Chapter 64: What Can't You Do? (2)

"Here it is."

The intern, with an extremely brisk attitude, brought the incision and drainage set.

With the help of the nurses, it was not a usual task.

Although Suhyuk was only in his first year, he was being openly pushed by the internal medicine department.

Moreover, he was the son of the highly successful Dr. Lee Hyunjong.

As an intern who wanted to continue his training at Tae-hwa Medical Center, it was an inevitable situation.

[Indeed, Lee Hyunjong is quite influential.]

Baruda, who was being treated almost like a third-year chief or fellow, spoke with a satisfied tone.

In contrast, Suhyuk had a slightly tense expression.

Although diagnosing was something he had done before, cutting into a patient's body was not something he was used to.

It would be strange if he didn't feel tense here.

[First, the incision point is exactly where the catheter was inserted. Easy, right?]

‘Oh.’

Of course, with Baruda's help, he was confident he could do it perfectly.

[Clean the area with Betadine, in a circular motion, gradually expanding. Yes, that's good.]

Having memorized the textbook and even compiled YouTube videos to show him, it would be foolish if he couldn't do it.

Fortunately, Suhyuk was not a fool but a very intelligent person, so the surgery was proceeding smoothly.

[Have the intern hold the gauze and stand by.]

‘Ah, okay.’

Following Baruda's instructions, Suhyuk had the intern stand by and then picked up the anesthetic syringe.

In the old days, when both patients and doctors were full of fighting spirit, incision and drainage were sometimes done without anesthesia.

But that was an old story.

If it could be done painlessly, it should be done painlessly.

"It will sting a little."

"Yes..."

After informing the patient that he would be administering anesthesia, Suhyuk injected the anesthetic near the incision point.

Using a dental syringe, which has an incredibly thin needle, and following Baruda's advice thoroughly, there was almost no pain.

[If you do it better, it won't hurt at all. The patient just winced.]

‘It's fine. This is good enough. I'm not going to be a surgeon anyway.’

[That's true, but it's a bit disappointing.]

‘Tell me next time. Just cut with the scalpel, right?’

[Yes. Cut about 1 cm long and 0.5 cm deep at the center of the area you disinfected. There will be some bleeding, but it won't be severe.]

‘Okay.’

Although Suhyuk received a bit of a scolding, he picked up the scalpel without losing his composure and made a cut at the point Baruda indicated, which also seemed to be the core of the abscess.

"Does it hurt?"

"Huh?"

"No, I just made the cut."

"Ah, yes."

While confirming that the area was thoroughly numbed.

Squish.

At the same time, pus began to gush out from the area where the catheter had been inserted, which was likely connected to the transplanted kidney.

"Intern, apply pressure from above. The patient might feel pain."

"Uh, yes."

Following Suhyuk's instructions, the intern pressed the gauze, and a large amount of pus flowed out through the 1 cm incision.

"Wow."

"Is, is the patient feeling better?"

The intern, who hadn't made the incision, looked very proud.

Medical staff often make such expressions when draining pus, but Suhyuk, the one who actually did it, couldn't.

‘Is this... already... damaged?’

[It still functions, but if this level of infection continues, it will definitely be damaged. We need to find the causative agent and treat it.]

‘Let’s send a culture test first.’

[Good idea.]

He also intended to send a blood culture test.

But more samples are always better.

Moreover, this was not just a clump of bacteria but a clump of bacteria collected from the infection site.

Of course, it wasn't pure bacteria but a mixture of bacteria and dead white blood cells.

Still, it was good to perform a culture test from the pus if possible.

"Wow... Look at how much is coming out. It seems you hit the exact point."

"Indeed. It's only a 1 cm cut..."

"No wonder he's Lee Hyunjong's son. He's the best genius since our hospital and university were founded."

"But Professor Lee Hyunjong says that Dr. Suhyuk is even more of a genius than him."

After performing the culture test, Suhyuk continued to remove the pus.

An enormous amount was coming out, as the emergency room staff were whispering.

Thanks to this, the patient's face looked much better than before.

It was natural, as the bacteria and pus that had been brewing inside the body were now flowing out.

"Thank you."

"No, it's my duty. Since a room has been arranged... I'll see you upstairs. We'll start the antibiotics here and then go up."

"Yes, doctor."

After removing the pus, Suhyuk also inserted a catheter to continuously drain the pus.

He then attached vancomycin, as he had mentioned, and sent the patient to the ward.

The next thing he did was call Shin Hyuntae.

"Yes, Professor. This is Suhyuk."

"Hey, Suhyuk. My nephew."

"Not... exactly... that's a bit..."

"Dr. Lee said to call me dad. I need to get used to it."

"Not..."

"Alright. What's up? Oh, you're on duty?"

Shin Hyuntae answered the phone in a very friendly manner and only then got to the point after a few more words.

Since Suhyuk was used to this atmosphere lately, he wasn't flustered.

He calmly and perfectly continued his report.

