Chapter 120: Tumors Can Be Found Anywhere (1)

Tumor?

“Yes, tumor. Wasn’t it initially suspected to be a thyroid tumor?”

That’s…true.

Not all thyroid tumors were cancerous. In fact, most of them weren’t. While many were benign and had no significant impact on function, some did secrete excessive amounts of thyroid hormones—more accurately, they recklessly released hormones without proper regulation.

“Think beyond just the thyroid gland.”

Do you have any idea what it might be?

“I do indeed.”

Hmm.

In the past, Suhyuk would’ve pestered the system for more information right away, but not anymore. For one thing, there was no rush this time around.

If he hadn’t attached the Ecmo earlier, it might not have been possible now. However, since it was already connected, they had bought at least one or two more days. The only concern was keeping the thoracic surgeon waiting for too long.

“Oh, I just need to check the equipment settings once more.”

“Please go ahead.”

Fortunately, the thoracic surgeon glanced briefly at Suhyuk before heading towards the Ecmo machine. This bought some additional time.

‘Expand your search area, right? Hmm.’

Instead of wasting this precious time, Suhyuk began exploring possibilities. He first considered hormones that could increase heart rate:

‘There’s thyroid hormone, but that’s unlikely. It can’t be thyroid-stimulating hormone either.’

The hormones in our body maintain homeostasis through complex systems. To simplify it, when there is a deficiency of thyroid hormone, thyrotropin-releasing hormone (TRH) is secreted to signal the production of more thyroid hormone, creating a system where thyroid hormone levels remain balanced.

In other words, even without a tumor directly affecting the thyroid gland itself, if there is a tumor relentlessly producing TRH, it could lead to an excessive amount of thyroid hormone being produced within the body. However, in such cases, the thyroid gland typically becomes enlarged beyond its normal size.

Yet, this patient’s thyroid appeared normal, and Dr. Baruda had confirmed that the issue was not related to the thyroid gland. Therefore, Suhyuk decided to broaden his search criteria.

Fortunately, there aren’t many hormones that increase heart rate in our body.

‘Then… Could it be from the adrenal glands?’

Suhyuk quickly recalled the relevant organ due to his extensive knowledge base.

Baruda nodded as if impressed by Suhyuk’s deduction.

[Yes. It is one of the tumors that can occur in the adrenal gland.]

‘Pheochromocytoma? Ah, upon closer inspection…the symptoms do align somewhat.’

[It’s not just somewhat; they perfectly match. As I mentioned earlier, despite the heart being in such a state, its heartbeat was not elevated. This implies someone or something is forcibly making it beat.]

‘Yes, your words are correct. I need to verify it.’

At that moment, the thoracic surgeon returned. Suhyuk looked at him with anticipation for an answer. In reality, as a fellow talking to a resident, they were not on equal footing for conversation. However, the thoracic surgeon held Suhyuk in high regard due to his being the director’s son.

“Have you made a decision?” The thoracic surgeon asked politely, expecting Suhyuk to agree with taking the patient away.

Contrary to expectations, Suhyuk shook his head. “No. The cause of the patient’s heart issue… It seems more likely related to an endocrine disorder.”

“Really? In the emergency room, they ruled out diabetic ketoacidosis and…?” The thoracic surgeon tilted his head with confusion. Moreover, Dahoon and Hayoon also shared similar expressions. They thought this patient was completely outside their purview now.

“Yes, it isn’t due to such conditions.”

“Furthermore, the biggest problem for this patient is… stress cardiomyopathy, right? If we manage the heart aspect, wouldn’t we be better suited for this case?”

The unexpected response caused the thoracic surgeon to lose his composure. He recalled the advice from his professor, warning him not to engage with those associated with Lee Hyunjong.

“Ah, I am not denying that. You also attached an Ecmo.”

“Then why don’t you transfer him to Internal Medicine? From what I see, there is no evidence suggesting an endocrine issue.”

“No, it isn’t like that. There is a high possibility that an endocrine disorder caused the stress-induced cardiomyopathy.”

“Lee Suhyuk-ssi. Didn’t Dr. An Dahoon tell you if the thyroid was normal and alcohol wasn’t the cause, then it might be due to an unknown reason or another infection? It is all recorded here?”

Ecmo couldn’t just be attached because someone asked for it. This held true even if the request came from Suhyuk.

Moreover, even if it was not the director’s son but the director himself requesting this, their response would have been the same. Before approaching Internal Medicine, thoracic surgery had thoroughly reviewed the records. Based on those findings, they concluded that Internal Medicine could not contribute much to the case, which led them to suggest transferring the patient. Thus, the reaction from thoracic surgery now seemed somewhat inevitable.

Suhyuk didn’t appear upset and simply smiled, “That was my initial thought.”

“Initial thought? It hasn’t been long since Ecmo was initiated… Have you changed your mind already?”

“Well, medical reasoning can evolve rapidly at times, right?”

“Medical…reasoning?”

The thoracic surgeon was unsure how to handle Suhyuk’s confident yet polite demeanor. Despite knowing that Suhyuk was only a second-year resident, it felt like he was dealing with a professor.

Should I give him some details?

