Chapter 72: Dyspnea (2)

The patient was admitted under Professor Shin Hyun-tae for now. It wasn’t clear if it was an infection or something else, but considering his previous history of tuberculosis and fluid buildup in his lungs, this decision was made.

[As Manager An, transferring to another department is easy when needed.]

‘Yes, that’s true.’

Of course, there were some political considerations involved. Admitting such a young professor without proper justification could potentially lead to complications. Fortunately, if the initial diagnosis held up, treatment would likely proceed smoothly. However, issues might arise if the case required transfer to another department or even a different field entirely. With Shin Hyun-tae, all it took was a phone call saying, “Hey, can you take my patient?” But Sungyuk had to provide ample justification for any transfers.

How is the patient doing?

I haven’t received any calls during the night, so he should be fine. However, there probably hasn’t been much improvement.

‘Hmm.’

Suhyuk wasn’t sure whether to feel happy or sad at Baruda’s words as he headed towards the hospital room.

In front of the station stood An Dae-hoon with a nervous expression on his face. The patient chart in his hand was already crumpled from being handled multiple times since dawn.

“Ah, Doctor!”

As soon as he spotted Suhyuk, Dae-hoon gave him a deep 90-degree bow.

“Oh, no need for such… It’s alright.”

Feeling awkward, Suhyuk tried to stop Dae-hoon but realized that this behavior seemed ingrained and unlikely to change until death.

“Anyway, how’s our patient from yesterday? Kim Seungjoon.”

“Yes. The results from yesterday’s pericardial fluid test came back.”

“Ah. That is good. Can I see it?”

“Yes. Here they are.” An Dae-hoon pointed at the monitor with military precision just like yesterday.

As he mentioned, the examination results were displayed on the screen. There were numerous results such as Turbidity (degree of cloudiness), RBC (red blood cells), and WBC (white blood cells). Among them, Suhyuk first checked ADA (adenosine deaminase).

This test was primarily used to assess tuberculosis activity, and high levels indicated a possible presence of tuberculosis.

“[It shows 61 U/L.]”

That’s low.

“While we can’t completely rule out false negatives, the likelihood of tuberculosis is significantly reduced.”]

‘Then… it suggests another systemic disease.’

[Considering the patient’s hair loss and rash around the cheeks, we should take them into account. It is possible that all these symptoms have a single cause.]

Hair loss, rash near the cheeks, pericarditis, and pneumonia - there could be one disease causing all these issues simultaneously.

‘Could it be related to autoimmune diseases?’

[Given the patient’s young age, it is highly likely.]

‘I remember the spleen was enlarged… What were the results of other blood tests?’

[Only basic tests were conducted, but hemoglobin levels were at 9.5 g/dL with white blood cell count at 2600.]

‘Both counts are low. These are also characteristics commonly seen in autoimmune disorders.’

Based on yesterday’s patient observation and current test results, Suhyuk started to revise his diagnosis. An Dae-hoon felt slightly frustrated as this process was conducted without any explanation from Suhyuk.

‘Indeed… They say geniuses think differently…’

Of course, Dae-hoon might have been biased due to his admiration for Suhyuk.

“I request tests that can confirm autoimmune diseases: ANA, Histone Ab, Anti-dsDNA, ANCA IF, C3, C4, and CH 50.”

The tests mentioned by Baruda were typically glossed over during medical school by doctors outside of Internal Medicine.

These were unfamiliar terms to many doctors, but they were crucial for internal medicine specialists as most autoimmune diseases could be diagnosed using these tests.

“Ah…”

Suhyuk preferred not to waste time diagnosing patients, so he immediately began prescribing treatments. Witnessing this, An Dae-hoon’s mouth dropped open, still perplexed by Suhyuk’s actions.

It dawned on Suhyuk that he might have been too assertive in handling the case alone.

‘Professors would understand right away, but…’

An Dae-hoon was only in his first year, after all - it was expected that there would be gaps in his knowledge at this stage.

“Firstly, based on yesterday’s test results, the ADA levels were low. It indicates that it is not tuberculosis. However, the patient has anemia, a deficiency of white blood cells, and an enlarged spleen. What should we suspect?”

“Uh…”

“It’s okay since you’re only in your first year. Consider autoimmune diseases.”

“Oh… Ah! That’s why these tests were ordered?”

“Yes. You learned about them during medical school, right? But they might seem unfamiliar because they aren’t commonly prescribed. I experienced the same when I was starting out.”

Thanks to Baruda, Suhyuk could quickly correct his knowledge gaps, but indeed, he initially found the tests strange.

“Oh… So, should we change the medication then? Stop the antibiotics?”

“No, no. We need to be very careful.”

Based on the results so far, the possibility of an infectious disease had greatly decreased. However, it wasn’t possible to immediately suspect an autoimmune disease and use medication for it. The drug that needed to be used was steroids.

If the diagnosis was correct, there would be a response. But what if it was wrong?

‘The patient will succumb to bacteria or viruses…’

Steroids played a variety of roles. At the same time, they were really powerful drugs. They were also cheap. That’s why they were used in many departments for various conditions. Nevertheless, it was true that caution was required when using them.

There could be multiple reasons for issues with steroids, but currently, it was due to their immune-suppressing function.

‘A patient who previously responded well eventually passed away.’

He had witnessed a patient being consumed by fungal infection in real-time after unknowingly administering steroids despite the presence of fungi. It would have been better if they arrived earlier. Unfortunately, the patient’s advanced age and pre-existing conditions masked the initial symptoms.

Suhyuk did not want to repeat this experience with his own patients. In emergency situations where every second counts, he wouldn’t hesitate to use them without much consideration, but that wasn’t the case here. Therefore, opting for the safest approach was the right decision.

