Chapter 161: What is the cause? (4)

“MRSA, as expected.”

MRSA. At one time, it was considered a super-bacteria, but now it had become resistant and could be transmitted through community contact. It has become relatively common; however, this did not mean it was weak. The decision to assume that most antibiotics would have little effect on it turned out to be correct.

“You switched to Vancomycin?” asked Manager Shin Hyun-tae, who looked haggard after just two days.

As expected, Dr. Soohyuk nodded with a similar expression of defeat on his face.

“Yes… As soon as you mentioned gram-positive cocci found in the cerebrospinal fluid, I switched to vancomycin without consulting anyone.”

“Oh.”

Using antibiotics like vancomycin before receiving culture results was considered a financial loss. Being the department manager, Shin Hyun-tae couldn’t help but think about this aspect first, which embarrassed him slightly.

‘No… No, we were prepared for losses when we accepted this patient…’

How could one even consider making money while practicing critical care medicine? It might sound strange in a capitalist society where everything revolves around finances, but it held true for intensive care units. In fact, most cases in such settings typically resulted in financial deficits.

In fact, most cases of critical care resulted in financial losses for hospitals. Manager Shin Hyun-tae barely managed to regain his composure and spoke as any professor would in this situation:

“Well done. However…”

“Yes, there’s no significant improvement in infection symptoms.”

“No improvement? But from what I can see…”

The vital signs looked stable overall. Although not ideal, they were holding steady.

“Yes, um…the follow-up CT scan today shows that the bleeding appears to be absorbed. Neurosurgery mentioned they don’t need to intervene since the intracranial pressure is well-controlled.”

“Oh? What did thoracic surgery say?”

Shin Hyun-tae murmured ‘thankfully’ while looking down at the patient’s chest. It didn’t reveal anything more, but he felt like he could clearly see the echocardiogram performed by Lee Hyunjong every morning.

“Ah, yes.”

In reality, Suhyuk was viewing the stored ultrasound image using Baruda. At the same time, he recalled his conversation earlier that morning with a third-year thoracic surgeon. They agreed to proceed with surgery whenever the risk level was confirmed as manageable.

“Firstly, there is an unconditional need for aortic replacement surgery. We could continue monitoring, but… Considering the improved platelet count after transfusion and reduced bleeding, I believe it would be best to attempt the surgery.”

“Surgery… Will he survive?”

Shin Hyun-tae clicked his tongue while holding onto the patient’s shoulder. The fever had decreased somewhat with vancomycin, but it was still hot to touch. Although not as high, the temperature remained at around 37.8 degrees Celsius.

“I don’t know, but if we leave him like this, he will definitely die.”

Suhyuk also grabbed the patient’s finger. There were changes that wouldn’t be detected unless one closely examined the fingers, even by doctors.

‘The particles have now entered the blood vessels at the extremities.’

“Yes, the range isn’t large yet, but if left untreated, all his fingers and toes will need to be amputated.”

The end arteries, also known as terminal arteries, were crucial because once they got blocked, it was game over for the tissue supplied by them due to the lack of alternative routes for blood flow. The tissues receiving nutrients from these arteries included fingers, toes, eyes, tips of noses, and even the brain.

Since the patient’s brain had already sustained some damage, there was no guarantee that other areas would remain safe indefinitely.

“Professor, take a look here…”

Suhyuk pointed out a tiny black spot on the tip of the patient’s finger, barely visible like a speck of dust, to Shin Hyun-tae.

“Damn it.” Shin Hyun-tae’s language had become increasingly coarse lately, and he immediately understood what this meant. Although occurring at different locations, these were akin to cerebral infarctions. The bleeding might have been stopped, but none of the clots lodged in the patient’s brain had been resolved yet.

“If we delay further, there could be issues with his nose and eyes as well. Even if we save him then…”

“He would suffer severe disabilities.”

In some cases of multiple cerebral infarction, amputation of the tip of the nose or limbs was necessary. Suhyuk had only read about such instances in case reports, but Manager Shin Hyun-tae vividly recalled one from long ago. With his eyes closed, he could still picture the scene: the patient sobbing uncontrollably after surgery and the gradual breakdown of his wife.

It was one of the most challenging days during his career as an infectious diseases specialist.

“Then… let’s proceed with the surgery.”

“Yes, Professor Shin. We will begin shortly.”

“Okay. Um… I’ll be staying overnight at the hospital again today, so please inform me once the surgery is completed.”

“Understood, Professor Shin.”

Ultimately, Shin Hyun-tae confirmed to move forward with the surgery despite the possibility that the patient might die on the operating table due to this decision.

‘At least waiting until now has been worth it?’

As Shin Hyun-tae left the intensive care unit, he tried to console himself. It wasn’t entirely false either. The patient’s condition had improved slightly compared to when they first arrived.

‘Can we really perform the surgery?’

Instead of immediately calling thoracic surgery, Suhyuk sat down beside the patient’s bed.

Ironically, Suhyuk felt warmth from the patient’s body temperature. It was strange as the patient was dying due to this infection causing the fever.

[The question of whether it is appropriate to perform surgery seems misplaced in this situation.]

Suhyuk had become slightly sentimental with these thoughts. However, Baruda remained unaffected and provided only a matter-of-fact response. Suhyuk didn’t expect deep philosophical insights from Baruda, so he wasn’t disappointed or upset. He was just curious why Baruda deemed the question inappropriate.

‘What do you mean by that?’

[The patient must undergo surgery under any circumstances. The question “can I perform surgery?” is relevant only when surgery is optional.]

‘Ah… Well, yes. Is that your judgment too?’

