Cha Sujin stared at Taeho as if she were looking at a ghost.
Taeho nodded.
“I have an idea what it might be.”
“Two years ago, I went to Da Nang, Vietnam, with my family.”
“You ate a lot of local street food then, didn’t you?”
“Yes. I’ve always loved Vietnamese food. Banh mi, pho… I ate a lot.”
“Then did you also eat at markets or street stalls where there was nowhere to wash your hands?”
“I did. A lot of local places have poor sanitation. There were many times when I just wiped my hands roughly with wet wipes and ate.”
Taeho’s suspicion had solidified, but to be certain, he tapped Rema lightly.
-I will scan the patient.
-Analyzing…
Even as that went on, Taeho continued taking her history.
“Attorney, up until now, you’ve only been receiving Botox treatment for essential blepharospasm, correct?”
“That’s right. At first it worked, but these days it doesn’t even last two months. Since six months ago, my hands have been trembling too, and I can’t concentrate…”
“And you were only told it was because of stress?”
“Yes.”
A term surfaced in Taeho’s mind as if a text message had arrived.
Neurocysticercosis.
Was this the effect of his heightened intuition?
But when diagnosing a patient, one had to use every possible method to increase accuracy. He couldn’t make a diagnosis on suspicion alone.
Just then, Rema produced its result.
-Strong suspicion of calcified neurocysticercosis, with three calcified cysts visible in the basal ganglia region.
-MRI required to confirm whether active cysts are also present.
As expected, I wasn’t wrong.
Taeho spoke in a more confident voice.
“I don’t think this is simple blepharospasm. There’s a possibility it may be neurocysticercosis.”
Cha Sujin looked utterly baffled.
“Neurocysticercosis? Are you saying it’s a parasite?”
“It’s still a hypothesis. In hot regions like Da Nang, street food in particular is often contaminated with human feces. Eggs from the pork tapeworm can be mixed in. If those eggs enter the body, they hatch in the intestines, and the larvae travel through the bloodstream to the brain, where they form cysts.”
“My brain?”
Cha Sujin swallowed her breath.
The thought that she had been harboring parasites in her head for two whole years suddenly sent a surge of fear through her. She had thought there wasn’t much that could frighten her, but parasites inside the brain were on an entirely different level.
But she was a seasoned attorney. The more intense her emotions became, the colder her expression grew.
“Then do I need brain surgery? Or am I supposed to just wait until the neurocysticercosis destroys my brain?”
Cha Sujin imagined herself lying in an operating room while someone dug around inside her skull, and took a deep breath.
Taeho smiled as if telling her not to worry.
“Most cases can be completely cured with medication. It depends on the number of cysts, but we use an oral drug called albendazole, and sometimes combine it with steroids to suppress the inflammatory response. If there are many cysts, we may also use a drug called praziquantel.”
“It can be treated with pills?”
Cha Sujin let out a sigh without realizing it.
Something that could be treated so simply—had she really spent all this time getting Botox injections instead?
“What matters is confirming the diagnosis. Attorney, were you planning to return to Seoul today?”
“No. I was planning to stay overnight. I have another matter near Gangneung tomorrow morning.”
“Then let’s do this. Our clinic has a CT scanner, but we don’t have high-resolution equipment like an MRI. We’ll take a brain CT today to check for calcification, and I’ll schedule an MRI for you at Samcheok Medical Center tomorrow. We’ll also request a serum EITB antibody test.”
“But a primary clinic has a CT scanner?”
Cha Sujin’s eyes widened.
Taeho answered with a smile.
“It’s difficult to get approval for one in newly built clinics these days, but equipment brought in long ago can still be used.”
“Ah. Then when will the test results come out?”
“The CT will be available this afternoon, the MRI images tomorrow night, and the antibody test in three days. If my assumption is correct, we’ll see small cysts and calcified lesions near the basal ganglia.”
“Good. Then can we do the test right now?”
Cha Sujin wanted to move the test up even by a single minute. She felt that only after confirming her eyelid twitching was due to a parasite would she be able to sleep tonight.
Taeho nodded.
“Of course.”
***
“Attorney, the CT results are out.”
Cha Sujin looked at the film with a tense expression.
“This white dot… So you’re saying this is evidence that there’s a parasite in my brain?”
“Yes. It’s a calcified cyst. The shell of a dead parasite has hardened into a lump of calcium. Fortunately, it’s small, and there’s almost no surrounding brain edema.”
Cha Sujin looked considerably relieved.
“I had an MRI and everything before. Why didn’t they find it then?”
“Depending on technical issues or the characteristics of the lesion, they may have failed to detect it. Also, if they weren’t suspecting neurocysticercosis from the beginning, it could be difficult to find. Even if a white dot about five millimeters wide appears in the basal ganglia, they might think it’s just nonspecific calcium rather than calcification.”
So a diagnosis could differ this much depending on the hospital—no, depending on the doctor in charge.
Then again, it was the same for attorneys.
Depending on how the same case was interpreted legally, and which laws were applied, victory and defeat could be reversed completely.
Cha Sujin wondered if it had been fate that she met a doctor named Kang Taeho in this remote region today.
If she had not taken on this case in the first place, she would never in her life have received treatment at this small clinic called Geumsan Clinic.
There was still one question left. Cha Sujin asked cautiously.
“But isn’t it too late, after two years? Even if I receive treatment, will there be side effects? Since you said it’s my brain…”
“If calcification remains, epilepsy can occur in rare cases, but even if we treat it now, the cysts can be eliminated and your symptoms should improve significantly. Don’t worry.”
