Chapter 73: Dyspnea (3)

Until yesterday afternoon’s rounds, the patient had been doing well. However, the current state of the patient was far from good.

Both Shin Hyun-tae, who rushed over in surprise, and Jung Min-kyung, the rheumatologist treating the patient as part of their collaborative care team, wore grim expressions on their faces.

“When…when did this start?” Manager Shin Hyun-tae looked flustered as he turned to An Dae-hoon.

Dae-hoon shared his unease. Just yesterday, they were discussing plans for the patient’s discharge after the weekend. But now, the situation had taken a dire turn, with the patient rapidly deteriorating.

“Yesterday…last night. But it only lasted briefly before improving.”

“Hmm.”

“How was the patient’s urine test?”

Shin Hyun-tae closed his mouth, and during this moment, Professor Jung Min-kyung of Rheumatology spoke up. An Dae-hoon hastily began searching for the patient’s test results. It was natural as no one had memorized all the results perfectly.

“There was persistent hematuria and proteinuria. However, since the urine output matched the daily fluid intake, we were monitoring it closely.”

Of course, Suhyuk was an exception. His mind contained not only the patient’s test results but also most textbooks on medicine.

“And today’s chest X-ray?”

“I haven’t checked that yet. Apologies.”

Suhyuk wasn’t directly responsible for this patient; he was merely observing Baekman’s care. Therefore, he hadn’t been checking the patient’s status every morning. Moreover, he only learned about the issue when informed just now. Considering it was early Saturday morning at 6:30 AM, there was no blame to be placed.

He had just been informed about the issue moments ago. Moreover, considering it was 6:30 AM on a Saturday, there was no reason to blame anyone.

“No, it’s fine. Let’s check now. First-year resident?”

“Yes. Ah… here it is.”

“Hmm.”

At first glance, today’s chest X-ray appeared similar to yesterday’s. However, upon closer inspection, differences were noticeable.

“Here… The diaphragm line seems slightly blurred.” With Baruda’s assistance, Suhyuk quickly pointed out the change, indicating the lower left side of the monitor where the patient’s right lower chest area was visible.

“Ah… There’s fluid buildup.”

Despite rapid improvement due to steroid treatment, fluid had reaccumulated in the patient’s lungs.

What could be the cause? Suhyuk instantly had a hunch as he looked at the X-ray. As a professor of rheumatology with extensive experience treating systemic lupus erythematosus patients, Jung Min-kyung reached the same conclusion.

“Kidney failure… It seems that lupus has invaded the kidneys.”

Jung Min-kyung reported to Shin Hyun-tae since her rank was lower than his.

Shin Hyun-tae’s face darkened, and he nodded grimly.

The kidneys! They were vital organs.

“What do you think, Suhyuk?”

“Yes, I agree with your assessment. During acute inflammatory episodes, kidney involvement is common. The patient’s urine test results likely reflect this issue.”

“Then…”

“We need to increase the steroid prednisolone to 60 mg and add hydroxychloroquine. Ah, I’m sorry. I should have asked Professor Jung Min-kyung…” Suhyuk answered Shin Hyun-tae’s question out of habit before turning towards Jung Min-kyung. As a newly appointed associate professor, she was known for being quite strict. However, she also had a good understanding of Suhyuk’s expertise.

“No, no. As expected from you indeed. My opinion aligns with yours. Let’s make those medication changes first… And when her condition allows, we should promptly perform a kidney tissue biopsy.”

“A tissue biopsy? Isn’t it not just for diagnosis?”

“Yes. It is necessary to determine the type of medication.”

As the name suggested, a kidney tissue biopsy was quite invasive. With the patient’s condition deteriorating like now, performing it solely for diagnostic purposes would be unreasonable. However, if it could help decide on a treatment plan, the situation changed significantly.

“Then…we should proceed. I’ll explain this to the guardian. The test…”

“I will notify Professor Kim Jinsil from the Radiology Department.”

Despite being only in his second year, Suhyuk had surprisingly wide connections within the hospital. While rumors about him being the director’s son might have given him some leverage, his actual abilities were undeniably impressive.

Almost everyone who received treatment from Suhyuk once favored him. Thanks to this reputation, he could confidently contact professors from other departments, even on weekends.

“Yes, go ahead, Suhyuk. Professor Jung Min-kyung… I’m sorry, but please take care of the patient over the weekend.”

“Understood, Manager An. Don’t worry. I’ll treat her as if she were my own patient.”

With that arrangement, the patient was soon taken down to the ultrasound room on the first floor of the Radiology Department.

Normally, there would be no need for a resident to accompany her, but given her critical condition, it felt necessary. Besides, with it being the weekend, Suhyuk had nothing else to attend to.

“I apologize, sir. It’s all because of me…” Feeling deeply remorseful, An Dae-hoon repeatedly bowed his head.

“No, no. We’re on the same team. I should have been more attentive. Yesterday…when I saw him in the afternoon, I should’ve noticed…”

Of course, Suhyuk didn’t think that way at all.

[Indeed. Why didn’t we realize it earlier?]

Baruda shared the same sentiment.

Instead of blaming An Dae-hoon, both were criticizing themselves.

‘I should have checked his calf just once.’

[By the way…isn’t there a daily urine test?]

‘Yes, you’re right.’

[Have there been any changes in the results?]

‘There haven’t…been any significant changes.’

[Then can this be considered the cause of his symptoms?]

With An Dae-hoon anxiously pacing nearby, Suhyuk and Baruda engaged in a continuous dialogue. Given Baruda’s advanced analytical skills combined with Suhyuk’s growing expertise, their conversation was highly productive.

‘Hmm… It’s not the cause? Then what do you suspect?’

[I came here because I was unsure about it.]

