Chapter 152: I Must See the Patient (4)

“Patient.”

Suhyuk stopped the patient using his staff as they exited the elevator towards their hospital rooms. It was not difficult to approach since the patient wasn’t walking but being wheeled on a bed.

“Oh, yes. Doctor.” The patient looked exhausted.

It was understandable considering how challenging it had been for them initially, and now with the colonoscopy procedure completed.

Looking back, Ha-yoon appeared to be shrugging her shoulders.

‘Ah, she must have performed the enema. Right.’

As repeatedly mentioned before, interns often end up handling tasks that no other doctors want to do. There is quite a variety of such duties, and if asked about the worst task, it would undoubtedly be administering enemas. Enemas come in different types, and likely, the one Ha-yoon performed yesterday was among the more tolerable kinds.

[Please provide an explanation. Whenever I think about Ha-yoon, my mind goes blank.]

‘A-Alright. And what do you mean by “mind going blank”?’

[Typically, people describe being in a daze with open mouths and unfocused eyes as having their minds go blank.]

‘Was I like that?’

[For approximately one second earlier.]

‘Damn.’

Fortunately, Suhyuk didn’t dwell too long on his thoughts about Ha-yoon. This was because he had a patient right in front of him, and Baruda’s urgency prompted him to continue quickly before any questions arose from the patient.

“Firstly…you just came back from a colonoscopy, correct?”

“Yes.”

The response came not from the patient but her guardian, the mother, who wore a face full of concern, as most guardians would under these circumstances. It was understandable given the situation.

It was uncommon for patients to be admitted directly from the outpatient clinic of a university hospital. Moreover, the professor hadn’t even shown his face yet.

“The colonoscopy results… We have determined the cause of your son’s frequent bloody stools, abdominal pain, and occasional diarrhea.”

“R-really? What is it?” The mother asked urgently.

Fortunately, during this exchange, the bed had been wheeled into the hospital room by the transport personnel. Otherwise, other patients passing by would’ve stared at them, possibly thinking there was an argument occurring.

“It’s Crohn’s disease.” Suhyuk alternated between looking at the patient and his mother as he provided the answer.

The diagnosis might sound significant, but it wasn’t. When Suhyuk was still a student, Crohn’s disease was considered very rare; however, its prevalence has gradually increased over time, making it more commonly seen in university hospitals, though not yet widespread among the general population.

The prevalence of Kron was steadily increasing, and while not common, it had become quite frequent at university hospitals.

“I don’t understand how she didn’t know she had Kron.”

Baruda’s opinion made sense to some extent. Regardless of where they trained, any doctor performing a colonoscopy would have detected it.

‘She is too young. They probably wouldn’t even consider Kron.’

However, considering her situation, it wasn’t surprising. Who thinks about getting a colonoscopy in their 20s? It was likely that her symptoms were dismissed as minor issues and left untreated.

“Kron? What is that?”

In any case, the patient’s guardian blinked in confusion upon hearing the term ‘Kron’. While medical professionals were familiar with this condition, it was not widely known among the general public.

“It’s a type of inflammatory bowel disease… You can think of it as an autoimmune disorder. For some unknown reason, our immune cells start attacking our own body. In this patient’s case, the target is now…the digestive system.”

“Ah…”

The mother couldn’t fully grasp what was being explained to her. However, that wasn’t important right now. The priority was informing them that there were treatments available for this condition. Since treatment would be quite lengthy anyway, there would be ample time to provide more detailed explanations later. Currently, soothing the patient and their guardian, even just slightly, was urgent.

“We’ll begin treatment today. We won’t use strong medications yet since we’re still awaiting tissue examination results. Even though it might sound concerning, various treatment options have been developed, so please don’t worry too much. Just observe how things progress.”

“Uh…yes, doctor.” The mother seemed to be focused on understanding what Kron disease was, so she couldn’t respond appropriately to Suhyuk’s words.

This time, it was the patient who opened their mouth, “So…if this Kron disease is cured, will everything else improve?” As they asked, the patient held onto their sagging skin. It was disheartening to see such severely drooping skin despite the patient being relatively young.

‘If only that were possible…’

Unfortunately, it wasn’t. With a wry smile, Suhyuk gently shook his head. He couldn’t lie, even if he felt sorry for them. Suhyuk well understood the weight of the white coat he wore. While comforting patients was important, he never instilled false hope.

“No, the patient’s skin condition is due to another disease.”

“Another disease…? Has it been diagnosed?”

Suhyuk and Baruda noticed traces of hope appearing in the patient’s eyes. Most people believed that once a diagnosis was made, treatment would inevitably follow.

Feeling even more sorrowful than before, Suhyuk continued, “Yes. For accurate confirmation, we need to perform genetic testing… However, initially, I suspect Pseudoxanthoma Elasticum.”

“Pseudo-what?”

“Pseudoxanthoma Elasticum. In English, it’s called PXE.”

After explaining clearly to the patient, Suhyuk turned towards Dahoon and Ha-yoon standing behind him. He switched to using medical terminology for their benefit.

He was confident they had never heard of it before since he himself encountered this diagnosis for the first time today.

