Chapter 21: This is Confusing (1)

"How's the patient?"

After finishing the afternoon outpatient clinic, Professor Jo Tae-jin asked Chief Resident Kim In-su as he walked into the ward.

Kim In-su glanced at Su-hyuk for a moment before speaking.

"Patients who received chemotherapy as scheduled are expected to be discharged without any significant complications. Those who were admitted over the weekend for chemotherapy, being not their first cycle, are also expected to be fine."

Severe drug side effects that everyone fears usually appear early on.

If it was fine at first, it was highly likely to remain fine.

Of course, the side effects of chemotherapy could worsen depending on the dosage and duration of use.

"Is that so? So they're all routine patients?"

"Yes, Professor."

"That's good. We need to have times like this too."

Professor Jo Tae-jin gave a bitter smile.

This was because the hematology-oncology ward, where the most patients died per unit room in the entire hospital, was right here.

Among them, the 15th floor West ward, which he was in charge of, had many terminal patients, so he had to witness a lot of deaths.

"By the way, how's that patient?"

After a brief smile, Professor Jo turned to Su-hyuk.

Although he didn't specify who, Su-hyuk immediately knew who Professor Jo was talking about.

"Yes, Patient Park Kyung-won was transferred from the ICU to a general ward two days ago. Currently, the inflammation markers in the blood tests are decreasing, and the pain in the affected area has also decreased from 9 to 4 on a subjective scale."

"Medication?"

"The frequency of painkillers has been reduced by half."

"That's good."

Pain can sometimes be just a minor indicator.

But at other times, it can be the most important of all indicators.

A decrease in the subjective score was certainly a good sign.

However, the fact that the reduction in painkiller use was objectively confirmed was even better.

"How about exercise?"

"Currently, the level of exercise is inconsistent, so he's only doing wheelchair walking. There are no significant restrictions on movement. According to the neurology department, there should be no permanent aftereffects."

"What does the ENT department say?"

"They perform endoscopic examinations every morning and evening. The images from today's consultation show this."

Instead of describing the images verbally, Su-hyuk showed them directly.

Naturally, both Professor Jo Tae-jin and Kim In-su's gazes were drawn to them.

The images were red and swollen, clearly not looking good.

However, compared to the initial state, they showed significant improvement.

At that time, it was so bad that it made one wonder if the cancer had really recurred.

"What about this bone erosion?"

Professor Jo Tae-jin pointed to the back wall of the nasopharynx, which appeared to be completely hollowed out in the image.

While the inflammation had largely subsided, this made the hole appear even larger.

Moreover, the three doctors present were well aware that this hole was directly connected to the spinal cord, which was a significant concern.

If even water got in and caused an infection, what would happen?

There was no guarantee that it would recover as well as it had now.

"They plan to maintain the current treatment until the necrotic tissue improves further, and then perform surgical reconstruction."

"Surgery? Here?"

The nasopharynx is tissue located in the middle of the nose.

In other words, it's in the center of the face.

Approaching it is the worst-case scenario.

Surgery would likely require cutting through half of the face.

"Yes. Fortunately, they started treatment early, so... it's possible with endoscopy. I didn't get the exact details, but..."

[You're unsure, right? There's a high possibility of using the fascia lata for reconstruction.]

"There's a high possibility of using the fascia lata for reconstruction."

Su-hyuk finished speaking, feeling slightly embarrassed.

Of course, Professor Jo Tae-jin, who was listening, didn't think anything of it.

'This kid is really something...'

Usually, internal medicine doctors have little interest in surgical procedures.

But a truly excellent internal medicine doctor should be well-versed in the final treatment as well.

Even if they can't perform it themselves.

This way, they can provide proper explanations to their patients.

"Alright. At least give them a rough idea. It would be confusing for the patient if you suddenly mention surgery."

"Yes, Professor."

"And..."

Instead of continuing the ward round, Jo Tae-jin refreshed the list of inpatients.

When the desired patient didn't appear, he opened the list of outpatient patients from the afternoon.

"Where... Ah, here it is."

After scrolling for a while, he stopped at the name "Park Sang-a."

"This patient was admitted from the outpatient clinic. I heard there were available beds when I confirmed by phone, but it seems the admission procedures haven't been completed yet."

Hearing his mutter, a ward nurse hurried over and responded.

"Yes, Professor. We were informed that a patient would be coming from the outpatient clinic. We're still arranging the ward... They are expected to arrive in about one to two hours."

"Then I won't see them today. Chief, you can go home. Su-hyuk, go and greet them."

Kim In-su smiled contentedly at Jo Tae-jin's words.

At this time, other chiefs were probably getting scolded severely for handling the first-year residents' mistakes, let alone going home.

Professors often considered the mistakes of first-year residents as those of second- and third-year residents.

'Originally, I was supposed to rotate with a first-year resident next month and get a relatively easy department...'

