Chapter 5 : The First Rounds Again (2)
Chapter 5 - The First Rounds Again (2)
After making rounds of the patient rooms, the treatment team gathered in the conference room again.
“There was an acting out (acting out, expressing negative emotions through violent behavior). I think we need to rethink the treatment strategy for that patient.”
“Yes, Professor. I will consider changing the medication.”
“To which medication?”
“I’ll replace Risperidone with Amisulpride.”
At Kim Seok-yong's answer, Lee Gwang-seop's brow furrowed for a very brief moment.
‘He doesn't seem to like it much.’
But Lee Gwang-seop slowly nodded and said,
“Alright. Let's try that for now.”
Even if it wasn't the answer he wanted, he respects the resident's opinion as much as possible. That was his style.
“Everyone, please be particularly careful about safety. The safety of the treatment team is our top priority. Chief, take special care of the new first-year doctors.”
“Yes, Professor.”
“Let's end it here for today.”
There was a bit of a commotion, but the first rounds concluded like that.
The ward nurses also left one by one, and the discussion among the residents continued.
“It's not like this every day, so don't worry. You absolutely must not run away.”
Chief Resident Kim Min-hong smiled while looking at the two first-years.
Someone threw cold water on the warm atmosphere.
“Seok-yong, are you seeing the patients properly? He's been hospitalized for over two weeks; is it okay for him to still be like that?”
As expected, it was Kim Min-hong's colleague, 4th-year Choi Ji-hoon.
“I'm sorry. I will work hard.”
“You're a second-year now. Don't see patients half-heartedly and really put in some effort. Back in my day, if a patient got to this state, I couldn't even go home...”
Kim Seok-yong bowed his head deeply at the continued reprimand.
‘Do I have to see this again?’
Seeing him so dejected, Sihyeon naturally frowned.
Finding a resident as diligent as Kim Seok-yong in all of Samah University Hospital would not be easy.
The fact that the patient isn't getting better quickly is just because the symptoms are severe; it's hard to blame the doctor in charge.
‘You're still the same, sir.’
Sihyeon looked at Choi Ji-hoon with a cold gaze.
He seemed to believe that attacking juniors while talking about responsibility would both establish his authority and allow him to assign work as a penalty, killing two birds with one stone.
While he was listening with a bitter smile, Choi Ji-hoon suddenly turned his head this way.
“And, Dr. Cheon Si-hyeon.”
“Yes?”
Sihyeon asked back at the tone that was suddenly trying to sound heavy.
“Do you even have a sense of awareness? The principle is for multiple people to safely restrain a violent patient together. Self-protection is the basic rule; is it okay for you to just rush in alone like that and get hurt?”
“…….”
‘What kind of novel nonsense is this?’
As expected, he doesn’t disappoint.
‘If he’s so worried, he should have at least held one of the arms when the patient was being restrained.’
He was the one who just watched from the corner of the room with his arms crossed while several people were struggling to move the patient.
— A patient is stabbing a nurse, and you first-years just watch right next to them? She’s pregnant and can’t even take medication properly—do you know how much it hurts? Are you lacking empathy?
When the words he had said before the regression came to mind, a laugh almost burst out.
‘Either way, he ends up coming out like this.’
Back when I didn’t know anything, I would have felt guilty and hurt by those words, but now that time has passed, I know for sure.
That his attitude toward subordinates is just like that.
Especially since I was in a situation where I owed a debt of gratitude to Kim Seok-yong, seeing him being mistreated made me even more furious.
“Ji-hoon, take it easy. You’ll make the first-years lose their spirit. No one was hurt, so it’s fine.”
Kim Min-hong, unable to watch any longer, dissuaded Choi Ji-hoon.
“Min-hong. You always say only good things, and since I take on the villain role, I’m always the bad guy, right? But what can I do? Someone like me has to say these things so the discipline in the medical office...”
Choi Ji-hoon said, as if feeling slighted.
Villain role, my foot.
He’s just a villain.
‘It will be a bit different this time.’
Sihyeon showed a strange smile while looking at him.
