Chapter 27: Let's See the Patient (3)

“Ah… Yes. Then.”

Suhyuk slowly rose as if he was reluctantly getting up. In contrast to his demeanor, Suhyuk confidently accepted the microphone from Lee Hyunjong. This could be considered quite strange by others since Lee Hyunjong never showed such behavior before.

“Look at him, look. He loves his son so much… It must be hard for those without a director father.”

“He used to say ‘I married medicine’… When did he have such a grown-up son?”

While the unaware residents whispered amongst themselves, Suhyuk cleared his throat while holding the microphone.

“Don’t waste time; let’s get started.”

Suhyuk’s coughing fit lasted longer than necessary due to Baruda urging him on with pride.

I know, I know.

Nodding, Suhyuk finally opened his mouth after briefly glancing at where Hwang Sunwoo had been standing earlier.

Hwang Sunwoo turned slightly left as he couldn’t bear to meet Suhyuk’s gaze.

“The patient is a seventy-eight-year-old male currently weighing sixty-two kilograms at one hundred and sixty-three centimeters tall. While not particularly robust, these numbers aren’t bad for his age. He quit smoking thirty years ago, and his chest X-ray shows no signs of lung cancer. In other words, it suggests that a chronic condition is unlikely.”

As Suhyuk spoke, Hwang Sunwoo’s expression soured, while Kim Jinyoung’s face brightened somewhat.

Suhyuk’s opinion aligned with his own, despite Suhyuk being considered one of the greatest geniuses since Taehwa Medical Center opened its doors recently. As a third-year resident, Hwang Sunwoo felt quite embarrassed about this, but it wasn’t surprising given Suhyuk’s reputation as an exceptional Royal among Royals.

“However, the symptoms don’t seem typical for acute pneumonia. There’s no cough or difficulty breathing. The patient only complains of general weakness.”

As Suhyuk continued, Kim Jinyoung’s expression mirrored Hwang Sunwoo’s confusion.

“Yes, I understand that it’s not either of those two conditions. Most likely, everyone here already grasped that much. So, what is your diagnosis?”

Director Lee Hyunjong’s expression seemed less critical and more expectant as he asked Suhyuk another question. Despite appearing exhausted, Suhyuk slowly walked towards the podium instead of immediately answering.

“Ah, do you need this for reference? Here.”

In place of the flustered Kim Jinyoung, Manager Shin Hyun-tae, who was seated at the head of the table, handed him a laser pointer with a button to navigate PowerPoint slides.

“Thank you, sir.”

“No problem. Please continue.”

Manager Shin Hyun-tae shared a similar expression to Director Lee Hyunjong, urging Suhyuk to quickly present his findings.

Interestingly, Kim Jinyoung and Hwang Sunwoo’s expressions were completely opposite to everyone else’s, but no one paid attention to them. Instead, they watched Suhyuk, who was surprisingly favored by both influential figures of Internal Medicine, with bewilderment.

“Complete favoritism,” someone muttered under their breath.

This level of attention might have overwhelmed others, but Suhyuk remained composed.

“It seems Taehwa’s Internal Medicine case presentation truly helped.”

‘They mentioned positive reinforcement, using psychiatric terminology.’

Suhyuk had already successfully presented on larger stages, which gave him confidence now.

This experience was more helpful than beta-blockers or other medications. Instead of feeling overwhelmed, he felt just the right amount of energy coursing through him.

“First…you need to see the patient’s blood test results upon admission.”

As Suhyuk spoke, he navigated to the screen and pointed at a table Kim Jinyoung had quickly skimmed over earlier. For an elderly person, most values were surprisingly good. Only a few entries marked in red indicated abnormalities.

Among them, Suhyuk highlighted ‘Na’, which stands for sodium or sodium chloride.

“The normal range is between 135 to 145, but this patient has a level of 127.”

In older adults, low sodium levels can occur without any apparent cause.

However, for an elderly patient who had rapidly deteriorated to require hospitalization, it was essential to consider why this might be happening. Otherwise, they could waste time and potentially lose the patient.

“Nevertheless, there are no specific symptoms such as swelling, and considering the patient’s medication history, desmopressin taken for nocturia treatment could be contributing to hyponatremia. Therefore, the low sodium levels likely do not have a direct connection with the current symptoms. Oh, and it would be beneficial to discontinue desmopressin.”

Of course, not all abnormalities directly relate to the present symptoms, but systematically addressing each issue is crucial. This is well-known among excellent internal medicine doctors, so nobody questioned Suhyuk deviating from the main topic during the discussion. Instead, they were visibly impressed.

Instead, they were surprised by Suhyuk’s presentation.

“Is he…really just a first-year resident?”

“I feel like I’m listening to a lecture from a professor of nephrology.”

Some residents expressed their admiration aloud.

However, Kim Jinyoung and Hwang Sunwoo, who remained seated, couldn’t join in. Their faces turned bright red as they lowered their heads, accumulating resentment towards Suhyuk.

“Next, let’s look at the patient’s hemoglobin level, which is 9.1. The normal range is between 13 and 17, so this is quite low. It indicates anemia.”

