Chapter 77: Young Yet... (1)

Chapter 77: He is Young (1)

“I should have brought one.”

Suhyuk muttered while standing inside the elevator. Initially, he had rushed here, but upon reflection, it seemed unnecessary.

[I agree. You should have brought one. It won’t taste good once it cools down…]

‘You could have mentioned this earlier. You always seem to be late with your responses.’

[It’s due to performing calculations using Suhyuk’s brain. That makes me slower.]

‘Stop talking, just stop.’

Conversations with Baruda typically followed this pattern. It felt like his artificial intelligence was better at irritating people than making medical deductions.

Ding.

As Suhyuk shook his head, the elevator reached the first floor without delay.

When the doors opened, An Dae-hoon hastily stepped out and sprinted ahead.

“I will go ahead!” Suhyuk shouted, but he wished it wasn’t true.

‘It doesn’t seem like you’ll be much help.’

[Still, try to teach him well. Who knows? Maybe someday, he might provide useful notifications.]

‘Perhaps…it may happen eventually. Just not now.’

He could see this with his colleagues. Including himself, they were all interns wearing internal medicine scrubs. Now, they had become proper internal medicine doctors treating patients. It showed that Taehwa Hospital’s internal medicine training program was rigorous.

Tap.

Tap.

With these thoughts, Suhyuk walked towards the emergency room. Previously, using a cane felt uncomfortable, but now, he had grown accustomed to it. He moved quite quickly, albeit slower than others.

“Doctor!”

Thanks to Dahoon’s efficiency, he had already completed the initial questioning by the time Suhyuk arrived. Suhyuk glanced at the patient lying down behind Dahoon before looking back at him.

‘A female aged 21.’

He pondered what illnesses could cause fever in a young woman.

Meanwhile, Dahoon swiftly summarized the information he had gathered.

“The patient is a 21-year-old female who was diagnosed with appendicitis at a nearby hospital one week ago and underwent laparoscopic appendectomy.”

Appendicitis, often mistakenly referred to as “appendix inflammation,” occurs when the appendix, resembling a pig’s tail near the cecum, becomes inflamed. Laparoscopic appendectomy is considered a routine surgery in general surgery.

“Is it post-surgical infection?”

Of course, just because it was a basic surgery didn’t mean there were no risks involved. Suhyuk considered that post-surgical infection could not be ruled out since the patient had undergone surgery.

“It is possible.”

Baruda agreed with him.

“That… I am still unsure. In any case, the patient has had a fever for three days accompanied by nausea and vomiting. The hospital where the surgery took place detected abnormal liver function during their examination, leading to the transfer of the patient here today.”

“Liver?”

“Yes.”

“Hmm.”

If it were simply a localized post-surgical infection, it wouldn’t directly affect liver function. However, if the infection had significantly progressed, both the liver and kidneys could be damaged. Considering the patient’s relatively young age, this suggested that another underlying condition might need to be considered.

“Firstly, we need to conduct a physical examination and review the blood test results.” Baruda also considered it might not be a simple case.

Suhyuk accepted his advice and approached the patient. The patient’s complexion did not look good.

“Hello, Mr. Kim Isu.”

“A-ah, hello…”

To start, the patient’s lips were extremely dry, indicating dehydration due to fever. Suhyuk increased the rate of the IV drip connected to the patient’s arm while examining him closely.

[No yellowing of the skin is observed, but petechiae are noted on the ankles. We should check for any correlation after confirming the blood test results.]

‘That’s true. Isn’t he… slightly pale? Could it be anemia?’

[Based on the data Suhyuk has accumulated so far, there is over a 95% probability that his hemoglobin levels will fall below the normal range for anemia.]

‘His breathing sounds fine…’

After using a stethoscope, Suhyuk once again faced the patient.

“I will now press on your abdomen. Do you have any areas that hurt?”

“Ah… Yes. The place where I had surgery is slightly…”

“You mean the right lower abdomen?”

Suhyuk gently pressed his fingertips against the right lower abdomen of the patient. Simultaneously, he could fully sense the touch from the patient’s stomach area.

[There is no stiffness; it feels smooth.]

This indicated a low likelihood of severe internal infection.

“Ouch. It hurts when you press.”

Naturally, as Suhyuk applied more pressure with his fingers, the patient grimaced. However, there was no increased pain when Suhyuk removed his hand. This meant there was no rebound tenderness.

[The possibility of post-surgical infection appears to be low.]

‘Indeed. Hmm.’

Moreover, the fluid from the drainage tube inserted into the patient’s surgical site appeared to be fine. There was no pus, and it seemed transparent.

“First…it is difficult for me to explain why you have a fever right now.” After completely removing his hand from the patient, Suhyuk spoke towards both the patient and guardian.

The patient was preoccupied with their pain, but a slight dissatisfaction flashed across the guardian’s face. They had come to this prestigious hospital only to find that the doctors attending them were too young. It wasn’t unfounded as Suhyuk and Dahoon indeed looked youthful, partly due to their lack of sun exposure while working indoors at the hospital.

“Then…then what does this mean?”

Of course, Suhyuk couldn’t get upset immediately. Large hospitals often exerted their influence over patients, and most people with complaints didn’t voice them, especially in emergency rooms.

“Well, let’s start with basic tests and review the results. Since there is also petechiae…it is crucial to quickly examine the blood test results. Ah, as he underwent surgery, we should perform a CT scan of the relevant area.”

