Chapter 18: This is a bit difficult, isn't it? (2)

[Hmm...]

Unfortunately, Baruda's analysis didn't finish in an instant.

It seemed that the function of the head that Suhyuk had to use instead of the main body was somewhat inferior, as Baruda had mentioned.

Although he didn't want to admit it, it did seem to be the case.

"Um... Teachers, is there something wrong with the scan?"

Noticing that their conversation was unusual, the radiologist spoke up.

Since Suhyuk was still waiting for Baruda's response, the neurology resident and the radiologist had to answer.

"Yes... There's absolutely nothing unusual. Hmm..."

"There's nothing wrong? Oh, really..."

The radiologist, who had been in charge of MRI scans for a long time, could distinguish between normal and abnormal.

From his perspective, the patient's brain inside the MRI looked normal.

It was strange.

Given the patient's condition, it shouldn't have looked normal.

[Request additional tests.]

Just as the radiologist and the neurology resident were still pondering why it appeared normal, Baruda continued.

'What kind of test?'

[Request to expand the MRI scan to include the head and neck region.]

'Expand?'

[If the brain is fine, we need to consider other causes. There's a possibility it could be a spinal issue.]

'Well... That's possible.'

Why a lesion might have developed in the spine would be the next step to consider.

For now, it was more important to determine why the quadriplegia had occurred.

[It's best to make a quick decision. The scan will be over soon.]

'Ah.'

Suhyuk unconsciously looked towards the front of the imaging room.

The room had a transparent window, through which the patient being scanned could be seen.

Unlike the CT room, the MRI room's interior was designed to allow direct viewing because all electronic devices are inoperable inside.

Ding, ding, ding.

The slight vibrations and the patient's up-and-down movements indicated that the scan wasn't yet complete.

"Um..."

So, Suhyuk called out to the neurology resident and the radiologist simultaneously.

They had been talking for quite a while but hadn't reached a definitive conclusion.

As soon as Suhyuk spoke, they turned to look at him.

"Yes, Dr. Internal Medicine."

The neurology resident hadn't yet heard the rumors about Suhyuk.

Departments classified as minor often tended to be somewhat isolated from hospital gossip.

"If the cause of the quadriplegia isn't in the brain... What about extending the scan further down? If the contrast agent hasn't been administered yet... It might be possible."

"Oh. What's the current status?"

The radiologist quickly nodded in response to their words.

"Yes, the contrast agent hasn't been administered. If we proceed with the scan after the contrast agent, should we expand the area?"

"If possible, I would appreciate it."

"Hmm. Understood. The cervical region won't be visible in the pre-contrast images, but is that okay?"

Suhyuk hesitated for a moment at the technician's words.

How could he, who had just completed his first year and had only about a month left, decide whether it was possible or not?

"It's fine. I'll confirm it."

Fortunately, the neurology resident was present.

Thanks to this, the patient's scan could be changed to include the head and neck before the contrast agent was administered.

"Intern, the scan has been slightly changed, so it will take an additional 20 minutes!"

After delivering the message that would likely make the intern frown, the radiologist proceeded with the revised settings.

After some time, the images began to be transmitted one by one.

Starting with the head.

"Indeed, it's normal..."

The head images didn't change just because the contrast agent was administered.

However, as the image slices continued to come in, the expressions of the neurology resident and Suhyuk began to change strangely.

The nasopharynx.

The area near where the patient's cancer had been was terribly distorted.

"Recurrence...?"

The neurology resident shook his head in disappointment.

Instead of feeling sorry, Suhyuk tried to communicate with Baruda.

'This is strange. The patient only visited the ENT outpatient clinic last month.'

[According to the outpatient records at that time, there was no evidence of recurrence.]

'What about the images and endoscopy photos?'

Suhyuk recalled the patient's chart, which he had checked as soon as he arrived at the emergency room.

Since Baruda had already organized everything, it wasn't a difficult process.

'Sure enough, there was no recurrence at that time.'

However, the images being transmitted now suggested a recurrence.

The tissue was enhanced haphazardly by the contrast agent.

The lesion had even penetrated behind the nasopharynx.

"Oh."

And the lesion had even eroded the vertebrae and entered inside.

It meant that the spinal cord was invaded.

"This is..."

Suhyuk pointed at the image that had just been transmitted and continued.

"This is the cause of the quadriplegia."

"Yes, Dr. Internal Medicine. It wasn't a neurological cause. Hmm... I've never seen nasopharyngeal cancer be this aggressive..."

It couldn't be considered a cancer with a good prognosis.

Since it was located in a place not easily visible and often caused symptoms like nosebleeds, it was often discovered late.

However, this patient had been discovered when treatment was possible, and the treatment had been properly administered.

The chemotherapy had been administered precisely according to the cycle.

The radiation therapy had also targeted the nasopharyngeal cancer accurately.

'The chart and findings are so different... Isn't this strange?'

[It's not a typical behavior, but medicine is ultimately statistics.]

Baruda's words meant that anything could happen in medicine.

