In the taxi from JFK Airport to Manhattan, Taeho first came face-to-face with Mount Sinai Medical Center. Enormous hospital buildings towered over Manhattan’s Upper East Side.
In terms of bed count, Mount Sinai Hospital was a little smaller than Seyoung Seoul Hospital, where Taeho had done his residency. But the Mount Sinai Health System was one of New York’s major hospital networks, comprising eight hospitals. In total beds, medical staff, and clinical performance, there was no comparison.
As soon as Taeho arrived at Mount Sinai Hospital, he went straight to the nurses’ station in the neurosurgery ward.
“I’m here to see Dr. Lee Junbeom. I’m Dr. Kang Taeho from Korea.”
“Ah, you’re the consultant from Korea, right?”
The nurse, who had already received a note from Chief Lee Junbeom, confirmed it.
“Dr. Lee’s office is that way.”
Following the direction the nurse indicated, he was able to meet Chief Lee Junbeom.
The moment Chief Lee Junbeom saw Taeho, he clasped his hands in both of his.
“You must have had a difficult trip coming all this way, Director Kang.”
“Not at all. How is Junho?”
“As I told you, the situation isn’t good.”
Professor Lee Junbeom sighed and furrowed his brow. He looked ten years older than he had during the video conference. It had to be because of his son’s illness.
“First, you should meet Dr. Chen.”
The reason Chief Lee Junbeom was deliberately introducing Dr. Chen first was that Dr. Chen was Lee Junho’s attending physician. SSPE fell under neurology, so Lee Junbeom, the chief of neurosurgery, had no choice but to rely on Dr. Chen of the neurology department.
When Chief Lee Junbeom opened the door to the conference room, five or six members of the medical staff were seated around a round table.
Dr. Chen, whom Taeho had met during the first video conference, stood up to greet him.
“Dr. Kang, you’ve finally arrived. Welcome. I didn’t realize during the video conference, but you’re much younger than I expected. Let me introduce everyone. This is Dr. Johnson, our associate professor, and over there is Dr. Patel, our assistant professor.”
The expressions on the other doctors’ faces did not look particularly welcoming.
Dr. Johnson nodded perfunctorily, and Dr. Patel spoke outright.
“Dr. Chen, we already discussed this in the meeting. This isn’t appropriate.”
“I also don’t think it’s advisable for a non-specialist to get involved in such a complicated SSPE case.”
The young fellow, Dr. Williams, added a remark with an uncomfortable expression.
Chief Lee Junbeom spoke firmly, his face set.
“As the patient’s father, I want to try every possibility. And Dr. Kang is an exceptionally skilled physician.”
Dr. Johnson sighed and said,
“I understand how you feel, Chief. But this isn’t a matter of emotion. It’s a neurology case, so we have to be responsible for it.”
“I’m personally sorry, but we’ve already tried every standard protocol. Interferon, ribavirin, even inosine pranobex.”
Dr. Patel crossed his arms and replied sharply.
“That is precisely why I brought in someone new. Because we’ve tried everything.”
Perhaps because it concerned his own child, Chief Lee Junbeom did not back down either.
“Whoa, whoa.”
Dr. Chen raised both hands.
“We’re not saying we should hand the patient over to a doctor who just flew in from Korea. We’ve made countless efforts up to now, and at this point, we’ve hit a wall and can’t move forward. Dr. Kang has a talent for looking at situations from a new perspective. Right now, we’re simply trying to borrow that exceptional perspective of his. Of course, we will continue to be the ones treating patient Lee Junho.”
Thanks to Dr. Chen’s eloquence, the atmosphere calmed somewhat.
For Taeho, who felt every minute and second was precious, he spoke carefully.
“Would it be possible for me to look at the chart? There may be things I missed through the video conference.”
“That’s…”
Dr. Williams had just begun to speak, his expression displeased.
Dr. Chen quickly wrapped it up.
“A chart review should be fine.”
As they left the conference room, Chief Lee Junbeom sincerely apologized to Taeho.
“I’m sorry for calling you all the way here only for you to be treated like this.”
“It’s all right. At least now I can begin.”
Taeho answered calmly. What mattered to him now was not saving face, but Lee Junho’s life.
***
Outside the window, Manhattan was radiating brilliant lights.
Inside the neurology ICU, Taeho silently watched over Lee Junho. Lee Junho’s chest rose and fell faintly, and his skin was as pale as a dead man’s. He seemed like an entirely different person from the lively young man Taeho had seen in Geumsan-ri not long ago. His SSPE had rapidly progressed from stage one to stage three.
Ordinarily, it would have been difficult in an American hospital for a patient’s guardian or family member to remain at the bedside until this hour. But Taeho had been granted exceptional permission to stay in the ICU in his capacity as a consultant. It was thanks to Chief Lee Junbeom’s efforts.
Taeho had already stayed by Lee Junho’s side for nearly twenty hours, observing his symptoms. During that time, Lee Junho’s condition had not improved at all.
Beside him, the latest monitoring devices traced curves in steady rhythms.
“What am I supposed to do?”
Taeho looked at Lee Junho on the hospital bed.
He had examined every chart recording Lee Junho’s condition and the course of treatment so far. Rema, after analyzing all the data, could only recommend the same treatments the medical team here had proposed. Taeho had continued trying to find another method using Rema, but he remained at a standstill.
He was anxious that if time continued to pass like this, he would lose Lee Junho.
“Haa…”
Taeho quietly opened the door of the hospital room and stepped out into the hallway.
Perhaps because the tension had eased, he felt thirsty. He took a bottle of water from the vending machine, drank a sip, and sat down in a chair. As the cold water ran down his throat, his mind gradually settled.
