Chapter 93: Multidisciplinary (2)

As Suhyuk said, the conference room was bustling with activity.

It didn't seem like it was just a casual gathering; the seating arrangement was clearly defined.

[The front row is for the professors.]

‘Hematology, surgery, otolaryngology, thoracic surgery, neurosurgery... and even radiology, nuclear medicine, imaging, and pathology. Everyone is here.’

[Isn't that what multidisciplinary means?]

‘That's true, but...’

The multidisciplinary approach at Tae-hwa Medical Center wasn't on this scale.

Only one patient could be selected and discussed at a time.

Naturally, only one surgical department would participate, and even then, not all members of that department could attend.

In Korean medical practice, multidisciplinary discussions were more like informal small meetings rather than a formal part of treatment.

Not only was there no financial compensation for participating in multidisciplinary discussions, but they were often scheduled after 6 PM to avoid interfering with other treatments.

[It's the middle of the day... How can so many people gather like this? Who's taking care of the patients?]

‘So... Are they just here for a leisurely visit to the hospital?’

To Suhyuk and Baruda, it was absurd that the conference room was packed during the time they should be seeing patients and performing surgeries.

"Doctor Lee, don't just stand there. Go over there."

Just as he was looking around, Hank tapped his shoulder.

"Ah, yes, yes."

"Normally, this is where the professors sit, but Dr. Jeremy is on leave today. You can sit there."

Even without being told, Suhyuk could easily tell it was a professor's seat.

The people sitting around were all quite senior.

For Suhyuk, it was a rather intimidating position.

But it would be awkward to refuse, especially since it was a foreign professor, Hank, who offered it.

So he neatly placed his hands in his lap and sat down.

"Ah, yes."

"Sit comfortably. No one will mind."

Then Hank pointed to someone who was crossing his legs and even had his hands in his pockets.

"He's a first-year."

"Ah?"

"Here, it's like this. It's different from Korea."

"Ah, yes. I understand."

Suhyuk nodded and relaxed his hands a bit.

He didn't cross his legs, though.

"The multidisciplinary conference will now begin. The first patient is Thomas, a 67-year-old male. A 2 cm mass was observed in the cervical esophagus during a health check-up at our hospital. A biopsy was performed, and he was diagnosed with squamous cell carcinoma. He was admitted today and is scheduled for surgery tomorrow. We will discuss the multidisciplinary approach."

The multidisciplinary conference began.

At the same time, Baruda tilted his head.

[Isn't this a straightforward case?]

On the three screens in front, the rightmost showed an endoscopic image, the middle a CT scan, and the left a PET-CT.

While ordinary residents might not know, Baruda and Suhyuk certainly did.

They immediately had a clear plan in mind.

‘Hmm... Can't we just perform an esophagectomy and anastomosis?’

[That's right. Even with a generous margin, the location isn't that difficult. If it's really impossible, we can even transplant a segment of the small intestine.]

‘And post-surgery, can't we just do chemotherapy...?’

[Exactly.]

However, the professors began a very detailed discussion.

Hank started.

"How is the patient's ability to perform daily activities? The CT shows a rather thick neck."

"Ah... He can manage daily activities on his own, but he is quite overweight... We're not sure how he will do post-surgery."

"Does he have diabetes or hypertension?"

"He has both."

"Hmm... I'm concerned about the safety of the surgery. What do you think?"

One of the professors sitting opposite Hank nodded.

Looking at his name tag, he was indeed from thoracic surgery.

"The approach is the issue... But the otolaryngology department will handle it. They will also clear the cervical lymph nodes."

"Yes, we will handle it. Fortunately, the imaging shows no invasion into the airway. This approach should work."

Then he drew a quick sketch on the paper in front of him and began to explain the general approach to the otolaryngology team.

"Wait, wait. How far will you clear the cervical lymph nodes? There's a suspicious lesion on the left side, level 4."

As the explanation continued, a professor from imaging interjected.

He moved the CT image in the middle.

Sure enough, a mass was visible in the location he mentioned.

"The PET-CT shows a high likelihood of metastasis based on glucose uptake."

A professor from nuclear medicine added, moving the left image.

The otolaryngology professor nodded.

"Then we'll perform a lateral neck dissection on the left... and the same on the right."

"Agreed. Is that clear?"

He then looked back at Hank.

Instead of nodding, Hank looked at the pathology department.

"Hmm. The malignancy grade from the biopsy is moderate... A safety margin of about 2.5 cm should be sufficient. I think we can manage the resection."

To summarize:

The patient is overweight and has systemic diseases, but the surgical approach and resection are not difficult.

So, we will perform the resection, clear the cervical lymph nodes, and start chemotherapy afterward.

"Good. Then... We will determine the chemotherapy protocol based on the margin results after the resection. If the resection is successful, we may not need radiation therapy, but what do you think?"

"I agree. However, if cancer cells are found in the margins, radiation therapy is necessary."

"Agreed. Then... Next case."

When he came to his senses, 30 minutes had passed.

