Chapter 23: This is Confusing (3)

Chapter 23: Hey, This is Confusing (3)

“Ugh… Good morning, Suhyuk. Did you sleep well?”

Kim Insoo, the chief resident, smiled while greeting him due to getting a good night’s rest after his first year anniversary. His smile genuinely appeared warm and friendly.

Upon witnessing this, the nurses started whispering amongst themselves. They seemed to overlook Suhyuk talking to himself, considering it as just a habit. However, seeing Kim Insoo display such warmth for the first time after working together for three years was hard to ignore.

“What’s going on? I didn’t know he could smile like that.”

“Wow… Isn’t he being overly selective with who he smiles at?”

“If Dr. Hwang saw you now, she’d cry her eyes out.”

“But Dr. Hwang is somewhat…”

“In any case!” Kim Insoo smiled again at their friendly teasing.

“I’m just entering my third year, so I feel like I’ve grown more tolerant. You know how they say hospitals start looking pretty after three years?”

“Well… People who were demons during their first year often turn into angels by their third year. Though some remain demons throughout.” It’s true that familiarity breeds kindness, even if this analogy might seem odd. One must first be comfortable with themselves before extending compassion to others.

The situation described by the nurse wasn’t uncommon at all.

A first-year resident barely has time to breathe, let alone worry about others’ well-being. It’s not uncommon for their attitude to improve once they escape that phase, although there were also those who became even more unbearable after gaining power.

“In any case, how’s our patient doing?” Kim Insoo smiled briefly before turning toward Suhyuk with a look of deep trust on his face.

“Yes, Dr. Kim. The patient admitted yesterday slept fine without issues and didn’t mention anything concerning during rounds this morning. However…”

“What is it?” Kim Jinyong glanced at the clock behind Suhyuk as he asked. It was already past eight o’clock, which meant Professor Taejin Jo should be arriving soon.

‘Did something happen?’

Naturally, Kim Insoo started to feel uneasy. Usually, the chief’s rounds should have occurred around 7 am. If a first-year resident was the primary physician, it often happened earlier due to the need to cover up any mistakes made during the night.

‘Ah… I should’ve come earlier… Did I trust him too much?’

However, Suhyuk, despite being a first-year resident, demonstrated skills akin to a second-year resident when treating patients. This allowed Kim Insoo to relax and let his guard down over time. He had aimed to arrive before the professor, but hearing “except” couldn’t help but make him nervous.

“So… Patient Park Sangah.”

“Uh, quickly tell me. The professor might arrive soon.”

“I thought it may not be metastasis.”

“What? What do you mean by that, man?! That is Professor’s opinion. Moreover, if we look at the images…” Kim Insoo wanted to shout louder and longer. Even though he disliked yelling at Royals, he still desired to continue his tirade. However, he couldn’t proceed as he had to close his mouth.

“Why are you making so much noise?”

Suddenly, Professor Taejin Jo appeared beside them. It seemed like he had partied hard yesterday since today was dedicated solely to research without any outpatient clinics scheduled. His hair was slightly disheveled, and there was a faint smell of alcohol from his breath.

“T-That… That is…” Kim Insoo wanted to say something immediately but couldn’t find the words. He wondered if this was what it meant to be caught speechless despite having all the facts on his side.

Meanwhile, Professor Taejin Jo spoke again with a look of amusement on his face.

“Actually, I heard about it. Park Sangah’s condition might not be metastasis?”

As he said this, he plopped down heavily in his chair, almost diving into it as if seeking refuge. It seemed clear that he had plenty of time and was feeling sluggish from drinking too much the previous night. His intention to take things slow and engage in a leisurely conversation was palpable.

“Why do you think so?”

Professor Taejin Jo, like other Internal Medicine professors, asked questions with genuine interest. If he were from surgery, Suhyuk might have faced objects thrown at him for dismissing their opinions. Indeed, those in Internal Medicine tended to be more composed, although some harbored grudges silently and sought revenge later. Fortunately, Professor Taejin Jo was not such a person.

“May I show you an image first?”

Kim Insoo hoped Suhyuk would dismiss it as just a thought, but instead, Suhyuk confidently displayed an image, ready for a full presentation.

It was the same scan they had seen before yesterday’s rounds - an MRI clearly showing Park Sangah’s liver.

‘No matter how you look at it, this appears to be metastasis.’

Professor Taejin Jo and Kim Insoo simultaneously had the same thought as they raised their eyebrows. However, considering Suhyuk’s confident expression, it might not be a joke after all. While others would burst out laughing at this situation, those who experienced it firsthand couldn’t dismiss it so easily.

Over the past week, Suhyuk had truly displayed remarkable performance, exceeding even the expectations one might have for a first-year resident.

“Let’s begin.” With these thoughts, Professor Taejin Jo gestured towards the image with his chin.

