Chapter 65: Sometimes the Cause (1)

"What am I missing?"

Suhyeok couldn't fully focus on Baruda because he was still in the middle of a conversation with Shin Hyuntae.

However, he had become somewhat accustomed to this kind of conversation, so he could at least keep up with the flow.

[Yes, Suhyeok. What kind of patient is this?]

Instead of immediately sharing his thoughts, Baruda asked a question.

At first, Suhyeok often got annoyed, but he realized that this was Baruda's way of educating himself and Suhyeok, a method that evolved over time.

So, instead of getting annoyed, Suhyeok decided to answer the question sincerely.

"A patient taking immunosuppressants."

The patient was taking two different immunosuppressants.

It had only been about a month since the transplant surgery.

[Correct. It's easy to infer that the patient's immune system is suppressed compared to a normal person.]

"Right. That's why we suspect a superbug infection."

Suhyeok answered while looking at Shin Hyuntae.

"I think so too."

He was giving a general response to Shin Hyuntae.

Suhyeok and Shin Hyuntae were confident that the patient's immunosuppression had somehow influenced the superbug infection.

It was a reasonable hypothesis.

First, the patient had multiple opportunities to come into contact with superbugs.

The patient had been in the ICU for quite some time.

And even a small number of superbugs could cause an infection given the patient's weakened immune system.

'This is the most likely scenario right now.'

[I don't intend to completely rule out the possibility of a superbug infection.]

"Hmm? Then do you suspect something else? It was clearly a bacterial infection, not a viral one."

[It's not a viral infection either.]

"Hmm."

Suhyeok realized that Baruda was suspecting a type of disease that he hadn't considered and fell silent for a moment.

He had nothing to say and was also waiting for Baruda's next question.

As expected, Baruda soon asked another question.

[Why is this patient taking immunosuppressants to suppress their immune system?]

It seemed like a rather naive question.

But Suhyeok knew that, despite Baruda's human-like behavior, Baruda was fundamentally an AI.

This meant that Baruda didn't do anything without a purpose.

Or rather, Baruda didn't do anything without a reason.

'The patient needs it. They received a kidney transplant a month ago.'

So, Suhyeok answered honestly.

[Yes, this patient received a kidney transplant.]

Baruda emphasized this as if it were a crucial point and confirmed it again.

'What?'

Suhyeok was confused and tilted his head.

Meanwhile, Shin Hyuntae was still considering which antibiotic to use after imipenem and even contacted the transplant surgery team to discuss the maintenance of immunosuppressants.

He also sought opinions from the nephrology department.

But no one could provide a definitive answer.

They could only think that the patient had about a week left.

This was because, in cases of sudden infections after organ transplants, multiple organ failures often followed quickly.

'What's the point? Why is the patient's transplant important?'

Thanks to Shin Hyuntae being distracted by calls with other professors, Suhyeok could now fully focus on his conversation with Baruda.

Baruda, as if waiting for this moment, responded more energetically.

[This patient received a kidney transplant, and the kidney is strongly suspected to be the source of infection based on the examination, history, and CT scan.]

'Right. The kidney is currently suspected to be the source of infection.'

Although he didn't fully understand, Suhyeok was forming a vague conclusion that the infection might have occurred in the operating room or ICU.

'Ah.'

Suhyeok then realized that he hadn't fully grasped the most important cause of infection.

Baruda, as if proud of Suhyeok's realization, continued.

[Then, the first place we should investigate is not the operating room but the source of infection in the brain-dead donor who provided the kidney.]

'Organ donor... Ah... I see. Right!'

The medical standards at Tae-hwa Medical Center were world-class.

An infection in the operating room?

That was highly unlikely.

And it would be irresponsible to risk a patient's life on such a low probability.

Of course, there could be such a possibility in the ICU, but a urinary tract infection seemed unusual.

[Therefore, I request the collection of data on the organ donor.]

Baruda finished what he wanted to say while Suhyeok was having his "Eureka" moment.

Naturally, Suhyeok had no reason to refuse.

So, he tapped Shin Hyuntae's arm, who had been holding the phone.

If it were another resident and professor, this might have seemed a bit careless.

But Shin Hyuntae was known to be very supportive of Suhyeok.

"Hey, why? Suhyeok."

Even while on the phone with another professor, Shin Hyuntae turned to Suhyeok first.

