Chapter 81: Proof of Genius (I)

“It is Lee Suhyuk.”

“What happened this time? Did you diagnose him with CJD? Didn’t I hear that was correct?”

“I heard if it wasn’t for Dr. Lee, the patient would have died.”

“There is also a rumor Professor Shin Hyun-tae knelt before Suhyuk because he didn’t know about the HLH protocol.”

“Wow… What is HLH protocol?”

“I don’t know either. How would I know something even the professor doesn’t know?”

As Suhyuk entered the emergency room, whispers could be heard from various directions. Most of them were due to An Dae-hoon. He had been present at the scene and, overwhelmed by emotion and immense admiration for Suhyuk, couldn’t help but share his account with everyone he met. As stories often do, each retelling exaggerated the events further until they reached their current state after about a week.

As with any tale, it became more exaggerated as it passed through people, and after approximately one week, the story had reached ridiculous proportions.

Are they crazy? Why would Professor Shin Hyun-tae kneel down to him?

Suhyuk was bewildered upon hearing this.

[Maybe he knelt internally. Don’t you know? The true genius of Taehwa Hospital is not Lee Hyunjong but Lee Suhyuk.]

‘Well… um…’

[Naturally, it’s all thanks to me.]

‘You’re quite…’

[Am I wrong?]

‘It might be true, but… keep quiet for now. We’re here to see patients.’

After calming Baruda, who seemed oblivious to time and place, Suhyuk looked around.

I looked like someone searching for a patient, and someone quickly approached me at this sight.

“Senior!”

It was Woo Hayoon. As it was nearing the end of March, she seemed more relaxed compared to when I first met her. It could be seen just by looking at her hair.

‘She dyed it.’

[Impressive.]

‘What is?’

[I remember during my internship days, Suhyuk’s hair was almost…]

‘Shut up, human. Focus on your task. Chest pain patient, chest pain.’

The fastest way to get treated in an emergency room wasn’t by screaming loudly and demanding attention from doctors. This would only earn you scornful looks without changing the order of treatment. Instead, clutching your chest upon arrival was guaranteed to expedite things.

Chest pain was a significant symptom that raised alarms among all doctors.

“Still, he is only an 18-year-old patient. It’s probably nothing serious.”

‘Well…you’re right about that. Let’s quickly check him and then go out for some good food.’

“Yes, but I received this call just fifteen minutes before my shift ended…”

‘Still, we have to respond when contacted. Anyway, let’s examine him swiftly. As you said, it might not be anything serious.’

Of course, not every patient with chest pain would receive such urgent attention from doctors. Chest pain in younger patients often indicated benign conditions, so there tended to be less urgency compared to older patients.

While they continued their conversation, Hayuni approached them.

“The patient is over there.”

“Ah, okay. How’s the patient history?”

Suhyuk had been passing by the emergency room when he received this call, so he hadn’t asked many questions beforehand. He only knew the age, name, and symptom of chest pain for the patient. Since Woo Hayoon was the one who contacted him, she quickly started to explain what she had gathered from her initial examination.

“So…firstly, the patient has reported experiencing pain for two days now. They visited a nearby internal medicine clinic where they were prescribed nitroglycerin, but it didn’t provide any relief, prompting their visit here.”

“Nitroglycerin?”

Nitroglycerin is typically administered when angina pectoris is suspected.

This meant it wasn’t a drug that could be prescribed to anyone by a local doctor. Naturally, Suhyuk’s eyes narrowed.

[Hrmm… Is this real chest pain?]

Baruda had similar concerns.

“Yes. He has epilepsy as an underlying condition and is currently taking 300 mg of phenytoin.”

“Phenytoin? For how long?”

“For about fourteen years…I believe?”

“He is only eighteen now but has been on phenytoin for fourteen years?”

“Yes.”

It meant he had developed epilepsy at four years old.

[A pediatric case of epilepsy. Hmm.]

Suhyuk walked shoulder-to-shoulder with Hayoon, his expression markedly different from when they first entered the emergency room.

“Hmmm… How is his EKG?”

“Oh, I have it right here.”

Suhyuk had heard through various channels about the interns applying for Internal Medicine positions. Among them was Woo Hayoon, who naturally stood out as the top graduate vying for a spot in Internal Medicine.

She was praised for her work ethic, and it shows.

“She is quick on her feet.”

In this world, there were doctors who didn’t bother with an EKG despite patients complaining of chest pain. Naturally, an intern carrying around an EKG report stood out among them.

“Hmm.”

Suhyuk immediately looked at the EKG handed to him by Hayoon. He quickly gleaned several pieces of information from it.

“It seems normal.”

At least, it wasn’t myocardial infarction.

The pulse rate is 90 bpm. Considering they haven’t been exercising, such a high heart rate… It indicates severe pain or bleeding.

It could be both.

Indeed.

Others might have dismissed it as normal based solely on the written diagnosis.

“The EKG appears normal.” Just like Woo Hayoon’s assessment.

“We need to observe further. Let’s monitor their clinical symptoms.”

However, Suhyuk had some suspicions.

This insight was possible due to his own experiences combined with the vast amount of knowledge and cases he had accumulated with Baruda.

“Over there.”

“Oh.”

The patient sat where Hayoon pointed. The pain appeared so severe that they couldn’t lie down, indicating it wasn’t simply muscle soreness.

“The distance between their eyes is wide.”

Moreover, this wasn’t the only distinctive feature of the patient. As Baruda mentioned, the space between their eyes was unusually large. While it could be considered a simple physical characteristic, Suhyuk couldn’t rule out a potential medical cause.

