Chapter 157: On Our Side (2)

“What’s wrong with the patient?” Suhyuk asked while following Dahoon.

The commotion was so loud that it seemed like the patient had already died.

“A 36-year-old male… He is a banker.”

“Hmm.”

A 36-year-old male. At this age, unless he had extremely unhealthy habits, it would be challenging for him to be at risk of death. Of course, if there were injuries involved, the situation could change significantly.

Suhyuk specialized in Internal Medicine, which typically dealt with chronic conditions or hematologic malignancies. However, this was Taehwa Medical Center - although its dominance has been gradually challenged by newer institutions, it still remained one of the most prestigious hospitals in South Korea, often handling severe cases.

‘That’s true.’

One couldn’t make assumptions based solely on age. Just last month, there was a female patient in her early twenties who nearly died.

“Four days ago, she experienced coughing and sore throat, so she took medication from a pharmacy. However, two days ago, severe chills, fever, and headaches prompted her to visit the emergency department of a secondary hospital.”

At first glance, it might seem like just a fever with a headache. However, becoming an excellent doctor requires reading between the lines.

Fortunately, Suhyuk could rely on Baruda’s assistance:

“[A working adult in their 30s… If they had to resort to visiting the emergency room despite trying over-the-counter medication, it suggests that the headache was not ordinary].”

‘Ah, right. Yes. It might have been his first experience with such a headache?’

[It is highly possible.]

Headaches were very common among modern people, but it should never be underestimated. In particular, if someone experienced a headache for the first time in their life, caution was required as it could indicate a potential cerebral hemorrhage.

“The patient’s initial brain CT showed no abnormalities, but today, he was found unconscious by a colleague who visited him due to his unexplained absence from work. They brought him directly to our emergency room.”

Naturally, the doctor who saw the patient that day would have had similar thoughts. As a physician working in the emergency department of a secondary hospital, they likely had extensive experience handling various medical conditions.

[If there were no abnormalities on the CT scan… It rules out quite a few diseases.]

Firstly, it could exclude a cerebral hemorrhage. Additionally, serious infectious diseases such as meningitis or abscesses within the skull could be excluded. Ideally, ischemic stroke could also be ruled out, but detecting strokes through a CT scan was challenging.

‘It might have been because the scan was taken too quickly at that time. There is no bleeding, but… I can’t determine if there’s an infection.’

[Indeed, you’re right.]

Moreover, as Suhyuk mentioned, timing could be an issue. In that case, infectious diseases previously dismissed needed to be reconsidered again.

“The patient… probably…”

While Suhyuk and Baruda were engaged in their conversation, Dahoon, who was leading them, momentarily stopped walking and craned his neck to look ahead.

Despite trying not to draw attention, they formed quite a distinctive pair - a bald man with a staff. They had already gained some fame around the hospital.

“Oh, Ms. Sellner! Over here!”

To add to the spectacle, Ha-yoon, the intern, called out to them. She had apparently finished her rounds in Internal Medicine and returned to the emergency room. During her first visit to the ER, she seemed disoriented, but now, she appeared more composed, wearing sneakers instead of Crooks shoes and a shirt rather than surgical scrubs. It seemed she was adapting quickly.

“Ah, yes. The patient seems to be in that treatment room over there.”

“Yes, let’s go. Did you not do anything for them in the emergency room?”

“Initially, he had a fever of 38.2 degrees Celsius, so immediately upon arrival, we conducted blood tests…including blood cultures.”

“What about antibiotics?”

Antibiotics were referred to as ‘anti.’

Before Dahoon could respond, Ha-yoon, who was confidently leading the way, answered:

“The brain CT scan showed no abnormalities at that time, but due to his headache and fever, we administered Ceftriaxone. Oh, this was after sending off the blood culture test.”

Her answer covered everything from rationale to conclusion, leaving nothing unaddressed. Even if this decision turned out to be incorrect, it’s unlikely any professor would reprimand her for following such a well-reasoned approach.

Doctors of Internal Medicine always make their best inference based on given clues. If there is plausible reasoning, it leads to acceptance.

[A good choice. I would have also chosen Ceftriaxone as the first antibiotic.]

Moreover, Ceftriaxone was objectively an excellent option in this situation. As a third-generation cephalosporin antibiotic, it could cross the blood-brain barrier. Whenever there were suspicions of a brain infection, considering this medication early was advisable.

“Great. What about blood pressure and heart rate?” Suhyuk continued questioning Ha-yoon.

He believed her assessment during the initial consultation was reliable enough, considering her demonstrated abilities thus far.

Considering Ha-yoon’s abilities observed so far, this was expected.

“Blood pressure is 90 over 42, and heart rate is 120 beats per minute.”

Indeed, Ha-yoon confidently provided the answer without any hesitation. One might argue that doctors should remember their patient’s vital signs, but interns often made unimaginable mistakes. Her response deserved praise.

“Huh… Not good? How about the EKG?”

“The EKG shows tachycardia… I’m not sure if there are other issues. The results are placed next to the patient.”

“Oh, right. For now… Here it is?”

“Yes.” Suhyuk nodded as he approached the patient.

“U-Uh…”

The patient was groaning continuously.