It was natural, given that multiple professors had discussed the diagnosis, surgery, and post-treatment management.

The other residents in the room seemed to take it for granted.

But not Suhyuk and Baruda.

[This is no joke, right?]

‘So... They plan the treatment for every patient like this?’

It wasn't a highly sophisticated discussion.

The conclusion wasn't significantly different from what Suhyuk and Baruda had thought.

But it still made their hearts warm.

These people weren't just looking at an esophageal cancer case; they were looking at the patient with esophageal cancer.

It might seem like a play on words, but as a doctor in the field, Suhyuk felt an indescribable sense of awe.

[If we do this... There won't be any mistakes, no matter who treats the patient.]

‘Right... The system... It's perfect.’

Moreover, this multidisciplinary approach was a perfect validation.

One person might make a mistake, but it's impossible for all the professors gathered here to make a mistake about a single patient.

If such a system were established, Tae-hwa Medical Center, or even Korean healthcare, could make a significant leap forward.

But the more he thought about it, the more his chest felt heavy.

‘Should I be grateful that there's something to learn?’

[But this system can't be implemented at Tae-hwa Medical Center right away.]

‘So...’

While the Korean healthcare system might not be perfect, it was still quite excellent.

This was especially evident when working at a university hospital.

At least, Suhyuk had never had to send a patient away due to the limitations of modern medicine.

He had never had to send a patient away because they couldn't afford treatment.

But what about the United States?

Just today, two patients he saw in the outpatient clinic had to leave because their insurance didn't cover the necessary treatment.

They would die because they couldn't afford it.

It was a system designed to achieve maximum effect with the least cost.

[How can we handle all patients with a multidisciplinary approach when we're already busy with regular consultations?]

But there were side effects.

How could they achieve maximum effect while reducing costs?

There were limits to reducing the costs of equipment and medication.

Ultimately, it came down to squeezing the staff.

In fact, a university hospital would immediately be short-handed if even one person went on leave.

‘That's true...’

[But it's good to see these discussions. It gives us a chance to analyze the discussion methods.]

‘Right. Hmm. Let's just watch, then.’

[Yes.]

The two of them chatted about practical implementation for a while, then, feeling exhausted, returned to the discussion.

Instead of the thoracic surgery resident who had been explaining earlier, another resident was now at the front.

The distance was too great to see which department was written on his name tag, but the screen behind him made it clear.

[Otolaryngology.]

‘Head and neck cancer... Hmm.’

As they had said, the right screen showed a laryngoscopic image, the middle a cervical CT, and the left a whole-body PET-CT.

"The next case is... Ben, a 42-year-old male. He had a lump in the front of his neck for a year, which he observed. Recently, he developed hoarseness and a sensation of a foreign body, and an ultrasound two weeks ago revealed a thyroid nodule. He was transferred to our hospital. There are two nodules in total, and a fine-needle aspiration biopsy of the central nodule revealed papillary thyroid carcinoma."

The resident clicked on the left screen during his presentation.

The image, which had seemed static, began to move.

It was a video.

[The left side isn't moving.]

‘This means vocal cord paralysis.’

[That's strange.]

‘Exactly.’

Papillary thyroid carcinoma.

The cancer often referred to as "benign" cancer.

While it might seem inappropriate to call cancer "benign," it is indeed a very mild type.

There were even papers suggesting that for nodules less than 1 cm, observation and surgery were equally effective.

But for such a small nodule to cause vocal cord paralysis?

It was strange.

It wasn't just Suhyuk who was puzzled; Hank also looked skeptical.

"Was there a reason not to perform a fine-needle aspiration biopsy on the nodule in the upper left?"

"Um... According to the records, there was scar tissue in front, making it difficult for the needle to penetrate."

"Hmm. Scar tissue?"

Hearing Hank's murmur, the imaging professor moved the mouse.

The cervical CT in the middle began to move, focusing on the upper left nodule.

"It seems he had an injury here before. You can see the scar here."

"Ah... That's true. But vocal cord paralysis from a nodule of this size... Does it usually affect the recurrent laryngeal nerve?"

"That's... not typical, but it can be in contact. As you can see here."

"Right. Hmm..."

The image clearly showed the nodule penetrating the thyroid capsule and pressing on the nerve.

Seeing this, the otolaryngology professor nodded and spoke.

"So, we plan to perform a total thyroidectomy and a neck dissection... followed by a vocal cord medialization procedure. He's young and works in sales..."

"Vocal cord medialization. It seems possible."

"Yes."

"But I still have a bad feeling about this."

The otolaryngology team had already planned the surgery and the follow-up.

However, Hank was still uneasy about the upper left nodule.

Suhyuk and Baruda felt the same way.

[If you look closely at the image... The upper left nodule might not be papillary thyroid carcinoma.]

‘Two cancers at the same time? What...’

[Can't you see it?]

‘I can see it.’

[Then raise your hand. The discussion is almost over. If we let it end like this...]

‘It will be a disaster, right?’

[Yes, it will be a disaster.]