Taeho spoke calmly without being flustered by the patient's exaggerated expressions.
"Yes, hello. Please tell me in detail what symptoms are troubling you."
"Doctor, please look at this skin. Here, pimples keep breaking out like this, my face is swollen, and it's itchy too. I really feel like I'm dying."
Her voice was high-pitched and fast... She was slightly short of breath when speaking.
Her hands were trembling slightly. It seemed like there was another problem rather than just skin trouble.
She had tried to cover it with thick makeup, but the area around her eyes was slightly swollen. While speaking, she kept touching her neck.
Indeed, now that his intuition had improved by 20%, there was much more he could see.
"When did these symptoms start?"
"Since a month ago. At first, pimples broke out one or two at a time, but they gradually worsened until it has come to this. I went to three dermatologists, but none of them had any effect."
I Misuk poured out large and small pill bottles from her handbag.
"I applied this one, and tried that one too, but there was no effect at all. I spent hundreds of thousands of won just on medicine, but it doesn't get better at all. My husband gets angry and tells me to stop spending money on hospital bills, and the kids say Mom is overreacting over nothing... Aigoo, no one knows how frustrated I am."
"Are there no other symptoms? Aside from the skin problem?"
"My skin problem is this serious—what else could be important? Do you know how much stress I'm under?"
When I Misuk raised her voice again, Taeho seized the decisive moment.
When her voice rose, the muscles in the front of her neck tensed. And unconsciously, the number of times she touched her neck increased. This was a sign of discomfort in the thyroid area.
"Please wait a moment. Show me your hand."
"My hand? My hand is fine."
When I Misuk extended her hand, Taeho lightly grasped her wrist and checked her pulse. At the same time, various pieces of information flashed through his mind.
Pulse: 112 beats per minute. Irregular. The tips of her fingers were trembling slightly.
"Have you had any recent weight changes?"
"My weight? Well. I think I may have lost some... But what does that have to do with my skin?"
"Are you sleeping well?"
"I haven't been able to sleep lately. I think it's because of the stress from my skin."
"Let me feel your neck for a moment."
"My neck? It doesn't hurt..."
Taeho palpated the patient's neck. Information transmitted through his fingertips.
The thyroid was definitely swollen. It had enlarged to about 1.5 times the normal size and was slightly firm.
It was hyperthyroidism.
"You mustn't only look at the skin problem. Our bodies are all connected. If there is a problem with thyroid function, it can affect the skin as well."
I Misuk asked with wide eyes.
"Then you're saying my skin problem is because of my thyroid?"
"The possibility is high. For an accurate diagnosis, a blood test is needed. We need to check your thyroid hormone levels."
Taeho continued explaining as he wrote the test referral.
"If it is hyperthyroidism, the skin problem will also resolve once the root cause is treated."
"Then is that why I didn't get better no matter how much I was treated at the dermatologist?"
"That's what happens when you treat only the symptoms without finding the cause."
The blood test results showed that her TSH (thyroid-stimulating hormone) level was markedly low, while her Free T4 (free thyroxine), Free T3 (free triiodothyronine), and TPOAb (thyroid peroxidase antibody) levels were all considerably high.
It was indeed hyperthyroidism.
Taeho showed the patient the blood test results and explained step by step.
"Especially since your TRAb level came out high, you are diagnosed with Graves' disease. This is a type of autoimmune disorder in which the body's immune system stimulates the thyroid to secrete excessive hormones."
"Then my skin problem was really because of this?"
I Misuk had a blank expression for a moment.
"Yes, that's correct. These are representative skin symptoms caused by hyperthyroidism. We will begin antithyroid drug treatment. The treatment period may be quite long, so you must take the medication consistently."
"Yes, I understand. Doctor, thank you so much. No other hospital told me anything like this..."
I Misuk couldn't speak for a moment and her chin trembled.
As if the sorrow she had endured until now was surging forth, she looked on the verge of tears.
"All this time, my family said a lot of hurtful things to me, that it was nothing, that I was being too sensitive. I'm relieved to finally know the name of the disease. To think I really am sick... Though it's not something to be happy about, being sick."
"Please don't worry too much. If you continue treatment going forward, a normal life is possible."
"Thank you, Doctor."
I Misuk expressed sincere gratitude and left the examination room.
***
The next patient was seventy-one-year-old Gim Pilsun.
A small-statured Vietnamese woman entered, supporting her mother-in-law, whose back was hunched.
The grandmother's gait was cautious.
It was the typical stooped posture seen when there is abdominal discomfort.
"Yes, hello. What symptoms bring you here today?"
The daughter-in-law answered as she seated her mother-in-law in the chair.
"Mother keeps saying she hurts. But she says she's fine. We need to get examined at the hospital."
"Oh my, I'm fine, I tell you. Doctor, it's because our daughter-in-law is acting fussy. When you get old, what doesn't hurt?"
Gim Pilsun scolded her daughter-in-law.
Taeho's brow furrowed slightly.
The unconscious gesture of trying to touch the upper right side of her abdomen. There was a high probability of a problem in the right upper quadrant.
"Mother, no! You've been saying your stomach hurts since several days ago. You couldn't sleep at night and kept tossing and turning!"
The daughter-in-law spoke firmly.
"It's just indigestion. It's because you ate too much."
"Mother, you ate the same as usual yesterday. And you were in the bathroom for thirty minutes—I saw you!"
