The Returning Doctor Wanted to Live Quietly - Chapter 331



Only Noblemtl

Episode 331. Giving orders (13)

A brief commotion.

When Oh Ji-ho returned to the audience without saying anything, Jin-hyeok stared at him intently.

There was no way Oh Ji-ho, who had spent his entire life worrying about surgery, would not have known.

but.

‘It’s too much to guard your rice bowl.’

It was clear that he thought that saying anything would be useless.

Well, I had a lot to lose.

That’s actually true.

If he brings up the issue of reinforcements right now and is dismissed, Vice President Jae-il Bu will become the hospital director.

It was clear that support for surgery would change dramatically.

As Jinhyeok remained silent for a moment, Jeong Seong-uk immediately approached him and asked.

“What did I tell you? Huh?”

“I didn’t say much.”

“You didn’t say anything?”

“yes.”

“Hey, no?”

“Oh, what is it? Seriously. Why are you doing that?”

The questioning of Jeong Seong-wook and Jang Hyuk-jun.

Jinhyuk pretended not to know and immediately opened the PPT.

I was going to present a romantic topic, but I changed my mind.

If reinforcements were realistically difficult, all one could do was to undermine the opponent.

Because all the romantic stories have been told by previous professors.

Dadadak.

Dadadak.

A case study that is written quickly.

Since this was a case study I had prepared to explain how difficult internal medicine is, I was able to write it down easily.

The problem was that Jang Hyuk-jun and Jeong Seong-wook both shook their heads at the sight.

“What, what is this?”

“Participatory class? Hey. I have to give a lecture.”

“Ah, where have you seen such a case before?”

“I’ve never heard of it… … .”

The grumbling continued for a long time.

Jinhyuk, who had been lightly ignoring it, climbed up onto the stage as soon as the break was over.

“So far, we’ve only looked at what surgery does. It seems like we’ve only looked at surgery. Let’s also look at internal medicine.”

“Okay, this time it’s a participatory class.”

As soon as Jinhyeok manipulated the controller, a PPT was displayed.

[Patient Status]

– A 30-year-old man visited the hospital complaining of back pain after surfing.

– I felt a pulling sensation on the back of my legs while surfing.

– Never fallen or bumped into anything.

– No underlying diseases.

– After 6 hours, the condition worsened to the point where it was impossible to urinate on one’s own.

Jinhyeok, who had brought up the case report, looked around the room with an innocent face.

And looking at him like that, Han Dong-soo said.

“That guy, that guy. He’s the devil. The devil. He only brings really difficult problems.”

“what?”

“I’m glad I’m not that guy’s junior.”

“When will you be our child?”

“Well, I guess so.”

While Oh Ji-ho tilted his head.

The screen changed again.

[Test Results]

Hint 1. T2 hyperintensity in the conus medullaris from the 9th thoracic vertebrae on spine MRI.

“The hints will be revealed little by little. If you guess correctly, you’ll get full marks. Right? Hospital Director!?”

Everyone turned their heads to look at Oh Ji-ho as Jin-hyeok continued.

When he nodded, not knowing English, a commotion arose.

Full marks.

It was a product that had been advertised to the polyclinic that was making rounds in the general internal medicine department some time ago, but it was an absurd special offer.

Jinhyuk smiled as he looked at the crowd chattering away.

“So, what do you do in this situation? You there, trainee.”

“Yes? Me?”

“Yes, since it’s an interactive lecture. Would you like to answer?”

“Um… … . We should suspect a central annular tear.”

“Why is that?”

“When you get an MRI, if there’s a high signal intensity, it means there’s a lot of water or fluid. Um… … It looks brighter than other areas… … It’s clear that there’s something wrong, like inflammation, a tumor, or an infection.”

“So you suspected a rupture of the annulus fibrosus? Isn’t that mainly caused by aging?”

“That, that.”

It doesn’t fit with the assumption that Nam-Hwan is 30 years old.

The audience immediately started to stir.

It’s about forcing yourself to remember things you learned in textbooks.

Another trainee raised his hand later.

“I learned that it can also be triggered by repetitive behavior.”

“Correct. Annulus fibrosus can be caused by injury, or it can occur as the spine undergoes degenerative changes.”

“Then what you just said is… … .”