This was much easier and better compared to rotating with a second-year resident.

Feeling good, he patted Su-hyuk's shoulder secretly.

"About this patient..."

Jo Tae-jin turned his head back to the monitor and opened the patient's chart.

Although he was in a position where he could look at the chart and give a rough idea after the patient was admitted from the outpatient clinic...

The internal medicine department of Tae-hwa Medical Center wasn't an easy place to handle even with such an attitude.

Of course, if someone had a solid background, things might be different.

"This patient originally had colorectal cancer and received about three cycles of FOLFOX chemotherapy. The primary lesion was completely removed, but during the recent abdominal MRI for follow-up... Why is this so slow?"

Professor Jo grumbled as he pressed the image button next to the patient's test results.

Since a slow computer wouldn't speed up just because of his grumbling, he had to stare blankly at the monitor for a while after grumbling for a long time.

"Ah, it's up. Can you see it?"

"Ah... There are multiple metastases in the liver."

Chief Kim In-su quickly responded.

As someone who aspired to be a professor, he studied quite diligently.

He knew that colorectal cancer often metastasizes, especially to the liver.

"Right. We'll do a workup. For now, don't mention metastasis to the patient... Just explain the liver biopsy. Got it?"

Now, Professor Jo Tae-jin was looking at Su-hyuk.

But Su-hyuk couldn't answer immediately.

[It seems a bit difficult to definitively say it's metastasis. There's not enough data to provide a detailed opinion...]

Baruda was saying something completely different from Professor Jo Tae-jin and Kim In-su.

'Metastasis... It might not be?'

Moreover, the findings on the current abdominal MRI clearly suggested metastasis.

Even an opinion from Professor Kim Jin-shil of the abdominal radiology department, stating that liver metastasis should be ruled out, was attached.

To say it wasn't...

[Su-hyuk fell asleep while reading a related paper, so the record is blurry. I can't provide a detailed opinion.]

'So, let's just let it go for now.'

[I agree.]

Fortunately, the conversation with Baruda was brief.

Moreover, Professor Jo Tae-jin already knew from experience and from others that Su-hyuk occasionally exhibited really strange behavior.

'It's not dangerous.'

So, he could wait patiently with the above thought.

"Ah, sorry. Yes, I'll do that."

"Good. Then I'll leave it to you. Let's check the other patients first. I have a meeting today, so I need to leave early."

"Yes, Professor."

Su-hyuk nodded and hurried forward.

Opening the ward room door was strictly the job of the first-year resident.

Even if there were students or interns, it was the same.

No matter how smart they were, it was just a basic duty.

Click.

Su-hyuk quickly opened the ward room door and turned to look at the two following him.

"This is Patient Park Kyung-won. Currently, he is undergoing hyperbaric oxygen therapy, daily disinfection, and steroid treatment for radiation-induced necrosis of the nasopharynx."

"Right."

The first-year resident not only had to open the door but also had to give a rough idea of who was in the room.

"Patient."

Of course, when greeting the patient, the first-year resident had to quickly move behind Professor Jo Tae-jin.

This was a professor's ward round, not a resident's or chief's.

It was a time that patients in the ward had to wait for all day.

"Yes, yes. Professor."

"How are you feeling?"

"Much better."

"Yes. The remaining issues can be resolved with surgery by the ENT department. They said it's a simple procedure, so don't worry too much."

"Thank you."

Although the explanation and time were minimal compared to a resident's ward round,

the comfort and reassurance the patients received were enormous.

"Good. Follow my instructions. Su-hyuk, when... Yes, when Patient Park Sang-a arrives, explain it well. Schedule the biopsy for tomorrow."

"Yes, Professor."

"Then I'll go. See you tomorrow."

"Yes, Professor."

After finishing the ward round, Professor Jo Tae-jin disappeared almost running, as if he had a very urgent appointment.

As soon as he was out of sight, Kim In-su also disappeared.

"I have an appointment today too. You're not on call today, right? Just admit the patient and rest."

"Yes, sir."

After waiting for Kim In-su to disappear, Su-hyuk closed his eyes for a moment.

'Let's go over the conversation in more detail.'

This was to communicate with Baruda.

[More data is needed to provide a more accurate opinion.]

'What kind of data? I've read quite a few papers on colorectal cancer.'

[What's the point of reading if you fall asleep?]

'... You don't even know which paper? I don't remember it at all...'

Su-hyuk's words made Baruda sigh in disappointment and continue.

["Radiology 2014 May."]

'What nonsense is this?'

[It's the paper you started reading but fell asleep. The title wasn't saved.]

'Ah.'

[Feeling a bit sorry now? Apologize or hit your head.]

'What's that supposed to mean? Where did you see that?'

[YouTube. The one Su-hyuk watches to save time while studying...]

'Enough. Enough. Let's go read the paper. If it's not metastasis, what is it...?'