Chapter 63: What Can't You Do? (1)

'Fever and immunosuppressants...'

[Let's first confirm what type of suppressant it is.]

'Okay.'

Suhyeok leaned on his cane and entered the emergency room.

"It's Suhyeok."

"Ah... He's not that handsome."

"What does his face matter? They say he's a genius."

"No, just saying. I thought he'd be incredibly handsome."

His reputation had already spread thickly throughout the hospital.

Naturally, after diagnosing and treating countless cases on his own.

Moreover, it was now officially announced that he was the son of Director Lee Hyunjong, who had been the subject of various rumors.

His appearance, made even more noticeable by his cane, contributed to the attention.

The moment he entered, all kinds of whispers broke out, which was no coincidence.

"Where is the patient?"

"Ah... They're over there."

Thanks to this, the intern who had contacted him was exceptionally polite.

Being the director's son and a genius first-year internist, it would have been strange if he weren't.

"I'll just take a look at the patient's records for a moment and then go see them. Have you done the ECG and ABGA? If not, do them now."

"Ah, yes, sir."

Suhyeok first sent the intern to the patient and then sat in front of the monitor.

He then opened the patient's records.

[Sun Geum-suk, female, 53 years old.]

'She had a kidney transplant a month ago due to end-stage renal failure. Hmm... Is it a rejection reaction?'

A month is too long to be an acute rejection, but it's hard to completely rule out an acute rejection.

However, Baruda's opinion was slightly different.

[It doesn't seem to be a rejection reaction based on the kidney function.]

'The kidney function has dropped a bit, hasn't it?'

[It's more likely that the donor's kidney function was already slightly reduced.]

'Hmm... So you're saying that the current fever is not directly related to this?'

[That's right. Of course, further confirmation is needed.]

'Got it.'

Suhyeok decided to investigate further and delved deeper into the patient's records.

'The medications are cyclosporine and mycophenolate.'

[These are common medications used after kidney transplants.]

'Right. Hmm.'

He also learned that the patient had been suffering from hypertension for about 20 years.

It seemed that the hypertension had led to kidney failure, which necessitated the kidney transplant.

Of course, since the patient had been treated at other hospitals before the transplant, this was all speculation.

But given that Suhyeok and Baruda were the ones making the speculations, they carried considerable credibility.

[The patient has been complaining of general weakness for the past two days.]

'The fever was confirmed upon admission.'

[Even so, it's not very high.]

The patient's temperature was 37.8°C, which only indicated a mild fever.

What caught Suhyeok's attention more were other values.

'Her blood pressure is 94/64... Her heart rate is 116... She's a hypertension patient, right?'

[It's much lower than her baseline blood pressure.]

'Let's start with an IV, then.'

The process of diagnosis was, of course, interesting and enjoyable.

Especially with Baruda, they almost always found the answer, making it even more enjoyable.

But first, he had to save the patient's life.

Diagnosing after the patient had died would be meaningless.

So, Suhyeok approached the patient with his cane again.

Although her blood pressure had dropped significantly compared to her baseline, it wasn't extremely low in absolute terms, so the patient was in the general emergency room, not the treatment room.

"Give 300 mL of normal saline at a full drip rate."

"Ah, yes, sir."

Suhyeok gave the order and then carefully examined the patient.

The main symptom was weakness, and she indeed looked very weak.

[She's 163 cm tall and weighs 38.5 kg.]

'Has she lost weight recently?'

[She weighed 43 kg when she was admitted for post-surgery treatment.]

Even then, she wasn't particularly robust.

But it was still much better than now.

It also suggested that she had lost weight over the past month.

This meant that the current situation might have been ongoing longer than initially thought in the emergency room.

'Hmm.'

Keeping in mind that it might not be an acute infection, Suhyeok began to observe the patient from head to toe.

Whether her eyes were yellow.

Whether her eyelids were pale.

Whether her breathing was rapid, or if she was using the intercostal muscles.

The condition of the area where she had surgery a month ago, and so on.

He examined everything very thoroughly.

[The surgical site is slightly red.]

'Yes. Especially the area where the tube was inserted is very red.'

[Yes. That area must be checked, but there don't seem to be any significant abnormalities elsewhere. However, the absence of abnormalities doesn't mean there's nothing wrong.]

'Right.'

She was taking immunosuppressants, so typical symptoms might be masked.

In such a situation, he had no choice but to rely on blood tests, X-rays, or urine tests.

So, Suhyeok decided to wait for the urine test results.

While looking at the ECG results brought by the intern.

"Ah."

The ST segment on the ECG was not entirely typical but was elevated compared to normal.

However, the amount of cardiac enzymes observed in the blood test was not particularly high.

Baruda quickly spoke after synthesizing these findings.

[It seems to be myocarditis rather than a myocardial infarction.]

'Is this due to systemic infection?'

Suhyeok looked at the patient with a bewildered expression.

She definitely looked a bit weak, but it wasn't a critically serious situation.

But Suhyeok was no longer just a doctor with theoretical knowledge.

