A competent doctor can cure everything - Chapter 75

[My Goldie♥]

Na-kyung swallowed nervously as she stared at the incoming call on her phone screen.

With trembling fingers, she pressed the answer button.

– Babe, what are you doing? Did you go to the café?

“Mm, I’m just at home.”

– Then, how about we go on a date tonight? We can look at wedding things too.

“I’m sorry, but I think I’ll be busy again today.”

On the other end of the line, she heard a long sigh.

That sound tightened around Na-Na-kyung’s chest.

– Babe, you know you’ve been acting strange lately, right?

“…”

– I heard there’s something called ‘Marriage Blue’. If you’re worried about something, just tell me.

“It’s not that.”

– Then it’s even weirder. Why are you avoiding me? Since I proposed to you…

His voice had grown cold and distant.

– Is that really what it is? Are you thinking that maybe we shouldn’t get married?

“No, that’s not it…”

Na-kyung bit her lip.

She clenched her fist so tightly that her nails dug deep into her palm.

It had already been almost a week since she was admitted to Hanbit University Hospital.

She hadn’t been able to tell her boyfriend about it.

She couldn’t bring herself to tell him the reason she was admitted.

‘Mom told me to just say it was a cyst removal surgery…’

But that wouldn’t work. Eventually, he would find out.

Even if I don’t get caught, I didn’t want to lie.

But I also didn’t have the courage to be honest.

‘How do I say this?’

Yes, I was diagnosed with early menopause.

No one knows if the treatment will take a year, two years, or if it’s something that can’t be cured at all.

Pregnancy? Childbirth? Obviously, I can’t do it.

But you’ll still marry me, right?

…How could I say something like that?

Moreover, her fiancé desperately wanted children.

He often talked about how his dream was to have three kids and live happily with them.

Telling him the truth was incredibly difficult.

‘What if he says it’s okay, and still asks me to marry him? That’s even more terrifying.’

Her kind and gentle boyfriend was likely to suppress his true feelings.

Did I even deserve that?

Did I have the right to make my boyfriend give up on having children?

Besides, this wasn’t just our problem.

She also knew her in-laws wanted grandchildren very badly.

So, wasn’t it too selfish to want to get married?

‘If I truly loved him, shouldn’t I let him go?’

After being diagnosed with the illness, Na-kyung’s mind was filled with these thoughts.

– Babe? Why are you so quiet?

“……”

– Did another person come into your life?

“…Yes.”

Na-kyung spoke with a determined voice.

Tears quietly flowed from her eyes as she said this.

“Let’s break up.”

* * *

On Monday, on the way to work, I almost stopped by the hospital café out of habit, but then I hesitated.

It was because of the middle-aged man standing in front of the counter.

He was the café owner and also Na-kyung’s father, and his face was filled with worry.

The whole family must be in turmoil because of his daughter.

But unfortunately, there had been no significant change in Jo Na-kyung’s condition yet.

Whether in the present or in the future within the next week.

‘……’

I couldn’t bear to face the owner, so I gave up on the coffee and went up to the ward.

Her medical team is using every method available to try and restore her ovarian function, including traditional medicine, acupuncture, moxibustion, and medicinal injections.

Under Professor Bu Yeo-jung’s guidance, they are doing their best, so we’ll have to wait and see with time.

With a bitter heart, I finished preparing for the rounds and sat down at the computer.

…But what is this?

I opened the EMR (Electronic Medical Records) that I hadn’t seen over the weekend, and the chart for Ms. Ryu Ji-hye was filled with golden highlights.

‘She’s going to have a fever starting tonight?’

I had indirectly warned Dr. Lee Yi-won about postpartum fever.

Naturally, I thought the future might have changed over the weekend.

But the chart still indicated that a fever was expected tonight.

I opened the vital sign graph for Ryu Ji-hye in the EMR.

(Vital signs usually refer to blood pressure, pulse rate, respiratory rate, and body temperature.)

Three times a day, the ward nurses measure the vital signs of the patients and input them into the EMR.

It’s then displayed in an easy-to-read vital sheet (graph with recorded vital signs).

Starting tonight, Ryu Ji-hye’s vital sheet is showing signs of chaos.

Records of her body temperature being measured at 30-minute to 1-hour intervals are glowing in golden yellow.

