously, I couldn’t bring up the death notice.
I needed to persuade the family within the bounds of reason.
But could rational persuasion really lead to a major change in a life-or-death decision?
The first to speak up was Rachel.
“I understand why you chose the IL-6 inhibitor. It’s a treatment that’s already been verified.”
She continued in a gentle tone.
“When you stand in front of a locked door, you naturally want to try the key that everyone has. Even if it doesn’t work the first time, you think, ‘Maybe I did something wrong,’ and try again. But what if that key was never meant to fit in the first place?”
“But maybe the issue was with the dosage…”
“That’s certainly possible. I’m not saying one answer is definitively correct.”
In truth, Rachel wasn’t blindly siding with us.
She had another reason for stepping in.
“What worries me is that it seems you’ve assumed, ‘If the doctors say so, it must be right.’ But the truth is, doctors still don’t know much about Castleman disease. Even the current approach isn’t targeted to Castleman specifically; it’s just following general medical protocols.”
David chimed in beside Rachel.
“Doctors will keep administering IL-6 inhibitors even if there’s no effect. In my case, they used the recommended dose and still repeated it three times. There was absolutely no response. Eventually, I took a huge risk and tried something different—and that’s why I’m still alive today.”
The testimony of a survivor who had faced the same situation carried weight.
However—
“You’re not Milo. In his case, he didn’t receive enough of the drug to begin with, so of course there was no effect.”
A doctor’s authoritative voice carried more weight than a survivor’s.
‘Well, it’s natural they’d go with the safer option.’
A verified treatment versus an uncertain one.
When forced to choose, most people would choose the former.
I too was planning to follow the doctors’ protocol—until I saw the numbers change on that death notice.
But now that I had, I couldn’t allow Milo to receive this treatment.
‘If this were a normal situation, I’d just solve it with money…’
If the other party were the hospital, I’d already be thinking of playing the “withdraw the donation” card.
But I couldn’t use such tactics on the patient’s family.
“Are you saying this could affect your decision to support the treatment costs? We are deeply grateful for your help, of course… but I think this is something we should decide for ourselves.”
That was what Milo’s mother said.
‘Did she catch on?’
I’d tried to apply pressure subtly—but she cut me off before I could even begin.
‘If they’re already this sensitive, any attempt at persuasion might backfire…’
If the opponent were the hospital, I wouldn’t care even if they accused me of blackmail.
If it’s just two powerful sides clashing, public opinion would likely be more sympathetic toward me.
But the patient’s family is different.
If parents facing the possible death of their three-year-old child interpret my “persuasion” as “coercion”?
That’s a straight path to social ruin.
“Of course, I’m absolutely not trying to pressure you. Whatever decision you make, I will respect it.”
Rachel offered genuine reassurance to Milo’s mother.
“It’s just that, maybe try letting go of the assumption that ‘doctors know everything,’ and carefully examine all the risks yourself. As I said before, this isn’t a situation where you get unlimited chances.”
“This was a decision made after a lot of thought. From our perspective, safety is the top priority. We can’t choose a riskier path.”
There was certainty in the parents’ voices.
‘Risk, huh…’
Suddenly, I was reminded of my past life.
When I was on the brink of death, I begged for even an untested experimental drug.
But everyone refused, saying it was too risky.
That’s how outsiders think.
They only see the “danger.”
But it’s different for the person at the center of it.
They prioritize something even higher than risk—
Survival.
‘If only the patient could understand that…’
But Milo was too young to grasp such reality.
I turned my head, and saw the boy sound asleep, buried in a pile of dinosaur plushies.
‘He’s not crying anymore.’
He said he liked dinosaurs, so I had a bodyguard clear out every dinosaur plushie from a nearby store.
Thanks to that, the boy who had been crying constantly was finally able to sleep peacefully.
“I hope you can understand our side as well. We just want to rest now…”
In the end, we failed to persuade them and were practically chased out of the hospital room.
A little while later—
After moving to the hospital’s lounge, Rachel muttered with a sigh,
“Maybe… the IL-6 inhibitor will work.”
I hoped so too.
Milo was too young to be dragged into Russian Roulette.
With Dylan, I had even felt a strange sense of camaraderie…
But Milo was different.
He was just a child caught in a war.
However—
Disease doesn’t discriminate.
Milo was already on the battlefield, and the dangerous treatment was scheduled to begin tomorrow.
The final say lay with the patient’s family.
And they had chosen the wrong answer.
There was no way to stop it.
But that didn’t mean I could just sit back and do nothing.
‘What should I do…?’
In the world of investing, no matter how impossible a situation seems, there is always a solution.
And there’s only one way to find that solution—
Liquidity.
