Chapter 17 : An Unexpected Patient (3)
Chapter 17 - An Unexpected Patient (3)
Valproic acid.
It is known as a treatment for epilepsy, but in psychiatry, it is primarily prescribed to alleviate symptoms of bipolar disorder or aggression.
Because it has no effect when the blood concentration is low and becomes toxic when it is high, it is managed through periodic blood tests to maintain an appropriate concentration.
‘The Valproic acid level in the blood test is 0 mg/L...’
Sihyeon had often experienced cases in the past where drug concentrations in the blood came out lower than expected.
It could be because it wasn't absorbed properly in the digestive system, or it could be because it vanished quickly from the body due to interactions with other drugs.
However, there was only one possibility for it to come out as a flat zero.
‘The patient isn't taking the medication.’
At this level, it wasn't a matter of accidentally missing a dose for a day or two. It was reasonable to assume he hadn't taken it at all since his outpatient visits prior to admission.
Sihyeon recalled the image of the patient receiving his medication from the nurse after breakfast, taking it, and then immediately heading to the bathroom.
‘Why did he do that?’
One possibility was that the patient didn't recognize his own illness and denied the need for medication. But it made no sense for someone to refuse medication after they had sought out the hospital themselves and even requested admission.
‘The remaining possibility is...’
A case where someone who has no symptoms acts the part of a patient. Though he couldn't know the exact reason, this possibility seemed most likely for now.
If it were the former, he could simply continue interviewing the patient and encourage him to receive treatment.
Since the patient would be suffering from symptoms himself, a clue for treatment wouldn't be hard to find if one searched diligently.
‘But what if it's the latter?’
In this case, the key was to figure out the patient’s reason for faking the symptoms.
Contrary to Sihyeon’s complex inner thoughts, the patient was sitting in the ward hall, leisurely watching TV.
Now that he had washed his hair, shaven, and changed into a clean patient gown, the image of the chronic schizophrenia patient he had seen yesterday was nowhere to be found.
‘What could it be?’
Fake patient. Psychological testing. Voluntary admission.
The words swirled in his head, but nothing specific came to mind. Just then, a trailer for a famous current affairs program appeared on the ward TV.
<Tracking Mystery Cases: Do You Want to Know That?>
It felt as if it were asking Sihyeon a question.
‘Yes, I want to know. I really want to know.’
Feeling frustrated, he stood up to get some fresh air, when new words flashed through his mind.
Crime scene.
Someone else’s blood on the clothes.
And a hair salon director.
‘A hair salon director?’
Sihyeon froze in the exact position where he stood at the station.
‘The Myeongdong Hairdresser Murder Case?’
It was a quite famous case that occurred around his second year of residency before the regression.
A young woman who ran a hair salon in Myeongdong was murdered by her cohabitant.
At first, the investigation proceeded as a heat-of-the-moment murder due to a love affair, but the more they dug, the more new facts were added one after another.
High-value stolen goods found at the culprit's house and a multitude of evidence suggesting additional crimes. The serial murder case quickly began to draw the public's attention.
However, there was a separate reason why Sihyeon became particularly interested in this case. It was because the culprit demanded a reduced sentence citing mental illness.
— What do you think about mitigating the sentences for crimes committed by the mentally ill?
It was a topic that was controversial even then, so Lee Gwang-seop had even asked the residents about it during rounds.
‘Could it be that person? It’s not like there are only one or two hair salons in the city, and schizophrenia is a common disorder.’
He couldn't remember the face of the culprit revealed to the media before the regression. However, the eeriness he felt every time he saw the patient weighed on his mind the entire time.
[Hair by Eugen Director Yu-jin / Myeong-dong Station Exit 8]
The business card the guardian gave me was still in my lab coat pocket.
‘Well, I can just check for myself.’
Sihyeon entered an empty interview room and picked up the receiver.
……
—Hello.
After a few rings, someone answered the phone.
It was a voice I’d never heard before.
It wasn't the guardian I had met in the Emergency Room yesterday.
“Is this Lee Yu-jin’s mobile phone?”
—Yes, that's right. She's busy right now; who shall I say is calling?
