Chapter 177: No Cause?, Part 2

Suhyuk continued to ponder the cause while walking towards the patient’s hospital room.

It can’t be alcohol. It’s not like he drinks daily… Three bottles per week wouldn’t lead to this.

[I am somewhat surprised it isn’t Wilson’s Disease.]

‘Me too.’

Usually, this condition was caused by Wilson’s Disease. Although Suhyuk wasn’t an experienced doctor yet, he had seen enough cases to make such observations.

‘That’s why Internal Medicine is fascinating.’

Thanks to this, there were occasional unexpected situations. Fortunately, these encounters brought excitement rather than shock.

[If you always got everything right, it would indeed be strange. Medicine is vast, and Soohyuk still has much to learn.]

‘Shut up…’

Of course, Baruda’s teasing always followed these moments, but Suhyuk had built up enough resilience to laugh it off by now.

“Patient, as I mentioned earlier, Doctor Lee Suhyuk is here.”

While Suhyuk was lost in his thoughts outside the hospital room, Dahoon entered and started boasting about him.

“He is an excellent doctor who has presented at multiple conferences and published several research papers. He will be of great help.”

The praise felt awkward since Suhyuk hadn’t become a professor yet. However, for a layperson, hearing about conference presentations and research papers sounded quite impressive. The patient nodded thoughtfully.

“I understand.”

“Yes, please come in, Doctor.”

“Hmm?”

Unfortunately, Suhyuk’s youthful appearance seemed to be a drawback.

When hearing about conferences and research papers, one would imagine a middle-aged doctor. However, when a person younger than Dahoon entered the room, the patient’s face soured slightly. He was already annoyed at being readmitted within a week for the same symptoms. Additionally, he was frustrated that instead of staying in a six-person ward, he had been placed in a private room only to be visited by this youngster. The only reason he didn’t openly express his displeasure was due to Dahoon’s demeanor.

“Sir, as I mentioned earlier, this is the patient with unexplained liver dysfunction and ascites.”

Dahoon’s tone and posture were incredibly respectful; it seemed like his head might touch the floor if he bowed any lower. Do people usually bow so deeply towards someone around their age? Even during his emergency room visits, interns or residents hadn’t shown such deference.

‘I don’t know much about him… but he seems older than his appearance suggests. Well… this doctor appears quite knowledgeable.’

The patient’s displeasure quickly faded as they looked at Suhyuk.

“Hello, I am Lee Suhyuk.”

“Oh, yes.”

Suhyuk greeted the patient with a professional smile while simultaneously observing their complexion.

[There is no yellowing of the skin.]

‘The amount of fluid accumulation is significant. It resembles the CT scan taken during admission.’

[I heard it decreased initially, so it must have increased again to this extent.]

Neither the reason for improvement nor deterioration was known. This situation made one want to scream out in frustration.

“Patient, may I ask you a few questions?”

“Yes.”

If Suhyuk continued to ponder only within his thoughts, there would be no need to visit the patient directly.

Thus, Suhyuk began asking questions, “By any chance, have you consumed alcohol since your discharge? I hope this doesn’t upset you as it’s a crucial part of the procedure.”

“No, I haven’t had any alcohol. And it’s okay; I just want to recover quickly.”

“Yes. Well, abstaining from alcohol hasn’t improved your condition.”

This indicated that alcohol-induced liver damage could be ruled out. Typically, with such conditions, symptoms worsen with drinking and improve or at least don’t deteriorate when abstaining.

Although one possibility was eliminated, Suhyuk wasn’t particularly relieved, as it was unlikely to begin with.

“Do you remember your weight at the time of discharge?”

“Ah… Yes. It was 55 kg back then.”

“Has it been steadily increasing?”

“No, it actually decreased to 53 kg.”

“Your weight is almost back to normal?”

“Yes.”

Suhyuk nodded while recalling the hospital chart he had just seen.

[Currently, she weighs 63 kg again.]

‘She gained 10 kg.’

Regardless of how much someone overeats, it is impossible to gain 10 kg within a week. This meant that most likely all the increased weight was due to the fetus.

“You have consistently taken diuretics, correct?”

“Pardon me? Oh… Yes. In any case, I continued taking the prescribed medication.”

“I see.”

What could this be?

It had been quite some time since Suhyuk felt such frustration. What should he do to resolve this situation?

[Let’s take another CT scan.]

‘Why bother with another CT scan? How much can change in just one week?’

At that moment, Baruda shared his opinion. Unlike before, it was not absurd advice. Indeed, why bother with another CT scan when one had already been done?

When Suhyuk showed disinterest, Baruda looked at him as if he were dealing with a ragged piece of cloth. As Suhyuk felt indignant about being treated this way, Baruda spoke again:

[Do you think I am suggesting to repeat the same CT scan?]

‘Then what do you mean? Is there another type of CT scan I don’t know about?’

[Oh dear.]

Before saying anything else, Baruda sighed heavily. Suhyuk began feeling annoyed by Baruda’s attitude once more.

Eventually, when Suhyuk threatened to cancel today’s chicken dinner, Baruda became anxious:

[No, what is wrong with you? Why are you getting so upset?]

‘Isn’t it because you’re irritating me?’

[Are you threatening me with chicken? You lack basic human decency.]