If a new flow has already begun...
Then rather than clinging to the old ways, I must find new opportunities within that new current.
The answer came to me sooner than expected.
With my resolve set, I looked directly at David.
“At this point, there’s only one way forward.”
#247. Milo (4)
“You have a solution? What kind of...?”
David looked at me in disbelief.
I nodded.
“For now, let’s continue administering the IL-6 inhibitor.”
“What?”
“And while he’s on it, we bring Milo back.”
“You mean… instead of prevention, you're suggesting suppression?”
“Exactly.”
“Suppression...?”
Rachel and Jessie asked simultaneously.
They would have to explain this to the patient’s family anyway.
So I added a bit more detail.
“If we administer the IL-6 inhibitor, Milo will teeter on a dangerous edge.”
The IL-6 inhibitor suppresses IL-6, a key component in immune response.
“When the immune system’s balance is disrupted, the body scrambles to find a new pathway. In that process, cytokines like TNF-a and IL-1B will spike explosively…”
The problem is that Castleman disease is a condition where the immune system’s ‘frenzy’ switch gets flipped.
But what if someone flips that switch amid all that chaos?
The outcome is obvious.
“A cytokine storm will erupt.”
An episode of Castleman disease—a cytokine storm.
Once triggered, it consumes the patient like a raging hurricane.
My proposal was simple.
“Before it becomes a full-blown storm, we detect it while it’s still just a gust—and suppress it.”
Of course, that’s easier said than done.
David was the first to pick up on that.
“But for that, we’d need to identify the epicenter of the storm in real time.”
Exactly.
To use this method, we’d have to monitor the constantly shifting cytokine levels inside Milo’s body.
“But ELISA tests take six hours to produce results. That’s not going to help…”
If that’s the case, stopping the storm becomes virtually impossible.
Even if we get results, it’d be six-hour-old data by then.
But I had already prepared an alternative.
“It’s not entirely impossible. Like I mentioned before, there’s a technique called ‘microfluidic immunoassay.’”
It’s a method that uses a tiny chip to measure cytokine concentration from minuscule amounts of blood.
“But I heard that hasn’t been commercialized yet...”
“You’re right. It’s still used only for research at places like Harvard and Stanford. But with that device, we can get results in 5 to 10 minutes.”
If the time lag is that short, we can respond the moment we detect signs of the storm.
“This is the best solution we have for now.”
“Hmm, but getting that device won’t be easy. Not to mention the cost…”
David trailed off, then gave a bitter smile.
He probably realized how pointless it was to worry about my wallet.
Then he changed the question.
“More importantly, how are we supposed to get a non-commercial device immediately? We’d need it by 2 p.m. tomorrow…”
I stood up at once.
“Leave that to me. In the meantime, you should explain the plan to the patient’s family and get their consent. I doubt they’ll refuse.”
The patient’s family has no reason to object.
We’re giving them information they’d gladly pay for—free of charge.
“I’ll get the device in the meantime.”
“Right now?”
It was 2 a.m.
But I answered with confidence.
“Yes, right now.”
Luckily, I had already taken delivery of my private jet.
If I were flying a rental, I would’ve had to wait until morning—but not today.
I headed straight for Massachusetts.
‘Should I try to get some sleep?’
It would take about an hour and a half to arrive.
I entered the jet’s bedroom to rest for a bit...
But even the bed and bedding that usually soothed my insomnia did nothing for me.
Even the oxygen bar was ineffective.
‘That’s odd...’
In the end, I arrived in Massachusetts without any rest.
My destination was the Harvard president’s residence.
It wasn’t hard to find.
Most prestigious universities traditionally house their presidents on campus.
“But… is it okay to just show up like this? Without prior notice…”
To the security guard’s question, I replied bluntly.
“I didn’t contact them on purpose.”
“Sorry? Why…”
“Who would be happy to get a call at this hour—especially if it came with a demanding favor?”
Of course they’d refuse.
“But still, you should’ve asked in advance...”
“If I had, they’d just prepare a list of excuses and reasons to say no by the time I got here.”
That’s why a surprise visit was best.
So I rang the president’s doorbell strategically, without warning.
“Who in the world is it at this hour…!”
The person who opened the door shouted irritably—then their eyes widened.
“You’re… no way!”
They recognized me instantly.
“Hello, I’m Ha Si-heon. I apologize for the intrusion, but this is an emergency. May I speak with you briefly?”
“What? What kind of emergency...?”
“A three-year-old child’s life is hanging by a thread.”
I cut straight to the point and asked to borrow the equipment Harvard owned.
The president looked completely flustered.
