Chapter 72: Dyspnea (2)

The patient was admitted to Professor Shin Hyuntae's ward.

Although it was unclear whether it was an infection or something else.

The decision was made considering the patient's previous history of tuberculosis and the fluid in the lungs.

"Since you're the head of the department, you can easily transfer the patient to another department if needed."

"Yeah, that's true."

Of course, there were also some political considerations.

If the young professor were to issue an admission order, it could lead to some difficult situations.

Hopefully, if the initial diagnosis is correct, the treatment will proceed smoothly.

However, if a transfer to another department is needed, that would be a problem.

If it were Shin Hyuntae, he could just call and say, "Hey, can you take my patient?" But in this case, he would need to provide various justifications.

'How is the patient doing?'

"There were no calls overnight, so they should be fine. But there hasn't been much improvement."

"Hmm."

Suhyeok headed to the ward with a face that showed he didn't know whether to be happy or sad about Baruda's words.

In front of the ward station, Andae-hoon stood with a tense expression, the patient's chart already crumpled in his hand from checking it multiple times since early morning.

"Ah, Professor!"

He bowed deeply as soon as he saw Suhyeok.

"Ah, no, that's a bit too much..."

Suhyeok, still feeling awkward, tried to stop him, but he knew it wouldn't change.

It seemed like this habit would never change, even until the end of his life.

"Anyway, how is the patient from yesterday? Kim Seung-joon."

"Yes. The results from the pericardiocentesis we did yesterday are in."

"Ah, that's good. Let's take a look."

"Here, I've pulled it up."

Andae-hoon, as stiff as he was yesterday, pointed to the monitor.

The monitor displayed the test results, including turbidity, RBC (red blood cells), WBC (white blood cells), and many others.

The first thing Suhyeok checked was ADA (adenosine deaminase), which is mainly used to assess tuberculosis activity. A high result would suggest tuberculosis.

"61 U/L."

"It's low."

"While we can't completely rule out a false negative, the possibility of tuberculosis is almost eliminated."

"So... it suggests another systemic disease."

"We need to consider the patient's alopecia and facial rash. They could all be due to a single cause."

Alopecia, facial rash, pericarditis, and pneumonia—all symptoms that could be caused by a single disease.

"Could it be an autoimmune disease?"

"Considering the patient's young age, it's the most likely possibility."

"True, the spleen was also enlarged... How were the other blood tests?"

"Only basic tests were done, but the hemoglobin was 9.5 g/dL and the white blood cell count was 2600."

"Both are low. That's a characteristic of autoimmune diseases."

Based on the patient's symptoms and the minor tests already done, Suhyeok started to form a diagnosis.

The whole process was silent, which made Andae-hoon feel a bit frustrated.

"Indeed... He's a genius, after all."

Of course, Andae-hoon, already infatuated, only saw the good in him.

"Let's request tests to confirm autoimmune diseases: ANA, Histone Ab, Anti ds DNA, ANCA IF, C3, C4, and CH 50."

The tests Baruda just listed are ones that doctors from other departments only briefly cover in medical school.

They are quite unfamiliar, but they are very important for internal medicine doctors.

Most autoimmune diseases can be identified through these tests.

"Ah..."

Suhyeok, who doesn't waste time on patient diagnosis, immediately started writing prescriptions.

Andae-hoon, not understanding what was happening, opened his mouth wide.

Only then did Suhyeok realize he was dominating the case too much.

"Professors can see it right away, but..."

Andae-hoon is a first-year resident, after all.

He's still at the stage where he doesn't know much.

"First, look at the ADA from yesterday's tests. It's low, so it's not tuberculosis. But the patient has anemia, low white blood cell count, and an enlarged spleen. What should we suspect?"

"Um..."

"It's okay, being a first-year. You can suspect an autoimmune disease."

"Oh... Oh! So that's why these tests are being done?"

"Right. You learned this in medical school, but it might seem unfamiliar because it's written in the prescription. I felt the same way."

Of course, Suhyeok could get immediate corrections from Baruda.

But it was still unfamiliar.

"Should we change the medication? Stop the antibiotics?"

"No, no. We need to be very careful."

The results so far have reduced the likelihood of an infectious disease.

However, we can't just start medication for the suspected autoimmune disease.

The medication would be steroids.

If the diagnosis is correct, the patient will respond.

But what if it's wrong?

"The patient will be overwhelmed by bacteria or viruses."

Steroids are a very versatile and powerful drug.

They are also inexpensive.

Therefore, they are widely used in many departments and for many diseases.

However, they are also a drug that requires caution.

The immune suppression function is the main concern.

"A previous patient who was transferred here eventually passed away."

The patient was given steroids without knowing they had a fungal infection, and the patient was literally being eaten by the fungus in real-time.

If they had come earlier, it might have been better.

But the patient was elderly and had underlying conditions, which delayed the initial symptoms.

Suhyeok didn't want to repeat such a situation with a patient he was directly treating.

In an emergency, he would use it without hesitation.

