Chapter 85: I Have to Go to America (2)

"Ah... So that's why you came to the emergency room?"

"Yes. It's chest pain, but since the patient is so young, the intern who saw it first notified me."

Lee Hyun-jong, seemingly valuing every moment, kept asking questions about the patient.

Suhyeok, who seemed to enjoy medical discussions with Lee Hyun-jong, responded quite enthusiastically.

[Listen well. Lee Hyun-jong is a real master, after all.]

Even Baruda took an active stance.

This was because Lee Hyun-jong was indeed a master, not just in terms of knowledge, but also in experience and thinking.

In short, he was someone from whom there was a lot to learn, and he didn't keep that knowledge tightly sealed.

"Hmm. How do you triage? It's chest pain, after all. Do young people come to the emergency room just because they have a little pain? Once they're here, you can't ignore the symptoms."

"Ah... That's... true."

Isn't that the case even now?

Initially, Suhyeok and Baruda focused on the patient's age of 18 and didn't fully recognize the severity.

Lee Hyun-jong saw this as the problem.

As he said, why would a young person come to such a large hospital?

It takes a long time and is expensive.

That means there's a significant level of discomfort.

"It's not just young people. There's dizziness, right? If you look at the prevalence, benign paroxysmal positional vertigo (BPPV) is the most common, right? Not just the most common, but overwhelmingly so. But does the emergency room statistics of Tae-hwa Medical Center show that?"

"Um... I don't know."

Suhyeok and Baruda were well-versed in externally published statistics but were rather ignorant of internal statistics.

They also thought there wasn't much point in looking at them.

After all, what was clinically important was universal statistics, not personal experience.

Baruda's principle was that being too tied to a single hospital's statistics could lead to skewed information.

Suhyeok felt the same way.

However, since Lee Hyun-jong was bringing up the statistics, it was hard to ignore.

So, Suhyeok couldn't help but listen closely.

"Even in the emergency room statistics of Tae-hwa Medical Center, BPPV is more common, but the difference is very small. The dizziness caused by neurological issues and BPPV is almost equally common."

"Can... that be true?"

By common sense, it didn't make sense.

The prevalence of BPPV and cerebrovascular diseases differs by at least tenfold.

"You're also buried in evidence-based medicine."

Lee Hyun-jong clicked his tongue at Suhyeok, who looked shocked.

Of course, he wasn't trying to denounce evidence-based medicine.

He was actually a proponent of it.

However, through numerous experiences, Lee Hyun-jong had gained a perspective that allowed him to step back and look at things from a broader view.

"Suhyeok, if you had a fever, would you come straight to the emergency room?"

"No. I would try medication or go to a local clinic first."

"Right. But what if your fever was 42 degrees? What would you do then?"

"Then I would go to the emergency room... Oh?"

Instead of getting angry or trying to teach, Lee Hyun-jong asked a question.

If they were smart, they would learn something from this question.

Suhyeok, of course, realized something.

"The severity of the symptoms... would be different. Especially at Tae-hwa Medical Center."

"Right. People don't come here unless it's serious. If someone comes here because they're dizzy, it's a different level of severity. Have you seen BPPV patients during your internship?"

"Yes."

Dizziness is a common symptom in women over middle age.

Among them, BPPV is the most common cause.

If you did a proper internship, you would have seen it.

"Those patients were all vomiting and in a mess, right?"

"Yes. Oh... Yes."

With the world spinning, it's not surprising that they would vomit everything they ate.

Of course, the medical staff who had to deal with the vomit had a tough time.

Anyway, BPPV was not a pleasant experience for interns.

"But not all BPPV patients are like that. Most just feel a spinning sensation."

"Ah... Really?"

"Yes. Those patients usually go to local ENT clinics. You can think of the patients who come here as filtered."

"Ah..."

"It's the same with chest pain. The chest pain we commonly see as benign usually goes to local clinics. Once they're here, you should consider the patient serious. Otherwise, you might miss something."

"I see. Wow... I really learn a lot talking to you, Director."

Suhyeok bowed his head in genuine appreciation.

Recently, working with Baruda and matching various diagnoses had made him somewhat arrogant.

But listening to Lee Hyun-jong now, he realized he still had a long way to go.

"Don't be like that. I learn a lot from you too."

Lee Hyun-jong chuckled and pointed ahead.

They had finally arrived at the thoracic surgery ICU on the third floor of the main building.

Turning his head, Suhyeok saw the door leading to the ICU.

Beep.

Suhyeok opened the door with his badge and walked in.

He was a well-known figure, but Lee Hyun-jong, who followed, was the director.

Naturally, a few ICU nurses hurried over.

They were recalling that there were no patients admitted under Lee Hyun-jong.

"Director, what brings you here?"

The first to speak was the head nurse of the thoracic surgery ICU.

Normally, she would be inside managing the nursing staff, but since thoracic surgery and other surgical departments usually do rounds before surgery, she was already waiting.

"Ah... I came to see a patient admitted here yesterday."

