Chapter 21: This is Confusing (1)

“How are the patients?”

After finishing his afternoon outpatient clinic, Professor Taejin Jo asked Chief Kim Insoo as they entered the hospital ward together.

Kim Insoo briefly glanced at Suhyuk before responding, “The patients receiving chemotherapy according to schedule are expected to be discharged without any significant complications. Those admitted over the weekend for their first cycle of chemotherapy should also be fine.”

Severe side effects from medications were typically observed early on, and if there were no issues initially, it was highly likely that everything would remain stable. However, the severity of side effects often increased with higher doses and prolonged use of chemotherapy drugs.

“Really? So just routine cases then?”

“Yes, professor.”

“That’s good. It’s nice to have some calm moments amidst all this.”

Taejin Jo gave a bitter smile. The Hematology-Oncology Department had the highest mortality rate per hospital room compared to other departments. Among them, the west wing of the fifteenth floor, where Taejin was responsible, witnessed numerous deaths due to many terminal patients being admitted there.

“Yes, how is that patient doing?” After briefly smiling, Professor Jo turned towards Suhyuk.

He didn’t mention any name, but Suhyuk immediately knew who he was referring to.

“Yes, Patient Park Kyungwon moved from the intensive care unit to a regular ward two days ago. Currently, her blood tests show decreasing inflammation levels, and she reported her pain level has decreased from a subjective score of 9 to 4.”

“And the medication?”

“The frequency of painkillers has been halved.”

“That’s good news.”

Pain could sometimes be insignificant, but at other times, it was the most crucial indicator. The subjective decrease in pain scores was certainly positive, but the objective reduction in painkiller usage was even better.

“How about physical activity?”

“Her movements are still inconsistent, so she is currently limited to wheelchair mobility. However, there aren’t significant restrictions on her movement. According to neurology, they don’t anticipate any permanent sequelae.”

“What does Otorhinolaryngology say?”

“We perform endoscopic examinations twice daily, morning and evening. Here’s today’s report with images from the collaborative consultation.” Instead of verbally describing the photos, Suhyuk directly showed them.

Naturally, both Professor Taejin Jo and Kim Insoo focused their attention on this.

The reddish area certainly didn’t look good, but compared to its initial state, it showed remarkable progress. Initially, it was so disheveled that one might have thought the cancer had recurred.

“What about the bone erosion here?” Professor Taejin Jo pointed at what appeared as a hole in the wall of the nasopharynx in the photo.

While the inflammation had significantly subsided, there was a downside - the hole seemed larger now. Additionally, all three doctors were well aware that this cavity directly connected to the spinal cord, causing them considerable concern. If any fluid entered and caused an infection, the consequences could be dire.

At that time, there was no guarantee of recovery like now.

“Firstly, they plan to continue treatment until the necrotic tissue improves more, and then perform reconstructive surgery.”

“Surgery? On here?”

The nasopharynx is located at the middle part of the nose, essentially the center of the face. Accessing it would be extremely challenging. There was a high possibility that half of his face might need to be incised for the surgery.

“Yes. Fortunately, since treatment started promptly…they believe it may be possible using an endoscope. I don’t have all the details yet, but…”

[He trailed off because he doesn’t fully understand? They’re likely considering reconstruction with fascia lata.]

“I think there’s a high chance they will use fascia lata for the reconstruction.” Suhyuk felt slightly embarrassed as he finished speaking.

Of course, Professor Taejin Jo had no such thoughts upon hearing Suhyuk’s response.

This guy is truly something…

Typically, internists have little interest in surgical treatments. However, exceptional internists should be knowledgeable about all aspects of patient care, including surgery, even if they don’t know how to perform it themselves. This allows them to properly explain procedures to their patients.

“Yes, good thinking. Let’s give her some hope, at least. She’d feel betrayed if we suddenly told her she needed surgery without any prior warning.”

“I understand, Professor.”

“And…” Instead of proceeding with his rounds, Taejin refreshed the list of hospital patients. When he couldn’t find the desired patient there, he brought up the outpatient appointment schedule for the afternoon.

“Let’s see… Ah, here it is.”

After scrolling up and down for quite some time, he stopped at the name ‘Park Sangah’.

“This patient was admitted from the outpatient clinic? When I confirmed by phone, there was supposed to be an available bed, but it seems like the admission process hasn’t been completed yet.”

Hearing his mutterings, a nurse hastily approached to provide an explanation.

“Yes, Professor. We were informed that one patient would be transferred from the outpatient clinic. However, we’re still arranging the hospital room… They are expected to arrive within one to two hours.”

“I won’t get to see her today then. Chief, you can also finish your shift now. Suhyuk, go greet her when she arrives.”

Kim Insoo wore a pleased smile upon hearing Taejin Jo’s words.

At this time, other chiefs were likely being severely reprimanded due to the mistakes made by their first-year residents. Professors often blamed the errors of the first years on the second and third years.

‘Originally, I was paired with another first year for next month, so we were assigned to an easy department…’

Compared to working with a second-year resident, it would be much more comfortable.

