Chapter 81: Proof of a Genius (1)

"It's Suhyuk."

"What this time? Pica? I heard you got that one right."

"If it weren't for that teacher, the patient would have died."

"I also heard that Professor Shin Hyuntae knelt down in front of him because he didn't know what the HLH protocol was."

"Wow... What's that?"

"I don't know either. How would I know something the professor doesn't?"

As Suhyuk appeared in the emergency room, whispers could be heard from all around.

Most of the whispers were due to Ahn Daehoon.

The guy, feeling both thrilled to have been at the scene and filled with intense admiration for Suhyuk, was telling everyone he met about it.

As is often the case with words, they became more exaggerated as they passed from person to person. By now, about a week later, it was quite a spectacle.

'Is he crazy? Why would Professor Shin Hyuntae kneel down?'

Suhyuk was almost driven to distraction by what he was hearing.

[He probably knelt down in his heart, didn't you know? The greatest genius at Taehwa Medical Center is no longer Lee Hyunjong but Lee Suhyuk.]

'Well... yeah...'

[Of course, it's all thanks to me.]

'You... a bit...'

[Isn't that so?]

'You're right, but... be a bit quieter. I'm here to see a patient.'

After calming down Baruda, who was being noisy regardless of time and place, Suhyuk looked around.

He clearly looked like he was searching for a patient.

Someone saw this and hurried over.

"Senior!"

It was Woo Hayun.

Since it was now the end of March, he seemed much more relaxed than when Suhyuk first met him.

Just looking at his hair, you could tell.

'He's grown it out.'

[Impressive.]

'What is?'

[When I saw Suhyuk during his internship, his hair was almost...]

'Quiet, man. Focus. It's a chest pain patient, chest pain.'

The fastest way to get treated in the emergency room isn't to shout and act angry. That would just get you glares, and your turn wouldn't change.

The best way is to come in clutching your chest.

Chest pain is a symptom that can raise alarm among all doctors.

[But it's an 18-year-old patient, right? It's probably nothing.]

'That... that's true. Let's see quickly, and then go out and eat something good.'

[Yes. Unfortunately, the call came 15 minutes before my shift ended...]

'Still, you should answer when you get a call. Anyway, let's see quickly. It might be nothing, as you say.']

Of course, not every patient's chest pain draws such urgent attention from doctors.

Chest pain in very young patients is often benign, so it tends to be less concerning.

While they were having this conversation, Hayun approached.

"The patient is over there."

"Ah, right. How's the patient's history?"

Suhyuk had just received the call while passing through the emergency room and hadn't asked many details over the phone.

He only knew the patient's age, name, and the symptom of chest pain.

Hayun, who had been the one to make the call, quickly began recounting what he had learned during the initial examination.

"Um... The patient has been experiencing pain for two days. He visited a nearby internal medicine clinic and was given one tablet of nitroglycerin, but it didn't help at all, so he came here."

"Nitroglycerin?"

Nitroglycerin is a medication that can be used when angina is suspected.

It's not something that just anyone gets from a local clinic.

Naturally, Suhyuk's eyes narrowed.

[Hmm. Is it really chest pain?]

Baruda felt the same way.

"Yes. The patient has a history of epilepsy and is currently taking 300mg of phenytoin."

"Phenytoin? How long?"

"About 14 years, he says."

"14 years? And he's 18 now?"

"Yes."

This meant the patient had epilepsy since he was 4 years old.

[Pediatric epilepsy. Hmm.]

Suhyuk's face was markedly different from when he first entered the emergency room. He walked alongside Hayun.

"Hmm... How about the ECG?"

"Ah, here it is."

Suhyuk had heard about the interns who were planning to join the internal medicine department through various channels.

Among them was Hayun, who had graduated top of his class and was applying to the internal medicine department.

'He's as good as they say.'

[He's sharp.]

There are interns who don't even take an ECG when they notify a chest pain patient.

In such a situation, an intern who carries the ECG around is naturally impressive.

"Hmm."

Suhyuk immediately examined the ECG Hayun handed over.

He could grasp several pieces of information right away.

[It's a normal finding.]

First, it wasn't a myocardial infarction.

'His heart rate is 90. Without any physical activity, for it to be this fast... it means either severe pain or bleeding.'

[Or both.]

'Right.'

Anyone else would have thought it was normal, given the "normal" written on the interpretation.

"The ECG was normal."

Just like Woo Hayun here.

"We'll have to see. We need to look at the clinical presentation."

But Suhyuk could add a bit of suspicion.

Thanks to the vast amount of knowledge and cases he had accumulated with Baruda, along with his own direct experience.

"That's him."

"Ah."

The patient was sitting where Hayun's finger pointed. He couldn't lie down due to the severe pain, which meant it was definitely not just a muscle strain.

[The distance between the eyes is quite wide.]

Moreover, the patient had another distinctive feature.

As Baruda had just mentioned, the distance between his eyes was quite wide.

It could be a simple physical characteristic, but it could also have a medical cause.

"Do you have any family members with heart disease?"