“I was just asking. It’s true that it’s mostly caused by aging. This is very common. Do you know anyone who works in internal medicine?”

“… … .”

“There are countless symptoms that confuse doctors in clinical practice. You can think of them as the same thing.”

As Jinhyeok smiled faintly, Han Dongsu, who was watching him, whispered again.

“Am I right? That guy is the devil. The devil.”

“By the way, what’s the problem? Why did you get hurt while surfing? You said you didn’t fall?”

“Huh? You don’t know?”

“Don’t you know? I’m a surgeon, a surgeon.”

“I don’t know. I’m a thoracic surgeon too.”

A quiet, oblivious voice.

Oh Ji-ho turned his head, looked at Jin-hyeok, and clicked his tongue.

Lee Jin-hyeok mentioned reinforcements again.

Maybe, as Han Dong-soo said, he was a devil.

A resident who is harassing the hospital director.

It was a case where it could not have happened.

but.

“He’s a genius… … .”

I couldn’t give up on that talent.

The dying light of the surgical room.

That was Jinhyuk’s existence.

* * *

A long series of wrong answers.

Then a second hint filled the screen.

Hint 2. Diagnosed with acute transverse myelitis. Neurological deficit was assessed as AIS D after 2 hours.

“If it’s AIS D, isn’t that serious?”

“Hey, no. Not even an A. If it’s a D grade, then that means your strength is still there.”

“Is that so? If it ends at ABCD, then it might be like that.”

“Are you stupid? AIS goes up to E level.”

When they are bickering and fighting among themselves.

Jinhyuk pointed out someone again.

“A trainee there?”

“Yes, I… … . Acute transverse myelitis. It’s a simple inflammatory disease.”

“It’s not just an inflammatory disease. It’s caused by a nerve dysfunction.”

“Well, since I got AIS D, I think it’ll be fine if I take steroids and rehabilitate.”

“That’s the result after 2 hours. After 6 hours, I couldn’t even urinate on my own?”

“Well then, um… … I’m curious about the specific symptoms.”

Jinhyuk immediately manipulated the controller.

Then additional symptoms filled the screen.

[Symptoms confirmed 3 hours later]

– Babinski sign not observed.

– No ankle brace.

– Normal deep tendon reflexes in both legs.

– Cerebrospinal fluid test is normal.

– Visual evoked potential test was normal.

At this, the crowd was stirred again.

“What was the Babinski sign?”

“Hey, that’s it. Signs of central nervous system damage.”

“Really? Then what does it mean that the deep tendon reflexes in both legs are normal?”

“You little punk. Did you fall asleep during neurology class? I mean, the nerve damage wasn’t extensive.”

“Hey, then why are you doing a visual evoked potential test? I hurt my back. Why are you checking my optic nerve?”

“That’s right. It’s normal, but why can’t I urinate after 6 hours?”

The discussion went on for quite some time.

Before we knew it, we were solving problems together.

This was no different from cheating, but Jinhyuk didn’t stop him.

After a while, someone who had not yet reached a conclusion raised his hand.

“I’m curious as to why you took a VEP (visual evoked potential) test.”

“Why did you check the optic nerve for no reason?”

“yes.”

“Well, I did it to check for central nervous system disease. I wanted to see if there were any abnormalities in other areas of the nervous system.”

“hmm.”

“Well, that’s true. I guess you could say they checked to see if I had multiple sclerosis.”

When we even talked about multiple sclerosis, an immune-mediated disease,

Immediately, Han Dong-soo turned his head towards Oh Ji-ho.

“That guy keeps twisting the problem.”

“Are you deliberately trying to lead people to the wrong answer?”

“yes.”

“Hey, no way.”

“Oh, I told you, you’re right.”

“I said no.”

The two are bickering.

One of the trainees asked if I had progressive relapsing multiple sclerosis.

I’m completely trapped.

The march of wrong answers that started like that continued endlessly.

Why did I hurt my back when I didn’t even fall while surfing?

Is there really no underlying disease?

Is it true that surfing puts a strain on your back?

Questions and answers flowed quickly.

After a while, when no one asked any questions, Jinhyuk raised the corners of his mouth.

[Symptoms confirmed after 8 hours]

– Loss of touch, position, and vibration sensations below the first lumbar vertebra.