Anemia was a common condition among elderly patients, especially prevalent in those living alone, like the current patient.

This was often due to malnutrition. However, if there were symptoms, it was crucial to investigate why this might be occurring. It would be dangerous to dismiss everything as simply age-related issues, especially when dealing with patients.

“Furthermore, the reticulocyte count, which measures immature red blood cell production, is low at 1.03. This indicates that the issue isn’t destruction of red blood cells but rather their inadequate production. It suggests a problem with hematopoiesis.”

This too was commonly observed in elderly patients. Essentially, all the points Suhyuk had raised so far could potentially be insignificant. Nonetheless, he showed no intention of stopping his explanation.

“Lastly, if you look at the basic blood test results for white blood cell components… The total number is significantly increased to 26,100 (normal range: 4,000-10,000). One might suspect acute infection, but remarkably, monocytes constitute 31%.”

“Hmm!” Lee Hyunjong nodded vigorously as if recognizing a decisive clue.

Professor Taejin Jo, who was currently overseeing Suhyuk’s case, had a similar reaction. Honestly, he hadn’t reviewed the distributed case materials beforehand due to his busy schedule, making his surprise even greater than Director Lee Hyunjong’s.

“I mentioned earlier about decreased normal hematopoiesis. What could this high percentage of monocytes indicate?”

Suhyuk now appeared quite relaxed as he glanced around the room.

As Suhyuk continued speaking, Kim Jinyoung and Hwang Sunwoo’s faces turned pale. They suspected one particular disease based on his explanation. Even though they might not have been diligent students, their training at Taehwa Medical Center forced them to learn certain things.

Oh no, we messed up… Haah… Why didn’t I think of that earlier?

Kim Jinyoung, especially as a third-year resident entrusted with presenting this case, couldn’t help but deeply sigh over failing to consider it.

Of course, Suhyuk did not stop talking. He had yet to reveal the answer. Engaging the audience was merely part of his process.

“Yes, specifically, blood cancer. Considering the progression speed and the patient’s age, multiple myeloma is the most likely diagnosis.”

As soon as he delivered his diagnosis, Shin Hyun-tae opened his mouth from his seat at the head of the table. In truth, Director Lee Hyunjong had also attempted to speak, but since he didn’t have a microphone, no one could hear him clearly. Thus, it was left to Shin Hyun-tae to address the group.

“Excellent. What tests should we run?”

“I recommend an MRI and CT scan of the spine, peripheral blood smear test, serum immunoelectrophoresis, among others.”

“Yes. Professor Jang, what do you think?”

It was clear that Dr. Kim’s answer was correct, so comprehensive that there wasn’t much else anyone could add. That’s why all eyes turned to Jang Doksoo, who was currently in charge of the patient’s care.

Jang Doksoo already knew the answer because he had previously discussed this case with other professors from the Hematology-Oncology Department prior to the presentation. However, hearing someone else present their findings almost verbatim, despite being only a first-year resident, caught him off guard, leaving him momentarily speechless.

However, he was both surprised and flustered that this first-year resident had articulated their discussion almost verbatim. He was so taken aback that he couldn’t immediately respond.

“What do you think about his proposal?” Manager Shin Hyun-tae pressed him further. To be more precise, it took a discreet kick under the table to get Jang Doksoo talking.

“Oh, uh… Right… Hmm. I believe it’s an excellent plan.”

“No, not your opinion. What do you think of Professor Jang’s plan?”

It wasn’t quite what one would expect from a professor-level response, which prompted Shin Hyun-tae to prod again.

Get your act together, damn it.

Despite being colleagues, there was a significant age gap between them.

Even Shin Hyun-tae, who had become a professor during Jang Doksoo’s residency days, kicked Jang Doksoo’s leg again. This time, it was with emotion and caused considerable pain.

“Ouch. Uh, yes… That…I agree. However, we cannot completely rule out infection. It would be better to add chest CT scans, blood culture tests, and sputum culture tests.”

Fortunately, there were no further kicks. His response sounded more like that of a professor this time.

“Excellent. Shall we assign the patient right now? To Oncology?”

Neither Professor Shin Hyun-tae, Jang Doksoo, nor any other professors believed this patient belonged in the Infectious Diseases Department. As Suhyuk stated, this patient had cancer, which required prompt diagnosis and treatment for survival.

Otherwise, she would inevitably die.

“Yes, I’ll take her.” Taejin Jo raised his hand and pointed at Suhyuk still standing near the podium. “I will assign Dr. Lee Suhyuk, who is currently in his first year of residency, as the primary physician. Is that okay with everyone?”

Naturally, there was no opposition. Among all the residents gathered here, including Hwang Sunwoo, who had been previously assigned to this patient, and Kim Jinyoung, who served as chief resident, Lee Suhyuk knew the most about the case. Not only that, but he demonstrated a level far above his peers.

He’s truly a genius!

At that moment, Lee Suhyuk’s name became deeply ingrained in the minds of almost every professor present.