Chapter 77: Young (1)

"I should have brought one."

Suhyeok muttered to himself while standing in the elevator.

He had rushed over without thinking, but now he wondered if he should have anticipated this.

[You should have. You should have brought one. It gets cold and tastes bad...]

'You could have mentioned that earlier. You always play catch-up.'

[That's because I'm running on Suyeok's brain. That's why I'm slow.]

'Let's not talk, let's not talk.'

Conversations with Baruda usually followed this pattern.

How could an AI be better at annoying people than making medical inferences?

Ding.

As he shook his head, he realized he was already on the first floor.

Andaeun rushed out and ran forward as soon as the door opened.

"I'll go ahead!"

Suhyeok just wanted to take the credit for that.

'That probably won't help much.'

[Still, try to teach him well. Who knows? He might end up giving useful notifications later.]

'Probably... It will happen, but not now.'

He could see it from his peers.

All of them, including Suhyeok, were interns wearing internal medicine gowns.

Now, they were all full-fledged internal medicine doctors treating patients.

This meant that the internal medicine residency at Tae-hwa Medical Center was no easy feat.

Tap.

Tap.

Suhyeok walked toward the emergency room, lost in thought.

The cane, which used to be so inconvenient, had become quite familiar to him.

It was still slower than others, but he had picked up some speed.

"Teacher!"

Thanks to that, when he arrived, Andaeun had already completed the initial examination.

Suhyeok glanced at the patient lying behind Andaeun and then looked back at him.

'A 21-year-old woman.'

He was thinking about what diseases could cause fever in a young woman.

Meanwhile, Andaeun quickly recounted what he had just asked the patient.

"The patient is a 21-year-old female who was diagnosed with appendicitis at a nearby hospital a week ago and underwent a laparoscopic appendectomy."

Appendicitis refers to the inflammation of the vermiform appendix, which is often mistakenly called appendicitis.

The inflammation of the appendix, which resembles a pig's tail, is a basic surgery in general surgery.

"Is it a postoperative infection?"

Of course, just because it's a basic surgery doesn't mean it's risk-free.

Suhyeok thought that since the patient had surgery, a postoperative infection couldn't be ruled out.

[It's possible.]

Baruda agreed.

"That's... I don't know yet. Anyway, she has had a fever for the past three days, accompanied by nausea and vomiting. The tests conducted at the hospital where she had surgery showed abnormal liver function, so she was transferred to our hospital today."

"Liver?"

"Yes."

"Hmm."

If it were a simple postoperative infection, it wouldn't cause liver dysfunction.

If it were a more advanced condition, it could affect the liver and kidneys.

But the patient was young.

This meant that other diseases should also be considered.

[First, we need to conduct a physical examination and review the blood test results.]

Baruda also suggested this, considering the possibility that it wasn't a simple case.

Suhyeok, accepting his opinion, approached the patient.

The patient looked very pale.

"Hello, Ms. Kim."

"Ah, hello..."

Her lips were dry, indicating she was dehydrated due to the fever.

Suhyeok increased the rate of the IV drip connected to her arm and examined her.

[Jaundice is not observed, but petechiae are present on the ankles. We need to see if there's a correlation with the blood test results.]

'Right. She looks... a bit pale. Could she have anemia?'

[Based on the data Suhyeok has accumulated so far, there's a 95% chance that her hemoglobin level is below the anemia threshold.]

'Her breathing sounds fine...'

After performing auscultation, Suhyeok looked at the patient's face again.

"I'm going to press on your abdomen now. Is there any particular area that hurts?"

"Ah... Yes. The area where I had surgery is a bit..."

"Your right lower abdomen, right?"

Suhyeok gently pressed the patient's right lower abdomen with the pads of his fingers.

He could feel the texture of her abdomen.

[No rigidity, it's soft.]

This suggested that the possibility of a severe internal infection was low.

"It hurts a bit when you press."

Of course, when Suhyeok applied a bit more pressure, the patient's face contorted.

But the pain didn't worsen when he released his hand.

This meant there was no rebound tenderness.

[The possibility of a postoperative infection is low.]

'Right. Hmm.'

Moreover, the fluid from the drainage tube inside the patient's surgical site was clear, with no signs of pus.

"I can't tell you exactly why you have a fever right now."

Suhyeok, having finished his examination, addressed the patient and her guardian.

The patient was in too much pain to care about the specifics.

However, a hint of dissatisfaction flashed across the guardian's face.

This was because the doctors who came to examine her at such a large hospital were too young.

Indeed, Suhyeok and Andaeun were young, and their faces were even younger.

Living in the hospital without much sunlight had made them look even younger.

"Then... What happens now?"

Of course, the guardian couldn't just lash out.

Large hospitals have a certain level of authority.

Most patients, even if they have complaints, don't voice them, especially in the emergency room.

