A Doctor's Clinical Diary 1 : A Heart in the Hive

Prologue – Dawn in the Examination Room

There is a distinct scent in the air that I feel every time I walk down the hospital corridors. It's a strange mix of the sharp smell of disinfectant, a bit of humidity, and the mingled anxiety and hope of people. I walk these halls every morning at dawn. My body is heavy from the late-night consultations and surgeries of the day before, but the cold, shining fluorescent lights awaken me once again. I have been living as a doctor here for 15 years, and I still ask myself the same questions every day: "Why did I choose this path? And for whom is this one line I am recording today?".

On my desk, charts are scattered untidily, and various images are displayed on the monitor viewer. Tucked among them is a thin notebook. This is the clinical diary that I am beginning to write again, starting today.

The name 'clinical diary' is really a secret habit of my own. As an intern, there was a time when I would sit in a corner of the ward after an all-night shift and write, sketching the faces of the patients. Back then, I wrote simply "to remember". I recorded not just the hard facts like the patient's medical history, imaging findings, and test results, but also the fear and joy I felt, and the expressions of the patients and their families. However, at some point, I became busy and, overwhelmed by the world outside the examination room, I stopped writing. There is only one reason why I am picking up the pen again now: I want to recapture the countless moments that have slipped away during my time as a doctor.

Half-past three in the morning. The hospital was quiet, but the steady rhythm of an electrocardiogram could be faintly heard from somewhere. The sound of a nurse's footsteps on a 새벽 shift in the intensive care unit echoed down the hallway. I picked up my coffee cup and took a sip. As the bitter taste went down my throat, the story I would record today slowly came to mind.

A few days ago, a patient knocked on my examination room door. A 36-year-old man, his face grimacing as he complained of discomfort in his right upper abdomen. He said the finding was discovered incidentally during a health check-up, but there was something more than a simple test result in the patient's expression. He looked like a typical office worker, but he couldn't hide a strange tension and anxiety at the end of every sentence. I showed him the ultrasound images and began to explain. “As you can see, there are multiple septa inside the gallbladder. A normal gallbladder is a single pouch, but in this case, the inside is divided like a honeycomb.”. The patient nodded, but his eyes were still wavering. At that moment, I recalled the 'clinical diary' again. I decided that I had to record this patient, to capture not only his disease but also his life.

The profession of a doctor always has a dual nature. When explaining to a patient, you must be objective and calm. But when I leave the examination room and am left alone, their stories burrow into my heart. The patient's anxiety, the family's tears, the success and failure of a treatment all pour in at once and settle heavily. Where should I place this weight?. In the end, there is nothing to do but write it down.

The reason I picked up the pencil again today is that patient. The rare malformation found in his gallbladder, a multiseptate gallbladder. It is a rare disease mentioned in only a few lines in medical textbooks. Because it is uncommon, it leaves a stronger impression on a clinician. And above all, my perspective on the patient's life changed through this illness.

I wrote on the first page of my notebook. “August 2025, a man came into the examination room. He complained of a vague discomfort in his right upper abdomen. But what he truly showed me was the wavering heart of a human being in the face of illness.”.

I looked at the ultrasound image on the computer monitor. The gallbladder on the screen was not uniform. Several thin lines divided the lumen, as if drawing a honeycomb. I magnified and re-examined this image countless times. The gallbladder wall was not thick, and there were no signs of gallstones or tumors. But those irregular septa lingered in front of my eyes for a long time. As if they were talking to me. For a doctor, an image is not just data. It is a story told by the patient's body. And I have to read the patient's life from that story.

The 'clinical diary' has now begun again. I will record the faces and stories I encounter in my daily practice. Beyond simple diagnoses and findings, I will capture the trajectory of the patient's life, the fear and comfort I felt, and the insights gained during the treatment process. My life as a doctor is a continuous series of diagnoses and treatments, but what I truly want to hold on to is the story of people. Illness exists within life, and life can shine or falter through illness. I will record all of those moments.

