Chapter 67: Sometimes the Cause (3)

Shin Hyun-tae was, without a doubt, an exceptionally skilled infectious disease specialist. Naturally, he was the type of person who could recall the name of a relatively obscure fungus like Scedosporium when he heard it. This made him even more impressed with Su-hyuk.

‘This kid… this kid is really…’

If Professor Jang Deok-soo, who worked under him, had given such advice, he would have been surprised, but not to this extent. After all, Jang Deok-soo had dedicated his life to infectious diseases, just like him. But what about Su-hyuk? He was only in his first year.

[Request to change the medication.]

Even when Professor Shin Hyun-tae almost trembled in response to Su-hyuk’s words, Baruda did not hesitate to offer advice. A diagnosis only gains meaning when it leads to treatment. If they wasted time confirming the diagnosis and lost the patient, there would be nothing more pitiful.

‘Voriconazole?’

[Yes. According to the papers published so far, Voriconazole is the most effective treatment for Scedosporium.]

‘Right.’

Su-hyuk agreed, so he immediately spoke up.

“Professor.”

“Uh, uh.”

Shin Hyun-tae was in a good mood, naturally smiling.

“Shouldn’t we change the medication?”

“Oh, right. Yes.”

“Should we start the treatment with Voriconazole?”

“Yes. Voriconazole. Yes. Voriconazole.”

When the conversation turned to treating the patient, his expression became more serious. Scedosporium was visible in the pathology slide, and since the donor had drowned, it was most likely the causative agent. Voriconazole was the most effective drug for Scedosporium.

‘But the current condition is not good…’

However, the patient’s condition was the most important factor. If the condition was too poor, even the best medication might be ineffective.

‘If we could stop the immunosuppressants, it would be better.’

Both the nephrology and transplant surgery departments had advised against stopping the immunosuppressants. The transplanted kidney’s function was already declining, and stopping the immunosuppressants could make things worse.

Shin Hyun-tae thought that solving the current infection was necessary to plan for the future, but modern medicine doesn’t run on personal opinions alone. As knowledge grows and deepens, even professors must listen to others.

“Let’s maintain the immunosuppressants and add Voriconazole.”

“Should we also maintain the antibiotics?”

“Yes. It’s likely a mixed infection.”

“Understood.”

In the early stages of infection, one pathogen often causes the problem. However, as the infection progresses, the affected tissue becomes more susceptible to other infections. The most significant issue in this patient was the Scedosporium that entered through the transplanted kidney, but ignoring other bacteria would be a big mistake.

“This should work.”

Shin Hyun-tae muttered as he watched the Voriconazole being administered to the patient. If the medication worked, they might see some improvement by tomorrow. If not, they might face a cold corpse. Although death was familiar in internal medicine, dealing with critically ill patients, it was never easy.

“I’ll keep an eye on the patient from the ICU on-duty room tonight.”

“Right. Adjusting the IV and other treatments will also have an impact.”

“Yes, Professor.”

“Right…”

Shin Hyun-tae glanced at Su-hyuk for a moment before turning back to the patient. The patient’s condition should have improved after being admitted, but it only seemed to worsen with each round of checks.

“See you tomorrow. If the condition worsens, let me know.”

“Yes, Professor.”

However, Shin Hyun-tae’s responsibilities extended beyond this patient. He had other patients to attend to and, as the head of the department and a professor, the entire internal medicine department relied on him. After a brief moment, he had to leave the ICU, feeling less guilty knowing he had entrusted the patient to Su-hyuk, his most capable resident.

[Su-hyuk, please look for more related papers.]

Baruda spoke immediately as if waiting for Shin Hyun-tae to leave the ICU.

‘Huh?’

[The diagnosis of Scedosporium is correct, but Voriconazole being effective is only a general case. This patient’s infection is in a very special state.]

‘Ah, that’s… right.’

Su-hyuk saw the merit in Baruda’s opinion. The same pathogen could cause different infections depending on the host’s condition, and the treatment might need to be adjusted.

Fortunately, the world had advanced to the point where, with money, one could access any journal. Su-hyuk also had the director’s ID from Lee Hyun-jong, and Taehwa Medical Center, being the top hospital in the country, had paid enormous sums to access most journals. Additionally, key professors paid even more to access more journals. Essentially, the only papers he couldn’t access were those not yet published.

