Chapter 71: Dyspnea (1)

“Ha.”

An Dae-hoon, who had just completed his first year as a resident doctor, hung up the phone with a soft sigh.

If only he could move swiftly like Lee Suhyuk during his intern days last March. He wished to confidently diagnose patients with conditions even professors couldn’t identify offhand. However, reality was a mess.

“Huff…huff.”

Despite being merely 23 years old, the young patient struggled for breath, and An Dae-hoon felt helpless on his own.

“I’ve done the arterial blood test!”

Turning away from his deep sighs, An Dae-hoon noticed Woo Hayoon, a newly minted intern still grappling with nerves.

‘Why did she have to start her emergency room rotation in March…’

An Dae-hoon empathized with Woo Hayoon’s nervousness as he knew how she felt.

“U-um, let me see.”

“Yes, sir. Here is the result.” Woo Hayoon tried to hide her nervousness by maintaining a calm demeanor while handing over the test results.

“What do you think, senior?” As usual, Hayoon was friendly and approachable even amidst the emergency room chaos. Her camaraderie was heightened due to being part of the same club as An Dae-hoon.

Oh, damn.

Dae-hoon wanted to meet Hayoon’s expectations, but it proved challenging. The patient’s arterial blood gas analysis showed no significant abnormalities.

Is this just hyperventilation…or something else?

The oxygen saturation level was at 100%. Carbon dioxide levels were slightly lower than normal, while the pH value was slightly higher.

The body was becoming alkaline as carbon dioxide was being expelled from it. An Dae-hoon, who had been an intern just two days ago, could only think of hyperventilation syndrome as his diagnosis. However, the patient seemed to be struggling too much for simple hyperventilation. Hyperventilation shouldn’t cause the muscles between the ribs to contract significantly.

‘Ugh.’

As he sank deeper into confusion, he heard footsteps approaching from somewhere nearby.

Tap.

Tap.

These steps sounded slightly different than usual, which made them more welcome.

It was Suhyuk.

“Hello!”

Upon spotting him, Woo Hayoon immediately bowed deeply in greeting. March interns were known for their strict adherence to hierarchy, but her deference appeared excessive even by those standards.

Her greeting was filled with admiration for Suhyuk.

“Huh? Oh…you’re doing your internship now?”

“Yes, senior. It has been awhile.”

“Apologies. I mentioned wanting to meet up, but it’s been hectic.”

“It’s okay. You really have been busy.”

“I’ll see you often this month since we’re both in the emergency room. Let’s grab a meal together sometime.”

“Really? Yes, thank you!”

Hayoon seemed desperate to stay longer, but as a March intern in the ER, she essentially had no free time. This applied regardless of whether one belonged to the Royalty or not. Especially for someone like Hayoon, who always strived to do her best, the workload would be even heavier.

“Yes, coming right away!”

Soon, he had to rush towards another patient. Even as he did so, his eyes kept switching between the test results and the patients. In other words, An Dae-hoon was deeply troubled but couldn’t reach any conclusion when he approached Suhyuk. He looked extremely subdued, as if he felt guilty of some crime.

“I thought you would do something.”

Baruda spoke with a disinterested tone while observing this first-year intern, An Dae-hoon.

Don’t be too harsh on him. All first-years act like that, especially during March.

Even Baruda himself had been filled with enthusiasm back then. Fortunately or unfortunately, he met Baruda early on. Otherwise, he would have experienced many trials and errors. Through those experiences, he would’ve realized how insignificant he truly was as a doctor. One didn’t need to look far; just compare yourself with your peers at a similar level, and it became apparent. There were things in life one simply couldn’t overcome through effort alone.

Before one gained experience, all knowledge inside their head was useless to them.

“A blood test for arterial blood gas analysis? What do you think?”

“I-I believe it is hyperventilation syndrome.”

“Hyperventilation…?”

Suhyuk had eyes too. In his opinion, this patient wasn’t suffering from simple hyperventilation syndrome. The patient really looked like he was having difficulty breathing. Of course, his respiratory rate was high, but that was probably compensating for his labored breathing.

[His breaths are shallow. His respiratory rate is close to 40 per minute, yet there isn’t much decrease of carbon dioxide levels in his blood.]

‘Is there fluid buildup somewhere?’

[Most likely. Please examine him closely.]

‘Ok.’

Suhyuk strode towards the patient.

“How are you doing? Hmm. Mr Kim Sungjoon.”

“Yes…huh…”

“Did your symptoms start a week ago?”

“Yes…”

As Suhyuk asked questions, he started examining the patient’s body.

Since he was quite young, he looked very healthy. However, there were some abnormalities that couldn’t be ignored.

[You seem to have lost some hair.]

‘The top of his head is balding by two or three centimeters.’

[Are you stressed out?]

‘I don’t know. Hmm.’

Firstly, he had alopecia. There was a circular patch of alopecia near the top of his head.

[Your cheek seems red.]

‘It doesn’t look like sunburn. Rather…’

[Does it look like a rash?]

‘Yes.’

[Hmm.]

‘He has no underlying health conditions.’

Suhyuk continued talking with the patient while mentally noting down the abnormalities.

In any case, since the patient was having difficulty breathing, it was better for Suhyuk to speak slowly.

“Did you show any symptoms before this?”

“No. Ah, umm…huh…han…a year ago…”

“Yes.”

“Tuberculosis… I have been treated for it… before.”

“Tuberculosis?”