“Please tell her it's Cheon Si-hyeon from the Psychiatry Department at Sama University Hospital.”
—Just a moment. Director!
The person who answered seemed to be a staff member at the hair salon.
—Yes, Doctor. This is Lee Yu-jin.
Lee Yu-jin herself took the phone as soon as the employee finished speaking.
“I’m calling to ask a few questions. Since when did your husband start going out frequently at night?”
—Um, I think it’s been about a year. He goes out even more often lately.
‘The past year. Perhaps...’
Sihyeon immediately followed up with the next question.
“I see. By any chance, have you seen any items at home lately that weren't there before?”
—Items I haven't seen before? For example, what kind?
“Jewelry or valuables.”
Sihyeon spoke while keeping in mind the stolen goods found at the culprit's house before the regression.
—That, well...
Yu-jin could not answer readily to the question he asked just in case.
“It’s alright. Please speak.”
—Actually, I started seeing rings at home that I hadn't seen before a while ago...
According to Yu-jin, when women's rings she hadn't seen before appeared at home, she questioned Jo Dong-gyu.
—Well, I thought it could happen.
Jo Dong-gyu was running a pottery studio, and he made the excuse that a customer had left them behind while working, and it was awkward to leave them at the shop, so he brought them home.
—...Until I found the ring he said he'd returned to the customer in his car again.
The more he spoke with Lee Yu-jin, the more suspicious points increased.
“By any chance, are you two legally married, or in a common-law relationship?”
Sihyeon asked.
It wasn't an absolutely necessary question, but he asked with the hope that this detail, at least, wouldn't match.
—We haven't registered our marriage yet.
But the answer was just as expected.
The victim of the past murder case was also a cohabitant, not the culprit's legal spouse. Evidence such as stolen goods and bloodstained clothing had been found at the house.
Sihyeon’s suspicion was gradually turning into certainty.
“I can't shake the feeling that Mr. Jo Dong-gyu continues to do dangerous things.”
—Yes, me too. I hope he receives good treatment and gets better...
‘This was the reason the treatment progress was at 0.’
A vicious antisociality to the point of committing serial murders.
Unfortunately, this kind of tendency is not easy to treat.
There are even some who argue, to an extreme degree, that antisociality itself is not a subject of treatment.
“You must report him. Even if it's to prevent a bigger incident.”
He knew that reporting one's own cohabitant to the police was not an easy thing to do, but he had to convince her.
There were too many people in danger, and too many who would be in danger. Of course, including Lee Yu-jin herself.
—Re, report him?
“Yes, first look for other stolen goods at home and then...”
Sihyeon began explaining his plan to Lee Yu-jin.
……
‘What should I do about this?’
The expression on Sihyeon's face as he left the interview room was not good.
—It’ll be difficult for now. It’s because of the illness; he’s not that kind of person originally.
“No one has reported Mr. Jo Dong-gyu even though there is someone else’s blood on his clothes. What do you think that means?”
—Couldn’t it be that he just got into a scuffle with some acquaintances? Let’s try treating him a bit more...
Those were the last words Lee Yu-jin left behind.
‘You must report him. Otherwise, you might die!’
In his frustration, he almost said those words out loud.
“Excuse me, Dr. Cheon Si-hyeon?”
Someone called Sihyeon, who was standing in the hallway.
It was Jo Dong-gyu. He hadn't realized because he was so absorbed in the call, but it was already time for the interview.
“Ah, Mr. Jo Dong-gyu. Come this way, please.”
Sihyeon guided Jo Dong-gyu to the interview room.
He put his phone on silent and took out a paper chart for brief notes.
“How are you feeling today?”
“I made a mistake with another patient briefly this morning, but I’m fine now. I apologized to them.”
Certainly, looking only at his current appearance, he didn’t look like the person who had picked a fight with another patient a few hours ago.
“Has the hearing of voices decreased as well?”
“Yes, it was really severe before admission, but after coming here, I think it’s decreased by 90 percent. The medicine must be working really well.”
Yeah, right.
Sihyeon gave a bitter smile to himself.