This was one of the reasons why a proper AI diagnostic framework hadn't yet emerged.

Of course, the lack of an AI capable of calculating all five senses was a much bigger reason.

Baruda, the only AI in the world to solve this problem, continued.

[The lesion visible in the images is likely a recurrence of cancer. I recommend treating it according to the recurrence protocol.]

'Hmm...'

But Suhyuk wasn't satisfied with the result.

He felt like he was missing something.

[Suhyuk, Suhyuk is not Sherlock Holmes. Follow the protocol.]

Of course, Baruda ignored such thoughts.

"Then I'll leave a note for the neurology department. After admission, please consult about the quadriplegia."

The neurology resident, confirming that it wasn't an issue for his department, patted Suhyuk's shoulder and left the imaging room.

By then, the scan was complete, and the intern who had brought the patient out of the MRI room covered the patient's face.

The patient had clearly been unconscious when brought in, but now their eyes were open.

"Huh?"

"Maybe it was too noisy during the scan... I'm not sure, but the patient opened their eyes."

"Can you step aside for a moment?"

"Yes."

Given the current scan results, it wasn't unusual for the patient to open their eyes.

If the brain was intact, the patient should have been fully conscious.

[Now that I think about it, it's strange. Why was the patient unconscious?]

'Are you asking that now?'

[Aha.]

Suhyuk silenced Baruda for a moment and approached the patient.

The patient turned their eyes with great effort to look at Suhyuk.

"Can you speak?"

"Yes..."

A hoarse voice came out.

It could be due to a dry throat, but given the lesion seen in the MRI, it was more likely that the vocal cords weren't functioning properly.

'Incomplete paralysis?'

This was also strange.

If the lesion was cancer, it would have caused complete paralysis, not incomplete paralysis.

Suhyuk accumulated several questions while asking the patient.

"Patient, do you remember when you lost consciousness earlier?"

"Ah... Yes."

"What happened? Were you just lying down?"

"No, no. I was in the bathroom... Suddenly, I couldn't move my body and fell. Then I lost consciousness."

"Bathroom...?"

"Yes, I had to urinate."

This meant that the patient was moving until just before the paralysis occurred.

[I don't understand.]

'What if an AI says that?'

[Then should it lie and pretend to know? No such AI exists, and it shouldn't.]

'Damn it.'

[When you run out of words, you curse. That's a bad habit.]

'Such a... dog.'

Suhyuk held back another curse.

It felt like Baruda was right.

Moreover, there were many more important things to do than argue with Baruda.

"Patient, for now, we'll take you back to where you were. I'll perform a few tests on the way."

"Um... Yes."

The patient nodded with effort.

In a normal situation, this wouldn't be unusual.

But now, it was very strange.

[Did the patient just move their head?]

The patient had clearly been described as quadriplegic.

The neurology resident who had just left had also noted no movement.

"Can you hold my hand?"

"Yes..."

But the patient was clearly holding Suhyuk's hand.

It was a very weak grip, but it wasn't complete paralysis.

[Is it not cancer?]

'You bastard... What are you doing?'

Suhyuk's reprimand made Baruda pause for a moment before counterattacking.

[Let's analyze the current patient's lesion in relation to the extremely limited number of cases Suhyuk has read.]

'If you analyze, just analyze. What's with the "extremely limited"?'

[It's just a statement based on facts.]

'Oh...'

[Let's start with the medical history.]

'...'

Suhyuk shook his head and turned back to the patient.

But in that short time, another change had occurred.

"Um...?"

The patient could only blink their eyes and showed no other movement.

Even the hand that had been holding Suhyuk's had fallen, completely limp.

"Can't you speak now? If so, blink your eyes twice."

The patient blinked twice in response to Suhyuk's words.

The fact that quadriplegia could change so unpredictably was simply astonishing.

'Should I notify the senior doctor first?'

Not knowing something and struggling with it could be considered a sin.

The patient would suffer the consequences.

[The analysis result... It seems more fitting to consider an infection or a necrotic disease rather than cancer.]

Baruda, who had completed the analysis, spoke with a somewhat uncertain tone.

'Why?'

[Because the number of cases is extremely limited.]

'You bastard...'

[Anyway, we need to consider other diseases besides cancer. Do you have any other ideas?]

'Just wait and see.'

Suhyuk closed his eyes for a moment.

What could have caused the lesion behind the nasopharynx in this patient?

'Infection?'

[There are no reported cases of infections causing such severe and selective nasopharyngitis.]

'Necrosis?'

[Autoimmune diseases rarely selectively invade the nasopharynx. 'Wegener's' is a possible candidate, but the probability is very low.]

All valid points.

One word caught Suhyuk's attention.

It was a word he had just mentioned.

'Wait. Necrosis?'

[Do you have any insights?]

'This patient received radiation therapy. Quite a high dose. To the nasopharynx.'

[Of course, it was for nasopharyngeal cancer... Oh!]

'I get it. I'll notify the senior doctor.'