Chapter 7 : Different This Time (2)
Chapter 7 - Different This Time (2)
“Really? It seems our new resident doctor has something else in mind; let’s have a discussion. Which prescription do you think is better?”
On the other hand, Jin Cheol-yeong seemed to have become curious at Sihyeon’s words.
“I believe we should go with a combination therapy of Lamictal and Abilify,” Sihyeon answered.
These were the medications that Kim Su-yeong had maintained stably until the end of her treatment, following several medication changes in the past.
However, the residents began to stir at those words.
“Do you think that’s appropriate? Lamictal is a drug that is ineffective for acute mania,” Choi Ji-hoon said, rebuking Sihyeon.
“You don’t just change drugs blindly, do you? You don’t even know basic indications!”
If Jin Cheol-yeong hadn’t been listening, he seemed ready to not hesitate with even harsher words.
“That’s...”
This time, even Sihyeon couldn’t find anything else to say in response.
Based only on the bipolar disorder treatment guidelines of this period, his words were the orthodox view. Rather, Sihyeon’s argument lacked persuasiveness.
‘I can’t exactly say I’ve tried them all before.’
At this rate, he would have no choice but to repeat the trial and error he had experienced before.
“Why? I’d like to hear the reason you think so as well.”
Just as he was feeling the frustration, Jin Cheol-yeong threw another question.
“First of all, it’s because of side effects.”
“Side effects?”
“In the last few days, there has been a weight gain of about 2kg. She is in a state of being extremely negative toward medication.”
“Even so, she’s at a normal weight... no, she’s close to being underweight, so what’s the problem? You must maintain authority as a clinician. Aren’t you being dragged around too much by the patient?” Choi Ji-hoon said as if it were pathetic.
“As someone preparing to debut as a singer, she is particularly sensitive to that part. There is a concern that she might arbitrarily stop the medication after discharge.”
It wasn’t so much a concern as a fact that would happen. Frequent treatment discontinuation and relapse due to weight gain. That was the biggest reason for considering a medication change before the regression.
“And in a recent interview, I confirmed that the patient is taking diet pills. I made her stop for now, but if her weight is not maintained, she might start again, which could lead to a relapse.”
“If it’s diet pills, what are the ingredients?” Choi Ji-hoon continued to press.
“...I haven’t identified them yet. However, looking at the side effects the patient experienced, including manic symptoms, I ‘assume’ they are drugs in the central nervous system stimulant category.”
“An aspiring singer and CNS stimulants...”
Jin Cheol-yeong nodded slowly.
“Well, since she already took them, are the ingredients that important? I assume you’ve explained enough so she won’t take them ever again?”
“Yes, Professor. I will make sure that doesn’t happen.”
“Right. For now, change the medication as Dr. Cheon suggested.”
“But there is still the risk of acting out and disrupting the ward atmosphere...” Choi Ji-hoon protested.
“Didn’t you just say the patient is close to being underweight? I think the staff residing in the ward alone can handle it.”
“…….”
“If there is nothing else, we’ll end the rounds here.”
Jin Cheol-yeong gave a beaming smile toward the residents and then left the conference room just like that.
‘There’s no way he was just guessing... what an interesting fellow.’
A faint smile spread across his lips as he left the ward.
……
One week later.
Kim Su-yeong's treatment proceeded very smoothly.
“How are you feeling this morning?”
“I slept soundly. It feels like it’s been months... no, years.”
Having suffered from chronic sleep deprivation until then, she had slept soundly for over 12 hours a day for the past few days.
‘This was exactly four weeks' worth.’
Before the regression, there was a reason she had lived on sedatives for a whole month. Since she was taking drugs close to stimulants, manic treatments couldn't have worked properly.
Stopping the diet pills that could worsen manic symptoms was effective for now, but Kim Su-yeong found further stability as she continued her interviews with Sihyeon.
He simply nodded silently with an expression as if he understood everything, yet she felt strangely comforted.
“Ugh, what do I do about all the credit card installments? I don’t know how I ended up like this.”
When her mania was at its peak, she had been throwing money around. Shoes, handbags, and even an expensive guitar she bought impulsively right before admission.
“Now you should earn a lot of money with that guitar.”
“I really hope so, but...”
“Don't worry. It will definitely happen.”
Sihyeon answered with a bright smile.
“You’re quite the optimist, Doctor.”
“Pardon?”
“Isn’t that just a sales pitch for psychiatrists? Competition in this industry is so fierce.”
She said it like that, but she didn’t seem to dislike it.
‘That’s unfair. I’m serious.’
About a year after discharge, once her mood stabilized, Kim Su-yeong became able to write even better songs.
And not long after, she debuts as a singer-songwriter through an audition program.
Anyway, an optimist. It was the first time he’d heard that.
Sihyeon didn't like groundless, reckless positivity, such as the idea that the universe helps you if you wish for it earnestly.
He could say things like this now because there was such clear evidence.
Vague hope is sometimes dangerous. This was a thought Sihyeon had always held.
Things will get better after this month. It will improve once the year changes. He hated those groundless words that repeatedly brought only frustration and disappointment.
Because there was a high possibility that what remained in the end was learned despair.
— Since it's a disease with a considerably high risk of relapse. I think there may be overwork and chronic sleep deprivation during trainee life, so it is true that I am worried. According to the literature, the course of bipolar disorder is...
The words he had said to the patient in the past flashed through his mind.
Orthodox but not very helpful...
Just mediocre explanations.
“If you maintain your current prescription steadily, there probably won’t be a relapse for the time being. Once your mood stabilizes, you will naturally be able to write good songs that will surely appeal to the public.”