“Hmm. Understood.”

The guardian nodded reluctantly.

[He seems dissatisfied.] Baruda detected the concern on the guardian’s face.

It’s fine. We just need to provide a quick diagnosis.

Suhyuk exuded confidence. This wasn’t his first time dealing with such situations. If the results were favorable, it typically improved the relationship with the patient.

“Doctor! The results from the emergency room tests have come out!”

“Oh, yes. Let’s see.”

At that moment, An Dae-hoon informed Suhyuk about the test results conducted immediately upon the patient’s arrival at the emergency room. These were routine tests but would undoubtedly provide significant insights. Taehwa Hospital’s emergency room tended to perform extensive testing due to its high severity cases.

“The patient has pancytopenia,” Baruda muttered firmly as soon as he saw the results.

As Baruda mentioned, the patient showed a severe decrease in white blood cells, red blood cells, and platelets. Although the cause was unknown, just based on these findings, it indicated something extraordinary.

‘Even liver function levels are abnormal. AST is 2000, and ALT is 650.’

“[The LDH is also elevated. Bilirubin levels are normal though. Hmm.]”

Additionally, they confirmed that the patient had an increased tendency to bleed. Fortunately, the D-dimer level (indicating deep vein thrombosis) was not significantly high yet, but if it progressed further, the patient’s life would be at risk.

“Uh-oh.”

Suhyuk’s remark made Dahoon nervous. The test results were filled with red flags, indicating something wasn’t right, but he couldn’t pinpoint exactly how bad it was. Honestly, considering the patient’s young age, Dahoon initially thought they might be okay. However, Suhyuk’s expression suggested otherwise.

“S-Suhyuk, what do you think?”

Dahoon asked, but even Suhyuk couldn’t provide a definitive answer. There were still too few clues for a precise diagnosis.

However, Suhyuk could only recall the list of issues:

[Lets summarize: fever, nausea, vomiting, and pancytopenia. The liver values are also elevated, and LDH is increased.]

‘Then we should initially consider viral or toxic hepatitis.’

[It’s still difficult to completely rule out infection at the surgical site. If it has progressed to sepsis, all these findings are possible.]

‘What medication was being used? There is a possibility that the pancytopenia might be due to the medication.’

[Ah, please confirm this.]

There were multiple medications involved. In particular, long-term use of antibiotics could cause pancytopenia. Therefore, Suhyuk checked the patient’s medication history and found that the hospital where the surgery was performed had been using first-generation cephalosporins orally.

‘This seems unlikely.’

[Still, it is better to be cautious. Exclude this medication and use drugs from another class. I recommend Aztreonam or Levofloxacin.]

‘Um. That sounds good. Regarding the increased liver values… How about trying hepatotonics? There isn’t much evidence for acute cases but…’

[Well, there is no harm in trying. As Suhyuk mentioned, the evidence is insufficient, but it is good to attempt various treatments until a clear diagnosis is made.]

‘Okay. What about D-Dimer?’

[It is the most urgent issue. It appears that clotting disorders have already progressed within the branching blood vessels. We need to closely monitor and administer platelet transfusions if necessary.]

‘Yes. Let’s do that.’

After reaching an agreement with Baruda, Suhyuk took out his phone from the pocket of his gown.

“Dahoon, I’ll inform the professor, so you should let the patient know about their admission.”

“Ah, yes.”

Dahoon approached the patient, thinking how fortunate he was to work under someone senior like Suhyuk. Typically, second-year residents would delegate both informing the professor and talking to patients to first years. In this regard, Suhyuk was genuinely considerate towards Dahoon, although it wasn’t challenging for Suhyuk to handle notifications himself.

Regardless, it was beneficial for the first-year resident.

“Yes, Professor,” Dahoon responded as Suhyuk dialed Shin Hyun-tae’s number.

“Uh, uh… What happened? Is there a problem with the patient?”

After all, Suhyuk had recently completed inserting an Ecmo device without any issues. Naturally, Shin Hyun-tae’s response was swift, almost urgent.

“Oh, no… The patient is now stable.”

“Ah… Then?”

“A different patient arrived at the emergency room, so I called you.”

“Oh. What kind of patient?” Hearing about another patient, Shin Hyun-tae relaxed and spoke more casually, clearly showing his trust in Suhyuk. Honestly, when Suhyuk was on duty, Hyun-tae could afford to be less concerned about patients. There wasn’t anyone else who embodied the phrase “takes care of everything efficiently” as well as Suhyuk.

“A 21-year-old female patient underwent laparoscopic appendectomy for acute appendicitis at another hospital one week ago.”

“Hmm.”

“Three days ago, she experienced fever and elevated liver enzymes, receiving treatment at that hospital before being transferred here.”

“Yes.”

“She has pancytopenia with elevated liver enzymes and LDH levels. The d-dimer is currently around 5, not too high yet… However, there is a tendency towards bleeding, and already showing signs of petechiae.”

As Suhyuk spoke up to this point, Professor Shin Hyun-tae’s voice trembled again.

“You don’t suspect Disseminated Intravascular Coagulation (DIC), do you?”

“Yes.”

“I’ll be right there… Keep her admitted. Who’s on-call tonight, you or An Dae-hoon?”

“Probably An Dae-hoon?”

“That bastard An Dae-hoon… Anyway, I’m coming.”