Chapter 16 : An Unexpected Patient (2)
Chapter 16 - An Unexpected Patient (2)
“Doctor, over here.”
As expected, the guardian looking for Sihyeon was Jo Dong-gyu’s wife, whom he had seen in the ward earlier.
“What did you want to see me about?”
“Um, there’s something I need to tell you...”
The guardian scanned the surroundings.
— “Arrest! Give me one ampoule of Epi!”
— “The airway is swollen; I can’t intubate!”
Doctors and nurses were rushing frantically between patients whose lives were on the line. This was certainly not a place where one could have a calm conversation.
“Let’s go this way.”
Sihyeon pointed toward an interview room designated for guardians in the Emergency Room.
It was a place where he used to frequently eat snacks or take short naps during his ER internship rotation; fortunately, it was empty now.
“What was it you wanted to say?” Sihyeon started the conversation.
“Could my husband stay hospitalized for a bit longer? A month? Or even just three weeks at the minimum?”
“What do you mean by that? Asking for a longer hospitalization?”
Sihyeon had seen many guardians who hoped for the patient’s quick recovery and early discharge, but this was the first time someone had point-blank asked to extend the stay.
“It’s because... I’m so scared.”
The guardian’s eyes wavered, and her upper body began to tremble slightly.
Sihyeon recalled the look in the patient’s eyes back in the interview room.
‘There was definitely a murderous glint in his eyes.’
If the patient couldn't hide his discomfort even during an interview with the attending physician, how bad must it be when they were alone at home?
“During the acute phase of schizophrenia, a patient can be more sensitive than usual. Still, he will improve once he receives proper treatment.”
“It’s not just that!”
The guardian beat her chest in frustration.
“He says women keep laughing at him. There’s no way that’s happening... That’s also a symptom, right? And he’s become so suspicious that he won’t let me talk to others about him.”
“Ah, so that’s why your expression was so poor in the interview room earlier.”
Hearing the guardian’s words, Sihyeon now understood why she had requested a separate interview.
“Is his refusal to do the psychological testing part of the same context?”
“I don’t know about that. But it’s certainly not because we don't have the money for the testing fee.”
Actually, the testing didn't really matter. Treatment was the priority, not the tests. What Sihyeon was curious about was the patient’s intention behind avoiding the tests.
“Lately, he goes out every night, and I have no idea what he’s doing. I’m so worried that he might harm someone.”
The guardian wore a look of pure terror.
“By any chance, has he been staying awake recently, becoming more talkative, or spending a lot of money?”
“No. Nothing like that.”
“Are there any new drugs or health supplements he’s started taking recently?”
“None that I know of.”
‘It doesn't seem to be bipolar disorder or a substance-related issue.’
Sihyeon narrowed down the possible diagnoses in his head.
“And you know what’s really eerie? Sometimes he comes back with blood on his clothes, but no matter how I look at it, I don't think it’s his blood. There wasn't a single scratch on his body.”
Sihyeon’s brow furrowed.
‘It’s as if he’s searching for a target to attack.’
While he had seen aggressive schizophrenia patients occasionally in the past, a case like this was rare.
“I understand what you’re saying. We will monitor him closely in the ward.”
“Here is my business card. Please contact me anytime if something happens. I’m planning to close my shop for a while because I’m so anxious about my husband.”
——
Hair by Eugen
Director Yu Jin / Myeong-dong Station Exit 8
02-38xx-0067
010-76xx-0067
——
“So, you were a hairdresser. Is your name Yu Jin?”
Eugen.
Coincidentally, it was the same name as the German psychiatrist who first coined the term schizophrenia (formerly known as dementia praecox).
“Yes, my real name is Lee Yu Jin. Please take good care of my husband.”
The guardian gave Sihyeon a deep bow and left the Emergency Room.
……
The next morning.
[System: Ward Dominance begins. (1/30)]
Sihyeon started his day as usual. Beyond the station, he could see patients receiving their morning medications.
