Chapter 15 : An Unexpected Patient (1)
Chapter 15 - An Unexpected Patient (1)
A department dinner.
It was a gathering Sihyeon had always felt uncomfortable with.
He was worried that the seniors might scold him for speaking so brashly to Choi Ji-hoon today.
However, that expectation was pleasantly subverted.
“Sihyeon sees patients well, is good at investing, and from what I saw recently... somehow I feel like he'd even be good at fighting. Is there anything you can't do?”
“Thank you, Doctor.”
Kim Seok-yong said while pouring a drink for Sihyeon.
“Our Jin-ho is doing well, spending his own money to feed the patient diligently, aren't you? That person has improved a lot.”
And beer filled Hwang Jin-ho’s glass as well.
‘Why is he giving so little?’
The levels in both glasses were at an awkward height, as if he’d stopped halfway.
While Sihyeon was wondering why, Kim Seok-yong spoke.
“Chief, shall we go with poktan* today?”
[N: Poktan most commonly refers to Korean Fluffy Egg Bomb (Gyeran Poktan-Jjim), a popular Korean side dish, or Bomb Shot (Poktan-ju), a cocktail.]
‘I’m screwed.’
Although Kim Seok-yong usually didn't enjoy drinking, when the atmosphere was as good as today, he became as heavy a drinker as anyone.
Kim Seok-yong filled the rest of the glass with soju.
“We don’t know what will happen tomorrow, but for now, let’s drink a lot today.”
Kim Min-hong said excitedly.
As the atmosphere ripened, the residents began to talk about tomorrow's strategy.
“Chief. What are you going to do from now on?”
“Well. Honestly, at this point, I wonder what the point of predicting is. It’ll just go however the market movers want. Even charts are meaningless.”
Kim Min-hong said while draining his glass.
“The volatility is so extreme, how about we clear our positions and exit if it starts high tomorrow?”
“Won’t it keep going for a while?”
“Ugh, I’m too nervous to keep holding. What if it hits the lower limit again?”
The other residents expressed their opinions as well. Meanwhile, they watched Sihyeon’s reaction.
“In my opinion...”
And finally, Sihyeon opened his mouth.
The residents’ gazes focused on him instinctively.
As if waiting for a professor’s comments after rounds.
“The volatility is extreme, but for the time being, the closing price will likely be near the upper limit. If it starts with a gap-up, sell and then rebuy; if it starts low, wait and then buy.”
It was a trading technique they had never heard of, but everyone seemed to agree.
Though he was a first-year in psychiatry, in this specific field, he had earned the absolute trust of the other residents.
“But Sihyeon. Did something happen between you and Dr. Choi Ji-hoon? I get startled every time I see you guys.”
Kim Seok-yong asked once he was somewhat tipsy.
“Nothing much happened.”
“Really? ...Well, it seems like I’ll be spending more time with you, Sihyeon, so I guess I should take your side. Hahaha.”
“I’m his classmate, so it’s awkward for me to take sides. If you’re going to fight, do it when I’m not around. It ruins the atmosphere, you know?”
Normally, it would be natural to scold Sihyeon.
Yet he was grateful to Kim Min-hong for speaking like this.
“Sihyeon! You won’t be like that when I’m Chief next year, right? I’m counting on you in advance.”
Third-year Kwon Won-ju said playfully.
Sihyeon... -ah?
She was someone who had always used formal language even with junior residents—strict and showing no emotion.
Kwon Won-ju was one of the people he found most difficult during his life in the psychiatry department, but today her vibe seemed different from usual.
“No way! I’ll work hard.”
Sihyeon said as he accepted and drank the alcohol offered by Kwon Won-ju.
“Anyway, I’m looking forward to tomorrow. Are we having another dinner tomorrow too?”
Hwang Jin-ho was also excited.
The drinking session continued late into the night.
It was still the beginning of the term, yet I already felt quite close to my fellow residents. Many things had changed since the regression, but this was the part that felt most tangible.
……
The next morning.
[System: Fatigue is reduced due to the effect of the Recovery Potion.]
‘Can I use this on other people too?’
The effect of the item was truly beyond expectations.
‘It would be a huge hit if I sold this as a hangover cure.’
Normally, it would have been difficult to even drag my body out of bed after the drinks I had yesterday, but today was manageable.
Actually, it wasn't just manageable; I felt almost no different than usual.