“Do you have any family members with heart conditions?” Suhyuk approached the patient, considering these possibilities.

The patient frowned deeply and shook their head. “I’m…an orphan.”

“Ms. Sellner, she grew up in an orphanage,” Hayoon added simultaneously, sharing information from her earlier inquiry.

“Ah, I see.”

Suhyuk looked at the patient again, who was in a similar situation as himself. He always did his best for all patients, but he felt slightly more invested this time.

“How is your pain?”

“When…when I am still…it feels better…but it hurts terribly when I move. It’s dizzying.”

“Dizzy?”

Her heart rate had increased. The pain was so severe that she couldn’t control her body properly, and now dizziness had set in.

“[Considering her age, this doesn’t make sense…]”

‘Do you suspect aortic dissection?’

“Yes, indeed.”

Aortic dissection literally meant the tearing of the aorta. However, it wasn’t about the artery bursting outward with blood. Instead, it referred to the inner lining of the multi-layered aortic wall being torn, allowing blood to flow between its layers.

In other words, there was no external bleeding, but it meant the patient would lose a significant amount of blood internally. This condition explained why the patient’s heart rate increased and dizziness occurred. Moreover, if this disease was missed, it could lead to the death of the patient.

“First… shall we call thoracic surgery? I’ll do an echocardiogram.”

The most urgent task in the emergency room is identifying conditions that cannot be overlooked. Thus, Suhyuk decided to prepare for an echocardiogram while asking Hayoon to call thoracic surgery.

Calling another department always made interns feel burdened. However, Hayoon was one of those who admired both An Dae-hoon and Lee Suhyuk.

Moreover, she was an intern aiming for Internal Medicine.

“Yes, sir. But…what should I tell them?”

“Oh. Based on the symptoms, suspecting aortic dissection will make them come down immediately.”

“Aortic dissection.”

Hayoon graduated at the top of her class, but she was still just an intern starting her March rotation. Considering her level of experience, it would have been almost impossible for her to consider aortic dissection under these circumstances.

I knew… An Dae-hoon’s advice was spot-on.

Thanks to Suhyuk’s actions, he now seemed like a god to Hayoon. The emergency room lights behind him even created a halo-like effect.

“I understand, sir!”

“Yes, great. I’ll leave it to you.” Suhyuk glanced back at Hayoon’s more confident response compared to earlier before turning his attention back to the patient.

The patient was still sitting hunched over and panting heavily. It appeared that they were experiencing extreme pain.

“I’ll perform some tests.”

“What? Oh, yes.”

“Can you lie down for me?”

“If I…lie down…it hurts…”

“It will only take a moment. Just briefly, please.”

“Ugh… Alright.”

Although the patient looked extremely reluctant, they complied. Considering their immense pain, very few patients would defy a doctor’s orders under these circumstances.

Vrrr.

As soon as the patient lay down, Suhyuk closed the curtain and brought over an ultrasound machine from the adjacent treatment room. Despite being only a second-year resident, his handling of the equipment was reminiscent of a cardiology fellow’s skill level. This wasn’t surprising, considering he had performed numerous echocardiograms under Lee Hyunjong. Although some grumbled about him receiving unwarranted privileges, everyone fell silent upon witnessing his proficiency. At least, they did so openly.

“This might be cold.”

“Oh, yes.”

The patient couldn’t bear to look at Suhyuk and turned their head away. To perform an echocardiogram, it was necessary to lower the top clothing near the neck area. Suhyuk, however, remained completely focused on the task without any ulterior motives.

The only thing that mattered was whether it was aortic dissection or not.

[Ah! There is dilation near the root of the aorta.]

There’s also backflow. The heart isn’t beating properly.

[It clearly indicates aortic dissection. For more accurate results, an endoscopic ultrasound would be better but…]

‘I don’t know how to perform that yet. It is too invasive.’

[Well, thoracic surgeons will be satisfied with this information. They can proceed with further tests if needed.]

‘Indeed. Hmm.’

In fact, up to this point, the role of Internal Medicine could be considered complete since they had identified aortic dissection as the cause for the patient’s chest pain. Under normal circumstances, Suhyuk would have stepped aside at this stage. However, something about this case felt unusual.

[What could be the underlying cause?]

The patient was only 18 years old, which meant they were too young to have this condition typically.

‘Pediatric epilepsy with the distance between the eyes…’

[You suspect it might be due to a congenital disorder.]

‘I don’t think so?’

[No, I believe your opinion is valid. The slight scoliosis further supports your suspicion.]

‘Hmm.’

In such cases, it was crucial to identify any underlying conditions. Even if Suhyuk successfully treated the aortic dissection, there was still a risk of death from other causes.

[Let’s start with a full-body examination first. It will take some time for thoracic surgery to arrive.]

‘Okay.’

Suhyuk promptly began examining the patient from head to toe once again. However, he couldn’t gather any additional information beyond what he had already noted.

He measured the distance between the eyes and checked for scoliosis.

“Would you like to try something?”

“Huh? Oh, yes.”

Next was the neck. It was somewhat unexpected request, but the patient accepted it. Almost no one refuses anything asked by doctors in emergency rooms.

[The hyoid bone is bifid.]

This should be enough to figure it out.

[I suspect it could be a congenital disorder weakening connective tissues.]

In normal individuals, about 2% have a bifid hyoid bone. However, observing a bifid hyoid bone in a patient with aortic dissection had different implications. This was especially true for Suhyuk, who possessed extensive medical knowledge.

‘I understand now, what it is.’