Suhyuk silently nodded and pointed to the distinct masses embedded within the liver. Compared to the surrounding healthy liver tissue, these masses appeared significantly darker, suggesting potential metastatic lesions from colorectal cancer.

“If you look closely at these… Do they not appear to have slightly blurred boundaries?”

“Hmm?”

“As you can see here, these masses… Their borders are not clean.”

“Ah.”

Upon hearing Suhyuk’s explanation, it seemed plausible.

Suhyuk continued as he observed their nodding heads.

“As you know, metastatic lesions from colorectal cancer typically exhibit very distinct and clear boundaries. Here… I’ve captured separate images for reference. These are scans of patients currently admitted with similar conditions.”

“Hmm… Yes, that’s true. However, given the current situation, metastasis remains the most likely cause for multiple masses like this. This alone isn’t enough to differentiate between possibilities.”

Taejin Jo spoke as if he found it quite interesting. It sounded plausible but wasn’t convincing yet. Of course, Suhyuk didn’t bring this up based on just one thing. He waited for Taejin’s response before moving onto the next point.

“Yes, Professor. However… please look at the shadows.”

“The shadows?”

“Isn’t patient Park Sangah’s mass slightly brighter than those confirmed to be metastases?”

“Ah…this…why is this happening?”

This characteristic wasn’t noticeable when viewed separately. For someone without Baruda’s assistance like Suhyuk, it would’ve been challenging to discern such subtle differences.

Taejin Jo was a professor of Hematology-Oncology, not Radiology where one constantly analyzes images, making it even more surprising for him.

“There is a reason.” As always, Suhyuk demonstrated his skill of pausing before delivering important information.

“What is it? Tell me quickly.”

It worked on Taejin Jo as well. He had long forgotten that he was testing Suhyuk, completely captivated by Suhyuk’s logic and reasoning. Kim Insoo felt similarly intrigued.

‘What is this? What exactly?’

Although Taejin Jo’s presence prevented Insoo from openly expressing his curiosity, his eagerness to hear Suhyuk’s explanation matched Taejin’s anticipation.

“In our country, Primovist is commonly used as a contrast agent during MRI scans.”

“Primo…what?”

“It is Primovist.”

“And… what does this have to do with it?” Taejin Jo asked, expecting a significant connection.

Suhyuk nodded as if he wouldn’t disappoint his expectation.

[Based on Suhyuk’s expression, I think he has more talent for acting than medicine. If it were me, I would have just said it outright.]

‘If you did that, it wouldn’t seem extraordinary.’

[Exactly. According to my analysis, both individuals, Taejin Jo and Kim Insoo, show 100% anticipation.]

Baruda was currently working on analyzing human emotions using Suhyuk’s expressions as a baseline reference. While Suhyuk found it pointless, Baruda insisted that having such knowledge could prove useful someday.

Baruda was collecting data, stating that it would be useful someday.

“Primovist costs 150,000 won per vial, so it is rarely used abroad. However, due to the high incidence of liver cancer in our country, this contrast agent is mainly used here.”

“What is its characteristic?”

“It is well absorbed by liver cells.”

“Huh?” Professor Taejin Jo had a puzzled expression on his face, and Kim Insoo quickly mirrored him.

Suhyuk looked at them with satisfaction before pointing again at the video from earlier. “Let’s watch the video once more. Look at the masses in patient Park Sangah compared to those confirmed as metastatic.”

“Mm.”

Professor Taejin Jo and Kim Insoo didn’t answer as they stared intently at the video. Until yesterday, they thought it was obvious that Park Sangah’s lesions were metastatic, but now they appeared significantly different from those caused by true metastasis.

“Bright… It is definitely brighter. Then?”

“It means Primovist has been absorbed. Compared to healthy liver cells, the absorption is less.”

“I see…”

“If this tissue originated from colorectal cancer, there shouldn’t be any absorption because the colon doesn’t have liver cells. Just like the patient with liver metastases here.” Suhyuk pointed to the pitch-black mass of the liver metastasis patient.

Professor Taejin Jo nodded, looking bewildered, his gaze fixed on Park Sangah’s lesion.

“Then this… What is it? Liver cancer…? It isn’t liver cancer. This doesn’t look like liver cancer.”

“It originated from liver cells.”

“What?”

“This patient used FOLFOX for chemotherapy. As part of the regimen, oxaliplatin was administered.”

“Ah. I see!” Finally, Taejin Jo nodded with confidence on his face.

Kim Insoo still couldn’t grasp it but mimicked Professor Taejin’s expression. He nodded slightly as if he had caught onto something.

“Oxaliplatin is toxic to liver cells. In other words, these masses represent localized liver damage caused by the chemotherapy drugs, not metastases from colorectal cancer.”

Suhyuk looked at them and concluded his short but intense presentation.

Taejin Jo stared at Suhyuk’s face for a moment before finally opening his mouth.

“Wow… You… you really…”

He almost seemed about to cry from emotion.