Chapter 75: Dyspnea (5)

‘Clean your mouth, you brat...’

Suhyeok, flustered, called Baruda once more, but Baruda remained silent.

He had returned to his calculations.

It was not unreasonable that a guy with a supercomputer ended up using Suhyeok’s brain.

“What are you planning to do for the treatment?”

In the meantime, the patient had been admitted to the Cardiac Care Unit, or CCU.

Given that the patient was Shin Hyuntae and Suhyeok, the son of Director Lee Hyunjong, was overseeing the case, it was only natural that a bed had been prepared long ago.

“Prepare for intubation... and adjust the ventilator settings in advance.”

Suhyeok, ignoring Lee Hyunjong’s response, quickly issued instructions.

He wanted to buy a minute, but given the patient’s condition, he couldn’t afford to waste time.

Thus, he managed to give all the instructions in just 20 seconds.

‘Being too excellent can be a problem, too.’

He tried to provoke Baruda, but Baruda remained silent.

‘Sigh.’

Suhyeok sighed and looked at the patient.

The patient was now gasping for breath.

Although the oxygen saturation was still maintained,

it seemed likely that intubation would be necessary before the day was over.

‘Is it really that simple to just manage the breathing?’

He couldn’t help but recall the patient’s heart function he had seen earlier.

It was only 15%.

This indicated severe heart failure.

While stress-induced cardiomyopathy usually recovers within 4 weeks,

a 15% state for even a week would be fatal.

Something had to be done.

“First, we should continue the treatment for lupus, which is the cause of stress-induced cardiomyopathy.”

“Like the steroids and immunosuppressants we are using now?”

“No. We should eliminate any medications that could burden the heart and use only steroids... 60mg of prednisolone.”

“Hmm.”

Lee Hyunjong, unusually uncertain, nodded.

He agreed, but wasn’t sure if this was the best course of action.

It was understandable.

Such a rapid progression in a young patient was rare.

Even a genius couldn’t immediately formulate a treatment plan.

Suhyeok’s ability to bring the case this far with his brilliant diagnostic flow was impressive.

“And?”

“We need to check the blood pressure...”

Suhyeok looked at the monitor by the patient’s bedside.

Despite the medication, the systolic blood pressure had not recovered to 100.

The heart rate was also maintained at around 120 beats per minute.

If this continued, the patient would die from heart failure.

“What can we do?”

Lee Hyunjong, noting the patient’s fading consciousness, expressed his concerns.

Instead of a clear answer, his worries emerged.

This prompted Shin Hyuntae, who had been relying on them, to let out a scream.

“Bro, what do we do if you do this?”

“What can we do? The progression is too fast. This is something beyond what medical staff can handle.”

“But... the patient is young. I told the family it would be fine every time I made rounds.”

“At that time... based on the information we had then, it was fine.”

They hadn’t anticipated the stress-induced cardiomyopathy.

They had only been monitoring the improving inflammation levels and lung X-rays.

It wasn’t a mistake; the situation had just changed.

“So I asked Suhyeok, but he’s not sure either.”

“Of course not. Bro, he’s only in his second year. He’s not a professor.”

“But you agreed he was at a professor’s level.”

“Yeah, but this is a hospital. What can you do, calling him ‘bro’?”

“Would it help if you called him ‘Director’?”

“Hmm? No. We need to think about it. But the question is whether he can endure... that’s the problem.”

Lee Hyunjong continued to voice his concerns, which were frustrating for Shin Hyuntae.

Shin Hyuntae, frustrated, stomped his feet, but to no avail.

After all, Lee Hyunjong was the best in cardiology.

It wasn’t that Shin Hyuntae was inferior.

Lee Hyunjong was likely still the best in the country.

Thus, they had to wait for a plausible plan from Lee Hyunjong, backed by solid reasoning.

[Analysis complete.]

If Baruda hadn’t been there, they would have been in trouble.

‘Oh, what did you find?’

[Suhyeok, you did read a lot, didn’t you? I found some relevant data, though it took a while to process.]

‘What, what is it?’

[This is currently the best option, but there might be resistance.]

‘Resistance? Is it a very risky treatment?’

[It could be seen that way.]

‘Shit...’

The mention of risk brought several treatments to Suhyeok’s mind.

If it were any other organ, it might be different,

but this was the heart.

There were treatments that could be extremely risky.

Some were beyond imagination.

[Let’s not go that far. What about an artificial heart? Is that an option?]

Fortunately, Baruda stopped Suhyeok’s runaway thoughts and provided a proper analysis.

