Chapter 94: Multidisciplinary Approach (3)

Instead of hastily raising his hand, Suhyuk looked at Hank. There was something suspicious about Hank’s demeanor, but he only hesitated without making any definite moves. In some ways, it was understandable.

“Should we proceed with thyroidectomy?”

The ENT and Radiology professors reaching this conclusion before him were all professionals. They could even be described as distinguished scholars of their time. Few people would openly disagree with such esteemed individuals, especially someone like Hank who had closely observed their remarkable achievements.

“Just a moment… Let’s watch the video for a bit longer.”

That was all Suhyuk managed to say.

However, neither the ENT nor Radiology specialists could gather any new information from the floating images. They were already fixated on one theory and couldn’t consider alternative explanations.

“Um…”

At that moment, Suhyuk, who had been deep in thought, spoke up:

“Yes, you’re right.”

His confidence was bolstered by Baruda’s continuous encouragement and support.

“Huh?” The ENT professor turned his gaze sharply towards Suhyuk, clearly questioning, ‘What is this?’ It was understandable since he had never seen Suhyuk before, not even recognizing the lab coat he wore. In essence, it suggested that Suhyuk wasn’t from this hospital but rather someone here for training from elsewhere.

“Oh… Isn’t he the one we saw earlier this morning?” Suddenly, a person who had remained silent until now, sitting quietly in a corner, opened their mouth to speak.

When Suhyuk turned around, he saw Dr. Cummings, an Otolaryngologist. Although he was a specialist in his field, knowing him meant that no one from the department would interfere with Suhyuk’s involvement.

“You know him?”

“Well, we briefly talked earlier. He seemed very intelligent… Let’s hear what he has to say. Professor Hank wouldn’t have brought a trainee for interdisciplinary learning without good reason.”

Hank nodded enthusiastically at this suggestion.

“Oh, yes. Earlier in the outpatient clinic, I noticed… His knowledge of tumors is quite extensive. It might be beneficial to get his perspective.”

Thus, Suhyuk gained the opportunity to contribute.

‘Somehow…I feel like my luck is unusually good.’

I didn’t expect someone like Cummings to give Suhyuk a chance to speak. It felt as if his luck had been consistently improving since meeting Baruda.

[Weren’t you fortunate to meet me?]

‘That… That’s…possibly true.’

Initially, it seemed more like bad luck, but lately, he considered himself lucky most of the time. Without Baruda, Suhyuk wouldn’t have experienced many of the opportunities currently available to him.

[There is no time to be relaxed, Suhyuk. Everyone is watching.]

‘Oh, right. You’re correct.’

[Can you handle this, Suhyuk?]

‘Of course. This isn’t my first time, right?’

[I believe in you.]

Baruda nodded, genuinely expressing his trust in Suhyuk. Feeling this confidence, Suhyuk opened his mouth to speak.

“Before stating my opinion… Can I hear the patient’s medical history one more time?”

“You mean that she had a lump for a year without seeking treatment?” The resident doctor, who was ahead of Suhyuk, responded with slight annoyance in his tone.

Of course, Suhyuk was beyond being hurt by such reactions anymore. Thanks to this resilience, he managed to nod nonchalantly.

“No, not that. She was hospitalized once before, correct?”

“Oh… But it is unrelated to her thyroid condition.”

It seemed the resident genuinely believed so.

It appeared as if it was completely overlooked without mention. However, on the screen displaying her medical records, there was a brief glimpse of it. Both Suhyuk and Baruda started to suspect something after seeing that particular part. They began questioning whether this truly was just thyroid cancer.

“But isn’t it part of the patient’s history? Could you please read it once again?”

Suhyuk pressed the resident further.

Internally, the resident found this absurd but couldn’t dismiss Suhyuk outright. While Suhyuk was merely a trainee, Hank, who mentored him, held the esteemed position of professor. Moreover, Cummings’ name carried significant weight, even enough for a textbook to be named after him in otolaryngology.

“Ummm… Yes. The patient visited our outpatient clinic ten years ago with symptoms such as enlarged lymph nodes and fever on both sides of the neck. They were diagnosed with Epstein-Barr virus (EBV) and received hospital treatment. Apart from that, there are no other significant medical histories or underlying conditions.”

“Yes, I see they have a history of EBV infection.”

“Yes.”

Despite Suhyuk’s emphasis, the resident seemed oblivious to its significance. However, Hank was different; he harbored some suspicions already.

It is rare for voice cord paralysis to precede thyroid cancer, typically occurring only in papillary carcinoma cases. But without clear evidence, Hank remained silent.

“When we return to the image… This patient has a history of infection with EBV along with enlarged lymph nodes at level II on the left side and upper pole.”

Suhyuk continued speaking with conviction while the ENT professor silently listened. Of course, he shook his head as he was convinced it was thyroid cancer.

“Hmm. The upper left is the thyroid gland, not the lymph node, right?”

“No. Please take a closer look. Can you see how it appears to have breached the capsule of the thyroid gland? In papillary thyroid carcinoma, especially at this small size, is it common for the tumor to break through the capsule?”

