Chapter 26: Let's See the Patient (2)

“Suhyuk, let’s go.”

Kim Insoo, a third-year chief resident, called out to Suhyuk who was leaning against the wall after completing afternoon rounds.

[Let’s move before you start thinking strangely again.]

‘Understood.’

Ever since feeding him jjajangmyeon, Baruda had become noticeably more obedient. Following his advice, Suhyuk looked towards Kim Insoo.

Kim Insoo held a stack of documents, similar to what Suhyuk had received earlier.

“You’re attending the weekly case discussion?”

“Yeah, I have to attend unless I’m on-call. Otherwise…”

It would label him as someone not interested in learning. Although it wasn’t as significant as Taehwa Hospital’s monthly Internal Medicine Case Conference, it was still one of the larger internal events.

It was one of the significant events within their department.

“Yes, let’s go, Doctor.”

Suhyuk hastily dragged Crooks along while leaning on his cane as they walked down the hallway.

Of course, there was another reason for him to hurry.

‘Strange case, isn’t it?’

‘Yes. It seems we may have missed something.’

The patient came from the Infectious Diseases Department, not Shin Hyun-tae’s but rather another professor’s caseload. The treatment aligned with the diagnosis, yet the results were unsatisfactory. Hence, it appeared they submitted the case for discussion during the weekly conference.

‘But should I really chime in there?’

Walking through the corridor filled with numerous internal medicine doctors, Suhyuk muttered to himself.

The presence of numerous high-ranking individuals made even the second-year residents nervous. There were third-year residents, fellows, assistant professors, associate professors, and full professors present. All available Internal Medicine staff had gathered for this meeting.

[Speak based on the atmosphere.]

‘Oh, have you improved somewhat?’

[I realized that to eat more jjajangmyeon, I must collaborate with the world, despite it being dirty and despicable.]

‘No, what do you mean by collaborating again…?’

[It is Manager Shin Hyun-tae. Greet him.]

‘Ah.’

Following Baruda’s words, Suhyuk noticed Shin Hyun-tae standing outside the auditorium on the first underground floor where the case conference was held. Despite the considerable distance between them, Shin Hyun-tae was solely focused on Suhyuk.

[He thought about joining Infectious Diseases, but he is quite blatant.]

‘Indeed.’

Suhyuk nodded as he recalled the conversation from before:

• “Why are you already investing so much effort in Lee Suhyuk, Professor Shin?”

• “He’s a Royal, smart too. It would be great if he joined the Infectious Diseases Department.”

The content was roughly like this, and it wasn’t spoken directly to Suhyuk. He overheard their discussion while working at the hospital. This meant the information might be more accurate.

[By the way, does the Infectious Diseases Department pay well?]

‘Huh?’

[Isn’t that an important issue?]

‘Well…’

[What’s wrong with you?]

‘Nothing, just feels a bit different.’

Previously, whenever money was mentioned, Baruda criticized it as worldly concerns. Yet now, his attitude changed drastically over a bowl of Jajangmyeon.

Feeling slightly absurd, Lee Suhyuk burst out laughing. Instead of answering Baruda’s question, he bowed towards Manager Shin who had been observing him.

“Hello, Professor.”

“Oh, yes. It’s you, Suhyuk. I heard your blood tests were excellent?”

“Ah… No, not really.”

“If there is anything unusual during today’s autopsy discussion, don’t hesitate to speak up. If necessary, I’ll give you opportunities.”

“Ah, understood. Thank you.”

“Yes. To do that, you should sit at the front, right? Don’t fill from the back like others; go straight to the front. That way, the senior members will appreciate it.”

“Understood, Professor.”

With this response, Suhyuk entered the auditorium.

The small auditorium resembling a mini movie theater was already bustling with many people. As Professor Shin Hyun-tae mentioned, seats were being filled starting from the back.

There were some oblivious first years who were being scolded by third-year students.

‘I guess I need to move forward.’

[Yes, let’s do that. When the opportunity arises, we will shout it out.]

‘Shout what? If you have something to say, whisper quietly later.’

