Chapter 117: Weakness of the Body (1)

“Huh? What’s wrong?”

Suhyuk wondered why An Dae-hoon approached him immediately after returning from the United States. Taehwa Medical Center was not a small clinic; there were numerous people with whom first-year resident An Dae-hoon could discuss patients. For instance, there were dozens of professors specializing in Internal Medicine alone.

“I… It’s Endocrinology and Metabolism department. Professor Seo Hyoseok’s team.”

“Ah.”

Upon hearing the name, Suhyuk instantly understood. Asking Seo Hyoseok directly would have been challenging. Despite being a doctor, he notoriously despised seeing patients more than anything else in the world.

Suhyuk asked An Dae-hoon about this patient while feeling frustrated that such a professor existed at Taehwa Medical Center. Whenever resident doctors tried to ask him questions, he often got angry and told them to study on their own.

“What kind of patient?” Suhyuk questioned.

An Dae-hoon unfolded a piece of paper prepared beforehand. It seemed like he had been diligently gathering information, anticipating Suhyuk’s arrival. The paper contained occasional notes written in different handwriting, which appeared to be from Woo Hayoon.

‘She is quite diligent for an intern.’

[During my internship, I slept whenever there was a chance.]

‘Normally, that’s expected for interns.’

[Woo Hayoon doesn’t seem to follow that pattern?]

‘She… She’s just peculiar.’

In any case, Baruda would become agitated whenever he found someone more diligent or smarter than Suhyuk. Naturally, Suhyuk’s expression remained calm; this level of interference no longer affected him. The years spent with Baruda were not wasted.

“A 52-year-old male patient… He was admitted to the emergency room yesterday.”

“Yesterday? Despite it being Sunday, Professor Seo Hyoseok accepted?”

“Well… I called but couldn’t reach him, so I sent a text notification. His reply simply said ‘Admitted’.”

“Oh.”

As expected, it was chaotic.

“And have you seen him today?”

“No… He just mentioned needing to attend to outpatient appointments and left.”

“Hmm. Alright.”

Suhyuk tried hard to suppress his curses and nodded.

‘What’s important now is not getting angry…’

The priority should be seeing the patient who was admitted to the hospital. Later, he would somehow need to bring down Professor Seo Hyoseok, but it wasn’t urgent at this moment. It might even be impossible right now.

“Continue. What kind of patient?”

“Yes, sir. They have been diagnosed with high blood pressure and diabetes for ten years. For their diabetes, they’re taking oral hypoglycemic agents, and for hypertension, diuretics.”

“Go on.”

Suhyuk felt somewhat relieved that despite having diabetes for ten years, the patient was still managing with oral medication alone.

Regardless of what happened, it indicated that his conditions had not progressed to severe stages. However, Suhyuk couldn’t completely relax as some patients who relied solely on medication often lacked proper management.

“[In fact, his condition might be very poor due to inadequate care.]”

‘I’ll keep that in mind.’

While Suhyuk conversed with Baruda, An Dae-hoon continued reading from the paper he had written notes on.

“Originally, the patient rarely drinks alcohol, but two days before admission, there was an incident where excessive drinking led to unconsciousness. On the morning prior to admission, symptoms included generalized weakness and approximately 30-40 instances of vomiting. Due to worsening weakness, he was brought to the emergency room yesterday.”

“You’ve never seen this patient before?”

“Yes…”

“Hmm.”

It was challenging to pinpoint a specific diagnosis based on these symptoms alone. However, even without being a doctor, one could recognize that vomiting thirty to forty times is extremely concerning. Yet, here was a renowned professor, specializing in endocrinology, unable to identify the severity of the situation.

“Where’s the patient?” Suhyuk decided he needed to see for himself.

Although An Dae-hoon and Woo Hayoon were diligent doctors, they were still relatively inexperienced. A first-year resident starting in May can be considered akin to an intern, while a May intern is essentially at the level of a medical student.

“The patient is in Room 9W on the ninth floor.”

“Okay. Let’s go.”

“Yes, sir.”

When Suhyuk readily agreed to see the patient without any further questions, An Dae-hoon’s expression turned more confident. This was inevitable since he trusted Suhyuk more than any professor. Woo Ha-yoon, walking beside them, wore a similar expression.

I wanted to ask my father about this case…but it’s good I didn’t.

Her father, Professor Woo Changyun, held considerable influence within the Endocrinology Society. His expertise far surpassed that of Seo Hyoseok. However, she refrained from consulting him because she knew his response would be predictable. Rumors were already swirling that Taehwa Hospital’s endocrinology department had become weak due to Dr. Seo’s incompetence. If she asked her father about a patient treated there, it would expose their precarious situation.

If Woo Hae-yeon asked about this patient at Taehwa Hospital, it would be obvious that chaos was imminent.

‘Lee Suhyuk… He will definitely treat him.’

As Woo Hae-yeon smiled with unwavering faith in Suhyuk, he continued questioning An Dahoon.

“Height and weight?”

“He is 178 cm tall and weighs 78 kg. He has a robust physique.”

“Then, the likelihood of a chronic cause decreases somewhat.”

Although these were simple pieces of information, Lee Suhyuk’s deductions based on them were incredibly complex.

“At admission, his blood pressure was 78 over 68… His heart rate was 155 beats per minute.”

“155 beats per minute? Was there any sign of arrhythmia?”

“No. It was just tachycardia.”

“Just tachycardia? Strange? Did you check everything?”

“Yes.”

