Chapter 73: Dyspnea (3)

The patient's condition was quite good until the afternoon rounds yesterday.

However, the patient before them now was not in such a state.

Surprised, Shin Hyuntae rushed over, and Professor Jung Min-kyung of the Rheumatology Department, who was also examining the patient in a consultation format, did not look well either.

"When... when did this start?"

Department head Shin Hyuntae looked back at Ahn Daehoon with a flustered expression.

Ahn Daehoon was equally flustered.

They had been discussing the patient's discharge after the weekend just yesterday.

But what about now?

The patient's condition was rapidly deteriorating.

"Yesterday... last night. But it was only for a short while, and then it improved immediately."

"Hmm."

"What about the patient's urine test?"

Shin Hyuntae closed his mouth, and in the meantime, Professor Jung Min-kyung of Rheumatology spoke up.

At her words, Ahn Daehoon quickly started searching through the patient's test results.

It was natural that the results didn't just pop up immediately.

"There was persistent hematuria and proteinuria. However, the urine output matched the daily I/O, so we were monitoring the progress."

Of course, Suhyuk was an exception.

His mind stored not only the patient's test results but also a significant portion of the textbooks.

"What about today's chest X-ray?"

"I haven't checked that yet. I'm sorry."

Suhyuk was only observing this patient, not treating them, so he hadn't been checking every morning.

He had just learned about the issue when he received a call.

Moreover, it was 6:30 AM on a Saturday, so it wasn't something he should be scolded for.

"No, it's fine. Let's check it now. First-year resident?"

"Yes. Ah... here it is."

"Hmm."

The chest X-ray taken today and the one from yesterday seemed to show no significant difference at first glance.

But upon closer inspection, there was a difference.

"Here... the diaphragm line has become slightly blunted."

Suhyuk, who caught this fact the fastest with Baruda's help, pointed to the lower left side of the monitor.

This was the location of the patient's right lower chest.

"Ah... there's fluid accumulation."

This was the moment when the patient's lungs, which had rapidly improved through steroid treatment, were filled with fluid again.

What could be the cause?

Suhyuk could instinctively tell the moment he saw the X-ray.

Of course, Professor Jung Min-kyung, who had extensive experience treating systemic lupus erythematosus (SLE) patients as a rheumatologist, felt the same way.

"Renal failure... it seems lupus has invaded the kidneys."

Professor Jung Min-kyung, being several ranks below Shin Hyuntae, reported in a formal manner.

Shin Hyuntae nodded with a darkened face.

The kidneys.

Such an important organ.

"What do you think, Suhyuk?"

"Yes. I agree. When inflammation occurs acutely, it often invades the kidneys. I believe the patient's urine test results reflect this."

"Then..."

"We need to increase the steroid dose to 60mg of prednisolone and add hydroxychloroquine. Ah, I'm sorry. I asked Professor Jung Min-kyung..."

Suhyuk, who habitually answered Shin Hyuntae's questions, looked at Professor Jung Min-kyung.

She had just become an associate professor and was one of the more intimidating professors.

But she was also someone who understood Suhyuk's position very well.

"No, no. As expected. I agree. Let's change the medication for now... and I think we should perform a kidney biopsy as soon as possible while the patient's condition allows it."

"A biopsy. Is it just for diagnosis?"

"No. It's a necessary step to determine the type of medication."

A kidney biopsy, as the name suggests, is a highly invasive procedure.

It would be impractical to perform it for diagnostic purposes alone when the patient's condition is deteriorating.

But if it can help decide the treatment plan, the situation changes significantly.

"Then... we should do it. I'll explain to the family. The test..."

"I'll notify Professor Kim Jin-sil from Radiology."

Suhyuk, despite being only in his second year, was quite well-connected within the hospital.

Partly because of the rumor that he was the son of the hospital director, but also because of his genuine abilities.

Almost everyone who had worked with Suhyuk, even just once, had a good impression of him.

Thanks to this, he could confidently say he would contact a professor from another department.

Even on a weekend.

He could do so without hesitation.

"Alright. Let Suhyuk handle it. Professor Jung Min-kyung... I'm sorry, but can you help monitor the patient over the weekend?"

"Yes, Department Head. Don't worry. I'll treat it as if it's my own patient."

Thus, the patient was soon taken down to the ultrasound room on the first floor.

Under normal circumstances, a resident wouldn't need to accompany the patient, but the patient's condition was too poor.

It was also a weekend, so there wasn't much else to do.

"Doctor, I'm sorry. It's because of me..."

Ahn Daehoon, feeling guilty, kept bowing.

"No, no. We're in the same team. I should have noticed it when I saw you yesterday... in the afternoon."

Of course, Suhyuk didn't think that way at all.

[That's right. Why didn't we notice?]

Baruda felt the same way.

Neither of them blamed Ahn Daehoon; they only blamed themselves.

'I should have just palpated the calf once.'

[But... isn't the urine test being done every day?]

'Right.'

[Was there any change?]

'No change.'

[Then can we say that's the cause of the symptoms?]

Thus, they started an endless conversation while Ahn Daehoon, who was anxious, stood beside them.

Baruda's analytical skills had developed significantly, and Suhyuk's abilities had also improved, making for a very productive conversation.

'Hmm... not the cause? Then what are you suspecting?'

