A competent doctor can cure everything - Chapter 76

“Urine test?”

An unexpected request from the intern who suddenly disappeared and then reappeared.

Lee Yi-won asked Lee Seon-Joon in disbelief.

“Yes. I just checked the patient’s CVA tenderness, and there was a reaction on the left side.”

“!!”

CVA (costovertebral angle) tenderness, also known as rib-spine angle tenderness.

The costovertebral angle refers to the angle between the lowest rib and the spine.

This angle is important because the kidneys are located here.

If there is pain when this area is tapped or struck, it is considered CVA tenderness.

In this case, acute pyelonephritis, kidney stones, or other urinary tract diseases are suspected.

‘How on earth did he think to check that?’

Pyelonephritis refers to an infection of the kidneys caused by bacteria.

Symptoms include high fever, chills, muscle aches, and pain in the lower back and sides.

Painful urination, a feeling of incomplete urination, and frequent urination are also common symptoms.

The patient is a postpartum woman who has been suffering from breast engorgement.

Lee Yi-won had naturally only considered the typical possibilities related to that.

Moreover, the patient did not report symptoms that suggest a urinary tract infection, such as painful urination or a feeling of incomplete urination.

‘Honestly… I never thought of it at all.’

So, Lee Yi-won had focused solely on the three major causes of postpartum fever.

Among them, there were actual symptoms of breast infection.

Given the situation, it was hard to think beyond the narrow perspective.

‘And it’s not like he spent days trying to figure it out… He figured it out right away?’

Lee Yi-won, feeling close to shock, managed to regain composure.

At this point, providing the correct treatment to the patient was more important than admiration.

She flipped through the duty roster and called the Western medicine resident.

“Hello, this is Lee Yi-won, a first-year resident from the Department of Obstetrics and Gynecology. I have a patient…”

After receiving the consultation order, emergency blood and urine tests were quickly conducted.

Early the next morning, Lee Yi-won checked the test results in the obstetrics office and was once again astonished.

‘There’s actually inflammation in the urine?’

If it were mastitis, there shouldn’t be any inflammation in the urine.

What was even more surprising was that the inflammation levels in the blood weren’t that high.

Honestly, after seeing these blood test results, she wouldn’t have suspected pyelonephritis either.

She probably would have just assumed it was due to mastitis or postpartum conditions.

“Sigh… What is with that intern, seriously?”

Lee Yi-won muttered to herself as she stood alone in the office.

At this point, her pride wasn’t even hurt.

Only when there’s some semblance of competition does jealousy arise.

This was a clear defeat for her, with no room for excuses.

* * *

The next morning.

After completing the morning briefing, Lee Yi-won waited anxiously.

“……”

The first-year resident, Lee Yi-won, was nervously anticipating whether the associate professor would get angry.

And standing quietly next to her was intern Lee Seon-Joon.

Both were waiting for Professor Bu Yeo-jung to speak.

“Who was it?”

“?”

“I mean, who thought to check for CVA tenderness?”

After a moment of silence, Professor Bu finally spoke.

In response to the professor’s question, Lee Yi-won glanced at Lee Seo-Joon instead of answering.

“I checked, Professor.”

Lee Seon-Joon calmly explained the situation.

“How did you think of that?”

“I think I was too focused on the fact that the patient was a postpartum woman, so I decided to change my diagnostic approach. Once I considered it without that context, I thought CVA tenderness should be checked.”

Lee Yi-won was worried she might get scolded by Professor Bu Yeo-jung for missing the diagnosis, but her fears were unfounded.

Professor Bu Yeo-jung had no words to say either.

After hearing the first part of the briefing, she had naturally assumed it was mastitis.

So, she was shocked when Lee Yi-won mentioned that there was CVA tenderness.

“To be honest, even I would have had a hard time diagnosing this. If the fever hadn’t subsided after a few days of treating for mastitis, then I would have reconsidered the diagnosis.”

Upon Professor Bu Yeo-jung’s confession, both Lee Yi-won and Lee Seon-Joon widened their eyes.

To hear such words from a professor known for her strong pride and charisma was surprising.

But what Professor Bu said next was even more surprising.

“Lee Seon-Joon, I apologize for dismissing you just because you’re an intern. From today, I’d like you to take over as the attending physician.”

“……?!”

“Both postpartum woman Ryu Ji-hye and patient Jo Na-kyung specifically requested you as their attending physician. From today, you’ll be responsible for both of them.”

“Thank you. I’ll do my best.”

“No, I should be the one thanking you. You’ve made a huge difference for my patients.”

That statement was true.

If only the blood test had been done in the early morning, she would have been reassured by the relatively low inflammation levels.

She probably would have thought it was just a simple case of mastitis and continued monitoring while doing breast pumping.

However, after detecting inflammation in both the urine and the CVA tenderness, the correct diagnosis could be made.

After the morning rounds, Lee Yi-won immediately placed a consultation order.

Normally, she would have requested a consultation with the obstetrics department, suspecting mastitis.

But instead, Yi-won wrote a referral to the nephrology department.

* * *

The postpartum woman and her family returned to the ward after seeing the nephrology outpatient department.

They then conveyed the message to their new attending physician, Lee Seon-Joon.

“The nephrology professor was really surprised. They asked how we thought of referring here. They said it’s a miracle that we caught this early because my symptoms weren’t typical.”

“That’s right. My daughter almost suffered for a while, but they said we came in at the right time.”

The postpartum woman’s mother, a restaurant owner, looked at Lee Seon-Joon with eyes full of gratitude.

“Doctor, how did you know?”

At those words, Lee Seon-Joon simply smiled without answering.