“No matter how urgent it is, we can’t just remove school research equipment on a whim. Besides—”
“I heard you’re building a new science and engineering complex. I’ll donate $300 million to it.”
At the word donation, his expression changed.
“D-Did you say $300 million?”
“Yes. The reason: ‘Moved by Harvard’s values that cherish young life.’”
From the way I spoke, as if the decision had already been made, the president quickly realized it was a conditional donation.
But—
“In that case, I’ll consult the department and faculty first once the sun comes up.”
In other words, he’d handle it during office hours.
But I couldn’t wait that long.
“Every second counts right now. We need the equipment operational by 2 p.m. today. Since transporting it won’t be easy, I’d like to take it aboard my private jet.”
That was code for: I’m taking it with me now.
So the president had no choice but to start making emergency calls to staff before dawn.
Eventually—
After some ups and downs, I succeeded in persuading the professor in charge of the device.
And I was even allowed to bring along two researchers familiar with operating it.
“So this is… Sean’s private jet.”
“Wow!”
The researchers were clearly impressed, but there was no time for sightseeing.
“Let me brief you on the situation.”
I got straight to the point.
“Stop a cytokine storm in real time? Is that… even possible?”
“We don’t know. No one’s ever tried. We’ll have to be the first.”
“This child is…”
The researchers' expressions hardened when they saw Milo in person.
They finally realized it was nothing like discussing theory behind a desk.
With resolute expressions, they began setting up the equipment beside the hospital bed.
The white machine buzzed softly, drawing Milo’s attention.
Hugging his dinosaur plushies, he tilted his head curiously and watched them.
“What’s that?”
“That’s...”
I was about to answer, but Milo flinched.
Kids don’t usually like me.
And I’m not exactly fond of them either.
After a short silence, Rachel gently explained with a warm voice.
“It’s a special machine. It’s going to help you get stronger.”
“Like a dinosaur?”
“Yes, like a dinosaur!”
“Dinosaur!!!”
Then one of the researchers approached Milo and took something out.
It was a small, smooth device—like a pen—for drawing blood.
The built-in micro-needle was designed to draw blood at five-minute intervals.
Milo hugged his stuffed animals tightly to his chest and squinted his eyes.
“A straw?”
Pointing at the thin tube connected to the blood-drawing device, he asked, and Rachel kindly replied again.
“Yeah, it’s like a magic straw.”
“Juice?”
“Yup, it’s a straw for drinking a special juice that’ll make you strong like a dinosaur.”
“Like a T-Rex?”
“Yes, just like a T-Rex.”
A small wrinkle formed on Milo’s forehead.
“Will it hurt?”
Rachel hesitated for a moment, then answered honestly.
“It might hurt a little. But if you want to become a T-Rex, you have to be brave through some pain. What do you say? If you don’t want to, we don’t have to do it.”
Even in a moment like this, it was so like Rachel to give the child a choice.
Milo thought hard for a while.
He glanced between the Brachiosaurus and T-Rex dolls in his hands, then finally chose the T-Rex.
Still hugging the toy, he extended his tiny finger.
“I want to be a T-Rex!”
It was a decision Milo made on his own.
Even if he didn’t fully understand what it meant.
In his own way, he had shown courage.
2:00 p.m.
The attending physician looked back and forth between the device next to the bed and the researchers, momentarily speechless.
“What is this...?”
“It’s a real-time monitoring system.”
The physician looked a bit uncomfortable.
Truthfully, even the doctors weren’t entirely confident about the IL-6 inhibitor’s efficacy.
But me?
Not only was I certain it would fail—I was so sure that I brought in an unapproved device to mitigate the fallout.
“...I see.”
The physician looked like he had a lot to say, but in the end, he just nodded.
‘This is why people should make regular donations.’
From tax deductions to subtle influence and “consideration”—it’s useful in many ways.
Anyway.
“We’ll begin now.”
At last, the IL-6 inhibitor was administered.
As the drug slowly spread through Milo’s system, I kept my eyes glued to the monitor.
“The data will update every five minutes.”
And exactly five minutes later—
The screen filled with numbers and graphs.
“IL-6 has decreased by 40%.”
An expected result.
After all, the drug suppresses IL-6.
The real battle starts now.
The immune balance had been disrupted.
Which meant the immune system would start searching for alternative routes—
“IFN-γ remains relatively stable… TNF-α is up by 20%… IL-1B, IL-10, and IL-8 are all increasing, along with MCP-1, GM-CSF, and CXCL9.”
“The immune system is in chaos.”
This was all expected.
The real issue was which of these factors would trigger the storm.
How long did we watch?
Soon, the winds began to stir.