‘This combination is really something else.’
Sihyeon’s gaze drifted toward the Recovery Potion and Deep Sleep Potion stored in his inventory.
It consumed a fair amount of points, but he could just replenish them by seeing patients diligently.
[System: Physical Training begins. (0.1/3km)]
Sihyeon started another day like that.
“A new patient will be admitted to the ward this afternoon. Dr. Cheon Si-hyeon, you take him.”
“Yes, Doctor.”
After the rounds ended, Kim Min-hong assigned a new patient to Sihyeon.
“He's a patient I've seen a few times in outpatients, but we couldn't admit him because there were no beds. The attending is Professor Lee Gwang-seop.”
As senior residents, Kim Min-hong, Choi Ji-hoon, Kwon Won-ju, and Ha Do-yeong saw outpatients about two to three times a week.
Since it was resident-led clinical work, the number of patients wasn't high compared to the professors, but they often reported patients with severe symptoms to a professor and had them admitted.
“Yes, Doctor. What kind of patient is he?”
“In my eyes, he’s a typical schizo (short for schizophrenia) patient. His name is Jo Dong-gyu, chart number 61901202. Check the outpatient chart.”
The new patient was, unexpectedly, someone Sihyeon had never seen before the regression.
‘A change already...’
Sihyeon’s expression became quite serious.
“Sihyeon, don’t be intimidated. He’s not a difficult patient. I think he’ll be fine for a first-year to handle. You can ask me if you have questions.”
Kim Min-hong, who had no way of knowing Sihyeon’s inner thoughts, said with a smile.
Because the first patient, Kim Su-young, was discharged early, there was a change in the room situation.
After her discharge, the remaining patient in that room moved to a six-person ward, leaving a two-person room completely empty.
‘So Room 902 has become a male ward now.’
It meant that the patients being admitted for the time being could differ from the past.
……
[Jo Dong-gyu M/32 Physician: R1 Cheon Si-hyeon / Attending: Prof. Lee Gwang-seop]
The patient only arrived at the ward late in the afternoon.
“Hello, I’m Dr. Cheon Si-hyeon, the physician in charge of the ward.”
“Ah... Hel... lo.”
The patient answered with his head hung low, his speech slurred and clumsy.
The patient, who was quite tall, was wearing a tracksuit and a thick padded jacket that looked like it belonged in the dead of winter.
‘Clothing inappropriate for the season.’
His hair was disheveled as if it hadn't been washed in days, his beard was scruffy, and he had a strong body odor. His gaze was fixed on empty space; there was absolutely no eye contact.
‘This is why he called him a typical schizo.’
A state where the patient cannot maintain personal hygiene due to extreme avolition. It was a common sight when schizophrenia patients experienced a worsening of symptoms.
“And the person who came with you is...?”
Beside him stood a guardian who had come up to the ward with him. She was tall and thin, wearing a flowing blouse and tight jeans, with heavy makeup on her face.
Somewhat large hoop earrings caught his eye.
“I’m his wife. Please take good care of my husband.”
‘To think they could look so different while living in the same house.’
The guardian had a bright, polished appearance that stood in stark contrast to the patient.
“Could you spare a moment?”
Sihyeon guided the patient and the guardian into the interview room.
————
[Chief Complaint]
1. Auditory Hallucinations (“I hear voices commanding me to kill.”)
2. Delusions (“Someone is trying to control my body.”)
3. Avolition
(Onset: Starting 1 year ago)
The above patient has no prior psychiatric history...
————
Sihyeon examined the initial consultation chart written by Kim Min-hong in the outpatient clinic.
‘Based on the chief symptoms, it seems likely to be schizophrenia...’
However, a patient cannot be evaluated by records alone. Every doctor may have a different perspective, and above all, Sihyeon was the type to trust what he saw for himself.
“Mr. Jo Dong-gyu, what kind of discomfort brings you here today?”
“…….”
The patient occasionally smiled inappropriately, but he was unable to answer the question.
– Delayed verbal response
– Blunted affect
Sihyeon began to record the patient’s status.
“I read in the outpatient records that you keep hearing voices in your ears. What kind of voices do you hear?”
“…….”
“Excuse me, Mr. Jo Dong-gyu?”
When there was no response for a long time, Sihyeon called the patient again.
“Kill... They tell me to kill. I hear it all day long.”
“Who?”
“Women... women...”
