Chapter 176: No Cause?, Part 1

“Ah, should we? Should we go inside?”

Despite not seeing each other for a while, residents were known to be indifferent about parting early due to their never-ending work. This was true for Suhyuk as well as everyone else present. They had merely postponed tasks, but once they returned, there would be mountains of work awaiting them.

“Yes, let’s head back then.”

Even if they didn’t plan on working today, it wouldn’t have mattered. These healthy young men in their late twenties were yawning profusely before 8 pm. Today, they managed to leave early, but yesterday, some only slept at 2 or 3 am.

If they didn’t rest when they could, all that awaited them was death. Although his residency had not lasted long, it felt like an eternity due to its harsh conditions.

“Hey, Dahoon.”

Suhyuk soon entered the hospital lobby. He refrained from calling his roommate while with their peers today, considering Woo’s workload as Baekdang. Regardless, rumors would spread, but Suhyuk wanted to avoid being the source of gossip.

“You really think and act like a robot.”

‘Shut up, dude. I’m doing this for you so you can enjoy some delicious food.’

“Yes, the tripe we ate today… Oh boy.”

It wasn’t bad enough to warrant a sigh, just not particularly memorable.

It wasn’t as if I wanted to limit myself to one portion because it tasted so good. Suhyuk felt similarly, and Baruda disliked filling up Suhyuk’s limited stomach with such food.

‘Later, we will eat something delicious. That should be fine.’

[Thank you, Suhyuk.]

Suhyuk was fully aware of this, and he knew how to use this knowledge to keep Baruda obedient. Consequently, their deal progressed smoothly.

“Ah, yes. Doctor!” Dahoon sounded quite flustered.

This might have been due to Suhyuk taking too long on his previous call before returning Dahoon’s call. It was somewhat strange. If it were an urgent patient, Dahoon would have called back or sent a text message.

“What is wrong with the patient?”

“It…it is the patient I saw last week.”

“Last week?”

What was she talking about?

Suhyuk continued questioning her while getting on the elevator.

“Where are you now? Which hospital room?”

“It’s Room 1907.”

“Room 1907? Is it a VIP room?”

“No… It’s just this was the only available room. Fortunately, there were no complaints from the previous occupant of the six-person room, but still, it feels burdensome.”

“Hmm, anyway, I’ll be right there. Please open up the chart when I arrive.”

“Yes, Doctor. Thank you.”

As Suhyuk hung up the phone, he checked the time displayed on his smartphone.

‘8:12 PM.’

Shouldn’t all outpatient clinics and such be closed by now? A patient he had seen last week being admitted at this hour didn’t bode well.

In any case, it wasn’t a good sign.

[It seems that the issue from when they were first admitted has reoccurred?]

‘Yes, probably. Hmm…’

[A patient who was in a six-person ward is now in a private room. This could be problematic.]

‘That’s right… The price difference should not have been this significant.’

To put it bluntly, staying in a six-person ward in South Korea was cheaper than any other lodging option available. It wasn’t just about value for money; it was remarkably inexpensive.

Considering meals were provided and the daily out-of-pocket cost was around 20,000 won, it was quite a deal. However, the cost of a private room was typically ten to even twenty times higher, far exceeding the six-person ward rates. Especially at Taehwa Medical Center, their private rooms were furnished like hotel suites, making them significantly more expensive—ranging from 20,000 won to 600,000 won per day.

It would be strange if Suhyuk wasn’t angry about this situation.

Ding.

At that moment, the elevator stopped.

“Doctor!”

Dahoon stood ahead of him. When he turned around, one of his colleagues, who appeared to be on night duty, hastily disappeared.

“It’s not part of their duties during the night shift.”

Baruda defended his colleague to alleviate Suhyuk’s frustration. Baruda was quite transparent - it seemed like he wanted to finish quickly so he could eat dinner. Despite considering himself smarter than Baruda, Suhyuk chuckled at how simple-minded his colleague could be.

“Hey, ready?”

“Yes. Please follow me…”

“What is the patient admitted for? Originally?”

“Is your stomach full?”

“Yes, here.”

As Suhyuk mentioned earlier, Dahoon had pulled up the chart. After confirming this, Suhyuk stopped asking questions and began to explore the chart. Even if Dahoon was a smart first-year resident, it was faster for Suhyuk to scan the information himself rather than rely on explanations. It would be more effective to ask specific questions about any points of interest.

[Ah, she’s 33 years old. Quite young?]

‘Based on her previous admission… Ten days before hospitalization, she experienced tingling hands and discoloration when exposed to cold water.’

[Hmm… Tingling and discoloration of the hands.]

Considering just these symptoms, one condition immediately came to mind: Raynaud syndrome.

However, Raynaud’s disease is chronic. Moreover, after learning from Soohyuk for a year, how could he not recognize it?

‘Then I should die.’

[Yes. For this mistake, you should be killed.]

Even Baruda couldn’t defend Suhyuk’s error. Thus, Suhyuk desperately scrolled down hoping to find something else.

‘Starting seven days before admission, there was bloating. Oh, or was it not?’

[Ah, during admission, there was an abdominal ultrasound. Huh?]

‘Why does it show liver cirrhosis? There is no previous history of such issues. How sudden is this?’

[That…is strange.]

Liver cirrhosis occurs at one of the final stages of liver diseases. The only worse condition would likely be cancer, but sometimes, there might not be much difference between them.

“Based on previous tests, all viral markers were negative.”

As Suhyuk was wondering about this, An Dae-hoon hurriedly provided additional information from behind him. It seemed these details weren’t recorded in her hospital records but elsewhere.

