Chapter 93: Multidisciplinary Approach (2)

As Suhyuk mentioned, the conference room was bustling with activity. It didn’t seem like a casual meeting but rather meticulously organized.

“The front row is reserved for professors.”

‘Blood Type, Surgery, Otolaryngology, Thoracic Surgery, Neurosurgery… Radiation Oncology, Nuclear Medicine, Medical Imaging, and Pathology departments are all present.’

“Isn’t this what multidisciplinary approach entails?”

‘Well, yes, but…’

The multidisciplinary meetings at Taehwa Hospital were never on this scale. They typically focused on one patient at a time, leading to only one surgical department being involved, and often not even all members from that department attended.

In South Korea’s healthcare system, multidisciplinary meetings were not part of routine treatment but rather akin to informal gatherings among doctors. Instead of being compensated for their time, these meetings often took place after hours at 6 PM due to concerns about interfering with other patient care.

“It’s still daytime… Yet, so many have gathered here. Who is taking care of the patients?”

‘Indeed… Are they visiting the hospital just for fun?’

For Suhyuk and Baruda, it seemed absurd that during prime patient consultation and surgical hours, the conference room was packed for a meeting.

“Dr. Lee, don’t stand there; come over here.”

As I briefly looked around, Hank tapped me on the shoulder.

“Oh, yes, sir.”

“Originally, these seats were for professors, but Dr. Jeremy is on vacation today. You can sit here.”

Without needing to be told, Suhyuk could easily identify the professor’s seat as everyone around him appeared significantly older. It was quite burdensome for Suhyuk to occupy such a position. However, he couldn’t refuse, especially since it was suggested by Hank, a foreign professor. He carefully placed his hands neatly on the table and sat down.

“Oh, yes, thank you.”

“Relax, don’t worry too much about etiquette.” Hank gestured towards someone nearby who had crossed their legs casually and even had their hand in their pocket. “He’s just in his first year here.”

“Huh?”

“It’s typical here, different from Korea.”

“Ah, I see. Thank you for letting me know.” Nodding, Suhyuk slightly relaxed his posture, though he refrained from crossing his legs or being overly casual.

However, Suhyuk didn’t cross his legs or act nonchalantly.

“The multidisciplinary conference will now begin. Our first patient is Thomas, a 67-year-old male. During our health screening, we observed a mass approximately 2 cm in size near the upper esophagus. After conducting a tissue biopsy, it was diagnosed as cancerous, and he has been admitted today. We plan to discuss this case for multidisciplinary input before the scheduled surgery tomorrow.”

As the multidisciplinary conference commenced, Baruda raised an eyebrow.

“Isn’t this a straightforward case?”

On the three screens displayed at the front, there were images from an endoscopy on the right, a CT scan in the middle, and a PET-CT on the left. While regular residents might not understand, both Baruda and Suhyuk immediately recognized the situation. They had already formulated a clear plan upon seeing the scans.

‘Um… Can’t we just remove it and reconnect?’

[Yes. Regardless of how much margin is given for resection, this location shouldn’t be difficult. If necessary, we can even remove the colon and perform a transplant.]

‘The postoperative treatment would involve chemotherapy… right?’

[Indeed.]

However, the professors began a deep discussion.

Hank started first, “How is the patient’s ability to perform daily activities? The neck appears quite thick based on the CT scan.”

“Ah… Although they can manage independently, their weight is significant… It’s uncertain how they will fare after surgery.”

“Do they have diabetes or high blood pressure?”

“Yes, both.”

“Hmm… I’m concerned about the safety of the surgery. What do you think?”

One of the professors seated across from Hank nodded in agreement. Based on his name tag, he was indeed a thoracic surgeon.

“The approach is problematic, but…the ENT department will handle it. They’ll clear out the lymph nodes around the neck as well.”

“Yes, we’ve got that covered. Fortunately, there’s no sign of invasion toward the airway on the scans. We can access it this way.” The professor sketched a rough diagram on the paper before him and began explaining their approach alongside the ENT specialist.

“Wait, wait. How far down will you be clearing the cervical lymph nodes? There appears to be a metastasis at level four on the left side.”

As Dr. Lim continued his explanation, the radiologist interrupted and pointed at the CT scan image displayed on the screen. Sure enough, there was a mass visible where he indicated.

“The PET-CT shows high glucose uptake, suggesting metastasis,” added the nuclear medicine specialist as they moved to the left side of the screen.

The ENT professor nodded in agreement.

“In that case, let’s perform a radical neck dissection on the left side… And likewise for the right.”

“Understood. Does this answer your question?” The attending surgeon turned toward Hank again.

Instead of nodding blindly, Hank glanced at the pathology department representative.

“Yes. Based on tissue analysis, malignancy is moderate… So securing a safety margin of about two and a half centimeters should suffice. It appears manageable.”

In summary: Despite being overweight with multiple systemic issues, surgically removing and dissecting the masses wouldn’t be difficult. Therefore, the plan was to proceed with excision followed by lymph node clearance before starting chemotherapy.

The patient was overweight and had multiple health issues, but the surgical approach and excision were not difficult. Therefore, they would first remove the tumor, clean up the cervical lymph nodes, and then start cancer treatment.

“Great. Then…after the margin results from the resection, we will determine the chemotherapy protocol. If the resection goes well, radiation therapy may not be necessary. What do you think?”

“I agree. However, if cancer cells are found in the margins, radiotherapy is essential.”