Feeling happier, he secretly patted Suhyuk’s shoulder.

“The patient is…” Taejin Jo turned towards the monitor again while opening the patient chart. Since the patient came from the outpatient clinic, they could have been instructed just to review the chart briefly. However…

The Internal Medicine department of Taehwa Hospital was not an easy place to work even with such determination. Of course, it could be different for someone with influential connections.

“She’s been undergoing three cycles of Folfox chemotherapy for colorectal cancer. The primary tumor had been completely removed, and she seemed fine until this recent abdominal MRI… Why is this computer so slow?”

Professor Jo clicked on the button to view medical images next to the patient’s test results window while grumbling. His complaints did nothing to speed up the sluggish computer, leaving him no choice but to stare blankly at the monitor for a moment.

“Oh, there it is. Can you see that?”

“Ah… there are multiple metastases in the liver.”

Chief Kim Insoo quickly responded. As someone aspiring to become a professor, he had diligently studied various subjects. He knew colorectal cancer was quite prone to metastasis, and among these cases, it often spread to the liver.

“Yes. We will perform further tests. For now, do not mention metastasis to the patient… Just explain that we need to examine liver tissue samples. Understood?”

Now Taejin Jo turned towards Suhyuk. However, Suhyuk couldn’t immediately respond.

“It seems unreasonable to definitively say ‘yes’ at this moment. Due to insufficient data, I am unable to provide detailed information, but…”

Baruda’s statement was completely different from what Taejin Jo and Kim Insoo had said earlier.

‘Transfer… It might not be?’

Moreover, anyone looking at the abdominal MRI would think it showed metastasis. There was even an attached opinion signed by Professor Kim Jinsil of Radiology stating that liver metastases should be ruled out. Yet Baruda disagreed with this assessment.

[Suhyuk fell asleep while reading papers related to the patient, so my records are unclear. I cannot provide detailed opinions at this time.]

‘Let’s move on for now.’

[I agree.]

Fortunately, the conversation with Baruda ended quickly.

Moreover, Professor Taejin Jo was well aware from his own experiences and hearing from others that Suhyuk occasionally exhibited truly strange behavior.

It’s not dangerous.

With this thought, he patiently waited for Suhyuk to finish.

“Oh. Sorry about that. Yes, I will inform them accordingly.”

“Great. Then please do so. Let’s check on the other patients first. I need to leave soon because of a meeting today.”

“Yes, Professor,” Suhyuk nodded as he quickly moved forward.

Opening the hospital room door was strictly the responsibility of the first-year resident, regardless if there were medical students or interns present. Intelligence didn’t matter; it was simply part of the basic protocol.

Swish…

Suhyuk swiftly opened the hospital room door and glanced back at the two following him.

“This is patient Park Kyungwon. Currently undergoing high-pressure oxygen tank therapy, daily disinfection, and steroid treatment for radiation necrosis of the nasopharynx.”

“Right.”

The first-year resident not only had to open the door but also inform others about who was present.

“Patient.”

Naturally, when greeting the patient, one needed to quickly hide behind Professor Taejin Jo like a ghost. This wasn’t just any regular or chief resident round; it was a professor’s round. Patients eagerly awaited this moment throughout the day.

“Yes, yes. Professor.”

“How are you feeling?”

“Much better now.”

“That’s good. The remaining issue can be resolved with surgery from Otolaryngology. They mentioned it as a simple procedure, so don’t worry too much.”

“Oh dear, thank you.”

Although his explanation and time spent were incomparable to that of a resident’s round, it provided immense comfort and reassurance to the patients.

“Good. Please follow my instructions as discussed earlier. Suhyuk, when… yes, when patient Park Sangah arrives later, give her a detailed explanation. Also, schedule a tissue examination for tomorrow.”

“Yes, Professor.”

“Well then, I must go. See you tomorrow.”

“Yes, Professor.”

With the rounds completed, Taejin Jo hurriedly left, seemingly due to an urgent appointment. As soon as he disappeared from sight, Kim Insoo also excused himself.

“I have an engagement today too. You’re on call tonight, right? After admitting patients, make sure to get some rest.”

“Yes, sir.”

Suhyuk waited until both Taejin Jo and Kim Insoo had departed before closing his eyes briefly.

‘Let’s delve deeper into what you said earlier.’

It was to talk with Baruda.

[I need more data to provide a more accurate opinion.]

‘What type of data? I have read quite a few papers on colorectal cancer?’

[Did you really read them? You fell asleep while reading.]

‘Hrmm… Do you know which paper? I can’t remember at all…’

Baruda clicked his tongue, sounding disappointed before continuing:

[Radiology 2014 May.]

‘What nonsense is this?’

[That is the paper you stopped reading. The title wasn’t saved because you fell asleep.]

‘Ahh.’

[Feeling a bit apologetic now? Offer an apology or hit your head.]

[Youtube. Suhyuk watches it to save study time…]

‘Fine. Fine. Let’s just look at the paper. If it isn’t metastasis then what is it…?’