Chapter 71: Dyspnea (1)

"Huh."

An Daehoon, who had just completed his first year, sighed lightly and hung up the phone.

He wished he could move around as swiftly as Lee Soohyuk did during his internship in March.

He wanted to confidently provide diagnoses that even professors and senior doctors couldn't think of.

But reality was a quagmire.

"Haa... Haa."

Despite the young man, who was only 23, gasping for breath, An Daehoon felt utterly helpless.

"Arterial blood test done!"

Just as he was sighing heavily, he turned his head and saw Woo Hayun, who had just become an intern and was still tense.

'Of all times, an intern in the March emergency room...'

An Daehoon thought that Woo Hayun must be having a harder time than he was.

"Hey, let me see."

"Sure. Here are the test results."

Trying to hide his nervousness, he put on his best gentle expression and took the results from Woo Hayun.

"What do you think, senior?"

Hayun was always very friendly, even in the emergency room.

They were from the same club, which made it even more so.

'Ah, damn.'

An Daehoon wanted to meet Hayun's expectations, but it was really difficult.

The patient's arterial blood test showed no significant features.

'Just hyperventilation...?'

Oxygen saturation was 100%.

Carbon dioxide levels were slightly low, and pH was slightly high.

This meant the body had become alkaline as carbon dioxide was expelled, but the only diagnosis that came to An Daehoon's mind, who had been an intern until a few days ago, was hyperventilation syndrome.

However, the patient's breathing seemed genuinely difficult.

How often did someone hyperventilate to the point where the muscles between the ribs were visibly sinking?

'Ugh.'

As he fell into a mental breakdown, he heard a clicking sound from somewhere.

Tap.

Tap.

A sound slightly different from ordinary footsteps.

And thus, more welcome.

It was Soohyuk.

"Hello!"

Upon seeing Soohyuk, Hayun immediately bowed deeply and greeted him.

March interns are usually very disciplined, but this seemed a bit excessive.

It was probably due to his deep respect for Soohyuk.

"Ah? Oh... You're an intern now?"

"Yes, senior. It's been a while."

"Sorry. I said I'd see you, but I've been too busy."

"No, you really have been busy."

"Since you're in the emergency room this month, we'll see each other often. Let's have a meal sometime."

"Really? Yes, thank you."

Hayun seemed to desperately want to stick around a bit longer.

But being a March emergency room intern was like being a real slave.

It didn't matter if you were a royal or not.

Especially for someone like Hayun, who tried hard, it was even worse.

"Yes, I'm coming now!"

So he had to rush to another patient.

An Daehoon, who had been deeply pondering the test results and the patient, approached Soohyuk without reaching a conclusion.

He looked as if he had committed a sin, completely deflated.

[You must have thought you could do something, right?]

Baruda said in a disinterested tone, looking at the first-year An Daehoon.

'Don't be so harsh. First-years are all like that, especially in March.'

He himself had been so enthusiastic.

Fortunately or unfortunately, he met Baruda.

Otherwise, he would have made many mistakes.

And he would have realized how inadequate a doctor he was.

Just by looking at his peers who were at a similar level, he could see that.

There are things in this world that can't be overcome with effort alone.

Before gaining experience, all the knowledge in your head is just dead knowledge.

"Arterial blood test? How is it?"

"Hyperventilation syndrome, I think."

"Hyperventilation...?"

Soohyuk, who had eyes, knew the patient was not just hyperventilating.

The breathing was genuinely difficult.

Of course, the respiratory rate was high.

But that was to compensate for the difficult breathing.

[The breathing is shallow. The respiratory rate is almost 40 per minute, but the decrease in blood carbon dioxide is not that significant.]

'Might be fluid?'

[Probably. Check it out.]

'Good.'

Soohyuk walked up to the patient.

"Hello, Mr. Kim Seungjun."

"Yes... Huh..."

"Did it start a week ago?"

"Yes..."

Soohyuk asked questions while examining the patient's entire body.

The patient, a young man, looked very healthy.

But there were some abnormal findings.

[The hair is a bit thin, right?]

'The top of the head is bald. About 2 to 3 cm.'

[Is he under a lot of stress?]

'I don't know. Hmm.'

First, there was hair loss.

Circular alopecia on the top of the head.

[The cheeks are red.]

'It doesn't look like sunburn. More like...'

[It looks like a rash.]

'Yeah.'

[Hmm.]

'The medical history says no underlying conditions.'

Soohyuk noted the abnormal findings in his mind while continuing the conversation with the patient.

Since the patient was so breathless, speaking slowly was actually better.

"Did you have any symptoms before this?"

"Yes. Ah, um... Huh... About... A year ago..."

"Yes?"

"Tuberculosis... I was treated for it."

"Tuberculosis."

If tuberculosis was not completely treated, it could easily recur.

It was probably unrelated to the hair loss and facial rash.