"First, we'll conduct basic tests and review the results. Since there are petechiae... it's important to quickly review the blood test results. Also, since she had surgery, we'll take a CT scan of the surgical area."

"Okay, I understand."

The guardian nodded.

[He's dissatisfied.]

Baruda noticed the guardian's expression.

'It's fine. We just need to make a quick diagnosis.'

Suhyeok exuded confidence.

This wasn't the first time he had experienced such a situation.

A good outcome usually improved the relationship with the patient.

"Teacher! The test results from the emergency room are in!"

"Ah, okay. Let's see."

At that moment, Andaeun informed him that the test results from the emergency room, which were ordered as soon as the patient arrived, were ready.

These routine tests would undoubtedly be very helpful.

Tae-hwa Medical Center's emergency room, known for its high severity cases, tended to order more tests than necessary.

[The patient has pancytopenia.]

Baruda muttered upon seeing the test results.

As he said, the patient's white blood cells, red blood cells, and platelets were all significantly reduced.

The cause was unknown.

Just this alone was not a normal situation.

'The liver function test results are also in. AST and ALT are 2000 and 650, respectively.'

[LDH is also elevated. Bilirubin is normal. Hmm.]

In addition, the patient's tendency to bleed had increased.

Fortunately, d-dimer (indicating deep vein thrombosis) was not significantly elevated, but if it progressed, it could be life-threatening.

"Wow."

Andaeun tensed at Suhyeok's words.

The test results were full of red flags, indicating something was seriously wrong.

However, he didn't know exactly how bad it was.

Honestly, he had been somewhat relieved because the patient was young.

But looking at Suhyeok's face, it didn't seem like things were good.

"Senior, what's going on?"

Andaeun asked, but Suhyeok couldn't give a definitive answer.

There were still too many missing clues to make a clear diagnosis.

He could only list the problems.

[To summarize, the patient has fever, nausea, vomiting, and pancytopenia. Liver function is also elevated, and LDH is increased.]

'So, we should first consider viral or toxin-induced hepatitis.'

[We can't completely rule out a postoperative infection yet. If it progressed to sepsis, all these symptoms are possible.]

'What medications is she taking? Pancytopenia could also be caused by medication.'

[Please confirm.]

Certain medications, especially antibiotics, can cause pancytopenia if used for a long time.

Suhyeok checked the patient's medications and found that the hospital where she had surgery had prescribed a first-generation cephalosporin orally.

'This is less likely.'

[Still, it's better to be cautious. Exclude that medication and use a different class. I recommend aztreonam and levofloxacin.]

'Hmm. That sounds good. For the elevated liver function... how about trying liver protection treatment (hepatotonics)? There's not much evidence for acute cases, but...'

[Well, it won't hurt to try. Although the evidence is lacking, it's best to try everything possible. Without a clear diagnosis, it's good to try various treatment methods.]

'Okay. What about d-dimer?'

[It's the most urgent issue. It appears that disseminated intravascular coagulation (DIC) is already progressing. We need to closely monitor and consider platelet transfusions if necessary.]

'Right. Let's do that.'

After reaching an agreement with Baruda, Suhyeok took out his phone from his gown pocket.

"Andaeun, I'll notify the professor. You go tell the patient that they're being admitted."

"Ah, okay."

Andaeun, thinking he had met a good senior, approached the patient.

Typically, second-year residents would notify the professor, and the patient would also be notified.

In this regard, Suhyeok was a very kind second-year resident.

Of course, it wasn't difficult for Suhyeok to notify the professor.

Still, it was a good thing for the first-year resident.

"Yes, Professor."

While Andaeun went to the patient, Suhyeok called Shin Hyuntae.

"Hey, what's wrong with the patient? Did something go wrong?"

Shin Hyuntae, who had just finished placing an ECMO, reacted quickly, almost urgently.

"No, no. That patient is stable."

"Oh... Then?"

"Another patient came to the emergency room, so I'm notifying you."

"Oh. What kind of patient?"

Shin Hyuntae, now relaxed, asked in a calm tone, showing his trust in Suhyeok.

Honestly, during Suhyeok's rotation, there was no need to worry too much about patients.

Suhyeok was the epitome of "handling things smoothly."

"A 21-year-old female who had a laparoscopic appendectomy at another hospital a week ago."

"Hmm."

"Three days ago, she developed a fever and elevated liver function, and was transferred to our hospital for treatment."

"Okay."

"She has pancytopenia, elevated liver function, and elevated LDH. Her d-dimer is around 5, not significantly high, but she shows a tendency to bleed and already has petechiae."

As Suhyeok spoke, Shin Hyuntae's voice trembled again.

"Are you suspecting disseminated intravascular coagulation (DIC)?"

"Yes."

"I'm coming... Admit her. Is your junior Andaeun or Suhyeok?"

"Isn't it Andaeun?"

"Andaeun... Anyway, I'm coming."