‘Who are you to lecture me on morals? Besides, we have a patient present. Even if our conversation is accelerated, it’s time for them to find this odd.’

Indeed, the silence had already exceeded five seconds. It might seem like a short duration, but during a dialogue between a doctor and patient, five seconds of silence felt quite long.

“Have you really eaten everything? Sometimes people miss some.”

“I told you I ate it all?”

Fortunately, Dahoon was well aware of Suhyuk’s occasional behavior, so he stalled by making idle chatter. However, since Dahoon didn’t possess any specialized knowledge or degree in this field, his attempts were rather clumsy.

However, this pitiful attempt should not be allowed to continue for too long.

‘What do you mean?’

[We haven’t done a liver dynamic CT yet. Since we already ruled out alcohol-related liver diseases…we need to determine the actual problem.]

‘Ahh.’

Liver dynamic CT - it was a specialized imaging technique developed due to the unique characteristics of the liver. It consisted of three phases: arterial, portal venous, and delayed phase. Typically, the arterial phase provided detailed views of arteries, while the delayed phase showed veins in detail. Compared to a standard CT scan, it offered significantly more information.

‘Yes, that should… reduce Identification Points.’

[Right? The downside is that reading these scans can be difficult.]

If another internal medicine doctor heard Baruda’s words, they would laugh in disbelief. Whether it was ultrasound, CT scan or MRI, abdominal imaging tests were challenging to interpret. Only highly skilled gastroenterologists could easily read them. In fact, even for experienced specialists, frequent discussions with radiologists were often necessary.

If I’m unsure about anything, I can always consult Professor Kim Jinsil.

[Nice to have connections.]

Fortunately, Suhyuk had built a network of knowledgeable individuals over time.

Moreover, it was essential to consult with an exceptional specialist from Radiology. Thus, Suhyuk confidently stated:

“I would like one more test.”

“A test? We’ve already done most of them previously?”

Confidence isn’t always welcomed, especially when suggesting additional tests.

“Yes, indeed. However, we now have more information compared to before, making further testing necessary.”

“Hmm…”

Suhyuk’s experience dealing with various challenging patients allowed him to navigate this conversation smoothly.

“We’ll perform a CT scan, but it will be different from the previous ones. It should provide us with more detailed insights.”

“Hmm…”

“From the records, it seems there were no significant side effects during the scan at that time. Is this correct?”

“Yes, well… Just a bit warm feeling?”

“This is also not much different. The disadvantage is slightly longer examination times compared to other scans, but it’s still shorter than an MRI. Dahoon, can you find out when we can schedule it? If possible, let’s do it early morning.”

Suhyuk naturally gave instructions to Dahoon, who eagerly followed them as this was what he had been hoping for. Despite initially thinking, “Did I say I would handle the patient?”, I simply observed their interaction. Seeing Dahoon move without any suspicion made me believe things might work out after all.

“Oh, Doctor! They said they could accommodate us in about 20 minutes? It’s available now.”

“Really? Hey, will there be enough time to call the transfer team?”

“I will go with the intern!”

“Ah… Yes, yes. Go ahead.”

Moreover, after seeing Dahoon excitedly preparing to take photos, Suhyuk became concerned about what would happen if they couldn’t capture any images.

“Well, I’ll be off now, patient.”

“Oh… Yes. Thank you very much.”

Surprisingly, he even expressed his gratitude.

“My apologies for my leg condition.”

“No, no. It’s alright. We’ll finish quickly and return!”

Suhyuk apologetically waved goodbye with great enthusiasm. If it weren’t for the fetus, he might have insisted on getting up despite his condition.

Witnessing this exchange, Baruda remarked casually:

“It seems there aren’t many truly bad people in the world.”

‘Patients may be difficult due to their pain. Once they recover, most become kind.’

[Well… there are exceptions, but it is usually true.] Baruda responded while scanning hospital data.

Among the records was an incident where a patient punched the doctor in the stomach after receiving treatment not covered by insurance despite being fully recovered. It might sound like a rare case, but surprisingly, such incidents occurred frequently. In fact, within Taehwa Medical Center, there was at least one occurrence each month.

‘The images are starting to come through.’

They had promised delivery within 20 minutes, and it seemed they began capturing as soon as they arrived. The videos were streaming live, which used to take several months in the past. However, since Lee Hyunjong became the director and invested in upgrading the network infrastructure, the process became significantly faster.

[I suppose you could call it the joy of throwing money around.]

While the impact wasn’t noticeable in everyday operations, moments like these highlighted its benefits.

‘Let’s take a look first. It should show something that wasn’t visible on the regular CT scan…’

[Even if we can’t see it, it might have meaning. We may need a radiology specialist.]

‘Still, let me see it just in case. Thanks to you, I’ve already reviewed thousands of abdominal CT scans.’

[Earlier, you were so reluctant when I asked. Look, isn’t it helpful now?]

‘If we find something, then great. But if not, stop wasting time. Why aren’t you responding?’

It was unusual for Baruda to be quiet at this point. As Suhyuk questioned him, he felt dizzy. It seemed like someone was stealing more of his brain functions. It was obviously Baruda.

‘Don’t tell me…’

[I am going full throttle. This proves that I am right.]