“Let’s hurry over there.”

“Yes, Dr. Belzer.”

Suhyuk’s footsteps gradually quickened. Unless the patient had been running laps, having a resting heart rate of 155 was highly unusual.

Slam.

When they entered the hospital room, they found the patient lying on a raised bed, half-conscious. He wasn’t completely unconscious but not fully lucid either.

“There is a possibility of acute alcohol poisoning, but these symptoms seem to persist too long for that.” Baruda immediately ruled out one potential diagnosis upon seeing the patient’s condition.

As Baruda mentioned, acute alcohol poisoning could exhibit similar symptoms. However, despite continuous intravenous fluids since arriving at the emergency room, the patient’s state remained unexplained.

However, it was inexplicable that despite continuous intravenous fluids since arriving at the emergency room, the patient’s condition remained unchanged.

“Let’s start with an EKG. Do you know where you are?” Suhyuk asked the patient while giving instructions to Dahoon and Hayoon simultaneously.

The patient, struggling for breath and barely conscious, couldn’t provide a coherent answer.

“It seems like a first-year trainee is handling this case…,” Baruda shook his head disapprovingly, clearly unimpressed.

Suhyuk shared similar thoughts but didn’t blame Dahoon entirely. After all, what made university hospitals great? It was their depth of expertise - having multiple specialists available. However, without Seo Hyoseok, the most experienced doctor who had fled, things were bound to be challenging.

“Dahoon, we need to start with intubation first. His breathing is too labored… Giving oxygen alone won’t be enough.”

“Ah, yes. I have prepared for it.”

“Good. Just administer a muscle relaxant immediately.”

“Uh… Immediately?”

“Yes. Don’t worry; I’ll handle it. Hand me Rocuronium.”

“Yes, sir.”

Dahoon briefly looked uneasy but, seeing Suhyuk’s confident demeanor, he connected Rocuronium to the patient’s IV line.

‘Yes. Dr. Lee Suhyuk isn’t just intelligent…’

He was also proficient in various skills required by internal medicine doctors, particularly outstanding in intubation.

[Yes, there. No, ah… I can’t do it myself, like this.]

‘Don’t use scary words. Express it accurately with direction and distance.’

[I am dying… Yes. One centimeter to the right. Yes, there. Like that.]

Of course, Suhyuk’s ability alone was not enough to insert the tube smoothly. In almost complete darkness, Baruda’s advice was absolutely necessary for intubation.

Sssk…

In any case, soon the tube was inserted, and the patient’s breathing rate significantly improved. After confirming the proper placement of the tube, Suhyuk turned towards Dahoon.

“Dahoon. This isn’t just about good oxygen saturation…”

He paused, emphasizing his point before continuing:

“It indicates severe respiratory distress.”

“Ah… then…”

“The respiratory rate is now over 25 breaths per minute. The intercostal muscles are moving rapidly up and down. This could lead to sudden death. If we were one hour late, the patient would have likely arrested by now?”

“Oh, I’m sorry.”

“There’s no need to apologize. Just be careful from now on as you’ve learned today.” Suhyuk once again looked at the patient while speaking.

Earlier, he couldn’t properly examine the patient due to their rapid breathing. Now that the patient’s breathing was stabilized, he decided to carefully observe them.

‘Firstly, the lung sounds aren’t great.’

[Yes. Murmurs are heard bilaterally.]

‘Does it indicate pneumonia?’

[No. Based on data analysis… this type of sound is primarily associated with pulmonary edema.]

‘Pulmonary edema… Then is it due to heart problems?’

“It would be good to check the EKG again. However, since the patient has a history of vomiting, we cannot completely rule out aspiration pneumonia.”

‘Ah right. He vomited.’

Of course, I needed to investigate the cause of the vomiting, but I also had to consider its potential consequences. Not only aspiration pneumonia but also electrolyte imbalances were possible outcomes.

“How’s the EKG looking? And can you display the blood test results from yesterday? Did you order all possible tests?”

“Yes, I ordered them just to be safe due to my anxiety.”

“Good job. Let’s review the EKG.”

“Yes.”

The best approach was to perform only the necessary tests. Naturally, this would be cost-effective. However, in medicine, it wasn’t always correct. The risk of inadequate testing could lead to loss of life. It was far better to incur some financial losses instead.

“Blood sugar is at 300, and…the white blood cell count is high too. Fortunately, electrolytes haven’t fluctuated significantly. The morning results show corrections for these values.]

‘Is it due to infection?’

“It seems that way, but…strange. Can an infection become this severe so suddenly?”

‘We should keep all possibilities open.’

As Suhyuk appeared uncertain, Dahoon retrieved the EKG results.

As soon as Suhyuk reviewed it, he realized this wasn’t just a simple arrhythmia.

“Dahoon…”

He sighed immediately after glancing at the results.

“Yes, Dr. Kim?”

“The patient’s EKG…it is strange. First, we need to perform an echocardiogram. Bring in the ultrasound machine.”

“Ah, yes sir.”

Dahoon rushed out of the room upon hearing Suhyuk’s command.

Simultaneously, Suhyuk turned towards Hayoon and the attending nurse. He then provided his assessment without any hesitation.

“First, administer vasopressors and cardiac stimulants… I’m not sure where exactly, but since there seems to be an infection, add levofloxacin to the current antibiotics regimen. If you haven’t sent the blood culture test yet, do so immediately. Check urine output every fifteen minutes. Prepare for Ecmo if there’s no improvement in heart function.”