Just then, he noticed an elderly woman sitting in the chair across from him, reading a book. Her white hair was neatly pinned up, and the way she turned the pages looked remarkably serene.
As Taeho stared at her without thinking, the old woman lifted her head, and their eyes met.
The old woman asked in a gentle voice,
“You’re still at the hospital at this hour. Are you a doctor?”
“I’m not a doctor here, but yes, I am a doctor.”
“Is a family member ill?”
“Not family, but there is someone I want to save.”
“Both are very interesting answers.”
The old woman gazed at Taeho for a moment, then smiled quietly.
“It will turn out well. Don’t lose hope.”
At that moment, Taeho felt warmly comforted. It was only a brief instant, but the anxiety lodged in his chest seemed to slowly fade.
“Thank you. Are you a patient here, ma’am?”
“Just some ailments that come with old age, and my family was worried. I’m admitted for a day to get various tests done.”
The old woman waved her hand as she answered. Her casual attitude seemed so relaxed that Taeho, watching her, found himself smiling as well.
The old woman turned her eyes back to her book, and Taeho returned to the hospital room with his heart feeling somewhat lighter.
***
After returning to the room, Taeho quietly approached Lee Junho’s side.
“Let’s check everything again from the beginning.”
Taeho went back over every treatment the medical team had attempted. After checking multiple times through Rema, he found that the types of drugs, the timing of administration, and the dosages had all been appropriate.
Then why had there been no change? They had used the right medications…
At that moment, something flashed through his mind.
“Wait…”
Taeho hurriedly opened the chart again. He examined the blood test values one by one, then stopped.
“That’s strange. The blood concentration is within the therapeutic range…”
He felt as though he had missed something. But he did not know what it was.
Taeho went to the nurse and requested additional test results.
“Could I also see the cerebrospinal fluid test results, if there are any?”
The moment he received the test sheet the nurse brought him, Taeho’s face hardened.
“This can’t be…”
The drug concentration in the cerebrospinal fluid was almost at the limit of detection. The blood concentration was sufficient, but in reality, hardly any of the medication was reaching the brain tissue.
It was as if lightning struck inside Taeho’s head.
“The blood-brain barrier!”
He whispered to Rema.
“Rema, analyze the blood-brain barrier permeability of interferon and ribavirin immediately!”
—Analyzing…
A few seconds later, shocking data appeared as a hologram.
—Interferon-α blood-brain barrier passage rate: 2.1%
—Ribavirin blood-brain barrier passage rate: 4.8%
For a moment, Taeho was speechless.
Only 2%?
He checked the figures again. There was no mistake.
“This was the answer. This was the reason every treatment has failed until now!”
His heart pounded violently.
The medication had not been reaching its target because of the blood-brain barrier.
He had found the blind spot the Mount Sinai medical team had failed to see.
“Rema. Is there a safe way to open the blood-brain barrier?”
Data began scrolling rapidly before his eyes.
Taeho held his breath and waited for the result.
A moment later, one line of text appeared clearly.
—MR-guided Focused Ultrasound (MRgFUS)
“MRgFUS?”
—Technology status: FDA-approved, in clinical use
—Principle: Temporary opening of the blood-brain barrier using microbubbles and focused ultrasound
—Success rate: Over 95%
—Side effects: Mild, temporary symptoms in less than 5%
Taeho sprang up from his chair.
“With this method, the medication could be delivered properly to the brain!”
Taeho calmed his excitement and requested additional information from Rema.
“Rema, check whether Mount Sinai has this equipment!”
—Searching Mount Sinai Hospital equipment database…
A few seconds of silence passed.
Taeho’s heart raced.
And at last, the result appeared.
—Mount Sinai equipment confirmed: Insightec Exablate Neuro
—Location: Radiology Department MRI Suite 3
In that instant, Taeho clenched his fist.
***
Taeho burst out of the lounge and walked down the hallway almost at a run. His heart felt as if it would explode.
Dr. Chen had said he was on night duty today. He had to meet Dr. Chen.
Luckily, before he had to search long, he ran into Dr. Chen passing by with a chart in hand.
“Dr. Chen!”
Taeho called out urgently. Dr. Chen turned around with a startled expression.
“It’s midnight, and you still haven’t rested, Dr. Kang?”
“Dr. Chen, you know MRgFUS, don’t you?”
Dr. Chen paused for a moment.
“Of course. We use it at our hospital for brain tumor treatment. But why all of a sudden?”
“I think it can be used to open the blood-brain barrier. What do you think?”
Taeho’s eyes flashed. Dr. Chen’s expression stiffened for an instant.
“Are you suggesting we apply it to patient Lee Junho?”
Dr. Chen’s voice held both surprise and concern.
Taeho explained that the drugs had not been getting in because of the blood-brain barrier.
“Amazing. The blood-brain barrier…”
“At present, this is the only hope.”
Dr. Chen sighed and looked around.
“Dr. Kang. Your discovery is very impressive. But this method has never been tried for SSPE. The IRB won’t approve it.”
“But if we can raise the permeability from 2% to 95%, there is a chance his symptoms will improve.”
“Make the proposal formally tomorrow. It won’t be easy, Dr. Kang. No, it may be close to impossible. But…”
Dr. Chen looked at Taeho and spoke with a serious expression.
“Let’s do our best to persuade them. For that child’s sake.”
Just then, the hospital announcement rang out.
—Code blue, Neurology ICU Room 314. Code blue, Neurology ICU Room 314.
Room 314.
Lee Junho’s room.
Taeho and Dr. Chen started running at the same time.