Chapter 160: What is the Cause? (3)

“This damn patient…”

Shin Hyun-tae muttered helplessly as he had been assigned to treat this stubborn patient. Despite sleeping at the hospital, he always maintained his neat appearance. However, now his beard was scruffy, and most notably, his hair was wildly disheveled.

“Wow, Professor Shin Hyun-tae has less hair than it appears?”

‘Don’t say such nonsense.’

Suhyuk quietly silenced Baruda’s snarky comment about Shin Hyun-tae’s deteriorating appearance. Although not entirely clear, Suhyuk himself didn’t look much better, if not worse than Shin Hyun-tae. This was likely due to continuously following the patient from the emergency room to the intensive care unit.

However, they couldn’t rest as the patient’s condition was steadily worsening.

“Just now…the follow-up cardiac enzyme test results came back…” Suhyuk forced himself to sit up and tapped on the computer connected to the patient’s bed. As he had been continuously monitoring the patient’s chart, the results were immediately visible.

“H-How is it?” Shin Hyun-tae asked anxiously, unable to take a break due to fluctuating blood pressure and heart rate of the patient.

Initially, despite knowing it was a challenging case, Hyun-tae believed that Suhyuk would handle it well since he had taken charge. They even exchanged goodbyes with plans to meet tomorrow before the sudden deterioration occurred.

However, it seemed like the patient took Shin Hyun-tae’s appearance as some kind of signal, and his vital signs suddenly worsened from that point on. As a result, Dr. Chae had to stay up all night attending to him.

‘Please, please get better…’

Deep down, he already knew the truth - there was no chance for improvement. Otherwise, he couldn’t explain the approximately 30 minutes of chaos caused by his superior earlier. Despite being an optimistic person and feeling extremely tired, he fervently prayed for a positive outcome.

“Well… The last CK-MB test showed 18.3.”

“What?! How did it change?”

“It’s now at 55.0…”

“What? R-repeat that again.”

“55…”

“Oh.” Reality can be brutally unforgiving.

If only CK-MB levels had increased, they could have blamed it on faulty testing.

“Tropinin also increased from 2.831 to 9.112. This…the heart is…”

“Damn it… Damn.”

Everything else had skyrocketed as well. There was no excuse for this. The patient’s heart was deteriorating rapidly with each passing moment.

“That bastard Hyunjong isn’t here yet?” Frustrated, Shin Hyun-tae eventually cursed at the absent director, who he considered as reliable as the sky itself. One could argue that Hyun-tae felt free to say whatever since the director wasn’t present, but unfortunately, that wasn’t the case.

“Well, look who finally showed up, you son of a bitch.”

“Hey.”

“So, did you just throw around ‘son of a bitch’ whenever I wasn’t around?”

“N-no, hyung. Seriously, this is my first time today.”

“But you seem quite proficient at cursing now, aren’t you?”

“It’s because I’m stressed, really stressed out. It’s been tough, hyung.”

Shin Hyun-tae bowed continuously and waved his hands frantically. Lee Hyunjong wasn’t someone who would tolerate such behavior, but surprisingly, he didn’t become angrier.

[It is probably due to two reasons.] Unexpectedly, Baruda analyzed and revealed the causes.

‘What are they?’

As humans tend to be curious, Suhyuk instinctively asked despite wondering if it was appropriate given Lee Hyunjong’s condition. However, considering Lee Hyunjong’s presence here, it might be okay to relax slightly.

[Currently, Professor Shin Hyun-tae isn’t covering up his baldness as usual. You may not know this, but Lee Hyunjong has never been angry with An Dae-hoon before.]

‘Oh?’

[I suspect…it could be because of his sensitivity towards baldness…]

It was strange logic, but it made sense. Every man at some point fears hair loss. Today’s laughter could lead to finding one’s own hair piled on the pillow tomorrow morning.

[And…the patient is not good. Especially his heart.]

‘Ah, yes. That’s right. Dr. Choi, he is a good doctor.’

Lee Hyunjong had been involved in numerous controversies throughout his career. Since becoming the director, there were scandals involving Baruda, and support from Taehwa Group headquarters decreased, causing the hospital’s ranking to decline. Despite this, why did Lee Hyunjong continue to receive support from frontline professors?

The reason stemmed from the fact that as a fellow physician, they couldn’t help but respect him for his medical expertise.

“Enzymes… increased. Ah, this. Let’s see the ultrasound. Transesophageal echocardiography. It is not possible to evaluate accurately without it.”

This was evident now as well. At 4 am, the director had come out of his way to examine another doctor and patient.

“Oh, yes. Professor, here.” Suhyuk handed over the pre-prepared ultrasound device.

Suhyuk could have performed a simple echocardiogram through the chest, but for accurate evaluation in such situations, transesophageal echocardiography, as Lee Hyunjong mentioned, was necessary. This advanced technique required additional specialization beyond internal medicine, specifically in cardiology, making it currently unattainable for Suhyuk.

“Watch closely and learn from me. With your skills, I bet you could master it after seeing it just once.”

Lee Hyunjong started the ultrasound while uttering words that even he thought were nonsense. As expected of someone who became a professor based solely on his medical skills without any political maneuvering, Lee Hyunjong’s technique was precise and swift.

“Hey, this… Is thoracic surgery on standby?”

In less than a minute, all the medical staff surrounding the patient could clearly see the heart window displayed by the ultrasound machine. The heart window appeared clean but held little hope.