He had gained considerable experience from treating many patients.

'She might suddenly deteriorate...'

[It's important to make a proper diagnosis as quickly as possible.]

'Let's do a CT scan while waiting for the urine test results. I'm too worried about this.'

[That's a good idea, Suhyeok.]

So, Suhyeok decided to get an abdominal CT scan to check the red, swollen area.

He judged that if there was a serious infection, it was likely due to the surgical site.

"Contact the CT room and have them scan immediately."

"Yes, sir."

The intern immediately called the CT room and emphasized that the person requesting the scan was Director Lee's son, Suhyeok.

The radiologist sighed briefly and then nodded.

"Come right away. We can push it through since there are no urgent cases."

"Thank you."

Thanks to this, the patient could be taken to the CT room immediately.

Suhyeok wanted to go with her, but his leg made movement difficult.

[The test results will come soon. Check the urine test first.]

'Right...'

[We are also analyzing the options for your leg. Don't be too disheartened.]

'Right... Let's check the urine first.'

So, Suhyeok started refreshing the test results while the patient was being taken to the CT room.

Suddenly, the results appeared, and Suhyeok and Baruda began analyzing them together.

'There's hematuria. The amount is not small...'

[There are also white blood cells. It's an infection.]

'Urinary tract infection... But the fever isn't that high.'

[She's taking immunosuppressants.]

'This is not good...'

[It's the worst-case scenario.]

A urinary tract infection after a kidney transplant.

There was a possibility that the transplanted kidney itself was infected.

If that were the case, even if the infection was successfully treated, kidney failure could recur.

Naturally, Suhyeok's face contorted.

[Ah, the patient is out. The image should be up.]

At that moment, Baruda drew his attention.

Despair would be appropriate only after the patient's condition worsened.

Now, he had to do his best to prevent that.

That was what Baruda considered an excellent doctor.

'Although the image is unclear due to the lack of contrast...'

[The transplanted kidney is swollen, and there is fluid accumulation around the area where the tube was inserted.]

'Is it pus?'

[We can't be 100% certain without contrast, but it's a reasonable assumption.]

'Damn it.'

The test results indicated that the patient had an infection in the transplanted kidney.

The infection was not a mild one and had spread throughout the body.

The only fortunate thing was that the chest X-ray was clear, but in the current situation, it was uncertain when and how pneumonia might develop.

"First... I'll admit her to Professor Shin Hyuntae's ward."

So, Suhyeok issued the admission order before even notifying anyone.

It wasn't out of arrogance.

It was because Professor Shin Hyuntae had given him full authority.

At least Suhyeok could admit patients without any formalities.

This was one of the privileges accorded to a national-level talent.

"Yes."

"Also, let's start vancomycin. Just vancomycin for now."

'Vancomycin' referred to vancomycin, a broad-spectrum antibiotic effective against resistant strains.

It was a precious drug usually used only after other antibiotics failed or when suspected from culture tests.

But sometimes, treating patients required breaking the rules.

Watching this patient deteriorate while waiting would be the same as letting her die.

"Yes, sir."

"And..."

Suhyeok knew that it would take some time for the patient to be moved to the ward after the admission order.

He also knew that time was of the essence for this patient.

[Do it yourself. Your leg is the problem, not your hands.]

'Me? Without calling a surgeon?'

[It's all about time. I'll coach you.]

'Hmm.'

Suhyeok hesitated for a moment, looking at the patient's swollen surgical site.

He felt a bit uneasy about incising it since he wasn't a surgeon.

[Just 1 cm is enough.]

But with Baruda's coaching, he thought he could manage it.

It was more of a procedure than a surgery.

Moreover, Suhyeok had experience performing various procedures with Baruda's coaching.

He was confident in his abilities.

Suhyeok pulled a chair and sat next to the patient.

The patient, who had been lying with her eyes closed, suddenly opened them.

She didn't have the energy to move much, though.

Anyway, Suhyeok faced the patient and spoke.

"Patient, you have an infection. Does this area hurt?"

He pointed to the surgical site.

The patient nodded slightly and replied with a hoarse voice.

"It... doesn't hurt."

"I'll make it a bit better. It might sting a little, but can you handle it?"

"I... can handle the pain..."

"Yes, I'll do my best to make it painless."

Suhyeok said this and turned to the intern.

The intern, who hadn't realized what he was about to do, just stared with wide eyes.

"Ah, bring me the incision and drainage set. Stand opposite me and assist."

"Here? You're going to incise here?"

Suhyeok was also surprised when he first heard it from Baruda.

But with the patient in front of him, he couldn't show any hesitation.

He had to act as if he was experienced.

He was confident he could do it.

"I'm good at it. Bring it."

"Ah... Yes."

The intern nodded and ran to get the set.

The emergency room staff, who had been watching, started whispering again.

Partly because they didn't realize it was a simple procedure, but mainly because it was shocking to see an internist with a scalpel.

"What, can he do surgery too?"

"He really is a genius..."