In cases where tuberculosis wasn’t completely cured, there was always a possibility of recurrence. However, it might not be related to hair loss or facial rashes as they could arise from different causes. Trying to attribute everything to one cause right away often led to difficulties - this was something Suhyuk had learned while organizing past year’s cases with Baruda.

“Have you ever been diagnosed with diabetes or high blood pressure?”

“No? Ah, no.”

Perhaps due to their young age, the patient seemed free of any underlying chronic conditions. Suhyuk asked about surgical history and other health issues but found nothing significant.

“Alright, let me listen to your lungs now. Oh, have you gotten an X-ray yet?”

“N-no. Not yet…”

“Then I’ll prescribe now while conducting the examination.”

“Yes, yes.”

After prescribing medication to An Dae-hoon, Suhyuk tapped on the lower lobe of the patient’s lung. He felt something dull, indicating that it might be congested. In the past, Baruda would not have been helpful during such physical examinations, but over the last year, he had accumulated considerable data related to his senses.

“It feels like… There is fluid present.”

‘Indeed… We need to take an X-ray urgently. Since there’s no fever… It could potentially be tuberculosis.’

“Yes, I agree with you.”

There was once a period when tuberculosis cases rapidly declined. However, as international travel increased and more people entered Korea from abroad, the infection rates gradually started rising again.

In other words, tuberculosis could not be ruled out completely.

“I will check your stomach as well. Can you lie down for me?”

“I-I…if I l-lie d-down, it’s harder to breathe… Haaah…”

“Please hold on.”

“Ummm…yes.” The patient reluctantly lay back.

After all, they were at a hospital, so shouldn’t they follow the doctor’s instructions? Moreover, based on Hayoon and now Daejoon’s deferential attitude towards Suhyuk, he seemed quite important.

‘Hmm. Why is his spleen enlarged?’

Meanwhile, Suhyuk rapidly scanned the patient’s abdomen.

[Indeed. We should suspect some systemic disease.]

He noticed the enlargement of the spleen, which was rather unusual. The patient was young, and there were no underlying health issues mentioned.

As Suhyuk was lost in thought, An Dae-hoon approached him.

“Doctor, she is ready. We can proceed now.”

“Oh, right. Sorry, could you please escort her to get the X-ray due to my leg?”

“No problem at all! Not at all! I am happy to help! I’ll take her there!”

“Thank you.”

“You’re welcome, sir.”

With gratitude, An Dae-hoon escorted the patient to the X-ray room. Thanks to this, the patient mistakenly believed that Suhyuk wasn’t just a second-year resident but possibly a very young professor.

I should listen carefully to whatever he says…

Unexpectedly, An Dae-hoon played a positive role in managing the situation.

In any case, chest X-rays typically don’t take much time, and the patient didn’t have mobility issues either.

As a result, An Dae-hoon quickly returned with the X-ray results.

“Sir, here it is!”

“It hasn’t come yet.”

“Should I ask for them?”

“No, no need for that. Oh, there it is.” Suhyuk chuckled at An Dae-hoon’s enthusiasm and turned towards the X-ray image.

He then clicked his tongue disapprovingly.

The lungs indeed had fluid buildup, but not just there.

‘There…is water in the pericardium.’

[It is pericarditis. Tuberculosis can also be a cause of this condition.]

‘Let’s remove the liquid first. There seems to be too much. The heart rate is already at 110 bpm. If we don’t act, the heart could fail…]

[I suggest asking Director Lee Hyunjong for assistance.]

‘No, I can do this.’

[Ah. Indeed. It seems possible.]

If it required cardiovascular angiography, Lee Hyunjong would definitely be needed. However, couldn’t this be handled by observing with ultrasound from outside?

Of course, attempting such a procedure as a second-year resident was beyond audacious and verging on insane. Yet, Suhyuk wasn’t your average second-year resident. He had already performed similar procedures multiple times.

“I need to examine the cardiac ultrasound, so please bring the ultrasound machine here.”

“Oh, yes! Should I notify the fellow doctor too?”

“Huh? No, I’ll inform him later. Let me take a look first.”

“Ah… As expected!” An Dae-hoon thought about Lee Suhyuk being a genius as he rushed to bring the ultrasound machine. Since it was Taehwa Hospital, even the emergency treatment room had cardiac ultrasound equipment available.

“Hmm.”

Suhyuk skillfully turned on the device and placed it on the patient’s chest.

“It might be cold.”

“Uhh… Yes.”

“If you bear with it for a moment, it will feel better soon.”

“Yes…”

The patient found it much harder to breathe lying down compared to sitting up. It was inevitable since there was fluid around their heart. Fortunately, Suhyuk was very proficient at using the ultrasound machine.

“It stings.”

I wondered when he had disinfected the area as he immediately found the spot and inserted the needle.

“Ugh.”

“It is draining well now.”

“Yes, yes…”

Suhyuk was able to extract around 100 cc of fluid. Just thinking about this enormous amount being present within the pericardium, it was easy to predict how much discomfort the patient must have experienced.

“Huh?”

Contrary to expectations, the patient seemed very comfortable now.

“How do you feel?”

“B-better. Am I cured now?”

The patient even asked if they were completely healed. Of course, that wasn’t possible.

“Nope. Now the treatment will begin. It can recur again. You need to be hospitalized.”

Suhyuk spoke while looking at the fluid he had just extracted. It wasn’t completely clear but neither was it turbid.

[Tuberculosis doesn’t seem to be the cause.]

‘Is it a viral disease?’

[For now…for now, I don’t know yet. More information is needed.]

‘I’ll admit him, so let’s observe for now. Nothing will happen within a day or two.’