The Returning Doctor Wanted to Live Quietly - Chapter 359



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Episode 359. The Poison Miner (3)

“that is…….”

The explanation went on for a long time.

Everyone turned their heads and stared at Jeong Yeon-su.

He regained consciousness after two hours.

He was crying while hugging Kim Hae-min.

“Recovery is fast, but… … . Hmm.”

“Why? Is there something on your mind?”

“Isn’t it too early to do a test right now? You said you even did CPR because of the VT (ventricular tachycardia)?”

“That’s true, but… … .”

“How about we wait a little longer? If things go as planned, we’ll have to wait a long time.”

Kim Hyun-soo’s opinion.

It was a valid point.

Persistence VT.

CPR due to that.

It was necessary to wait a long time as they administered an electric shock to prevent cardiac arrest.

The two hours that passed until Jeong Yeon-su woke up again.

There wasn’t enough time.

But Jinhyuk, who had been thinking for a moment, shook his head.

“Because you never know when or how it will manifest. Why, people who commit suicide by jumping off a building. They usually die of cardiac arrest before even hitting the ground.”

“Will fear be projected?”

“It has already been expressed.”

“You said it was stress-induced cardiomyopathy?”

“Yes, it manifested as a psychological shock.”

Again, I’m saying that I don’t know what will happen.

The body influences the mind, and the mind influences the body again.

The principle was not known, but it was a well-known fact.

“Let’s watch the video first.”

At Jinhyeok’s words, everyone headed to the station.

Instead of Jinhyeok, the one who grabbed the mouse was thoracic surgeon Kim Hyunsu.

He was working on a subspecialty course in pulmonary edema and immediately accessed the PACS (picture archiving and communication system).

Click.

Click.

“The contrast is too uneven.”

“It’s calcified.”

“The size of the tumor is too big. It is a solitary pulmonary nodule… … .”

“… … .”

“If it’s lung cancer, there’s nothing we can do.”

“Don’t make any predictions.”

“That’s true, but… … . Ha… … .”

Kim Hyun-soo immediately let out a sigh, and so did everyone else.

They say it’s bad to judge by your own judgment, but this really was the worst.

For something that could be dismissed as a simple chest X-ray image, the presence of a large white shadow on the screen is eerie.

“Let’s assume it’s not lung cancer and run a simulation. We’re going to take a CT scan, check the images, and then do a bronchoscopy right away… … Can you do it?”

“Are you going to do it without sleep?”

“It has to be done without sleep.”

“Then I’ll take care of the magic. I’m busy in the respiratory medicine department sometimes, but I’ve done it myself many times.”

“Then, Mr. Kim, let’s go straight to the FNA (fine needle aspiration biopsy).”

“Then I will assist you from the side.”

“I will look for the paper.”

“I’ll look for the paper too.”

Responsibilities were divided in an instant.

Everyone dispersed and stood in front of the computers.

Before getting the CT scan, I planned to look up and study papers on patients with pneumoconiosis.

Did about 30 minutes pass like that?

Lee Tae-hee shouted.

“Is MRI more useful?”

“okay?”

“Oh, in the case of progressive massive fibrosis, there is a high possibility that it is not lung cancer.”

“What kind of paper is it?”

“Catholic Medical School. This is a paper analyzing lung cancer that occurred in patients with pneumoconiosis.”

“Okay, then let’s get an MRI too.”

As soon as Jinhyeok finished answering, this time it was Jang Hyukjun who stepped forward.

“If there is a high signal intensity in the margin, like water, there is a high probability that it is not lung cancer.”

“is it so?”

“Yes, this is the information reported from Seoundae.”

“Isn’t that a special case?”

“No, but there are still 30 cases.”

“then…….”

Studying that went on for a long time.

And discussion.

Nurse Janne Hooper, who was watching the scene, looked horrified.

* * *

“This is crazy. This is crazy.”

Janne Hooper, who had an accident.

She shook her head.

I already knew about the skills of Korean doctors.

But I never imagined that I would be this passionate.

That makes sense.

It’s already midnight.

It’s funny that you came running after just one phone call.

You even looked up papers.

Even though it was a fellow Korean patient, it was an action that was simply incomprehensible.

Isn’t that attitude completely different from that of a German doctor?

‘They say everyone in Korea works like slaves. Is that why?’

She tilted her head again and immediately picked up the receiver.

It looks like it won’t end with an endoscopy.

I had to prepare what I needed to prepare, even if it meant feeling sorry for the accident.

“Where are you?”

[Where is it? It’s stuck.]

“I think I’ll have to get a CT scan soon. Come here right now.”

[At this hour? There are no patients?]

“It’s a problem because there are patients.”

After waking up the radiologist on duty, Janne Hooper took various actions.

