Chapter 46: Raising the Difficulty Level, II

“Let’s go! Dr. Lee! I will lead the way!” Suhyuk appeared exactly two hours later with newfound confidence and shouted towards Director Lee Hyunjong.

Seeing this, Lee Hyunjong felt somewhat conflicted.

‘Oh right… Isn’t he acting strange?’

At one point, Hyunjong had avoided Suhyuk due to fearing his unpredictable nature. He was scared that Suhyuk might suddenly snap at any moment. However, after receiving a notification on the golf course, Suhyuk had managed to reach where he is now. Witnessing Suhyuk’s extraordinary behavior again today made Hyunjong uneasy once more.

Lee Hyunjong’s unease wasn’t unfounded.

During his residency days, he had witnessed his professor being stabbed by a fellow senior who was pursuing a doctoral degree.

I’m not as ruthless as that professor… Right?

The aforementioned professor truly behaved like a demonic incarnation. Compared to him, Hyunjong could be considered an angel, albeit still on the crueler side of the spectrum.

Currently, what concerned Hyunjong the most was Suhyuk’s bulging gown pocket.

“S-So, what do you have there? A scalpel? Scissors?”

“Huh? No, it’s nothing like that.”

“Oh, let me see… Ah, it’s a tablet?”

“Yes. This is small enough to fit in my gown pocket. It was useful when I made lecture materials before.”

“Aha. Yes. That’s good.”

“Huh?”

Suhyuk wore an expression asking ‘What do you mean that’s good?’ Hyunjong tried his best to ignore it.

“No, no. Let’s go. The kids are waiting for us.”

“Okay!”

Despite being called a medical school, it took only ten minutes on foot from the hospital building. Taehwa University had moved their medical school next to the hospital separately from the main campus. This relocation was possible because, apart from the preparatory year, medical students followed a fixed curriculum similar to high school, covering both general education and specialized subjects.

“It has been a while.”

Since becoming an intern, Suhyuk hadn’t walked this path until now. He opened his mouth with a sentimental expression on his face.

“Is it your first time since coming to the hospital?”

Lee Hyunjong immediately responded without hesitation partly due to boredom and partly feeling embarrassed about his earlier unease.

“Yes. I rarely leave the hospital.”

“I see. Our hospital’s internship is quite tough. Still, back when I was an intern…”

Soon, Suhyuk regretted engaging in conversation as Lee Hyunjong began reminiscing vividly about his past experiences. The detailed tales made Suhyuk feel like he was stuck in March of his own internship year, even though he should have been focused on entering his fourth year lectures.

“I’ll tell you more later.”

[Beg him to decline this offer, please. Please.]

Even Baruda was at his wit’s end. Suhyuk agreed entirely with Baruda’s opinion, but he couldn’t refuse. Lee Hyunjong had become like a true father figure for Suhyuk.

“Yes, Professor. I am really looking forward to it.”

“Yes. Everyone loved my story.”

Suhyuk wondered if they would have reacted similarly even if Hyunjong wasn’t the director. Instead of voicing his concern, Suhyuk sat down near the computer located beside the lecture hall. This was where residents occasionally sat when accompanying professors. Naturally, their purpose wasn’t solely to attend lectures;

The role of flipping through PowerPoint slides was assigned to people here. It seemed like a waste for doctors to be doing such tasks, but this occurred frequently at university hospitals.

“Oh, you’re here, upperclassman?” Woo Hayoon spoke up as Suhyuk connected his tablet to the monitor. She sat in the front row and appeared very studious, just as expected from the daughter of a professor.

“U-um… yes.”

“But Professor Lee Hyunjong usually comes alone. What lecture is today?”

“Oh…” Suhyuk looked puzzled about what he should say.

At that moment, Lee Hyunjong interrupted belatedly.

“Ahem! No cheating allowed!”

Hayoon, not understanding what was happening, recoiled back in surprise. However, she wasn’t scared as she had known Lee Hyunjong since her childhood and understood his personality well.

“Cheating?”

“Yes. It’s not allowed.”

I still didn’t understand what he meant, but one thing was clear - having a proper conversation with Lee Hyunjong under these circumstances would be challenging.

Whiiing.

Meanwhile, Suhyuk’s tablet screen connected to the monitor, which then linked to the beam projector. The PowerPoint title displayed on the front screen read:

A 63-year-old male patient admitted for difficulty breathing that started three days ago

Upon seeing this title, Professor Lee Hyunjong gave an enigmatic smile.

‘Of course. A first year… It is difficult for them to create proper cases.’

No matter how he looked at it, this title sounded too similar to the PBL problem Suhyuk had solved over the weekend. The only differences were the duration of breathing difficulty and age. With slightly lowered expectations, Lee Hyunjong opened his mouth,

“Let’s discuss the PBL from the weekend next period. For third period, let’s do a PBL based on this case. Are you seated by your groups?”

“No sir.” At the director’s question, the representative student raised their hand and responded.

Lee Hyunjong waved his hand dismissively, looking like someone mixing ingredients together.

“Then please group up immediately.”

“Yes, Professor.”

By fourth year, these students weren’t just ordinary students anymore.

Lee Hyunjong knew well about the power hospital professors wielded from his internship days. Moreover, Lee Hyunjong wasn’t just any professor but also the director of the hospital. The students quickly rearranged themselves as if they were following a strict schedule.