“We need to be careful with immunosuppressants. Let’s maintain antibiotics for now and decide after reviewing the test results.”

“Ah, yes.”

“I’ve prescribed the medications, so let’s check on the patient.”

“Yes, sir!” An Dae-hoon rushed towards the hospital room as if he was accompanying a professor.

If it were later in the day, they would have first confirmed whether the patient was in their room. However, it was barely past seven o’clock. Moreover, Kim Seungjoon’s condition did not allow him to wander around freely.

“Patient.” Thanks to this timing, Suhyuk encountered the patient immediately upon entering the hospital room.

Next to the patient lay the EKG performed earlier today, indicating that an intern had likely visited while An Dae-hoon was at the station.

“Ah yes, Doctor.”

The patient’s condition had significantly improved after yesterday’s pericardiocentesis procedure. Fortunately, it didn’t seem like he had consumed any stimulants again.

Suhyuk nodded with satisfaction and began by examining the EKG.

“The heart rate is within the normal range now.”

‘Hmm… But isn’t there…a slight weakening of electrical conduction?’

“A feeling? Have you forgotten about evidence-based medicine?”

‘No, no. It definitely seems slightly weaker. Compare it to yesterday’s EKG.’

Suhyuk was performing a task that no one else could manage. He mentally summoned the exact EKG from the previous day and compared it with the current one.

Baruda, who made all this possible, sounded somewhat uneasy after Suhyuk’s request.

[Upon closer inspection, it appears slightly weak.]

‘Is it due to the intern? Errors can occur in EKG readings.’

[I doubt it is an error. No one else would have detected this discrepancy.]

‘Still, include it in your analysis just in case.’

[Yes. Understood. I believe that is a valid suggestion.]

After quickly finishing his conversation with Baruda, Suhyuk once again looked at the patient.

“Do you feel feverish?”

“Huh? Oh…No, I’m fine.”

“How about breathing difficulties?”

“Much better now.”

“No coughing either?”

“Yes.”

As he asked these questions, Suhyuk confirmed the observations from yesterday.

‘Hair loss and rash around his cheeks. These symptoms haven’t changed.’

“I see.”

Meanwhile, one of the nurses entered the hospital room and rolled up the patient’s sleeve.

“We need to perform some tests. I’ll take some blood.”

“Ah, okay.”

She drew quite a bit of blood. Perhaps due to the young age of the patient, the test was straightforward.

Suhyuk briefly observed the extracted red blood before turning back to the patient.

“You should be able to see the results this afternoon. At that time, I will explain everything.”

“Oh, yes… By any chance, is it serious? My parents were worried when they heard about my hospitalization.”

“Hmm.” Suhyuk pondered for a moment, considering Baruda’s input.

Based on Baruda’s assessment:

“[Considering your progress so far, it doesn’t seem like it will lead to a very severe condition].”

‘Right?’

[Yes.]

As both his and Baruda’s opinions were similar, he cautiously gave a positive response.

“Do not worry too much. This is just part of the verification process.”

“Ah, yes… Thank you.”

“If any unusual symptoms occur, please let us know immediately.”

“Yes.”

Suhyuk reassured the patient before leaving the hospital room.

He returned to the room late in the afternoon after receiving the test results with Shin Hyun-tae.

An Dae-hoon acted like a human door opener, ensuring nothing obstructed their path.

“Patient, this is Professor Shin Hyun-tae. As Dr. Lee Suhyuk mentioned earlier, we have the results.”

“Ah, hello.”

“Yes, let’s include your guardian as well. First…”

Shin Hyun-tae decided it would be better for Suhyuk to explain rather than himself.

‘It is preferable for the person who made the diagnosis to speak.’

He looked at Suhyuk, and unlike other residents, Suhyuk confidently stepped forward without any hesitation. He recalled briefing Professor Shin Hyun-tae before their rounds earlier.

Although the ANA level decreased, the Anti-dsDNA is clearly elevated, and both C3 and C4 levels are low. It is definitely Systemic Lupus Erythematosus (SLE).

This had already been confirmed with Baruda, giving Suhyuk considerable confidence when he spoke:

“The test results indicate that the patient has systemic lupus erythematosus, commonly known as ‘SLE’.”

“That… Isn’t it a serious disease?”

“It is considered one of the difficult diseases to treat, but recently, it can be well-managed.”

“Still, isn’t it exempt from military service?”

To bring up military service here… Suhyuk was slightly taken aback, but he kindly responded.

“The patient’s condition has rapidly deteriorated, so with this level of Lupus, they are exempted.”

“Oh, I went for nothing…”

The patient seemed relaxed as their symptoms were currently under control. They appeared unaware of what it meant to live with a chronic illness for the rest of their life.

However, Suhyuk didn’t delve into the detailed hardships faced by Lupus patients. After all, they would gradually learn about them over time. It was best to focus on the immediate issues at hand now.

“Anyway, there is still some fluid accumulating around the patient’s heart. From the chest X-ray taken this afternoon, we can see that there is also fluid buildup in the lungs. Therefore, we will keep you hospitalized and start steroid treatment.”

“Oh…then it will be okay?”

“Yes. If you follow our instructions properly, everything should be fine.”

The patient nodded calmly, and Suhyuk wasn’t overly concerned either. This remained true until the weekend arrived, and he received a notification from An Dae-hoon.

“Doctor! The patient has a fever! And they’re having trouble breathing!”

“Suddenly today?”

“Well, last night…there was a brief episode, but it subsided quickly. However, it worsened this morning!”

“What could it be? I’ll be right there.”

Suhyuk felt like stepping on a landmine, as the inflammation levels had been steadily improving until this point.