Chapter 34: I Told You So? (1)

[Insulinoma! Insulinoma!]

Of course, Baruda had completed his analysis before Suhyuk opened his mouth. However, Suhyuk was not paying attention to him.

[I’ve told you a hundred times! Insulinoma!]

Since you keep repeating it, it sounds like a curse now. Can you please be quiet? You’re slower than a human, tin can.

[Ah… Ah… I just guessed correctly based on the data I gathered!]

Nonsense about guessing. I’m simply a genius, even more so than I thought.

[Ah…]

After silencing Baruda, Suhyuk finally shared his answer with Kim Jinyoung.

“I suspect insulinoma.”

“In… what?”

“Insulinoma. There is also evidence of lesions visible on the CT scan.”

“Hey…”

Kim Jinyoung stopped after saying ‘hey’. He had heard of it before but couldn’t immediately recall where. However, Suhyuk wasn’t socially inept to the point of challenging Kim Jinyoung, a notorious third-year resident doctor. Of course, he sometimes unintentionally made mistakes due to Baruda’s interference.

‘Shit… Where have I heard this before?’

Thanks to this, Kim Jinyoung was able to buy some time. As he continued pondering, he eventually realized that he had encountered this term before.

‘Didn’t they say it’s incredibly rare?’

Insulinoma - one type of benign tumor found in the pancreas. It could be suspected when there were symptoms of uncontrolled excessive insulin, but it was exceedingly uncommon.

Even residents at small hospitals might not encounter this condition once during their three-year residency. Yet here was someone diagnosing it in the emergency room? And as a first-year resident no less?

Kim Jinyoung felt more anger than disbelief.

This bastard’s ego seems to have ballooned from all that praise…

Was he acting like a genius despite being exposed as a fraud just days ago? It made Kim Jinyoung want to take him down a peg or two.

Plus…if I disturb Professor Seo Hyoseok on his weekend…he’ll really lose it.

The professor hated being contacted outside of work hours so much that some wondered why he didn’t simply open up his own private practice instead of staying at a university hospital. Calling him based solely on the word of a first-year resident would be sheer madness.

In other words, they would have to enter the hospital and notify patients directly on weekends. Both Seo Hyoseok and Kim Jinyoung disliked being contacted during their off days for the same reason. Therefore, Suhyuk decided to start with him as it was the easiest path.

“Hey, do you know how rare insulinomas are?”

“Oh… Yes, I am aware.”

Insulinomas were so rare that discussing its prevalence per 100,000 people seemed pointless. However, Suhyuk had discovered numerous pieces of evidence beyond just the ultrasound image. His response was confident and immediate, which irked Kim Jinyoung even more.

“This bastard… Acting like he’s a staff member instead of a first-year resident. Huh? What makes you so cocky?”

“Huh? Oh… My apologies.”

Suhyuk was taken aback by this sudden confrontation.

“Why is this jerk causing trouble again?” Baruda also sounded flustered, resorting to cursing immediately.

Baruda seemed equally flustered and resorted to cursing immediately.

However, Suhyuk couldn’t respond like that. He was only in his first year, unaware of the rumors surrounding Kim Jinyoung. Thus, he continued apologizing.

“Sorry? If you knew it was wrong, why did you make this ridiculous diagnosis without consulting anyone?”

“I’m sorry.”

As Suhyuk repeated his apology, he painfully realized why Kim Jinyoung had such a bad reputation. Despite not being particularly skilled, becoming the common enemy among junior doctors wasn’t coincidental.

“You need to prepare a presentation explaining why you diagnosed insulinoma by tomorrow’s rounds. It should be at least ten slides, including information about insulinomas themselves.”

“Ah… Should I admit the patient then?”

“Are you crazy? Keep them in the emergency room.”

“In…the emergency room?”

Suhyuk inadvertently looked towards the patient. The effects of the sedative had just worn off, and he was dazedly looking around. To keep him in the emergency room in this state? It wasn’t medically or ethically right.

“Yes, present it. Don’t fucking call me on the weekend for something that isn’t certain yet, you third-year resident. This is all because there’s no damn penalty.”

However, insisting on hospitalization again would be suicidal. Kim Jinyoung appeared to be someone who wouldn’t change his mind easily. After spewing several more vulgarities, he finally spoke meaningfully:

“Listen carefully. You’ve never annoyed me before, understood?”

“Oh, yes, Dr. Kim.”

“And if your presentation tomorrow is inadequate, you’re really screwed, got it?”

“Yes,” Suhyuk readily nodded as he believed there was sufficient evidence.

His firm response further angered Kim Jinyoung, triggering his feelings of inferiority.

“You mentioned getting a CT scan, right? A first-year resident ordering a CT scan without notifying me? Oh, very good job, excellent work indeed.”

Despite it being standard practice for doctors to receive prescriptions after examining patients, Jinyoung insisted on making things difficult.

“Go to the Radiology Department and get the reading yourself.”

“Yes, sir.”

“Not from a resident but directly from a professor.”

“Umm… by tomorrow?”

“Exactly. You’ve already given the diagnosis, remember? So make sure you obtain the official report, not just a verbal one from a resident. If you’re that confident about your diagnosis, then…”

Suhyuk couldn’t respond with equal confidence this time. While most patients might not know what the Radiology Department entails, within this university hospital, it held supreme authority.

At least within this university hospital, the Radiology Department was considered to be at the top of the hierarchy. There is even a saying that first-year residents from other departments must adjust their schedules around those from radiology.

