Chapter 67: Cause (3)

Undeniably, Shin Hyun-tae was an outstanding infectious disease specialist. Naturally, he recognized the name of the unfamiliar fungus, Scedosporium.

This made him appreciate Suhyuk’s greatness even more.

He… He truly is…

If Professor Jang Deoksu had provided this advice instead, Hyun-tae would still have been surprised but not to this extent. After all, Deoksu had dedicated his life to infectious diseases just like Hyun-tae himself.

However, what about Suhyuk? Wasn’t it only his first year?

“I request a change in medication.”

Even amidst the near-shock on Shin Hyun-tae’s face upon hearing Suhyuk’s words, Baruda didn’t hesitate to offer further guidance.

A diagnosis only held meaning when it led to treatment. If time was wasted trying to pinpoint the exact disease and ultimately lost the patient, there would be nothing more disheartening than that.

‘Boriconazole?’

“Yes. Based on the reported research papers so far, boriconazole is the most effective treatment for Scedosporium.”

‘Right.’

Suhyuk agreed with this assessment and promptly spoke up.

“Professor.”

“Hm? Yes.” Shin Hyun-tae seemed quite pleased, evident by his cheerful expression.

“Don’t we need to change the medication?”

“Oh, yes. Absolutely.”

“Should we start treating with boriconazole?”

“That’s right. We should use boriconazole. Yes, boriconazole.”

As their conversation shifted towards patient care, their expressions turned significantly more serious compared to earlier.

Scedosporium was observed on the pathology slide, and since the donor had drowned, it was most likely the causative agent. Boriconazole was the most effective drug against Scedosporium.

‘However, her current condition is not good…’

Regardless of how effective the medication might be, what mattered most was the patient’s state. If she were too weak, any treatment could prove futile.

‘It would be great if we could discontinue the immunosuppressants.’

Both the nephrologists and transplant surgeons advised against stopping them. The transplanted kidney’s function was already declining, and discontinuing the inhibitors could leave them with no options for recovery.

In Shin Hyun-tae’s opinion, they should first address the infection to ensure better outcomes later. However, modern medicine did not solely rely on individual opinions.

As his knowledge increased and deepened, even as a professor, he had to listen to others’ opinions.

“Yes, let’s continue with the inhibitor and add boriconazole.”

“It would be better to maintain antibiotics too, right?”

“That’s correct. It is likely a mixed infection.”

“Yes.”

In the early stages of infection, often only one type of bacteria causes problems. However, as the infection progresses, the affected tissues become increasingly vulnerable to other infections. In this patient, the primary issue was undoubtedly Scedosporium, a fungal infection introduced through the transplanted kidney. Nonetheless, it was crucial not to overlook other bacteria present.

Ignoring them could lead to significant complications.

“We need this medication to work effectively.” Shin Hyun-tae muttered while observing the administration of boriconazole following Suhyuk’s prescription.

If this drug works well, they might encounter a slightly improved patient tomorrow. Otherwise, they could be faced with a cold corpse.

As Internal Medicine dealt with patients having severe underlying conditions, death was commonplace, but it never became acceptable.

“I will observe him overnight from the intensive care unit on-call room.”

“Yes, adjustments to intravenous fluids and such may also have an impact.”

“Understood, Professor.”

“Right…” Shin Hyun-tae briefly glanced at Suhyuk before turning back to the patient.

The patient should improve after being admitted to the hospital. However, during each round of consultations, his condition worsened instead.

“See you tomorrow. If there is any deterioration, please contact me.”

“Yes, Professor.”

However, Shin Hyun-tae had numerous responsibilities beyond this patient. With multiple patients and his role as the department head, it wouldn’t be an exaggeration to say that the entire Internal Medicine department relied on him. Although he gazed at the patient for a moment longer, he couldn’t stay indefinitely and had to leave the intensive care unit. The thought of leaving the patient in charge of Suhyuk, the most competent resident he knew, somewhat eased his guilt.

“Suhyuk, I request you to find additional research papers related to this case.” Baruda immediately spoke up, almost as if waiting for Shin Hyun-tae to exit completely from the ICU.

‘Huh?’

[I believe the diagnosis of Scedosporium is correct. However, boriconazole being effective is under normal circumstances only. This patient has been infected under very special conditions.]

‘Ah, that’s…true.’

To Suhyuk, Baruda’s opinion made sense. Even with the same bacteria, the course of infection could vary greatly depending on the host’s condition. The treatment might also need to be adjusted accordingly.

Fortunately, this world was incredibly advanced, and for a fee, one could access research papers from any conference worldwide. Additionally, Suhyuk possessed the director’s login credentials passed down by Lee Hyunjong. As Taehwa Medical Center claimed to be the best hospital domestically, they had secured browsing rights for most medical journals by paying substantial fees.

Moreover, the main professors paid for access to even more conferences. It wouldn’t be an exaggeration to say that Suhyuk could access all published research papers.

‘Let’s see…’

Suhyuk immediately sat down at one of the computers located at the intensive care unit station.

