Chapter 114
Clap!
The applause was louder than expected.
The nurses preparing IV drips, the interns organizing charts, and even a patient's guardian passing through the hallway.
Every gaze within a ten-meter radius of the station turned to me at once.
I hurriedly lowered my hands, which had been frozen in midair, and coughed as if nothing had happened.
“It's nothing. Please keep working. Haha.”
Embarrassment is momentary, but a diagnosis lasts forever.
I quickly turned toward Kim Ji-hoon.
Kim Ji-hoon still couldn't tear his eyes away from the grotesque teratoma mass on the monitor.
“Ji-hoon.”
“Huh? What?”
“Call Neurology again.”
“Call Neurology again?”
Kim Ji-hoon asked back, looking disgusted.
He seemed bothered by the idea of having to call that rude second-year resident, Hwang Juhyeok, again.
We'd been brushed off because he'd said not to call unless we had the data.
But now things were different.
“Yeah. At this point, even that foul-tempered bastard won't be able to turn us away.”
I tapped the monitor.
“If there are encephalitis symptoms and they find a mass this big in the abdomen? If you see that and still tell them to see Psychiatry first, you're not a doctor, you're a quack. They'll definitely come down.”
“True.”
“And... no. Wait. OB-GYN... no... damn it, just call both.”
After a moment of thought, I waved a hand.
OB-GYN has to remove the cause, and Neurology has to treat the encephalitis and manage the seizures.
In any case, both services need to sit down together and sort it out.
This isn't the time to decide who to call first or second.
We're Emergency Medicine.
We set the stage; we can't take that thing out ourselves.
“Uh? Uh... okay.”
Kim Ji-hoon picked up the receiver with a solemn expression.
Beep. Beep.
After confirming that Kim Ji-hoon was irritably pressing the phone buttons, I headed toward the ER door.
Now only the most important task remained.
‘Ah, right. I should make the call.’
As I walked down the corridor, I took my phone out of my pocket.
The person who had just been puzzling it over with me.
[NP Joo Jeonghyeon]
I pressed the call button.
As soon as it rang twice, he answered.
[Yes, this is Joo Jeonghyeon from Psychiatry.]
“Doctor, this is Han Hyeonjae from Emergency Medicine.”
[Oh, Dr. Han! Did you get the results?]
His voice was taut with tension.
Because if nothing turned up, the patient would have to be sent back to Psychiatry.
“Yes. We found it. I don't think you need to come back down again.”
[…What? You found it?]
“On the abdominal CT, a giant teratoma about 8 cm in size was found in the right ovary. Taken together with the clinical picture, it's anti-NMDA receptor encephalitis.”
[Huh....]
An exclamation burst from the other end of the line.
“We just put in consults with Neurology and OB-GYN. Now that the organic cause is clear, we'll arrange admission on our side. Thank you for taking the time to help us.”
[Wow... all right. Understood. Take care.]
I hung up and put my phone back in my pocket.
My steps felt light.
And I'd lightened the psychiatrist's burden, too.
I took a deep breath and opened the door to the family waiting room.
Creak.
The air in the waiting room was heavy and cold.
Amid the TV's hum, the patient's mother could be seen in a corner seat, talking on the phone with someone.
She was clutching a tissue tightly, her shoulders trembling.
“…No, I mean, Hye-ji suddenly started screaming like a madwoman and... I couldn't even recognize her....”
Her tearful voice filled the waiting room.
“What are we supposed to do, honey... if this is schizophrenia or something, what happens to our daughter... what if she has to live locked in a hospital on medication for the rest of her life....”
Was this what it felt like for a mother to watch her perfectly normal daughter go insane overnight?
I carefully approached and tapped her shoulder.
“Ma'am.”
She startled and turned her head.
“Oh, uh. Honey. The doctor is here. I'll call you back in a bit.”
The patient's mother soon ended the call.
“Yes, doctor.”
I stepped closer to her and began with the calmest voice I could manage.
“Ma'am, for now you can relax a little.”
“Pardon?”
“The test results are in, and the psychiatric illness we first worried about doesn't seem to be it.”
The mother's eyes widened.
“Not a mental illness? Then what? Then why is our child doing this? She can't be faking it, can she....”
“No. She's not faking it. And it's not a mental illness.”
I took a breath and started the explanation I had prepared.
“We did both a brain CT and an abdominal CT, and in the patient's abdomen—more precisely, in the ovary—we found a mass called a teratoma.”
“A mass?”
“Yes. Inside this mass are tissues similar to brain cells, and when the body's immune system tried to get rid of it, it mistakenly attacked the brain too. That's what caused inflammation in the brain.”
I pointed to my head as I spoke.
