Chapter 80: Young Yet... (4)

“What’s happening inside and why isn’t he coming out…?”

Professor Shin Hyun-tae could not hide his anxiety outside the hospital room. Thankfully, there were no screams heard from within. However, it was unsettling that Suhyuk had been inside for quite some time.

‘Why did he bring a microscope?’

Upon further reflection, this also seemed strange.

“Whoa.”

As he regained his composure, he realized he was standing in front of the hospital room. His unease must have driven him here unconsciously. He considered turning back but decided to peek inside since he’d come all this way.

‘Hmm…?’

When he looked, Shin Hyun-tae caught sight of Suhyuk from the side.

Suhyuk was observing something through a microscope with such seriousness that Hyun-tae felt guilty for not accompanying him earlier. Upon reflection, the ‘Lee Suhyuk is a Troll’ theory originated from Lee Hyunjong’s nonsense. Until now, Suhyuk had never shown any harmful behavior towards others. Although his actions were somewhat strange at times, just like right now…

‘But what…is he looking at?’

As soon as Hyun-tae felt assured of their safety, his curiosity surged. Conveniently, the microscope seemed to be designed for educational purposes, featuring an additional lens on the right side next to the main one. An Dae-hoon didn’t dare approach Suhyuk while he was engrossed, and the intern, preoccupied with finishing work quickly and resting, hadn’t utilized the spare lens.

The intern was thinking only about finishing quickly and returning the microscope to rest, so his lens remained empty.

‘Let’s see…’

Thanks to this, Shin Hyun-tae approached like he was possessed and looked through the lens. Lee Suhyuk didn’t notice Shin Hyun-tae because he was intensely focused on his own lens while conversing with Baruda. Of course, Shin Hyun-tae quietly approached without disturbing Suhyuk as much as possible.

‘What is this… This isn’t bone marrow?’

As soon as he placed his eye against the lens, his initial thought was ‘Has this bastard gone crazy?’ He never expected someone would suddenly enter a hospital room at dawn for a bone marrow examination. Moreover, he couldn’t believe they would examine the extracted bone marrow right there on the spot.

During his first year, Lee Suhyuk had been quite bold, but now as a second-year intern, he was completely reckless. What amazed Shin Hyun-tae even more was that not only did Suhyuk perform the bone marrow test perfectly, but also the angle of the microscope was spot-on.

‘Crazy… He already extracted the bone marrow? It looks like he did it with one strike… How is there so much? Is this guy truly a monster?’

Shin Hyun-tae believed he wouldn’t be surprised by anyone’s abilities after working alongside the genius Lee Hyunjong. However, ever since meeting Lee Suhyuk, he found himself constantly astonished.

Meanwhile, Suhyuk was muttering something to himself. So focused was he that he seemed unaware of speaking aloud.

“The cell count is 30%. It is normal indeed. It isn’t cancer.”

“It’s not reassuring that the bone marrow is normal…”

“That’s correct. A significant number of histiocytes have been observed.”

“And the reason for this…”

“Large multinucleated giant cells were detected.”

“Multinucleated giant cells are observed in Parvovirus infections.”

Parvovirus - also known as ‘Parvovirus B19’, it rarely caused acute hepatitis and histiocytosis when infected.

“This crazy…” Professor Shin Hyun-tae blurted out a curse upon hearing this information.

It wasn’t due to anger but rather shock. For someone like him, who was renowned for his good character, to react in such a manner indicated just how extraordinary the situation was.

It was just too surprising. For someone known as quite a respectable person to be involved in this matter… It truly was extraordinary.

“Uh, Professor Shin. When did you arrive?” Suhyuk finally noticed Shin Hyun-tae’s presence and looked away from the main lens towards him.

Shin Hyun-tae debated what to say before deciding on a vague explanation. “I just arrived. Since no one else was around, I thought you might be here.”

For a moment, An Dae-hoon appeared puzzled by his words but quickly bowed under Shin Hyun-tae’s unspoken pressure.

“Oh, I see,” Suhyuk nonchalantly accepted the explanation without giving it much thought.

However, Shin Hyun-tae couldn’t let it go easily. The conversation he had just overheard with Suhyuk continued to swirl in his mind, causing confusion.

“W-What did you say earlier? While observing through the microscope.”

“Ah… right. I will inform you about it now.”

“Yes, go ahead.”

Shin Hyun-tae was still puzzled as to why Suhyuk underwent bone marrow testing. To resolve his curiosity, he needed an explanation from Suhyuk himself. Shin Hyun-tae leaned against the wall, nodding vigorously, feeling slightly overwhelmed as a patient’s guardian listening intently to the young doctor’s words - someone who appeared quite authoritative to all present.

The doctor began, “Firstly, among the current issues facing the patient are fever, abnormal liver function tests, pancytopenia, elevated LDH and ferritin levels. Among these, I believe pancytopenia is the most critical situation.”

“Yes, that’s right. We conducted tests suspecting blood cancer, antibiotic suppression or autoimmune diseases.”

“None of those three results were satisfactory. It means we need to consider other causes…”

The situation had changed from yesterday. As a result, Shin Hyun-tae listened even more attentively and leaned forward, detaching himself completely from the wall.

“Hmm, yes. So what do you suspect?”

“Ferritin levels increase when red blood cells are destroyed, correct?”

“That’s true.”

“However, there were no abnormalities found in the peripheral blood smear test. This implies that the cause of destruction of this patient’s red blood cells is something else.”

