Chapter 75: Dyspnea (5)

‘This bastard…’

In his confusion, Suhyuk called Baruda again, but there was no response from him. It appeared that Baruda had returned to the network once more. Considering he could only influence Suhyuk’s brain despite having access to a supercomputer, it wasn’t surprising.

“What about treatment?”

Meanwhile, the patient was transferred to the cardiac intensive care unit, commonly known as the CCU. As this was Shin Hyun-tae, the patient of Director Lee Hyunjong’s son with Baek overseeing, everything was prepared well in advance for his arrival.

“Prepare for intubation… and adjust the ventilator settings.”

Suhyuk swiftly gave instructions while ignoring Lee Hyunjong’s question.

Ideally, he wanted to take one minute for these preparations, but given the patient’s condition, there was no time to waste. Consequently, Suhyuk rapidly issued instructions and completed them within just 20 seconds.

‘Being overly efficient also has its drawbacks.’

He intentionally provoked Baruda again, but there was still no response.

‘Sigh.’

Suhyuk momentarily sighed before looking at the patient. The patient’s breathing had become labored now. Although their oxygen saturation levels were still maintained, it seemed highly likely that intubation would be necessary before the day ended.

‘Is simply focusing on respiration enough?’

He couldn’t help but recall the patient’s cardiac function he had observed earlier - barely reaching 15%. This indicated severe heart failure.

While stress cardiomyopathy typically resolved within four weeks, if her ejection fraction remained at 15% for just one week, it would likely lead to death. It meant they needed to take action urgently.

“For now, regarding the cause of stress cardiomyopathy…it’s advisable to continue treating lupus.”

“You mean steroids and immunosuppressants as before?”

“No. We should eliminate any medications that could burden the heart and use only steroids… Prednisolone 60mg.”

“Hmm.” Lee Hyunjong nodded with uncertainty, which was unusual for him. His reaction indicated his agreement but also conveyed doubt about whether this was truly the best course of action.

His skepticism was understandable. Such rapid progression of the disease at such a young age was indeed rare.

Despite being a genius, it was impossible to immediately devise a treatment plan. Suhyuk’s remarkable diagnostic flow had brought them this far, and Lee Hyunjong felt grateful for that alone.

“And…?”

“We need to check the blood pressure first…” As Suhyuk spoke, he glanced at the monitor attached to the patient’s head.

Despite administering medication earlier, the systolic blood pressure hadn’t recovered below 100. Additionally, the heart rate remained consistently above 120 beats per minute. If the heart stopped under these conditions, it would be fatal.

“What should we do?” Seeing the patient’s consciousness fading, Lee Hyunjong voiced his concern, revealing his uncertainty. This moment of doubt caused Shin Hyun-tae, who had been fully trusting Suhyuk, to almost scream in panic.

“H-Hyung. What should we do?”

“What else? The progression is too fast. This…this isn’t something the medical staff can handle.”

“Still…the patient is young. Every time I made rounds, I told the guardian that everything would be okay.”

“At that time…it was true then.” They didn’t know about stress-induced cardiomyopathy back then. They were just confirming the improving inflammation levels and lung images day by day. It wasn’t wrong per se; the situation had simply changed.

“That’s why I asked Suhyuk as well…but he also wasn’t clear.”

“W-Well of course. He’s only in his second year, not a professor yet.”

“But haven’t you praised him as being at a professor level before?”

“You agreed with it too, hyung.”

“Hey hey. Everything is fine, but this is a hospital. What if I call you hyung?”

“Do you want me to answer as Director Shin?”

“Huh? No. It seems like something I need to think about. However, can it be endured…that’s the problem.”

Lee Hyunjong continued to speak nonsense from Shin Hyun-tae’s perspective. Shin Hyun-tae kept shaking his feet, but that was all he could do. After all, Lee Hyunjong was the best when it came to heart issues, not just compared to Shin Hyun-tae. He likely remained the top surgeon in the country. Thus, they had to wait for Lee Hyunjong to present a plausible plan with solid reasoning behind it.

[Analysis completed.]

That would’ve been the case if not for Baruda.

‘Oh. Did something come up?’

[Suhyuk, it seems you read quite a bit. The relevant data has been inputted. It took some time due to the blur.]

‘W-What is it?’

[I believe this is currently the best option, but there may be resistance.]

‘Resistance? What…is it a dangerous treatment?’

[It could be seen as such.]

‘Shit…’

At the word ‘dangerous’, various treatments came to Suhyuk’s mind. If it was another organ, it might have been different, but this involved the heart. It could become extremely risky, with some possibilities beyond imagination.

[Let’s not go that far. What about artificial hearts? Are they available? Is it possible?]

Fortunately, Baru caught Suhyuk’s thoughts before they flew off towards Andromeda, providing a proper analysis:

[Firstly, we need to connect him to Ecmo.]

Of course, this wasn’t a straightforward treatment either.

‘Ecmo…? His heart hasn’t stopped yet. Ecmo is…’

Ecmo (ECMO) - Extra-Corporeal Membrane Oxygenation, also known as extracorporeal membrane oxygenation device. Simply put, it was a machine that replaced the functions of the lungs and heart.

In other words, this equipment forcibly extended the life of someone who needed or would soon need cardiopulmonary resuscitation.

