Chapter 151: I Must See the Patient (3)

“The biopsy results are out. My opinion is Kron for now. It could change, but…almost 99%?”

The gastroenterologist had examined up to the ascending colon using a colonoscopy before turning towards Suhyuk.

It might sound like the procedure was straightforward, but it was actually quite difficult.

“There was a stricture in the transverse colon. You managed with a pediatric endoscope. Your skills are impressive.”

‘Of course, this is Taehwa. Do you think anyone can work here?’

“But why do you trail behind Ashian and Chilseong Hospitals?”

‘Stop talking nonsense.’

After shutting Baruda’s mouth, who seemed intent on making annoying remarks, Suhyuk looked at the gastroenterologist.

“I agree… Then should we start with some medication?”

“Medication? It would be disastrous if it is tuberculosis.”

The term ‘disastrous’ here was not used positively for a simple reason. Kron, which both Suhyuk and the gastroenterologist suspected, was an autoimmune disease. The medications typically used to treat it were immunosuppressants or anti-inflammatory drugs. On the other hand, tuberculosis was a representative infectious disease. If they administered immunosuppressants, it could lead to a catastrophic spread of tuberculosis right before their eyes.

Of course, Suhyuk had considered this possibility.

“How about mesalamine?”

“Ah, mesalamine. Hmm.”

As expected, the gastroenterologist was highly knowledgeable about inflammatory bowel diseases like Kron and tuberculosis. They were well-versed in various medications, and Suhyuk’s suggestion of mesalamine was indeed quite astute.

“Good. I think that should work.”

“Thank you.”

“No problem at all. It needs to be done once the prescription is ready anyway. Asking now saves time and avoids any misunderstandings later on.”

“As the primary physician, it’s my responsibility to check.”

“That’s commendable. Once you become chief, make sure to instill this mindset during training. Dealing with current residents is becoming unbearable.”

The expression of the gastroenterologist genuinely conveyed his regret. During his own training days, which were admittedly more brutal due to the four-year program when internal medicine was still highly competitive, conflicts were commonplace.

But nowadays? Even mild criticism could provoke hostility from first-year residents.

“Yes, understood, sir.”

“Indeed, if only everyone were like you, things would be much smoother.”

In comparison, Suhyuk, despite being a Royal, was polite and intelligent.

Suhyuk sensed Dr. Shin’s sincerity and nodded once again. They quickly left the examination room before the patient woke up, accompanied by Dahoon and Ha-yoon as before.

“How did it feel seeing Kron directly?” He asked this question considering their second-year status.

“[There was significant bleeding.]”

‘Yes, there was bleeding visible during the endoscopy.’

“[If they had strained the area with the stricture, it could have been disastrous.]”

‘It’s fortunate that they possess such skills.’

Of course, Suhyuk engaged in deeper conversations with Baruda while Dahoon and Ha-yoon provided their responses.

“This is my first time observing through an endoscope… It was fascinating. I’ll never forget this experience.”

“Me too. Now, I will definitely remember the characteristics of Kron disease.”

Initially, Suhyuk didn’t intend to pay much attention to their answers, but Dahoon and Ha-yoon, being avid fans, gave their best responses.

Despite this, Suhyuk answered their questions to the best of his ability since Dahoon and Ha-yoon were self-proclaimed members of his fan club.

“Yes, that’s why I brought you here.”

Suhyuk maintained his friendly demeanor while internally conversing with Baruda:

[I am certain there is another cause for the bleeding tendency. It seems…]

‘Do you think it might be related to the skin?’

[Yes. The bleeding tendency and deteriorating skin… Hmm.]

‘I don’t recall studying anything like this before.’

No matter how much he thought, nothing came to mind. By now, both Suhyuk had become accustomed to accessing Baruda’s database, just as Baruda had familiarized itself with Suhyuk’s brain. However, if no information was found, it meant Suhyuk hadn’t previously encountered or studied such a condition.

[Hoh. You are honestly confessing now?]

‘It’s not a confession; this is actually your fault.’

[What? No… Why would it be my fault that Suhyuk doesn’t know something?]

‘I studied according to your guidance, and yet, I encountered something completely new today.’

[Wa… This…]

‘No need to feel wronged. Did you really think I followed everything you asked me to study daily?’

[Tsk.]

Baruda genuinely appeared irritated by Suhyuk’s words, but he couldn’t refute them. Upon reflection, Suhyuk had indeed been diligently studying lately. Except for times when physical exhaustion prevented him, he consistently completed his assigned studies before going to sleep. As a result, his knowledge base steadily grew, leading to smoother patient treatments.

It was true until yesterday.

Yes, indeed. Shut up.

“That is…”

I told you; it’s your fault.

“Ugh…”

I need to study. Choose.

Suhyuk continued pressing Baruda as they entered the elevator. Dahoon and Ha-yoon quickly followed behind him.

“So should we just prescribe mesalamine for the patient?”

Dahoon asked simultaneously. Technically, he was the primary physician, although Suhyuk had been overseeing the case with him. Naturally, he was curious about the treatment plan for the patient.

“Huh? Oh no, not yet. We need to monitor her progress first.”

“Do you suspect any other diseases besides Kron?”

“You know CDAI, right? The index for Kron.”

“Uh… I am aware of it, but I don’t know the formula.”