“So…you suspected histiocytic phagocytosis? The bone marrow examination was done to confirm it.”

“Yes. As you saw earlier, there is clear evidence of histiocytic phagocytosis.”

“Uh, yeah… Right.”

In truth, Shin Hyun-tae could only identify ‘bone marrow cells’ under the microscope. It was difficult for him to determine if it was normal or not. This wasn’t his area of expertise. However, with his disciple confidently explaining it before him, he couldn’t admit his lack of knowledge and simply nodded along. Consequently, the conversation delved into more complex territory.

“The presence of histiocytic phagocytosis despite normal bone marrow findings indicates Parvovirus-induced histiocytic phagocytosis syndrome. The observation of giant proerythroblasts further supports this diagnosis, especially considering the signs of hepatitis, as Parvovirus can cause acute hepatitis.”

“Uh… right.”

Nodding, Shin Hyun-tae thought he would need to search or ask someone about ‘giant hemophagocytic cells’ later. Suhyuk assumed that Shin Hyun-tae understood everything perfectly. However, if Baru had analyzed Shin Hyun-tae’s expressions, it might have been different. Unfortunately, Baru was now intensely focused on devising treatment plans after completing the diagnosis.

“Therefore, I propose following the HLH-2004 protocol immediately,” Suhyuk recited Baruda’s recommendation verbatim.

“The HLH-2004 protocol…”

Shin Hyun-tae couldn’t help but feel astonished.

‘Actually, I’m not entirely sure about this…’

Even if histiocytic disorders were caused by infections, they no longer fell under the jurisdiction of infectious diseases specialists. Treatment typically involved immunosuppressive agents and steroids, with bone marrow transplants sometimes necessary depending on the progression of the disease. In other words, it was primarily managed by hematologists-oncologists.

It was impressive that Shin Hyun-tae had even heard of the HLH 2004 protocol for treatment.

“Since treating her effectively might be challenging within our infectious diseases ward, transferring care to Professor Taejin Jo from the Hematology-Oncology Department would likely be beneficial.”

Fortunately, Suhyuk had no intention of holding onto patients outside his specialty area.

The competence of nurses was as crucial to treatment outcomes as that of doctors themselves. For infectious diseases, it was best handled within the infectious diseases department, and for hematological conditions, patients had better prognoses when treated by the Hematology-Oncology Department.

As soon as Shin Hyun-tae heard about transferring Suhyuk’s case, he beamed and nodded enthusiastically. He’d been dreading having to treat something outside his expertise, so naturally, he welcomed Taehee’s suggestion.

“Yes, let’s do that. I’ll give him a call.”

“Understood, Professor.”

“And…who should be the primary physician?”

“I don’t have many patients at the moment, so I can continue seeing Mr. Yoon.”

“Oh, sure. That sounds good. I think Taejin would prefer that too.”

This was ideal for Shin Hyun-tae. A patient he wasn’t quite sure how to handle would now be transferred to another professor. He didn’t feel guilty about it at all, since it hadn’t been his fault. Regardless of what had happened, Sungyoon’s condition hadn’t been properly diagnosed until now. If the patient received proper treatment from here on out, his prognosis should improve considerably.

‘Probably…this is one of those rare cases…where histiocytosis was diagnosed this quickly…’

As he made the call, he realized just how absurd everything sounded.

The patient had only been admitted two days ago. Technically, less than twenty-four hours had passed since admission. Yet, they were able to correctly identify the cause of histiocytosis, which suddenly afflicted a young and otherwise healthy 21-year-old male.

‘This patient… If she doesn’t need a bone marrow transplant later, it’s all thanks to Suhyuk.’

What would have happened if she had gone to another hospital? It probably would have been delayed by at least a week. Firstly, deciding on the bone marrow test itself would have taken considerable time. Even if they conducted the test promptly, reading the results would have required one or two additional days.

‘Actually… The same applies to our hospital. Without Suhyuk…’

Taehwa Medical Center wouldn’t have handled it any differently. Without Suhyuk, nothing would have changed.

“Yes, Manager Shin. This is Taejin Jo.”

As Shin Hyun-tae’s thoughts reached this point, Taejin Jo answered his phone call.

“Ah, it’s not about that. One of my patients has been diagnosed with histiocytic necrotizing lymphadenitis. It seems to be due to parvovirus.”

“What? You have such a patient? Did you consult with other specialists?”

“No.”

“How did you diagnose it then? This disease is not easily suspected.”

Taejin Jo’s surprise was understandable. Even Shin Hyun-tae hadn’t considered histiocytic necrotizing lymphadenitis before Suhyuk mentioned it. The condition was extremely rare. While surgery or acute deterioration could be risk factors, the likelihood of developing this illness remained very low. Honestly, suspecting this disease seemed quite unusual and would be virtually impossible without an extensive knowledge base.

“Oh, well… I started suspecting histiocytic necrotizing lymphadenitis.”

Of course, he didn’t reveal this to his junior colleague Taejin Jo.

“Did Manager Shin really diagnose it alone?”

Taejin Jo wasn’t easily convinced either.

“Yes, damn it! Suhyuk did it!” Eventually, Shin Hyun-tae became angry.

“I knew it.”

“What do you mean ‘I knew it’? I am the professor, not him.”

“You are from the infectious diseases department.”

“So what about Suhyuk? How does he know something like this?”

“He is a genius, the greatest in Taehwa Hospital’s history.”

“That…that’s true. Really…I was surprised this time.”