Chapter 44: What Kind of Problem Is This? (3)

[Hmm...]

Baruda hummed as he looked at the red spots.

Suhyeok did the same, and even Hayun did.

"Sure enough, you're different, senior."

"Huh?"

Surprised by Hayun's sudden comment, Suhyeok took his eyes off the rash and looked at Hayun.

Hayun, still looking at the rash, continued.

"This problem, my dad said he copied it exactly. He said he would give it in the second semester."

"Oh..."

"So I know all the problems, but I'm still struggling."

It seemed he hadn't told Suhyeok.

'Professors...'

They could have at least told their own children.

They kept it so secret.

It's not for nothing that there are terms like 'egoism' and 'professoritis.'

"He said to look at this carefully."

Hayun, unaware of Suhyeok's thoughts, continued.

After hearing this, Suhyeok was convinced that his intuition was right.

'See? Did you hear? This is the key.'

[But I don't really understand. It's non-specific. These rashes are.]

Non-specific.

It's one of the things medical people hate the most.

'Ah, the patient's symptoms are non-specific.'

It's usually used like that.

It sounds like something is there, but it's almost the same as saying, 'Ah, I don't really know about this patient.'

'What a pain.'

[No... It's really non-specific. There are no characteristics.]

'No, no.'

Suhyeok, hearing Baruda repeat the word 'non-specific,' suddenly shook his head.

Hayun, who had leaned in quite close, almost got hit by Suhyeok's head.

"Ah."

Hayun, looking surprised, stepped back and stared at Suhyeok, who seemed to have frozen.

He didn't seem to realize that he almost hit Hayun.

'I've heard he's a bit strange sometimes.'

Professor Woo Changyun, who had recommended meeting him first, hadn't mentioned him much since then.

Since he was in a different hospital and very busy, it couldn't be helped.

On the other hand, Professor Jo Taejin, who often visited as a hometown junior or school junior, would talk about Suhyeok when he was bored.

- The kid is a bit strange at times, but he's a real genius, you know?

And the phrase 'The kid is a bit strange at times' always preceded any story about Suhyeok.

'Sure enough, he is a bit strange.'

Hayun looked at Suhyeok, who hadn't moved for almost a few minutes, with a curious expression.

Of course, Suhyeok's brain hadn't really stopped during that time.

'You said it's non-specific. Repeatedly.'

[Yes, it's non-specific.]

'But could that actually be a characteristic?'

[What? A lack of characteristics... is a characteristic?]

'Yes. As you said, the patient's pneumonia is indeed severe. It's severe, but it's not the cause. What we need to focus on is the rash.'

[That... That's true.]

In internal medicine, the most important thing is not how the patient got to this state but 'why.'

To do that, we need to trace back to the earliest symptoms.

'Where do non-specific rashes usually appear?'

Suhyeok redirected Baruda's attention and asked the question.

They had diagnosed many cases together, but this was the first time for such a situation.

So Baruda made a gesture of confusion.

Of course, this was all happening in Suhyeok's mind.

'Are you daydreaming?'

[Ah, no. No, Suhyeok, I'm sorry.]

'Where do non-specific rashes usually appear?'

[Even without an allergy, contact with rough materials can cause a rash.]

It was a correct statement, but not the answer Suhyeok was looking for.

'Not that.'

[They can also appear with a fever above a certain degree.]

'Not that. They don't appear all over the body, only in the folds.'

If Baruda were human, he would have been annoyed.

But Baruda was an AI.

An AI designed for diagnosis.

[Hmm... Non-specific rashes can also appear due to an allergic reaction to medication.]

'Right. That explains the rash all over the body.'

[But if we follow Suhyeok's logic, we need a reasonable explanation for the lack of itching in the initial rash.]

'The patient is elderly.'

[Symptoms can be non-specific in the elderly. Hmm.]

Baruda fell silent for a moment.

No matter how much data he had, he was still far from mastering medicine.

The human body is different from a machine, with significant variations from person to person.

Baruda spoke again after a few minutes.

[If we consider a drug allergy that we initially ruled out, specifically DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)... many symptoms can be explained.]

A drug reaction isn't limited to skin rashes.

It can cause various issues like fever, lymph node swelling, hepatitis, nephritis, and eosinophilia, which can lead to multi-organ failure in the patient.

[But the treatment for DRESS is steroids. If the diagnosis is wrong, i.e., if the patient has an infection, it could lead to irreversible consequences.]

'You're right.'

Steroids suppress all inflammatory responses.

So while they would be the best medicine for a drug allergy, using them in the presence of an infection would be like giving poison.

The patient would be eaten alive by viruses or bacteria.

