Chapter 26: Let's Go See the Patient (2)

"Shuhyeok, let's go."

Chief Kim In-sung, in his third year, called out to Shuhyeok, who had been leaning against the wall for a moment after the afternoon rounds.

[Let's move before you start thinking weird thoughts again.]

‘Got it.’

Shuhyeok, who had become noticeably more obedient after being fed jajangmyeon, looked at Kim In-sung as Baruda suggested. Kim In-sung was holding a stack of documents, and Shuhyeok had also received a similar stack.

"Are you going to the weekly case discussion?"

"Yeah, I have to. If I don't, I'll be labeled as someone who doesn't study."

It wasn't as big an event as the monthly Taehwa Internal Medicine Case Presentation, but it was still one of the larger internal events.

"Okay, let's go, sir."

So Shuhyeok hurriedly pulled his crutches and walked down the corridor with his cane. Of course, there was another reason for his haste.

‘Strange, isn’t it? This case.’

[Yes, it seems like there's something we've missed.]

It was a case from the Infectious Diseases department, but not for Professor Shin Hyun-tae. It was for another professor under him. The treatment was appropriate, but the results were not satisfactory. So, it was submitted for the weekly case discussion.

‘But, can I really speak up there?’

Shuhyeok muttered to himself as he saw the many internal medicine doctors walking down the corridor. There were so many senior doctors that even the second-year residents were shrinking their shoulders.

Third-year residents, fellows, assistant professors, associate professors, and full professors—all the available internal medicine staff were gathered.

[Let's see how the situation goes.]

‘Oh, so you’ve grown a bit?’

[To get more jajangmyeon, I realized I need to be dirty and despicable and collude with the world.]

‘No, you don’t need to go as far as colluding…’

[It’s Professor Shin Hyun-tae. Greet him.]

‘Ah.’

Shuhyeok snapped back to reality and saw Professor Shin Hyun-tae standing in front of the small lecture hall in the basement, looking directly at him from a distance.

[You said you wanted to go to the Infectious Diseases department, but this is quite overt.]

‘That’s true.’

Shuhyeok nodded, recalling a conversation he had heard before.

- Why is Professor Shin already putting so much effort into Lee Shuhyeok?

- He’s a royal, smart. If he comes to the Infectious Diseases department, it’s a big plus.

This was the gist of what he had overheard in the office.

[But, does the Infectious Diseases department make good money?]

‘Huh?’

[Isn’t that an important question?]

‘Well…’

[Why are you asking?]

‘No, it just seems a bit different.’

Whenever he talked about money, he was called worldly, but now he’s changed so much over a bowl of jajangmyeon.

Shuhyeok found it a bit ridiculous and laughed.

Instead of responding to Baruda, he bowed to Professor Shin, who had been looking at him.

"Hello, Professor."

"Oh, Shuhyeok. I heard you did a great job with the rounds?"

"Ah… No, not really."

"Today, if you see something strange during the case discussion, speak up freely. If you need a chance, I'll give it to you."

"Ah, yes. Thank you."

"Good. To do that, you should sit in the front. Don’t fill in from the back like the others. The seniors will like it if you sit in the front."

"Yes, Professor."

Shuhyeok answered and entered the room. The small lecture hall, shaped like a small cinema, was already crowded with many people, and they were filling in from the back, as Professor Shin had said. A clueless first-year resident was being scolded by the third-year residents.

‘I guess I should go to the front, then.’

[Do that. When the opportunity comes, speak up.]

‘Speak up? I should tell you quietly later.’

[Okay, I understand.]

‘Are you going to speak out again? Damn it, don’t do that. It’ll be a big problem.’

[No, I’m not crazy. I won’t. But based on the analysis of Professor Shin Hyun-tae’s expression…]

‘Don’t do an analysis that’s always wrong.’

Shuhyeok shook his head, remembering the last time, and sat down in the front.

"Oh, Shuhyeok."

It turned out he was sitting next to Director Lee Hyun-jong. It was a seat that professors usually didn’t take, so it had been empty until Shuhyeok filled it. Since it would be awkward to get up now, Shuhyeok forced a smile.

"Hey, Director. Hello."

"Yeah, yeah. Sit comfortably. You should study with a relaxed mind."

"Yes."

"But did you read the case in advance? Of course, you did, right?"

After telling him to sit comfortably, Director Lee immediately asked an uncomfortable question.

‘That’s why no one else sits here except Professor Shin…’

Shuhyeok thought but didn’t stop talking.

After all, he was talking to the director, who could be said to hold the future in his hands.

"Yes, I read it."

"Is there anything strange?"

From his expression, it seemed he had found something strange.

‘Hey, what do you say? Do your analysis.’

[What’s the point of doing an analysis that’s always wrong?]

‘Are you upset? I put up with all your nonsense.’

[Hmm.]

Baruda sighed as if something was bothering him and continued.

[From now on, I won’t comment on the analysis.]