“I see. What kind of voices did you primarily hear?”
“I don’t hear them now, but before, I heard a lot of voices saying ‘Kill! Kill!’ When it got bad, I’d lose my sense of reality... I felt like I really might do it if I wasn't careful, you know?”
It was a serious topic, but Jo Dong-gyu spoke with an expression as if it were no big deal.
He even seemed slightly excited.
— I heard auditory hallucinations telling me to kill all day long. I couldn't resist. I am truly sorry to those who passed away.
The words the pixelated culprit had said in the past overlapped.
Hearing those words, he first felt goosebumps, but then anger gradually surged within him.
‘Why are you dragging our patients into this?’
In fact, it's only because a few cases exposed in the media are sensationalized; the crime rate among the mentally ill is not significantly different from the general population.
The bigger problem is people like this demanding reduced sentences using mental illness as an excuse.
As a result, prejudice against mental illness strengthens, and innocent patients who are receiving proper treatment end up being the ones who suffer.
“Is it a man's voice? Or a woman's voice?”
He decided to watch him more for now.
To see how much this guy had studied the disorder.
And how rich his imagination was.
“It’s a man’s voice. I grew up under an extremely strict and violent father when I was young. Could that be the influence?”
Now he’s even blaming his parents.
It seemed he had prepared his interview material quite diligently in his own way.
‘Shall I get started?’
Sihyeon put his hand in his lab coat pocket.
“It’s a relief that your symptoms have improved, but your symptoms seem a bit different from those of general patients.”
It was the first time Sihyeon, who had only been listening to Jo Dong-gyu for a long while, offered his own opinion.
“Hmm, is that so?”
For a moment, he felt Jo Dong-gyu flinch.
“Shall I say the auditory hallucinations are non-specific?”
“Non-specific... what does that mean?”
“The constant repetition of the same words is closer to an obsession rather than a hallucination. Is it possible that you simply want to kill someone?”
Sihyeon asked with a smile on his face.
“N-No way. That can’t be it. You sure have a good sense of humor, Doctor.”
Jo Dong-gyu waved his hands dismissively in strong denial.
“But it can be treated, right? I’m suffering so much...”
“Using a small amount of sedatives might help. Since you usually have insomnia, some sleeping pills should be fine.”
“Will that be enough? Then what will my diagnosis be? In the outpatient clinic, they said it was ‘schizophrenia.’”
Jo Dong-gyu cautiously brought up the topic of the diagnosis.
“To be honest... I’m not really sure about the diagnosis.”
At the unexpected answer, he wore a flustered expression.
“What does that...”
“First of all, it bothers me that the symptoms are non-specific. And your reaction to the medication is unusual as well.”
“Haha. That’s just because my constitution doesn't handle medicine very well.”
“The medication I prescribed for you... it’s the type that can affect fine muscle movements, yet there’s none of that. Even your eye movements right now are far too natural.”
Sihyeon said, staring intently into his eyes.
“Are you saying I’m pretending to be a patient or something?”
Jo Dong-gyu spoke as if he were frustrated.
“I’m just a patient who wants to get better. Why would I do such a thing while paying expensive hospitalization fees despite my poor finances?”
“Who knows? Maybe you buried a few people in the mountains and came to the hospital as an insurance policy?”
Sihyeon said with a playful laugh.
“Haha. Your jokes are going too far.”
“I don’t particularly like jokes, though.”
In an instant, the trace of laughter vanished from Sihyeon’s face as he looked at Jo Dong-gyu.
“Who the hell are you?”
In the next moment, Jo Dong-gyu’s expression turned icy cold.
“Let’s just say I’m someone who knows something about what you—the patient... no, Jo Dong-gyu—have been doing.”
“If you keep running your mouth without any evidence, you won't walk away in one piece. I’m discharging tomorrow, so make sure you write that medical certificate properly. If you want to die of old age, keep my words in mind.”
Slam!
The interview room was empty after the patient left.
Sihyeon took his cell phone out of his pocket and placed it on the table.
“Now, what are you going to do?”
A period of silence passed.
Then Sihyeon spoke.