Chapter 54
Chapter 54
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Translator: crow
Chapter Title: Chaotic First Conference (3)
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With the presenter's final "Thank you," the seminar room filled with polite applause.
I clapped mechanically, my soul adrift.
It's finally over.
The presiding elderly professor took the microphone.
"Yes, we'll now have five minutes for Q&A. If you have a question, please raise your hand."
"Ah... I listened to the presentation closely. I'm Lee Hyun-woo from Ajou University Hospital. Regarding the patient's average length of stay and post-discharge follow-up period..."
Hmm, should I point out the flaw in this presentation?
LatteIsTalk: HellSlave. Now's the time.
HellJoseonSlave1: What do you mean now?
CardiologyGhost: Go for it. Make this conference legendary, HellSlave.
HematomaIsHell: Smash that bogus diagnosis! Academia knows no mercy!
HellJoseonSlave1: What exactly should I ask and how?;; Tell me that first. I can't just jump on stage yelling "Hey! You're wrong!"
In response to my desperate plea, the gallery's mad mentors unleashed a barrage of precise, ruthless tactical instructions like they'd been waiting for it.
CardiologyGhost: Frame it as a question. Never state it definitively. Not "You're wrong," but stick to the stance of "I'm a clueless noob, so I'm humbly asking the esteemed presenter if this possibility was considered."
HippocratesHeir: Exactly! Wear the mask of academic humility while beating them down!
CardiologyGhost: Say it like this. "In the echocardiogram you showed earlier, the apical myocardium appears abnormally hypertrophied unlike the textbook Takotsubo cardiomyopathy findings, so I was wondering if the possibility of apical hypertrophic cardiomyopathy exacerbated by stress was considered. I'd like your expert opinion on this, presenter."
Fucking perfect.
"Hey, let's get out of here for real now. This is boring."
Kim Ji-hoon grabbed my arm and tugged.
"No, I have a question."
"What?"
Ignoring Kim Ji-hoon's shocked expression, I shot my right hand up high.
The presiding professor, who had just locked eyes with me while the previous questioner sat down and he scanned for the next, met my gaze.
"Are you insane? What the hell? Hey, put your hand down!"
Kim Ji-hoon freaked out beside me, trying to yank my arm down, but it was too late.
"Yes, the gentleman with glasses there. Please state your affiliation and name, then ask your question."
"Yes. Hello. I'm Han Hyun-jae, first-year resident in Emergency Medicine at Busan Cheongjin Medical Center."
At my introduction, several professors' eyes lit up with interest.
"I greatly enjoyed your excellent presentation. Before my question, could you please show slide 12 again, the cardiac ultrasound image?"
Subtle dismay flickered across the presiding professor's and presenter's faces at my request.
But they had no grounds to refuse.
My question held no intent yet. It was just asking to see the image again.
The presenter manipulated the laptop, bringing up the contentious image on the screen.
The seminar room's atmosphere shifted subtly.
Starting from the moment a first-year resident pinpointed and requested a specific slide be shown again.
I felt that change throughout my body.
Especially the gazes of the professors in the front row, which had noticeably sharpened.
Just moments ago, a couple of gray-haired old professors had been hesitating whether to raise their hands, looking bored.
Now their faces bore that "Oh ho, check this guy out?" glint.
Damn. Don't stare like that—it’s pressuring me.
When you watch with eyes that intense, even my heart starts pounding.
I screamed internally.
The presenter clicked the mouse a few times and grabbed the mic.
"Yes. One moment... Here's the requested slide 12."
"Ah, yes. Thank you, doctor."
I gripped the microphone tighter with trembling hands.
My heart was thumping wildly.
Phew.
Calm down, calm down.
"Thank you again for the excellent presentation, doctor. As a junior resident still learning the ropes, I might have missed something basic, so for my own understanding, I'd like to ask one thing."
I humbled myself as much as possible.
CardiologyGhost's teaching.
"First, I'm curious if you measured the apical myocardial thickness during diastole in the patient's cardiac ultrasound image separately."
Thickness.
As I emphasized that word, I caught one front-row professor's lip curling faintly upward.
I pressed on.
"Textbook stress-induced myocardial stunning should thin the affected muscle beyond normal as it stretches, but when I looked at the image earlier..."
I paused, pointing at the screen.
"To me, the apical region seemed thicker than the rest of the heart..."
Finally, I wrapped this entire assault in the magic phrase that disguised it as an innocent question.
"...Of course, I might be mistaken due to my lack of experience."
This was the line.
It was like beating the crap out of someone then going, "Whoa, lesson learned!"
A one-second silence blanketed the seminar room after I finished.
Then murmurs erupted from all sides like a wave breaking the quiet.
"Thickness?"
"Huh? Now that you mention it..."
"Look at that image again. It's true. Why's the apex so thick?"
People started whispering.
Low "Ah!" realizations burst out here and there.
The truth, invisible moments ago, was dawning on them.
The presenter on stage stared blankly at the screen and me alternately, face drained white, speechless.
Hmm, has his mental game collapsed?
"Diastolic thickness?"
The presenter's mouth flapped a few times before a strangled voice squeezed out.
"Uh... um... well..."
Sweat beading, he desperately racked his brain.
"Ah... that... It was such a classic Takotsubo cardiomyopathy apical ballooning (*apical ballooning) finding that we didn't measure myocardial thickness separately..."
The moment that answer landed, the seminar room's air chilled again.
"Classic, so no need to check."
The most dangerous, arrogant thing a doctor could say.
"I see. Thank you for the detailed answer despite your busy schedule. If I may follow up, in the patient's initial ECG, were there no findings strongly suggesting myocardial hypertrophy, like giant T-wave inversion in the chest leads V2 through V4?"
Giant T-wave inversion.
The front-row professors' eyes flashed as those words left my mouth.
"Uh... um... er..."
All color drained from the presenter's face.
"Ah, I was about to ask that."
"There was T-wave inversion. But was it that deep?"
Murmurs exploded everywhere.
The presiding professor grabbed the mic.
"Presenter, one moment. Please bring up the ECG slide again."
The presenter, face nearly in tears, shakily displayed the initial ECG on the screen.
The presiding professor stood, using a laser pointer to highlight one spot.
V3, V4 leads.
Exactly as I'd pointed out, a sharp, deeply inverted T-wave was etched clearly there.
"The T-wave... it's inverted. Depth looks like at least 10mm."
The presiding professor turned off the pointer and looked at me.
"The first-year resident Han Hyun-jae from Busan Cheongjin Medical Center who asked that question. Any additional comments or follow-up questions on this finding?"
Every eye in the seminar room turned back to me.
I adjusted the mic.
Whispers reached my ears clearly.
"Apical HCM? (*apical hypertrophic cardiomyopathy)"
"A first-year EM resident spotted that on the fly?"
"Aseong Hospital's glory days are over. Coming to present after missing basics like that."
"Tsk tsk, really smearing mud on his mentoring professor's face."
"Didn't the mentoring prof even review it properly? Let that slide through?"
I tried my best to ignore the chatter and, following CardiologyGhost's advice, offered my own counsel.
"Yes. In my limited view, this case seems more like acute exacerbation of apical hypertrophic cardiomyopathy than Takotsubo. If it's apical HCM, the patient lives with constant sudden-death risk. So you should contact the patient ASAP and have them return for precise testing including cardiac MRI..."
A heavy silence descended on the seminar room the instant I finished.