Yet, Suhyuk, a mere first-year resident, had been told to get his scan read by a professor? It was more likely he wouldn’t show up due to it being the weekend. This order was essentially telling him to die.

“Hey, why aren’t you answering? Are you dumb?”

“Ah…no.”

“Do everything I said by tomorrow.” Kim Jinyoung’s smile widened as if pleased with Suhyuk’s hesitant response before hanging up the phone.

That dirt-poor bastard… making a scene during someone else’s presentation.

Finally, he felt avenged for the humiliation he endured during the presentation.

“Hey! Aren’t you going to defend your tower?” Additionally, he needed to urgently return to his game. With the same smug expression, Kim Jinyoung put down his phone.

Swish.

Suhyuk placed his phone back into his gown pocket.

[Despite being third-year residents together, there is a world of difference between you and Kim Insoo.]

Baruda, who had been silent until now, spoke up.

‘Dr. Kim may be somewhat cold…but he never compromises on his work. He is also intelligent.’

[I heard rumors that he will become a fellow soon.]

‘This guy…is truly a bastard.’

[However, he is your senior. You must follow his instructions.]

‘Ah, how annoying.’

Shaking his head, Suhyuk looked at the patient. If the mass seen on the CT scan was indeed an insulinoma, they needed to admit the patient immediately and schedule surgery. However, given their current situation in the emergency room, it wasn’t possible to even request assistance from the surgical department.

Surgery for uncontrolled insulinoma was extremely dangerous, and Suhyuk didn’t have the authority to perform it.

[Baruda spoke again towards the troubled Suhyuk.] First, provide the treatment you can here, Suhyuk.”

Baruda’s tone lacked any emotion as usual, but his advice was correct like always.

I guess that’s what I should do.

[Surgery is not possible at this time. I recommend administering Diazoxide (an insulin secretion inhibitor).]

Isn’t Diazoxide a rare medication? Do we even have it here?

[This is Taehwa Medical Center. We have all medications available in Korea.]

Well then…

Suhyuk nodded and stood up. His expression had relaxed compared to when he hung up the phone earlier. This was because Diazoxide would buy them some time.

The drug inhibits insulin secretion from beta cells of the pancreas and is considered the optimal treatment when surgery cannot be performed immediately, such as in this case.

“How did it go?”

As Suhyuk moved towards his patient, Oh Jinsung approached him with concern etched on his face. It seemed he had overheard parts of the conversation.

“The first-year resident didn’t seem to appreciate being given such a rare diagnosis. I got reprimanded.”

“Jinyoung has always been like that. He criticizes even if you’re right, doesn’t he? Don’t worry too much about it.”

“Yes, but…I’m concerned since we couldn’t admit her for observation.”

“You think it’s risky to keep her here? Should we consider temporary psychiatric admission?”

Suhyuk momentarily felt tempted by Jin-sung’s suggestion, but considering the patient’s situation, he shook his head.

This place seemed safer than a psychiatric ward. Although the nurses here were not specialized for emergencies related to internal medicine, they had experience handling various emergency situations.

“No, hyung. Since I’m on duty anyway…I can take care of him here.”

“Alright… If you need to interview the patient or consult with their guardian, let me know.”

“Yes, hyung. Thank you.”

“Sure thing. I have another call to attend to. See you later.”

“Okay.”

Perhaps influenced by his recent conversation with Kim Jinyoung, Suhyuk felt as if a halo was shining around Oh Jinsung’s receding figure. In this cold university hospital, he truly embodied a saintly presence.

“Let’s start treatment first.”

However, there was no time to remain lost in thought. Following Baruda’s advice, Suhyuk prescribed Diaxazide.

As expected, since it was an unfamiliar prescription, the nurse needed to confirm with the doctor before administering the medication to the patient. The patient still appeared confused but did not hesitate to take the medicine. It seemed quite effective as no symptoms were observed for several hours after administration.

“The patient appears stable. The last blood sugar test also showed levels around 90.”

‘Then…we need to go to the Radiology Department.’

“Will there be any professors available during the weekend?”

‘Yes, this is Taehwa Medical Center.’

One of the benefits of being at a large hospital - apart from various other advantages - is its abundant human resources. Other hospitals might be empty on weekends, but Taehwa Medical Center operated differently.

“To…request it directly from the professor?” The on-call resident of the Radiology Department, who was in their third year, looked at Suhyuk with ‘are you crazy’ eyes.

Suhyuk needed to brace himself for rejection when asking a resident, but now he wanted to approach a professor?

“Yes, sir. I have a valid reason. By any chance, is the abdominal radiologist professor here today?”

“Let me check… Oh, Professor Kim Jinsil… She came earlier to examine an ultrasound image for a liver transplant patient. There she is.” With a resigned expression, the resident pointed towards the approaching professor.

She had strikingly tight hair and appeared sharp overall.

The resident secretly prayed as if his personality demanded it. However, Suhyuk couldn’t defy Kim Jinyoung’s words. He cautiously approached Professor Kim Jinsil and greeted her.

“Hello, Professor Kim Jinsil. I am Lee Suhyuk from Internal Medicine, first year.”

“Lee Suhyuk? Ah, Actinomycosis. What brings you here?”

To Suhyuk’s surprise, Professor Kim Jinsil responded warmly. For some reason, she seemed very friendly and even offered him her seat.

“Oh, thank you. May I request your expertise on interpreting a patient’s abdominal CT scan due to persistent hypoglycemia with accompanying neurological symptoms?”

“Hmm. Let’s see the images. What do you suspect?”

“An insulinoma.”

“Ah, that’s quite rare. Alright… let’s check if you’re correct.”