Chapter 28: Let's See the Patient (4)

“How is the patient?”

“Fortunately, due to the quick diagnosis, he responded well to chemotherapy. However…”

Taejin Jo smiled wryly as Suhyuk trailed off.

The process of killing cancer cells was likely progressing smoothly. However, treating cancer required more than just focusing on eliminating the tumor itself; one must also consider the patient suffering from it. Overlooking this could inadvertently lead to the death of the patient during treatment.

“The patient’s advanced age, isn’t it?” Taejin Jo spoke reassuringly, understanding Suhyuk’s concerns.

“Yes. His overall health is rapidly deteriorating. We’ve been administering intravenous fluids and steroids to minimize side effects, but…”

Suhyuk looked with a bitter expression towards the hospital room where the patient was admitted.

“The kidney function is worsening. I requested dialysis.”

He recalled what Baruda had mentioned earlier that morning. Despite starting dialysis as per Baruda’s advice, the patient’s condition continued to deteriorate rapidly rather than improve.

“He experienced vomiting, diarrhea, and acute renal failure?”

“Yes, possibly…”

“Hmm. That’s concerning. Still, receiving this diagnosis within two months is relatively fast… Did you say he was healthy before showing symptoms?”

“Yes. There were no known issues prior to his illness.” Suhyuk mentally reviewed the patient data stored by Baruda.

According to the records, the patient had been able to lead a normal life until falling ill recently without needing assistance from others.

Previously, he didn’t require assistance from others, but now, without a nurse, he couldn’t even go to the bathroom.

“It’s fortunate if you can reach the toilet. Currently, due to excessive buildup of toxins, I have severe diarrhea like water.”

‘I saw it earlier… Continuing this treatment is not feasible…’

As Suhyuk nodded with determination, Professor Taejin Jo also nodded, although their thoughts were entirely different.

“Have we received consent for do-not-resuscitate orders? Perhaps?” Taejin Jo considered the patient’s age and the economic situation of his guardians.

‘If only he could recover. It would be great if he could, but…’

In this current state, recommending continued cancer treatment would cause distress for both the doctor and the patient.

Saving a patient’s life was undoubtedly important, but based on his extensive experience, Taejin had learned to consider more practical aspects as well. Having encountered numerous similar cases before, he believed it would be more appropriate to end treatment at this stage and give the patient time to prepare for their final days. His long career led him to this conclusion.

I must find a way forward, but not like this.

On the other hand, Suhyuk, being a young doctor with limited exposure to patient deaths, held contrasting views from Professor Taejin Jo. One could argue that these differences stemmed from Suhyuk’s idealism or perhaps his ambition. To Suhyuk, the patient’s age represented merely another challenge to overcome rather than a reason to abandon treatment.

If it were about the economic situation of the guardians, one could argue that Suhyuk might reconsider his stance on appropriate treatment due to financial constraints. However, as a young and inexperienced doctor, he had not yet fully grasped the connection between treatment and money.

“No, I haven’t discussed it with them, Professor.”

Thus, Suhyuk had never broached the topic of death with patients or their guardians before. Naturally, signing a Do Not Resuscitate (DNR) consent form hadn’t even crossed his mind.

“Yes, let’s get that signed this afternoon.”

“Mm-hmm.”

Suhyuk simply nodded without offering any further response. Taejin Jo observed Suhyuk’s stubbornly closed mouth for a moment before shaking his head.

“Have you ever dealt with a patient who passed away?”

Taejin Jo had also been through his residency period. During that time, he was young and believed firmly that with determination, all patients could be saved.

I even refused to acknowledge the limitations of modern medicine.

Despite not being an exceptional resident, Taejin held such beliefs. How much more so would Suhyuk, a prodigy unparalleled among his peers?

The professor sensed what Suhyuk might have experienced.

“Yes, Professor. But still…”

“As long as you chose Internal Medicine, you’ll encounter this eventually.”

“I understand…”

“This patient has no hope. It doesn’t matter how you feel about it.”

“But their disease stage is still…”

“You’re right. Based solely on the disease stage, the patient should survive.”

In medical terms, ‘disease stage’ refers to the progression of a disease, typically categorized as stages 1, 2, 3, or 4.

Currently, the patient’s disease stage was ‘stage 2’ according to Taehwa Medical Center’s data, meaning they should not have died yet.

“However, this patient is elderly. Their kidneys cannot withstand it anymore. Continuing chemotherapy here will only cause more suffering.”

Suhyuk deeply agreed with these words. Before Professor Taejin Jo arrived, he had witnessed during rounds with Kim Insoo how much pain the patient endured throughout the day.

Nevertheless, agreement did not necessarily mean consent.

“[Due to the patient’s kidney failure, the planned bone marrow transplant after chemotherapy needs modification. I recommend mini-hematopoietic stem cell transplantation.]”

