Chapter 94: Multidisciplinary (3)

Instead of raising his hand rashly, Suhyuk looked at Hank.

Hank seemed a bit suspicious, no matter how you looked at him. However, he only flinched and didn't show any particularly active movements.

In a way, it was natural.

"Then, let's proceed with the total thyroidectomy?"

After all, the ENT and radiology professors in front of him were all experts. They could even be called the leading scholars of their generation.

There weren't many people who could outright say no to the opinions of such experts.

Especially someone like Hank, who had been closely observing their achievements all along.

"Just a moment, let's look at the images a bit more."

That was about all he could say.

However, neither the ENT nor the radiology department could gather any new information from the floating images. They were already so fixated on one idea that they couldn't think of anything else.

"Um..."

At that moment, Suhyuk, who had been pondering, spoke up.

[Right, well done.]

Encouraged by Baruda's constant support and encouragement.

"Hmm?"

Naturally, the ENT professor's gaze fell on Suhyuk. It was as if he was asking, "What's this?"

It was understandable. He was a complete stranger.

Even his gown was unfamiliar.

In other words, he wasn't from this hospital but a trainee from somewhere else.

"Ah... Isn't that the friend we saw this morning?"

Then, someone who had been silent in the corner spoke up. It was Dr. Cummings, the patriarch of ENT, when he turned his head.

Although he was a specialist in the sciences.

In any case, knowing him meant that no one in ENT could treat him casually.

"Do you know him?"

"Well, we had a brief chat. He seemed very smart... Let's hear what he has to say. Professor Hank wouldn't have brought a trainee to the multidisciplinary meeting for no reason."

At those words, Hank nodded with a very welcoming expression.

"Ah, yes. We saw outpatients together this morning... He has extensive knowledge about tumors. I think it wouldn't be bad to hear his opinion."

That's how Suhyuk managed to get the floor.

'Somehow... Don't I feel a bit lucky?'

To think that someone like Cummings would lay the groundwork for him.

Ever since meeting Baruda, it felt like his luck had been on a roll.

[Isn't meeting me the greatest stroke of luck?]

'W... Well... That could be true.'

At first, it was honestly considered a misfortune.

But lately, it felt like a stroke of luck much more often.

If it weren't for Baruda, Suhyuk wouldn't be enjoying most of what he has now.

[It's not the time to daydream, Suhyuk. Everyone is looking at you.]

'Ah, right.'

[Can you do it, Suhyuk?]

'Of course. It's not like I've only done this once or twice.'

[I believe in you.]

Baruda seemed to nod, truly believing in Suhyuk.

With his trust, Suhyuk spoke up.

"Before I share my opinion... Could I hear the patient's medical history again?"

"Are you talking about the lump that has been there for a year but hasn't been treated?"

The ENT resident in front of Suhyuk replied with a slightly annoyed tone.

Of course, Suhyuk was long past the stage where he would be hurt by every little thing.

So he could shake his head nonchalantly.

"No, not that. The patient was hospitalized once, right?"

"Ah... But that's an unrelated medical history to the thyroid."

It seemed he really thought so.

He had even skipped mentioning it.

But it was visible on the screen showing the larynx.

Both Suhyuk and Baruda had started to suspect it from that screen.

Whether this was really just a simple thyroid cancer.

"But it's part of the patient's medical history, right? Could you read it once?"

So Suhyuk pressed the resident again.

The resident was inwardly exasperated but couldn't just ignore him.

Suhyuk was just a trainee, so he could be dismissed as nothing, but Hank, who had laid the groundwork for him, was a professor.

Moreover, Cummings was a symbolic figure in ENT, with a textbook named after him.

"Um, yes. The patient visited our outpatient clinic 10 years ago with symptoms such as bilateral cervical lymphadenopathy and fever. They were diagnosed with Epstein-Barr virus (EBV) and received inpatient treatment. Apart from this, there are no other significant medical histories. No underlying diseases."

"Yes, the patient has a history of EBV infection."

"Yes."

The resident didn't seem to understand the significance, even with Suhyuk's emphasis.

But Hank was different.

He had already been suspicious.

How often does vocal cord paralysis precede thyroid cancer?

Especially in papillary thyroid carcinoma.

He had just been silent due to lack of clear evidence.

"Returning to the images... This patient has a history of EBV infection and simultaneously shows enlarged lymph nodes in the left upper thyroid and the left level 2."

Even as Suhyuk spoke with a decisive tone, Hank listened silently.

Of course, the ENT professor shook his head.

He was convinced it was thyroid cancer.

"Hmm. The left upper is the thyroid, not the lymph node, right?"

