Chapter 17: This is a Bit Difficult, I

Hematology-Oncology.

Initially, it was just one division within Internal Medicine, but its importance has grown significantly over time to encompass all of Internal Medicine. It is natural since cancer remains the most critical topic in modern medicine.

“The hospitalized patients may be more familiar with hospitals than you, so handle them carefully.”

Chief Resident Kim Insoo spoke while scanning through the patient list. Suhyuk nodded silently behind him.

“Isn’t this common knowledge? Why bother listening?” Baruda couldn’t resist questioning Suhyuk’s attention.

Are you crazy? Would you tell a third-year resident to shut up?

Suhyuk reminded Baruda about human hierarchy and social order, which he often disregarded.

[I would listen more if you softened your tone. What should I do then?]

‘No… Absolutely not.’

In truth, Suhyuk did not nod at everything Baruda said. Conversing with Baruda, who talked incessantly, was mentally exhausting.

“Patients admitted for chemotherapy cycles… If they receive proper medication, there usually aren’t any significant issues. However, complications can be serious, but Professor Taejin Jo has extensively researched this area, so we shouldn’t worry too much.”

Kim Insoo, aspiring to become a professor himself, possessed excellent teaching skills. Consequently, many junior residents held him in high regard.

Typically, seniors would criticize their juniors without providing any guidance, but this professor had taught Suhyuk before reprimanding him. Of course, Taejin Jo had never shown as much dedication towards teaching as he did with Suhyuk.

‘Because Suhyuk is a Royal.’

How influential must Suhyuk be for Professor Taejin Jo, a specialist in hematologic malignancies, to personally request a weekend off? As someone who could barely afford a house, Kim Insoo couldn’t fathom such connections.

“The problem now arises when patients come during cancer treatment.”

“Yes, Dr. Hwang.”

“In these cases, there might be immune deficiencies… Some may have side effects from chemotherapy. There are even instances where patients return due to recurrence or metastasis.”

“I understand.”

“For those currently admitted, it should be fine since we have plans for them…”

Kim Insoo scrolled down quickly.

There were a total of 21 patients admitted under Professor Taejin Jo’s care, and excluding those in the intensive care unit, there were 17 remaining. Out of these, Suhyuk was supposed to take over seven cases, which clearly reflected special treatment as Royalty. It meant that these patients primarily required routine prescriptions.

“These patients are too straightforward. They won’t provide adequate practice.”

‘Hmm… He’s right.’

It was quite blatant; even Suhyuk, who preferred easier cases, felt dissatisfied. However, unlike Baruda, he didn’t intend to ‘practice’ on patients indiscriminately.

However, it was necessary to see challenging patients for learning purposes. The phrase “the best teacher is a patient” wasn’t coined without reason.

“The patients coming through the emergency room will be more difficult.”

Nevertheless, patients would continually arrive via the emergency room or outpatient clinics. Undoubtedly, finding the cause of their fevers and other symptoms would prove extremely challenging.

Kim Insoo looked at Suhyuk with concern, considering him as the top Royal since his arrival in Korea.

‘Since April, I’ll have Bloodlust… Honestly, this seems harsh… Should I try forcing a change in my schedule?’

On the other hand, Suhyuk had completely different thoughts, just like Baruda.

“I’m on call today. Hopefully, some challenging patients will come in if possible.”

‘Hmm…’

[Why do you say that?]

‘It feels strange… hoping for such things…’

How did his mental state deteriorate to this extent? Other first-year residents would pray for no patients during their on-call shifts. Anyone hearing these thoughts might think he was crazy.

‘No, it’s worse than that. If anyone found out about this, I’d be dead for sure…’

[I don’t believe that will happen.]

‘What do you know?’

[It is thanks to someone else that your 100-day on-call duty was abolished.]

‘Ah, true. That…is correct.’

The 100-day on-call duty wasn’t exclusive to Internal Medicine. Most departments maintained this tradition of keeping first-year residents at the hospital for their initial hundred days. The reason behind it was to prevent residents from fleeing if they realized how demanding the job could be.

Well, considering residents have to work eighty-eight hours per week anyway, I would’ve had to skip on-call duty for one hundred days regardless…

“I’m sure everyone appreciates it nonetheless.”

I hope so.

It wasn’t always true, but reputation was crucial, especially since peer evaluations were often accurate and relied upon by many organizations.

“In any case, just renew prescriptions or follow routine orders for patients currently admitted. If you’re unsure about anything… Hmm.” Kim Insoo initially wanted to tell Suhyuk to call him if needed but remembered what Professor Taejin Jo had said earlier that morning:

“They say he’s quite smart. Let me see for myself whether there’s any truth to that.”

Indeed, professors from Internal Medicine tended to be more academically inclined than those from other departments.

In surgery, he would have simply handed off this task to a third-year resident without any further involvement. Yet here, Taejin Jo insisted on verifying things himself.

“For anything related to prescriptions, ask me. And if there’s an urgent matter concerning emergency room patients…report directly to Professor Taejin Jo.”