"Ms. Son Geum-suk, a 53-year-old woman, was diagnosed with hypertension 20 years ago and progressed to end-stage renal failure 10 years ago, receiving dialysis. She underwent a deceased donor kidney transplant a month ago and is currently taking cyclosporine and mycophenolate as immunosuppressants. She came to the emergency room two days ago with generalized weakness and had a fever of 37.8°C, for which I received a notification."

"Ah... This is going to be tricky. How about the chest?"

"The lungs are clear, but there are signs of inflammation at the transplant site. I performed an incision and drainage, and about 32 cc of pus was drained."

"32 cc? That's a lot... What about kidney function?"

"It's a bit low, but she's still producing urine."

"Hmm."

Shin Hyuntae's voice had dropped significantly from when he first answered the phone.

The patient's condition was not just poor but almost in the worst-case scenario, which was natural.

Even as a professor of internal medicine at a university hospital, who deals with death almost daily, he was not used to such situations.

"Also, pus was detected in the urine test."

"Urinary tract infection... But is the transplanted kidney the source of the infection?"

"Yes."

"Hmm."

Shin Hyuntae sighed again.

It wasn't that he couldn't come up with a treatment plan.

He was just worried about the patient.

"Have you started antibiotics?"

"Yes, I immediately used vancomycin."

"Good. Let's see this patient first thing tomorrow morning."

"Yes."

"If anything unusual happens at night, call me. In the early morning, do a chest X-ray, urine test, and blood test again. Oh, and an ECG."

"Yes, Professor."

Suhyuk nodded and hung up the phone.

He then followed the instructions from Shin Hyuntae, added what he thought was necessary, and followed Baruda's advice, performing almost a perfect treatment.

However, the reality they faced when they visited the patient the next day with Shin Hyuntae was not so easy.

"Her temperature... 38.2°C. It's risen."

Shin Hyuntae frowned as he checked the patient's vital signs.

"Ha... Ha..."

The patient, who had shown no breathing problems until last night, was now breathing rapidly.

This made it difficult to communicate properly.

The chest X-ray taken in the early morning clearly showed the lungs turning white, indicating the reason.

"The infection has progressed to pneumonia."

"But you started vancomycin, right?"

"Yes, as soon as she came in yesterday."

"Did you send a culture?"

"Yes, but..."

The results wouldn't be available for at least a week.

While this wasn't an unusually long time in general, it would feel like an eternity for this patient.

At the current rate, critical damage would likely occur within 5 days.

By then, it would be too late to identify the causative agent properly.

"Is it VRE?"

"It's possible."

VRE.

Short for "Vancomycin-resistant Enterococci," it refers to super bacteria that are resistant to vancomycin, which was originally developed to treat resistant bacteria.

While the infection rate is naturally low, this patient was a chronic renal failure patient who had also received an organ transplant.

Her hospital stay had been extremely long.

It wouldn't be surprising if she had been exposed to any bacteria.

"Let's switch the antibiotics to imipenem."

"Yes, Professor."

It was unusual to change antibiotics after less than a full day of use.

Especially for an excellent infectious disease professor like Shin Hyuntae, it was a rare occurrence.

The time it takes for antibiotics to take effect is usually around 48 hours after administration.

But sometimes, rules need to be broken.

Because no rule is more important than the patient's life.

"And... move her to the ICU. Intubate her and check her vitals every 15 minutes."

"Yes, Professor."

Suhyuk looked slightly flustered at the mention of checking vitals every 15 minutes.

This meant that the assigned nurse would have to be changed frequently.

But what could he do?

The patient seemed like she would die if they didn't.

Suhyuk had no choice but to nod.

"Shall I do the intubation?"

"No, I'll do it. Give me some sedatives."

"Yes."

Suhyuk picked up the plastic tube he had prepared next to the patient, ready to insert it if needed.

The nurses administered sedatives and muscle relaxants, waiting for the patient's consciousness to fade.

[Now.]

Following Baruda's advice, he inserted the tube into the patient's throat.

It was a nearly perfect intubation, as always.

"You really can do anything."

Shin Hyuntae gave a brief compliment and pulled the bed where the patient was lying.

"Let's change the antibiotics as I said. I hope imipenem works."

"Yes, Professor."

Suhyuk also pulled the bed and headed to the ICU with Shin Hyuntae.

While breathing into the tube he had just inserted, he connected the patient to a ventilator upon arrival at the ICU.

[There's nothing left for me to do in the prescription.]

‘Of course. How many critical patients have we had?’

[However... The diagnosis is the problem. We still haven't identified the causative agent.]

‘We can only hope imipenem works...’

After quickly writing the prescription, Suhyuk looked at the patient again.

The person who was conscious yesterday was now intubated and lying in the ICU.

The situation was clearly getting worse, and the only weapon Suhyuk had was imipenem.

While it was a very powerful antibiotic, it was uncertain whether it would work.

The result was confirmed the next morning, and it was not good.

"The pneumonia... has progressed further."

"Imipenem didn't work either..."

"What is this? It's too fast to be due to immunosuppressants..."

"Hmm..."

While Shin Hyuntae and Suhyuk took turns sighing in front of the worsening patient, Baruda spoke up.

[Suhyuk, I think we're missing something.]