Fortunately, the other vitals are fine, but her temperature continues to hover above 38.5°C.

‘It looks like Dr. Lee Yi-won is on duty for obstetrics tonight.’

There are traces of Dr. Yi-won giving orders in the future chart.

Following her instructions, an anti-inflammatory painkiller is administered throughout the night, but the fever doesn’t subside.

By early morning, an emergency blood test order for consultation has been placed.

‘The blood test results show a slight increase in the white blood cell count and CRP levels.’

(CRP: C-Reactive Protein. The normal value is below 0.5 mg/dL.)

The increase in these indicators suggests infection or inflammation.

However, the levels are not severely elevated.

This level of fever could be a physiological increase that sometimes occurs postpartum.

But there’s something strange.

‘The future chart only shows a few days ahead.’

Tomorrow morning, Professor Bu and Dr. Lee Yi-won will suspect mastitis and will request a consultation with the obstetrics department for a Western medicine approach.

They will prescribe antibiotics for a few days, but the fever persists.

The chart ends there.

It’s likely that after this, there are too many variables to predict.

‘Dr. Lee Yi-won, Professor Bu, and even the Western medicine obstetrics department have all been involved, and yet the fever hasn’t gone down?’

Coincidentally, I’m on duty tonight.

It’s typical for the person who has had the weekend off to take the Monday shift.

I need to find the cause as quickly as possible from now on.

‘Can I solve such a difficult problem?’

I feel overwhelmed, but I can’t just stand by.

I recall what I said during the last obstetrics study session.

The three major causes of postpartum fever are genital infections, mastitis, and breast engorgement.

Genital infections occur when there’s an infection in the perineum or inside the uterus.

But this patient had a cesarean section, not a vaginal birth.

‘She didn’t have an episiotomy, and her abdominal incision from the C-section has long healed cleanly.’

If it’s an infection inside the uterus, like endometritis…

It’s characterized by lower abdominal pain, tenderness in the uterus, foul-smelling lochia (postpartum vaginal discharge), and more.

If it worsens, the infection can spread into the pelvis, causing peritoneal irritation symptoms.

‘I need to focus on asking about this during the interview.’

The next thing to consider is a problem with the breast.

Breast engorgement occurs when excessive milk accumulates in the breasts, causing swelling and pain.

The whole breast is generally warm to the touch, and pain is common.

Body temperature is usually between 37-38°C, and the fever typically lasts no more than one day.

If breast engorgement persists for a long time, it can lead to mastitis.

If the inflammation affects the milk ducts, it’s called mastitis.

‘Unlike breast engorgement, mastitis causes redness, swelling, and pain in one breast only.’

It’s also more severe than engorgement, with a high fever of over 38.5°C and chills.

Muscle aches throughout the body are often present as well.

Although I, as an intern, check the patient’s condition every morning and write progress notes…

The nurses are the ones directly observing the breasts.

I opened the simple chart the nurses write, called the “Nursing Log.”

———-

– 20XX. 8. X.

Patient Ryu Ji-hye complains of pain in the upper outer side of her right breast.

Swelling, warmth, redness, and tenderness present.

“The newborn is hospitalized, so direct breastfeeding is difficult.”

Encouraged breastfeeding and pumping.

———-

The recently written nursing logs were mostly like this.

‘There are many complaints of breast pain. It seems like the cause is either breast engorgement or mastitis.’

Thinking this, I approached the nurse who had written the log.

“Excuse me, nurse. Regarding Ryu Ji-hye, when you saw her, was her breast engorgement severe?”

“Ah~ yes. The baby has jaundice and is undergoing phototherapy, so direct breastfeeding isn’t going well. We’ve been helping with pumping, and even with the massage therapist coming, she’s still suffering from breast engorgement.”

Breast milk is more effectively expressed when the newborn directly breastfeeds, rather than using a breast pump.

It seems the engorgement developed because the baby couldn’t breastfeed properly.

Moreover, since this is her first pregnancy, she might not be as skilled with pumping.

With these considerations in mind, I went to interview the patient.

When I asked about the lochia, the patient recalled the details.

“The color of the lochia? It’s brown now. There’s no mucus or foul smell.”

Lochia initially discharges as red, then gradually changes to brown, yellow, and white, disappearing over time.

The patient’s lochia was brown, fitting for the seventh day postpartum.