“It seems impossible to have a conversation with him. He is unconscious and appears almost comatose.”

This conclusion came after Baruda noticed no appropriate response when Suhyuk pressed his fist against the patient’s chest. Suhyuk agreed with Baruda’s assessment and turned towards the guardian who looked around the same age as the patient. Based on their dissimilar appearances, it seemed unlikely they were family members.

“By any chance, how are you related?”

“Oh, we’re colleagues from work.”

Suhyuk nodded, confirming his suspicion before continuing.

“When you found him at home, what was his state of consciousness? Could he communicate with you?”

“No, no… He has been like this from the start.”

“Oh.”

This meant they had no idea when this condition started. Naturally, Suhyuk’s forehead creased deeply.

“We took a brain CT scan two days ago, but it would be best to check again first.”

There was a high possibility that the issue lay in the patient’s head, yet they couldn’t pinpoint when it began. It could have already resolved itself by now, although it sounded cruel to think so. However, such is the nature of neurological conditions; there’s a reason why the golden hour concept exists.

“Dahoon, let’s get another CT scan immediately once we can schedule it.”

“Ah, yes. Ms. Sellner.”

After giving his prescription, Suhyuk looked at the guardian again.

“Do you know him well? The patient?”

The guardian appeared quite surprised, so Suhyuk decided to change the topic slightly. Fortunately, whether it was due to effective communication or the guardian’s calm nature, they were able to continue their conversation seamlessly.

“Oh, yes. Well… I’m closest with him.”

“That’s good to hear. Did he have any pre-existing conditions?”

“Pre-existing conditions…?”

“As I can see now, there is a scar on his chest. Have you heard anything about him having surgery or suffering from an injury?” Suhyuk asked while pointing at the patient’s chest, which he had exposed for the EKG test.

The patient was quite frail with a straight scar located right down the middle of their chest.

“Ah… I’m sorry, but I don’t know about this.”

“Do you happen to have any contact numbers for their family?”

“She lived alone here. Her mother is in the countryside… She might be on her way now.”

“Hmm.” Suhyuk sighed and looked again at the patient’s chest.

“It seems more like…a surgical scar rather than an injury.”

‘It looks like it happened during childhood, based on the scar.’

[Yes. They likely had congenital heart disease.]

‘Not good.’

While most congenital heart defects can now be cured through surgery, the patient appeared to be in their thirties.

If she had surgery for her congenital heart defect, it would have been at least twenty years ago. With modern medicine advancing rapidly, there could be unknown issues with surgeries performed back then.

“Sir, they are ready to take the CT scan!”

“Oh, really? Let’s go immediately. Watch your breathing carefully. Understood?”

“Yes! I will go with Hayuni.”

“Ah, okay.”

Suhyuk frowned but moved aside upon hearing about the CT scan. He wanted to accompany them, but due to his leg injury, it was impossible.

“Ah, guardian.”

“Yes, sir.”

He didn’t want to waste any time idly, so he called over the patient’s guardian.

“The patient was working until yesterday, correct?”

“Oh, yes. She went to work.”

“How was it at that time?”

“Um…”

Suhyuk initially asked open-ended questions but decided to change his approach. Open-ended questions were better suited for Baruda or other medical professionals. However, they often proved ineffective with non-medical individuals.

“Did she complain of severe headaches?”

“Oh, yes. She said it still hurt despite taking medication.”

“Did her headache gradually worsen?”

“That… I’m not exactly sure, but I think so.”

When questioning non-medical individuals, it was best to ask specific questions. This ensured capturing all relevant information without missing any details, although there would be limitations since he wasn’t directly interacting with the patient.

“So, it progressively got worse? That indicates deterioration indeed. Is this from the patient’s home?”

Suhyuk raised his eyebrows and stood up. He then pointed to a small bag next to the patient’s bed. It was more of a plastic bag containing various items.

“Ah, yes. I just… brought some clothes.”

“Were there any medications inside? From the emergency room?”

“Oh, yes. Here. These are the pills.”

“Thank you. The guardian is providing great assistance with the treatment.”

“No… No. If I knew he would be this sick, I should have taken better care of him.”

Apparently, the guardian seemed more like a true friend rather than just a colleague. Sensing the genuine concern from the guardian, Suhyuk felt an even greater sense of responsibility.

“He has been taking Meiacet as an antibiotic.”

‘Well… it’s not a bad choice for oral antibiotics.’

Suhyuk’s expression grew darker as it seemed like he had made a good choice. The lack of response to the antibiotic indicated that the bacteria were highly resistant.

“Doctor! The scan is complete!” At that moment, a shout came from the CT room. It was Dahoon.

“Oh, I’ll check the images.”

In the past, Suhyuk would have needed to wait longer, but now with the advent of 5G, small volume scans such as brain CTs could be reviewed almost instantly.

Click.

Using the nearby computer, Suhyuk immediately accessed the patient’s images.

“Woah.” He let out a sigh.

The cause for his reaction was a white area visible on the right side of the scan. Without using any contrast agents, this finding implied only one thing.

“Subarachnoid hemorrhage! The patient has a subarachnoid hemorrhage!”