The Returning Doctor Wanted to Live Quietly - Chapter 364



Only Noblemtl

Episode 364. After the surgery (2)

Clinical reasoning.

And the diagnosis.

Easier said than done. The process was complicated.

Information collection through physical examination, questioning, and palpation.

And checking various medical records.

It was a matter of putting together a puzzle of different pieces, and if I was not careful I could have misdiagnosed it.

so.

“Hmm… … .”

Jinhyeok let out a sigh once again, and Jang Hyukjun, who was watching him, felt frustrated.

“You don’t know, do you?”

“yes.”

“Then I’m telling you it’s certain.”

“You hit me in the face?”

“That’s not necessarily the case, but it could be.”

“Then you wouldn’t have come to the hospital. You could have caught something for nothing… … .”

“No. The patient came in person. The guardian came running late.”

The guardian tried hard to hide his embarrassment and even handed over a business card.

Jinhyuk’s head turned towards the patient.

She talking to her son.

At first glance, it looked light.

That’s not all.

The child, who identified himself as a reporter, was also caressing his mother’s hand with a worried expression.

A seemingly normal couple.

Jinhyuk shook his head again.

Sometimes, humans can become infinitely evil.

I knew that fact better than anyone else, but I didn’t want to believe it.

This is not my hometown, it is a faraway place.

Over the past three months, the Koreans I met have been living together as a family, tightly knit. Of course, there were still conflicts.

“after…….”

When Jinhyuk sighed.

Janne Hooper approached.

Emergency room nurse.

It was the nurse who hastily diagnosed Jeong Yeon-su’s illness and then caused her to collapse.

“Teacher, have you confirmed the diagnosis?”

“No, not yet. I ran a routine checkup and it’s fine.”

“Really? Then shouldn’t I call you right away?”

“yes?”

“If you suspect elder abuse, you must report it to the police. Unlike Korea, Germany has a mandatory reporting system.”

He himself says that as a medical professional, he is obligated to report elder abuse.

Korea also has such a law.

Medical personnel.

schoolmaster.

Welfare facility workers.

Etc. etc.

If you discover any suspicious circumstances of child or elder abuse, you must report it without fail.

Of course, there are many people who don’t do it because they are afraid of retaliation.

“I don’t know yet.”

“You don’t know yet?”

“yes.”

“hmm.”

“Please watch a little longer.”

“All right.”

Fortunately, she just shrugged her shoulders without saying much.

The past three months.

It was enough time to build trust.

Jinhyeok, who had been buying time like that, looked around in hopes of finding something. Then he immediately let out a sigh.

Nurses, nursing assistants, and other doctors working in the emergency room.

They were all looking at their guardians with blank expressions.

If we don’t find out the cause quickly, we’re in for a big fight.

As expected from a German who is known for being stubborn and principled, it was something that someone could have reported.

Jinhyeok turned his head towards Jang Hyukjun and whispered in Korean.

“If this continues, something big will happen.”

“Yes? Why?”

“If the assault is true, it doesn’t matter. If it’s a misunderstanding, it’s a big deal.”

“Are you worried that it will feel like racism?”

“That’s true, but it hurts. If you report abuse, you’ll be locked up in the police station right away.”

“ah…….”

“I live with my son in a foreign land. Imagine being reported. I’m worried. It’s a shock.”

He said that he would be shocked if his son was investigated for visiting the hospital.

As you get older, it’s normal to feel like everything is your fault and even suffer from depression.

I never even thought about what I would do if I lived.

“I hadn’t thought about that… … . Hmm.”

“Let’s check the test results again first.”

“Okay, then.”

That’s the result of checking again.

Various values, including white blood cell counts, are normal.

Arterial blood test results were also normal.

Of course, very weakly.

There were some that were really just barely outside the normal range.

“The sodium level is a little low.”

“It was 132. It’s a bit ambiguous to call it hyponatremia.”

“Potassium is also 5.5… … .”

“This is also not a case of hyperkalemia.”

“Urine test too… … .”

“That’s so typical.”

“… … .”

Jinhyuk was silent for a short while.

That’s understandable, since he has diabetes, the only numbers shown were those that only a diabetic patient would see.

Microalbuminuria.

It is literally at the level where proteins such as albumin are leaking out and foam is produced.

