Chapter 91: Outpatient Clinic (2)

‘This fucking bastard?’

Steve glared at Suhyuk as if he wanted to devour him whole. If they were outside, it wouldn’t have been difficult for Steve. Standing well over six feet tall, Steve had an imposing physique compared to Suhyuk’s average build and his injured leg. However, this was a hospital, and moreover, Hank was present.

“What’s wrong?” Hank scratched his bald head while asking with a hint of irritation on his face. He likely felt frustrated because he didn’t receive the expected response from his trainee, who had already seen the patient ahead of him but remained silent even in front of another trainee. Although Hank didn’t care much about impressing the trainee, being embarrassed in their presence was another matter.

“Um…”

“What’s wrong with you? Go ahead and tell me what you observed.”

“Ummm… Yes, sir. Um…”

“Yes, go on.”

Hank urged Steve to speak.

For Steve, it felt like death. He had to pretend he knew something despite his ignorance. Anyone who has been through this situation knows the pain involved. However, there was no choice. The professor, Hank, the most influential faculty member of the Hematology-Oncology Department that Steve aspired to join, was waiting for him.

“Well… Firstly, the patient…has melanoma.”

“I’m aware of that. Iowa City Hospital sent over their medical records with the diagnosis.”

“Oh… Right. It’s been six months since they started having nosebleeds… Their nasal congestion began about a month ago.”

“Hmm…”

There wasn’t anything new regarding Steve’s symptoms. Of course, it was crucial for medical professionals to repeatedly check and confirm them. Doctors could miss questions, but patients might recall unexpected clues while describing their symptoms.

Unfortunately, everything Steve mentioned had already been documented in his file. Hank had read through it twice by now due to how long this appointment was taking, which meant he found this conversation tedious.

“No, tell me what you see.”

“Oh…right. In your nasal cavity…there is melanoma.”

Hank sighed deeply at Steve’s words and shook his head. His eyes immediately sharpened as he started to interrogate Suhyuk.

“Size?”

“Uh…about two centimeters?”

“How deep is it?”

“I…I don’t know.”

“What is the most important aspect of melanoma?”

“D-depth.”

“You didn’t check that?”

“Well…”

Until now, Hank had seemed somewhat intimidating due to his muscular build but maintained a friendly demeanor with his bald head and smile. However, he suddenly transformed into someone resembling a detective, aggressively questioning Suhyuk like he was conducting an interrogation. Despite not being directly confronted, Suhyuk felt uneasy just witnessing this exchange.

“So, it’s a melanoma within the nasal cavity, right?”

“Yes, yes.”

“What’s the prognosis? Is it typical?”

When Hank did not receive a proper answer, he changed his line of questioning while placing his leg on the table in front of him. Instead of asking about a specific case, he focused on the disease itself. Normally, this would have been easier for Steve since answering questions about diseases was something he had done ever since medical school. However, it became tricky when he knew nothing about the condition.

“Uh…”

“You don’t know?”

“Well…perhaps? If it can be removed surgically?”

“Oh boy. So is surgery the treatment then?”

“Um…”

Hank shook his head again as he observed Steve’s stammering responses.

“You don’t know anything about this disease, do you?”

“I…I’m sorry. I will study it.”

“I’ve been practicing for almost four years now, and soon I’ll be a specialist. How can you not know about this?”

“Uh…”

“For heaven’s sake. Anyway, hmm.” Hank was about to proceed directly to the examination room but stopped to glance at the clock on the wall and Suhyuk.

We still have some time.

Under normal circumstances, they should have conducted a detailed discussion regarding the case. During this process, the resident would learn, and the professor could review his knowledge and plans. It might be slightly boring for the patient, but it was an unavoidable procedure once admitted to a university hospital. This approach ensured greater safety and accuracy.

Should I ask him? He probably won’t know anyway…

Hank pondered briefly before opening his mouth, showing no expectations, much like Steve earlier.

It was obvious. In fact, this condition was extremely rare. Moreover, Hank didn’t expect a resident from a remote area to know something even an Iowa State Hospital Internal Medicine resident couldn’t identify.

“So…what do you think, trainee?”

Hank referred to Suhyuk as ‘trainee’ since he couldn’t remember his name. Additionally, asking “What do you think?” seemed insincere without specifying what thoughts or opinions were being sought.

[These bastards are all the same.]

‘Do I need to flatter him?’

[Yes. Are you ready? Let’s begin.]

‘Alright.’

Despite the dismissive question, Suhyuk had no intention of giving a careless response. As mentioned earlier, he intended to demonstrate his abilities.

“Firstly, melanoma occurring within the nasal cavity is extremely rare. Until recently, it was primarily reported in case studies.”

“Oh.”

Hank paused from grabbing the doorknob as Suhyuk’s answer was much more plausible than Steve’s response. He turned around to find that Suhyuk had not stopped talking yet.

“However, there is now a considerable number of case reports, so it is no longer considered an unknown disease. This patient… Thomas shows quite typical symptoms.”