‘Let’s see…’

Su-hyuk sat down at a computer in the ICU station.

[Search for ‘Scedosporium, post-transplant infection’.]

Baruda advised Su-hyuk to search for papers on Scedosporium infections after transplantation. Although it seemed rare, the number of documents was overwhelming. The challenge was finding the useful ones.

‘Let’s filter by citation count.’

[Yes.]

Su-hyuk had read many papers and had developed some expertise. Papers with fewer citations were often of lower quality, though this wasn’t always the case. Most of the time, it was true.

[Most of the citation counts are low.]

In rare cases like this, most papers had low citation counts. Su-hyuk had to use a more labor-intensive method to filter the papers.

‘Let’s check the abstracts first.’

[Yes.]

‘Ah… the computer is really slow.’

[That’s just how ward computers are.]

Baruda, once part of the world’s best computer, clicked his tongue in disdain. Despite this, the speed didn’t improve, and they had to waste time.

‘Phew.’

[Keep looking.]

‘My eyes are going to fall out.’

[The check results are fine. You have mild dry eye, so blink consciously.]

‘Phew…’

[We need to save the patient.]

‘I know, I know.’

Fortunately, Su-hyuk was human, but Baruda was not, allowing for a somewhat inhuman dedication to the patient. It might sound strange, but it was true.

‘Ah, this… This situation is similar to ours.’

[Hmm.]

By around 9 PM, Su-hyuk found a useful paper.

[It’s a paper from MD Anderson, published in the International Journal of Transplantation.]

The credibility of the publishing institution and journal was reassuring. If Taehwa Medical Center aimed to be the best in the country, MD Anderson aimed to be the best in the world. They wouldn’t publish frivolous papers.

‘The donor drowned. He fell into a stream.’

[The stagnant, dirty water is a match.]

‘There were two fevers before brain death was declared. They were treated as undifferentiated fever.’

[In the first case, the patient died after transplantation.]

Su-hyuk had already suspected Scedosporium, but MD Anderson only identified it after the patient’s autopsy.

[After that, MD Anderson established an internal guideline. If a transplanted patient has undifferentiated fever, they must review the donor’s data.]

‘Hmm… So the second case… This one also died.’

[The diagnosis was made after multiple organ failure had progressed. There was no way to save the patient.]

Multiple organ failure occurs when major organs like the kidneys, liver, brain, and heart are affected by infection. Even a healthy person would likely die in this situation, and for a transplant patient, it was a death sentence.

‘The third case… They saved the patient here. Let’s look closely.’

[The diagnosis was made early, on the fifth day of fever.]

‘We’re faster. That’s encouraging.’

[This patient also had a kidney transplant.]

‘What was the treatment? That’s important now.’

[Scroll down a bit more.]

‘Okay.’

While continuously exchanging opinions with Baruda, Su-hyuk scrolled down. Fortunately, MD Anderson didn’t forget the most important part when sharing key cases: the treatment.

‘The basic treatment is Voriconazole, as expected.’

[They used a combination therapy.]

‘This… This is a new drug.’

[Echinocandins. A type of antifungal, but rarely used in clinical settings. According to data analysis, Taehwa Medical Center has a small supply.]

‘And… Ah. Can we use this too?’

Relieved that this was Taehwa Medical Center, Su-hyuk moved the mouse to the last medication. It was GM-CSF.

[Our patient is immunosuppressed, so it’s worth trying.]

‘Right? Macrophages… They would help with the fungal infection.’

The Korean name for this unfamiliar drug was ‘Granulocyte Macrophage Colony-Stimulating Factor.’ It is naturally produced in the body and can activate macrophages when administered. Macrophages are effective against large pathogens, so they would be helpful in this situation.

[Request to use it.]

‘Okay.’

So, Su-hyuk briefly consulted with Shin Hyun-tae, who, of course, praised him and approved the medication. Thanks to this, the patient’s condition improved the next day.

“The oxygen saturation is up. How about the X-ray?”

“The lungs are clear. The medication is working.”

“Good… Su-hyuk, you saved the patient.”

“Thank you.”

“You’re a genius.”

As Shin Hyun-tae and Su-hyuk praised each other, Baruda interrupted.

[Su-hyuk, it’s not time to relax.]

‘Why again?’

[The donor also donated the liver, heart, and lungs.]

‘Ah.’

[The patients who received these organs are also at risk.]