Currently, Baruda stopped presenting any further opposition without alternatives. Of course, he would still oppose if it could harm the patient. However, Suhyuk realized that Baruda knew how to wait until he had better insights or analysis.

‘In any case, there is meaning behind performing a kidney tissue examination.’

[That’s correct. But we must also consider the possibility of obtaining inconclusive results.]

‘Hearing your thoughts, it seems valid… Hmm…’

[Suhyuk’s analytical abilities have significantly improved now, so please give it some thought.]

‘Understood. Hmm.’

With that, both fell silent, lost in their own contemplations.

“Oh, Doctor Suhyuk.” Suddenly, Professor Kim Jinsil appeared.

As it was the weekend, she arrived dressed casually, likely from home.

“Professor Kim Jinsil. I’m sorry.”

“It’s okay. The patient is urgent, so we need to examine them. But do you have someone who can review the test results?”

“Yes. Department Head Shin has been searching everywhere for such a person.”

“Is it a VIP case?”

“No, not exactly…but the patient is too young.”

“Oh, indeed. Both Manager Shin and Teacher Suhyuk… They are passionate. Very passionate.” Despite being on the weekend, Professor Kim marveled at their dedication before entering the ultrasound room.

Inside, the patient was waiting seated as they couldn’t lie down due to breathing difficulties.

“For the examination, you’ll need to lean forward momentarily. Is that alright?”

“Yes, it’s fine. We came prepared just in case,” replied Suhyuk instead of the patient, tapping on a set of intubation tools he had ready nearby.

She tapped on the biopsy set prepared beforehand. For someone from the Radiology Department, this was a moment of great significance.

“Okay. Then… Please lie down first. It might sting.”

With that, Professor Kim Jinsil promptly began the examination. Known for her skilled hands and dealing with a young adult patient, the procedure ended quickly.

“Now, press firmly here. If it’s lupus, there could be bleeding tendencies. Serious complications can arise if you don’t apply pressure.”

“Yes, Professor. Thank you very much.”

“You’re welcome. By the way, where should I go now? If there’s anything else you need me to do, let me know right away. We’ll handle it immediately.”

“No, Professor. There shouldn’t be any further issues.”

“All right then. Keep up the good work… And regarding the research paper, let’s discuss it next time.”

“Understood, Professor.”

With those words, Professor Kim Jinsil swiftly left the examination room almost as soon as she arrived.

As she mentioned, kidney biopsies could be quite risky for patients with systemic diseases like lupus. Due to this, An Dae-hoon applied strong pressure on the biopsy site as advised by Suhyuk, even though it was already wrapped with bandages.

“I don’t think there will be any bleeding.”

His firm and effective compression pleased Baruda. With this reassurance, Suhyuk headed towards the hospital room.

“Yes, Professor. I’ve sent up the sample.”

“Ah, good job. They’ll examine it right away. For now, let’s maintain your current medication regimen. As you requested earlier, Professor Jung Min-kyung has prescribed additional medications.”

“Understood, Professor.”

“Alright. If anything happens, please contact me immediately. I’ll be nearby the hospital.”

“Yes, sir.”

Suhyuk informed Shin Hyun-tae about the progress of his treatment.

I felt that Shin Hyun-tae had some plan, but I couldn’t completely relax. Thus, we headed to a restaurant near the hospital to have dinner with my family.

Meanwhile, Suhyuk and An Dae-hoon moved the patient to their hospital room before heading towards the cafeteria as well. Naturally, they didn’t go outside; it was the staff cafeteria located on the basement floor.

“We need to eat. Otherwise, we won’t be able to endure.”

“Yes, sir.”

Although these words seemed trivial,

An Dae-hoon took them deeply to heart, treating them like invaluable advice.

As they began eating the hospital food, honestly, it wasn’t great. It was Saturday lunchtime at the staff cafeteria, meaning only those on duty - residents, interns, or nurses working shifts - were present. Thankfully, it was Taehwa Medical Center; otherwise, the quality might’ve been even worse.

“Mmm.”

“Hoo.”

As they were eating their food, their phones started to ring simultaneously.

Vrrr vrrr vrrr.

Riiing riiing!

Suhyuk and Dae-hoon’s cellphones rang at the same time. Both of them showed the same number on caller id. It was the number for the hospital room where patient Kim Sungjoon was staying.

“Could it be…?”

They spat out what was in their mouth as they answered their phone.

“The patient…his blood pressure is dropping!”

“It’s now ninety over fifty-five!”

Ninety over fifty-five. If his blood pressure had dropped that quickly, it meant he had lost quite a bit. In such cases, patients could slip away in the blink of an eye. Healthy patients from other departments might have been able to endure this, but Internal Medicine dealt with different set of patients.

“I’m coming up!”

“I’ll be right there!”

Both residents got up simultaneously. There was still quite a bit of food left on their trays, but no one said anything about wasting the food.

Whenever residents moved this quickly, it meant someone’s life was on the line.

Du-du-du.

They ran towards the elevator. Of course, Suhyuk couldn’t run fast due to his injured leg. However, An Dae-hoon supported him as if their lives depended on it, and they were able to reach the elevator quickly. During this time, neither of them spoke a word. An Dae-hoon was panicking, while Suhyuk was conversing with Baruda.

[Is this bleeding from the kidney biopsy?]

‘Could that be possible? I pressed down so hard on her wound!’

[Then why is her blood pressure falling? We should first consider hypotension caused by internal bleeding. It is always best to consider the most likely cause first.]

‘I need to see for myself.’

[Let’s hurry, Suhyuk.]

‘Do you think I can make the elevator go faster?’

[Call the director. Maybe he knows something.]

‘Stop talking nonsense…’