Staying in the bathroom for a long time meant she was having difficulty with bowel movements due to abdominal discomfort.
"Elder, please tell me specifically where and how it hurts."
"It's a bit bloated and somewhat stuffy."
Each time she spoke, she subtly furrowed her brow. Especially when she said it was bloated, she unconsciously touched slightly beneath her right ribs. The gallbladder area.
"Are you eating well?"
"Yes, I eat a lot."
"Mother, why are you lying? You ate very little yesterday."
"Hey, you... What do you mean, lies?"
Taeho said gently.
"I will examine your abdomen."
Taeho palpated the patient's abdomen. The patient's expression changed very slightly with each touch.
She furrowed her face as if there was tenderness in the right upper quadrant. But it was more concentrated in the gallbladder area than the liver.
"Do you feel fatigued?"
"That's right. When you get old, your sleep gets bad..."
"Mother, you've been lying down all the time lately."
"Have I?"
"You did yesterday. You've been doing it constantly lately."
"What on earth are you going on about?"
The mother-in-law and daughter-in-law continued to bicker.
Taeho carefully observed the patient's eyes. The sclera had turned slightly yellow.
There were mild jaundice symptoms. But it wasn't to the degree of hepatitis... The likelihood of temporary biliary obstruction due to gallstones was high.
"Elder, is the color of your urine different from usual?"
"I'm not sure about that..."
As Gim Pilsun hesitated, the daughter-in-law quickly answered again.
"It's more yellow than usual."
"Oh my! How do you know that too? Did you follow me into the bathroom?"
"Mother, you often came out without flushing. I went in and saw."
Taeho asked again.
"Elder, doesn't it hurt more after eating greasy food?"
"It does. I think so..."
This time too, as Gim Pilsun tilted her head, the daughter-in-law answered.
"That's right! We ate samgyeopsal a few days ago. You kept tossing and turning at night!"
"Then, Elder, please take a deep breath when I press here."
Taeho pressed beneath the patient's right ribs and had her take a deep breath. The moment he did so, Gim Pilsun stopped breathing.
"Ah!"
"Does it hurt?"
"It suddenly hurts. How strange."
"This is called Murphy's sign, a symptom that allows us to suspect gallstones."
At the unfamiliar term, the daughter-in-law's eyes widened and she asked.
"Gallstones? What is that?"
"Cholelithiasis is a condition where small stones called gallstones form in the gallbladder. They mainly form when cholesterol or bile components clump together. When you eat greasy food, the gallbladder contracts, and these stones can block the gallbladder's entrance, causing pain at that time."
Taeho guided the patient to the examination room for an ultrasound.
"We'll check the gallbladder with an ultrasound."
Gim Pilsun's gallbladder appeared on the ultrasound screen. Several bright spots were visible inside the gallbladder.
"Look, these white spots are gallstones. There are quite a lot."
The daughter-in-law watched the screen beside him and exclaimed in wonder.
"Wow, there really are stones! Mother, look here!"
"Are those things on there really what they call stones?"
Gim Pilsun suddenly furrowed her face with worry.
"This can commonly occur with age. Fortunately, at this stage, it hasn't progressed to cholecystitis. Be grateful to your daughter-in-law. Thanks to coming in early, treatment with oral medication should be sufficient."
"Really? We truly don't need surgery?"
"Yes, I'll prescribe antispasmodics and anti-inflammatory drugs. And take a medication that promotes bile secretion as well."
The daughter-in-law took out a pen and paper from her small bag and asked methodically.
"What foods should we be careful of?"
"Avoid greasy food, fried food, and nuts. Instead, mainly eat bland foods, and take small, frequent meals."
"Are rice noodles okay?"
"Yes, rice noodles are fine. Just make sure not to use too much oil. And sufficient water intake is important too. Drink at least eight glasses of water a day."
"Yes. Eight glasses of water a day."
The daughter-in-law carefully wrote down each word.
"I'll see you again in a week and adjust the prescription."
"Yes, understood, Doctor."
"Thank you."
Gim Pilsun and her daughter-in-law left without arguing for the first time, saying goodbye like a close mother and daughter.
After the two left, Taeho asked Rema.
"Rema, the diagnostic accuracy really seems to have improved a lot, doesn't it?"
—That's correct. Through your enhanced intuition and systematic approach, accurate diagnosis has become possible even with complex symptoms.
Taeho felt his intuition growing more acute the more he concentrated. It was very useful when seeing patients, but using it too much in daily life caused him to tire easily, so he needed to control it.
Taeho learned to use his enhanced intuition with selectivity and focus.
More than anything, the speed and accuracy with which he diagnosed patients had become far better than before.
***
He had been alternating between scheduled patients and village patients without rest for several days.
The clinic door opened, and a middle-aged woman entered with two children.
Eleven-year-old Bak Minjun and eleven-year-old Bak Minseok.
"You two are twins, aren't you?"
When Taeho spoke with a smile, Minjun and Minseok nodded their heads at the same time.
"Where does it hurt?"
"Since last night, both of them suddenly developed a fever and said they had headaches. When these kids catch a cold, they always catch it together."
The children's mother said.
Taeho nodded and said.
"That can happen since you live together. Then shall the doctor take a look? Who wants to go first?"
The moment Taeho looked at the two children in turn, he felt something strange.
Huh, what is this?