Suhyeok, knowing the urgency of the situation, decided to speak directly instead of signaling to continue the call.

"Professor, the source of infection is the kidney."

"Huh? Right. The circumstances point to that. That's why we suspect an infection in the operating room and are treating it as a superbug."

"But what if the infection came from the organ donor?"

"Huh? Huh..."

Like Suhyeok earlier, Shin Hyuntae was momentarily speechless.

It was a shift in thinking he hadn't considered.

The source of infection wasn't in the patient but in the donor who provided the organ.

It wasn't an easy thought to come by.

"Wait. Ah... Professor Yu. Sorry, I need to hang up for a moment."

But once the idea came to mind, it was the kind of realization that made one wonder why they hadn't thought of it before.

"Hey, Suhyeok. So... the source of infection could be the donor?"

"Yes. If it's a superbug that doesn't respond to imipenem, there's no chance of recovery."

"That's... that's right."

Shin Hyuntae looked at the patient, whose condition had worsened in just one day since he was admitted to the ICU.

The pneumonia was spreading, and if left unchecked, death could occur very quickly.

"Then, it would be meaningful to find other causes and attempt treatment for those causes. Of course, if it's a superbug... there's nothing we can do. But an infection in the operating room is hard to accept."

"Right. Our hospital's transplant surgery team wouldn't make such a mistake. So, the infection from the donor is more likely."

"Then I'll look into it."

"But if the transplant was a month ago... additional tests might not be possible."

"Examining the cause of death might still provide some clues."

"Hmm."

Shin Hyuntae thought for a moment and then nodded.

Suhyeok's suggestion seemed the most likely.

Moreover, following Suhyeok's advice had never led to any harm.

He had a strong feeling that this would be no different.

So, he immediately called the transplant surgery team.

"Ah, Professor Yu. Sorry, sorry. I just had a sudden thought."

The transplant surgery professor was Professor Ryu Jin-soo, who had helped Suhyeok with a patient who experienced side effects from boricozole.

"Oh, no, it's fine."

As a newly appointed associate professor, he was very respectful to Shin Hyuntae, a well-known figure.

"Right. I need some information for this. For the patient, Son Geum-suk. Can you provide information on the organ donor?"

"Huh? Ah... that... it's..."

By principle, information about organ donors is kept confidential.

So, Professor Ryu Jin-soo hesitated to speak.

"But this information is essential for the patient's treatment. Without it, the patient will die."

But when a patient's life is at stake, principles don't matter.

Especially when it's a patient he operated on.

Professor Ryu Jin-soo thought for a moment and then nodded.

"I'll send the patient's information to your email, Professor."

"Thanks. And forward it to Dr. Lee Suhyeok in our department."

"Dr. Lee Suhyeok? Is he your attending physician now?"

"Yeah."

"Understood."

If it were another professor, they might have thought it unnecessary to send it to a resident.

But Professor Ryu Jin-soo had received significant help from Suhyeok.

So, he immediately sent the information to Suhyeok as well.

Suhyeok and Shin Hyuntae, who were in different locations, could simultaneously check the email.

The organ donor had died at a different hospital, not at Tae-hwa Medical Center, so the attached files included a mix of charts and reports.

It would take some time to analyze.

[Open all the windows.]

Of course, this wasn't a problem for Suhyeok, who had Baruda.

He could open 8 windows and analyze 8 pages at once.

[The patient is quite young. A 24-year-old male.]

'No underlying diseases confirmed... found in the Han River. Hmm.'

It turned out that the donor had been drinking with colleagues near the Seongsu Bridge on the Han River, went to the bathroom, and drowned.

He was brought to a nearby hospital in cardiac and respiratory arrest via 119 but was declared brain dead after 6 days of hospitalization, and the family agreed to organ donation.

[There were three episodes of fever during the hospital stay.]

'No positive results from blood, urine, or sputum cultures.'

[It would have been easier if something had come up. What a pity.]

Baruda clicked his tongue, as if returning to the starting point.

It was a gesture often used to express deep regret, which always made Suhyeok, a real human, find it amusing.

But at that moment, Suhyeok was gaping in surprise.

He remembered a case report he had read under Baruda's guidance and on his own.

'No, no. There's no need to regret it.'

[Yes?]

'I think I know the cause... the cause.'