But now, he can say at least this much.
With the most certain evidence possible.
“If you dislike optimism, let's call it a wish.”
“A... wish?”
At Sihyeon's words, Kim Su-yeong's eyes widened.
“I don't know if the situation is good or bad, but I truly wish for it to turn out that way for you.”
“You wish for me to do well... Does that mean you've become my fan too, Doctor?”
Kim Su-yeong laughed as if it were amusing.
“Is that so? That’s correct. Because I hope you become healthy again and succeed somehow.”
“I see. I'll have to work hard to earn the money for the guitar. I'll try for one more year, and if it doesn't work out, I'll quit.”
Kim Su-yeong clenched her fist.
“One year is short. Try for two years... no, at least two and a half more years.”
Autumn of his 3rd year before the regression.
He remembered feeling proud after seeing Kim Su-yeong appear on an audition program on TV. It was exactly two and a half years from now.
“Pardon? Why specifically 2 years and 6 months?”
Kim Su-yeong asked back, perhaps finding it strange that Sihyeon was speaking like a fortune-teller. Sihyeon was momentarily flustered but soon found a suitable answer.
“In the case of first-episode mania, maintenance treatment should last at least a year to a year and a half. During that time, you shouldn't be stressed, so it’s better to take things slowly. If you say you’ll prepare for another year after that period, that makes it two and a half years.”
“Ah... I see. And here I thought you knew the future or something, Doctor.”
“I’m probably right. I have a pretty good hunch about these things.”
Like that, Kim Su-yeong was step-by-step making plans for after her discharge.
……
‘This is a bit problematic.’
As Kim Su-yeong improved, a new worry arose for Sihyeon. Because the patient was being discharged early, an empty bed had opened up in the room.
Originally, Kim Su-yeong should have been discharged in mid-April. If her early discharge creates more bed space and the bed turnover rate increases, new patients who weren't there before might be admitted.
Immediately, there was a possibility that the second patient Sihyeon would take on would be different from before the regression. On top of that, what if the order of patients taken in rotation with Hwang Jin-ho gets tangled, as he had worried before? The patient groups the two of them treated could end up completely reversed.
‘Should I deliberately see patients slowly? No, that’s not right...’
He couldn't forcibly keep sufficiently recovered patients in the ward.
“It seems our daughter has found her old self again. In fact, she seems even more stable than usual.”
Kim Su-yeong had improved noticeably and returned after spending the weekend with her family. The guardians cautiously asked how it would be if she were discharged at the beginning of the week.
‘If there were no major problems during her leave, it should be fine.’
Naturally, Sihyeon also agreed. Although it felt a bit early, surely nothing bad would happen.
“I thought she’d be here for over a month, but she’s leaving surprisingly early.”
The head nurse muttered softly as she watched Kim Su-yeong packing her discharge bags in the room.
“Really? She got better right after admission, so I didn't see it that way.”
Another nurse at the station tilted her head.
“The feeling when she first entered the ward suggested at least a month... Is medication getting better these days?”
‘How did she know?’
Sihyeon couldn't help but be impressed inwardly. She wasn't the head nurse for nothing. It seemed she could estimate how long a patient would be hospitalized just by looking at the way they walked into the ward.
Is that the kind of insight one gains after thirty years of nursing?
Considering the flow of events before the regression, it was a chillingly accurate judgment. That is, if one were to exclude the new variable: the fact that the doctor in charge was Sihyeon.
“Thank you for everything. Let’s not see each other here again, but make sure to catch me on a broadcast later!”
Kim Su-yeong stood at the exit of the closed ward and offered her farewell to Sihyeon.
Sihyeon’s eyes widened at the sight of her, having changed into civilian clothes. Her attire and features weren't much different from when she was admitted, but there was something magnetic about her lively expression. Images of her from the TV before the regression overlapped in his mind.
“I’ll be rooting for you.”
“You said two and a half years last time, right? I’m going to work really hard until then.”
Sihyeon nodded silently.
“I’ll be going now. Good... bye.”
In the next moment, the hand Kim Su-yeong extended came into view.
‘A handshake...’
One could think of it as a sign of friendliness in its own way, but it was a difficult situation for Sihyeon. This was because physical contact between a therapist and a patient—especially with a patient of the opposite sex—was to be avoided as much as possible. It was a universal principle, but there were often patients who felt slighted by it.
Sihyeon’s hand stopped in mid-air.
“Ah, I’m sorry. We are supposed to avoid physical contact with patients...”
But in the next moment, Sihyeon’s eyes grew large.
“It’s okay. We hold our fans’ hands a lot.”
Kim Su-yeong gave a bright smile, while holding Sihyeon’s hand firmly.
……
‘Shortened it by three weeks. Without getting a single sedative...’
Looking at the patient and her family waiting for the elevator outside the closed ward, he felt proud deep down. Sihyeon stood in that spot for a long while, until the doors of the elevator they boarded were completely closed.
“Now then, back to work...”
The moment he turned his head toward the ward, a wave of dizziness, the likes of which he had never experienced before, surged through him. In an instant, Sihyeon’s frame wavered.
Ding-dong!
A notification sound followed. It was a vivid sound, as if it were echoing inside his skull.
[system: System activation successful.]
[Loading 'Every Chart in the World']
[A significant portion of the chart contents has been modified. Would you like to check? Y/N]
‘What on earth is...’
Sihyeon couldn't help but doubt his own eyes.
Pop-up windows were floating in mid-air along with the notification sound.
A sight he had never once seen before began to unfold in front of him.