Chapter 159: What's the Cause? (2)

There was both a brain hemorrhage and a stroke. It could be described as a situation driving one to madness. At least, it was inevitable from the perspective of the medical staff since bleeding and clotting were opposite mechanisms for diseases.

“Damn.” Naturally, Professor Choi Junyong of Neurology swore aloud.

Of course, until now, the situation had been challenging. However, there seemed to be some hope with just a brain hemorrhage. Now, that path felt instantly erased, leading to his outburst.

“Huh, what?” A resident in neurosurgery let out a sigh, expressing disbelief on their face.

“Hmm.”

In contrast, Suhyuk closed his eyes.

This unprecedented situation prompted Baruda to discuss it with Dr. Shin.

A simultaneous hemorrhagic stroke and ischemic stroke?

“We also need to consider her fever and turbid cerebrospinal fluid.”

Fever and turbid cerebrospinal fluid were clear indicators of infection, specifically suggesting meningitis affecting the brain. Could meningitis cause both a hemorrhagic and ischemic stroke simultaneously? While a hemorrhagic stroke was possible, an ischemic stroke was rare under these circumstances.

Both brain hemorrhage and blockage… The turbid cerebrospinal fluid could all be consequences.

This implied there might be an underlying cause for these symptoms. And most likely, this cause could be attributed to a single disease.

It was highly unlikely for multiple serious conditions to simultaneously occur in a young adult male.

“I agree with you, but I am still uncertain.”

Baruda honestly admitted his lack of knowledge. He was confident that this statement wouldn’t make him appear incompetent. After all, it’s said that empty vessels make the most noise, and those without expertise often hesitate to admit their ignorance.

Suhyuk fully acknowledged Baruda’s abilities, so he refrained from criticizing him. However, Suhyuk’s expression grew more somber.

‘Completely clueless?’

“We don’t have enough clues yet, but there is one thing that stands out.”

‘What?’

“The scar on the patient’s chest.”

‘Ah.’

Unconsciously, Suhyuk turned towards the patient upon hearing Baruda’s words.

The patient was still undergoing an MRI scan, so Suhyuk couldn’t see their chest directly. However, Baruda had stored all the data in his Database. Without closing his eyes, he could clearly visualize the patient’s appearance.

‘Without a doubt, this is a scar from open-heart surgery.’

[Based on the tension and direction of the stitches, it appears likely that the surgery occurred before puberty.]

What diseases would require open-heart surgery during childhood?

Both Suhyuk and Paul thought of congenital heart defects. They couldn’t pinpoint the exact condition, but they knew the patient had undergone some form of heart surgery.

‘Then, this…the most probable diagnosis might be endocarditis?’

Endocarditis refers to inflammation of the inner lining of the heart, as suggested by its name.

It was extremely rare for individuals with normal heart tissue to develop this condition. The heart receives and expels blood at tremendous speed, making it difficult for bacteria to adhere.

“Yes, if there’s surgical expertise involved, it is possible.”

However, things could change slightly if there were scars or valve surgeries near the heart’s entrance. Even with successful surgery, the altered structure would differ from the original heart. There might be slight obstructions, creating spaces where bacteria could potentially accumulate.

‘Considering his flu-like symptoms…it’s plausible. It’s definitely possible.’

Suhyuk’s face gradually brightened. As an internal medicine doctor, what brings him the greatest joy? Uncovering the cause of a patient’s distressing symptoms - moments like these always put a smile on his face.

It was the moment to uncover the cause of the patient’s distressing symptoms. Naturally, Suhyuk couldn’t help but smile at this prospect.

“However, it is now challenging to directly address the underlying condition.”

‘That…that’s true.’

He couldn’t fully beam with joy. If they had suspected the issue right when the symptoms first appeared, it might have been possible to intervene earlier. But currently, the complications arising from endocarditis were immense.

“What should we do, Professor Choi Junyong?” Suhyuk turned to Choi Junyong, the most senior doctor present and the one with decision-making authority, seeking his opinion on treatment.

Fortunately, as a professor at Taehwa Medical Center, Choi Junyong was highly regarded for his expertise.

“Firstly, emergency surgery is not required. Instead, managing her blood pressure with medication seems more critical. Of course, we need to inform neurosurgery about this situation just in case.”

“Yes, Professor Choi, I will notify them immediately. We’ll ensure that hypotensive therapy can be performed whenever needed.”

“Good.” Choi Junyong briefly exchanged opinions with the neurosurgical resident.

Regardless of what happens, if medication doesn’t work, they would likely have to perform surgery. For this, collaboration with neurosurgery was absolutely essential.

“Well…actually, isn’t the narrowing quite small and not causing significant issues currently?”

“Yes, Professor.”

Next up was Suhyuk, as he had initially notified everyone about the patient’s condition. This meant Suhyuk was still primarily responsible for the patient’s care.

This indicated that Suhyuk was still managing this patient’s case as the primary physician.

“Blood pressure can be managed in the intensive care unit… The problem is we don’t know the cause.”

Thus, Choi Junyong began discussing his theory with Suhyuk. It wasn’t solely because Suhyuk was the primary physician; even professors from other departments acknowledged Suhyuk’s skills.

“Ah… Based on the surgical scar on the patient’s chest, I suspect it could be endocarditis.”

“Oh… There’s a surgical scar?”

“Yes, there’s a straight line following the patient’s sternum.”

“I see.”

If the scar had not been a straight line or located elsewhere than along the sternum, they might have dismissed it as unrelated to surgery. However, accidentally leaving such a precise scar along the sternum was highly unlikely.

