Chapter 20: This is a bit difficult, IV

“Radiation necrosis.” Professor Taejin Jo muttered, repeating the disease name mentioned by Suhyuk.

‘Hmm.’

Internally, his mind was racing. To be more precise, he was trying to align Suhyuk’s observations with the diagnosis of radiation necrosis.

‘It certainly is…unusual for paralysis to change depending on posture or condition.’

The characteristic of cancer cells was their ability to destroy tissues upon contact. Of course, inflammation could also occur when exposed to these cells. However, causing such drastic changes as described was extremely rare, if not unheard of altogether.

‘Yet suspecting an infection seems far-fetched.’

Among the causes of nasopharyngitis, there were bacteria or fungi that could cause such severe infections. Additionally, since the patient had received chemotherapy, their immune system might have been compromised.

However, for the disease to progress this rapidly without any signs of infection was quite unnatural. At least, a skilled internist wouldn’t initially consider infection as a potential cause. Yet, it couldn’t be completely ruled out either, lest they risk losing the patient.

“That sounds plausible. What treatment will you administer then?” Professor Taejin Jo now stood still, not expecting their conversation to continue this far. Surprisingly, he found himself thoroughly engrossed in discussing with Suhyuk.

He never expected to have such a conversation with a first-year resident. Although it seemed absurd even to him, he couldn’t help but engage further as they had already started this heated debate.

“I would ideally like to start high-dose steroids.”

“Why is that?”

“Since radiation necrosis is involved, steroids are one of the primary treatments. They should be most effective.”

“But why did you add a caveat?”

Taejin Jo had already developed a treatment plan after hearing Suhyuk’s diagnosis of radiation necrosis.

If only we could expose her to radiation…

Initially, his plan was to administer radiation, but now, not a trace of that thought remained. It was clear that doing so would exacerbate the necrosis.

Perhaps because of this, they could have lost their patient. It wasn’t just possible; it was highly likely. In fact, there were numerous case reports indicating such outcomes.

‘I can’t completely rule out infection.’

“You’re correct. Although it may not sound natural, medicine ultimately relies on statistics.”

Meanwhile, Suhyuk’s thoughts were racing after hearing Taejin Jo’s question. To be more precise, he was consulting with his reliable advisor, Baruda.

‘So using steroids is still risky, right? I want to use them, but…’

[If the infection is due to fungi, you might witness the patient dying in real-time. If that’s what you desire, by all means, administer high-dose steroids.]

‘Do you always speak so rudely?’

[I only state the truth.]

Unfortunately, Baruda’s words were accurate.

Steroids were currently the most potent anti-inflammatory drugs available. They had dramatic effects in various situations; however, their potency came with severe side effects. Among these, immune suppression was particularly concerning in Suhyuk’s current condition.

[The patient received chemotherapy based on cisplatin. This means that during treatment, there could have been immune suppression. Normally residing fungi within the nose…]

‘As I already know this, can you shut up? Professor Taejin Jo is starting to look at me strangely.’

[I also noticed that Suhyuk’s face looked somewhat strange.]

‘Shut it. In situations like this, trust my words without question.’

[Honestly, it hurts my pride, but considering Hwang Sunwoo’s case, I will remain silent.]

After silencing Baruda, Suhyuk observed Professor Taejin Jo. As expected, Taejin was watching him with a perplexed expression.

‘There really is something odd about him.’

Both Lee Hyunjong and Shin Hyun-tae had praised Lee Suhyuk as truly exceptional. While Shin Hyun-tae tended to exaggerate slightly, even under his optimistic view, he would commend residents who merely put in extra effort. On the other hand, despite being much stricter than Hyun-tae, Lee Hyunjong acknowledged Lee Suhyuk’s genius. Interestingly, both of them mentioned there was something peculiar about Suhyuk.

However, Taejin Jo also believed Lee Suhyuk wasn’t dangerous.

Is he truly not dangerous?

As such, Professor Taejin Jo took a slight step back but didn’t assume a defensive stance.

Lee Suhyuk opened his mouth towards Professor Taejin Jo.

“The patient received chemotherapy using cisplatin-based anticancer drugs. This suggests that their immune system has already been weakened.”

“Wait, why are you repeating everything?”

“Therefore, we cannot completely rule out the possibility of fungal or bacterial infections from organisms residing within the nasal cavity spreading to the nasopharynx.”

“Suhyuk. Are you trying to provoke me? When will you shut up?”

Despite Baruda’s frequent interruptions, Suhyuk remained undeterred and continued speaking. His explanation was well-articulated, impressing Taejin Jo with its sophistication.

“Yes, among cancer patients receiving radiation therapy… especially those treated for facial areas, fungal infections… particularly mucormycosis is relatively common.”

“Right. If it was Aspergillus fungi, there might be a chance even after administering steroids, but with Mucorales fungi… we may have to watch as the fungus consumes the patient in real-time.”

