Chapter 63: What's the Big Deal?

‘Immune suppressants for fever…’

[Firstly, confirm what type of inhibitor it is.]

‘Okay.’

Suhyuk entered the emergency room with his cane.

“I am Lee Suhyuk.”

“Ah… He isn’t that handsome.”

“Why does appearance matter? They say he’s a genius.”

“Well, just saying. I thought he would be incredibly good-looking.”

His skills were already widely known within the hospital. It was natural since he had diagnosed and treated numerous cases independently. Moreover, there was now official confirmation about the long-rumored fact that he was the son of Director Lee Hyunjong. His appearance also stood out due to the cane. The moment he entered, whispers spread, which was no coincidence.

“Where is the patient?”

“Ah… Over there.”

Thanks to this, even the intern who contacted him was incredibly friendly. Being the son of the director and a genius first-year Internal Medicine doctor - it would be stranger if he wasn’t treated well.

“I’ll just check the patient’s records for a moment before seeing them. Have you done an EKG or ABGA? If not, do it now.”

“Oh, yes. Dr. Lee.”

Suhyuk sent the intern to attend to the patient while he sat down at the monitor. He then brought up the patient’s record.

[Son Geumsuk, female, age 53.]

‘She received a kidney transplant a month ago due to end-stage renal failure. Hmm… Is it rejection?’

Although one month had passed, it couldn’t completely rule out the possibility of acute or subacute rejection reactions. However, Baruda had a slightly different opinion.

[However, the new kidney function appears to be satisfactory.]

‘Isn’t it slightly lower than expected?’

[It is more likely that the donor’s kidney function was somewhat diminished.]

‘Hmm… It seems your opinion doesn’t significantly relate to the current fever issue, right?’

[That’s correct. Of course, further verification is needed.]

‘Understood.’

Suhyuk decided to investigate further and delved deeper into the patient’s records.

‘The medications are Cyclosporine and Mycophenolate.’

[These are standard drugs commonly used after kidney transplantation.]

‘Indeed. Hmm.’

Apart from the medications, he discovered that the patient had been suffering from hypertension for approximately 20 years. Suhyuk surmised that her kidney failure might have resulted from complications due to this long-standing hypertension, leading to the need for a kidney transplant.

Of course, this was all speculation since the patient had been treated at another hospital before receiving the kidney transplant. However, given that Suhyuk and Baruda made these deductions, they held considerable credibility.

“[The patient has complained of general weakness for two days now.]”

Her fever was confirmed upon admission.

“[Even then, it’s not high.]”

The patient’s temperature was 37.8 degrees Celsius. It could barely be classified as having a fever.

More importantly, other vital signs caught Suhyuk’s attention.

‘Her blood pressure is 94 over 64… Her pulse rate is 116… But she has hypertension.’

“[These readings are unusually low compared to her baseline blood pressure.]”

‘Let’s start with intravenous fluids first.’

The process of diagnosis was naturally enjoyable and fun for Suhyuk. This was especially true when working with Baruda as they often found answers together. However, saving lives should always come first. Diagnosing after a patient’s death held no value.

Suhyuk once again leaned on his cane and approached the patient.

Although her blood pressure was relatively low compared to her usual readings, it wasn’t critically low enough to warrant immediate transfer to the treatment room instead of the general emergency room.

“Please administer 300cc of normal saline at full drop rate.”

“Ah, yes, Dr. Shin.”

After giving this instruction, Suhyuk quietly examined the patient. As mentioned earlier, her primary symptom was weakness, and she indeed appeared very frail.

[Based on my earlier observation, her height is 163 cm, and she weighs 38.5 kg.]

‘Did she lose weight recently?’

[During her post-surgery hospitalization, she weighed 43 kg.]

Although not particularly robust at that time either, it was significantly better than her current state. This also suggested a high likelihood of rapid weight loss over the past month, indicating that her condition might be more longstanding than initially thought in the emergency room.

‘Hmm.’

Considering that this might not be an acute infection, Suhyuk meticulously examined the patient from head to toe. He checked for jaundice in her eyes, pallor under her eyelids, rapid breathing, or any signs of intercostal muscle use. He closely observed the area where she had surgery a month ago, among other things, conducting a thorough inspection.

“The operated area is slightly red.”

‘Yes. Especially where the tube was inserted.’

“Yes. We definitely need to check that area… Apart from that, there doesn’t seem to be any significant issues. However, it’s difficult to conclude everything is fine just because no abnormalities were observed.”

‘That’s true.’

The patient might not have been taking immunosuppressants. In such cases, typical symptoms could potentially be masked. Consequently, relying on blood tests, X-rays, or urine analysis becomes crucial in these situations.

Suhyuk decided to wait for the urine test results while reviewing the EKG brought by the intern.

“Huh.”

Although the ST segment pattern on the EKG wasn’t entirely typical, it showed an elevation compared to normal levels.

However, the level of cardiac enzymes observed in the blood test was not high.

After reviewing all the findings, Baruda quickly spoke up:

[I believe it is more likely inflammation of the heart muscle rather than blockages.]

‘Is this due to the ongoing infection spreading throughout his body?’

Suhyuk stared at the patient with disbelief on his face. The man certainly looked weak, but Suhyuk didn’t think the situation appeared that severe.

Yet, Suhyuk was no longer just a doctor relying solely on theoretical knowledge. He had gained considerable experience from treating numerous patients over time.

If we don’t act swiftly…

[It’s crucial to make an accurate diagnosis as soon as possible.]

