In that instant, Taeho felt as if gravity had changed.
‘So this is what it feels like.’
A sudden heaviness in his right arm and leg. A sensation as though heavy stones had been tied to them.
But that wasn’t all.
‘Pressure in the head?’
He felt a strange pressure. As if something were slowly pressing down on his brain.
If it were ordinary ALS, there shouldn’t be a sensation like this…
ALS was a degenerative disease of the motor neurons. There was muscle weakness and atrophy, but it did not cause intracranial pressure or a feeling of pressure in the head.
Taeho focused more deeply. He tried to delicately catch the abnormal signals coming from the body.
‘To distinguish it precisely, something is pressing from the left rear side.’
The pressure began in the left occipital region and spread toward the right.
Taeho’s eyes flew open.
“Hup!”
“Director, are you all right?”
Principal No asked in alarm. Taeho’s expression looked pained.
Taeho drew in a rough breath and said,
“Mr. No, this isn’t ALS.”
“Pardon?”
No Seongjin and Principal No were both startled at the same time.
“What you’re feeling right now is pressure that begins in the left occipital region, isn’t it? As if something heavy is pressing down on your head?”
“Yes! That’s exactly what it feels like! How did you know?”
“Let me check one more thing.”
Taeho began carefully palpating No Seongjin’s neck and head. He was checking for traces of trauma or tender points.
Taeho’s fingers stopped at the left rear side of the neck. It was extremely subtle, but it felt slightly different from the other areas.
“Does it hurt here?”
“No, not really…”
But Taeho caught the minute change in No Seongjin’s expression. He had frowned for a split second.
Taeho asked,
“Have you suffered any major injury to your head recently?”
No Seongjin’s eyes widened, and his face stiffened for an instant.
Principal No also noticed the change in his son’s expression.
“Seongjin, did something happen?”
“Nothing happened.”
But Taeho was already certain.
He’s hiding something.
What could it be?
“Mr. Seongjin, there must be no secrets between a doctor and a patient. For an accurate diagnosis, you need to tell me everything.”
A heavy silence settled over the examination room.
No Seongjin shook his head.
“A secret? There isn’t one.”
Taeho suddenly realized he had asked the wrong question.
In this case, what he was hiding wasn’t important. Why he was hiding it was!
“Principal, would you wait outside for a moment? I’d like to speak with Mr. No alone.”
At Taeho’s request, Principal No looked flustered.
“I’m his guardian. What is this about? Is there something bad…”
“No. It’s for an accurate diagnosis. Please don’t worry, and just wait outside for a moment.”
Reluctantly, Principal No left the examination room.
Once the door closed, the atmosphere changed noticeably. Taeho could see a little tension leave No Seongjin’s shoulders.
“Mr. No, I’ve seen many patients until now, and sometimes patients are hiding something.”
No Seongjin avoided Taeho’s gaze.
“Especially in front of family. Especially their parents. Sometimes it’s because they don’t want to worry them, and sometimes it’s for other reasons.”
“What are you trying to say…?”
“Within the last six months, have you ever drunk excessively?”
“What? Why are you asking something like that?”
No Seongjin flinched and asked back.
Taeho’s intuition reacted with a jolt.
He had hit the mark.
“It may be related to your symptoms. Have you ever drunk alcohol, injured your head, and not remembered it very well?”
No Seongjin was silent for a long while.
Taeho quietly watched No Seongjin’s trembling hands.
He’s nervous.
No Seongjin sighed and opened his mouth.
“Actually, about five months ago, there was one day when I drank a lot. I had a huge fight with my girlfriend that day.”
Taeho waited quietly. He did not rush the patient until he spoke on his own.
“It was about marriage. My mother was fine with it, but my father opposed my marrying her. At first, he said her eyes were too small, that she was too short, and later he said our families didn’t match.”
No Seongjin sighed again. They were reasons he was ashamed to even tell his girlfriend.
Taeho nodded.
“So you drank.”
“Yes. I drank far more than usual. My girlfriend said that if my father was going to oppose it to that extent in the end, how could we get married? She said we should end things.”
“You must have been deeply hurt. How did you injure your head?”
After hesitating for a moment, No Seongjin answered.
“I’m ashamed to even say it, but back then, I felt so pathetic. I couldn’t defy my father, but I didn’t want to lose my girlfriend either. But in reality, I couldn’t do anything. So…”
No Seongjin’s face turned bright red. It was a shameful memory he did not even want to think about again.
“I tried to die. A useless bastard who couldn’t even protect his own woman. What’s the point of living? I think I was drunk and had thoughts like that. So I went up a mountain and jumped off a rock.”
“Then you must have been badly hurt. Why are there no hospital records?”
“I don’t know if it was because I’d been drinking… When I came to, I was fine except for a little pain in my head. After I sobered up, I realized I hadn’t fallen from anywhere that high. I thought, so even when I’m drunk, I’m too scared to climb somewhere high, and felt even more pathetic. That day, I just quietly went home.”
“And after that, you never received medical treatment at a hospital?”
“No.”
“I can understand how you must have felt. But when your leg paralysis started and you went to the hospital, you should have told them. If you’ve ever received a major blow to the head, many things change…”
“I thought it had nothing to do with it because it happened a long time ago. At the time, there was nothing wrong with my body either. …More than anything, I felt so pathetic that I wanted to forget everything about that night.”
No Seongjin covered his face with both hands, looking tormented.
Taeho tapped the frame of his glasses and spoke as if to himself.
“We’ll need to reanalyze the possibility of ALS-like symptoms caused by a chronic subdural hematoma.”