“Hmm, hmm. Yes. Continue.” Hank’s expression had significantly changed compared to earlier.

Suhyuk sounded like a highly experienced doctor. His tone indicated someone who had written numerous research papers or extensively read and analyzed them. In other words, this resident was speaking at a professorial level.

“Firstly, it occurred in the lateral nasal cavity, which is typical. Based on your statement that nosebleeds started six months ago, it can be inferred that this condition began at least six months prior. However, with a size of only 2 cm, we can predict that its histological characteristics may not be highly aggressive. Of course, this is just a prediction and could vary.”

“Hmm…” As Suhyuk continued speaking, Hank’s posture gradually changed, becoming more attentive. Even Steve, initially skeptical, was now captivated. It felt like following a well-crafted detective novel, each deduction seamlessly building upon the previous one.

Internal medicine had some aspects related to this, but few people could provide such detailed answers on the spot - it was almost like a presentation.

‘What is going on here?’

Hank shook his head continuously as if Suhyuk had gone mad.

Of course, Suhyuk had no intention of stopping and continued speaking.

“The depth is important for prognosis, but it cannot be confirmed with the naked eye. Before conducting a tissue examination, it would be best to perform an MRI scan. Fortunately, since the initial hospital did not conduct a tissue examination, we can examine the original state.”

“Yes, MRI…”

“Additionally, it would be best to perform the tissue biopsy during surgery. If handled improperly, there is a risk of artificial metastasis. Melanomas within the nasal cavity behave quite differently from those located elsewhere.”

“Yes, I’ve seen cases where they metastasized.”

“Indeed… And although we need to examine the histological characteristics for confirmation, regardless of the subtype, melanomas that develop without UV exposure typically have a poor prognosis.”

“That’s true. Their behavior differs significantly.”

In most cases, skin cancers, including melanomas, occur in areas with high sun exposure, such as the bridge of the nose or back of the neck. While melanomas in these locations are still concerning,

Skin melanomas were relatively easy to remove and often responded well to medication. In contrast, nasal cavity melanoma could be considered a completely different type of cancer.

“Of course, since our patient is younger than the average age of onset at sixty…it might slightly improve their prognosis. Based on previously published case reports, the five-year survival rate barely reaches forty percent. I believe it’s crucial to fully inform the patient about this aspect as well.”

“Wow.” It was a perfect response, even better than what Hank had anticipated. He inadvertently expressed his admiration before quickly waving it off with his hand.

Suhyuk had no idea what it meant, but Steve understood.

‘Really…I am truly amazed.’

Hank was not typically expressive. As a doctor from the Hematology-Oncology Department, which dealt with death more than any other department even within university hospitals, showing such emotion was rare for him. There were only two instances when Hank displayed this level of excitement: either he heard an astounding presentation or there was news about a groundbreaking new drug.

“What is your name?”

“Lee Suhyuk.”

“Lee Suhyuk… Which hospital do you work at?”

“The Taehwa Medical Center.”

“Oh, right. They publish many research papers. Tae… Who again?”

“Professor Taejin Jo actively publishes papers.”

“Ah, right. That was his name. Sorry about that. Korean names are difficult for me.”

“It’s okay. I also have trouble remembering foreign names.”

Hank, with a surprised expression on his face, once again started probing Suhyuk more seriously this time.

“You’re currently in your fourth year? Or third?”

“No, my second year.”

“Second year? Wow.”

It seemed Hank decided to unleash all his ‘wows’ today as he repeatedly exclaimed it. After several ‘wows’, he turned back to Suhyuk.

“What do you usually do on weekends?”

“Huh? Not much really. Since I don’t rent a car…I usually just stay at my accommodation.” Suhyuk gently tapped his uncomfortable leg.

It wasn’t that I couldn’t drive, but it was easier to make excuses rather than explaining my lack of confidence behind the wheel. Fortunately, this worked universally well.

“Oh, sorry.”

“It’s okay.”

“If you don’t mind… On Saturday evening, there is a small party for Internal Medicine professors. Would you like to join us? Everyone brings delicious food, so it should be worth attending. I can give you a ride.”

“Ah, thank you very much.”

“I’ll introduce you to the professors then. With trainees coming and going frequently, we often overlook them… However, knowing your name will help us pay more attention to you.”

“Yes, thank you.”

“Shall we go?”

“Yes.”

Hank patted Suhyuk’s shoulder instead of Steve and headed towards the outpatient clinic. Following Suhyuk’s plan, Hank examined the patient after which Suhyuk and Steve were sent to another patient. This time, it was room number two.

Apparently, patients waited in their rooms while doctors visited them. It felt strange but there was nothing to fear as he had confirmed his abilities this time.

‘My skills…are recognized even in the United States.’

[Naturally, because I am Baruda.]

‘Doesn’t your excitement make it seem less natural?’

[Indeed, you are correct. I was created specifically to compete against Watson in the United States.]

‘Anyway, what could it be this time?’

[Does it matter? There are very few conditions that Suhyuk and I do not know about.]