“Alright. Let’s move on to the next case…”

Realizing it, thirty minutes had already passed. Given that several professors discussed diagnosis, surgery, and post-operative care for each patient, this duration seemed inevitable. The other residents present also took it as a matter of course.

However, Suhyuk and Baruda felt differently.

“Are you serious?”

‘So… is this how they plan treatment for every patient?’

It wasn’t some high-level discussion. The conclusions reached by these professors weren’t significantly different from those Suhyuk and Baruda had drawn earlier. Nonetheless, Suhyuk felt a warmth in his heart.

These individuals were not merely focusing on the esophageal cancer case; they were considering the patient suffering from it. It might sound trivial as they were treating the same patient, but to Suhyuk, a doctor working in the field, this was profoundly moving.

“With this approach…regardless of who treats the patient, there shouldn’t be any mistakes.”

‘Yes… This system…is flawless.’

Moreover, this multidisciplinary approach itself served as perfect validation.

One person might make a mistake, but it was impossible for all these professors gathered here to err simultaneously regarding one patient. If this system were established, not just Taehwa Medical Center but healthcare in South Korea would take a significant leap forward.

However, as his thoughts deepened, he felt increasingly frustrated.

‘Should I be grateful that there is something to learn from this?’

[But this system cannot currently be implemented at Taehwa Medical Center.]

‘That means…’

Suhyuk couldn’t claim perfection for South Korea’s healthcare system, but it was undeniably quite advanced. This became even more apparent while working at a university hospital. At least, Suhyuk had never encountered situations where patients were turned away due to financial constraints within modern medicine’s limitations.

No patient was ever turned away due to lack of funds. However, what about the United States?

Today alone, two patients had to leave after their insurance failed to cover necessary treatments. It meant they would die because they couldn’t afford it.

This outcome could be attributed to a system designed for maximum efficiency at the lowest cost possible.

“Despite being overwhelmed with treating patients…how can we manage interdisciplinary care for all?”

However, there were inevitable drawbacks.

How does one achieve maximum effectiveness while minimizing expenses? There were limits to reducing costs associated with equipment and medication. Ultimately, hospitals resorted to squeezing more work out of their staff. In reality, even if just one person took a day off, university hospitals struggled to cope with the increased workload.

Well, that makes sense…

I must say, it’s quite fascinating to observe this debate. It gives me another opportunity to analyze their discussion format.

Yes. Hmm… Let’s see how it goes first.

Understood.

The two briefly discussed potential solutions before returning to the debate, seemingly worn out by their own conversation.

A different resident had taken over from the thoracic surgeon who’d been presenting earlier. Suhyuk couldn’t make out what specialty was written on the resident’s chest badge due to the distance between them, but he could tell based on the screen behind her.

[It appears to be otolaryngology.]

Bilateral neck mass… Ah.

As they explained, endoscopic images of the posterior pharynx were displayed on the right side of the screen, cervical CT scans in the middle, and whole-body PET-CT scans on the left.

“The next case is…Ben, a 42-year-old male. He noticed a lump on the front of his neck one year ago but opted for watchful waiting until experiencing hoarseness and difficulty swallowing two weeks ago. An ultrasound revealed thyroid nodules, leading to his referral here. There are two total nodules; a fine-needle aspiration biopsy from the central nodule showed papillary thyroid carcinoma.”

During the presentation, the resident clicked on the left screen. What appeared as a still image suddenly moved—it was a video clip.

“[The left side seems immobile.]”

‘Ah, it indicates vocal cord paralysis.’

“How strange.”

‘That’s right.’

Papillary thyroid carcinoma-it was often referred to as ‘benign cancer’. While questioning whether labeling any form of cancer as benign made sense, this particular type indeed had a remarkably mild nature.

In any case, it was known for its moderate nature. There were even research papers suggesting that surgery and observation had similar outcomes when dealing with tumors less than 1 cm in size.

So how could such a small thyroid cancer cause vocal cord paralysis? It seemed peculiar.

Suhyuk wasn’t alone in his doubts; Hank also appeared puzzled.

“By any chance, is there a reason why no fine-needle aspiration biopsy was performed on the mass located at the upper left?”

“Hmm… According to the records, there seems to be scar tissue in front, making it difficult to insert a needle.”

“Huh. Scar tissue present?” Upon hearing Hank’s murmur, the Radiology professor moved the mouse. As a result, the central cervical CT scan began shifting towards the mass at the upper left corner.

“It appears he had an injury here before. You can see the scar tissue.”

“Ah… Indeed, there is. But for this size of mass causing vocal cord paralysis… In other words, does it typically affect the recurrent laryngeal nerve?”

“That’s…not typical, but they do seem to be intertwined. Look over here.”

“Yes, I see. Hmm…”

The scan clearly showed the mass penetrating the thyroid capsule and affecting the nerves. The ENT professor nodded as he observed this.

“Therefore, we plan to perform a total thyroidectomy along with cervical lymph node dissection… followed by subsequent medialization thyroplasty. Considering his young age and occupation as a salesperson…”

“Vocal cord surgery… It seems possible.”

“Yes.”

“However, this is bothering me somewhat.”

The ENT specialist had already planned future surgeries. However, Hank found the shape of the mass at the upper left quite strange. Similarly, Suhyuk and Baruda noticed it as well.

[Video… If you look closely… There might be another tumor on the upper left side.]

‘Two cancers simultaneously? How could that be…?’

[Don’t you see it?]

‘I do see something.’

[Then raise your hand. The discussion is almost over. If we finish like this…]

‘Will I die?’

[Yes, you will likely die.]