[First, we need to start ECMO.]

Of course, this wasn’t an easy treatment.

‘ECMO...? The heart hasn’t stopped yet. ECMO...’

ECMO (Extra-Corporeal Membrane Oxygenation) is a device that replaces the function of the heart and lungs.

In other words, it extends the life of someone who needs or will soon need CPR.

[According to the data Suhyeok obtained six months ago, in cases of stress-induced cardiomyopathy due to lupus, with an initial ejection fraction of about 15%, there is a 90% chance of cardiac arrest.]

‘Six months ago...’

[In such cases, the prognosis is extremely poor, often leading to death.]

‘That can’t happen.’

[Additionally, according to the data Suhyeok obtained three months ago, a two-week trial of ECMO in stress-induced cardiomyopathy, regardless of the cause, has been reported to have a positive effect on patient outcomes.]

‘That... could be possible. If ECMO is started, the heart can enter a semi-forced rest period. If the cause is something like a myocardial infarction, where the muscle is dead, the chances of recovery are slim. But in stress-induced cardiomyopathy, the muscle is just exhausted. Giving it rest is meaningful.]

[However, if the heart does not normalize after a two-week trial, a heart transplant is necessary.]

‘Why...’

[This is not yet statistically proven. However, the Mayo Clinic’s judgment is based on the observation that two weeks on ECMO is similar to four weeks without it.]

‘That makes sense. Running ECMO for more than two weeks is burdensome. If the condition doesn’t improve by then, a transplant should be considered.]

[Do you understand, Suhyeok? If you need more explanation, I can provide it.]

Baruda reminded Suhyeok of Lee Hyunjong and Shin Hyuntae, who were already in their own world.

Suhyeok, who was trying to squeeze information out of Lee Hyunjong, shook his head.

‘No, I understand.’

[Then please end this ugly argument. I can’t watch anymore.]

‘Okay.’

Suhyeok made a ‘hmm’ sound and tapped the floor with his cane.

Since his leg injury, he thought this might be one of the few good things.

It was easy to draw attention and elicit sympathy without hurting anyone.

“Hmm?”

“Why, Suhyeok.”

Moreover, Lee Hyunjong and Shin Hyuntae were known to be Suhyeok’s fans.

Even if he had called them with a “Hey, you guys, I have something to say,” they would have turned around.

“Professor, I read a paper from the Mayo Clinic before.”

“Hmm, go on.”

Mayo Clinic is a world-renowned hospital in Minnesota, one of the best in the world.

“In cases of stress-induced cardiomyopathy due to acute lupus flare-ups... like this patient, with a cardiac output of 15%, there is a 90% chance of cardiac arrest within a week.”

“90? That high? For lupus?”

“Yes, that’s what the report says. Although the number of cases is small, the Mayo Clinic’s experience is clear.”

“Go on.”

Lee Hyunjong was now fully focused on Suhyeok.

Shin Hyuntae, who had been trying to get Lee Hyunjong’s attention, turned his body as well.

“Therefore, I suggest preemptive ECMO insertion. It’s a difficult decision and will require convincing the family, but it’s very risky.”

“ECMO... hmm.”

The mention of ECMO darkened the faces of both professors.

ECMO is a device used to save people who are essentially dead.

Shin Hyuntae, who had thought the patient wasn’t that bad, now saw the patient’s face turning even paler.

“Professor, the patient’s consciousness is already fading. The heart rate might be weaker than before. Considering that I had started dopamine before coming down, the situation is bad.”

“Right.”

Fortunately, Lee Hyunjong didn’t take long to decide.

He was a world-renowned authority in cardiology.

While he hadn’t seen this exact case,

he had dealt with countless similar cases.

“Let’s do it. Contact the family. We’ll start it first. I’ll take responsibility. The director will take responsibility, so they shouldn’t have any complaints.”

“Really? The director?”

“Yes. I was already considering ECMO. But after hearing you and seeing the patient’s condition, there’s no reason not to. It’s too risky now.”

“Thank you.”

“Good. Is that all?”

Lee Hyunjong, already dialing the thoracic surgery department, asked Suhyeok.

He didn’t expect any more input.

But this wasn’t Suhyeok.

He already had a plan, one that Baruda had mapped out for two weeks ahead.

Naturally, he was about to speak.

[Brum brum.]

‘Don’t add weird sound effects.’

[Pshh...]

‘Don’t add more anxiety.’

[Then please speak quickly. They look anxious.]