Chapter 64: What's the Big Deal? (2)

“Here it is.”

The intern swiftly brought over a set of surgical instruments with utmost professionalism. It was possible due to assistance from nurses, and naturally, this wasn’t a common occurrence. Although Suhyuk had only one year less experience than his colleagues, he was clearly favored by Internal Medicine. Moreover, he was the son of Lee Hyunjong, the most successful director at Taehwa Medical Center. As someone aspiring to continue training at Taehwa, the intern couldn’t help but comply.

“He truly embodies Lee Hyunjong’s excellence,” Baruda remarked contentedly, treating Suhyuk almost like a third-year chief or fellow despite his junior status.

On the other hand, Suhyuk appeared slightly nervous, although diagnosing patients was routine for him. However, wielding a scalpel on a patient was not something he was accustomed to, making his apprehension understandable.

It wasn’t surprising for someone to be nervous when wielding a knife on a patient’s body. It would have been more unusual if Suhyuk wasn’t anxious.

[F-Firstly, the incision point is exactly where you inserted the tube earlier. Easy, right?]

‘Yes.’

With Baruda’s assistance, Suhyuk was confident he could perform this perfectly.

[Use Betadine centered around that spot. In circular motions, gradually increasing the area. Yes, perfect.]

Suhyuk had not only mastered textbook knowledge but also watched numerous YouTube videos, so it would be foolish if he couldn’t execute these steps correctly. Fortunately, Suhyuk was quite intelligent and not foolish, allowing the surgery to progress smoothly.

[Instruct the intern to hold gauze and stand by.]

‘Ah, yes.’

Suhyuk followed Baruda’s instructions by waiting for the intern and then picking up the anesthesia syringe. In ancient times, when both patients and doctors were full of fighting spirit, surgeries were performed without anesthesia. However, those days were long gone. The correct approach was to minimize pain whenever possible.

“You might feel a slight pinch.”

“Yes…”

After informing the patient about the upcoming injection, Suhyuk administered local anesthesia near the incision site. Using a dental syringe, known for its incredibly thin needle, along with following Baruda’s advice precisely, ensured minimal discomfort for the patient.

[If you do it better, it won’t hurt at all. The patient grimaced just now.]

‘It’s fine. This is good enough. I’m not performing surgery.’

[That may be true. It’s just slightly disappointing.]

‘Let me know next time. Should I use a knife?’

[Yes. Cut approximately 1 cm deep and 0.5 cm wide around the area where you previously disinfected. There will be some bleeding, but it should not be severe.]

‘Okay.’

Despite receiving slight criticism, Suhyuk remained focused as he picked up the scalpel. He cut at the spot indicated by Baruda, which also appeared to him as the core of the abscess.

“It doesn’t hurt?”

“Huh?”

“No, it feels good now.”

“Oh, okay.”

I confirmed that there was minimal anesthesia applied.

Ziiip.

At the same time, pus started gushing from where the catheter had been inserted, likely connected to the transplanted kidney.

“Intern, press down gently above here. It might be painful for the patient.”

“E-eh, yes.”

Following Suhyuk’s instruction, the intern pressed firmly with gauze, and despite the tiny incision of about 1 cm, a significant amount of pus poured out.

“Wow.”

“I-I feel some relief now?”

The intern looked quite proud, even though they hadn’t made the incision themselves. This expression is common among medical staff when draining pus, but Suhyuk couldn’t share their satisfaction.

Many healthcare professionals made this expression when draining pus, but Suhyuk couldn’t help it.

Is this already… beyond repair?

[It still has functionality, but… if this level of infection continues, it will inevitably be damaged. We need to identify and treat the cause.]

‘Firstly, let’s perform a culture test.’

[That is a good idea.]

Of course, we planned to conduct a culture test on his blood as well. However, having more samples would always be beneficial. Moreover, this wasn’t just any random sample; it was obtained directly from the source of infection. Naturally, it contained not only bacteria but also dead white blood cells mixed within. In any case, performing a culture test on the pus would be highly informative.

“Wow… Look at that amount. He really hit the exact point.”

“Yes, it seems like he only extracted about 1 cm…”

“It isn’t surprising with Lee Hyunjong’s son. He is considered the greatest genius since the founding of this university hospital.”

“But Professor Lee Hyunjong said that Teacher Lee Suhyuk was more talented than him.”

After performing the culture test, Suhyuk continued to remove pus. As the emergency medical staff murmured, an enormous amount was being drained. Thanks to this, the patient’s face looked much better compared to before. It was natural as the bacteria and pus within his body were continuously being removed.

“T-Thank you.”

“No, it’s just part of my job. The patient seems stable now… I will see you upstairs. We’ll administer antibiotics before transferring them.”

“Yes, doctor.”

After removing the pus, Suhyuk inserted a drain to continuously extract any new accumulation. As promised, he sent the patient to their hospital room with vancomycin attached.

Next, he called Shin Hyun-tae.

“Hello, Professor. It’s me, Suhyuk.”

“Oh, Suhyuk. My nephew.”

“Well…that is a bit…”

“I heard the director wants you to call him ‘dad’. So, I need to adapt too.”

“No…”

“Alright. But what’s up? Oh, are you on duty?”

Shin Hyun-tae answered the phone warmly and exchanged pleasantries for a few moments before getting to the main topic.

Suhyuk wasn’t flustered as this atmosphere had been prevalent lately. He calmly continued with his perfect notification:

“Son Geumsuk, a 53-year-old woman diagnosed with hypertension 20 years ago and progressed to end-stage renal failure 10 years ago. She has been receiving dialysis treatment until undergoing brain-dead donor kidney transplantation one month ago. Currently taking immunosuppressants Cyclosporine and Mycophenolate Mofetil. Admitted two days ago due to generalized weakness, presenting with a fever of 37.8 degrees Celsius upon emergency room arrival, triggering this notification.”

