Chapter 20: This is a bit difficult, isn't it? (4)

"Radiation necrosis."

Professor Jo Taejin muttered the disease name that Suhyuk had just mentioned.

'Hmm.'

In his mind, he was furiously thinking.

More precisely, he was trying to match the symptoms Suhyuk had described with the diagnosis of radiation necrosis.

'Certainly... the degree of paralysis changing depending on the posture or condition is quite unusual.'

The characteristic of cancer is that it destroys tissue upon contact.

Of course, it can also cause inflammation when it merely comes into contact.

But causing such a dramatic change is extremely rare.

Or rather, it's almost non-existent.

'To suspect an infection would be out of the blue.'

There were bacteria and fungi that could cause such severe infections among the pathogens causing pharyngitis.

The patient had received chemotherapy, so their immune system might be weakened.

But to show such rapid progression without any signs of infection?

That would be quite unnatural.

At the very least, a competent internist should not consider infection from the start.

But it shouldn't be completely ruled out either.

Otherwise, the patient might be lost.

"That sounds plausible. What treatment will you use, then?"

Now, Professor Jo Taejin had stopped walking.

He hadn't expected the conversation to continue this far, but he was thoroughly enjoying the unexpected and engaging discussion with Suhyuk.

To be so engrossed in a conversation with a first-year resident was quite absurd, even to himself.

But what could he do?

The heated debate had already begun.

"If I could, I would start with high-dose steroids."

"Why?"

"Because steroids are one of the first-line treatments for radiation necrosis. They would be the most effective."

"But why did you add a caveat?"

Professor Jo Taejin had already formulated a treatment plan after hearing about radiation necrosis from Suhyuk.

'If radiation was applied...'

He no longer had any intention of applying radiation as initially planned.

Doing so would undoubtedly worsen the necrosis.

It might even cost the patient their life.

Or rather, the possibility was very high.

There were many case reports that documented such outcomes.

'Infection can't be completely ruled out.'

[That's right. It's not natural, but medicine is ultimately about statistics.]

Meanwhile, Suhyuk was also thinking deeply about Jo Taejin's question.

More precisely, he was in conversation with Baruda, a reliable advisor.

'So, steroids are still a bit risky, right? I want to use them... but...'

[If it's a fungal infection, you might see the patient dying in real time. If you want to see that, go ahead and use high-dose steroids.]

'Why do you have to say things so rudely?'

[I only speak the truth.]

Unfortunately, Baruda's words were true.

Steroids were the most potent anti-inflammatory agents available.

They could produce dramatic effects in various situations, but they also came with serious side effects due to their potency.

The most concerning side effect in this situation was immunosuppression.

[The patient received chemotherapy based on cisplatin, which means immunosuppression might have already occurred during treatment. The fungi normally living in the nose...]

'I get it, so shut up. Professor Jo Taejin is starting to look at me with a strange expression.'

[Even I can see that Suhyuk's face looks a bit strange.]

'Shut up. In situations like this, I'm always right.'

[My pride is hurt, but I'll keep quiet, thinking of the Huang Xianwu case.]

After silencing Baruda, Suhyuk looked at Professor Jo Taejin.

As he had expected, Professor Jo was looking at him with a very complex expression.

'He really is a bit strange.'

Both Lee Hyunjong and Shin Hyuntae had raved about Suhyuk being a true talent.

Shin Hyuntae, who had a tendency to praise even mediocre residents who worked hard, had been one of them.

Lee Hyunjong, who was much stricter, had also acknowledged Suhyuk's genius.

Both of them had mentioned that Suhyuk had some unusual traits.

But they had also said he wasn't dangerous.

'He really isn't dangerous, right?'

So, Professor Jo Taejin took a slight step back but didn't assume a defensive posture.

Suhyuk then spoke to Professor Jo Taejin.

"The patient received chemotherapy using a cisplatin-based regimen, which suggests that immunosuppression has already occurred."

[Wait, you're repeating it word for word?]

"Therefore, we can't completely rule out the possibility of an infection caused by normal flora or fungi in the nose."

[Suhyuk, are you a scoundrel? When to shut up?]

Although Baruda kept interrupting, Suhyuk continued speaking without wavering.

Baruda's confident words were so well-structured that even Professor Jo Taejin found them highly satisfactory.

"That's right. Among patients who have received radiation and chemotherapy... especially those treated in the facial area, infections... particularly fungal infections, are relatively common."