Lee Hyun-jong, who was on familiar terms with the head nurse, spoke in a relaxed manner.

The head nurse, knowing his quirks, didn't say anything unnecessary like, "There are no patients under your care here."

"Which... patient?"

"That... Loeser's syndrome."

"Loeser's syndrome?"

"Ah, you mean aortic dissection?"

"Ah... Yes, yes. You mean the female patient? This way. The surgery ended in the early morning, and we're still cleaning up."

In surgery, patients are often remembered by the name of the surgery rather than the diagnosis, especially in thoracic surgery, which is one of the most challenging surgical fields.

Even the nurses shared this tradition.

"Here she is."

"Ah."

Suhyeok, who had followed Lee Hyun-jong without thinking, couldn't help but take a deep breath.

The patient's condition was even worse than he had imagined.

While ICU patients in internal medicine are also serious, they don't usually have so many visible injuries.

Moreover, the numerous tubes connecting the inside and outside of the body gave a bizarre impression.

[Didn't you see this during your internship?]

'But it wasn't my patient then.'

[Do you mean it feels different?]

'Yes.'

[I don't understand.]

'You... You will.'

Suhyeok was quite troubled, seeing the patient he had seen just yesterday.

In contrast, Lee Hyun-jong was actively examining the patient's condition.

He first looked at the surgery records and then observed the patient's vital signs and appearance.

"Has the genetic test not been done yet?"

"No, there was no such instruction."

"Then go do it."

"Um... Without contacting the attending physician?"

"Go. I'll take responsibility. Anyway, it looks like the social welfare department will be contacted... so the cost won't be an issue. I'll handle it."

"Ah... Yes, I understand."

He was even giving prescriptions arbitrarily.

In fact, it was a good thing for the patient.

A diagnosis based on clinical estimation and one confirmed by genetic testing are entirely different.

"And why isn't the angiotensin inhibitor being administered? I saw your opinion in the consultation just now."

"The attending physician hasn't... seen it yet."

"What's he doing that he hasn't seen it yet?"

"He left at 5 PM today."

The head nurse pointed to the clock, which had just passed 7 PM.

This meant the attending physician had only been in bed for about an hour and a half.

She was implying that they should understand.

But Lee Hyun-jong wasn't the type to show such understanding.

"What does it matter? If there's a patient, the doctor should see them. Anyway, don't make excuses and give the medication."

"Without a notification?"

"He's sleeping. And I'm a cardiology professor. I know this disease well. If we don't, it might burst again."

"Um... Yes, I understand."

The head nurse, who was about to say something, nodded.

Even if a thoracic surgery professor came, the result wouldn't change.

There might be more arguments, but Lee Hyun-jong would definitely win.

"The records say the specimen was sent to the pathology department. Was this from the operating room?"

"Yes? Ah, yes. The specimen... is not the responsibility of the ICU."

"Good. Then follow the instructions for the prescription. Suhyeok, let's go to the pathology department."

"Pathology department?"

Suhyeok, who thought it was over, looked puzzled.

Of course, Lee Hyun-jong had no intention of explaining.

He just took Suhyeok with him.

"Rumors are true... Director Lee Hyun-jong is indeed eccentric."

A senior nurse, watching Lee Hyun-jong leave, muttered.

The head nurse shook her head.

"He's a gentleman compared to the old days. When Professor Wang was here, we fought every day. Right here. They even came to blows, like boxers?"

"Really?"

"Yes. This way... is fortunate."

"Then, should we wait for the attending physician or the professor's opinion for the prescription?"

The senior nurse, sensing the head nurse's lack of affection for Lee Hyun-jong, asked.

There was also a sense of pride in her own thoracic surgery department.

She also thought it was presumptuous for an internal medicine doctor to come and prescribe.

But the head nurse shook her head again.

"No, follow it as is."

"Why?"

"Lee Hyun-jong... has made many mistakes, but never in medical judgment. He's not called a genius for nothing. Just follow it as is."

"Ah... Yes."

While the ICU matters were being sorted out, Suhyeok and Lee Hyun-jong had already reached the pathology department office.

Since the third floor operating room produces the most specimens, the pathology department is also located on the third floor.

Ding-dong.

Lee Hyun-jong pressed the doorbell next to the entrance.

A voice came from inside.

"Is it an emergency specimen?"

It wasn't the regular specimen time yet.

"No. I came to see a patient."

"Patient? There are no patients here."

The pathology department only had specimens.

Naturally, the person on the other side looked confused.

The department head, who was about to start a meeting in the next room, looked like 'here he comes again.'

"Is it the director?"

When asked through the intercom, Lee Hyun-jong nodded.

"Ah, Cheol-yong? Open the door. Just take out one specimen."

"Meeting..."

"Do you want to hear the doorbell all during the meeting?"

"No. I'll open it now."

Suhyeok, watching Lee Hyun-jong, had a question.

'Did he become the director because he's the best at fighting?'

[Judging from his attitude now, it's a plausible hypothesis.]