After wandering around like that for a long time.

Hearing the news, even the head of the emergency medicine department, who was usually not seen, came up to me and started talking to me.

“What happened?”

“Oh, sir. That’s… … .”

A long, continuous notification.

As a professor in charge of a department, he did not act rashly.

Check and recheck the chart yourself.

but.

“Hmm… … .”

He also let out a deep sigh.

It was a natural reaction since I ran all the basic tests and nothing came up.

“What about the promotion?”

“There was no pain at all.”

“Aren’t you enduring it?”

“yes.”

“Well, if it’s an old bruise, then that could be the case. I guess I should report it first… … . Just in case… … .”

“Oh, no, sir.”

“… … ?”

“I don’t know yet.”

Jinhyuk quickly shook his head.

The head of the emergency medicine department is blunt, expressionless, cold, and a diehard principled person.

Having spent the past three months together, I have a pretty good idea of ​​what kind of personality he has.

Just an ordinary German.

It was nothing more, nothing less.

As expected.

He shook his head.

“I’m sure you know this, but principles are more important than anything else. Even if you say she’s a suspected patient, you still have to report it.”

As he spoke again, Jinhyuk’s head snapped back.

He himself may have been wrong, but he had to buy some time.

I haven’t checked everything yet.

“It might be a blue spot.”

“Blue spot?”

“Yes, you know that it’s more common in Asians than in Westerners, right?”

“It’s not the back of the hand or the instep? Aren’t those the areas where it usually manifests?”

“Around the eyes, head and neck, buttocks, limbs, and even the oral mucosa. It is true that it mostly appears on the backs of the hands and feet, but I know there are many other cases.”

“Could it be a pigmented lesion that mainly occurs in Asians?”

“yes.”

Actually, I wasn’t even sure.

I was just stating one of the possibilities.

Even he himself doesn’t know what’s going on yet.

I just hoped the injuries weren’t from assault.

If you’ve been hit by your son in a faraway land, it wouldn’t be the first time.

Originally, assault was easy at first, but it keeps happening over and over again.

I hoped not, because then her life would be too harsh.

Did you know that feeling?

Or is it because of another possibility?

The head of the emergency medicine department, who had been thinking for a moment, nodded his head belatedly.

“Let me check first.”

* * *

Suddenly, in front of the patient.

The head of the emergency medicine department stepped forward himself.

“Are you sick?”

“No, it doesn’t hurt.”

“Then here.”

“It doesn’t hurt there either.”

Kuk.

Kuk.

A long period of promotion.

The head of the emergency medicine department stepped forward in person.

The patient kept shaking his head.

It is said that pressing hard on skin that has turned blue does not hurt.

It wasn’t a sign of him forcing himself to endure it.

“Can the Tyndall effect (where light is scattered and skin appears blue) happen like this… … . Hmm.”

“It may appear as small as a dot, but I have learned that this is not uncommon.”

“No, that’s not what I meant. I’m saying this because I don’t think it’s deep inside the dermis.”

“that…….”

“First, call a dermatologist.”

“yes.”

Jinhyeok gave a short answer and called the dermatologist saved on his phone.

Of course, he came down a long time later.

Slowly.

It was a very German doctor-like attitude, working like a civil servant.

The dermatologist, who had been moving slowly for a while, took out a dermatoscope and checked the lesion.

High-magnification dermatoscope that cannot be seen with the naked eye.

After a while he tilted his head.

“What about the color change? Was there a color change?”

“yes?”

“Well, it turned black and then blue again. Or maybe it got a little darker… … I was wondering if there was a change.”

“No, it just appeared out of nowhere and then grew in scope.”

“Really? It’s a bit much to call it a blue mole… .”

After a while of trailing off, he continued speaking.

“It’s the same as a cyanotic mole because it grows too quickly in size and range. But the color is too bright to be called that.”

“Are you saying the blue is too strong?”

“yes.”

“The lesion shape is irregular and the edges are distorted… … .”

“Ah, that looks similar to a blue mole. Hmm. Let me take another look.”

The dermatologist revisited the lesion using a dermatoscope.

And adjust the magnification too.

Polarized and non-polarized.

And it wasn’t long before he opened his mouth again, even adjusting the lighting.

“The pattern is not typical.”

“A pattern?”