‘Let’s get a CT scan while waiting for the urine test results. I’m feeling uneasy about this.’

[That’s a good idea, Suhyuk.]

Consequently, Suhyuk decided to perform an abdominal CT scan to examine the swollen area, suspecting that the surgery site might be the primary cause of the serious infection.

Suhyuk concluded that if there was a severe infection, it was likely due to the surgical site.

“Please contact the CT room so they can scan him immediately.”

“Yes, sir.”

The intern promptly called the CT room and emphasized that Suhyuk, the director’s son, had requested the scan. In response, the radiographer sighed briefly before nodding.

“Come right away. We don’t have any urgent patients, so we can fit you in.”

“Thank you very much.”

Thanks to this, the patient could proceed directly to the CT room.

Suhyuk wanted to accompany him if possible, but his injured leg made movement challenging.

[The test results will be available soon anyway. Let’s start with the urine analysis.]

‘Yes…’

[I am also analyzing ways to fix your leg. Please do not be too disheartened.]

‘Well…for now, let’s focus on this urine test.’

Suhyuk sent off the patient and started refreshing the results continuously. Suddenly, the results appeared, and Suhyuk began analyzing them with Baruda.

‘There is hematuria. The amount is significant…’

[White blood cells are present as well. It indicates an infection.]

‘A urinary tract infection… But, the fever seems limited to this extent.’

[It is due to the immunosuppressive drugs being taken.]

‘It’s not good…’

[The situation is dire.]

A urinary tract infection after a kidney transplant?

There was a possibility that the transplanted kidney became infected. If so, even if the infection was successfully treated, it could lead to renal failure again.

Naturally, Suhyuk’s face distorted with concern.

[Ah, the patient has arrived. The image should be visible now.]

At this moment, Baruda drew his attention. Despair can come later after something goes wrong. Currently, their utmost priority was to prevent any harm to the patient. This is what Baruda believed made an exceptional doctor.

‘Although it is unclear without using Yeongje…’

[The transplanted kidney appears swollen. There is also fluid accumulation around the site where the tube was inserted.]

‘Is it pus?’

[I cannot be 100% certain without Yeongje, but it is reasonable to make that judgment.]

‘Damn.’

Based on the test results, the patient had developed an infection in the transplanted kidney. It was not a mild infection as it had already spread throughout the body. Fortunately, the chest X-ray appeared clean; however, pneumonia could develop at any moment given the current situation.

“First… I’ll admit him under Professor Shin Hyun-tae.”

Suhyuk decided to admit the patient before sending out any notifications. This wasn’t due to arrogance or overconfidence.

It was because Manager Shin Hyun-tae had delegated all authority to Suhyuk. At least, Suhyuk could admit patients without needing seniority or anything else. This could be considered one of the courtesies extended to national-level talents.

“Yes.”

“Furthermore, let’s start with Vanco.”

‘Vanco’ referred to vancomycin, a broad-spectrum antibiotic effective against resistant strains. Normally, it would be reserved for use after trying other antibiotics or when suspected during culture tests, making it a precious medication. However, there were times when principles needed to be broken for the sake of patients. In this case, simply observing and waiting would essentially mean sentencing the patient to death.

“Yes, ma’am.”

“And…”

Suhyuk was well aware that it took considerable time before patients could be transferred to their rooms after being admitted. He also knew he needed to save as much time as possible for this particular patient.

“You can drain it yourself. Your legs may not function properly, but your hands work fine.”

‘Me? Without calling for a surgeon?’

“It’s all about saving time. I will guide you through it.”

‘Hmm.’

Suhyuk hesitated while examining the swollen surgical site on the patient. He felt uneasy performing such a procedure without being a surgeon by training.

“A mere 1 cm incision should suffice.”

However, with Baruda’s guidance, Suhyuk believed it was feasible. It would be more like a minor procedure than a full-blown surgery.

Moreover, Suhyuk had received various training from Baruda, so he felt confident in his abilities.

Scrrrk.

Suhyuk pulled up a chair next to the patient’s bed and sat down. The patient, who had been keeping their eyes closed all this time, suddenly opened them wide at Suhyuk’s approach. Despite showing signs of life, they lacked the energy to move much.

Nonetheless, Suhyuk faced the patient and began speaking gently.

“Patient, you have an infection here. Does it hurt?”

He pointed to the area requiring surgery.

The patient gave a slight nod, responding with a hoarse voice:

“Ahh…it hurts.”

“I’ll make it feel better for you. It might sting a bit, but is that okay?”

“I can…handle pain…”

“Yes, I’ll minimize your discomfort.”

As Suhyuk spoke, he glanced back at the intern.

The intern’s eyes widened as he had no idea what Suhyuk was planning to do.

“Ah, give me the incision set. Stand opposite me and assist.”

“W…you’re going to cut him here?”

Initially, Suhyuk himself was surprised when Baruda explained it earlier, but now wasn’t the time to show any hesitation with a patient right in front of him. He needed to appear as confident and skilled as possible. After all, he believed he could perform this procedure successfully.

“I’m proficient at this. Bring it over.”

“Umm… Yes, sir.” The intern nodded and rushed off to fetch the set.

As they observed this exchange, murmurs once again spread among the emergency room medical staff. It wasn’t just the simplicity of the procedure that shocked them; the fact that an internal medicine doctor seeking surgical tools was equally surprising.

“What? Is he performing surgery too?”

“He must be some kind of prodigy…”