[Based on data acquired by Suhyuk six months ago, if the initial ejection fraction due to stress-induced Takotsubo cardiomyopathy caused by Lupus is around 15%, there is a 90% chance of experiencing cardiac arrest.]

‘Six months ago…’

[The prognosis in this case is extremely poor. Most cases lead to death.]

‘That can’t happen.’

[Additionally, based on data acquired by Suhyuk three months ago, it has been reported that attempting Ecmo for two weeks regardless of the cause can have positive effects on patients with stress cardiomyopathy.]

‘That… makes sense.’

If Ecmo was used, the heart would be forced to rest during that period. If there were other causes such as a myocardial infarction leading to muscle death, the chances of recovery would indeed be slim. However, understanding stress cardiomyopathy as simply causing exhaustion rather than killing the cardiac muscles simplifies the situation. It implies that giving the heart rest could make a significant difference.

[However, if heart function does not normalize within two weeks, a heart transplant will be necessary.]

‘Huh… Why?’

[This is not yet statistically proven. However, this was the judgment from Mayo Clinic. The basis for their conclusion is that ‘two weeks on Ecmo is equivalent to four weeks without it’.]

‘It sounds plausible. Well… running Ecmo for more than two weeks can be burdensome. If there is no improvement by then, they would have to consider a transplant.’

[Is everything clear, Suhyuk? If you need further explanation, I am happy to provide it.]

Baruda noticed Lee Hyunjong and Shin Hyun-tae engrossed in their own world, completely ignoring Suhyuk.

To be precise, he was squeezing Lee Hyunjong for information.

“Ah, I don’t know… For now. This situation is quite rare?”

“The best heart surgeon in the world, right? Did you receive this from NEJM or something similar?”

“‘Something similar’? Where did this bastard learn such strange words? What does it mean? It’s making me really annoyed.”

“It means exactly what you understood.”

“This damn guy, seriously. Ah, let me see the data first.”

“With the patient in this condition, where do you think you’re going? Look here.”

“Wow, look at him. He insisted on being called ‘hyung’, but now he speaks to me like this.”

Suhyuk had a similar expression as Baruda. With a slightly disdainful gaze, Suhyuk shook his head.

‘No, I understand.’

[Then let’s end this ugly argument. I can’t stand to watch it anymore.]

‘Okay.’

Suhyuk hummed at Baruda’s words and tapped his cane on the ground. Suhyuk thought that becoming disabled might have one advantage - he could easily attract attention while eliciting sympathy instead of hurting others’ feelings.

“Hmm?”

“What? Suhyuk.”

Moreover, Lee Hyunjong and Shin Hyun-tae were well-known for being foolish towards Suhyuk. Even if Suhyuk had called them with something like ‘Hey, you bastards, do you have anything to say?’, they would still have turned around.

“Professor, there was a research paper published by Mayo Clinic that I read before.”

“Hmm, go ahead.”

Mayo Clinic was a world-renowned hospital located in Minnesota, USA. It could be considered one of the best hospitals globally without any objections.

“Due to acute lupus-induced myocarditis… patients with cardiac output as low as 15%, like this patient, have a staggering 90 percent chance of experiencing cardiac arrest within a week.”

“Huh? 90 percent? That high? What about Lupus?”

“Yes, that is what has been reported. They were cautious due to the limited number of cases, but this is the experience at Mayo Clinic.”

“Continue.” Lee Hyunjong now fully turned towards Suhyuk.

Seeing Lee Hyunjong’s attention, Shin Hyun-tae completely faced him.

“Due to this, I wonder about preemptive Ecmo insertion. It is not an easy choice, and we need to persuade the guardian but…it is too risky.”

“Ecmo… Hmm.”

The mention of Ecmo darkened both professors’ faces simultaneously. This was because Ecmo was used for patients who were practically dead. In particular, Shin Hyun-tae had been thinking that the patient wasn’t at that stage yet, but now he started looking even paler.

“Professor. He is already losing consciousness. His heartbeat may have weakened more compared to before. Considering the Dopamine infusion I administered prior to coming down here, the situation isn’t good.”

“Yes.”

Fortunately, Lee Hyunjong didn’t ponder for long. After all, he was considered a world-renowned authority when it came to heart-related issues. He hadn’t experienced this exact case before, but there were countless similar cases he had encountered previously.

“Dal-ja, contact the guardian and inform them we will proceed with Ecmo first. I’ll take responsibility. If the director agrees, you won’t have any objections, right?”

“Huh? The director?”

“Yes. Honestly, I was already considering Ecmo. But after hearing your explanation and seeing the patient’s condition, there’s no reason not to proceed. It’s too risky otherwise.”

“T-Thank you.”

“Yes. Then is it okay?” Lee Hyunjong asked while dialing thoracic surgery’s number. His expression suggested that there couldn’t be anything more to discuss.

However, this wasn’t Lee Suhyuk if he stopped here. He already had a plan in place—a meticulously crafted strategy for the next two weeks. Naturally, his lips started moving as he prepared to initiate it.

[Brrrmm-brrrm.]

‘Don’t add strange sound effects.’

[Pssshhh…]

‘And don’t make it seem uncertain.’

“Then please hurry and tell me. They look quite anxious over there.”