Chapter 91: Outpatient (2)

‘What, this bastard?’

Steve glared at Soohyuk as if he wanted to devour him.

If they were outside, it wouldn't be that difficult.

Steve was a towering giant, over 180 cm tall, while Soohyuk was of average build and had a leg injury.

But this was a hospital.

And it was right in front of Hank.

"Why are you like that?"

Hank scratched his bald head and spoke.

A faint irritation crossed his face, probably because he wasn't getting the answer he wanted.

He had let Steve see the patient first, but now Steve was standing there without saying a word.

And in front of the intern.

Even if the intern didn't matter much, being embarrassed in front of him was another story.

"That... "

"Just tell me what you saw."

"That... Yes, I understand. Um."

"Good, go on."

So, he pushed Steve.

For Steve, it felt like a death sentence.

He had to pretend to know things he didn't.

Anyone who has been in that situation knows the pain.

But what could he do?

Hank, the most influential professor in hematology-oncology, whom Steve aspired to, was waiting.

"That... The patient... has melanoma."

"I know that. The Iowa City Hospital sent over the report. It's already diagnosed."

"Um... He started having nosebleeds six months ago... and his nose has been blocked for a month."

"Hmm."

The symptoms weren't really new.

Of course, it was important for medical staff to repeatedly confirm them.

They might miss a question, but patients could recall unexpected clues while reviewing their symptoms.

Unfortunately, what Steve was saying was already in the report.

Steve had taken longer to see the patient than expected, and Hank had already read the report twice.

This meant he was getting bored.

"Tell me what you saw."

"Ah... Yes. There is... melanoma in the nasal cavity."

Hank sighed deeply and shook his head.

Then, with a sharp look, he started to grill Steve.

"Size?"

"Um... about 2 cm?"

"Depth?"

"That... I don't know."

"What's the most important thing in melanoma?"

"D, depth."

"Didn't you check that?"

"That... "

Until a moment ago, Hank, who had a somewhat intimidating presence but a smiling face, had suddenly turned into someone like a detective.

It felt like an interrogation, and even Soohyuk, who wasn't even there, felt his legs shaking.

"Anyway, it's melanoma in the nasal cavity, right?"

"Yes, yes."

"What's the prognosis? Generally?"

When he didn't get a proper answer, Hank put his legs on the table in front of him and changed the nature of his questions.

Instead of asking about the case, he asked about the disease itself.

Normally, this would have been easier.

Answering questions about diseases was something he had been doing since he was a student.

But it was different if he didn't know anything about the disease.

"That... "

"You don't know?"

"Um... If it can be removed by surgery?"

"Ah, so you're treating it with surgery?"

"Um... "

Hank shook his head again, looking at Steve, who was still hesitating.

"You don't know anything about this disease, do you?"

"That... I'm sorry. I'll study."

"You're in your fourth year, right? You'll be a specialist soon, and you don't know this?"

"That... "

"Damn. Anyway, um."

Hank, who was about to head straight to the examination room, stopped and looked at the clock on the wall and Soohyuk.

'There's still some time left.'

Normally, a deep discussion about the case should have taken place.

Through this process, the resident would learn, and the professor could review his knowledge and plans.

It might be a bit boring for the patient, but it was an inevitable process when coming to a university hospital.

It was also safer and more accurate.

'Should I ask? Even though I don't expect him to know... '

Hank thought for a moment and then spoke.

It was natural, as the disease was extremely rare.

Moreover, if the resident from the Iowa State Hospital didn't know, it was unlikely that a resident from a remote area would know.

"That... What do you think, intern?"

He used the term "intern" because he couldn't remember the name.

Moreover, asking what he thought was a lack of sincerity.

He didn't even ask what he thought.

[These guys are all the same.]

'Can you help me?'

[Yes, I'm ready. Let's start.]

'Okay.'

But Soohyuk had no intention of giving a careless answer.

He was determined to show his worth.

"First, melanoma occurring in the nasal cavity is a very rare disease. Until recently, it was considered a case report."

"Oh."

Hank stopped reaching for the doorknob.

Soohyuk's answer was much more plausible than Steve's.

He turned around, and Soohyuk was still speaking.

"But now, there are quite a few case reports, so it's no longer an unknown disease. This patient... Thomas's case is quite typical."

"Hmm, hmm. Go on."

