Chapter 110: Something is Really Strange (1)

The prisons in the United States were relatively humane. Although it was only once a month, prisoners could be transferred to a university hospital for treatment. There was no reason for Iowa State University Hospital to reduce medical fees due to their status as prisoners. The full cost of treatment came from the prison’s budget. Naturally, the accompanying prison guards did not look kindly upon the inmates.

“Cough, cough.”

Suhyuk and Steve had entered Professor Epps’ outpatient clinic together.

Normally, Suhyuk and Steve would first consult with Professor Epps, followed by discussions regarding the results. However, slightly different procedures applied to patients from the prison.

Unlike other patients who had received treatment at primary and secondary care facilities before being referred here, these patients were directly transferred from prison infirmaries. Typically, patients avoided coming to tertiary care institutions such as university hospitals; however, these prisoners desired to visit the university hospital by any means necessary. It was their only opportunity to see the outside world.

“Your cough is quite severe?” As Professor Epps asked this question, suspicion filled his face. The medical report from the prison infirmary mentioned nothing unusual except for persistent coughing. Of course, it was common for lung diseases like lung cancer or pneumonia to present primarily with coughing without other significant symptoms.

The patient before him appeared too young and healthy for such symptoms.

Cough, cough.

Instead of answering, the handcuffed prisoner—whose cuffs were also chained around his neck—continued to hack away. He wore an orange prison jumpsuit straight out of a movie with white sneakers. It was unclear whether he had shaved or plucked all his hair off, but either way, there was a grotesque tattoo on his head. Just looking at him made Professor Epps uneasy.

Eventually, after another bout of coughing, the patient managed to speak up.

“Yes… Cough! It won’t stop.”

“I see. Hmm, okay.” Moreover, there wasn’t any known illness that caused incessant coughing like this.

“How long has it been?”

“Three weeks! Three weeks! Cough!”

And he had this cough for three weeks? It would be normal if his voice was hoarse by now. However, the patient’s voice sounded clear and strong.

“It seems like a lie.”

‘Indeed…it sounds like a lie.’

Baruda Suhyuk shared the same opinion. Yet, neither of them had ever encountered someone feigning illness before. Well, there was one instance, but that turned out to be an actual disorder rather than faking sickness.

“This isn’t Munchausen syndrome; that is a mental health condition.”

‘Right. This…this is truly feigning illness.’

“But since they’re exhibiting symptoms, we can’t completely dismiss their claims.”

‘We never know for sure.’

One might think that doctors can always identify patients feigning illness, but unfortunately, doctors are human too. Moreover, they are trained to listen to their patients’ discomfort rather than dismiss it.

“Well… let’s start with a CT scan. We have X-rays from yesterday at the infirmary. Nothing showed up then, but you never know.” Following his training, Dr. Epps ordered further tests.

The patient looked towards the clinic door, delighted at the prospect of spending more time outside his cell. The prison guards flanked him on both sides, their expressions stern as they escorted him out. Watching this scene unfold, Dr. Epps sighed quietly.

“At first, I thought it would be community service.”

Naturally, medical treatment for prisoners wasn’t initiated by their requests. It stemmed from the previous prison warden’s humanitarian perspective, and everyone present at that meeting, including Epps, agreed with him. Regardless of how severe their crimes were, they believed these patients deserved the best medical care possible. No doctor could argue against such a sentiment.

However, over time, this well-intentioned initiative had become an opportunity for inmates to misbehave.

“Well…we still need to discuss this, though. Steve, what do you think about these X-rays?”

Dr. Epps briefly looked disheartened before turning towards Suhyuk and Steve. He showed them X-ray images printed from the infirmary. Honestly, this was my first time seeing such images presented like this - printed X-rays. In Korea, where most medical institutions had digitized their systems, it was indeed rare to witness.

“Well… It seems normal?” Steve responded promptly without any hesitation.

Epps then shifted his gaze to Suhyuk.

“I don’t see anything abnormal on these images.” Suhyuk’s answer seemed similar to Steve’s but held a significant difference. To a skilled pulmonologist like Dr. Epps, the distinction between stating ‘it appears completely normal’ versus ‘nothing abnormal is visible on these images’ was clear.

‘Indeed…their levels are different. Well…it’s not like Steve was unaware.’

Epps gave a bittersweet smile and nodded.

“Yes. There is nothing abnormal visible on this X-ray image. In fact, considering his persistent coughing, there should be some changes in the trachea or at least signs of bronchiectasis, but none are present. Hmm… A frontal chest X-ray doesn’t fully reveal all aspects of the lungs, so we would need to perform a CT scan, but…I doubt anything will show up.”

Ultimately, Epps indirectly implied that it seemed like a feigned illness. Ideally, cases like this should have been filtered out by the prison infirmary, but reality made it challenging due to potential scrutiny from human rights organizations if any condition went undetected.

Missing any illness could result in human rights organizations targeting them. In fact, there had been an incident several months ago where they’d missed sudden-onset deafness in a patient and faced consequences for it.