"No, look closely. Isn't it a form that has broken through the thyroid capsule? In papillary thyroid carcinoma, especially of this size, is it common for it to break through the capsule?"

"Not common... But."

"It could be a coincidence. But we are doctors, which means we are scientists. We should focus on evidence rather than coincidence."

Suhyuk interrupted the foreign professor he had just met and continued his explanation.

Yet, he didn't give the impression of being rude.

His explanation was incredibly compelling.

"Rather, it would be more reasonable to consider that the cancer in the left upper lymph node has broken through the thyroid capsule and entered inside. If so, it would also explain how it invaded the recurrent laryngeal nerve and caused vocal cord paralysis at this size."

"Is it a non-Hodgkin's lymphoma that developed after EBV infection...?"

"Yes, exactly."

"Hmm."

The ENT professor, who had heard this explanation, fell silent.

Upon hearing it, the opinion of a 1cm papillary thyroid carcinoma breaking through the capsule and eating into the recurrent laryngeal nerve seemed less plausible than what the small Suhyuk in front of him had said.

"Come to think of it... It does look like non-Hodgkin's lymphoma on the images. Of course, we can't diagnose based on images alone... Did you do a PET CT?"

Even the radiology department seemed to have changed their mind to non-Hodgkin's lymphoma.

His gaze turned to the nuclear medicine professor.

The nuclear medicine professor looked very flustered.

"Um? No, no. Who would do a PET CT for thyroid cancer?"

It was a valid point.

Nowadays, it was said that even 1cm papillary thyroid carcinoma could be monitored without surgery if regular tests were done.

So why would you do a PET CT?

It's a test to check for metastasis.

"Isn't it suspicious for non-Hodgkin's lymphoma, and yet you didn't do it?"

"Um? No... Professor, you... You were also thinking it was thyroid..."

The nuclear medicine professor looked like he wanted to hit the radiology professor with the mouse he was holding.

But he couldn't move his hand, as the radiology professor was of a much higher rank.

America is free, they say, but only in certain professions.

The medical community in America was also quite narrow.

Or rather, it was even narrower.

Here, recommendation letters had a decisive impact on employment and job changes.

"Because I didn't know the medical history. It all fits together. What's your name, doctor?"

"Lee Suhyuk."

"Lee Suhyuk... Korean?"

"Yes. I'm a second-year resident in internal medicine at Taehwa Medical Center."

"Ah... Taehwa. Do you know Professor Lee Hayeon?"

It was impossible not to know Lee Hayeon if you were at Taehwa.

While not as prominent as Lee Hyunjong, he was well-regarded in radiology.

Moreover, Suhyuk had collaborated with Professor Kim Jin-sil, his protégé.

"Yes. He's a professor in the abdominal part of our radiology department."

"Steady stream of excellent people, huh. Hmm."

The radiology professor nodded with a meaningful expression upon hearing Suhyuk's answer.

He seemed deeply impressed.

Of course, not everyone was just amazed.

Hank, who had been suspicious from the start, was already changing his plan.

Not just a little, but completely overhauling the diagnosis.

"Now... With the possibility of non-Hodgkin's lymphoma raised, it's absurd to proceed with the surgery as planned."

He postponed the surgery first.

It was only possible because the accompanying cancer was not another type but papillary thyroid carcinoma.

While non-Hodgkin's lymphoma is not the worst cancer, it's not comparable to papillary thyroid carcinoma.

"Perform a fine-needle aspiration on the left upper thyroid lymph node... ENT, please check the Waldeyer's tonsillar ring with an endoscope. And let's do a PET CT."

Then he laid out the diagnostic plan step by step.

All of it was reasonable, so no one could object.

In fact, even if it were unreasonable, no one would have objected, as they were all looking at Suhyuk, who had made this possible for Hank.

'Medical history and images... And just by the strange behavior, he could lead the conversation to this point?'

Of course, it could turn out to be a bust.

There could be a papillary thyroid carcinoma that behaves this way by coincidence.

But would that diminish Suhyuk's evaluation?

It wouldn't.

No internal medicine resident could present such a logical argument.

'Taehwa...'

'Lee Suhyuk...'

Thanks to this, everyone deeply engraved the name of Taehwa Medical Center or Suhyuk in their minds.

[Everyone is amazed.]

'Of course. They were ignoring me.'

[But you won't be satisfied with just this, right?]

'No. Where's the outpatient clinic tomorrow?'

[According to the schedule Steve showed me, it's pulmonology.]

'Pulmonology...'

[Let's turn it upside down tomorrow.]

'Sounds good.'