“Director. Thank you so much!”
Cha Sujin was sincerely grateful.
If it had not been for Director Kang Taeho, she would have spent her whole life suffering from eyelid twitching without knowing why, getting Botox injections over and over. She would have assumed her worsening concentration was due to aging and given up.
Just thinking about it was horrifying.
The only way she could repay him was to fight with all her might for Director Kang Taeho.
For his sake, she would win no matter what!
Cha Sujin clenched her teeth and steeled her fighting spirit.
“Then I’ll contact you again as soon as there’s progress on the case you entrusted to me.”
“Yes. Please be careful on your way. And make sure to stop by Samcheok Medical Center tomorrow.”
“I will. Thank you, Director Kang Taeho.”
With the grim expression of a general heading onto the battlefield, Cha Sujin left Geumsan Clinic.
***
Three in the morning, the temporary laboratory on the second floor of Geumsan Clinic.
Gihwan was hunched over the microscope again today. The temporary laboratory, barely six pyeong in size, just managed to hold sterilization equipment, an emergency fire extinguisher, and a waste disposal container. The space was so cramped that one could barely squeeze between the equipment.
“Another failure.”
Gihwan sighed as he checked the HPLC analysis results. The purity of the TNF-alpha inhibitory protein was stuck at 62%. It was far below the minimum purity of 85% needed for Park Seong-u’s treatment.
On the lab bench lay samples from multiple failed attempts. He had repeated column chromatography three times, but the purity would not rise any further.
“There’s a limit to what I can do with this equipment.”
Gihwan muttered.
If the R&D center had been completed, he could have used a high-resolution FPLC system and multistage purification equipment, but for now, all he had was simple column chromatography and basic analytical devices.
The research institute would be completed in May of next year. If he waited until then, he would be able to conduct proper research.
But the problem was that Park Seong-u’s condition did not seem likely to hold out until then. He was receiving treatment even now, but recently his condition had been deteriorating at an alarming rate.
The issue was stamina. To overcome the illness, he needed sufficient physical strength, but Park Seong-u’s body had been ruined by his long period of homelessness.
Since yesterday, he had been unable to even get out of bed because of the pain in his legs.
“Mr. Gihwan, are you still researching?”
Taeho opened the laboratory door and came in.
“Director. Why aren’t you sleeping at this hour?”
“I couldn’t sleep. How is it going?”
Taeho, too, was deeply troubled because he was worried about Park Seong-u’s condition.
Gihwan could not hide his frustration. He let out a sigh and confessed.
“I keep getting stuck at 62% purity. Even if I change the column, even if I change the buffer solution, it won’t go any higher.”
Taeho looked around the laboratory.
Gihwan’s lab notes, the reagents used, the equipment arrangement…
He had a strong feeling that the approach was wrong at some fundamental level.
What is it?
He had never once had this feeling before when he came to the laboratory.
Taeho soon realized the reason.
It was thanks to his improved intuition.
“Dr. Gihwan, wait a moment.”
Taeho examined the lab notes closely. As he read down the page, one section caught his eye.
“This part. Looking at the protein expression conditions, something seems strange.”
“Which part?”
Gihwan tilted his head.
To gain a little more certainty, Taeho tapped Rema lightly and said,
“You incubated it at thirty-seven degrees, right? But doesn’t TNF-alpha inhibitory protein originally become more active in an environment lower than body temperature?”
Rema understood Taeho’s intent and produced an analysis.
-Correct. The optimal expression temperature for TNF-alpha inhibitory protein is 32 degrees Celsius. At 37 degrees, the protein structure partially denatures and activity decreases.
Gihwan’s eyes widened, and he slapped his knee.
“That’s right! I was only thinking of general protein expression conditions. This protein is special.”
To Taeho, the problems began appearing one after another, as if a fog that had been clouding his vision had lifted.
Was this the power of intuition?
It was a sensation so intense that even he was surprised.
“With our current equipment, large-scale purification is difficult. I think we need to change our approach to small-batch, high-purity purification.”
“Small-batch, high-purity?”
When Gihwan asked back, Taeho felt an inner certainty that this was exactly what they had to do.
“We make a customized protein specialized only for Mr. Park. Not a general-purpose therapeutic agent, but a protein optimized for his immune profile.”
“Is something like that possible?”
Gihwan asked again.
Taeho tapped Rema lightly once more and said,
“Well… If we analyze Mr. Park’s blood sample, wouldn’t it be possible to modify the protein so it’s optimized for him?”
Rema immediately began its analysis.
-It is possible. Taking patient Park Seong-u’s HLA type and cytokine profile into consideration, binding affinity can be improved by 40% through three amino acid substitutions. In this case, even at 70% purity, it will produce therapeutic effects equivalent to the standard 95% purity.
After hearing Taeho’s words, Gihwan thought in silence for a moment, then exclaimed in admiration.
“Personalized medicine! Then we can make it with the equipment we have now. Hah, why didn’t I think of that until now…”
Gihwan, who had been called a genius since childhood, found it strange that he could even have such a thought. Taeho, who had only briefly looked around, had grasped the problem and come up with a solution far faster than he had, despite the fact that he had been holed up in the lab the entire time.
Director Kang Taeho really is a genius after all.
Gihwan decided to think of it that way. But then…
“Uh, Director, are you all right?”
Gihwan shouted in shock.