'What should we do? It would be a waste not to try.'

[Hmm.]

Baruda fell silent again.

He seemed to be analyzing something.

Only then could Suhyeok look away.

Hayun was looking at him with a rather surprised expression.

"Ah, sorry. I get a bit... when I'm focused."

"No, it's fine. Professor Jo Taejin told me about it."

"Ah... You see Professor Jo sometimes?"

"He sometimes visits my home."

"Ah..."

At such times, Woo Hayun really felt like a golden spoon and a royal.

It was hard to imagine a home where professors visit regularly.

For an orphan like Suhyeok, it was unimaginable.

Just as he was starting to feel envious, Baruda spoke up.

[Let's do a biopsy.]

'Biopsy... of the rash?'

[Yes, of the rash.]

'Ah! If eosinophilia is found, it would confirm the diagnosis.'

[Yes, that's right. Before we see the results, it's best to continue antibiotic treatment. The lung reaction could also be due to medication, but the situation is too serious to stop the medication before we're sure.]

'Right.'

Suhyeok nodded.

Baruda was right; the chest X-ray was too severe to just stop the medication.

If it got worse, it would be hard to save the patient.

So, the final tests and results were decided.

"Let's do blood cultures, sputum cultures, PCR, and a biopsy of the rash."

Suhyeok, instead of just pressing the button, explained to Hayun.

Hayun, as expected, was curious about the last test.

"The rash?"

"Yes."

"What can we learn from a biopsy?"

From the way he asked, it seemed he had never considered it.

It was natural.

Lee Hyunjong had set a trap at the beginning of the current medical history.

This isn't a side effect of medication.

"An increase in eosinophils would suggest a drug side effect."

"But..."

"Let's try it. What do we have to lose?"

"Five lives."

"Huh? Lives? We didn't have that in my time."

"Someone got all the answers right by guessing, so... they added it."

"What a mess."

Suhyeok, forgetting he was in front of Hayun, cursed.

But Hayun didn't mind.

She had also cursed a few times when alone.

"What kind of PBL has lives? How many do you have left?"

"One... more."

"One. Huh."

So if Suhyeok failed this time, it would be the end.

[Think of it as a real case. You won't make a better decision than the one you've already made.]

Just as he was about to give up, Baruda's words echoed in his mind.

As always, they were the kind of words that made him focus on the patient.

'Right... I'll try. I don't think there's a more logical answer than this.'

Suhyeok was completely in agreement with the tests and treatment he had discussed with Baruda.

So he looked at Hayun with confidence.

"This is right."

"Hmm."

Hayun looked at Suhyeok for a moment and then nodded.

"Yes, senior. If I did it alone, I'd get it wrong and the patient would die."

"Good. Then let's choose. We'll do these tests. For treatment, add teicoplanin and start dialysis. Until the test results come in."

"Yes."

After making the choice, a sand timer appeared.

Next to it was a doll representing the patient and vital signs.

"If this is wrong, the patient will suddenly get worse and die."

"Such a bad taste..."

"Yes, it feels really creepy."

"Right away?"

"No, about three days?"

"Three days... We won't see the results of the culture tests anyway."

Just as Suhyeok said that, a day passed.

As expected, only one test result appeared.

The biopsy of the rash.

The culture tests would take a few more days to complete.

The patient would die before those results came in.

"Let's see..."

Suhyeok quickly clicked on the biopsy result.

Hayun leaned in close to the pad.

They were so close that they could have shared their exhaled carbon dioxide, but neither Suhyeok nor Hayun noticed.

[Moderate infiltration of lymphocytes and eosinophils around the blood vessels was observed.]

Suhyeok was completely absorbed in the conversation with Baruda.

'Right.'

[Yes, it's a reaction to medication.]

'I was right.'

[You seem very pleased.]

'Why aren't you arguing?'

[I couldn't analyze it that way.]

'Kid. Anyway, let's add steroids. Don't stop the antibiotics.'

[Yes, that's a good idea.]

Suhyeok, having made the decision in his mind, spoke up.

"It seems to be an allergic reaction to medication, right?"

"Ah... So eosinophils... It's like that?"

Hayun, still a student, didn't fit in as smoothly as the other professors.

Suhyeok chuckled, remembering his own naive past.

"Yes. So let's use steroids."

"Ah... Yes. Yes. I would have died anyway."

"Alright, let's do it."

Suhyeok, seeing that Hayun hadn't fully understood the situation, set the treatment plan.

The sand timer appeared again, and the next day arrived.

"Much better, right?"

"Wow... The lungs are better too!"

"Right. Now that it's confirmed, let's stop the antibiotics and go with steroids."

"Yes! Senior! Thank you so much!"