I think he’ll be convinced and leave if I provide more information. After all, since we put Ecmo on the patient, he has the right to know.

Okay.

Although their conversation inside Suhyuk’s mind lacked any noble sentiments, his acting skills maintained a serious expression throughout. Consequently, the thoracic surgery fellow remained completely oblivious to this fact.

“The symptoms appeared when the patient consumed alcohol, correct?”

“Y-yes.” The fellow briefly glanced at the patient.

I wasn’t boasting, but the Ecmo was connected perfectly. If left untouched without any intervention, it would have been fine for some time.

“In other words, alcohol acted as a trigger. However, even after removing the alcohol, the patient’s condition rapidly deteriorated. This means that while alcohol may have triggered the symptoms, it was not the ultimate cause.”

“Uh… Right. That makes sense.” The fellow barely managed to suppress his naive response of “Oh really?”

Meanwhile, Suhyuk continued speaking seamlessly. His explanation seemed too well-structured to be improvised on the spot. Not only Dahoon and Hayoon, but even the attending nurses were becoming captivated by his narrative.

“So, we can infer that this disease has similar effects as alcohol intoxication. Are you following me so far?”

“Uh… Yes. Sure. That makes sense.”

The fellow was having trouble believing Suhyuk was just a resident. He could barely keep up with him.

“As you know, alcohol increases our heart rate. Among various diseases causing increased heart rates, thyroid-related conditions come to mind. To be precise, hyperthyroidism, thyroid-secreting tumors, or pituitary gland tumors secreting thyroid-stimulating hormones are possibilities.”

“Oh…”

The fellow vaguely recalled these terms from his student days, now distant memories resurfacing.

Yes, those things exist.

In his thoughts, he completely forgot that Suhyuk had mentioned earlier there was nothing wrong with the thyroid gland. It wasn’t entirely his fault. Dahoon and Hayoon were nodding along without any objections. They were too engrossed in organizing Suhyuk’s words within their minds.

“However, based on my ultrasound results, the thyroid is clean. This means it isn’t causing the symptoms. There must be some other underlying condition.”

“Hmm. Another condition?”

“Yes. It could be a pheochromocytoma.”

“Oh. Pheochromocytoma…”

While the name might sound unfamiliar, pheochromocytoma wasn’t as rare in large hospitals like Taehwa Medical Center.

Due to the nature of this disease, it was quite likely that patients with this condition would be seen by thoracic surgeons.

“Brown cell tumors activate the sympathetic nerves. This explains why the patient’s pulse is rapid. There have been numerous reports stating symptoms worsen after alcohol consumption. It also explains why her symptoms progressed even after she stopped drinking.”

“Oh… Th-there could… there could be a possibility.”

“Yes. That’s why we want to continue monitoring her from Endocrinology. Is that alright?”

“C-certainly. Then…”

“I still request Thoracic Surgery continues overseeing the Ecmo. Could you please do so?”

“U-Understood. Let’s do that. Um… Then… I will be on my way…”

The fellow hastily left the intensive care unit with a flustered expression. He regretted not getting upset after hearing Suhyuk’s explanation. Fortunately, it didn’t seem like Suhyuk blamed him. Nonetheless, he felt embarrassed about his initial reaction.

On the other hand, Suhyuk had gained admirers. Dahoon and Hayoon were almost star-struck.

“How is this possible?”

“He truly amazes me. Wait, how could you suspect all of this without even examining her?”

Their admiration was boundless.

“Unbelievable!”

“He must be a genius! No, ‘genius’ doesn’t even begin to describe him.”

If left unchecked, they would continue praising him forever. Of course, neither Suhyuk nor Baruda disliked being praised. However, it was preferable to receive praise from professors rather than junior doctors.

“Enough, enough. I still need to confirm things.”

“Oh. How… should we proceed?”

“The best option is a CT scan, but that might be difficult.”

“It’s unlikely due to the Ecmo machine.”

It could have been arranged if deemed absolutely necessary, but it would have caused various inconveniences and potentially negatively impacted the patient.

“Let’s use ultrasound instead.”

“Huh? Can you see inside the abdomen with ultrasound?”

Suhyuk decided to use ultrasound for this case.

Dahoon firmly believed that Suhyuk could accomplish anything, so naturally, he started to panic again.

“No, you haven’t learned it yet.”

“Ah.”

“We need Professor Kim Jinsil for this.”

“I’ll contact her.”

“No, no. She is busy with me. It’s better if I call her directly.”

After stopping Dahoon’s chatter, Suhyuk called Professor Kim. Kim Jinsil already had a favorable view of Suhyuk and happened to be available at that moment, so she promptly answered his call.

“Hey, what’s up?”

Instead of abruptly requesting an ultrasound, Suhyuk briefly explained the situation. Naturally, after hearing the explanation, Professor Kim was astonished.

After hearing Suhyuk’s explanation, it seemed very plausible that the patient had brown cell tumors. However, she hadn’t considered this possibility before receiving his call.

“Uh… Yes, yes. I’ll go and take a look right away.”

Professor Kim ended the call with surprise evident in her voice. As she learned more about him, she couldn’t help but wonder why such a talented student wasn’t part of their department.