Chapter 39: If Not Delirium, Then What? (1)

"Patient! You just had surgery!"

Rather than the incapacitated Suhyuk, the others rushed to the patient much more quickly.

In particular, Professor Ryu Jin-soo of the Transplant Surgery Department almost slid over to lay the patient down.

It was a natural occurrence.

This patient had not undergone just any surgery, but a lung transplant.

Due to the use of immunosuppressants, the patient had developed pneumonia, leading to a partial lobectomy and a transfer to the ICU.

"No! My wife is having an affair!"

However, the patient was a very robust individual.

Moreover, he was in his 30s, still brimming with energy.

For Ryu Jin-soo, who had only ever handled scalpels in his life, there was no choice but to be pushed aside helplessly.

"Hey."

"Hey! No! You can't get up!"

Fortunately, there were several nurses in the ICU besides Ryu Jin-soo.

With the youngest and only male nurse, Lee Chul-jin, at the forefront, they managed to lay the patient back down.

The patient had just been about to pull out the chest tube that was inserted in his chest.

"Phew."

What would have happened if it had been pulled out?

Professor Ryu Jin-soo would have had to rearrange the operating room and perform emergency surgery again.

The patient's immune system was clearly not normal.

So, he let out a sigh of relief and approached the patient.

"Wife! Affair!"

The patient was still repeating the same words.

It was a delusion, which, in fact, was one of the common symptoms seen in the ICU.

"Delirium, it's delirium."

Ryu Jin-soo muttered this as he approached the patient.

By then, Suhyuk had also moved close to the patient.

[Delirium. This is the most likely diagnosis at the moment.]

'So, there's nothing to worry about, right?'

[But it's not common.]

'Not common?'

Ryu Jin-soo, standing beside the patient, didn't even glance at Suhyuk, who was lost in his own thoughts.

The situation was too urgent, and he couldn't afford to pay attention to someone from another department, even if "Internal Medicine" was written on the left side of his chest.

"For now... consult with Psychiatry. For now..."

Ryu Jin-soo looked down at the patient with a slightly darkened face.

"Affair!"

The patient was still trapped in the delusion that his wife was having an affair.

In this state, any kind of interview or treatment seemed impossible.

"For now, let's sedate him."

Though he didn't like it, he decided to administer a sedative first.

'How much longer will this extend the recovery period...?'

One of the drugs that can cause delirium is a sedative.

So, the principle is to use it as little as possible.

However, as is well known, there is no principle that applies in all situations.

Especially in the field of medicine, where people are treated, this is even more true.

"Yes, Professor."

"For now, just ask Psychiatry to review the medication. If he starts causing trouble again... it will be a real problem."

After the sedative was administered, Ryu Jin-soo approached the patient and examined the wound area, muttering to himself.

All the residents and nurses around nodded their heads.

Only Suhyuk was lost in his own thoughts.

Or rather, he was engrossed in a conversation with Baruda.

'What do you mean it's not common? That sudden delusion and aggression are classic delirium, right?'

Suhyuk had seen a few delirium patients before.

It was a natural occurrence for anyone who had done an ICU internship.

And the symptoms of this patient were very similar to those of the delirium patients Suhyuk had seen so far.

[First, look at the patient's age.]

However, Baruda was not a creature that reasoned based on limited direct experience.

He was an AI that could treat direct and indirect experiences equally.

And he was quite a high-performance one.

'Age... hmm. 34. He is young.'

Delirium usually occurs in the elderly.

It might sound a bit insensitive, but aging is not particularly beneficial in medical terms.

[That's right. The age is not common.]

'Is that all? This is a lung transplant patient. How weak must he be?'

[You just saw him push Professor Ryu Jin-soo away with one hand.]

'No... that's not what I mean. Just because he has good muscle strength doesn't mean he's healthy.'

Of course, muscle strength is often positively correlated with various health conditions.

But having strong muscles doesn't mean you're immune to chronic diseases.

Baruda didn't argue with Suhyuk's point.

[You're right. But there's more than just the age that's not common.]

'Such as?'

[What time is it now, Suhyuk?]

'Huh? Why the time all of a sudden?'

[Just answer.]

Suhyuk looked around, not understanding.

The patient was already deeply asleep after the sedative.

One nurse was carefully monitoring the patient's oxygen saturation to ensure his breathing remained stable.

'It's 2 PM.'

Suhyuk thought it was bright because it was daytime.

And this thought soon led to a sense of something being off.

'2 PM?'

[Yes, it's daytime.]

'Delirium... '

[It usually occurs at night.]

'Um... but we can't conclude it's not delirium just based on these two factors.'

[Your point is valid. I suggest further observation.]

'What... '

Suhyuk glanced at the clock again.

It was indeed 2 PM.

If there were urgent patients in the ward, it would be a very busy time.