But this isn't an emergency.

So, the safest approach is best.

"Be careful with immunosuppressants. We can maintain the antibiotics and decide after seeing the test results."

"Ah, yes."

"Since the prescriptions are done, let's go see the patient."

"Yes, Professor!"

Andae-hoon ran to the ward as if he were serving a professor.

If the timing was uncertain, we would first check if the patient is in the room.

But it was well before 7 AM.

Besides, Kim Seung-joon wasn't in a condition to go anywhere.

"Patient."

Thanks to this, Suhyeok could immediately see the patient upon entering the room.

Next to the patient was an ECG taken that day, probably by an intern while Andae-hoon was at the ward station.

"Ah, yes. Professor."

The patient's condition was clearly better after the pericardiocentesis yesterday.

Fortunately, there were no signs of deterioration.

Suhyeok nodded in satisfaction and first checked the ECG.

"The heart rate is within the normal range."

"Hmm... But it feels a bit... weaker, doesn't it?"

"Feel? Did you forget about evidence-based medicine?"

"No, no. It's definitely a bit weaker. Compare it with yesterday's ECG."

Suhyeok was doing something no one else could.

He was recalling the exact ECG from yesterday in his mind and comparing it with the current one.

Baruda, who made this possible, became slightly anxious after Suhyeok's comment.

"Upon closer inspection, it is a bit weaker."

"It could be an intern's error. Such errors can happen in ECGs."

"It's unlikely to be an error. No one would catch this."

"Still, include it in the analysis. Just in case."

"Understood. I think it's a valid point."

After quickly finishing the conversation with Baruda, Suhyeok looked at the patient again.

"Do you feel feverish?"

"No... No, I'm fine."

"How about shortness of breath?"

"Much better."

"No coughing?"

"No."

While asking questions, he was also confirming the observations from yesterday.

"Alopecia and facial rash. These haven't changed."

"Right."

Meanwhile, a nurse entered the room and rolled up the patient's sleeve.

"We need to draw some blood for tests."

"Ah, yes."

A considerable amount of blood was drawn.

The tests went smoothly, probably because the patient was young.

Suhyeok looked at the red blood for a moment before turning back to the patient.

"The results should be available by this afternoon. I'll explain them to you then."

"Ah, yes... But is it serious? My parents are worried because I'm admitted."

"Hmm."

Suhyeok thought for a moment, consulting with Baruda.

"Based on the current course, it doesn't seem to be a very serious situation."

"Right?"

"Yes."

Since their opinions were the same, he could give a cautiously positive response.

"Don't worry too much. This is just a confirmation process."

"Ah, yes... Thank you."

"If you experience any unusual symptoms, let us know immediately."

"Yes."

After reassuring the patient, Suhyeok left the room.

He returned to the ward later in the afternoon, after the test results were in, with Professor Shin Hyuntae.

Andae-hoon, acting like a door-opening machine, made sure there were no obstacles in front of Shin Hyuntae and Suhyeok.

"Patient, this is Professor Shin Hyuntae. As Dr. Lee Suhyeok mentioned earlier, the results are in."

"Ah, hello."

"Yes. Let's have the guardian listen as well. First..."

Shin Hyuntae decided it would be better for Suhyeok to explain, as he was the one who made the diagnosis.

"Since the person who made the diagnosis is explaining, it's better."

So, Suhyeok stepped forward, not flustered like other residents, recalling the briefing he gave Professor Shin Hyuntae before the rounds.

"Although ANA is low, ANTI ds DNA is high, and C3 and C4 are low. It's 100% SLE (Systemic Lupus Erythematosus)."

He had already confirmed this with Baruda.

So, he could speak with confidence.

"The test results show that the patient has systemic lupus erythematosus, also known as SLE."

"Is... Is that a serious disease?"

"It's considered a chronic disease, but recent management is very good."

"But isn't it a disease that exempts you from military service?"

Mentioning the military was a bit surprising.

Suhyeok, though a bit taken aback, answered kindly.

"Since the patient is showing acute exacerbation, this level of lupus qualifies for exemption."

"Ah, I went for nothing..."

The patient, feeling much better, seemed relaxed.

He didn't seem to fully understand what it meant to have a chronic disease.

But Suhyeok didn't delve into the difficulties of being a lupus patient.

The patient would learn that gradually.

For now, focusing on the current issue was better.

"Anyway, the patient still has some fluid in the pericardium. The chest X-ray taken this afternoon shows fluid in the lungs as well. Therefore, we will maintain hospitalization and start steroid treatment."

"Ah... So, it will get better?"

"Yes, if you follow the treatment, it will be fine."

"Yes, I understand."

The patient nodded, and Suhyeok wasn't too tense.

This was the case until the weekend and before Andae-hoon's notification.

"Professor! The patient has a fever! And is short of breath!"

"Suddenly today?"

"Yesterday... It happened briefly last night but got worse this morning!"

"What's going on? I'll be right there."

It felt like stepping on a landmine, as the inflammation markers were slowly improving.