An Dae-hoon scratched his head with a guilty expression on his face. However, there was no need for him to feel guilty. The CDAI consists of eight items, and each item has different scoring criteria.

“Well, just knowing about it is impressive for a first-year resident.” Suhyuk started by complimenting An Dae-hoon before continuing, “The score is quite low. But based on the endoscopy findings, there seems to be a tendency towards bleeding… And you mentioned she had this issue since childhood, right? This suggests there might be another underlying cause.”

“Ah.”

“It could possibly be related to her skin sagging, but… I’m not entirely sure yet.”

“That… Since I’ll be preparing for the afternoon ward rounds anyway, let’s investigate together.”

“Sounds good?”

“Yes. It’s my honor.”

With Suhyuk’s compliment, An Dae-hoon blushed and chuckled. If his appearance was better, he might have seemed cute at that moment. Unfortunately, as he bowed his head, it revealed his receding hairline, making him look pitiful instead.

“Can I help too?” At this moment, Ha-yoon raised her hand to volunteer.

Suhyuk, familiar with intern schedules, tried to stop her: “Are you sure? You’ll kill yourself working like this.”

Unlike residents whose daily schedules were roughly predictable, interns could be on-call without prior notice. They had to sleep or eat whenever they got the chance because their downtime could disappear unexpectedly.

“I’m fine. I won’t overdo it. I’m just curious.”

“Hmm.”

However, Suhyuk understood Ha-yoon’s feelings well. Despite being interns, they were still doctors with valid medical licenses. Yet, at this university hospital, their roles often involved more menial tasks rather than directly treating patients. Naturally, when opportunities arose to participate in actual patient care, it was exhilarating for them. This excitement was even greater for someone as intelligent and ambitious as Ha-yoon.

“Yes, let’s do that then,” Suhyuk nodded in agreement.

Meanwhile, the elevator carrying the trio stopped at the hospital ward floor.

Dahoon cautiously asked if the professor had visited, but the nurse shook her head, expressing surprise at his question with her expression.

“He won’t be coming today.” Suhyuk negated Dahoon’s concern and sat down at the computer station.

The nurse placed her ever-present notebook on the counter and shook her head as usual. Normally, people frowned upon occupying this station area, but no one dared to say anything to Suhyuk Baek. Firstly, he was truly exceptional, and secondly, his research almost always yielded results regardless of the topic.

“I will also search for information.”

“Me too!”

“Oh, right. Let’s do it together.”

And so, all three started searching the internet simultaneously.

Suhyuk preferred using PubMed over Google since it was considered the best website for finding academic papers. The downside was that it took some time to get used to navigating the site.

What should I search for? Skin conditions?

[Cutaneous laxity. This seems to be an appropriate term.]

‘Ah, skin laxity. Hmm. Yes.’

Suhyuk thought Baruda was truly amazing as he typed the suggested word into the search bar. However, there were more diseases causing this symptom than he expected. Among them were some conditions Suhyuk had previously diagnosed.

Here, bleeding tendency? Hmm. That’s strange. I don’t recall.

He added ‘bleeding tendency,’ which was currently the most concerning issue for the patient, but it didn’t yield any results. Despite feeling quite frustrated, Suhyuk still had Baruda at his disposal.

[The symptoms could be due to Kron disease. More importantly… It would be better to search with characteristics from other patients.]

‘What?’

[Displaying patient image.]

Baruda projected the appearance of the patient into Suhyuk’s mind.

People with extraordinary memories were often said to have photographic memory. However, this wasn’t quite accurate. It was literally just like viewing a photograph.

‘Ah, right. I didn’t notice it due to the sagging skin around his eyes. There are yellow spots, aren’t there?’

[Requesting additional input for ‘yellowish papular lesions’.]

‘Sure.’

With this change in search terms, something emerged compared to earlier.

‘Hmm. This…feels promising.’

[Pseudoxanthoma elasticum (elastic fiber yellow tumor). The condition is not present in the database.]

‘Shall we start with review papers?’

[Yes. I recommend first building your background knowledge.]

Among them, Suhyuk’s attention was drawn to Pseudoxanthoma elasticum (PXE).

The name itself was difficult, and naturally, it was quite rare.

‘Skin sagging… vision deterioration, bleeding. Bleeding from digestive organs?’

[This matches so far. Let’s read further.]

‘Okay.’

With Baruda’s assistance, Suhyuk rapidly read through the research papers. His reading speed had increased due to reviewing numerous papers, and with Baruda providing simultaneous translations, he was several times faster than others.

‘It can be exacerbated by Kron.’

[Oh. This seems like a significant sign.]

‘And it causes Vitamin K deficiency. Ah, here it is.’

Suhyuk stopped reading at a certain point and started tapping his desk.

He quickly stood up despite his injury.

Baruda didn’t mock Suhyuk’s sudden movement as he could share in Suhyuk’s joy to some extent.

“Uh, upperclassman.”

“You already figured it out?”

Dahoon and Ha-yoon looked at Suhyuk with surprise spreading across their faces. It was understandable since they had been researching for less than twenty minutes. Yet, Suhyuk claimed to have found the diagnosis? It seemed implausible based on common sense.

At that moment, the patient emerged from the endoscopy room accompanied by their guardian. Both appeared distraught, which was expected given the continuous tests without any answers. Of course, Suhyuk had no intention of prolonging this situation further.

“Let’s go see the patient first. When explaining to them, we’ll discuss together.”