Outside the window, dawn was breaking. The morning light seeped through the branches of the zelkova tree in the hospital courtyard, emitting a soft glow. I took a deep breath. Another day begins. And another patient is waiting for me. The first chapter of the clinical diary has thus opened. I don't know what meaning this writing will have in the future. But one thing is certain: at the moment of writing this, I am not just a doctor, but a witness who seeks to understand another human being.

Chapter 1 – The Patient’s First Visit

The moment the examination room door opens, I feel a unique change in the air. With every patient who enters, their gait, expression, and the trembling of their fingertips convey many stories. This day was no different.

A 36-year-old male. What caught my eye before the numbers and name on the file was the line of his shoulders. They were slightly slumped, but with a hidden tension. The patient carefully closed the door and sat down in the chair, his gaze briefly falling to the floor. “Doctor, my right upper abdomen has been a bit uncomfortable lately.” his voice was low, but it had a certain resolute resonance. Although it could be a simple stomach discomfort, I always first listen for the 'weight of anxiety' contained within.

I opened the chart and asked, “How long has it been like this?”. “For... about two months, I think. It doesn't hurt, but it's more of a... dull ache, you could say. Sometimes it feels like I can't digest properly, too.”. He continued speaking, then paused. When I looked at his eyes, he added cautiously, “Actually... my father had surgery for gallstones a while ago. So I get worried for no reason.”.

At that moment, I realized that his discomfort was not just physical pain. It was a psychological anxiety stemming from his family's medical history—the fear of "what if I am walking the same path?". I guided him to the examination table. I applied cold gel and placed the transducer on his right upper abdomen. The black shadow of the gallbladder slowly appeared on the ultrasound screen. And I saw it right away.

Thin lines were complexly intertwined, dividing the lumen of the gallbladder. It was like an unfinished maze, or a honeycomb. The gallbladder wall was not thick, and no stones were visible. However, multiple septa were minutely dividing the gallbladder. A page from a textbook flashed through my mind—Multiseptate gallbladder, a rare congenital malformation.

My hand instinctively pressed the freeze button on the ultrasound machine. The septa, clearly visible on the screen, looked alive. The patient, lying down, rolled his eyes as if trying to read my expression. “Is it something serious?”. I paused and then answered, “There are multiple septa formed inside your gallbladder. It's not a common structure. Fortunately, there are no gallstones or inflammation visible. But... it is a very rare form.”.

“What do you mean by a rare form?” he slightly raised his torso. I calmly explained again, “This is called a 'multiseptate gallbladder.' It's often congenital. To put it simply, you can think of it as a gallbladder with a structure divided like a honeycomb.”. He was silent for a while. The ticking of the clock in the examination room seemed to echo loudly. I felt that in his silence, his mind was being separated like the many septa: anxiety, curiosity, relief, and then anxiety again.

I printed the image and showed it to him. On the black and white photo with layers of lines, I drew a small circle with a pen and explained, “These lines you see here are the septa. Usually, the gallbladder is one large space, but yours is divided into several compartments. Fortunately, no gallstones are visible at all. Nor are there any findings that would suggest cholecystitis.” He looked at the photo and said with a slight laugh, “It really looks like a honeycomb.” I nodded. “That's right. That's why it's also called a 'honeycomb gallbladder.'”.

However, his laughter quickly faded. “So is this dangerous? Do I need to have surgery like my father?”. In his eyes, I saw the fear of an unplanned future. As a doctor, giving an answer that is both honest and hopeful is one of the most difficult moments. “Surgery is not necessary in all cases. If you have no symptoms, observation is sufficient. But if the discomfort persists like this, surgical treatment may be considered.”. He nodded, but his fingertips were trembling slightly. In that trembling, I read the 'instinctive fear of a human being accepting an illness'.

As the consultation was ending, he cautiously asked, “Doctor, is this a common illness?”. I thought for a moment and then told him the truth, “It is very rare. I have only seen such a clear case in papers. It’s a disease mentioned in a few lines of a textbook.”. His eyes widened. The word 'rare' can sometimes be a comfort to a patient, but it can also bring new anxiety. He laughed for a moment, then let out a long sigh. “I guess being rare isn't always a good thing.”.

