Chapter 27: Let's See the Patient (3)

"Ah... Yes. Alright."

Suhyuk reluctantly got up, moving very slowly.

However, in stark contrast, he confidently took the microphone from Lee Hyunjong.

This could be considered quite strange to others, as Lee Hyunjong was not the type to show such a side.

"Look at that. He's so... How can a father who doesn't have a son to love live in this world?"

"He used to say, 'I'm married to medicine,' but when did he have such a grown-up son?"

While the residents, who knew nothing, gossiped among themselves, Suhyuk cleared his throat while holding the microphone.

[Don't waste time; let's start.]

It was a rather long cough, to the point where Baruda, who was urging him, seemed more enthusiastic about Suhyuk's presentation than Suhyuk himself.

'I got it, I got it.'

Suhyuk nodded and finally began to speak, briefly glancing at the spot where Hwang Seonwoo had been standing.

Hwang Seonwoo, unable to meet his eyes, turned his head slightly to the left.

"The patient is a 78-year-old male, currently 163 cm tall and weighing 62 kg. While he's not particularly robust, his measurements aren't bad for his age. He quit smoking 30 years ago, and his chest X-ray shows no signs of lung cancer. This suggests that the likelihood of a chronic condition is low."

Hwang Seonwoo's face darkened, while Kim Jin-yong's face brightened slightly.

Given that Suhyuk, who was recently hailed as the greatest genius since the opening of TaeHwa Medical Center, seemed to share his opinion, it was a rather embarrassing situation for a third-year resident.

However, if the person in question was Suhyuk, who was rumored to be exceptionally talented and even considered the cream of the crop, it wasn't so surprising.

"But the symptoms don't quite fit acute pneumonia. There's no cough, no shortness of breath. The only symptom the patient expresses is general weakness."

As Suhyuk continued, Kim Jin-yong's face also began to resemble Hwang Seonwoo's.

"Right. I understand it's not those two conditions. I think everyone here had a general idea. So, what's your diagnosis?"

Director Lee Hyunjong asked Suhyuk again, his face filled with high expectations rather than a challenging tone.

He seemed quite eager, but Suhyuk, instead of answering immediately, slowly walked to the podium.

"Do you need some materials? Here, use this."

Instead of the flustered Kim Jin-yong, Section Chief Shin Hyuntae, who was sitting in the chair, handed him a laser pointer, complete with a button to advance the PowerPoint slides.

"Thank you, Section Chief."

"No, no. Go ahead."

Section Chief Shin Hyuntae had a face very similar to Director Lee Hyunjong's, as if urging Suhyuk to speak quickly.

In contrast to the expressions of Kim Jin-yong and Hwang Seonwoo, no one in the room paid much attention to the two residents.

They simply looked at Suhyuk, who was receiving unusual favor, and the two influential figures in the internal medicine department with bewildered expressions.

"He's completely showing favoritism, favoritism."

Some even muttered this much.

At this point, it might have been a burden for Suhyuk, but he wasn't nervous at all.

[The TaeHwa Internal Medicine case presentation was indeed helpful.]

'They call it a positive feedback loop in psychiatry.'

He had already successfully presented on a much larger stage, and that experience was more helpful than any beta-blocker.

Instead of pressure, he felt just the right amount of energy.

"First, we need to look at the patient's blood test results upon admission."

As Suhyuk said this, he flipped to a slide that Kim Jin-yong had only glanced at.

For an elderly person, the results were not bad.

There weren't many red marks, indicating abnormalities.

Among them, Suhyuk pointed to 'Na,' also known as sodium or natrium.

"The normal range is 135 to 145, but this patient's level is 127."

While it's not uncommon for elderly people to have low sodium levels without a specific reason, it's important to consider why this might be the case in an elderly person who was previously healthy but suddenly became ill.

Otherwise, you might waste time and lose the patient.

"However, the patient doesn't show symptoms like edema, and the desmopressin he was taking for nocturnal polyuria could be a cause of the low sodium. Therefore, the low sodium is not related to the patient's current symptoms. By the way, it would be good to discontinue the desmopressin."

Not all abnormalities are related to the current symptoms, but it's necessary to go through each one.

Since all the excellent internal medicine doctors in the room knew this, no one questioned why Suhyuk was deviating from the main point.

Instead, they looked surprised.

"Is he really a first-year?"

"I thought he was a nephrology professor talking."

Some residents expressed their amazement.

However, Kim Jin-yong and Hwang Seonwoo, who were now being compared to Suhyuk, were not so impressed.