But these could also be caused by different reasons.

If you try to connect everything to one cause from the beginning, you're bound to hit a wall.

That's what he learned from reviewing cases with Baruda over the past year.

"Have you been diagnosed with diabetes or hypertension?"

"Huh? No."

The patient was clearly young, so it seemed he had no underlying conditions.

Soohyuk asked about other surgical histories, but there was nothing significant.

"Let me listen to your chest. Did you get an X-ray?"

"Ah, no. Not yet..."

"Then I'll write a prescription. While I examine you."

"Okay."

Soohyuk asked An Daehoon to write the prescription and then tapped the patient's lower lungs.

It felt dull, as if something was filled.

In the past, Baruda would have been no help in such an examination.

But over the past year, he had accumulated data on the five senses.

[Fluid. There's fluid.]

'Sure... I need to get an X-ray quickly. No fever... It could be tuberculosis, really.'

[Yes, I think so too.]

There was a time when tuberculosis was rapidly declining.

But with the increase in international travel and more people coming to South Korea from abroad, the infection rate was slowly rising.

So it couldn't be ruled out.

"I'll also check your abdomen. Can you lie down?"

"Lie... down... and... it... gets... harder... to... breathe..."

"Just a moment."

"Um... Yes."

The patient reluctantly lay down.

After all, he was in the hospital, so he had to listen to the doctor.

Besides, from the attitude of Hayun and Daehoon, Soohyuk seemed to be a high-ranking person.

'Hmm. Why is the spleen enlarged?'

Meanwhile, Soohyuk quickly examined the patient's abdomen.

[That's right. We should also suspect a systemic disease.]

He then noticed the enlarged spleen, which was quite unusual.

The patient was young and said he had no underlying conditions.

While he was pondering, Daehoon spoke up.

"Doctor, it's ready. They said we can go now."

"Ah, sorry. Can you take him? My leg..."

"Ah, no! No! Not at all! I'll go and come back!"

"Thanks."

"No, no."

An Daehoon disappeared with the patient to the X-ray room, looking flattered.

As a result, the patient mistakenly thought Soohyuk was a young professor rather than a second-year resident.

'No matter what, I should listen carefully...'

An Daehoon unexpectedly played a role in the positive cycle.

Anyway, a chest X-ray doesn't take long.

The patient wasn't having mobility issues.

So they could quickly take the X-ray and return.

"Doctor, I'm back!"

"It hasn't come through yet."

"Should I send it over?"

"No, no. That's not necessary. Oh, it's coming through."

Soohyuk, amused by the enthusiastic An Daehoon, turned to the X-ray.

Then he clicked his tongue.

The lungs were filled with fluid, but so were other areas.

'There's fluid in the pericardium.'

[It's pericarditis. This can also be caused by tuberculosis.]

'First, let's drain the fluid. There's too much. The heart rate is 110. If this continues, the heart will collapse...'

[We should ask Director Lee Hyunjong.]

'No, I'll do it.'

[Ah, right. It's definitely possible.]

If it required a coronary angiography, he would have to call Lee Hyunjong.

But this was something he could handle with an ultrasound.

Of course, for a second-year resident to do this would be beyond presumptuous, almost crazy.

But Soohyuk wasn't a typical second-year resident.

He had already done it a few times.

"Get the ultrasound. And bring the fellow doctor's notice."

"Huh? No. I'll do the notice later. I want to see it first."

"Ah... As expected!"

An Daehoon, thinking Soohyuk was indeed a genius, ran off and brought the ultrasound.

Since it was Taehwa Medical Center, there was an ultrasound machine in the emergency room.

"Hmm."

Soohyuk turned on the machine skillfully and placed it on the patient's chest.

"It's a bit cold."

"Ugh... Yes."

"It will feel better in a moment."

"Yes..."

The patient was much more breathless lying down than sitting up.

With fluid in the heart, it was inevitable.

Fortunately, Soohyuk was very skilled at using the ultrasound.

"It will sting a bit."

Before he knew it, he had disinfected the area, found the right spot, and inserted the needle.

"Ouch."

"The fluid is coming out well."

"Yes, yes..."

Soohyuk managed to extract about 100cc.

It was an enormous amount, and to think it was in the pericardium.

It was easy to imagine how difficult it must have been for the patient.

"Huh?"

In proportion, the patient was much more comfortable.

"How do you feel?"

"Good, good. Am I all better?"

He even asked if he was completely healed.

Of course, that was impossible.

"No. We're just starting treatment. It could fill up again. You need to be hospitalized."

Soohyuk said this while looking at the fluid he had just extracted.

It wasn't completely clear.

But it wasn't turbid either.

[It's probably not tuberculosis.]

'Might be a viral disease?'

[We still... We still don't know. We need more information.]

'Since we're hospitalizing him, let's wait and see. It won't change in a day or two, right.'