A Chaotic First Conference (3)
With the presenter's final words, polite, customary applause filled the seminar room. I clapped my hands half-heartedly. Finally, it's over.
The elderly professor acting as the chairperson picked up the microphone. "Yes, we will now have a five-minute Q&A session. If you have any questions, please raise your hand."
"Ah... Yes, thank you for the wonderful presentation. I'm Lee Hyun-woo from Ajou University Hospital. I was wondering about the patient's average length of stay and the post-discharge follow-up period..."
Hmm, should I point out the flaw in this presentation?
In response to my desperate plea, the eccentric mentors of the gallery began issuing highly detailed and vicious tactical instructions, as if they had been waiting for this exact moment.
"Hey, let's seriously get out of here. This is boring." Kim Ji-hoon tugged at my arm.
"No, I have a question."
"What?"
Leaving Kim Ji-hoon's dumbfounded expression behind, I raised my right hand high.
The previous questioner sat down, and the chairperson, who was scanning the room for the next hand, locked eyes with me.
"Are you crazy? What's wrong with you? Hey, put your hand down!" Ji-hoon hissed, frantically trying to pull my arm down, but it was too late.
"Yes, the doctor wearing glasses over there. Please state your affiliation and name, then ask your question."
"Ah, yes. Hello. I am Han Hyeon-jae, a first-year resident in the Department of Emergency Medicine at Cheongjin University Medical Center in Busan."
At my introduction, the eyes of several professors gleamed with interest.
"Thank you for the excellent presentation. Before I ask my question, would it be possible to see slide twelve again—the echocardiogram image shown earlier?"
At my request, a subtle flicker of embarrassment crossed the faces of both the chairperson and the presenter. However, they had no excuse to refuse. My question didn't carry any obvious hostility yet. I was simply asking to see an image again.
The presenter clicked his laptop, bringing up the slide in question on the screen.
The atmosphere in the seminar room shifted subtly. It began the moment a first-year resident specifically requested to review a particular slide. I felt that shift with my entire body.
Most notable was the change in the eyes of several professors sitting in the front row. Just moments ago, two or three gray-haired senior professors had looked thoroughly bored, hesitating whether to even raise their hands. Now, their faces wore expressions that clearly said, Oh? Look at this kid.
Damn it. Don't stare like that, it's too much pressure. If you watch me with such intense eyes, my heart is going to jump out of my chest.
I screamed inwardly.
The presenter clicked his mouse a few times and picked up the microphone. "Yes. One moment... Here is slide twelve as requested."
"Ah, yes. Thank you, doctor."
I gripped the microphone, my hand trembling slightly. My heart was pounding. Whew. Calm down, calm down.
"Thank you again for the wonderful presentation. Since I am still a junior resident in training, I might have missed something basic. I would like to ask a question to help clarify my understanding."
I lowered myself as much as possible. This was the Cardiology Ghost's teaching.
"First, I was wondering if you have separate data measuring the thickness of the apical myocardium during diastole from the patient's echocardiogram."
Thickness.
The moment I emphasized that word, I saw the corner of one front-row professor's mouth twitch upward. I pressed on.
"Textbook cases of stress-induced myocardial stunning usually show the affected muscle stretching and becoming thinner than normal. However, when I looked at the image earlier..."
I paused briefly, pointing at the screen.
"...it appeared to me that the muscle near the apex was actually thicker than the other parts of the heart."
Finally, I added the magic sentence to wrap this entire assault in the guise of an innocent inquiry.
"...Of course, it is highly possible that my lack of experience caused me to misinterpret the image."
This was the line. It was the equivalent of beating someone to a pulp and then saying, "My goodness, thank you for teaching me a valuable lesson!"
As soon as I finished speaking, a heavy silence fell over the seminar room for a brief second. Then, breaking the silence, a wave of murmurs began to ripple through the crowd.
"Thickness?"
"Huh? Now that he mentions it, he's right."
"Look at that image again. It really is. Why is the apex so thick?"
People began to whisper. Low gasps of realization erupted here and there. A truth that had been invisible just moments ago was starting to reveal itself.
On the podium, the presenter's face had turned pale. He was looking back and forth between the screen and me, utterly speechless. Did his brain just short-circuit?
"Diastolic thickness?"
The presenter's mouth opened and closed a few times before a strained, squeezed voice barely managed to escape his throat. "Uh... well... um... that is..."
Breaking into a cold sweat, the presenter desperately racked his brain. "Ah... that... because it was such a classic case of apical ballooning in Takotsubo cardiomyopathy, we didn't... separately measure the myocardial thickness."
The moment that answer left his mouth, the air in the seminar room turned ice-cold. "We didn't check because it was classic." It was the most dangerous and arrogant statement a doctor could make.
"Ah, I see. Thank you for the detailed answer despite your busy schedule. Then, I would also like to ask if the patient's initial EKG showed any findings strongly suggestive of myocardial hypertrophy, such as giant T-wave inversions in the precordial leads V2 through V4."
Giant T-wave inversion.
The moment those words left my mouth, the eyes of the professors in the front row flared.
"Uh... um... well..." All color drained from the presenter's face.
"Ah, I was actually planning to ask about that."
"There was a T-wave inversion. But was it really that deep?"
A massive wave of murmuring broke out across the room.
The chairperson grabbed his microphone. "Presenter, wait a moment. Pull up the EKG slide again."
With a look that was almost on the verge of tears, the presenter's trembling hand clicked to display the initial EKG on the screen.
The chairperson stood up from his seat and pointed a laser pointer at a section of the screen. Leads V3 and V4. Just as I had pointed out, those leads clearly showed sharp, deeply inverted T-waves.
"The T-wave is... inverted. The depth... looks to be well over ten millimeters." The chairperson turned off the laser pointer and turned his head toward me. "Doctor Han Hyeon-jae, the first-year resident from Cheongjin Medical Center's Busan hospital who asked the question. Do you have any additional comments or further questions regarding this finding?"
Every eye in the seminar room locked onto me once again. I adjusted my grip on the microphone. The whispers from all around reached my ears with crystal clarity.
"Apical HCM?"
"An EM first-year caught that at a glance?"
"Asung Hospital is past its prime. To come to a conference and miss something so basic..."
"Tsk, tsk. He's throwing mud right in his advisor's face."
"Did his advisor even review this? How did they let this pass?"
I tried my best to ignore the chatter and delivered my final piece of advice, exactly as the Cardiology Ghost had instructed.
"Ah, yes. In my limited opinion, this case seems to warrant consideration as an acute exacerbation of apical hypertrophic cardiomyopathy rather than Takotsubo cardiomyopathy. If it is indeed Apical HCM, the patient is constantly at risk of sudden cardiac death. Therefore, it would be highly advisable to contact the patient as soon as possible, have them return to the hospital, and perform detailed examinations, including a cardiac MRI..."
The moment I finished speaking, a heavy, suffocating silence descended upon the seminar room.