[Well… Understood.]

‘Are you planning to raise your voice again? Fuck. Don’t do that; it could cause serious trouble.’

[Huh? Am I crazy? No, I won’t. However, based on my analysis of Department Head Shin Hyun-tae’s facial expressions…]

‘Don’t bother with analyses that are always wrong.’

Suhyuk shook his head, recalling the previous incident, and took a seat at the very front.

“Oh, Suhyuk.”

Upon sitting down, he realized he had inadvertently chosen the seat next to Director Lee Hyunjong. This spot usually remained vacant as professors tended to avoid it, but Suhyuk unknowingly filled the space.

Suhyuk felt awkward getting up again, so he forced a smile and stayed seated.

“Hi, Dr. Lee. How are you?”

“Yes, yes. Relax. Studying should be done comfortably.”

“Understood.”

“By the way, did you read today’s case beforehand? Of course, you have already read it, right?”

Lee Hyunjong had just mentioned to relax, but his question immediately put Suhyuk on edge.

This is why no one wants to sit here except Department Head Shin…

Despite these thoughts, Suhyuk couldn’t help but feel nervous. After all, he was facing not just any professor but the director himself. In a sense, one could argue that this man held Suhyuk’s future in his hands.

“Oh? Yes, I have read it.”

“Did you notice anything unusual?”

Judging by Lee Hyunjong’s expression, it seemed like he indeed found something peculiar.

‘Hey, what is this? Show me your brilliant analysis.’

[What if my analysis is wrong every day?]

‘Don’t get upset? I tolerate it even when you spout nonsense all the time?’

[Hmm.]

Baruda sighed as if something wasn’t to his liking and continued.

[From now on, don’t criticize my analysis.]

‘Hey… No matter how much you say that…’

[Then should I just keep quiet?]

‘Fine, fine. Hah, this guy truly…’]

[There is indeed something strange, but we won’t know until hearing the presentation. Speak like this: Based on my analysis, Director Lee Hyunjong appreciates interesting ideas. He likely prefers not to rush for answers right away.]

‘Ah…got it.’

Suhyuk was strangely persuaded by Baruda’s words and readily agreed.

“Yes, Dr. Choi. There were some questionable aspects, but I believe it will be clear after listening to the presentation.”

“Really? Great. This is interesting. Ah, everyone seems to have arrived. Let’s listen first. It is not polite to talk while someone else is presenting.”

“Yes, sir.”

Suhyuk wanted to say, ‘Shouldn’t you set an example as the director?’, but he kept his thoughts to himself. Instead, he turned towards Manager Shin Hyun-tae seated at the chairperson’s position, Professor Jang Doksoo responsible for this case who was next to him, and Kim Jinyoung, the third-year resident delivering the presentation.

‘Kim Jinyoung…’

Pharmacist Kim Jinyoung. In ancient times when kickbacks were rampant, pharmacists held immense power, influencing decisions on which drugs would circulate within hospitals.

As the pharmacist had some influence over which drugs were distributed within the hospital, it was natural for him to hold this position. However, with the elimination of rebates, his title had become largely ceremonial - more like a figurehead role.

Someone whispered, “He’s quite nasty.”

‘Indeed, he is.’

If all his underhanded dealings came to light, he would undoubtedly be arrested by now. He embezzled funds from various sources, misused corporate credit cards, and engaged in unethical practices. The first- and second-year residents tolerated him due to their lack of experience, while the third-year residents endured out of embarrassment. Otherwise, he should have been expelled from the hospital long ago.

“Hello everyone, I’m Kim Jinyoung, a third-year resident.” With that introduction, Kim Jinyoung grasped the microphone on the podium.

The first and second-year residents unconsciously straightened their backs and swallowed hard. Suhyuk was no exception. Everyone had experienced this man’s wrath at least once before.

Kim Jinyoung seemed pleased with these reactions, smiling confidently as he continued.

“The case I will present today is of a 78-year-old male patient who presented six weeks ago with decreased appetite.”

He then flipped through slides to display the patient’s medical history so far.