“R-Regurgitation? This is it?” Suhyuk exclaimed upon recognizing the issue immediately.

Blood was flowing in the wrong direction, which should never happen. Despite Suhyuk correctly identifying the problem, Lee Hyunjong couldn’t bring himself to praise him due to the dire situation.

“Yes… Oh… This is flowing back from the left ventricle. Previously, there was surgery done for this… Yes, it seems to be Ventricular Septal Defect (VSD). It looks like a patch was applied… There appears to be an infection. The aortic valve… It seems to have dissolved.”

The dissolution of the aortic valve. Although expressed in one sentence, its implications were significant. There was a high possibility that another open-heart surgery would be required.

“Firstly… I will call thoracic surgery. I already explained the situation earlier, so both the on-call doctor and Dr. Baek are aware.”

“Oh, please hurry them along. Wow… This…I haven’t seen something this severe in quite some time.”

Lee Hyunjong quickly took a screenshot and removed the ultrasound device, his face filled with astonishment. As he mentioned, it had indeed been a long while since he’d encountered such a case.

“In truth, if they had asked about surgical options at the second hospital during their initial visit, these possibilities should have been considered.”

That’s…true. They missed something there.

Timing is crucial in any field, and medicine is no exception. There are countless cases where minor issues could have been prevented from escalating to more serious problems. It was unfortunate, but what could be done?

For now, he needed to focus on the patient before him.

“They’re on their way.”

“Right, yes. They better hurry. Ah…but this…is it possible to operate right away? How’s his head? I heard he lost quite a bit of blood earlier. Looks like he’ll lose even more.”

Lee Hyunjong nodded and pointed at the ultrasound images and videos he’d taken earlier.

There appeared to be something stuck all over his aortic valve. It could be seen as just clumps of fungus. If these chunks broke off and traveled through the artery, they could cause blockages wherever they got lodged. They were also responsible for infections wherever they attached themselves.

“Oh…yes. There is bleeding near the right frontal lobe, and we have stenosis here.”

“Look at this. Can you operate under these circumstances? The cerebral hemorrhage might worsen…”

With the aortic valve damaged, it was clear that an aortic valve replacement surgery would be necessary. As its name suggested, it wasn’t an easy procedure by any means. In this particular case, the biggest challenge would be initiating extracorporeal circulation.

“Oh, he’s here.” While Lee Hyunjong continued expressing his concerns, the on-call thoracic surgeon rushed in.

It seemed like this on-call doctor had just come from another patient and hadn’t had time to fully process the situation. This was unsurprising, as thoracic surgery departments were often understaffed due to their lack of profitability.

“So, you’ve heard the gist already, right?” Despite being from a different department with which he didn’t have particularly good relations, Lee Hyunjong couldn’t help but feel sympathetic towards the sleep-deprived junior colleague before him.

“Oh, yes, Dr. Choi.”

“This is the ultrasound image of our current patient. As you can see, there’s backflow in the main artery. Do you notice it?”

“Ah…”

The on-call doctor was in his third year, indicating that he had enough knowledge for his level of experience. The image of a blood-soaked operating room immediately flashed before his eyes. Had the director not been present, he might have let out some choice swear words.

“It seems we’ll need to perform a valve replacement…”

“Yes.”

“By the way, if this patient has another brain hemorrhage? Won’t you need to use your extracorporeal circulation machine?”

“Oh, yes. In that case, we would require significant amounts of heparin.”

Heparin was a well-known blood clot inhibitor. When extracting blood from the body and using a machine as a substitute for the heart’s pumping function, it was crucial to prevent blood clots. Thus, they had no choice but to administer heparin; however, given the current situation, its use could significantly worsen the patient’s brain hemorrhage.

“This… It’s difficult for me to make a call on my own. I think we should consult with the thoracic surgery professor and involve the guardian as well. Ah, is the guardian here yet?” Lee Hyunjong turned to Suhyuk, thinking it would be beneficial to meet the guardian since he was already present.

“Not yet. They’re coming from the countryside… It seems they won’t arrive until later today.”

However, the guardian had not arrived yet. Lee Hyunjong’s face showed even more distress than before. He already knew his father had passed away, and from Shin Hyun-tae’s earlier phone call, he learned that his mother was also gone.

‘What if…she expires before her guardian arrives…?’

Despite Suhyuk’s rapid diagnostic abilities, this was still their situation. As Lee Hyunjong bit his lower lip, the on-call thoracic surgeon completed his conversation with the professor.

“After reviewing the images, he believes it is too risky to proceed with surgery now. For starters…he suggests monitoring while administering antibiotics. Of course, if Internal Medicine deems surgery necessary, we will proceed.”

In other words, they were asking Internal Medicine to guarantee the risk of surgery. Lee Hyunjong, Shin Hyun-tae and Suhyuk all closed their mouths.

[It is better to administer antibiotics while waiting for the results of the cerebrospinal fluid culture test. As thoracic surgery said, it is too risky. There is also the possibility of table death.]

‘Ah, but if this starts going towards the terminal arteries, it will be really bad.’

[I hope not.]

‘Sigh…’

Lee Hyunjong, Shin Hyun-tae, Suhyuk, and Baruda were present here. In other words, there was a world-class cardiologist, Korea’s top infectious disease specialist, the promising Suhyuk, and the world’s only perfect medical artificial intelligence. Yet currently, there was no answer. First, we had to wait.

“Then… Let’s observe him while using antibiotics…”

We almost needed a miracle.