“Yes. It’s not skin-deep. It’s not the typical steel blue pattern either.”

“Shouldn’t we get a biopsy?”

“Why even a biopsy? … It’s not even suspicious of melanoma.”

It is unlikely to be a melanoma disguised as a blue nevus.

It seemed like he was planning to finish his treatment and go back.

Jinhyeok, who had little knowledge about dermatology, shook his head.

“Is there any possibility of PIH (post-inflammatory hyperpigmentation)?”

“Hmm. That’s… … .”

As the dermatologist tilted his head, Jinhyuk turned his head towards the patient.

“Patient, is there anything unusual happening?”

“yes?”

“I was wondering if something unusual happened, like if your face suddenly started itching and you scratched it, or if you got bitten by a bug, or if you got burned, or if you got an infection. Do you have any skin care treatments… ?”

“No… … . Not at all… … .”

The patient’s answer was a little drawn out.

A face that looks somewhat serious.

He looks very surprised.

That makes sense.

From the head of the emergency medicine department to a dermatologist.

And the situation is being watched by surgeon Jang Hyuk-jun.

It was quite frightening to see not only emergency room doctors but also other department doctors come down and have serious faces.

But we can’t just give up just because the patient is scared and surprised.

The questioning continued for a long time.

There were also many things that came to light late.

There was also no discoloration due to vascular lesions.

Insertion of other pigment substances. So it wasn’t a tattoo either.

Well, I guess that’s to be expected, considering my age.

Minocycline pigmentation was even less so.

There is no way that a 70-year-old man suffering from acne would have caused changes in skin pigmentation by taking antibiotics for a long time.

Now, all possibilities have been eliminated.

As the head of the emergency medicine department reached for his cell phone, Jinhyeok was the first to respond.

“Sir, just in case, I think it would be a good idea to run some additional tests.”

* * *

A few hours later.

Jang Hyuk-jun came down in a fluster.

“What happened?”

“The endoscopy is finished.”

“What are the results?”

“Chronic atrophic gastritis. Bile reflux gastritis. Nothing else.”

“Did you also get an abdominal CT scan?”

“Yes, there is a little fatty liver. The only thing that has been confirmed is that the common bile duct is dilated.”

“What about the pathology lab?”

“It’ll be out in five minutes.”

Jang Hyuk-jun stuck out his tongue at Jin-hyeok’s answer.

To this extent, it can be called over-testing.

Jinhyuk was truly doing his best.

A possible misunderstanding.

What to do to prevent the shock caused by it.

Well, he didn’t say anything special because he had been watching Lee Jin-hyuk’s personality for a long time.

The type of person who does something more when told not to.

Lee Jin-hyeok also had a strangely rebellious nature.

Sometimes I speak like an old man.

After a while like that.

The report arrived from the pathology room.

Click.

Click.

Epidermal examination performed using an optical microscope.

There were no special observations.

Dark brown granules in the dermis.

And the blue granules are deposited.

Although it looked like a normal bruise on the outside, it was written that it was also deposited in the basement membrane of blood vessels and hair follicles.

“You said earlier that you looked calm only on the outside. That’s not true.”

“It’s a little different from what you see with your eyes.”

“hmm.”

“But there’s nothing unusual… … .”

“Oh, but this is… … .”

“Why? What is it?”

“There are also eccrine glands (sweat glands). Is this normal? Sweat glands only have the function of regulating body temperature and excreting waste.”

Jang Hyuk-jun’s point.

By the way, it was written that high-density granules were also observed in the eccrine glands.

The silence began from then on.

I just gained knowledge of internal medicine.

Dermatology is another area.

Jinhyuk continued to reflect in silence.

But soon after, he took out his cell phone.

Jang Hyuk-jun asked at that sight.

“Where are you trying to call?”

“I’m in Korea.”

“Ugh. It’s dawn there now. The time difference is 7 hours. You should just ask a dermatologist.”

“Hey, what’s the point of asking people who only think about getting off work?”

“Do you know anyone? I don’t know anyone in the dermatology department at the hospital you know.”

“There must be someone who knows.”

Jang Hyuk-jun with an expression that says he doesn’t understand English.

Jinhyuk called right away.

It’s 2 a.m. in Korea.

It was time for most people to go to bed, but there were still some people who couldn’t sleep.