* * *

The next day.

The causative bacteria were identified through a urine culture, and once the correct antibiotic was administered, the postpartum woman’s fever quickly subsided.

“Doctor, thank you. You treated my back pain during pregnancy, and after childbirth, you found my pyelonephritis…”

“Now that I think about it, meeting Dr. Lee Seon-Joon has truly been a great blessing for our daughter.”

It was now time to visit Ryu Ji-hye as her attending physician.

The two women kept thanking me for a long time, not easily letting me go.

Then, Ryu Ji-hye looked at my face with an apologetic expression.

“Doctor, I’m sorry to bother you again, but could you look at one more thing for me?”

“Bother me? Not at all. What is it?”

“Well, my skin looks like this.”

Ryu Ji-hye, with her mother’s help, showed me the back of her shoulder.

“This is…”

A salmon-colored rash was unevenly spread across her skin.

“Yesterday, the massage therapist who came to see me found it. She said she had seen a lot of cases where postpartum women developed this kind of rash, and that oriental medicine treatment was more effective than Western medicine. She suggested I ask my attending physician about it.”

“I see.”

“I’m worried it might affect my breast milk, so I don’t want to take Western medicine if I can avoid it. Do you think oriental medicine can help?”

I began taking her medical history as she looked worried.

“Is this area itchy?”

“Yes. It’s not too severe, but it itches, especially at night.”

“Is it just here, or is it elsewhere?”

“Yes, it seems to be just here on my shoulder.”

The diagnostic algorithm of Professor Bu Yeo-jung began to work in my mind.

First, the category should be ‘pregnancy and postpartum pruritus.’

This can be divided into cases with only itching, cases with a rash, and cases with blisters or discharge.

The first thing to consider is atopic dermatitis or cholestasis of pregnancy.

However, the patient didn’t have a history of atopic dermatitis, and the blood test didn’t show any increased bile acids.

Excluding these factors, Western medicine has not clarified the pathogenesis of pregnancy pruritus.

However, in traditional Korean medicine, this condition is classified as “Imsin Sinyang” or ‘pregnancy-induced itching’.

For women who are typically blood-deficient, pregnancy worsens this deficiency, making it the underlying pathology of pregnancy pruritus.

Considering factors such as the form of the rash, the severity of itching, skin dryness, and other factors, the diagnosis can be divided into three main categories:

1. Blood deficiency type
2. Wind-heat type
3. Ying-wei disharmony type

“Considering the salmon-colored rash, the worsening itching at night, and the patient’s pale complexion…”

A prescription immediately came to mind.

The current prescription is Shenghua Tang, which helps with uterine contractions and the expulsion of lochia in the early postpartum period.

It was just the right time to change the herbal formula.

The next formula I had considered was Bocheo Tang, a basic prescription for treating deficiency caused by postpartum qi and blood insufficiency.

“Although it’s a safe formula, it’s not strong enough to treat postpartum pruritus.”

To change the prescription, I would first need to get confirmation from Professor Bu Yeo-jung.

I went directly to look for her.

I didn’t have to go to the professor’s office or outpatient department; I ran into her at the ward station.

When I mentioned the postpartum woman’s skin rash, the professor asked me a question.

“It’s really common for women who’ve never had skin issues to develop hives or rashes after childbirth. Why do you think that happens?”

“I think it’s because the blood deficiency has worsened, or in other words, it’s an immune system issue that arises when the body’s strength decreases postpartum.”

“You always pick the right answers. Where do you find the time to study? You seem so busy with work.”

Her mention of being “busy with work” seemed to refer to the team doctor duties.

I just smiled quietly at her compliment.

“So, what’s your diagnosis and prescription?”

“I’m diagnosing it as blood deficiency type pruritus and would like to add Danggui Yinzi to the prescription.”

“Why? As I always say, if you can’t explain it clearly to others, then it’s not really your knowledge.”

“I didn’t think it was the wind-heat type because the rash wasn’t red or large, and there were no obvious scratch marks from intense itching. It also didn’t seem like Ying-wei disharmony because the skin wasn’t overly dry, and there was no darkening around the eyes.”

“Hmm.”

“And Danggui Yinzi is used to moisturize the skin and is commonly used for atopic dermatitis or allergic skin conditions. The formula contains blood-tonifying herbs like Angelica, Peony, and Chuanxiong, making it suitable for blood deficiency type pruritus.”

I finished speaking and looked closely at Professor Bu Yeo-jung’s expression.

Satisfaction appeared in her eyes.

“That’s a perfect answer, no need for me to add anything. Go ahead and change the prescription.”

Just as I was about to leave after saying goodbye, the professor suddenly spoke.

“By the way, have you ever thought about joining obstetrics and gynecology?”

“Ah… I haven’t really thought about it deeply yet.”

“That’s fine. No need to beat around the bush. Being a man doesn’t make a difference when seeing patients, but our department only accepts women. I can’t even remember the last time we had a male resident.”

The professor grumbled and then asked a rather odd question.

“Do you have a romantic partner?”

“?”

“I have a daughter, and she looks like me, so she’s not bad looking.”

I could feel the eyes of those around us shift in my direction.

No way. That strict professor couldn’t possibly be saying this…

“Would you be interested in meeting her?”

I was doomed. Of all places, this had to happen at the station.

Soon, the news would spread quickly through the whole hospital, like a neuron signaling, thanks to the nurses.

I quickly rejected the idea, but it was already too late. I could see the nurses’ lips curling in amusement.

And, as expected, it didn’t take long before I was given the nickname “Tangerine Son-in-law” (potential son-in-law)…