“The first-years might be bored since they don’t have patients yet. I’ll assign patients from the ones newly admitted tomorrow, so just wait a bit. Are there beds in the ward?”
“Two people are scheduled for discharge. Those waiting for admission from the outpatient clinic are scheduled to be admitted tomorrow,” Kim Seok-yong replied.
“Perfect. Who wants to see one first?”
“I’ll see one first.”
Sihyeon readily raised his hand.
‘At least the order must be the same as before.’
When a patient is admitted to the ward or emergency room, the two first-years take turns receiving the patient.
What if the first button starts off wrong?
The patients that Sihyeon and Hwang Jin-ho would see in the future could end up reversed compared to the past.
“Good. Very motivated, aren’t you? Then Jin-ho, you see the next patient.”
“Yes, understood.”
Hwang Jin-ho had looked quite nervous for a while.
Even though he had seen many patients during his internship, receiving a patient as the attending physician brought a different level of responsibility.
“Dr. Hwang Jin-ho, don’t worry too much. In the beginning, I’ll look over all the patient orders and everything for you, so just work hard.”
“Yes, thank you.”
Kim Min-hong said, patting Hwang Jin-ho’s shoulder.
Usually during this period, the 4th-year resident receives reports on the 1st-years’ inpatients and provides supervision.
Senior residents teach and help the 1st-years, who lack clinical experience, so they can adapt well.
“Dr. Cheon Si-hyeon will be looked after by Dr. Choi Ji-hoon.”
Once again, Chief Kim Min-hong was in charge of Hwang Jin-ho, and Choi Ji-hoon was in charge of Sihyeon.
Up to here, everything was exactly as it was before.
Part of me wanted to see patients with Kim Min-hong, but it didn't really matter.
Because now, I won't just live submissively being pushed around by that Choi Ji-hoon.
“Is there really anything I need to look over for you? From what I saw earlier, you seem to know a lot and it seems you’ll do very we~ll on your own.”
Choi Ji-hoon smirked sarcastically.
‘Cocky brat. Even so, he’s just a first-year.’
Clinical experience.
Experience gained from seeing actual patients is not something that can be known through medical school studies alone.
It was common knowledge in this field that no matter how outstanding a first-year was, they could not surpass even a mediocre second-year.
Right now, he was just so immersed in knowledge learned from books that he couldn't read the room at all. Choi Ji-hoon curled the corners of his mouth, imagining Sihyeon kneeling and crying while asking for advice before long.
‘I’ll do fine on my own, so I just hope he doesn’t get in my way.’ Even as a fourth-year resident, he was no match for Sihyeon’s level, having already finished all his studies for the specialist exam.
Furthermore, Sihyeon had already mastered all the latest findings that would be released over the next few years. The gap was bound to be even wider.
“Yes, I look forward to your guidance.” ‘He seems to be raring for a fight. But even then, he’s still just at a resident’s level.’ Sihyeon smiled back at Choi Ji-hoon.
……
The next afternoon.
As Kim Seok-yong had said, two new patients were admitted. Sihyeon examined the chart of his first assigned patient.
———
[Kim Su-yeong F/22 Attending R1 Cheon Si-hyeon / Attending Prof. Jin Cheol-yeong]
Main Problems
1. Decreased need for sleep
2. Increased spending
3. Irritable mood
(Onset: 3 weeks ago)
The above patient has no prior psychiatric history and, according to the patient and guardian, usually……
———
She was a patient who had received an admission order during an outpatient clinic visit a few days ago. Sihyeon thoroughly examined all the records from the patient's first outpatient visit up until just before her admission to the ward.
Looking at the contents written in the initial consultation chart, the patient was in the exact same state as when he had treated her four years ago. ‘She was a severe bipolar disorder patient.’
Bipolar disorder. This illness, commonly known as manic-depression, is a disease where periods of depression and periods of elation appear periodically.
People jokingly ask those with mood swings if they have bipolar disorder, but medical bipolar disorder is a distinctly different concept.
It can manifest as mood changes lasting for weeks or more, and in severe cases, it requires inpatient treatment.
Especially during an acute manic episode, patients show a completely different side of themselves, such as talking about nonsensical plans, engaging in uncontrollable spending, or wandering around without sleeping.