[Jo Dong-gyu M/32 Physician: R1 Cheon Si-hyeon / Attending: Prof. Lee Gwang-seop]
Jo Dong-gyu also received his medication from the nurse, tossed it into his mouth, and swallowed some water.
“Hello. Did you sleep well?”
“Ye-es...”
Sihyeon offered a greeting, but the patient gave a short reply in a slurred voice and immediately headed toward the restroom.
Delayed response.
And an attitude that still seemed wary.
For the time being, it seemed difficult to have a proper interview with the patient.
– Slept well without tossing and turning during the night.
– Consumed about half of breakfast.
– No interaction with other patients; watches TV in the hall.
According to the guardian, he used to go out and wander every night before admission, but fortunately, he slept well in the ward and showed no problematic behavior.
‘For now, I'll keep him on what he was taking in outpatients...’
Since Kim Min-hong had increased the dosage right before admission, Sihyeon planned to maintain the current dose for a few days—until Jo Dong-gyu started shouting in the ward hall.
“You! What did you just say to me?”
“Huh? I didn't say anything.”
“You just cursed at me, asking why a young punk lives like this! What do you know?!”
Jo Dong-gyu growled at a young female patient who was quietly watching TV on one side of the ward.
“Orderly!”
Two ward orderlies and Sihyeon immediately ran out to restrain Jo Dong-gyu.
There was no physical collision between the two patients, but if left alone, the atmosphere suggested a fight would break out.
“Violence is not permitted in the ward.”
“Didn't you hear that woman cursing at me just now?”
“Please go into your room first. We’ll talk separately in the interview room later.”
Despite the minor commotion, the patient unexpectedly followed Sihyeon’s words and went into his room obediently.
‘Was it an auditory hallucination?’
Hearing hallucinations of people insulting him is one of the common symptoms for schizophrenia patients.
Seeing how he reacted sensitively to hallucinations despite being fine all night, he was still in an unstable state where one couldn't tell which way he might bounce.
It was a relief, at least, that he went into his room without resisting the physician's orders.
Otherwise, they might have faced a situation requiring isolation in the stabilization room and an injection of sedatives.
[Medication Adjustment]
– Lorazepam 1mg BID (Increased)
– Risperidone 2mg BID (Increased)
– Valproic acid 500mg BID (Increased)
After issuing the additional prescriptions to increase the existing medications, Sihyeon began preparing for the rounds.
……
“Jo Dong-gyu in Room 901 is a patient admitted through outpatients with a chief complaint of auditory hallucinations and delusions of persecution that have persisted for several months. He is believed to have exhibited a lot of aggressive behavior before admission...”
“I see. How has he been since being admitted to the ward?”
After listening to Sihyeon’s report, Professor Lee Gwang-seop asked back.
“He slept well and had no particular issues until last night, but this morning, there was friction with another patient. It is believed to be hallucinatory behavior (action resulting from auditory hallucinations).”
“Is that so? Let’s pay special attention to safety. I believe he came up from the Chief’s outpatient clinic; are there any comments?”
Lee Gwang-seop now turned to Kim Min-hong.
“He had auditory hallucinations, but until now, there were no behavioral issues. He was even a patient with a certain degree of insight (the degree to which one recognizes their own illness)...”
Kim Min-hong reacted as if this were unexpected.
“According to the guardian, she said there are many times when he is threatening at home. She said he goes out often every night and she's worried an accident might happen,” Sihyeon added.
“Guardian? Did that patient’s guardian come with him?”
“Yes. His wife came up to the ward with him yesterday.”
“Wife? That patient is single. Isn't it his girlfriend? The one who works for an insurance company?”
“No. His wife runs a hair salon.”
The details Kim Min-hong and Sihyeon were discussing were completely different. It was almost as if they were talking about two different patients.
‘Is he two-timing?’
But to think that, the patient’s physical state was a total mess.
“Inconsistency is also meaningful. Let’s evaluate him thoroughly.”
Lee Gwang-seop listened to both of them alternately, made a brief comment, and then concluded the rounds.
