Chapter 57: Academic Society (2)

‘Medical history?’

Suhyeok's trust in Baruda had risen to an extreme compared to before.

Therefore, instead of doubting the diagnosis itself, he asked how the diagnosis was made.

[Yes, Suhyeok. The patient has a history of splenectomy.]

Baruda, too, was much more cooperative with Suhyeok compared to before.

Thanks to this, the two could continue a more productive conversation very quickly at the critical moment when Jo Taejin was about to pick up his phone again.

‘Splenectomy is performed when the spleen becomes too large and needs to be removed.’

[That's correct. Why do you think the spleen became enlarged?]

‘Obviously, it's because there was a lot of hematopoiesis outside the bone marrow... Wait, hematopoiesis outside the bone marrow?’

Suhyeok mumbled to himself and then his face lit up as if he had a eureka moment.

Baruda, confident that this expression was not for nothing, continued in a very proud tone.

[You've really improved, Suhyeok. I am deeply impressed.]

‘Right, that makes sense. Tuberculosis seems a bit off.’

[Yes. Even though tuberculosis is common in our country, there is insufficient evidence to suspect it.]

After all, the only thing the patient had was three months of steroid treatment in the past.

There were no signs of previous tuberculosis lesions.

There was no similar medical history in the patient's statements.

Therefore, it was much more logical to explain this phenomenon based on the current disease the patient had.

With this confidence, Suhyeok opened his mouth.

Just as Jo Taejin was about to reach for his phone.

“Professor.”

“Yes, Suhyeok.”

Fortunately, the relationship between Jo Taejin and Suhyeok was as solid as it could be.

Although it was mostly Jo Taejin who was almost unilaterally courting Suhyeok.

In any case, it was a great help at times like this.

Suhyeok continued speaking to the affectionate Jo Taejin, despite interrupting the professor's action.

“About that image... Is it really tuberculosis?”

“Huh?”

Jo Taejin's face showed that he thought it was a strange question.

The image from earlier had a quite distinctive appearance.

Yet, it could be something else.

If someone other than Suhyeok had brought this up, Jo Taejin would have been furious.

But strangely, Jo Taejin was not angry at all.

‘Why is my heart beating so fast?’

His heart was pounding to the point of being surprised himself.

It was because he felt that Suhyeok would present a very plausible argument.

Even if it wasn't the correct answer.

It seemed likely at the moment.

But that was fine.

“Why do you think so?”

So, Professor Jo Taejin put his phone back in his pocket and opened his laptop.

The other residents, seeing this, all thought to themselves.

‘Damn. If I were not Suhyeok, I would be so jealous I couldn't live.’

Of course, Jo Taejin was not such a devilish professor.

But he was not a pushover either.

He was a professor of hematology and oncology, after all.

One of the frontlines in the battle against diseases in internal medicine.

Would such a person just smile all the time?

That would be even stranger.

‘If I were in his place... No, I wouldn't even sit next to him.’

Why would he sit next to someone when there were empty seats around?

He would just end up annoying the professor by talking.

But fortunately, Suhyeok was Suhyeok.

The one Jo Taejin favored.

“Here, look. Doesn't this look exactly like tuberculosis?”

Jo Taejin chuckled and paused the image.

At a point where a narrowed area in several segments was clearly visible.

It was so characteristic that even Baruda and Suhyeok would think it was tuberculosis.

But they could also see something odd, having already thought of another diagnosis.

“The shape is definitely that of tuberculosis. But if you look at the blood test results Kim In-soo sent, it's definitely a bit strange.”

“Test? This one? Well... There are no inflammation markers.”

Jo Taejin had just glanced at the blood test results.

He had been an internal medicine professor at Taehwa Medical Center, the best in the country, for several years. How could he not understand this?

“But with the steroid use and the patient's chronic myelofibrosis, it's even harder for the values to show up properly.”

He had already built a plausible argument.

It sounded so convincing that Suhyeok had to call Baruda.

‘Hey, are we right?’

[Yes, we are. Professor Jo Taejin will agree with just one word.]

‘Okay.’

But Baruda's words were more convincing.

Thanks to this, Suhyeok gained courage and started reciting what he had thought about.

“Yes, that's true. But if you look at the narrowed area, it is limited to this specific region. This is a different finding from typical tuberculosis.”

“That's... Hmm. That's true. But tuberculosis can invade segments.”

Jo Taejin was pleased with Suhyeok's solid logic.

How many residents had made baseless claims like ‘I don't think so’?

Compared to them, a resident who could engage in such a discussion was like a breath of fresh air.

“Yes, that's true. But if you look closely at this narrowed segment, isn't there something unusual?”

“The lesion? The lesion itself doesn't seem unusual.”

“Not the lesion, but the area it has invaded. What about that?”

“The area...?”

Jo Taejin tilted his head at Suhyeok's words.

‘Not the lesion, but the area?’

He had never even considered such a thought.

Perhaps because of this, he immediately felt he had missed something.