“TNF-α is rising faster than expected. IL-1B has doubled, and IFN-γ is suddenly spiking... MCP-1 is up threefold.”
“Increased MCP-1 means more monocytes are flowing in, so it shouldn’t be a major issue right now.”
“But CXCL9 is climbing too fast. So is IL-4…”
“The B cell activation rate is unusually rapid.”
Still, it wasn’t quite at a dangerous level.
Maybe strong winds, at most.
‘This is harder than I thought...’
It wasn’t like spotting a breeze across a calm field.
It was like choosing the most storm-prone current among dozens of raging gusts all around us.
Then—
“D-dimer and ferritin levels are also surging.”
Both blood coagulation and inflammation markers were skyrocketing.
It was a sign that the storm was imminent.
“I think we should stop here...”
When I suggested that, the medical team looked conflicted.
“To properly assess the IL-6 inhibitor’s effectiveness, we need at least 48 hours of administration. This kind of instability was expected. What’s important is whether the immune system forms a new, functioning defense after the chaos settles.”
If we stop now, we’ll just have to start over again later.
So rather than prevent the storm, we had to let it come.
And the moment it hit—we’d intervene to minimize the damage.
‘Where will the alarm go off...’
As I watched—
Milo’s body temperature rose, and his breathing became shallow.
Several markers fluctuated, but none had crossed a critical threshold yet.
Then suddenly—
“IL-1B and TNF-α spike!”
The numbers on the monitor surged wildly.
IFN-γ, CXCL9, MCP-1, CCL5, IL-8...
All kinds of inflammatory cytokines skyrocketed simultaneously.
An uncontrollable immune overreaction.
The storm had arrived.
“Stop IL-6 inhibitor! Administer Anakinra 2mg/kg IV bolus—right now!”
The most dangerous factor now was IL-1B.
We had to suppress it to calm the storm.
But—
“VEGF and D-dimer are still climbing!”
“Temperature just hit 102°F! Blood pressure 70/40!”
“Insert central venous catheter!”
Alarm sounds filled the entire room.
As the medical team rushed in, the researchers and I quickly stepped aside.
“Central venous pressure is at 2 mmHg! Capillary leak syndrome is progressing!”
‘This is... dangerous.’
Excessive inflammation had damaged the endothelial cells, causing fluids to leak from blood vessels.
It wasn’t just about inflammation anymore.
“Rapid infusion of normal saline bolus!”
Despite the rapid fluid injection, the blood pressure wouldn’t recover.
“SpO2 is 89%! Entering hypoxic danger zone!”
“Secure arterial line! Run ABG!”
“Results are in! pH 7.25, lactate 5.8 mmol/L, PaO2 58! Metabolic acidosis with hypoxia!”
Hypoxia.
It meant oxygen wasn’t properly reaching the tissues.
“Start norepinephrine at 0.1 µg/kg/min! Don’t lose track of BP!”
“Peripheral cooling increasing, pulse at 140, sinus tachycardia on ECG!”
“He’s going into shock!”
“Increased muscle tone in limbs! Showing signs of clonic seizures!”
Septic shock.
Milo’s tiny hand began trembling like a seizure, and his limbs stiffened.
“Administer midazolam 0.1 mg/kg IV!”
“Patient has lost airway reflex!”
“Prepare for intubation! Initiating RSI!”
“The seizures have subsided, fortunately.”
We managed to bring Milo back.
Barely pulled him back from the edge between life and death.
But it was too early to be relieved.
“Luckily there’s no critical damage to major organs, but his platelet count is at 50,000, and his blood pressure dropped to 70/40. Due to the lack of oxygen, his kidneys and liver are experiencing ischemic injury.”
The aftermath of the seizure was serious.
Neurological complications couldn’t be ruled out.
Still, I didn’t give up hope.
Because of the number that appeared on the death notice.
[Time of Death: March 11, 2023]
[Time Remaining: 2,677 days]
[Survival Rate: 29.8% (+5.8%p)]
The survival rate had increased significantly.
It meant Milo had gained more time.
“The problem is... there’s still a risk of another seizure. If the storm returns—”
He might not survive next time.
We had to find the right treatment—fast.
“We need to restore his strength quickly and administer rapamycin.”
Maybe the second drug would work.
At least the numbers looked promising.
I believed in it.
Naturally.
“Then let’s all get some rest and regroup tomorrow morning.”
None of us had slept in nearly three days.
That meant we weren’t in any shape to continue this fight.
We had to save Milo with rapamycin.
And if even that failed, we’d have to find another alternative quickly.
So starting tomorrow, the real war would begin.
It was going to be a long battle.
We needed to conserve our energy.
So we all left the hospital.