Soon, not long after, Jinhyuk came and said.

“I’ll go get a CT scan first. If any patients come, please call me.”

“I don’t think he’ll come.”

“Just in case.”

“This is our Plattenbau hospital. The ambulance also sends emergency patients to hospitals in West Berlin first.”

It was strange for me to say that the hospital was doomed, but Yanne Hooper simply waved it off.

The CT scan was taken like that.

I took the photos three or four times in the supine position, and then laid down on my side and took the photos several times.

Inhalation and exhalation.

The difference between exhaling and inhaling was captured, as well as the entire lungs from the apex to the base.

The problem is.

“You’re saying that instead of sending it to the radiology department, you’re going to interpret it right away?”

The radiologist was also said to be at a loss as to what to do.

“Yes, we’ll pass it on, but we’ll take a look at it too.”

“that is…….”

“Why? It doesn’t work?”

“No, that’s not it.”

“This is unprecedented. Just a moment.”

Jinhyuk snatched the mouse in an instant.

First, I measured the size of the object.

A round lump.

Its size was no different from that of the X-ray image.

The problem is that it is impossible to make a judgment based on CT alone.

Rather, it only provided confirmation that there was a suspicion of lung cancer.

But he couldn’t give up like this. Jinhyuk shook his head internally and then started moving the mouse busily.

Click.

Click.

front.

Front and center.

Center back.

Back to the back.

Outer and inner.

Back to the outer center.

We continued to examine the CT image, zooming in and dividing it into sections.

I hope that’s not the case.

It was just an expression of hope that it was mistaken for lung cancer, and the first to react was thoracic surgeon Kim Hyun-soo.

“There are more little things than I thought.”

“Most of them are concentrated in the back.”

“It’s a characteristic of a patient with pneumoconiosis. First, let’s measure the length. Here, here.”

“It’s less than 1cm.”

“If the long axis is that long, you should pass.”

“Then let’s pass here too.”

“It just looks like a small calcification. Should I just get an MRI?”

“I wonder.”

The video review was over in an instant.

When Jinhyeok saw the radiologist with a blank expression on his face, who had no way of understanding Korean, he urged him on.

“Please open the MRI room too.”

“Huh? Is it over already?”

“yes.”

“Really?”

“Let’s go first.”

There used to be a separate radiologist in charge of MRI, but it’s now the middle of the night.

The radiologist who was dragged into the CT room while sleeping soundly acted clumsily.

The MRI taken following this.

Magnetic resonance imaging, which was noticeably different from computed tomography (CT), filled the screen.

hereto.

“I heard that it’s not good to show high signals in T1-emphasized images, right?”

“You could say it’s a characteristic finding, but it’s not necessarily the case.”

“The border looks imperfect.”

“It seems like the diaphragm is ruptured… … .”

“It looks like it’s necrotic or calcified here.”

“Ignore that.”

“Progressive massive fibrosis is said to have a short T2 relaxation time… … On the other hand, lung cancer is said to have a long T2 relaxation time. Hmm… … .”

“It’s ambiguous.”

“Yes, it’s ambiguous.”

The conversation went on for quite some time.

I knew that MRI plays a critical role in diagnosing lung cancer in patients with pneumoconiosis, but I couldn’t be sure.

This is because, unlike CT, it was difficult to interpret.

That’s why there is a radiology specialist.

However, the CT image interpretation findings have not yet been released.

Those who could not leave the anxious patient alone began to move quickly.

* * *

Forceps for biopsy.

A device for removing foreign bodies.

Needles for fine needle aspiration of lymph nodes and masses around the bronchi.

The endoscopy room was not much different from those in Korean hospitals, which was perhaps to be expected.

“What is your PT (prothrombin) time?”

“It’s normal.”

“There is no platelet abnormality?”

“There is nothing wrong.”

“Oral anticoagulants?”

“I am not taking any medications.”

The conversation went on for quite some time.

It might have been awkward for them to be together, but they were doing what they always did.

I plan to remove the tissue and examine it.

That’s why blood clotting time is more important than anything else. If the bleeding doesn’t stop, it’s a big deal.

Jinhyuk immediately administered atropine.

Anticholinergic drugs to reduce secretions and also drugs to prevent bradycardia.

Jinhyeok, who had finished taking his medication, glanced at Jeong Yeonsu.

Patients who still tremble slightly.

I was feeling anxious.

“I also take anti-anxiety medication.”

“The true effect would be too great. Isn’t it a bit too much? It’s not often given to patients with respiratory diseases.”

“It may be because of the inhibitory effect, but still.”

“Then let’s lower the capacity.”

“I’ll go with half dose.”

“Yeah.”