‘Hey… Even if you’re upset, you don’t have to be so cold…’

[Then should I just keep quiet?]

‘Got it, got it. Damn, this guy is really…’

[There is something strange, but I need to hear the presentation to know. Speak like this: “There is something I find suspicious, but I need to hear the presentation to understand.” The analysis shows that Director Lee Hyun-jong likes interesting things and doesn’t like hearing the answer right away.]

‘Ah… Got it.’

Shuhyeok was convinced by this and went along with it.

"Yes, Director. There is something I find suspicious, but I need to hear the presentation to understand."

"Good. That’s interesting. Ah, everyone is coming in. Let’s listen first. It’s not polite to talk while someone else is presenting."

"Yes, Director."

Shuhyeok wanted to say, "Wasn’t it you who started talking first?" but didn’t say it out loud.

Instead, he turned his head to look at Professor Shin Hyun-tae, who was sitting in the chair of the chairperson, the case’s responsible professor, Jang Deok-soo, and the third-year resident, Kim Jin-yong, who was presenting.

‘Kim Jin-yong…’

Pharmacy Director Kim Jin-yong.

In the old days, when kickbacks were rampant, the power of the pharmacy director was absolute. They decided which drugs would be distributed in the department. But now, with no kickbacks, it’s just a nominal position.

A figurehead, you might say.

[He’s said to be a real scumbag.]

‘He really is.’

If you add up all the things he’s done, he should be in jail by now.

He eats into the department budget for various reasons, misuses the corporate card, and so on.

The first and second-year residents are too disgusted to do anything, and the third-year residents are too embarrassed to do anything. If not, he would have been kicked out of the department long ago.

"Hello, I’m third-year resident Kim Jin-yong."

Kim Jin-yong, holding the microphone on the podium, greeted everyone.

The first and second-year residents involuntarily swallowed and straightened their backs. Shuhyeok was no exception.

Everyone had experienced his treatment at least once.

Kim Jin-yong, looking satisfied with the change, continued with a relaxed smile.

"The case I will present today is about a 78-year-old male patient who came to the hospital six weeks ago with a complaint of loss of appetite."

He then showed the patient’s medical history on the screen.

"The patient had lower back pain due to spinal stenosis for the past five years but was able to dress and eat independently."

This meant that his daily life was not affected.

Since the information was already distributed in advance, everyone just nodded.

"Six weeks ago, he began to complain of increasing fatigue and spent more than 12 hours a day in bed. Two weeks ago, his appetite decreased and he experienced nausea, reducing his food intake by half."

This indicated that he had developed systemic weakness, which was quite serious given his age.

If he were younger, it might have been dismissed as just being tired, but this patient was 78 years old.

"Additionally, his systemic weakness worsened to the point where he could no longer change his clothes by himself, leading to his visit to our outpatient clinic and subsequent hospitalization."

For an elderly person, a decline in the ability to perform daily activities is a very dangerous sign. It’s not uncommon for them to pass away suddenly.

So, deciding to hospitalize him even without a diagnosis was a very good decision.

"Looks like he’s thorough, but surprisingly meticulous."

Sure enough, the director praised this aspect.

As he muttered, the screen changed to show the patient’s chest X-ray.

"As you can see, there is increased shadowing in the lower lobes of both lungs. The blood test shows increased CRP, leading to a diagnosis of pneumonia caused by a community-acquired infection. Considering the patient’s age and severity, we started him on levofloxacin from the beginning."

Levofloxacin is almost the ultimate antibiotic, except for resistant strains.

"After five days of treatment, his symptoms seemed to improve, but they have worsened again now."

If it were pneumonia, improvement would have been expected. However, the patient’s symptoms worsened again after just three days.

So far, this was the patient’s medical history. Now, it was time for the discussion.

"Another chest X-ray showed no change from the previous one. We concluded that the systemic weakness was of unknown cause and submitted it for the case discussion."

As soon as Jin-yong finished, Lee Hyun-jong raised his hand and spoke before Jin-yong could react.

"So, as the presenter, what do you think, Kim Jin-yong?"

In other words, he was telling him to think for himself.

Jin-yong, though momentarily taken aback, answered as a third-year resident should.

"I think it’s possible that the pneumonia is resistant to levofloxacin."

But this answer didn’t satisfy Lee Hyun-jong.

"Is systemic weakness the most common symptom of pneumonia?"

"That’s… No."

"Then why are you fixated on pneumonia?"

"From the X-ray…"

"This patient is 78 years old. Don’t you think it could be an old lesion?"

"Um…"

"Considering you’re a third-year resident, is that all you can think of? Is there no one else? Who is the attending physician for this patient?"

Someone in the back stood up at Lee Hyun-jong’s question.

It was second-year resident Hwang Seon-woo.

"What do you think?"

Hwang Seon-woo, known for his lack of knowledge, couldn’t possibly give a proper answer.

But he was smart enough not to say pneumonia.

"Lung… lung cancer."

But this answer only made everyone laugh.

"What do you