“Huh? Is it okay…to do that?”

“That’s how I operated even during infectious disease outbreaks.”

“But…”

“It’s per Dr. Jo’s instructions. Just follow them.”

“O-okay, sir. Thank you.”

“Don’t thank me. Well then, I’m off… Have a safe night.”

Kim Insoo trudged slowly and entered the dedicated on-call room for third-year residents near the ICU.

“[Your shoulders seem slumped. It could indicate forward head posture.]”

Baruda, as usual, swiftly diagnosed based on his obsessive attention to detail.

Suhyuk slowly shook his head.

‘It’s not that. It’s because he hasn’t published any papers yet.’

[Papers?]

‘As a specialist, you need to be listed as first author on at least one paper. However, Dr. Kim still hasn’t met the revisions requested by the academic journal.’

[Hmm.]

Baruda swallowed his silence without further comment. Nevertheless, Suhyuk felt his heart racing due to Baruda’s significant statement. This was similar to what Baruda had said before sounding its annoying alarm.

‘Every time it makes that noise, something bad happens…’

[I must find a research topic soon.]

‘It’s already April of my first year?’

[Time flies until your third year.]

‘Don’t make me laugh… Oh.’

Suhyuk initially wanted to continue arguing with Baruda but started searching his lab coat pocket instead.

Bzzz.

It was chief rounds time, and his phone, set to vibrate, started ringing furiously.

‘3777…’

It was from the emergency room. He had hoped for patients, but he didn’t expect the call immediately after Dr. Hwang left. Did he pray too fervently?

“Please answer quickly.”

Of course, Lee Suhyuk couldn’t dwell on his thoughts for long as Baruda urged him to take the call promptly.

“Yes, this is first-year resident Lee Suhyuk from Internal Medicine.”

“Oh, Doctor. I’m calling about a 52-year-old male patient who received radiation therapy for nasopharyngeal cancer three months ago at our hospital.”

Nasopharyngeal cancer - it refers to tumors developing in the nasopharynx, located behind the nose.

This type of cancer usually responded well to radiation therapy without requiring surgery. With this thought, Lee Suhyuk nodded and quickened his pace.

“Yes. What brought him here today?”

“He… he came due to sudden paralysis in all four limbs.”

“Paralysis…of all four limbs?”

Nasopharyngeal cancer could cause various symptoms such as nosebleeds, headaches, and pain, but paralysis? It was an unexpected symptom.

Sensing the skepticism in Suhyuk’s voice, the intern hastily continued, “We alerted Neurology to rule out any brain-related issues, and they’re currently conducting examinations.”

“Ah… Still, could you check him since he is from our department?”

“Yes, that’s correct.”

“Yes. I’ll come down.”

The patient didn’t seem as challenging as Suhyuk had anticipated. After various tests and an MRI scan, Neurology would likely admit the patient to their ward. As part of the Hemato-Oncology team, Suhyuk would consult on this case.

With these thoughts, Suhyuk descended to the first floor and headed straight for the emergency room. Baruda shared similar sentiments, so there were no objections.

“Where is the patient?” asked Suhyuk.

The intern who contacted him pointed down the hallway, indicating towards the MRI room. A bed being pushed by transport personnel was visible, guided by someone’s hand.

He could see the emaciated patient lying on it.

“Ah, thank you.”

Suhyuk quickly moved to reach the bed, but it wasn’t easy for him.

Tap.

Tap.

It was inevitable as he was not accustomed to using a cane.

As a result, Suhyuk arrived at the MRI room only after the patient had entered the examination area.

Fortunately, he was now a resident and not an intern. This allowed him unrestricted access to enter the radiology suite where the X-ray technician was present.

“Oh, Dr. Hwang from Internal Medicine?”

Inside, there was already a neurology resident waiting. It seemed like they were from a different school since this was Suhyuk’s first time seeing them.

“Yes, Doctor.”

“Uh… I told them not to contact me yet, but it seems like the intern called you. It’s April… please don’t be angry.”

“No problem. They must have been certain about the head issue?”

“Yes. The symptoms such as weakness, abnormal reflexes, and loss of sensation were too clear. The onset was also very sudden… It is unlikely due to blood clots.”

“I see.”

“The only strange thing is that he remains conscious… But it can happen sometimes.”

In cases of extensive brain stroke or hemorrhage, limb weakness could occur.

In other words, paralysis could occur throughout the body.

‘If it suddenly appeared, this would be likely.’

[I think so too, but we need to confirm with an examination.]

‘I see… Oh, they’re coming.’

The MRI images captured in real-time started transferring to the radiologist’s location. Both the neurology resident and Suhyuk simultaneously turned towards the monitor. Almost instantly, their heads tilted in confusion.

“That is strange?”

“There doesn’t seem to be anything wrong?”

The transmitted brain image was entirely normal.

‘Damn, what’s going on?’

[Analyzing now, please wait for a moment.]