Chapter 54

Episode 54 Chaotic First Academic Conference (3)

With the presenter’s final "Thank you," courtesy applause filled the seminar room. I clapped my hands a few times, completely devoid of soul.

Finally, it's over.

The Old Professor serving as the moderator grabbed the microphone.

"Yes, we will now have a five-minute Q&A session. Anyone with questions, please raise your hand."

"Ah... yes, thank you for the wonderful presentation. I am Lee Hyeonwoo from Ajou University Hospital. I was just wondering about the patient's average duration of hospitalization and the follow-up period after discharge..."

Hmm, should I criticize this presentation?

Latte is Mine: Hell Slave. Now is the time.

Korean Slave 1 (Male): Now is the time for what?

Cardiology Ghost: Go, go, quickly! Become the disruptor of the conference, Hell Slave.

Hematoma is Hell: Smash that bogus diagnosis into pieces! There is no mercy in academics!

Korean Slave 1 (Male): Tell me exactly what and how I should ask first;; Just let me know that. I can't just suddenly sprint up to the stage and shout, 'Hey! You're wrong!'

As if they had been waiting for my desperate plea, the crazy mentors in the Gallery began issuing highly specific and vicious tactical orders.

Cardiology Ghost: You have to frame it as a question. Never make a definitive statement. Maintain the stance until the bitter end of: "I am a total nobody so I don't know much, but I am curious if there is any possibility of this, so I would like to ask for the esteemed presenter's insights," rather than "You are wrong."

Hippocrates' Descendant: Correct! It's about beating the opponent to a pulp while wearing the mask of academic humility!

Cardiology Ghost: Say it like this: 'Looking at the echocardiogram image you showed earlier, unlike the textbook findings of Takotsubo cardiomyopathy, the apical myocardium appears abnormally hypertrophied. I would like to ask for the presenter's valuable opinion on whether you have considered the possibility of apical hypertrophic cardiomyopathy, another disease that must be differentiated, which might have been exacerbated under stress conditions.'

Damn, that is perfect.

"Hey, let’s seriously get out of here now. This is boring." Kim Jihun tugged at my arm.

"No, I have a question to ask."

"What?"

Leaving behind Kim Jihun’s dumbfounded expression, I shot my right hand straight into the air.

As the previous questioner took their seat, the moderator professor, who was looking around for the next question, locked eyes with me.

"Are you crazy? What's wrong with you? Hey, put your hand down!" Kim Jihun freaked out beside me and tried to pull my arm down, but it was too late.

"Yes, the teacher wearing glasses over there. Please state your affiliation and name, and ask your question."

"Ah, yes. Hello. I am Han Hyeonjae, a 1st-Year Resident in Emergency Medicine at Cheongjin University Busan Medical Center."

At my introduction, the eyes of several professors sparkled with interest.

"Thank you for the excellent presentation. Before my question, would it be possible to see slide number 12 again, specifically the echocardiogram image you showed earlier?"

At my request, a subtle look of embarrassment brushed past the faces of both the moderator and the presenter at the same time. However, there was no justifiable excuse to refuse. After all, there was no hidden intent behind my question yet. It was merely a request to see the image again.

The presenter manipulated the laptop to display the image in question on the screen.

The air in the seminar room changed subtly. It had been shifting from the exact moment a 1st-Year Resident pinpointed and requested to see a specific slide again. I felt that shift with my whole body.

Most notable was the change in the gaze of a few professors sitting in the front row. Two or three silver-haired old professors, who had been hesitating whether or not to raise their hands with boring expressions just a moment ago—their faces now lit up with a look that said, 'Oho, look at this kid?'

Shit. Don't stare like that, it's a lot of pressure.

If they watched me with such intense stares, it felt like even my heart would start trembling. I screamed on the inside.

After clicking the mouse a few times, the presenter grabbed the microphone.

"Yes. Just a moment... Here is slide 12 as requested."

"Ah, yes. Thank you, Teacher."

I repositioned the microphone with a trembling hand. My heart was thumping loudly.

Whew. Let’s calm down. Calm down.

"Thank you again for the wonderful presentation, Teacher. Since I am a low-year resident still in the learning process, I might have missed something basic, so I would like to ask one thing to help my understanding."