Hank's expression was quite different from before.

His tone was that of a very experienced doctor.

This was clearly the tone of someone who had written or read and analyzed many papers.

In other words, a resident was speaking at the level of a professor.

"First, it occurred in the left nasal cavity, which is also typical. From the patient's statement that the nosebleeds started six months ago, we can infer that the onset was at least six months ago. If the size is 2 cm, we can predict that the histological characteristics are not extremely aggressive. Of course, this is a prediction and can change."

"Hmm..."

The more Soohyuk spoke, the more Hank's posture changed.

Even Steve, who initially looked displeased, was now paying attention.

It was like watching a well-structured detective novel.

Internal medicine, in part, had such an aspect.

Almost no one could give such an impromptu answer, or rather, a presentation.

'What is this?'

Hank kept nodding, thinking Soohyuk might be crazy.

Of course, Soohyuk had no intention of stopping and continued.

"Depth is important for prognosis, but it can't be confirmed visually. It's best to take an MRI before a biopsy. Fortunately, the hospital where the patient was first seen didn't perform a biopsy, so the original form can be preserved for the examination."

"Yes, MRI..."

"Also, it's best to perform the biopsy during surgery. There's a risk of artificial metastasis if you touch it carelessly. Nasal cavity melanoma is quite different from melanoma in other locations."

"Yes, there have been cases of metastasis."

"Yes. Also... While the exact histological characteristics need to be seen, since this melanoma occurred without exposure to UV light, the prognosis is not good."

"Yes, the behavior is different."

In the case of common skin cancer, it usually occurs in areas with high UV exposure.

For example, the bridge of the nose or the back of the neck.

Such melanomas are also scary, but they are relatively easier to remove and respond well to medication.

In contrast, melanoma in the nasal cavity is almost a different type of cancer.

"Of course, the patient is younger than the average age of onset, which is 60, so it might be a bit better. However, based on the analysis of the case reports published so far, the 5-year survival rate is only 40%. I think this point should be clearly communicated to the patient."

"Wow."

It was a perfect answer.

Even better than what Hank had in mind.

He couldn't help but exclaim and wave his hand.

Soohyuk didn't know what it meant, but Steve did.

'Really... He's really surprised.'

Hank wasn't the type to express emotions so openly.

Especially as a hematologist-oncologist, one of the most death-related departments in a university hospital.

There were only two reasons for Hank to show such a reaction: an amazing presentation or the announcement of a new drug.

"What's your name?"

"I'm Soohyuk."

"Soohyuk... Hospital?"

"Taehwa Medical Center."

"Oh, there. They publish a lot of papers. Jo... who was it?"

"Professor Jo Taejin actively publishes papers."

"Oh, right. That's his name. Sorry, Korean names are a bit difficult for me."

"No, I also have trouble remembering names from other countries."

The very surprised Hank then, this time with considerable sincerity, started to ask Soohyuk about his background.

"Are you in your fourth year? Third year?"

"No, I'm in my second year."

"Second year? Wow."

Hank seemed determined to use up all his lifetime supply of "wow" today.

After a while, he turned to Soohyuk again.

"What do you do on weekends?"

"Um, nothing much. I don't have a car, so... I was planning to stay in my accommodation."

Soohyuk tapped his injured leg.

It wasn't that he couldn't drive, but it seemed more plausible to make an excuse.

Fortunately, it worked well universally.

"Oh, sorry."

"No, it's fine."

"If it's not too much trouble... There's a small party for the internal medicine professors on Saturday evening. Why don't you come? Everyone is good at cooking. I can give you a ride."

"Thank you."

"I'll introduce you to the professors. There are so many interns, so I don't pay much attention, but knowing your name will help."

"Thank you."

"Shall we go?"

"Yes."

Hank, instead of Steve, patted Soohyuk's shoulder and headed to the outpatient clinic.

After seeing the patient, he sent Soohyuk and Steve to another patient, this time in room 2.

It seemed that here, patients waited in their rooms, and the doctor went to them.

It was unfamiliar, but there was no need to be afraid.

Now he knew for sure.

'My skills... work even in America.'

[Of course, with me, Baruda.]

'Isn't it a bit too excited to say it's obvious?'

[Actually, it is. I was created to compete with America's Watson.]

'Anyway, what's next?'

[Does it matter? Soohyuk and I don't know many diseases anymore.]