I placed a hand on his shoulder and said, “It's rare, but fortunately, dangerous complications are uncommon. For now, observation is more important than worry.”. After he left the examination room, I sat in my chair for a while. His ultrasound image was still on my desk. The faint lines on the black screen seemed to be talking to me, “Record it. Don't forget.”. I opened my notebook. I wrote down the first record of the day. “Patient: 36-year-old male. Main complaint: right upper abdominal discomfort. Ultrasound: presence of multiple septa, no gallbladder wall thickening, no gallstones. Diagnosis: multiseptate gallbladder. In the patient's eyes, I saw a fear deeper than the illness. The disease was medically rare, but his anxiety was profoundly human.”. This first encounter left a lasting impression beyond a simple consultation. The rare disease of multiseptate gallbladder eventually began to write a new story in the patient's life. And that story left a deep mark on the first page of my 'clinical diary'.

A Heart in the Hive: A Doctor's Clinical Diary

Prologue – Dawn in the Examination Room

There is a distinct scent in the air that I feel every time I walk down the hospital corridors. It's a strange mix of the sharp smell of disinfectant, a bit of humidity, and the mingled anxiety and hope of people. I walk these halls every morning at dawn. My body is heavy from the late-night consultations and surgeries of the day before, but the cold, shining fluorescent lights awaken me once again. I have been living as a doctor here for 15 years, and I still ask myself the same questions every day: "Why did I choose this path? And for whom is this one line I am recording today?".

On my desk, charts are scattered untidily, and various images are displayed on the monitor viewer. Tucked among them is a thin notebook. This is the clinical diary that I am beginning to write again, starting today.

The name 'clinical diary' is really a secret habit of my own. As an intern, there was a time when I would sit in a corner of the ward after an all-night shift and write, sketching the faces of the patients. Back then, I wrote simply "to remember". I recorded not just the hard facts like the patient's medical history, imaging findings, and test results, but also the fear and joy I felt, and the expressions of the patients and their families. However, at some point, I became busy and, overwhelmed by the world outside the examination room, I stopped writing. There is only one reason why I am picking up the pen again now: I want to recapture the countless moments that have slipped away during my time as a doctor.

Half-past three in the morning. The hospital was quiet, but the steady rhythm of an electrocardiogram could be faintly heard from somewhere. The sound of a nurse's footsteps on a 새벽 shift in the intensive care unit echoed down the hallway. I picked up my coffee cup and took a sip. As the bitter taste went down my throat, the story I would record today slowly came to mind.

A few days ago, a patient knocked on my examination room door. A 36-year-old man, his face grimacing as he complained of discomfort in his right upper abdomen. He said the finding was discovered incidentally during a health check-up, but there was something more than a simple test result in the patient's expression. He looked like a typical office worker, but he couldn't hide a strange tension and anxiety at the end of every sentence. I showed him the ultrasound images and began to explain. “As you can see, there are multiple septa inside the gallbladder. A normal gallbladder is a single pouch, but in this case, the inside is divided like a honeycomb.”. The patient nodded, but his eyes were still wavering. At that moment, I recalled the 'clinical diary' again. I decided that I had to record this patient, to capture not only his disease but also his life.

The profession of a doctor always has a dual nature. When explaining to a patient, you must be objective and calm. But when I leave the examination room and am left alone, their stories burrow into my heart. The patient's anxiety, the family's tears, the success and failure of a treatment all pour in at once and settle heavily. Where should I place this weight?. In the end, there is nothing to do but write it down.

The reason I picked up the pencil again today is that patient. The rare malformation found in his gallbladder, a multiseptate gallbladder. It is a rare disease mentioned in only a few lines in medical textbooks. Because it is uncommon, it leaves a stronger impression on a clinician. And above all, my perspective on the patient's life changed through this illness.

I wrote on the first page of my notebook. “August 2025, a man came into the examination room. He complained of a vague discomfort in his right upper abdomen. But what he truly showed me was the wavering heart of a human being in the face of illness.”.