I lowered myself as much as possible. This was the teaching of the Cardiology Ghost.

"First, I would like to ask if you have separate data measuring the apical myocardial thickness during cardiac diastole on the patient's echocardiogram image."

Thickness.

The moment I put strength into that word, I saw the corner of one professor's mouth in the front row faintly curl upward.

I continued talking.

"Textbook-wise, if it were myocardial paralysis caused by stress, the muscle in that area should stretch out and become thinner than normal. However, when I looked at the image earlier..." I paused for a moment and pointed at the screen. "...to me, it looked like the muscle toward the apex was actually thicker than other parts of the heart..."

Finally, I appended the magic sentence to wrap this entire attack into a harmless, innocent question.

"...Of course, it is highly possible that I saw it wrong due to my lack of experience."

This was the sentence. It operates on the same logic as beating someone to a pulp and then saying, "My goodness, I have learned a valuable lesson from you!"

As my words ended, a one-second silence gripped the seminar room. And breaking that silence, a wave of whispering voices from everywhere came rushing in.

"Thickness?"

"Huh? Now that he mentions it, he's right."

"Look at that image again. It's true. Why is the apex so thick?"

People began to murmur. Low groans of realization popped up here and there. Truths that had been invisible just a moment ago were beginning to surface.

On the stage, the presenter's face had gone completely pale. Alternating their gaze between the screen and me, they couldn't utter a single word.

Uh, did their mental state completely shatter?

"Diastolic thickness?"

The presenter's mouth puckered a few times before a strained voice barely leaked out of their throat.

"Uh... well... uh... so..." The presenter broke into a cold sweat, desperately racking their brain. "Ah... that... because it was such a classic case of apical ballooning in Takotsubo cardiomyopathy, we didn't... separately measure the myocardial thickness."

The moment that answer came out, the air in the seminar room chilled to ice once again.

'We didn't check because it was classic.'

It was the most dangerous and arrogant statement a doctor could ever utter.

"Ah, I see. Thank you for the detailed answer despite your busy schedule. Then, as an additional question, I would also like to ask if there were any findings strongly suggestive of myocardial hypertrophy, such as giant T-wave inversions, in the precordial chest leads from V2 to V4 on the patient's initial EKG."

Giant T-wave inversion.

The moment that term left my mouth, the eyes of the professors sitting in the front row flashed.

"Uh... well... uh..."

Color completely drained from the presenter's face.

"Ah, I was about to ask that."

"There was a T-wave inversion. But was it that deep?"

An immense wave of murmuring exploded from everywhere. The moderator professor grabbed the microphone.

"Presenter, hold on a moment. Pull up the EKG slide again."

With a face on the verge of tears, the presenter moved a trembling hand to display the initial EKG picture on the screen. The moderator professor stood up from his seat and pointed at a section of the screen with a laser pointer.

Leads V3 and V4.

In those leads, just as I had accurately pointed out, sharp, deeply carved, inverted T-waves were clearly stamped.

"The T wave... is inverted. The depth... looks to be well over 10mm." The moderator turned off the laser pointer and turned his head toward me. "Uh, the 1st-Year Resident Han Hyeonjae from Cheongjin Medical Center Busan Hospital who asked the question. Do you happen to have any additional comments or further questions regarding this finding?"

Every gaze in the seminar room converged on me once again. I adjusted my grip on the microphone. The whispering voices from all around reached my ears with crystal clarity.

"Apical HCM?"

"An EM 1st-year caught that at a glance?"

"Asung Hospital is a thing of the past now. Coming to present while missing something that basic."

"Tsk tsk, he's throwing mud straight at his supervising professor's face."

"Did the supervising professor even review this? They just let this pass?"

Trying my best to ignore the words floating around, I began to offer my own loyal advice, exactly as the Cardiology Ghost had coached me.

"Ah, yes. In my short opinion, rather than Takotsubo cardiomyopathy, this case should probably first consider the possibility of an acute exacerbation of apical hypertrophic cardiomyopathy. If it is indeed Apical HCM, the patient is always carrying a risk of sudden death. Therefore, it seems necessary to contact the patient as quickly as possible, have them revisit the hospital, and take measures for close examination, including a cardiac MRI..."

The moment my words ended, a heavy silence settled over the seminar room.