In other words, under these circumstances, using steroids carried high returns but also extremely high risks. Had this been related to money or some other non-life-threatening matter, one might consider taking that risk. However, when dealing with a person’s life, such a gamble was unacceptable.

“Indeed. So what’s your opinion?” Taejin Jo smiled and posed the question, impressed by Suhyuk’s ability to engage in a debate at almost equal footing. He had a strong feeling that Suhyuk would suggest the same treatment he himself was considering.

Taejin had anticipated Suhyuk to suggest the treatment he himself was considering.

“I would like to start with hyperbaric oxygen therapy as it is less invasive and can treat infections.”

“Hmm.”

While Taejin expected this answer, he was genuinely surprised when Suhyuk actually proposed it.

He hit the bullseye, didn’t he?

Hyperbaric oxygen therapy involves exposing patients to high concentrations of oxygen within a pressurized chamber. Initially developed for treating conditions like carbon monoxide poisoning or decompression sickness, its use expanded over time due to its dramatic effectiveness on various other ailments.

“Good. I’ll make the reservation right away… No, let me handle that. What else do you want to try?”

Taejin Jo continued with his questions. For most residents, especially those in their first year, this would be incredibly annoying. However, Suhyuk didn’t find Professor Taejin Jo’s continuous questioning burdensome; instead, he saw it as an opportunity.

‘I thought I might become an Infectious Diseases professor, but maybe Hematology…’

[Based on our conversation, my advice to you is ‘Do not drink kimchi broth.’]

‘Shut up for a moment. Just tell me what you want. I wish to perform tissue examination. Correct?’

[I agree.]

‘Good.’

If Baruda said so, it was almost always accurate. Although there were occasional inaccuracies due to insufficient information.

“I believe we should conduct a tissue examination.”

“Tissue examination? What do you expect to find?”

“I expect to see inflamed tissues. However, through frozen section or staining tests, we can confirm the extent of fungal infection. If these show negative results, I believe we should proceed with treatment for radiation necrosis.”

Having heard this far, Professor Taejin Jo nodded vigorously. The ability to provide such detailed answers indicated more than just luck or casual reading on the subject.

“Good. Take charge of this patient and explain the next steps to them. I’ll arrange for high-pressure oxygen therapy, and regarding the tissue biopsy…I’ll handle that as well. It might be challenging for you.”

Booking facilities or requesting help from other departments could be quite challenging tasks, especially for first-year residents like Suhyuk. The professor offering to handle these matters was indeed significant. It was no surprise that Suhyuk bowed gratefully.

“Yes, thank you very much, Professor.”

“Don’t mention it. Go ahead; your patient is waiting.”

“Understood, Professor.”

“Oh, and…” Taejin Jo paused, stopping Suhyuk just as he was about to briskly head towards his patient with a bow. Suhyuk turned back, wondering if there might be another presentation assignment coming up.

“Who originally handled Baekdang?”

“It’s Chief Doctor Kim Insoo, sir.”

“Ah, Insoo… Hmm.”

Suhyuk answered promptly despite Taejin’s unexpected question. He simply observed Professor Jo repeating ‘Insoo’ to himself.

“Let’s do this. From what I’ve seen, you don’t need Baekdang. Just handle cases independently. Notify me immediately if any patient requires hospitalization. For other patients… have Insoo or another second-year resident confirm them. Understood?”

“Yes, Professor.”

Suhyuk nodded vigorously in response to Taejin Jo.

With this decision, Suhyuk gained the authority to directly notify professors in both Infectious Diseases and Hematology-Oncology units. It might seem insignificant, but it was indeed remarkable for a first-year resident.

He was performing tasks typically assigned to second or third-year residents as a first-year resident. In a university hospital where even the smartest first-year resident ranked below the dumbest second-year resident, this situation could be considered almost miraculous.

“Yes, then go ahead. You need to finish with the patient quickly and get some sleep.”

“Thank you, Professor.”

After his final greeting, Suhyuk rushed towards the patient.

Fortunately, the patient’s paralysis had somewhat subsided compared to earlier. Thanks to this, Suhyuk confirmed that his explanation was well understood. Consequently, the patient did not question why they were being placed inside a high-pressure oxygen tank.

‘Will it work?’

Suhyuk watched curiously as the patient entered the tank.

[I don’t know.]

‘Why not? You should be able to predict it.’

[There is insufficient data for accurate predictions.]

‘Aren’t you studying diligently?’

[Does diligent study make someone an excellent doctor? Experience is necessary.]

‘Experience… That’s something I can’t help with, right? Time is needed.’

He had barely been working as an internal medicine doctor for over a month, so what experience was Baruda talking about?

Baruda continued speaking despite Suhyuk’s lukewarm response.

[I would appreciate it if Suhyuk could maximize your efforts to reduce this time. Sleep only enough to survive.]

‘Stay cursed and die… Damn.’