“It’s not…common. However,”

“It could be coincidence, but Professor, we are doctors and scientists. We should focus on evidence rather than coincidence.” Suhyuk interrupted the foreign professor he was meeting for the first time and continued his explanation. Despite this interruption, it didn’t come across as rude due to the compelling nature of his reasoning.

“Instead, it is more plausible that the lymphoma from the left upper lymph node penetrated the thyroid capsule. This would also explain how the tumor, at its current size, invaded the recurrent laryngeal nerve causing vocal cord paralysis.”

“You’re suggesting it’s a non-Hodgkin lymphoma arising after EBV infection…is that correct?”

“Yes, exactly.”

“Hmm…”

Upon hearing this explanation, the ENT professor closed his mouth. Suhyuk’s theory seemed more plausible than his own suggestion that a small thyroid papillary carcinoma, barely 1 cm in size, had penetrated its capsule and affected the recurrent laryngeal nerve.

“You know… it does resemble non-Hodgkin lymphoma on the images. Of course, we can’t diagnose solely based on these scans, but… Have you performed a PET-CT scan?”

Even Radiology now leaned towards non-Hodgkin lymphoma as the diagnosis. The ENT professor’s gaze shifted to the Nuclear Medicine professor, who looked visibly flustered.

“What? No, not yet. Why would we do a PET scan for thyroid cancer?”

His concern was valid.

Currently, for thyroid papillary cancers less than one centimeter, it was considered safe to monitor them with regular check-ups instead of performing surgery immediately. So why bother doing a PET-CT scan?

It is used to detect whether there has been any metastasis throughout the body.

“But you didn’t suspect non-Hodgkin’s lymphoma?”

“What? No…that…until just now, even Professor Shin thought it was thyroid…”

The nuclear medicine professor looked like he wanted to hit the radiologist on the head with his mouse if possible. However, he couldn’t move his hand as the radiologist held a higher position. While the United States boasted freedom and equality, this applied only to certain professions. The medical community remained highly exclusive, arguably more so in America due to the significant influence of recommendation letters on job opportunities or career changes.

The medical community was quite close-knit in the United States as well, if not even more so. Recommendations held significant weight when it came to job opportunities or career advancement.

“Well, we didn’t know about his condition beforehand. It fits perfectly now. What’s your name?”

“Lee Suhyuk.”

“Lee Suhyuk…? Are you Korean?”

“Yes. I’m a second-year resident at Taehwa Medical Center.”

“Oh… Taehwa. Do you happen to know Professor Lee Hahyun?”

It was impossible not to be familiar with Lee Hahyun while working at Taehwa. Although she wasn’t as renowned as Lee Hyunjong, she had a strong reputation within the field of radiology. Additionally, Suhyuk had collaborated closely with Kim Jinsil, who could be considered her protégé.

“Yes, she is our professor specializing in abdominal imaging.”

“They consistently produce excellent individuals, hmm.” The medical imaging professor nodded with a meaningful expression after hearing Suhyuk’s response. It seemed he was deeply impressed.

However, not everyone was surprised by this revelation. Hank, who initially sensed something amiss, had already begun revising his plans significantly - not just minor tweaks but a complete overhaul of the diagnosis itself.

“Given the possibility of non-Hodgkin lymphoma… it would be absurd to proceed with surgery as planned.”

Firstly, they decided to postpone the operation. This change was feasible because the accompanying cancer was specifically thyroid papillary carcinoma, rather than another type. While non-Hodgkin lymphoma also has poor prognoses, it still pales in comparison to thyroid papillary carcinoma.

“Perform fine needle aspiration biopsy from the left upper thyroid lymph node and… use endoscopy to check Waldeyer’s tonsillar ring (the pharyngeal tonsils, lingual tonsils, etc., where non-Hodgkin’s lymphoma often metastasizes) at ENT. Oh, let’s also get a PET-CT scan.”

He methodically outlined his diagnostic plan. No one could argue against it as everything made sense. In fact, even if Suhyuk had suggested something unreasonable, no one would have dared to object because they were all focused on Suhyuk, who enabled Hank to speak up.

Based solely on medical imaging findings, patient history…and unusual behavior, he was able to reach this conclusion?

Of course, it could have resulted in nothing. There might be a case where papillary thyroid carcinoma exhibited this behavior purely by chance.

However, would this diminish their evaluation of Suhyuk? Absolutely not. No other resident doctor in Internal Medicine could present such logical reasoning.

‘Taehwa…’

‘Lee Suhyuk indeed.’

Thanks to this incident, everyone deeply etched Taehwa Medical Center and Suhyuk’s name in their minds.

[Everyone seems quite surprised.]

‘Naturally. They were likely ignoring him before.’

[So, you’re not going to leave things as they are, right?]

‘Indeed. Where is our outpatient clinic tomorrow?’

[According to Steve’s schedule, it’s Respiratory Medicine.]

‘Pulmonology…’

[Let’s turn it upside down tomorrow.]

‘Good.’