“All viral markers were negative?”

“Yes.”

“Hmm…”

Viral markers refer to tests that check for viruses causing chronic hepatitis such as Hepatitis B or C. With all markers being negative, it ruled out viral infection as a cause of liver cirrhosis.

“Does she drink alcohol frequently?”

Alcoholic liver cirrhosis is not as prevalent in South Korea as one might expect. This isn’t due to healthier drinking habits compared to other countries; rather, it’s because Hepatitis B has been more widespread here.

Moreover, it was not a man but a woman. Although alcohol-related issues were increasing among women recently, they were still rare cases.

Suhyuk asked with little expectation in his voice:

“She kept denying it… However, as we asked her daily, she admitted to drinking two or three bottles of beer per week.”

“Huh? Two or three bottles? Ah, per week.”

If she drank two or three bottles of beer every day, it would have been unquestionably linked to alcohol consumption. Drinking two or three bottles per week indicated moderate social drinking.

Confused, Suhyuk moved on to the next question:

“How about liver function tests? Were there any abnormalities?”

“No, sir. Liver enzymes…were normal. Albumin levels were also within range, and all other liver values were fine. The Complete Blood Count (CBC) showed no abnormalities.”

“Really? Was there anything unusual?”

“There was slightly elevated bilirubin.”

“How much?”

“0.7 mg/dL?”

The normal range for bilirubin is 0.5 mg/dL, so 0.7 mg/dL wasn’t significantly high. However, it didn’t explain the apparent liver cirrhosis seen on the ultrasound. This was strange.

“Hey… Did you get a CT scan during your previous hospitalization by any chance?”

“Oh, yes, I did.”

“Really? Let’s take a look.”

“Yes, sir.”

Upon reviewing the CT scan, Suhyuk found that liver cirrhosis was not clearly evident. It was present but not as severe as indicated by the ultrasound.

“Huh?” [What’s going on?]

‘I don’t know either,’ thought Suhyuk, puzzled. He pointed to the initial ultrasound image from the patient’s first admission records.

“What’s with this? Wasn’t it done at our hospital?”

“Ah… Yes, locally.”

“Ah, was it low resolution?”

“It seems there might have been an error. However, we confirmed an enormous amount of bile present. Additionally, the patient reported losing 10 kg from her initial weight of 53 kg.”

“So, there was indeed a sudden liver dysfunction, right? But it hasn’t been long enough for the gallbladder to rupture… Hmm.”

Dahoon instinctively started to respond with “yes,” but then closed his mouth. Suhyuk’s thoughtful humming and head nodding indicated he was deeply immersed in thought.

‘A woman in her 30s with sudden liver dysfunction… And earlier, she exhibited Raynaud symptoms.’

[Could it be an autoimmune disease?]

‘Possibly autoimmune hepatitis or Wilson’s disease.’

[I doubt they would have overlooked those during her previous hospitalization.]

‘Ah…this isn’t his first hospitalization.’

Despite Suhyuk’s frequent travels, the doctors at Taehwa Medical Center were not incompetent. They were renowned enough for rumors to spread about it being a fourth-tier medical facility rather than third-tier.

“By any chance, have you tested for Wilson’s disease and autoimmune hepatitis?” Suhyuk asked confidently.

Dahoon nodded in response, “Yes, Professor Shin instructed me to perform those tests.”

“What were the results?”

“They came back negative. We didn’t find anything.”

“Haven’t you checked for rheumatic conditions as well? Considering he exhibited Raynaud symptoms.”

“Ah… Yes, but all tests were negative.”

Hmm.

All tests came back negative, huh? As someone diagnosing patients, there was nothing more disheartening than this scenario. Both Dahoon and the liver specialist professor must have felt utterly helpless. However, despite these results, couldn’t they still have reached a diagnosis? After all, it’s Taehwa Medical Center, known for its excellence.

“[That can’t be the case.]”

‘Right?’

A potential diagnosis did come to mind after all.

“So, did you treat her for Idiopathic Raynaud Syndrome?”

When Suhyuk mentioned this diagnosis, An Dae-hoon visibly startled before nodding with admiration, recognizing Suhyuk’s expertise.

How could Suhyuk, who was only in his second year, make a diagnosis faster than or even equal to that of a professor? He truly lived up to being called a monster.

“Yes. I treated him based on those symptoms.”

“Ensaid?”

“Yes.”

“On the fourth day of hospitalization, there were no significant changes except for a decrease in ascites… Additionally, the patient mentioned drinking alcohol. Since we couldn’t find any other cause… We decided to first observe him after he stopped drinking, as an outpatient.”

“But he’s back today.”

“Yes.”

It seemed that despite quitting alcohol, the patient’s condition worsened. What could have led to this return?

Suhyuk judged it pointless to delve deeper into the chart at this moment.

“Let’s go see the patient.”

“She is in her hospital room. Um… she might react aggressively due to discomfort.”

“Don’t worry. I’ve dealt with patients for quite some time now.”

“I’m sorry…”

“It’s okay, man. Let’s first check on the patient and then eat chicken. Haven’t you had dinner yet?”

“Oh. Thank you.”

The most enthusiastic reaction to Suhyuk’s mention of chicken came not from Suhyuk’s stomach or Dahoon but from Baruda.

“Why did you offer me chicken just because it sounds nice?! We don’t have anything else to eat!”

‘I’ll order two chickens.’

“[Hm… Can we choose four different flavors? Or maybe half-half for two flavors.]”

‘Well… that works.’

“Alright, let’s do our best. Now, let’s visit the patient.”