I looked at the ultrasound image on the computer monitor. The gallbladder on the screen was not uniform. Several thin lines divided the lumen, as if drawing a honeycomb. I magnified and re-examined this image countless times. The gallbladder wall was not thick, and there were no signs of gallstones or tumors. But those irregular septa lingered in front of my eyes for a long time. As if they were talking to me. For a doctor, an image is not just data. It is a story told by the patient's body. And I have to read the patient's life from that story.

The 'clinical diary' has now begun again. I will record the faces and stories I encounter in my daily practice. Beyond simple diagnoses and findings, I will capture the trajectory of the patient's life, the fear and comfort I felt, and the insights gained during the treatment process. My life as a doctor is a continuous series of diagnoses and treatments, but what I truly want to hold on to is the story of people. Illness exists within life, and life can shine or falter through illness. I will record all of those moments.

Outside the window, dawn was breaking. The morning light seeped through the branches of the zelkova tree in the hospital courtyard, emitting a soft glow. I took a deep breath. Another day begins. And another patient is waiting for me. The first chapter of the clinical diary has thus opened. I don't know what meaning this writing will have in the future. But one thing is certain: at the moment of writing this, I am not just a doctor, but a witness who seeks to understand another human being.

Chapter 1 – The Patient’s First Visit

The moment the examination room door opens, I feel a unique change in the air. With every patient who enters, their gait, expression, and the trembling of their fingertips convey many stories. This day was no different.

A 36-year-old male. What caught my eye before the numbers and name on the file was the line of his shoulders. They were slightly slumped, but with a hidden tension. The patient carefully closed the door and sat down in the chair, his gaze briefly falling to the floor. “Doctor, my right upper abdomen has been a bit uncomfortable lately.” his voice was low, but it had a certain resolute resonance. Although it could be a simple stomach discomfort, I always first listen for the 'weight of anxiety' contained within.

I opened the chart and asked, “How long has it been like this?”. “For... about two months, I think. It doesn't hurt, but it's more of a... dull ache, you could say. Sometimes it feels like I can't digest properly, too.”. He continued speaking, then paused. When I looked at his eyes, he added cautiously, “Actually... my father had surgery for gallstones a while ago. So I get worried for no reason.”.

At that moment, I realized that his discomfort was not just physical pain. It was a psychological anxiety stemming from his family's medical history—the fear of "what if I am walking the same path?". I guided him to the examination table. I applied cold gel and placed the transducer on his right upper abdomen. The black shadow of the gallbladder slowly appeared on the ultrasound screen. And I saw it right away.

Thin lines were complexly intertwined, dividing the lumen of the gallbladder. It was like an unfinished maze, or a honeycomb. The gallbladder wall was not thick, and no stones were visible. However, multiple septa were minutely dividing the gallbladder. A page from a textbook flashed through my mind—Multiseptate gallbladder, a rare congenital malformation.

My hand instinctively pressed the freeze button on the ultrasound machine. The septa, clearly visible on the screen, looked alive. The patient, lying down, rolled his eyes as if trying to read my expression. “Is it something serious?”. I paused and then answered, “There are multiple septa formed inside your gallbladder. It's not a common structure. Fortunately, there are no gallstones or inflammation visible. But... it is a very rare form.”.

“What do you mean by a rare form?” he slightly raised his torso. I calmly explained again, “This is called a 'multiseptate gallbladder.' It's often congenital. To put it simply, you can think of it as a gallbladder with a structure divided like a honeycomb.”. He was silent for a while. The ticking of the clock in the examination room seemed to echo loudly. I felt that in his silence, his mind was being separated like the many septa: anxiety, curiosity, relief, and then anxiety again.

I printed the image and showed it to him. On the black and white photo with layers of lines, I drew a small circle with a pen and explained, “These lines you see here are the septa. Usually, the gallbladder is one large space, but yours is divided into several compartments. Fortunately, no gallstones are visible at all. Nor are there any findings that would suggest cholecystitis.” He looked at the photo and said with a slight laugh, “It really looks like a honeycomb.” I nodded. “That's right. That's why it's also called a 'honeycomb gallbladder.'”.