The patient struggled to continue the interview. Perhaps even at this moment, he was unable to focus because of the auditory hallucinations ringing incessantly in his ears.
The patient hung his head and clutched his hair as if in pain. He seemed to need stabilization more than an immediate interview.
‘Severe auditory hallucinations. And they are command hallucinations...’
Sihyeon’s expression began to harden.
In cases where a patient lacks reality testing, they sometimes act exactly according to the content of their hallucinations.
Furthermore, if the voices were constantly and repeatedly telling him to harm someone, the situation was looking quite dangerous.
“Ma’am, the patient seems to be struggling. Since when has he been like this?”
“The symptoms got worse starting late last year, but thinking back, he’s been a bit different from usual since early last year. He looked dazed and depressed...”
Sihyeon nodded slowly. The fact that there were subtle changes long before the severe symptoms appeared was a significant detail.
‘The acute phase was three months ago. Have the prodromal symptoms been present for a year?’
It was a gradual change rather than a sudden onset. This finding was more consistent with the course of schizophrenia than bipolar disorder.
“What kind of work did he primarily do before he got sick?”
“My husband? He was at the shop...”
As she answered Sihyeon’s question, the guardian suddenly seemed flustered and trailed off.
‘What was that just now?’
Sihyeon had spent four years doing nothing but treating patients, outside of the time he spent eating and sleeping in the hospital.
It was a very brief moment, but there was no way he would miss the flash of terror that crossed her face.
“Ma’am? What did you just say...?”
“Oh, n-no. He worked at a company. Just... an ordinary company.”
The guardian tried to gloss over her words.
In the next moment, what caught Sihyeon’s eye was the patient’s expression, which was quite different from before.
Rage filled his eyes. Sparks were practically flying from the patient’s eyes as he looked at his wife.
“Mr. Jo Dong-gyu, what kind of duties were you in charge of at the company?”
“I... I worked on a production line at a fac-factory.”
“Ah, I see. By any chance, did you do shift work? Did you usually suffer from insomnia?”
“I... slept well.”
The patient instantly returned to a dazed expression and continued answering slowly. The aggressive gaze from just a moment ago was nowhere to be found.
‘What’s with this couple?’
Though it wasn't openly visible, a subtle war of nerves was unfolding between the two.
“First, please get plenty of rest in the ward, and we’ll proceed with medication at the same time. Also, since it’s your first admission, a full psychological battery...”
“Could the testing be done later in outpatients?”
The patient asked before Sihyeon could even finish his explanation.
“Pardon? It’s better to do it since you’re already admitted...”
“My financial situation has become a bit difficult since I became unable to work. The testing fee is expensive... Let’s treat the symptoms first and do the tests later.”
“Understood. Then we’ll do as—”
As Sihyeon was about to answer, the handbag on the guardian’s lap stood out particularly.
‘Mer... hes?’
Even to Sihyeon, who was a novice when it came to luxury goods, the bag looked quite expensive. It felt like selling just the handle of the bag could pay for the hospital bill.
The more the interview continued, the more things he couldn't understand.
……
“Then I’ll be going now. Please take good care of my husband.”
After the first interview ended, the guardian hurried out of the ward.
“Mr. Jo Dong-gyu, starting this evening, I’ll be slightly changing the medication you were taking in the outpatient clinic. Let me know if you have any discomfort.”
“Yes.”
The patient slowly nodded. Occasionally, he talked to himself or gave an inexplicable smile. It was a common sight during an acute exacerbation phase.
‘Is it just my imagination?’
What still weighed on his mind was the patient’s expression when he glared at the guardian in the interview room.
‘His face was very clear. Even if it was only for a moment.’
Bzzzzzt.
While he was lost in thought, his phone began to ring.
[02-20xx - 0119]
It was the Emergency Room.
“Psychiatry R1 Cheon Si-hyeon speaking.”
—Doctor, this is the ER. A patient’s guardian says they want to meet you.
The ER nurse explained the situation.
‘It probably isn't Kim Su-young’s guardian.’
Since Kim Su-young had been discharged in a much more stable state than in the past, there was no reason for them to come to the ER.
Sihyeon’s gaze turned toward Jo Dong-gyu, who was sitting in the ward hall, blankly watching TV. At this point, there was only one patient’s guardian who would be looking for him.
“Yes, I’ll be right there.”
Sihyeon headed straight for the ER.