Chapter 28: Let's See the Patient (4)

"How is the patient doing?"

"Fortunately, the diagnosis wasn't too delayed, so the response to chemotherapy is good. However, ... "

Professor Jo Taejin looked at Suhyuk, who trailed off, and gave a wry smile.

The process of killing the cancer itself was going well.

However, treating cancer wasn't just about the cancer itself.

The patient suffering from the cancer had to be considered.

Overlooking this could lead to the patient dying from the treatment itself.

"The patient is quite elderly, right?"

Professor Jo Taejin asked in a soothing tone, as if understanding Suhyuk's concerns.

"Yes. His physical condition is deteriorating rapidly. We're giving him a lot of intravenous fluids and steroids to minimize side effects, but ... "

Suhyuk, with a bitter expression, looked toward the ward where the patient was admitted.

"His kidney function is worsening. We've requested dialysis."

He then recalled what Baruda had said that morning.

Even after starting dialysis, the patient's condition was not good.

In fact, it was heading toward the worst.

"There are symptoms of nausea, vomiting, and diarrhea. Is it acute kidney failure?"

"Probably, yes."

"Hmm. That's a serious issue. Still, being diagnosed within two months is relatively quick. Was he healthy before he got sick?"

"Yes. He was fine until then."

Suhyuk recalled the patient's data stored by Baruda.

According to the records, the patient was able to live a normal life before falling ill.

He could manage on his own without any help.

Now, he couldn't even go to the bathroom without a caregiver.

"Going to the bathroom would be a blessing. Right now, due to the high level of toxins, he's having diarrhea almost like water."

'I saw it earlier too ... Continuing this treatment is too much ...'

As Suhyuk nodded, as if making a decision, Professor Jo Taejin also nodded.

However, the thoughts in their minds were entirely different.

"Have you received a Do Not Resuscitate (DNR) consent form? Just in case?"

Professor Jo Taejin was considering the patient's age and the economic situation of the family.

'Of course, it would be good if he recovers. But ...'

Continuing to recommend chemotherapy in this situation would be painful for both the doctor and the patient.

While saving the patient's life was important, his experience taught him that more practical aspects needed to be considered.

Having seen so many similar cases, Professor Jo Taejin believed that ending the treatment and giving the patient time to conclude his life was the right path.

His long experience led him to this conclusion.

'He must get better. But not this way.'

On the other hand, Suhyuk, being a young doctor, had a different perspective. He hadn't experienced enough patient deaths to think like Professor Jo Taejin. This could be called his idealism or his audacity.

To Suhyuk, the patient's age was just another challenge to overcome, not a reason to give up treatment.

If the family's economic situation were different, it might be a reason to reconsider the treatment's appropriateness.

But Suhyuk, still a rookie doctor, hadn't accumulated enough experience to directly link treatment and money.

"No, I haven't. Professor."

So, Suhyuk hadn't yet talked about death with the patient or the family.

Naturally, he hadn't even considered getting a DNR consent form.

"Get it this afternoon."

"Hmm."

Suhyuk didn't even say "yes" to Professor Jo Taejin's suggestion.

Professor Jo Taejin looked at Suhyuk's stubbornly closed mouth for a moment, then shook his head.

"Have you never had a patient die?"

Even Professor Jo Taejin had been a resident once.

He had also been young and believed that he could save every patient with determination.

'There was a time when I couldn't accept the limitations of modern medicine.'

Even though he wasn't an outstanding resident, he had gone through that phase.

What about a unique genius like Suhyuk?

Professor Jo Taejin somehow understood.

"Yes, Professor. Not yet ..."

"As an internist, you'll see it eventually, you know?"

"Yes ..."

"This patient has no hope. Regardless of your feelings."

"But the stage of the disease is still ... "

"Yes, you're right. By the stage alone, the patient should survive."

The stage referred to the progression of the disease, such as Stage 1, 2, 3, or 4.

The patient's stage was 2, which, according to Taehwa Medical Center's data, was not a stage where the patient should be dying.

"But the patient is elderly. His kidneys can't handle it. Continuing chemotherapy will only make him suffer."

Suhyuk deeply agreed with this.

He had already seen how much the patient suffered during the rounds with Kim In-su before Professor Jo Taejin arrived.

But agreeing didn't mean he would consent.

"Currently, the planned chemotherapy followed by bone marrow transplantation needs to be modified due to the patient's kidney failure. I recommend a mini allogeneic hematopoietic stem cell transplantation."

