Chapter 185: What is this? (1)

Every Wednesday at 6:30 pm, internal medicine doctors of Taehwa Medical Center gathered together.

The word ‘all’ couldn’t be used because everyone was too busy. Although attendance was mandatory if one had time, finding such free time in a university hospital was challenging.

While heading to the auditorium, Taejin Jo received a text message from Professor Kim Jinsil.

“Mr. An Dae-hoon, please check on the patient admitted earlier.”

“Yes, professor.”

“Please also keep an eye on Soohyuk.”

“Yes, professor. Don’t worry.”

He promptly gave instructions to the residents and replied with gratitude.

The auditorium was located near the outpatient and cancer centers, so it wasn’t far away. As soon as I pressed the send button, I arrived at the entrance to the auditorium.

“Please bring your lunch inside.”

At the entrance, secretaries were distributing sandwiches. In conferences, there is hardly any time for both presentations and meals. Following advice from a senior professor who wanted to address both issues simultaneously, this tradition had been established long ago.

“Thank you.”

“Thanks.”

“Sign your name before entering.”

“Oh, yes.”

Attending such conferences was necessary for later taking specialist exams. Previously, first-year residents would write down the names of third- or fourth-year residents and sign on their behalf, but nowadays, it has become more challenging.

Moreover, Lee Hyunjong currently had a dokkaebi-like expression on his face.

“Get inside quickly, quickly. How many times have I told you today’s case is difficult?” He gave a smack to the residents hesitating while checking if the signature was genuine or not. It would be a mistake to underestimate him just because golf was the only sport he played throughout his life.

“Ugh.”

“Huff.”

On the field, he was known as a ‘great single hitter’. However, it wasn’t due to short game but rather his drive shots. There was one stroke of genius:

“Oh, our Soohyuk.” In front of Suhyuk, he could only wear a broad smile. “Go slowly, go slowly. Hey, you guys move aside, idiots! Clear the way for Soohyuk, damnit!”

He even volunteered to be the pathfinder, causing those standing nearby to almost get pushed aside.

“Seriously…”

“Look at his extreme love for his son.”

“It is sad, really sad.”

There were complaints from various places, but Lee Hyunjong didn’t care about such things.

“Now, sit here.”

“Huh? This seat is too close to the front…”

“If someone smarter than you comes along, give up your seat. But there isn’t anyone like that. Just sit down.”

“Eh…”

“Sit down, damn it. Today’s case is no joke. If you see any mistakes, boo them loudly. Let them know.”

Lee Hyunjong was referring to ‘that guy’ as none other than Shin Hyun-tae.

As he watched Lee Hyunjong, Shin Hyun-tae shook his head, recalling yesterday’s events.

I must have been crazy… Seriously…

Why had he gone to see Jongi? Why did he insist on asking him directly instead of investigating it himself or discreetly through their fellow guildmates?

Hmm. Hmmmm.

Shin Hyun-tae vividly remembered Lee Hyunjong’s reaction upon seeing the case file after nearly ten days of agonizing over it. It was understandable, as this wasn’t the first time they’d encountered such a situation.

He definitely knows about it. But why won’t he share with me?

All Hyun-tae had asked today was for Hyunjong to present the case publicly. He figured that during the discussion among so many people, someone might reveal the information he sought.

In other words, he intended to criticize Shin Hyun-tae here.

‘Hyung… Why are you doing this? Really. I am the Manager.’

Suhyuk had complained several times, but it was futile. Lee Hyunjong only replied that there was nothing embarrassing since no one would know about it anyway.

“Alright, let’s begin.”

Lee Hyunjong sat next to Suhyuk and pointed forward. He noticed Shin Hyun-tae with his head bowed low for some time now.

“Hmm.”

Of course, Shin Hyun-tae wouldn’t present directly himself as he held the position of manager. Lee Hyunjong didn’t want such a spectacle either. It was enough to tease him personally.

“Hello everyone, I am Yoo Jisang from Internal Medicine, second year.”

Yoo Jisang became the scapegoat. He was slightly clumsy, slated to become the pharmacy chief, and currently wearing a troubled expression on his face.

The moon had changed just yesterday, and naturally, he was assigned this bombshell case to present.

“A 51-year-old female patient presented with difficulty breathing and fever.”

Difficulty breathing and fever - as soon as these two words were uttered, every internal medicine doctor in the auditorium thought of pneumonia. They wondered if it might be a case for Shin Hyun-tae, the head of the Infectious Diseases Department.

“Seven years ago, the patient underwent mitral valve replacement surgery due to mitral regurgitation.”

However, upon hearing ‘mitral valve replacement,’ another condition came to mind.

‘Could it be endocarditis?’

“It is possible…but isn’t this the case Lee Hyunjong asked you to upload? It likely won’t be straightforward.”

‘Ah, indeed.’

[Still, it is highly likely, so I will add it to the list of potential issues.]

The mitral valve refers to the structure between the left atrium and ventricle that prevents blood from flowing back into the atrium once it enters the ventricle. Mitral valve insufficiency means this function has been compromised, while ‘replacement’ implies the damaged valve was removed and replaced with an artificial one.

The problem arises because even with advanced technology, artificial valves can still lead to blood clots or bacterial growth, unlike natural valves. As a result, patients with such replacements must be routinely checked for endocarditis, which is relatively rare in the general population but common among these specific cases.