Their faces were red, and they kept their heads down, harboring resentment.

"Next, the patient's hemoglobin level is 9.1. The normal range is 13 to 17, so it's quite low. This indicates anemia."

Anemia is a common finding in the elderly, especially in those living alone, where nutritional deficiencies are common.

However, if there are symptoms, it's important to consider why this might be the case.

Assuming it's just because they're elderly can be dangerous, especially when they come in as patients.

"However, the reticulocyte count, which indicates the production of immature red blood cells, is also low at 1.03. This suggests that the problem is not with the destruction of red blood cells but with their production. It indicates an issue with hematopoiesis."

This is also a common finding in the elderly, meaning that everything Suhyuk mentioned so far might not be significant.

However, Suhyuk had no intention of stopping.

"Finally, looking at the white blood cell count in the basic blood test... The total count is 26,100 (normal range: 4,000 to 10,000), which is significantly elevated. While this could suggest acute infection, the monocyte count is as high as 31%."

"Hmm!"

Lee Hyunjong nodded vigorously, as if this was a crucial clue.

Professor Jo Taejin, who was Suhyuk's attending physician, also nodded.

He was genuinely surprised, as he hadn't even looked at the case materials distributed in advance, citing his busy schedule.

"Earlier, I mentioned that hematopoiesis was reduced. What does the high monocyte count suggest?"

Suhyuk now looked around the room with a more relaxed expression.

The more he did, the paler Kim Jin-yong and Hwang Seonwoo became.

They suspected a particular disease, even if they hadn't studied as much.

After all, you learn a lot by osmosis during your residency at TaeHwa Medical Center.

'Oh, I'm done for... Why didn't I think of that...'

Especially Kim Jin-yong, a third-year resident who was responsible for the presentation, was deeply sighing.

Of course, Suhyuk didn't stop talking.

He hadn't given the answer yet.

Engaging the audience was just part of the process.

"Yes, it's blood cancer. Given the progression and the patient's age, multiple myeloma is the most likely."

As soon as Suhyuk gave the diagnosis, Section Chief Shin Hyuntae, who was sitting in the chair, spoke up.

Director Lee Hyunjong had also tried to speak, but without a microphone, he wasn't heard.

Thus, the floor went to Shin Hyuntae.

"Good. What tests should we do?"

"Spinal MRI, CT, peripheral blood smear, and serum protein electrophoresis."

"Right. What do you think, Professor Jang Deoksoo?"

It was clearly the right answer.

It was hard to add anything more.

So, Shin Hyuntae turned to Jang Deoksoo, the patient's attending physician.

Jang Deoksoo had already discussed the case with the hematology-oncology professors before the presentation and knew the answer.

However, he was very surprised and flustered that a first-year resident could recite the discussion almost word for word.

He was so flustered that he couldn't immediately respond.

"What do you think?"

Thanks to Shin Hyuntae's prompting, he finally spoke.

More accurately, after Shin Hyuntae discreetly kicked his leg, he managed to speak.

"Ah, yes. I... I think it's an excellent plan."

"No, that's not what I meant. What do you think of Professor Jang Deoksoo's plan?"

It was a rather low-level response for a professor.

So, Shin Hyuntae couldn't just stand by.

'You idiot, get it together.'

There was a significant age difference between them, despite both being professors.

Shin Hyuntae, who had been a professor since Jang Deoksoo's residency days, kicked his leg again, this time with more force.

"Ouch. Ah, yes. I... I agree. However, we can't completely rule out infection, so it would be good to add a chest CT, blood culture, and sputum culture."

Fortunately, he didn't make any more mistakes.

This response was much more professor-like.

"Good. Shall we transfer the patient to hematology right away?"

Neither Professor Shin Hyuntae, Professor Jang Deoksoo, nor the other professors thought the patient belonged in the infectious disease department.

According to Suhyuk, the patient had cancer and needed proper diagnosis and treatment as soon as possible.

Otherwise, he would die helplessly.

"Yes, I'll take him."

So, Professor Jo Taejin raised his hand.

He then pointed to Suhyuk, who was still standing at the podium.

"I'll assign the primary care to first-year resident Suhyuk. Is that okay?"

Naturally, there was no opposition.

Among all the residents present, including Hwang Seonwoo, who had been the primary care physician, and Kim Jin-yong, who had been the chief resident, Suhyuk knew the patient best.

In fact, he had shown a level of understanding that was far beyond the others.

'This kid is a real genius!'

It was a moment when Suhyuk's name was deeply etched in the minds of almost all the professors.