Sihyeon’s first patient, Kim Su-yeong, was a patient who visited the hospital due to periodically recurring severe mania.
“Doctor, the guardian is asking to see you for a moment. They are waiting outside the ward right now.”
“Yes, I understand.”
Although the principle is to interview the patient first and see the guardian later, information is sometimes gathered from guardians when an interview with the patient is not smooth.
— Her spending lately is out of control. She used up almost the entire limit of her overdraft account... It's not like an entertainment agency trainee makes any money...
— She doesn't even sleep at night and dances all night long, saying she has new choreography ideas.
— She supposedly signed a contract for a house near a broadcasting station out of the blue, saying she could pay it all back once she debuts. Is there any way this can be canceled?
Suddenly, the image of the guardians sighing with faces full of worry came to mind.
“I am Cheon Si-hyeon from the Psychiatry Department. Are you Kim Su-yeong’s guardians?”
“Ah, so you’re the doctor. Please take good care of her.”
As he stepped out of the ward, two familiar people greeted Sihyeon.
“Will our Su-yeong be okay? She’s become a completely different person from her usual self... Why would such a kind girl suddenly act like this...”
The shock that guardians experience when seeing a completely transformed patient is beyond imagination.
At this moment, reassuring them is the most important thing.
However, it is not easy to hear from a hospital that someone will get better quickly.
This is because if you speak too optimistically and the condition worsens, it is difficult to avoid criticism.
That is why doctors are inevitably passive when discussing a patient's progress.
“She will return to her original self. Please, don’t worry too much.”
However, Sihyeon’s answer was a bit different from other doctors.
“Because the symptoms shown during a manic episode are ‘temporary.’ In Ms. Kim Su-yeong’s case, it will take about 6 to 8 weeks. I will try my best to shorten that period as much as possible.”
His attitude was one where a certainty that she would definitely get better could even be felt.
Since she was his first patient, Kim Su-yeong’s progress was particularly memorable.
“If that’s the case, it’s a relief, but...”
“Bipolar disorder is an illness where maintenance treatment is important. For her to maintain a good condition even after discharge, you, the guardians, must also find strength. Please leave the inpatient treatment to us and get some good rest today.”
At Sihyeon’s explanation, the expression of the patient’s mother, who had been on the verge of tears from worry, seemed to soften.
‘The patient’s mother had depression too.’
He remembered that the guardian’s depression had repeatedly relapsed depending on the daughter’s progress.
In a way, there were two patients.
After sending the guardians home, Sihyeon returned to the ward.
Although he had explained things in a way to reassure them as much as possible, Kim Su-yeong was by no means an easy patient.
In fact, it was more accurate to say she was on the difficult side.
First of all, her behavioral problems in the ward were severe.
Even after laughing pleasantly, she would often scream every day, and she would even get injured after falling while arguing with other patients.
‘Her medication response wasn’t good either.’
They used medications with strong sedative effects up to the maximum dose, and even that wasn’t enough, so they injected sedatives several times.
Even then, it took four weeks just for the mania to subside slightly.
Worry preceded him even before meeting the patient.
......
Upon entering the hospital room, a familiar face came into view.
Kim Su-yeong was sitting on the edge of the bed in the clothes she had worn outside, having refused even the hospital gown.
A somewhat tall and slender build.
Short hair dyed deep pink.
Large eyes and pale skin.
A cute impression that made her look younger than her age.
These were the types of details that would be written in the general description of a Mental Status Examination.
‘She’s just like she was before.’
To summarize in one word, her appearance was like a Barbie doll.
However, contrary to her delicate impression, she was by no means an easy patient.
Sihyeon swallowed hard, just as he had when he first met her.
“Hello. I am Cheon Si-hyeon, the doctor in charge of the ward.”
“The ward? Call my mom and dad right now! Do you know how many agency meetings I have scheduled for this evening? And what’s wrong with this doctor’s look? Do they not look at faces when hiring staff here?”
“…….”
The doll speaks... no, she’s cursing.
His first assigned patient, for whom neither consultation nor medication was easy, greeted him with the most offensive look in the world.