“S-sudo…”

“Pseudoxanthoma elasticum? Wow, such a disease exists…” As expected, Dahoon and Ha-yoon looked at each other with surprise on their faces.

Of course, Suhyuk didn’t stop talking due to their reactions. He still had much more information to convey.

“One characteristic of pseudoxanthoma elasticum is the stretching skin, as seen in our patient here. It often involves mutations in genes called ABCC6 or GGCX. The effects aren’t limited to the skin alone… It can also impact the heart and eyes. Therefore, I have requested consultations from both Cardiology and Ophthalmology departments.”

“Heart… Eyes…” Suhyuk continued to examine the patient while speaking.

While it was true that this condition could affect the heart and eyes, there didn’t seem to be any apparent issues with her vision.

[She is still young, so it’s possible her heart may not be affected yet.]

‘Your reassurance helps.’

[Age plays a significant role in medicine.]

Age indeed has its influence. Although the phrasing might sound harsh or dismissive, having worked in hospitals, Suhyuk knew firsthand how accurate this statement was.

Regardless, thanks to this insight, Suhyuk’s expression improved slightly as he continued.

“For now, she should be fine, but we’ll need to conduct further tests.”

“Th…that’s right.”

“And if we treat Kron’s disease, her symptoms will improve somewhat more.”

“Huh? Are they related?”

The two individuals behind the patient also looked surprised. As someone who had worked as an internal medicine doctor and dreamed of becoming one again, Suhyuk thought he knew enough about Crohn’s disease. However, today was the first time he heard about its connection to this new condition. Their expressions conveyed their surprise:

“Yes, although they don’t directly cause each other, Crohn’s disease can exacerbate false xanthoma elasticum.”

“Oh…”

“It seems your daughter’s Crohn’s disease has likely been present for around four years based on our consultation. Her skin condition would have worsened since then.”

“Now that you mention it… I think that’s true.”

Until then, the mother had been silently holding her daughter’s hand. She nodded. Four years was quite a long time, so she initially hesitated, but as it involved her daughter’s body, she realized Suhyuk was correct based on his explanation.

“Specifically, Crohn’s disease exacerbates symptoms of elastosis perforans serpiginosa due to vitamin K deficiency.”

“Vitamin K?”

“Yes, vitamin K.”

The patient and guardian exchanged glances, wondering why Suhyuk suddenly brought up vitamins after making progress with their concerns. Naturally, Dahoon and Ha-yoon behind them displayed slightly different expressions since they immediately sensed what he was implying upon hearing ‘vitamin K deficiency.’

Suhyuk continued, thinking how these two could almost be considered members of his fan club by now.

“If there is a deficiency, bleeding can occur. There is a deep connection between blood clotting factors and vitamin K.”

“Bleeding? Ah…”

“As a result, you may have experienced frequent bleeding since childhood. Before developing Crohn’s disease, it might not have significantly affected your daily life, but it likely worsened afterward.”

Both the patient and her mother nodded deeply, resonating with Suhyuk’s explanation.

The impact of this bleeding went beyond just bloody stools; it also caused gynecological issues. During previous visits to gynecologists, no significant abnormalities were found in their examinations. However, based on observing the patient’s skin, they suspected some congenital condition might be present.

It was clear that this issue didn’t start from childhood, and hearing suggestions that something might have been wrong since birth made Suhyuk even less inclined to seek treatment. However, after receiving today’s straightforward explanation, he felt somewhat relieved already.

“Fortunately, your Kron disease is not yet severe. The blood in your stool is due to a worsening vitamin K deficiency caused by Kron. I believe it will improve once we begin treatment.”

Suhyuk’s expression had visibly brightened compared to earlier. It was natural for patients to feel hopeful when doctors spoke of improvement. Yet, despite his relief, Suhyuk couldn’t bring himself to smile fully, and there was a reason for that.

“Will my skin condition also improve?”

His hesitance stemmed directly from the patient’s question at hand.

Unfortunately, there was no treatment yet for diseases caused by genetic mutations. Moreover, it was even more challenging when the tissues had already formed abnormally, such as causing excessive skin elasticity like in this case.

Thus, Suhyuk couldn’t help but shake his head.

“No, improving… refers to the bleeding. The skin condition is difficult to resolve.”

“O-okay…”

The patient appeared disheartened, and seeing their disappointment weighed heavily on Suhyuk’s conscience.

‘Damn it. Why are there still so many untreated diseases?’

Shouldn’t diagnosing lead to effective treatments? That’s what he couldn’t help thinking, although he knew deep down it wasn’t that simple. Still, he felt frustrated enough to want to complain about it.

Baruda, being a machine, couldn’t understand Suhyuk’s thoughts. However, this allowed him to provide guidance from another perspective.

[Instead of hoping for others to do it, why not create it yourself, Soohyuk?]

Despite Baruda’s impudent tone, his suggestion held considerable significance.

‘Create it?’

[Yes. It might be challenging initially due to your lack of knowledge, resources, and support.]

‘I don’t even have a clue where to start.’

[However, if you present something at the Pfizer conference, things could change.]

‘That… That makes sense. Indeed, it does. Hmm…’