“Ah… Sounds challenging. How’s her chest X-ray?”

“The lungs are clear, but there were signs of inflammation near the transplanted kidney area. We performed incision and drainage, extracting approximately 32cc of pus.”

“32cc? That’s too much… Then how is kidney function?”

“It’s slightly reduced, but urine output is still present.”

“Hmm.” Shin Hyun-tae’s voice had significantly lowered compared to when he first answered the phone. The patient’s condition was not just poor; it was nearing its worst-case scenario, which naturally affected his tone. Despite being a professor of Internal Medicine at a university hospital, constantly dealing with life and death, one could never truly become accustomed to such situations.

“Additionally, pus was detected in the urinalysis.”

“A urinary tract infection… But does it originate from the transplanted kidney?”

“Yes.”

“Hmm.” Shin Hyun-tae sighed once more.

It wasn’t that he couldn’t devise a treatment plan; rather, he was deeply concerned for the patient’s well-being.

“Has he received antibiotics?”

“Yes. We immediately administered vancomycin.”

“Good job. Let’s check on this patient first thing tomorrow morning.”

“Understood.”

“If anything unusual happens during the night, please call me. In the early morning, perform another chest X-ray, urine test, blood test, and ah, EKG as well.”

“Yes, Professor Shin,” Suhyuk nodded before ending the call.

Following both Shin Hyun-tae’s instructions and his own thoughts, along with Baruda’s guidance, Suhyuk implemented nearly perfect care for the patient.

However, when they revisited the patient the next day with Shin Hyun-tae, the reality they faced was far from reassuring.

“The fever… It’s now at 100.76°F. It has risen again.” Shin Hyun-tae frowned while checking the patient’s vital signs.

“Haa… Haa…” The patient’s breathing had significantly quickened since just last night, making communication difficult.

Just last night, there were no issues with the patient’s breathing, but now it had become significantly labored. This made effective communication difficult. The chest X-ray taken at dawn revealed the reason behind this change: their lungs appeared white on the scan, indicating severe infection.

“It has progressed to pneumonia.”

“But you administered vancomycin, right?”

“Yes, we started treatment immediately upon admission yesterday.”

“And cultures have been sent out?”

“Yes, but…”

It would take at least another week for the results. Normally, that wouldn’t be considered too long of a wait, but for this patient, it felt like an eternity. Given the current progression, fatal damage was likely within five days. By then, identifying the causative organism would already be too late.

“Could it be VRE?”

“It seems possible.”

VRE…

VRE stood for “vancomycin-resistant enterococcus,” referring to super bacteria that were even resistant to vancomycin, which was initially developed as an antibiotic against drug-resistant strains of bacteria. While infections from VRE had become less common, this patient suffered from chronic kidney failure and had undergone organ transplantation, meaning they’d spent far too much time in hospitals. It wasn’t surprising they’d been exposed to such bacteria somewhere along the way.

“We should switch antibiotics to imipenem immediately.”

“Yes, Professor.”

It was highly unusual to change antibiotics after using them for less than twenty-four hours, especially for someone like Shin Hyun-tae, an exceptional professor specializing in infectious diseases. Typically, it took about forty-eight hours for an antibiotic to take full effect.

However, there were times when principles needed to be broken. After all, no principle was more important than saving a patient’s life.

“And…move him to the intensive care unit. Intubate and monitor his vitals every fifteen minutes.”

“Yes, Professor.”

Suhyuk appeared slightly taken aback by the ‘every fifteen minutes’ part. Checking vital signs at such short intervals implied they would need to switch out nurses frequently.

But what could they do? The patient seemed likely to die otherwise. Suhyuk had no choice but to nod in agreement.

“Should I perform the intubation?”

“No, I’ll handle it. Please administer some sedatives first.”

“Understood.”

Suhyuk picked up the plastic tube he had prepared nearby, ready to insert it into the patient as soon as necessary.

The nurses administered sedatives and muscle relaxants to deepen the patient’s unconsciousness.

“Now,” prompted Baru.

Following Baruda’s advice as always, Suhyuk inserted the tube into the patient’s throat effortlessly, displaying his near-perfect intubation skills once again.

“You really can do anything.” Shin Hyun-tae briefly praised him before pulling the patient’s bed towards the intensive care unit.

“Let’s switch the antibiotics as discussed earlier. Have you heard of imipenem?”

“Yes, Professor.”

Suhyuk joined Shin Hyun-tae, pushing the bed alongside him towards the intensive care unit. As they arrived, he continued providing breaths through the newly placed tube while connecting the patient to a ventilator.

“[There is nothing left for me to prescribe now.]”

‘Of course not. I’ve handled several critical patients already.’

“[By the way… diagnosing remains problematic. We still haven’t identified the causative agent].”

‘I hope imipenem will work…’

Suhyuk quickly prescribed the medication and looked at the patient again. Until yesterday, the man had been conscious, but now he lay sedated in the intensive care unit with a breathing tube inserted. The situation was undoubtedly worsening fast, and Suhyuk’s only weapon was imipenem.

It was indeed a potent antibiotic, but it remained uncertain whether it would be effective or not.

The result could be confirmed the next morning, unfortunately, on the negative side.

“The pneumonia…has progressed further.”

“Imipenem also failed…”

“What is going on here? It’s too quick to blame immune suppressants…”

“Hmm…”

As Shin Hyun-tae and Suhyuk alternately sighed in front of their deteriorating patient, Baruda opened his mouth:

“[Suhyuk, I think we might have missed something.]”