“So the brain temporarily malfunctioned, causing hallucinations, shouting, and trouble controlling emotions.”
As I continued speaking, the mother's expression changed from moment to moment.
Those tangled emotions mixed together and twisted the mother's face.
“Then... you mean our child didn't suddenly go crazy, but that mass caused it? It's a physical illness?”
“Yes, that's right. It's a clear physical disease.”
Her legs seemed to lose strength, and she sank into the chair, covering her face.
“Oh, thank God... I really thought our child's life was over....”
After sobbing for a long time, the mother suddenly lifted her head and looked at me with wet eyes.
She had realized that the most important question was still unanswered.
“Then... will she get better? If we remove that mass, can she go back to the way she was before?”
“I can't give you a definite answer right now, like exactly when she'll be cured or that she'll wake up in a few days. The treatment won't be easy. She'll need surgery to remove the mass, and she may also need a long course of immunotherapy.”
I paused briefly, then continued.
This disease is often diagnosed late. It's not uncommon for people to spend months in psychiatric hospitals before it's finally found. But your daughter came to the hospital not long after the symptoms started. She's a very lucky case.
Now for the most important part.
If the diagnosis hasn't been delayed too much, most patients can make a full recovery. Even if it recurs, because we know the cause, it can usually be cured again. If treatment starts before brain damage occurs, the chances of her returning to normal are very high.
“Ah....”
A long sigh escaped the mother's lips.
She took my hand and kept bowing her head over and over.
Her tears fell onto the back of my hand.
All thanks to those noisy ghosts and the clues we'd luckily stumbled upon.
But right now, I felt glad that I could deliver that hope as this patient's doctor.
“The OB-GYN and Neurology doctors will be here soon. They'll explain everything in more detail.”
I gave the patient's mother one last pat on the shoulder and left the waiting room.
Behind me, I heard her calling her husband again in a hopeful voice, and my nose stung.
'Hmm, right. Once this gets handed off to Neurology....'
My footsteps sounded unusually loud as I walked through the ER corridor.
One corner of my chest felt heavy, yet strangely relieved.
That was when I was dragging my heavy body back to the station.
Familiar voices came from far away.
“No, ER doctor. Please listen to me.”
An irritable tone.
It was Hwang Juhyeok from Neurology.
Opposite him stood my classmate Kim Ji-hoon, his face red with anger.
“No matter how clinically plausible this may look, teratomas are among the fairly common tumors in women in their twenties, and pathophysiologically, just because a teratoma is there doesn't mean it will automatically lead to anti-NMDA receptor encephalitis, does it? It could be something found by chance.”
Hwang Juhyeok shot back stiffly, his arms crossed.
“What I'm saying is we should observe a little longer. There's not enough basis to admit her to Neurology right now.”
“No, doctor.”
Kim Ji-hoon thumped his chest in frustration.
“Then where are we supposed to admit her...? Psychiatry stepped back, saying it looks organic, and OB-GYN says they'll do the surgery but can't handle the encephalitis care.”
Kim Ji-hoon's voice grew louder.
“Then Neurology should be the ones to handle her, right? I mean, even if she's admitted under OB-GYN, shouldn't Neurology at least co-manage with steroids or IVIG
(* immunoglobulin)
? Starting empirical treatment right away is the right call.”
“No, but in the end, we need CSF
(* cerebrospinal fluid)
test results before we can make a definitive diagnosis. It takes forever for the antibody test results to come back, and if we recklessly use steroids and it turns out not to be this, what then?”
Hwang Juhyeok added with a sigh.
“And you said the MRI was normal, right? I saw the radiology report earlier, and it said there were no remarkable findings.”
“Doctor.”
Kim Ji-hoon let out a dumbfounded laugh.
“You know MRI can't confirm this, right? You'd know that better than anyone, doctor. Even if the MRI shows nothing, this isn't a disease you can rule out with a negative result.”
Facts.
Anyway, I was looking proudly at Kim Ji-hoon, who was carrying out Emergency Medicine's number one virtue: fighting with other departments.
But Hwang Juhyeok didn't budge.
There was no reason to drag things out by slyly sidestepping the point....
'Ah, this is just passing the buck.'
He was doing that because his shift was almost over.
If he decided on admission now, he'd have to write the admission order, do the initial treatment, and finish the charting, which would make him late getting off.
He was trying to find some excuse, drag things out, and then dump it on the night shift before slipping away.
That crazy bastard.
I was boiling inside.
“Haa....”
Should I step in?
Go over there and pick a fight?
Should I grab him by the collar and say, 'You goddamn crazy quack'?”
Just as I clenched my fist and was about to take a step forward,
“What's the problem?”
A voice rang out from somewhere.
It was Lee Minjae.