Baruda also suggested this.

So, the treatment plan he had been working on, which involved completely wiping out the patient's bone marrow with chemotherapy and then accepting new bone marrow, was being recommended for abandonment.

Instead, a new treatment method being tried in some hospitals was proposed.

'Mini allogeneic hematopoietic stem cell transplantation ...'

'Currently, this is the only treatment option available.'

'Yes ... If we have the bone marrow to transplant, we can't just let it go to waste ...'

Although it has improved compared to before.

Bone marrow transplantation and donation are still not actively carried out in Korea.

As a result, many patients who could be saved with suitable bone marrow die because they can't find a match.

However, this patient, perhaps by luck, received a call from the hematopoietic stem cell bank association as soon as he was added to the waiting list.

'The probability is one in 200,000.'

'We can't just let this opportunity go to waste.'

So, Suhyuk, seeing that Professor Jo Taejin seemed to have made up his mind, opened his mouth with difficulty.

It required considerable courage and could be considered impolite.

But Suhyuk had already become a legend in the hematology-oncology department and had built a personal relationship with Professor Jo Taejin.

This helped him reduce his burden.

"But, Professor ... There is a treatment that hasn't been tried yet."

"Untried treatment? What is it?"

"Mini allogeneic hematopoietic stem cell transplantation."

Chief Kim In-su, who had been listening silently, stepped back.

'Where does this guy keep finding these unheard-of diagnoses and treatments?'

He had a slightly annoyed look.

On the other hand, a faint smile spread across Professor Jo Taejin's face.

He was proud that a first-year resident knew about this experimental treatment.

"Mini allogeneic hematopoietic stem cell transplantation."

"Yes. The chemotherapy administered so far has likely severely suppressed the patient's bone marrow function. Many cancer cells have probably died as well."

"But not all of them."

Originally, transplanting another person's bone marrow after chemotherapy was a kind of reset.

After killing both the patient's bone marrow and cancer, the idea was to accept new bone marrow to survive.

This innovative treatment was so effective that it was being used in various types of bone marrow cancer.

However, one condition was necessary.

Both the bone marrow and cancer must be completely killed.

In this patient, this condition was not met.

"Yes, not all of them, but the surviving ones are likely fewer."

"Hmm."

Professor Jo Taejin, without explicitly contradicting, looked at the calendar.

Matching the hospital records, it had been quite a while since the chemotherapy started.

So, while the target dose hadn't been reached, a significant amount of chemotherapy had been administered.

"Then the cancer can be killed by the immune cells produced by the transplanted bone marrow."

If transplanting new bone marrow after killing both the bone marrow and cancer was innovative,

then transplanting new bone marrow after only partially killing the cancer was revolutionary.

"Are you aware that this is a risk?"

"But I think it's a worthwhile risk. Just the fact that we have a matching donor ... "

"Hmm. That's true."

Professor Jo Taejin recalled the many patients who had died while waiting for a donor.

Compared to them, this patient was in a better position.

He had an opportunity.

He didn't want to give up this opportunity too easily.

"I want to try it."

"Hmm."

Seeing Suhyuk's determination to save the patient, his heart moved a bit.

However, he wasn't ready to entrust the bone marrow transplantation to a first-year resident who had been in the program for less than two months.

"Kim In-su."

"Yes, Professor."

"Check the sterile room prescription. Patient ... Let's give it a try."

"Ah ..."

"What's the 'ah'? Let's give it a try."

"Yes, yes. I understand, Professor."

Thus, with Kim In-su's help, Suhyuk sent the patient to the sterile room after significantly lowering his immune system.

They didn't use any special methods; they just administered another round of chemotherapy.

As a result, the patient's already low immune system dropped to zero.

In other words, he was in a state where he couldn't survive in a normal environment.

'Now, the transplanted bone marrow ... must fight and win against the cancer cells.'

Suhyuk muttered to himself as he looked at the patient lying in the sterile room.

Since they shared the same view, Baruda was also looking at the same patient.

'To just hope for victory against the cancer cells in front of the patient, what a powerless statement, Suhyuk.'

'Hmm? Do you have any better ideas?'

[No, I don't.]

'What's your problem, man ...'

[It's just a fact that it's powerless.]

'Well ... That's true.'

Suhyuk wanted to find a way to counter, but he couldn't.

He just sighed.

The warm breath from his mouth fogged up the cold sterile room window.

Suhyuk left the ward, leaving the words "Please get well" on the fogged window.