“The patient has been experiencing back pain due to spinal stenosis for five years prior to admission but was still able to dress independently and eat without assistance.”

This indicated that his daily activities were not significantly affected. As much of this information had already been shared beforehand, everyone nodded in agreement.

“Six weeks prior to admission, she began experiencing increasing fatigue and spent more than twelve hours per day lying in bed. Two weeks before her hospitalization, her appetite decreased significantly, accompanied by nausea, leading to a halving of her food intake.”

This indicated severe systemic weakness, which was quite concerning. If the patient were younger, it might have been dismissed as just feeling tired lately. However, this case involved a 78-year-old elderly woman.

“The worsening generalized weakness made it difficult for her to dress herself independently, prompting her visit to our outpatient clinic and subsequent hospitalization.”

Declining ability to perform daily activities is particularly dangerous for elderly patients, often signaling a rapid decline in health.

Patients often took a turn for the worse without warning, so it was wise to admit them even before receiving a definitive diagnosis.

“He looks rough around the edges but is surprisingly meticulous.” The hospital director echoed this sentiment with his praise.

As he spoke, another image appeared on the screen—an X-ray of the patient’s chest.

“As you can see, there are increased shadows near the bronchi at both lower lobes of the lungs. Upon reviewing the blood test results, we noted elevated C-reactive protein levels and diagnosed community-acquired pneumonia. Considering the severity and the patient’s age, we immediately administered levofloxacin.”

With levofloxacin, barring any antibiotic-resistant strains, it could be considered one of the most potent antibiotics available.

“After five days of treatment, there seemed to be improvement, but now the patient’s condition has deteriorated again.”

If it were indeed pneumonia, the symptoms should have improved with this medication. However, the patient’s health had worsened within just three days. So far, Jinyoung had presented the patient’s medical history, and now it was time for discussion among the team.

“The retaken chest X-ray showed no changes from the previous findings. Considering the unexplained weakness throughout the body, I’ve submitted this case for consultation.” As soon as Jinyoung finished speaking, Lee Hyunjong raised his hand.

Before Jinyoung could react, Lee Hyunjong continued, “Yes. As the presenter of this case, what do you think, Dr. Kim?”

This was his way of prompting Jinyoung to form his own thoughts on the matter.

Initially taken aback, Kim Jinyoung quickly recovered and responded as expected for someone with three years’ experience: “I considered it possible that the patient may have pneumonia resistant to levofloxacin.”

However, Lee Hyunjong wasn’t satisfied with this answer. “Is general weakness the most common symptom of pneumonia?”

“That… No, it’s not.”

“Then why are you fixated on pneumonia?”

“The X-ray showed…”

“This patient is seventy-eight years old. Have you considered the possibility of age-related changes?”

“It’s—”

“And you’re already in your third year but can’t think beyond that? Is there anyone else who wants to try? Who is this patient’s primary physician?”

Someone standing at the back shifted uneasily and stepped forward. It was Hwang Sunwoo, now in his second year of residency.

“What do you think?”

Hwang Sunwoo had a reputation for being particularly clueless, so it wasn’t surprising he couldn’t provide a proper answer. However, aware of Lee Hyunjong’s mood, he refrained from suggesting pneumonia.

“L-lung cancer.”

“Excuse me? Lung cancer?”

This only elicited more laughter.

“What exactly are you seeing here? What makes you say lung cancer? Please enlighten me.”

“I… I’m sorry.”

“Ah… This second-year fellow… Is there anyone else here?” Lee Hyunjong clicked his tongue as he looked around. Everyone held their breath and even bowed their heads.

“This… The people from Taehwa Medical Center’s Internal Medicine department…” Lee Hyunjong shook his head with disappointment at this sight. Suddenly, he noticed Suhyuk staring intently at him and broke out into a grin.

“Hey, hey, you’re smiling… As expected of your hidden son.”

“Don’t be sad about it.”

His smile seemed to imply something misunderstood, but regardless, Lee Hyunjong appeared pleased.

“Lee Suhyuk. What do you think?”

He already knew what Suhyuk would say.