Baruda echoed this sentiment. He argued against the intended treatment of completely eradicating the patient’s bone marrow with chemotherapy and then introducing new marrow. Instead, he proposed a newer therapy recently attempted by some hospitals.

Instead, he proposed a new treatment that some hospitals had recently started attempting.

‘A mini hematopoietic stem cell transplant…’

[Currently, this is the only available treatment option.]

‘Yes… We cannot send away bone marrow without using it when we have a donor.’

Although there has been progress compared to earlier times, bone marrow transplantation and donation were not yet widespread in South Korea. Consequently, numerous patients who could survive with suitable bone marrow often died due to its unavailability.

However, luck seemed to be on this patient’s side as the Hematopoietic Stem Cell Bank Association contacted them immediately after being placed on the waiting list.

[The odds of finding a match are one in twenty thousand.]

‘We cannot just dismiss this.’

Suhyuk gathered his courage and hesitantly spoke to Professor Taejin Jo, who seemed to have already made up his mind. It required considerable bravery as it could also be perceived as impolite. However, Suhyuk had built quite a rapport with Professor Jo, and he was known as a legend within the Hematology-Oncology Department. This eased some of his burden.

“However, professor…there is still a treatment we haven’t tried.”

“A treatment not yet attempted? What is it?”

“It’s called mini-hematopoietic stem cell transplantation.”

Upon hearing this, Chief Kim Insoo quietly stepped back, having been silently listening until now.

‘Where does this kid keep finding these unfamiliar diagnoses and treatments?’

There was slight annoyance on his face.

On the other hand, Professor Taejin Jo’s face spread with a slight smile. He was proud of a first-year resident who knew about this experimental treatment method.

“A mini hematopoietic stem cell transplant.”

“Yes. Considering the chemotherapy administered so far, the patient’s bone marrow function must be severely suppressed by now. Many cancer cells would have been killed as well.”

“But not all of them.”

Originally, after administering chemotherapy, transplanting another person’s bone marrow could be seen as a reset. This innovative treatment involved killing both healthy and cancerous bone marrow before receiving someone else’s to survive. Due to its remarkable effectiveness, often described as miraculous, it is currently utilized for various types of bone marrow cancers.

However, there was one crucial prerequisite needed:

It aimed to kill both bone marrow and cancer. However, this patient’s condition contradicted that premise.

“Yes. They may not have been completely killed… Still, there should be fewer of them.”

“Hmm…”

Professor Taejin Jo didn’t argue further as he glanced at the calendar. Comparing it with the admission records, quite some time had passed since the chemotherapy began. Although Suhyuk was correct about not reaching the target dosage, absolutely speaking, a significant amount of anticancer drugs had already been administered.

“Then the cancer can be eliminated by the transplanted bone marrow… In other words, the immune cells produced from the new bone marrow will kill the remaining cancer cells.”

If killing both bone marrow and cancer for transplantation was innovative, then sparing some cancer while transplanting new bone marrow to specifically target those cells could only be described as revolutionary.

This method of killing only the bone marrow while leaving some cancer cells intact and then transplanting new bone marrow to eliminate the remaining cancer was revolutionary.

“You know it’s risky?”

“But I believe…it is worth taking this risk. Firstly, finding a matching donor itself is…”

“Hmm… That’s true.”

Professor Taejin Jo recalled numerous patients who had passed away waiting for donations. Compared to them, the current patient could be considered fortunate. He had been given an opportunity, so perhaps giving up too easily wouldn’t be right.

“I want to give it a try.”

“Hmmm…”

Seeing Suhyuk’s burning determination to save this patient also swayed his decision somewhat. However, he had no intention of entrusting the entire bone marrow transplant procedure to someone who was barely two months into their first year as a doctor.

“Insoo.”

“Yes, Professor?”

“Prescribe the sterile room for Mr. Baek. The patient…let’s give it a try.”

“Oh…”

“What do you mean ‘oh’? Let’s give it a shot.”

“Yes, yes. Understood, Professor.”

With Kim Insoo’s assistance, Suhyuk lowered the patient’s immunity before transferring him to the sterile room. There was nothing extraordinary about the method; they simply administered another round of chemotherapy. As a result, the patient’s already weak immune system dropped to zero. This meant that under normal circumstances, the patient would be unable to survive.

‘Now, the transplanted bone marrow… must just win against the cancer cells.’

Suhyuk muttered as he looked at the patient lying in the sterile room.

As they shared their vision, Baruda was also observing the same patient.

[Hoping for victory while facing the patient is powerless, Suhyuk.]

‘Huh? Do you have any suggestions?’

[No, I do not.]

‘Wait, what’s your problem…?’

[I am merely stating the truth of our powerlessness.]

‘Well…that’s true.’

Suhyuk wanted to counter but sighed, knowing it was futile. His warm breath fogged up the cold window of the sterile room. Before leaving, he wrote “Please survive” on the condensation and exited the hospital room.