“I didn't really know when seeing him in outpatients, but now that he's actually admitted, there are some peculiar corners,” Kim Min-hong said to Sihyeon as they left the conference room.
“Keep a close eye on him; I might have missed something.”
“Yes, Doctor.”
Just then, the patient was seen crossing the station to go to the bathroom. He was still moving slowly, staring blankly into space.
“Looking at that, he seems like a typical schizophrenia patient. Right?”
“Yes, but he seems somewhat different from the patients I've seen before,” Sihyeon said, looking back and forth between the outpatient medical records and the nursing notes.
“Says the kid who’s only seen exactly one inpatient so far. Hahaha.”
‘Oops.’
Kim Min-hong burst into laughter at Sihyeon’s answer. But that laughter didn’t last long.
Patient Jo Dong-gyu, who had gone to the bathroom, appeared before the two of them.
“Mr. Jo Dong-gyu?”
For a moment, he was almost unrecognizable.
Standing before Sihyeon was a Jo Dong-gyu who had washed his hair and was cleanly shaven.
He didn't smell at all, as if he had even finished a shower in that short time.
“Doctor, would it be possible for me to use the phone?”
“I’m sorry. For the first few days after admission, outings and phone calls are restricted.”
“I see. Then, could you perhaps pass a message to my wife to bring these items? To my wife.”
The patient wrote various things on a memo pad and handed it to Sihyeon. There was no irritation at all at the news that outings and phone calls were prohibited. He even looked polite.
—Towels, sketchbook, magazines... snacks.
Sihyeon checked the contents of the note while simultaneously observing the patient.
He took in the patient's facial expression, posture, and even the movement of his pupils as he handed over the memo.
His gaze stopped at the patient's fingertips.
“Yes, I have something I need to check urgently, so I’ll finish looking at this and then deliver the message.”
[System : Ward Dominance in progress. (17/30)]
It was just the right time for the blood test results that went out in the morning to come back, so he had to grasp them.
“Yes, it’s definitely good to be admitted. The medicine seems to be working well, too. I feel much better.”
The patient gave Sihyeon a broad grin and then moved away from the station again.
‘He looks familiar. Where have I seen him?’
He probably intended to express friendliness, but the result was a total failure.
For reasons unknown, Sihyeon felt a chill from the patient’s expression instead. Soon, his heart began to pound wildly.
‘He was showing hallucinatory behavior until a few hours ago, and now it suddenly vanishes?’
This patient was far, far from following a typical clinical course.
While there were often patients whose symptoms improved rapidly as they found a sense of stability after admission, wasn't this just too fast?
Suddenly, he became curious about the patient's treatment progress. At this rate, there would surely be a significant change.
[Jo Dong-gyu M/32 Physician in Charge: R1 Cheon Si-hyeon / Attending: Prof. Lee Gwang-seop]
Since he was a patient Sihyeon had never seen in the past, he wondered if there would even be a record in "All Charts in the World," but he touched "▼ View More" for now.
[Medication: Lorazepam 1mg BID, Risperidone 2mg BID, Valproic acid 500mg BID]
The medications were exactly as Sihyeon had entered them before the rounds. However, the content that followed was far beyond his expectations.
[Treatment Progress: 0/100 | Until Discharge: 6 days 2 hours 10 minutes 29 seconds]
‘Why is it like this...?’
It made no sense for the treatment progress to be at 0.
There was the treatment Kim Min-hong had been providing in the outpatient clinic, and although it hadn't been long since his admission, his condition didn't look that bad.
‘Is a brain lesion the cause? Or perhaps some other organic cause?’
If the symptoms were caused by a brain lesion or an infectious disease rather than a purely psychiatric issue, the way his symptoms fluctuated from moment to moment would be somewhat understandable.
Sihyeon immediately checked Jo Dong-gyu’s brain MRI scan report and blood test results.
As he reviewed the test results one by one, Sihyeon’s eyes widened.
[Serum valproic acid Level: 0 mg/L (not detected)]
Valproic acid not detected in the blood.
Watching the patient’s retreating back, a cold smile formed on Sihyeon’s lips.