“Good. Let’s begin immediately. Read through the given case thoroughly. Discuss which tests should be performed. Ahh. Today’s PBL will be led by Mr. Lee Suhyuk. You know him, right? He is your upperclassman.”

“Yes!”

Not many acknowledged it, but several nodded their heads. Naturally, Hayoon was among them.

“Alright, let’s start. Suhyuk, please take over.”

“Yes, Professor.”

Suhyuk leaned on his cane. This sight caused some whispers among those who were quick to spread rumors.

“I heard he had an accident, but it seems true.”

“Wow… His leg… Can he still be a resident with that?”

“He is a first-year for a reason.”

Of course, they weren’t speaking loudly enough to disturb Lee Suhyuk’s lecture.

“Firstly, here are the current symptoms.” Lee Suhyuk moved to the next slide of his PowerPoint presentation. A densely filled page appeared.

“The patient was diagnosed with diabetes twenty years ago and has been taking oral hypoglycemic agents since then. Two weeks prior to admission, the patient experienced coughing, phlegm, and nasal discharge, which improved after one week without any medication. Three days ago, shortness of breath began even at rest, and yesterday, difficulty breathing worsened when lying down, leading to a visit to our emergency department.”

“Hmm?”

Director Lee Hyunjong had assumed this would be similar to previous PBL problems, but he inadvertently raised his eyebrows due to the unusual symptoms presented.

‘Diabetes…with infection and respiratory distress?’

Moreover, there were intriguing clues being revealed. Naturally, Director Lee Hyunjong turned away from the students towards the screen.

“For diabetes, they were taking vildagliptin and gliclazide. You may not be familiar with these medications yet, so simply put, both drugs can be classified as insulin secretagogues. Ah, vildagliptin is primarily used for patients with impaired kidney function compared to typical diabetes cases.”

The explanation was concise and accurate. Thanks to this, both the students and Lee Hyunjong became immersed in the case. The medications being used made it feel incredibly realistic.

“At the time of admission, the symptoms reported were dyspnea (difficulty breathing) and orthopnea (worsening difficulty when lying down). There were no complaints of chest pain or palpitations.”

At this point, the students nodded understandingly. However, Professor Lee Hyunjong suspected what Suhyuk might be hinting at.

‘It’s a trap.’

No chest pain or palpitations. Upon hearing this, several diseases would immediately come to mind for exclusion, such as myocardial infarction, angina pectoris, or arrhythmia - some of the most serious heart-related conditions.

In any case, the screen changed, and Suhyuk continued speaking.

“From the physical examination, bubbling sounds were heard from both lower lobes of the patient’s lungs, and there was swelling in both legs.”

At this point, it was normal for doctors to think of at least one disease name. Naturally, some students nodded as they were fourth-year undergraduates at Taehwa Medical School. They all had the same diagnosis in mind.

‘Is it pulmonary edema?’

Expecting that Suhyuk might have similar thoughts, he moved onto the next slide. Contrary to the expectations of the students, the screen was empty.

“Now, if such a patient comes in, what tests would you like to perform? Please submit your group’s answer within five minutes.”

“Yes!”

As diligent students, they immediately entered discussions. Each group had someone leading the discussion, and Woo Hayoon was one of them.

“Firstly, there is likely w-w-water in the lungs. Let’s take a chest x-ray.”

“We should also test his blood. What about BNP levels? If it is pulmonary edema, the level would be significantly high.”

“Ah, true. And let’s perform basic tests as well.”

Most groups conducted their discussions similarly.

“Were these questions difficult?”

‘You can see for yourself.’

Suhyuk briefly nodded with a smile on his face.

Lee Hyunjong seemed to understand why Suhyuk smiled. As he could hear, he listened to the students’ discussions.

After solving a hard problem…he brought an even harder question.

Even interns or residents wouldn’t have missed this question. They were rigorously trained not to miss any diagnosis unless it was extraordinary. They knew which tests should be ordered even if they didn’t understand the reason behind them.

However, students were different. Their knowledge was limited, and they could only output what they knew.

“Alright, time’s up.”

After five minutes passed, each group representative ran towards Suhyuk with their paper. Suhyuk entered the requested tests from the papers onto his empty PowerPoint slides.

“Chest x-ray, basic blood test, urine analysis, BT pro-BNP… arterial blood gas analysis. Yes. We will proceed with these initially.”

Unfortunately, several essential tests were missing. Suhyuk gave a wry smile and wrote his observations under each test result. For the chest X-ray, he directly inserted the image.

“What is your interpretation of this picture?”

He then posed the question. Multiple students raised their hands and shouted out:

“Pulmonary edema!”

Their faces showed confidence, as if they were proud of correctly diagnosing the problem and saving the patient’s life.

However, Suhyuk’s reaction was lukewarm.

“Yes, it indicates pulmonary edema. The NT-proBNP level has increased to 2800. Here are the rest of the test results. Now, how should we proceed with treatment? Due to time constraints, I’ll only take one verbal response per group.”

If there was proper discussion, he would have distributed papers again. It seemed like they were just going through the motions. Suhyuk shook his head slightly and spoke:

However, the confident students continued to shout treatments for pulmonary edema as learned.

“Antibiotics!”

“Laxix!”

“Physical therapy by tapping on the back!”

Suhyuk noted down their suggestions and moved onto the next PowerPoint slide. The slide only contained the word ‘Progress’ with an empty space below it.

“Yes, after applying the mentioned treatments…”

As Suhyuk spoke, he typed in the words: ‘Patient Died’.