“Well, getting a CT scan will take some time anyway, so let’s see the next patient.” Epps nodded toward one of the prison guards still inside the room as he spoke.

Taking this as his cue, the guard opened the clinic door.

This was another difference between treating regular patients versus prisoners. The inmates couldn’t simply wait their turn alone in each examination room; instead, they entered only when called upon by the doctor. Beforehand, they would gather together in a waiting area under the supervision of guards. This precaution was understandable considering these weren’t petty criminals but mostly hardened gang members.

Creak.

The next prisoner entered on a wheelchair. Initially, Suhyuk suspected it might be a sham, but upon closer inspection, it seemed genuine.

[There is weakness in the right leg.]

‘His left leg is strong. It appears his right leg is truly problematic.’

[Well, he came to the respiratory clinic… although that’s not important.]

‘That’s true.’

As soon as the patient entered the examination room, they started coughing profusely. Judging the authenticity of the cough based solely on appearance could be seen as biased, but both Suhyuk and Baruda quickly reached their conclusion.

‘This patient is also faking…’

[Basically… this is so boring…] Baruda even glanced at Steve with disappointment. They had high expectations due to Steve’s claim about unexpected patients, only to encounter numerous malingerers.

It seemed like only hypochondriacs were visiting today.

‘Wait, hold on.’

“Why? When you cough, it’s only affecting your throat. Such a cough lasting for this long… and it occurs randomly at any time? No fever or abnormality in the laryngoscopy?”

Dr. Baruda now looked completely resigned. This patient had brought numerous test results and opinions from specialists, but everything was normal. All tests conducted by primary care facilities showed no abnormalities. Of course, other examinations might reveal something, but with symptoms appearing to be fabricated, there was little reason to suspect anything further.

However, Suhyuk began to reassure Dr. Baruda:

“Yes, the cough has been going on for about three weeks now.” Even as Professor Epps continued his skeptical examination, Suhyuk remained attentive.

‘Hey, take a closer look.’

[I am watching. In any case, I share Suhyuk’s vision.]

‘No, focus your attention carefully.’

[On what?]

‘Take a look at the patient’s fingernails.’

[Fingernails? Why suddenly the fingernails?]

Baruda maintained his dismissive tone but followed Suhyuk’s suggestion. Baruda excelled in analyzing information and making diagnoses based on it. However, even Baruda couldn’t match Suhyuk’s intuition, although this intuition was ultimately grounded in the data Baruda had accumulated. Regardless, Baruda could no longer ignore Suhyuk’s numerous successful insights due to their statistically significant outcomes.

‘Wait, those fingernails… Don’t they seem slightly abnormal?’

[Bizarre? Did you know diagnosing diseases through fingernails is almost superstition?] Baruda initially scoffed at Suhyuk’s observation.

However, after examining the patient’s nails more closely, he couldn’t dismiss it as before.

[Strange, isn’t it?]

‘Exactly. This isn’t normal. Where have I seen this before?’

A horizontal white line ran across the center of the patient’s fingernail. It was unrelated to the half-moon shape near the nail bed.

[Mee’s lines. They indicate heavy metal… often seen in lead or arsenic poisoning.]

‘Arsenic? Isn’t that highly toxic?’

[Indeed. Ah, did you notice something else just now? On the palm of their hand?]

‘I saw it.’

While Suhyuk and Baruda discussed another issue, Professor Epps continued with his examination. During routine blood pressure measurement, the patient’s palms became exposed.

To someone not paying attention, it was just an ordinary palm, but Suhyuk noticed something different:

[There are spots. It looks very dirty.]

‘Is this arsenic keratosis?’

[Is he really poisoned by arsenic? But considering his condition…]

‘His movements aren’t bad. His legs might be injured.’

[What could it be?]

‘I am becoming curious…’

At that moment, there were strong suspicions of arsenic or other heavy metal poisoning. If only the skin disease on the palm was present, I wouldn’t have delved deeper. The palm issue could occur after a single exposure in the past. However, the nail abnormalities indicated continuous exposure to some heavy metals for this patient.

Isn’t this too strange?

A patient exposed to heavy metals while being incarcerated, yet none of the other prisoners or guards were affected.

“Well then… Let’s get a CT scan for this patient as well.” Meanwhile, Epps concluded that it was malingering and ordered a CT scan.

‘Shit, what should I do? Should I catch him?’

[Shouldn’t we? It seems like no one is aware.]

Even the patient himself seemed unaware. If he knew, would he have pretended to be sick with heavy metal poisoning?

Suhyuk briefly struggled before grabbing onto the wheelchair as the prison guard started pulling it away.

“Hey… you?”

The prison guard initially intended to exert physical force but retreated upon seeing Suhyuk’s staff.

Suhyuk looked at the surprised Epps and Steve before continuing.

“Could I examine the patient a bit more? There’s something unusual about him.”