A situation where only half the dose is administered due to concerns that the respiratory center depressant effect may be excessive.

Of course, the dose was half of the usual, so the effect should have been minimal, but there was something called the placebo effect.

It took 45 minutes for the calming effect to spread throughout her body, but Jeong Yeon-su stopped shaking immediately.

What followed was the administration of lidocaine.

I held the lidocaine spray and sprayed it in my mouth for a long time.

A bronchoscopy will go into your nasal cavity, but it’s done to reduce your gag reflex.

Jinhyeok also did not forget to spray while exhaling to prevent laryngeal stiffness.

Of course, Jang Hyuk-jun and other classmates did not stay still during that time.

A bronchoscope inserted into the nasal passages.

Lubricate the end.

I prepared a blindfold.

I’ve finished setting up everything from the biopsy needle.

As soon as Jinhyeok finally put the blindfold on, Jeongyeonsu opened her mouth.

“Why the blindfold… … .”

“Because the medicine might splash in your eyes.”

“Ah… … . Yes, teacher.”

“The medicine is a bit spicy. If it goes down your throat, you can just swallow it.”

“yes…….”

“You must not move during the examination.”

Jinhyuk spraying lidocaine back into his nasal passages.

When all preparations were completed, Jinhyuk looked at Kim Hyunsu.

He is also a full-fledged thoracic surgeon.

Unlike himself, who had never done anything like esophagectomy, he could be called an expert.

“Let’s get started.”

At Kim Hyun-soo’s declaration, everyone’s attention turned back to the monitor.

An endoscope that curves toward the head, reaches the palate, and then passes from the palate to the larynx.

Jinhyuk administered lidocaine (local anesthetic) again at just the right time.

At the same time.

“Cough, cough.”

Jeong Yeon-su coughed.

Jinhyuk tried to coax him for a while.

Take a deep breath through your nose.

You have to hold back your cough.

He repeatedly urged me to exhale only through my mouth.

The inspection resumed immediately.

It continued to ride for a long time, with a camera attached to the end of an endoscope as thin as a snake.

A lesion that was identified not long after.

Posterior lobule of the right lung.

Origin of the bronchial tube.

The lump was blocking it tightly.

The mass that was visible on the CT scan was clear.

The problem is that it’s hardened.

As usual, tissue had to be harvested, but it was so hard that it had even become fibrotic.

“Shall we do it again orally? Let’s change the needles to bigger ones first.”

“No. Then you need general anesthesia, but your vitals aren’t that good… … . Let’s raise the pressure first.”

“Aren’t you level 5 now?”

“I’ll try up to 7 for now.”

I’ll try my best to make it as easy as I can.

Kim Hyun-soo played with his hands for a while.

As if 7 wasn’t enough, I increased the pressure of the punching needle to 10 and moved my hand around.

The organization that was obtained after much hardship.

Now it had to be sent to the pathology lab for testing.

But it was already well into the morning.

The pathology room duty just kept repeating that they would do it tomorrow.

When everyone is in a difficult situation.

Jinhyuk made a phone call.

The opponent is Christie, a research doctor who acts like a mad scientist.

Of course, it was late so there was no way I would be able to answer the phone right away.

But I didn’t give up and called several times.

She checked the time in her sleep and screamed.

[You right now for real!! It’s 3 AM right now!!]

These were German doctors who worked quite comfortably.

* * *

“Is it a primary lung tumor? Haaam.”

The biopsy results say it’s not lung cancer.

Everyone was busy cheering, forgetting how tired they were.

When Jinhyeok immediately grabbed Christie’s hand and repeatedly thanked her, she muttered to herself.

“This is crazy. Seriously. Everyone… … .”

okay.

It must have been absolutely crazy.

While others are working comfortably and making a lot of money, these guys come to a department where they can’t even open a business and work day and night.

It was something I couldn’t do without going crazy.

She clicked her tongue and shook her head several times, but when the Korean doctors didn’t budge, she said,

“But just in case, I think we should excise it before it spreads to a malignant tumor later.”

“Well, I’ll do it tomorrow.”

“You’re going to do it tomorrow?”

“Is there a problem? There don’t seem to be many patients… … .”

“No, that’s not an easy surgery. The entire upper lobe has to be removed. Why, what is that? The bronchial lymph nodes are also swollen and enlarged. While we’re at it, we should also dissect the lymph nodes!”

“You can do it.”

What an overly confident answer.

Christie was dumbfounded as she watched them respond as if they were going out to a neighborhood bar.

He himself is doing research that others don’t want to do.

Why on earth are these people like this?

Jinhyuk called the CS officer while ignoring Christie, who had an expression on her face that said she couldn’t understand.

The worst has already been avoided for now.

Nothing could be happier than this.