“The patient was doing well until two years ago when they experienced ventricular tachycardia leading to loss of consciousness. As a result, we implanted an intracardiac defibrillator. Since then, their condition has been classified as NYHA Class II (moderate heart failure). However, over the past seven days, it has deteriorated to Class III.”

“Hmm.”

I didn’t expect ventricular tachycardia and an intracardiac defibrillator to be mentioned here. Moreover, initially, the patient had moderate heart failure, causing shortness of breath even while climbing stairs. Now, reaching Class III meant experiencing discomfort even at rest.

‘A typical case for a general hospital.’

[Lee Hyunjong wouldn’t have chosen this patient for no reason.]

‘Based on what you’ve heard so far, it isn’t clear?’

[Ummm…]

Baruda hesitated, showing off its pride as a machine. However, eventually, it nodded.

[Yes, not at all.]

‘It seems like Professor Lee Hyunjong knows something.’

[How is this possible when I don’t possess such information?]

‘Do you think he inferred it from subsequent details?’

[I hope so. I don’t want to believe that I’ve adapted too much to Suhyuk’s CPU.]

‘Sheesh, you always have to have the last word.’

Suhyuk shook his head at Baruda’s provocation.

‘Ah, did I do something wrong?’

Being seated right in front, Yoo Jisang couldn’t help but notice Suhyuk’s reaction. Normally, with any other colleague, he might have let it slide, assuming they were just checking their phone. But this was Suhyuk after all.

‘Hah… This is driving me crazy.’

Due to this, Yoo Jisang became extremely nervous and continued speaking, “The medications being taken include Digoxin, Warfarin, Spironolactone, Amiodarone, and Dopamine.”

Of course, Suhyuk had no interest in Yoo Jisang’s attitude or tone. He was merely curious as to why his voice suddenly sounded shaky.

[I will record the medication details.]

‘Yes, but… Based on the patient’s condition, they seem to be taking the correct dosage of these medications.’

[Indeed, there doesn’t appear to be any error with the medications.]

‘Even if there were…it wouldn’t easily cause such symptoms. Notice the fever.’

[Correct.]

Coincidentally, Ji-sang had recorded the vital signs upon the patient’s admission. The blood pressure and heart rate were normal, but the body temperature was 37.8 degrees Celsius, precisely indicating a fever.

“The patient had coughing but no phlegm. He complained of weakness and fatigue throughout his body, but there was no chest pain, tachycardia or labored breathing.”

I heard quite a bit, but it still wasn’t clear to me. On the other hand, Lee Hyunjong wore a gentle smile on his face. It would’ve been much better if he looked straight ahead instead. Instead, Lee Hyunjong was watching Suhyuk as if asking ‘Do you know?’

‘Are you crazy?’

[I’m not crazy. Suhyuk is Baruda’s only input-output person.]

‘No, then do something.’

[Uh…]

‘Do you have any thoughts?’

[Nope. Nothing at all. Let’s watch some rap videos and push him harder. Do you think Lee Hyunjong could figure this out just by seeing it here? Even though he isn’t wearing fortune teller glasses.]

‘Well, it makes sense… right?’

It was unrealistic to expect diagnosing patients based solely on their appearance like in novels or comics. In the past, even the most brilliant doctors might have been able to do this due to limited diseases known at that time. However, now most of those diagnoses would likely be incorrect. The current era’s medical textbooks were three times thicker than before. Suhyuk found an old Harrison textbook so dense; he wondered if it was written in some foreign language.

“The following lab tests and X-rays were conducted upon admission.”

As Baruda anticipated, the test results quickly appeared. Being positioned closest, Suhyuk could read even the small font clearly.

Moreover, with Baruda’s help, Suhyuk could read it very quickly.

‘Anemia is present.’

[It’s not uncommon in heart failure patients. Don’t state the obvious.]

‘Uh… Sorry.’

Baruda was becoming quite irritable. It was understandable since he didn’t know much about this field. Continuously asking questions one doesn’t understand can indeed be frustrating for others.

‘The bleeding time is also prolonged. This might be due to medication.’

[I see blood in the urine. Hmm, is it truly endocarditis?]

‘Would Professor Shin Hyun-tae miss something like that?’

[Strange, isn’t it then?]

‘The arterial blood gas analysis shows decreased oxygen saturation. Well, expected with heart failure.’

[Ah… Look at the X-rays, focus on the X-rays.]

Typically, doctors don’t go through every detail of lab results; instead, they follow the standard practice of only mentioning significant findings. Otherwise, impatient professors would grow restless. Following this protocol, Yoo Jisang swiftly moved past the lab report.

‘There is a pacemaker ring. The heart rate regulation device seems fine. Through the right ventricle, right atrium and coronary sinus, there is a pacing lead to the left ventricle. Correct?’

‘Yes. Whoever performed this procedure did well. It can be seen clearly on the X-ray.’

‘The entire heart, including the left atrium, has enlarged. This is due to the original disease.’

‘The lungs appear overall pale. If it’s pneumonia, could it be viral rather than bacterial?’

‘Hmm… Yes, as you said. However, endocarditis might also be possible.’

‘They could have occurred simultaneously. Given the poor state of the patient.’

‘Ah, I see.’

The patient truly belonged in a general hospital. One could say that anything happening wouldn’t be surprising. The problem was that they still didn’t know what ‘it’ was.

‘What exactly is going on?’

[I hope Lee Hyunjong doesn’t notice…]