[“Search ‘Scedosporium post-transplant infection’].” Baruda advised Suhyuk to search for infections due to Scedosporium after transplant surgery.

It seemed like an incredibly rare situation, but there were still numerous documents found during his search. The task now was to find useful information within these results.

‘First, let’s filter by number of citations.’

[Yes.]

Of course, Suhyuk had accumulated some expertise after reading numerous research papers. In many cases, the quality of a paper was lower if it had fewer citations, meaning fewer other papers referenced it as a source. While this wasn’t universally true, it generally held for most articles.

[Most have a low number of citations.]

In rare situations like this one, overall citation counts tend to be low since there is limited existing literature on the topic. With few references available, Suhyuk needed to employ a more labor-intensive method to sift through the papers.

‘Let’s start by reviewing the abstracts first.’

[Yes.]

‘Ah… This computer is really slow.’

[It’s just how hospital computers are.]

Baruda, who was once part of the world’s best computer chip, clicked his tongue as if disappointed by this state of affairs. Despite their impatience, it didn’t speed up the process, and they were forced to waste precious time.

‘Sigh.’

[Please continue reading.]

‘I feel like my eyes might fall out.’

[Based on my scan, your eyes are fine. However, there is slight dryness, so consciously blink more often.]

‘Sigh…’

[We need to save the patient.]

‘Yes, I know.’

The fortunate aspect was that Suhyuk was human, but Baruda wasn’t. This allowed them to approach the patient’s care with somewhat unconventional methods, albeit sounding strange at first glance. Yet, it truly reflected their approach.

‘Ah, this…this situation seems similar to ours.’

[Hm.]

Finally, past 9 PM, Suhyuk found a useful research paper.

[A paper published by MD Anderson and featured in the International Transplantation Society’s journal.]

The institution that published it and the academic journal provided credibility. While Taehwa Medical Center claimed to be the best domestically, MD Anderson was aiming to be the top hospital globally. It wouldn’t publish any frivolous papers lightly.

‘Let’s see… The donor drowned. They fell into a creek and passed away.’

[It aligns with the stagnant water aspect.]

‘There were approximately two fevers before being declared brain-dead. Both were classified as unknown causes of fever.’

[In the first case, the transplant recipient died.]

Thanks to his earlier suspicions, Suhyuk had already detected Scedosporium, the fungal pathogen. It seemed that MD Anderson discovered this pathogen only after conducting an autopsy on the deceased patient.

[Afterwards, internal guidelines were established at MD Anderson. In case of unexplained fever in transplant patients, they must review the donor’s records.]

‘Hmm… So for the second case… This patient also died.’

[The diagnosis was made after multiple organ failures had progressed. There would have been no way to save them.]

Multiple organ failure refers to the decline in function of major organs such as kidneys, liver, brain, and heart due to infection.

Even for someone who was originally healthy, falling into this condition often led to death. For transplant recipients, it could be considered a death sentence due to its severity.

‘The third case… This is where you saved them. Let’s take a closer look.’

[The diagnosis was made promptly. It was on the fifth day of fever.]

‘We were even faster. That’s encouraging.’

[This patient also had a kidney transplant.]

‘How was it treated? That’s crucial right now.’

[Please scroll down further.]

‘Understood.’

Suhyuk continued scrolling while exchanging opinions with Baruda. Fortunately, MD Anderson never overlooked the most important aspect when sharing experiences about significant cases - the treatment itself.

There was information about treatment.

‘The basic one is boriconazole, as expected.’

[They used combination therapy.]

‘This… This medicine seems unfamiliar.’

[Echinocandins. It is a type of antibiotic but rarely applied in clinical cases. According to data analysis, Taehwa Medical Center has it in small quantities.]

‘And… Ah. Can this also be applied?’ Suhyuk felt relieved that they were at Taehwa Medical Center and moved the mouse near the last medication. It was a drug called GM-CSF.

[Our patient’s immune system is suppressed, so I think it can be tried.]

‘Right? Macrophages indeed… They will help catch Jinkoon.’

The unfamiliar drug, also known as Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), stimulates the production of granulocytes and macrophages in our bodies. When administered, it activates the body’s macrophages, which are typically effective against larger pathogens, making it potentially beneficial in this situation.

[I request its application.]

‘Okay.’

Suhyuk briefly discussed the matter with Shin Hyun-tae, who naturally agreed and praised the decision while administering the medication.

Perhaps due to this intervention…

The next day, they encountered a significantly different patient.

“His oxygen saturation is increasing. How about the X-ray?”

“The lungs look clean. The medication seems to be working well.”

“Great… Suhyuk, you saved this patient.”

“Thank you.”

“You truly are a genius.”

As Shin Hyun-tae and Suhyuk exchanged compliments, Baruda sounded a warning:

[Suhyuk, it’s not time to relax yet.]

‘Why again?’

[The donor donated not only their kidneys but also their liver, heart, and lungs.]

‘Ahh.’

[The recipients of these organs are also at risk.]