“I had a friend ask me if surfing is hard on your back. Yes, it is. You lean back and then surf.”

“You still don’t know? Then the answer is… … .”

I deliberately hold my breath.

A subtle technique to induce audience concentration.

After a long silence to elicit a reaction, Jinhyuk manipulated the controller.

[Answer]

Surfer’s Myelopathy

As soon as the correct answer was revealed, the room was in an uproar.

An unfamiliar disease name.

It was a disease that even Oh Ji-ho and Han Dong-soo had never heard of.

At that moment, Han Dong-soo started swearing.

“Fuck, how did you know that?”

At this, Oh Ji-ho also nodded his head.

“I, I’m glad I’m your senior.”

* * *

If you can’t solve a difficult problem, you can have them review your paper.

It was common for me to be asked to do the rest of my studies.

A sense of mission toward patients.

It was worse for the generation above Han Dong-soo and Oh Ji-ho.

So, as they were both shivering from the old memories, someone asked.

“I’ve never heard of this disease before. Could you explain it to me?”

“Surfing myelopathy. T2 hyperintensity observed in spinal MRI. This is the name given to a condition that occurs when one enjoys surfing.”

“… … .”

“If it’s severe, it can cause paralysis of the lower body. If it’s mild, it can be treated for a few months.”

“Then in Korea… … .”

“It’s a common disease in foreign countries. There aren’t many people in Korea who enjoy surfing yet, but it will happen soon.”

“Do I even need to know this?”

When someone raised their hand and shouted for courage, Jinhyuk’s expression hardened.

There was no such thing as a disease that could be classified as such.

To the doctor, it may be just one of many illnesses, but to the patient, it is a disease that has befallen him alone.

The attitude had to be taken straight.

“You should know. The patient who went to Hawaii. There was a case report from Samseon Hospital in 1971.”

“7, 71 years?”

“yes.”

Everyone was silent in a heavy manner.

71 years.

It was a case before they themselves were born.

At this, Han Dong-soo muttered.

“It was 1971, before overseas travel was even liberalized. What the hell. How did you know that?”

“Hey Professor Han.”

“Yes, sir.”

“Stop swearing. That’s why the internists are calling us ignorant.”

“still…….”

“Well, I guess he was the son of a high-ranking official.”

Before Han Dong-soo could answer, Jin-hyeok began explaining.

“There was a similar case in 1991. There was another similar case in 1994. There were two cases in 1999.”

“… … !”

“The number of surfers is increasing, whether you know it or not. You come back from Bali and suddenly your lower body is paralyzed. That kind of thing.”

The explanation started like that.

Internal medicine should know about diseases like this.

There was even talk that the IMF would soon be over and the number of people enjoying surfing would increase.

“An internist is someone who moves as if trying to solve a puzzle by looking at the symptoms right in front of him.”

“You have to study endlessly. Oh, isn’t that the same thing as drinking? No. There’s something called procedural memory. Have you tried StarCraft? You can think of it as being similar to StarCraft.”

It is said that once you memorize the shortcut keys, your hands will move automatically.

It continued to say that no special effort was required.

At this, everyone blinked.

In the future, surfing will become popular and widely known, especially in Yangyang.

But in this day and age, Jinhyeok’s explanation of an unheard-of disease was nothing short of genius.

* * *

The last lecture.

It was Han Dong-soo’s turn.

Jinhyuk sighed immediately after checking the PPT.

[Senior is the earth, junior is the sky]

[A medical institution that exists nowhere else in the world]

[Love for juniors, love for country]

[Romance from the heart]

Such a cliché catchphrase.

I tried to stop him because I knew he would be curious why he would bring something like that up.

but.

“Huh? You’re going to connect to the live surgery?”

“Uh, what? Is there a problem?”

“No, that’s not it.”

“Okay then. This patient came to us complaining of inability to swallow. For 21 years, he had only been eating through a gastrostomy. I will show you how to perform esophageal reconstruction. The attending physician is Professor Yoo Tae-kwang.”

Jinhyuk hesitated for a moment at Han Dong-soo’s explanation.

A patient who had only been eating through a gastrostomy tube for 21 years.

Attending physician Yoo Tae-kwang.

I’ve heard it somewhere.

No, it remained in my memory.

then.

‘Uh… … The surgery failed?’

It was a live surgery where the patient might die.