However, it was almost impossible for the scar to be cut straight along the cleavage by chance.

“Then there is a possibility… Still, we need to investigate other potential causes.”

“Yes. Based on the recent blood test results, her platelet count is low. This could also occur due to endocarditis, but I want to rule out any blood disorders as well.”

“Hmm, okay. By the way, what’s her platelet count?”

“It’s 54,000.”

“What? Really? That’s too low! She might experience further bleeding. We’ll need to administer a platelet transfusion.”

“Ah, yes, Professor. I will prescribe it immediately.”

As iron sharpens iron, two exceptional doctors rapidly advanced the patient’s diagnosis and treatment plan when they collaborated.

‘Hey, this is interesting.’

[This is new.]

It was a refreshing experience for both Soohyuk and Baruda. They usually discussed cases just between themselves; it had been a long time since they debated with another doctor from a different department.

Unaware that he was providing fresh stimulation and opportunities for growth to Suhyuk, Professor Choi Junyong continued their conversation.

“Wait, hold on. If her platelet count is low…”

“It’s to check for disseminated intravascular coagulation.”

“Oh. As expected. I envy you, Shin Hyun-tae.” Choi Junyong chuckled briefly at how his resident seemed ahead of him but quickly regained his serious demeanor.

Thump-thump-thump-thump-thump.

The patient was still undergoing an MRI scan. Unlike CT scans, MRIs took longer but were worth it as they detected pea-sized blockages, leading to a likely diagnosis of the primary cause.

With this thought, Choi Junyong posed a question carefully, aware that he wasn’t a specialist in cardiology and mindful of the exceptional resident before him:

“How do you plan to proceed with cardiac workup?”

It was more of a query than a discussion, reflecting his cautious approach due to his lack of expertise in this field. Moreover, dealing with no ordinary resident made him wary; any nonsense could lead to chaos.

“Ah…yes. First, we’ll perform an echocardiogram. Although the initial EKG was normal, I expect changes, so follow-up EKGs will be necessary. Additionally, I’ve already ordered heart enzyme tests.”

“Ah. Good. Very good.”

It seemed like there was nothing wrong with his response. Dr. Choi nodded continuously before speaking up again.

“Oh, then should this patient be referred to Internal Medicine?”

He had saved the most crucial question for last. Of course, regardless of which department they were assigned, everyone would do their best to assist in treatment. However, there’s a significant difference between being directly responsible for treating a patient and assisting on the sidelines. With patients as critical as this one, wouldn’t it feel burdensome to take charge?

‘Well… It might sound a bit insensitive, but…’

Intensive care medicine is both risky and not financially rewarding, making it unappealing from a departmental perspective.

“Oh, it seems like this should be handled by infectious diseases department.” Unlike Choi Junyong, Soohyuk didn’t hesitate for even a moment. His medical knowledge was comparable to any professor; however, he lacked experience. This lack of experience wasn’t just related to treating patients but also included attending hospital meetings and understanding financial matters.

“Hmm, yes.”

Of course, Dr. Choi Junyong had no idea that Suhyuk was unaware of the politics within the departments. Publicly, Suhyuk was known as the director’s son who frequently accompanied Shin Hyun-tae, the head of General Internal Medicine. There were rumors that they were grooming him early with the intention of making him a professor someday.

I think…I was once like that.

Due to this realization, Professor Choi Junyong inadvertently felt embarrassed and quickly excused himself from the scene.

“In any case, if anything seems off, please contact me. For brain pressure regulation, inform the intensive care unit, and I’ll send over a resident immediately.”

“Yes, thank you, professor.”

“Uh…yes, no problem.”

As soon as Dr. Choi left, the neurosurgical resident hastily departed from the emergency room, appearing rushed, possibly due to another call waiting for them.

“Neurosurgery is indeed incredibly demanding.”

‘Of course. One person oversees multiple beds in the intensive care unit.’

“There’s also much fascinating knowledge within their field…”

‘So you want me to do double boards?’

“It might be possible if requested, but it’s not feasible given your current situation.”

Baruda reminded Suhyuk about his leg injury.

‘Hmm.’

At this moment, Suhyuk was unsure whether this was fortunate or unfortunate for him.

“The tests are completed, Dr. Shin.” While he was lost in thought, the radiographer called out to Soohyuk indicating that the examination had finished.

Suhyuk nodded appreciatively and headed towards the testing area, accompanied by An Dae-hoon who had been waiting outside.

“Hey, good job,” Suhyuk said as they entered together, patting Ha-yoon on the shoulder. She was already setting up the IV line in the MRI room.

Smiling, Ha-yoon removed her earplugs and responded, “It’s okay. These earplugs help. Thankfully, there were no incidents while we were inside.”

“Yes, his vital signs still seem stable for now. For now. Have you seen all the scans? There are two additional obstructions, leading me to suspect meningitis and embolism due to endocarditis. It could be another condition as well… In any case, we decided to handle this case together. I’ll notify Professor Shin Hyun-tae.”

After providing a brief overview of his assessment, Suhyuk called Shin Hyun-tae.

He was returning to the treatment room with the patient when he received the notification.

“Uh, cerebral hemorrhage along with stroke. Even if there’s fever, focus on neurology… huh? We’re taking it? Oh, why?”

“I suspect it may originate from endocarditis.”

“Ah… understood… I’m still at the research lab. I’ll head down shortly…”

Upon receiving the notification, Shin Hyun-tae appeared somewhat dispirited. After hanging up, he cursed under his breath, unsure whether to blame Choi Junyong or Suhyuk.

“This damn guy.”