She also said there were no other unusual symptoms.

There was no lower abdominal pain, and pressing on the uterus didn’t cause any discomfort.

‘Then it doesn’t seem like a genital infection.’

“Any other discomforts?”

“Well… my back hurts, and my wrists are sore too.”

She sighed, explaining that it was likely from bending over to pump and twisting her wrists.

Before birth, a hormone called relaxin is secreted, which loosens ligaments.

Thanks to this, the pubic symphysis joint loosens, aiding in delivery. However, because other joints also loosen, it becomes a cause of postpartum pain, commonly known as “postpartum wind.”

The findings from the interview regarding breast engorgement were a bit unclear. It wasn’t quite at the level of mastitis yet, but both breasts were definitely engorged.

“Mrs, you mentioned that the pumping interval is 4 hours. Even though it hurts and is difficult, you should pump every 2–3 hours consistently.”

“They’re so swollen and painful that even touching them hurts. It’s hard to pump every 2 hours.”

“Still, in order to relieve the engorgement, that’s the only way.”

The fundamental solution for both breast engorgement and mastitis is more frequent breastfeeding. Particularly, the breast with mastitis should be breastfed more often.

If breastfeeding is stopped due to pain, the pain and inflammation can worsen, potentially leading to an abscess.

If breastfeeding doesn’t resolve it, anti-inflammatory drugs, painkillers, and antibiotics are used.

For breast engorgement, antibiotics aren’t needed, but for mastitis (inflammation of the milk glands), a bacterial culture of the milk is done, and appropriate antibiotics are prescribed.

* * *

“Dr. Yi-won, what was the patient’s temperature this morning?”

“Yes, professor. It was 37.3°C.”

During the morning rounds, I listened to the conversation between Professor Bu and Lee Yi-won, while my heart sank.

At this temperature, no treatment is needed yet. It’s not high enough to justify ordering tests at this point.

‘I think tonight might be when the breast engorgement progresses into mastitis.’

If that’s the case, the treatment would involve recommending more pumping, and if that doesn’t resolve it, painkillers and anti-inflammatory drugs. If that still doesn’t work, antibiotics would be the next step.

In other words, I agree with the treatment plan from both the eastern and western medical professors.

‘Even if I know the future, some things can’t be helped…’

Finally, the shift began.

By evening, Ryu Ji-hye began complaining of high fever and chills.

Her temperature quickly rose above 38.5°C.

Soon, she began to complain of body aches as well.

“Ugh… my muscles ache all over and my back hurts.”

In an emergency, Lee Yi-won and the nurses continued to come and go from the patient’s room.

But the fever only fluctuated and didn’t fully subside.

Before I knew it, it was past midnight.

At the ward station, Lee Yi-won, with a haggard face, made the decision.

“There’s no response to the pain-relieving and anti-inflammatory medication… I’ll order an emergency blood test.”

I, too, anxiously checked the patient’s future records during the occasional breaks.

The future still only showed a few days ahead.

Mastitis isn’t a rare condition, and it’s certainly not one that can’t be treated.

So why is it not resolving easily to the point where the future is uncertain?

I nervously rubbed my temples.

Then, suddenly… I stopped my hand.

“Could it be?”

A newborn with jaundice who can’t nurse properly.

Breast engorgement caused by awkward pumping.

A mother complaining of wrist and back pain from pumping.

“Could it be that everyone missed the truth because their attention was clouded by these factors?”

Let’s not focus solely on the fact that she’s a mother, but rather look at it from a broader perspective.

Sudden high fever, chills, and lower back pain.
What can we consider then?

“Dr. Lee Joon?”

I rushed out of the station and ran to the patient’s room.

The feverish mother was being attended to by her mother, the restaurant lady.

“Mrs, I need to perform an examination.”

“An examination…?”

“Please show me your back.”

The mother, confused, allowed me to place the back of my hand on her lower back.

Then, with my other hand, I clenched a fist and tapped it gently on the back of my hand.

“Ah! That hurts!”

Ryu Ji-hye immediately reacted sharply.

I found it. The cause.

“Dr. Lee Yi-won.”

I returned to the station and called out to Lee Yi-won.

She was about to call the resident physician in obstetrics to request the emergency blood test.

“Please request both blood and urine tests.”