“Yes. The patient must undergo surgery; it is just a matter of time. If treatment had been initiated earlier, things might have been different. However, by the time he arrived at Taehwa Medical Center, his aortic root structure was already severely damaged. At that point, surgery became not an option but a necessity.”

Surgery was not an option but a necessity. This phrase often indicated a poor prognosis for the patient. Suhyuk sighed and glanced back at him.

“U-um, Doctor. Should I…make the call?”

At that moment, An Dae-hoon beside him spoke up, looking equally troubled. It was understandable given how the patient’s condition under his care had rapidly deteriorated. Not only was he emotionally drained from working overnight, but also physically exhausted.

“No, no. I’ll handle it. You…go find the guardian first. We need to explain everything.”

“Ah…yes.”

An Dae-hoon’s face grew darker. If the patient was improving, meeting with the guardian wouldn’t be burdensome. However, the current situation was entirely opposite. Every encounter elicited involuntary sighs from him.

“Don’t be too harsh; I’ll handle the explanation. Just…mention the surgery casually.”

“Yes, Doctor.”

Fortunately, Soohyuk wasn’t a complete newbie fresh out of residency. Otherwise, An Dae-hoon would have been solely responsible for both contacting thoracic surgery and explaining everything to the guardian by now.

‘For this reason alone, I truly admire Lee Suhyuk…’

Unaware that part of Suhyuk’s actions were driven by reputation management, An Dae-hoon couldn’t help but deepen his admiration and loyalty towards him.

Oh man, look at his receding hairline.

Contrary to what An Dae-hoon thought, Lee Soohyuk had been staring at Nam Yoonsuk’s head and shaking it. He then picked up his phone, which displayed the number for thoracic surgery that he had dialed earlier.

The call was quickly answered, perhaps because they assumed it was about a surgery.

“Yes, Doctor Lee Suhyuk.”

“Hello, Doctor. That… I am calling regarding patient Nam Yoonsuk.”

“The surgery… Is this a confirmation?”

“Yes. We will explain everything to the guardian. Additionally, I’ll join you in the operating room to monitor the patient’s condition. Although, my assistance may not be significant.”

“No, no. We will feel much more at ease if your primary physician is present.”

There was always a difference between a primary and consulting physician. A consulting physician would focus only on issues related to their specialty, while a primary physician had oversight of the patient’s overall condition. In case any problems arose during surgery, it would be beneficial to have someone familiar with the patient’s history and lab results. Naturally, the thoracic surgeons welcomed Suhyuk’s offer.

“Yes. Then… please contact me once you secure an operating room. I’ll head over immediately.”

“Thank you very much, Doctor Lee Suhyuk.”

Despite being asked for assistance, Suhyuk received gratitude as he ended the call.

He exited the intensive care unit through the door An Dae-hoon had previously used.

‘Let’s see… Ah.’

There was no need to search for him. Firstly, he wasn’t in the waiting room but near the entrance of the intensive care unit. Secondly, it was evident from his tears.

“Mrs., uh… Mrs…”

An Dae-hoon gently patted the guardian’s shoulder with a helpless expression on his face. Considering An Dae-hoon’s usual demeanor, it was unlikely that he said anything inappropriate. The mention of surgery likely triggered her emotional outburst, as is common among mothers deeply concerned about their children.

“Oh…oh our…our Yoon Seok…”

The guardian was crying uncontrollably as if overwhelmed by emotions. An Dae-hoon focused solely on comforting his mother.

“Mother… Th-that… Um, Doctor.”

“It’s okay; I’ll explain everything.”

“Oh, yes. That… Guardian, Dr. Lee Suhyuk is here.”

Upon hearing ‘Lee Suhyuk,’ the guardian managed to stop her tears momentarily. For some reason, despite being young, he always spoke with authority and conviction. Whenever she asked other medical professionals about him, they praised him as a genius. Even the attending professor during rounds had spoken highly of him, so the guardian had utmost trust in Suhyuk.

“Ahhh, Doctor…”

“Guardian-ssi. As you may have heard…Patient Nam Yoonsuk needs to undergo surgery now.”

“Ahhh… That poor child…once again…”

“I understand your pain, but we cannot delay the surgery any longer. Fortunately, his condition is better than when he was first admitted.”

“T-Then…will he live if he has the surgery?”

Despite Suhyuk’s sharp intellect, this question posed a challenge for him to answer accurately.

[Based on Taehwa Medical Center’s thoracic surgery data and the patient’s current state, the survival probability is approximately 60%.]

It meant almost a fifty-fifty chance. Delivering such news to the guardian, who had been sobbing relentlessly with tears still welling up, seemed quite harsh.

‘What if I go inside and monitor Vital?’

[Nothing would change significantly unless you accompany me, Suhyuk.]

‘Got it, got it, understood.’

[Then it will increase to 80%.]

80%. It still meant there was a one-fifth chance of dying, but it was much better than a fifty-fifty chance. Additionally, Baruda shared his opinion further:

[I recommend entering together.]

‘Saving the patient?’

[That is also true, but primarily to build a relationship with the thoracic surgery professor.]

‘Why is that?’

[Because we need data from the thoracic intensive care unit for the AI diagnostic assistance system currently under development.]

‘That…isn’t that too materialistic a reason?’

[However, it is practical.]

He had a point. Once developed, this AI could potentially save more lives.

[It will generate revenue as well.]

And earning money would be beneficial…

In any case, Suhyuk faced the guardian and nodded firmly.

“Yes, I’ll do my utmost. I will enter the operating room as well. We must save him.”