While thinking this, Suhyuk approached the patient.

The patient, frowning deeply, shook his head.

"I'm an orphan."

"Teacher. He grew up in an orphanage."

At the same time, Hayun informed him of what he had asked earlier.

"Ah, I see."

Suhyuk looked at the patient, who was in the same situation as himself.

He always did his best when treating patients, but somehow his mindset felt a bit different.

"What kind of pain are you experiencing?"

"Still... It's a bit better when I'm still... But it hurts a lot when I move. I feel dizzy."

"Dizzy."

Increased heart rate.

Pain so severe he couldn't stand properly.

And dizziness.

[Considering his age, it doesn't make sense...]

'Signs that suggest aortic dissection?'

[That's right.]

Aortic dissection is a condition where the aorta tears.

It doesn't burst outward and cause bleeding, but rather the inner wall of the aorta tears, allowing blood to enter the wall.

This means that while there is no external bleeding, the situation is similar to losing a significant amount of blood.

It's a condition that can explain the increased heart rate and dizziness.

Moreover, it's a condition that can be fatal if missed.

"First... I'll call the thoracic surgery department. I'll do an echocardiogram."

The most urgent task in the emergency room is to identify conditions that must not be missed.

So Suhyuk decided to prepare for an echocardiogram and asked Hayun to call the thoracic surgery department.

It's always a burden for interns to call other departments, but Hayun was one of those who admired Suhyuk and Ahn Daehoon.

Moreover, he was an intern hoping to join the internal medicine department.

"Yes, senior. But... How should I notify them?"

"Ah. Based on the clinical symptoms, say you suspect aortic dissection. They'll come down immediately."

"Aortic dissection."

Hayun was an excellent intern who had graduated top of his class, but he was still just an intern, and it was only March.

It was almost impossible for him to think of aortic dissection in this situation.

'Sure enough... Senior Ahn Daehoon was right.'

Thanks to this, Suhyuk seemed almost godlike.

The emergency room lights behind him made it look like he had a halo.

"Understood, senior!"

"Okay. Thanks."

Suhyuk, hearing Hayun's more confident response, turned back to the patient.

The patient was still sitting, unable to straighten his back, and was breathing heavily.

The pain seemed very severe.

"I'll do some tests."

"Huh? Ah, yes."

"Can you lie down?"

"Lying down... hurts..."

"Just for a moment. Just a moment."

"Ugh... Okay."

The patient, though clearly reluctant, lay down.

Given the immense pain, it was rare for a patient to disobey a doctor in such a situation.

Click.

As soon as the patient lay down, Suhyuk drew the curtain and began handling the ultrasound machine he had brought from the adjacent treatment room.

He looked as skilled as any experienced cardiologist fellow, despite being only a second-year resident.

It was understandable, given that he had taken charge of real cardiac ultrasounds while working under Lee Hyunjong.

While some whispered about the unfair privileges, they had to keep quiet after seeing Suhyuk's results.

At least in front of him, they had to.

"This might be a bit cold."

"Ah, yes."

The patient, unable to look at Suhyuk, turned his head to the side.

To perform a cardiac ultrasound, the top of the patient's shirt had to be pulled down, but Suhyuk had no such thoughts.

All that mattered was whether it was a dissection or not.

[Hmm! The aortic root is dilated.]

'There's also regurgitation. The heartbeat isn't proper.'

[These are definitely signs of aortic dissection. It would be better to see a transesophageal ultrasound for a more accurate view...]

'I can't do that yet. It's too invasive.'

[Well, this will be enough for the thoracic surgery department. They'll proceed with further tests if needed.]

'Right. Hmm.'

In fact, the role of internal medicine was essentially over at this point.

They had identified that the patient's chest pain was due to aortic dissection.

In a normal situation, Suhyuk would have handed over the case here.

But something about this case seemed off.

[What could be the cause?]

The patient was only 18 years old, which is too young for such a condition.

'Pediatric epilepsy and the distance between the eyes...'

[You're suspecting a congenital condition.]

'I don't think so?'

[No, I think it's a valid consideration. There's also a slight scoliosis, which makes it even more suspicious.]

'Hmm.'

In such cases, it's best to clearly identify the underlying condition.

Even if the aortic dissection is treated, the patient could die from another cause.

[Let's do a full body examination. It will take some time for the thoracic surgery team to arrive.]

'Okay.'

So Suhyuk began examining the patient urgently, from head to toe.

But he didn't gain any new information.

The distance between the eyes and the scoliosis were the only notable findings.

"Do you want to try this?"

"Huh? Ah, yes."

Next was the neck.

It was a somewhat unexpected request, but the patient accepted.

In the emergency room, it's rare for a patient to refuse a doctor's request.

[The uvula is bifid.]

'With this, something should come to mind.'

[It's likely a congenital condition that weakens connective tissue.]

A bifid uvula can occur in about 2% of the general population, but in a patient with aortic dissection, it has a different significance.

Especially for Suhyuk, who had accumulated an excessive amount of knowledge.

'I see, I know what it is.'