‘What is it? What did he see?’

Until now, he had been lecturing as a professor.

Now, he was lagging behind.

It was natural.

He felt that his favored student had seen something he had not.

“Oh... This is a bit strange, isn't it?”

Fortunately, Jo Taejin was a professor at Taehwa Medical Center for a reason.

He soon identified the oddity.

“This is... a part of the digestive system... where... hematopoiesis is still possible...”

“Yes. The area capable of hematopoiesis is narrowed.”

“What does that mean...”

“It seems that a mass has formed here because the body is trying to produce blood.”

“Oh... That's right. This patient had a splenectomy.”

After a splenectomy in myelofibrosis, there can be an increase in extramedullary hematopoiesis as a side effect.

There could also be more severe side effects, such as leukemia.

‘Back then... Did I remove it for no reason?’

Jo Taejin suddenly recalled the past.

But even if he could go back, he probably wouldn't make a different choice.

Kim Sung-won's spleen was on the verge of necrosis.

If it hadn't been removed, he wouldn't have survived.

“Yes. That's why the patient only has abdominal pain and no blood in the stool. If it were tuberculosis and this narrowed, there would definitely be blood in the stool.”

“That's true. So, if we consider this as a mass due to extramedullary hematopoiesis... The blood test results also make sense.”

Occasionally, misdiagnosis is unavoidable.

But usually, when a misdiagnosis is made, it's because ‘This doesn't make sense’ or it's completely overlooked.

Jo Taejin felt a sense of catharsis as the previously unexplained aspects were now all explained.

“This is why I do internal medicine. It's great. Well done.”

“Thank you, Professor.”

“No need to thank me. I'm the one who's grateful. Ah, I should have given this case to you to present, not me. Professor Lee Hyun-jong beat me to it...”

Jo Taejin chuckled again and picked up his phone.

It was natural for the other residents, watching this, to sigh.

‘He's amazing... How does he diagnose that?’

Especially Yoo Ji-sang, Suhyeok's classmate, felt jealousy.

He had also been working hard.

He had achieved some success.

He had entered internal medicine with the dream of becoming a professor.

But no one looked at him the way they looked at Suhyeok.

It was natural.

There were excellent residents like Yoo Ji-sang every year.

In contrast, a resident like Suhyeok was unprecedented.

“Hey, In-soo. I saw the image.”

While Yoo Ji-sang and the other residents were feeling despair, Professor Jo Taejin hurriedly called Kim In-soo.

He was worried that Kim In-soo might have already taken action based on a tuberculosis diagnosis.

“Yes, Professor. I was giving the patient painkillers and checking other patients.”

Of course, Kim In-soo was a very experienced resident.

He wouldn't rush into anything and ruin things.

“Oh, good. You did well. The image doesn't seem to be tuberculosis.”

“What? Not tuberculosis?”

“Yes. I looked at it with Suhyeok. He suggested that the patient's splenectomy and the current lesion might be related, and it made sense.”

“Oh, Suhyeok...”

Kim In-soo's voice noticeably deflated when he heard Suhyeok's name.

After all, Suhyeok, just two years his junior, was overwhelmingly capable.

There were already talks of making Suhyeok a professor right away since he didn't have to go to the military.

This meant that Kim In-soo's chances of becoming a professor had drastically decreased.

Of course, Jo Taejin, who didn't consider such trivial emotions, continued with his own thoughts.

“It seems to be extramedullary hematopoiesis. You know, extramedullary hematopoiesis.”

“Oh? Oh... Yes, yes.”

“Right. Doesn't it make sense to you?”

“Yes.”

Kim In-soo, not fully understanding but deciding to pretend, agreed.

He didn't want to appear as a third-year resident who was far behind a first-year.

“Right, right. Do you know the treatment? Do it that way.”

The problem was that Jo Taejin didn't even suspect Kim In-soo's true thoughts.

Instead of explaining the treatment, he just told him to figure it out and hung up.

“Damn, what a mess.”

For Kim In-soo, this was a real disaster.

From the way Jo Taejin spoke, it seemed there was no clear treatment for this symptom.

But Kim In-soo had no idea what to do.

‘What should I do... Should I use steroids? No, if something goes wrong... Damn, I shouldn't have pretended to know.’

He always told junior residents, ‘Don't pretend to avoid trouble in front of me, or you'll cause an accident.’

Now, he had made the same mistake, which made him very frustrated.

Buzz.

His phone in his pocket rang.

Thinking it might be Jo Taejin, he quickly answered, but it was Suhyeok.

Not a call, but a text message.

<Professor said to arrange for radiation therapy.>

He couldn't help but laugh.

‘This kid...’

Kim In-soo, who had been in internal medicine for three years, knew Jo Taejin's character.

This person would never send a follow-up text message.

This meant that Suhyeok had sent the message on his own.

Fortunately, Kim In-soo, unlike Kim Jin-yong, was someone who appreciated favors.

‘Right, you should become a professor... You're the one who should...’