[I don't know, which is why I came down here.]

Baruda no longer opposed without a better alternative.

Of course, if it would harm the patient, she would naturally oppose it.

But she had learned to wait until a better analysis was available.

'Anyway, the kidney biopsy itself is meaningful.'

[That's true, but we should also consider the possibility that it might not show anything.]

'You're right... hmm...'

[Now that Suhyuk's analytical skills have improved, think about it.]

'Alright. Hmm.'

Thus, they fell silent, each lost in thought.

"Ah, Resident Suhyuk."

Just then, Professor Kim Jin-sil appeared.

She had come from home on a weekend, dressed in casual clothes.

"Professor Kim Jin-sil. I'm sorry."

"No, it's fine. The patient is urgent. We need to perform the test. But is there someone to examine the specimen after the test?"

"Yes. Department Head Shin Hyuntae has made arrangements."

"Is this a VIP case?"

"No, it's not... but the patient is very young."

"Ah, right. Both Department Head Shin and Resident Suhyuk... you're both passionate. Passionate."

Professor Kim looked at the two, who were working their hardest even on a weekend, with a sense of wonder, then entered the ultrasound room.

Inside, the patient was waiting, seated.

Lying down would make it hard to breathe, so it was unavoidable.

"During the test, you'll need to lie face down for a moment. Is that okay?"

"Yes, it's fine. I came down with the equipment to manage any issues."

It was Suhyuk, not the patient, who answered Professor Kim Jin-sil.

He was tapping the intubation set he had prepared in advance.

For the radiology department, this was a reassuring moment.

"Okay. Then... lie down. It will sting."

Thus, Professor Kim Jin-sil immediately began the test.

She was known for her skilled hands, and since the patient was a young adult, the test was completed very quickly.

"Press here firmly. If it's lupus, there might be a tendency to bleed. If you don't press, it could be serious."

"Yes, Professor. Thank you."

"No, no. But where should I go now? If there's anything else, let me know now. Now."

"No, Professor. There shouldn't be any more issues."

"Alright, then. Good work... and let's talk about the paper next time."

"Yes, Professor."

Thus, Professor Kim Jin-sil left the examination room almost as soon as she arrived.

As she said, a kidney biopsy, especially for a patient with a systemic disease like lupus, can be quite risky.

Therefore, Ahn Daehoon, coached by Suhyuk, firmly pressed the area where the biopsy was just performed.

He did so even after wrapping it with a bandage.

[There shouldn't be any bleeding with this pressure.]

It was a strong and effective pressure, even to Baruda's satisfaction.

Thus, Suhyuk headed to the ward with peace of mind.

"Yes, Professor. I've sent the specimen."

"Okay. Good job. The test will be done immediately. For now, keep the medication the same. Professor Jung Min-kyung has already prescribed the medication as you suggested."

"Yes, Professor."

"Alright. If anything happens, call me. I'll stay near the hospital."

"Yes."

While reporting the progress to Shin Hyuntae, it felt like he had a plan.

But it was also impossible to completely relax, so he headed to a restaurant in front of the hospital.

He wanted to have a meal with his family.

Meanwhile, Suhyuk and Ahn Daehoon moved the patient back to the ward and also headed to the staff cafeteria in the basement.

"You need to eat. You won't be able to hold on if you don't."

"Yes, Doctor."

It was a simple statement, but Ahn Daehoon took it to heart as if it were a golden rule.

He then started eating the hospital food, which, to be honest, was not very good.

It was Saturday lunch at the staff cafeteria, after all.

It meant that no one except the on-duty residents, interns, or nurses would be eating there.

Fortunately, it was Taehwa Medical Center.

Otherwise, the food might have been even worse.

"Hmm."

"Phew."

Just as they were eating, their phones rang.

Woo-wooo.

Waaah.

Both Suhyuk and Daehoon's phones rang simultaneously.

The same number was displayed on both phones.

It was the number of the ward where patient Kim Seung-joon was admitted.

"Can't be..."

They immediately spat out what was in their mouths and answered the call.

"The patient... the blood pressure is dropping!"

"The vital signs are 90 over 55!"

90 over 55.

If it had dropped significantly in a short time, it was a considerable drop.

In many cases, the patient could pass out with a "uh..." sound.

Healthy patients from other departments might be able to withstand it, but not in internal medicine.

"I'm coming up!"

"I'm on my way!"

Thus, they both stood up at the same time.

There was still quite a bit of food left on their trays, but no one would say anything about the leftovers.

When residents move so urgently, it means someone's life is at stake.

Thump, thump, thump.

Thus, they ran towards the elevator.

Of course, Suhyuk, with his injured leg, wasn't very fast, but Ahn Daehoon almost risked his life to support him, allowing them to quickly board the elevator.

During this time, they didn't exchange a single word.

Ahn Daehoon was in a panic, and Suhyuk was talking to Baruda.

[Is it bleeding from the kidney biopsy?]

'Is that possible? We pressed so hard.'

[Then why is the blood pressure dropping? We should first consider hypotension due to bleeding. Always consider the most likely possibility first.]

'Let's see when we get there.'

[Then hurry, Suhyuk.]

'Am I supposed to drive the elevator?'

[Call the director. Maybe he knows.]

'Don't talk nonsense...'