But at least for Suhyuk, it wasn't.

'Thanks to Baruda.'

He could quickly prescribe medication for most inpatients with Baruda's help.

Especially for patients who came in with a diagnosis, prescriptions would be issued almost immediately.

'The nurses like me because of this.'

He had heard that when handing over, his patients were always very neat.

Not only for today, but even for tomorrow and the day after, the prescriptions were already issued.

Thanks to this, Suhyuk had more time compared to other internal medicine residents.

[I recommend you start with the ICU chart.]

Meanwhile, Baruda seemed to find even the time Suhyuk spent in contemplation precious.

However, Suhyuk was also becoming interested in the patient, so he didn't let it go.

Swish.

He immediately started reviewing the ICU chart.

Professor Ryu Jin-soo had already left for another surgery, and the transplant surgery residents were also gone.

The ICU was now only staffed by nurses.

"Who's that? Psychiatry?"

"Looks like Internal Medicine."

"Isn't it Lee Suhyuk?"

One of them recognized Suhyuk.

The others, who had never heard of him, looked curious for more information.

"Lee Suhyuk?"

"Don't you know? He's the hidden son of the director."

This rumor was still only known to a few within the internal medicine department.

Moreover, they had fallen into doubt again due to the email sent by Director Shin Hyun-tae.

Otherwise, they wouldn't have said to leave him alone.

"Wow, he's a royal."

"But why is he here? For Pulmonology?"

"No idea. They didn't even consult with us."

"For now... just leave him alone. Don't get too close."

"R-right."

Getting on the bad side of a royal could be disastrous.

It was best to stay hidden unless absolutely necessary.

Fortunately, Suhyuk was more focused on the ICU chart than on his surroundings.

[The blood pressure, temperature, heart rate, and respiratory rate are all stable.]

The vital signs, which are the most important indicators of a patient's condition, were extremely stable.

They looked almost perfect.

'But the chest X-ray is a mess.'

[The results of the lung tissue biopsy show Aspergillus.]

Aspergillus.

A fungus that can occasionally be found in the bodies of healthy adults.

It doesn't cause problems in healthy adults due to the immune system, but in a patient with severely compromised immunity like this one, it can cause significant issues.

As it did in this patient.

'This is a tough pneumonia. Not bacterial, but fungal.'

[That's probably why they performed the lobectomy. Fortunately, the surgery went very smoothly.]

'It says here that it was a collaborative surgery with thoracic surgery. The surgeon was Kang Il-gu, a well-known figure.'

[I know. There are related papers in my data.]

'Oh, is that so?'

[You read it yourself, but you don't remember.]

Since it was data, he could load it without a single error.

But without the memory of reading it, it was all for nothing.

'Well... what's important now is not that.'

So, Suhyuk decided to let it go.

Fortunately, Baruda was also focused on the patient's condition and didn't argue further.

It was worth feeding him zazang noodles regularly.

[This isn't the first time for delirium.]

'Oh, right. It happened in the morning and last night too.'

[The morning episode was very brief.]

'They administered a sedative right away.'

[And there was an episode last night. Given the situation last night, it's hard to think of anything other than delirium, except for the age.]

'So, it's just delirium, after all?'

[The likelihood has increased.]

'Previous... oh, the tube was removed yesterday.'

[Yes, before that, they kept him completely sedated.]

That meant he didn't show any symptoms like delirium.

Feeling a bit deflated, Suhyuk approached the patient, Yang Jae-won.

Fortunately, Yang Jae-won's surgery went very well.

His vital signs remained stable throughout the surgery.

Since the tumor wasn't large, he could return to daily life soon if he recovered well.

As the attending physician, Suhyuk couldn't just ignore him because he was in another department.

So, after all his tasks were completed, around 8 PM, Suhyuk returned to the ICU.

"He's still sedated."

Yang Jae-won looked exactly the same as right after the surgery.

[The test results are also stable. It seems he can be extubated by tomorrow.]

'Should I go?'

[Why don't you study?]

'Good idea.'

Just as he was about to leave, Park Tae-soo had another episode.

"My wife is having an affair!"

As a doctor, he couldn't just ignore a patient experiencing delirium.

Especially since Suhyuk was the only doctor in the ICU at the moment.

"Administer a sedative! If he pulls out the chest tube, it will be a big problem!"

"Yes!"

The nurses, who were already on high alert due to the "royal," rushed to the patient.

Soon, the patient was sedated and fell to the side.

'Why haven't they consulted with Psychiatry yet? This isn't getting resolved.'

Just as Suhyuk was about to leave, Baruda called out.

[Wait!]

'What?'

[What time is it now?]

'2 PM.'

[The same as yesterday, exactly.]

'What?'

[The time when delirium symptoms were shown yesterday was also 2 PM. This...]

'Can't be a coincidence.'