"Yes. If it's Aspergillus, there might still be a chance after administering steroids, but if it's Mucormycosis... we might have to watch the patient being consumed by the fungus in real time."

In other words, in the current situation, steroids meant high return, very high risk.

If this were about money or something else, it might be worth taking the risk.

But when it comes to a person's life, that's not an option.

"Right. So, what's your opinion?"

Professor Jo Taejin smiled and asked, as he felt Suhyuk's answer would align with his own thoughts.

"I want to start with hyperbaric oxygen therapy, which is less burdensome and can also treat infections."

"Hmm."

He had expected this answer, but it was still genuinely surprising when it came out.

'You got the right answer, didn't you?'

Hyperbaric oxygen therapy, as the name suggests, involves exposing the patient to high concentrations of oxygen in a capsule-like chamber.

Originally designed to treat conditions like carbon monoxide poisoning and decompression sickness, it was later found to be effective for other diseases and is now used more frequently for those.

"Good. I'll book the hyperbaric oxygen therapy... no, I'll do it. What else do you want to do?"

Professor Jo Taejin continued his questions.

For a first-year resident, this would typically be a frustrating experience.

But Suhyuk felt it as an opportunity rather than a burden.

'I was thinking of becoming an infectious disease professor, but maybe hematology-oncology...'

[Based on my conversations with Suhyuk, a piece of advice I can give is, 'Don't drink kimchi broth.']

'Just shut up. What else do you want to do? I want to do a biopsy. Right?'

[I agree.]

'Good.'

If Baruda said so, it was almost certain to be true.

Although the information was still limited and sometimes inaccurate.

"I think a biopsy is necessary."

"Biopsy? What do you expect to find?"

"I expect to find inflammatory tissue. However, if we can confirm a fungal infection through frozen section or staining, and if the result is negative, we can proceed with treatment for radiation necrosis."

Professor Jo Taejin nodded vigorously after hearing this.

The ability to provide such a detailed answer indicated that this wasn't just luck or a quick read of a textbook.

"Good. Take charge of this patient and explain the plan. I'll book the hyperbaric oxygen therapy. For the biopsy... I'll do that too. It might be a bit difficult for you."

Booking facilities or coordinating with other departments was a challenging task, especially for a first-year resident.

For Professor Jo Taejin to offer to do it was a significant gesture.

It was natural for Suhyuk to bow his head in gratitude.

"Yes, thank you, Professor."

"Don't mention it. Go on, the patient is waiting."

"Yes, Professor."

"Oh, and one more thing."

Professor Jo Taejin stopped Suhyuk, who was about to rush to the patient.

Suhyuk looked back, wondering if he was about to be assigned another task like a conference presentation.

"Who is your chief resident?"

"Kim Insoo, sir."

"Ah, Insoo... hmm."

Although it was an unexpected question, Suhyuk answered without hesitation.

He simply observed Professor Jo, who was repeating the name "Insoo."

"Let's do this. I think you don't need a chief resident. Just work independently. If a patient needs to be admitted, notify me directly. For patients from other departments... consult with Insoo or a second-year resident. Got it?"

"Yes, Professor."

Suhyuk nodded vigorously in response.

This meant he had gained the authority to notify the professor directly in hematology-oncology, following his similar privilege in infectious diseases.

It might seem like a small thing, but it was a significant achievement.

A first-year resident taking on the responsibilities of a second or third-year resident was almost a miracle in a university hospital where the smartest first-year residents were often considered less capable than the least competent second-year residents.

"Alright, go on. Finish up with the patient and get some rest."

"Thank you, Professor."

Suhyuk bowed and rushed to the patient.

Fortunately, the patient's limb paralysis had improved somewhat since the last time.

This allowed Suhyuk to confirm that his explanation was being understood.

Thus, the patient didn't ask why they were going into the hyperbaric oxygen chamber.

'Will it work?'

Suhyuk tilted his head as he watched the patient enter the chamber.

[Don't know.]

'Why don't you know? You should know.'

[There's still not enough data to make a prediction.]

'You're studying hard, right?'

[Does studying a lot make you a great doctor? Experience is needed.]

'Experience... that's not something I can control, right? Time is needed.'

He had only been an internal medicine doctor for a little over a month. What kind of experience was he supposed to have?

Baruda continued the conversation, hearing Suhyuk's indifferent response.

[You should try to minimize the time needed. Get as much sleep as you need to survive.]

'You're just cursing me to death... you bastard.'