—Analyzing…
—Considering the patient’s symptom pattern and trauma history, there is a high possibility of secondary neurological symptoms caused by a chronic subdural hematoma.
As expected!
Additional testing was necessary, but if it was a chronic subdural hematoma, there was a possibility of treatment.
Taeho looked at No Seongjin and said,
“Mr. No, I think there may be hope.”
“What?”
“A chronic subdural hematoma can be misdiagnosed as ALS. If the hematoma is so minute that it wasn’t visible and the symptoms have appeared slowly and chronically. There are actual cases where patients were diagnosed with ALS and treated for eight months before a chronic subdural hematoma was finally discovered.”
“A subdural hematoma…”
“It can be treated with surgery. I’ll write you a referral, so go to a tertiary hospital and get reexamined. Since other hospitals didn’t find the hematoma, there’s a possibility that its location is too deep or that it’s extremely minute. Identifying the exact location is the most important thing. Once the location is found, you can undergo surgery.”
No Seongjin stared blankly, as if he could not believe it. He had thought his body would slowly become paralyzed and that he would simply wait for the day he died, but now, all of a sudden, he might live… It felt as though a storm were raging inside his head.
“Couldn’t you just perform the surgery, Director?”
“This is a primary care clinic, so it would be difficult to perform that kind of brain surgery here. If you need, I’ll personally call Department Head Yu Sihyeok at Samcheok Medical Center.”
“…Director. I have one more favor to ask.”
“Go ahead.”
“Please keep it a secret from my father that I tried to kill myself.”
Taeho felt that Principal No Deukguk’s presence was far greater to No Seongjin than he had thought. No Seongjin was a man in his thirties who looked sturdy and confident to anyone, but when it came to his father, he seemed to have a high degree of emotional dependence.
“The result is what matters, not the cause. If it makes you uncomfortable, just say you slipped while drunk.”
Taeho nodded.
***
“Are you saying surgery is truly impossible?”
Principal No Deukguk’s voice trembled. He could not believe what he had just heard from Department Head Yu Sihyeok.
Pointing to the scans, Department Head Yu Sihyeok explained,
“If you look at the CT and MRI results, the hematoma is located right next to the left motor center. Its position is very bad. In order to approach it surgically, we would have no choice but to touch a considerable amount of normal brain tissue.”
“Then what happens?”
No Seongjin asked in an anxious voice.
Department Head Yu Sihyeok answered with a dark expression.
“To be honest, with this level of difficulty, the success rate of surgery is less than ten percent. Even if we do remove the hematoma, there is over a ninety percent chance that permanent motor paralysis or a language disorder will remain.”
“Hah…”
Principal No let out a sigh. They had found hope at Geumsan Clinic and come all the way here, only for despair to find them again.
“Is there truly no other way?”
“No hospital would recommend surgery for a hematoma in this position.”
“Then what are we supposed to do?”
At Principal No’s question, Department Head Yu Sihyeok fell silent for a moment before speaking.
“We have no choice but to proceed with conservative treatment and monitor the progress.”
“Conservative treatment?”
“We manage the blood pressure, administer medication to lower intracranial pressure, and wait for the hematoma to be absorbed naturally.”
“Then does that mean he might recover without surgery?”
“To be honest, even that is only a slightly better possibility. It will be difficult to expect a full recovery.”
Department Head Yu Sihyeok shook his head.
Principal No asked in a trembling voice,
“What happens if we don’t treat it?”
“The hematoma will continue to grow, and intracranial pressure will rise. The paralysis may become more severe than it is now, and in the worst case, his life could be in danger.”
No Seongjin’s face turned pale.
“How much… How much time do I have left?”
“It is difficult to predict precisely, but judging by the current rate of progression, about six months to a year.”
Principal No squeezed his eyes shut and opened them again.
“Is there really no other way? Not even overseas? If he can be cured, I’ll spend everything I own and take him there.”
“Even the top hospitals in the United States or Germany would likely be in the same situation. In this case, the problem is the location of the hematoma.”
Principal No felt dizzy. He gripped the edge of the chair tightly and let out a low groan.
But he knew from experience that the more times were like this, the more he had to keep his head clear.
Principal No asked,
“By the way, Department Head, what do you think of Director Kang Taeho of Geumsan Clinic?”
“Director Kang?”
“Yes. Director Kang accurately diagnosed that this wasn’t ALS, but a hematoma.”
“That was truly remarkable diagnostic ability. He found what even we almost missed.”
“Then perhaps Director Kang might know another way?”
Department Head Yu Sihyeok pondered for a moment before answering.
“I acknowledge Director Kang’s skill as well. But even Director Kang Taeho wouldn’t be able to do anything about a case like this.”
On the way back from Samcheok Medical Center.
Principal No said,
“This won’t do. Let’s go back to Geumsan Clinic.”
“They said it won’t work there either.”
“Even if it doesn’t… I can’t believe it until I hear Director Kang say with his own mouth that it can’t be done.”
Principal No turned the steering wheel toward Geumsan Clinic.
***
And so, No Seongjin returned to Geumsan Clinic.
Principal No asked carefully,
“Director. Is there truly no way?”
Taeho stared for a long while at the imaging data they had brought from Samcheok Medical Center. It was certainly a tricky location. It would be difficult to resolve through surgery.
But if they only attempted conservative treatment, the condition had already progressed considerably, and the hematoma membrane seemed to have formed firmly. In its current state, there was even a possibility that it would grow larger instead.
Taeho sank into thought.
Then a thought suddenly occurred to him.
What if that method worked?