However, his laughter quickly faded. “So is this dangerous? Do I need to have surgery like my father?”. In his eyes, I saw the fear of an unplanned future. As a doctor, giving an answer that is both honest and hopeful is one of the most difficult moments. “Surgery is not necessary in all cases. If you have no symptoms, observation is sufficient. But if the discomfort persists like this, surgical treatment may be considered.”. He nodded, but his fingertips were trembling slightly. In that trembling, I read the 'instinctive fear of a human being accepting an illness'.

As the consultation was ending, he cautiously asked, “Doctor, is this a common illness?”. I thought for a moment and then told him the truth, “It is very rare. I have only seen such a clear case in papers. It’s a disease mentioned in a few lines of a textbook.”. His eyes widened. The word 'rare' can sometimes be a comfort to a patient, but it can also bring new anxiety. He laughed for a moment, then let out a long sigh. “I guess being rare isn't always a good thing.”.

I placed a hand on his shoulder and said, “It's rare, but fortunately, dangerous complications are uncommon. For now, observation is more important than worry.”. After he left the examination room, I sat in my chair for a while. His ultrasound image was still on my desk. The faint lines on the black screen seemed to be talking to me, “Record it. Don't forget.”. I opened my notebook. I wrote down the first record of the day. “Patient: 36-year-old male. Main complaint: right upper abdominal discomfort. Ultrasound: presence of multiple septa, no gallbladder wall thickening, no gallstones. Diagnosis: multiseptate gallbladder. In the patient's eyes, I saw a fear deeper than the illness. The disease was medically rare, but his anxiety was profoundly human.”. This first encounter left a lasting impression beyond a simple consultation. The rare disease of multiseptate gallbladder eventually began to write a new story in the patient's life. And that story left a deep mark on the first page of my 'clinical diary'.

Chapter 2 – The Doctor's Inner World and the Hospital's Scenery

The hospital is a strange place. Day and night are not clearly distinguished. Some people wake up at dawn, and others fall asleep in the middle of the night. Time flows outside the window, but inside, a day seems to stretch on infinitely.

Today, too, I returned to the examination room after finishing my morning rounds. As I set down my coffee cup, I suddenly thought of the ultrasound image of the 36-year-old male patient I had just seen. The image of the gallbladder divided like a honeycomb would not be erased from my mind.

Having lived as a doctor for more than a decade, I have seen countless ultrasound and CT images of patients, but some images just pass by, while others leave a deep impression on my mind. The multiseptate gallbladder I saw today is probably one of those cases. It's not just because it's uncommon. It's because the patient's eyes overlapped with the image and were clearly imprinted on my mind.

I walked down the hallway toward the hospital cafeteria. My breakfast is always simple. I had soup and side dishes on my tray, but my attention was not entirely on the food. Across the table, my colleague, Dr. Park, a surgeon, was sitting. He was always an energetic and resolute person who reassured his colleagues.

“How was your day?” he asked. “I saw a somewhat unusual patient. A multiseptate gallbladder.”. Dr. Park's chopsticks paused for a moment. “That’s rare. Something you'd only see in a textbook... But with the improvement in ultrasound technology these days, it seems the frequency of discovery has increased a little compared to before.”.

I nodded. “That’s right. The problem is, the patient complains of discomfort, but it's ambiguous to say it's a clear indication for surgery. When it’s asymptomatic, we just tell them to keep an eye on it, but when I face the patient's anxiety, I start to worry.”. Dr. Park smiled and said, “In the end, it's a matter of how honestly you talk to the patient. The more ambiguous the disease is from a doctor's perspective, the more confused the patient feels.”. His words struck a chord in my heart. The balance between honesty and comfort. It was a skill a doctor had to learn throughout their life.

After the meal, I stepped into the hallway, and sunlight poured in through the windows. Nurses walked quickly, and patients' families went in and out of the waiting room with heavy eyes. The hospital is always busy, yet there is an inexplicable stillness flowing within it. This is because it is a place where life and death, hope and fear coexist. I stopped for a moment and stood by the window. The view of the intensive care unit below the hallway was still unfamiliar yet familiar. The waveforms of the electrocardiogram on the monitor, the regular sound of the ventilator, and the guardians who were dozing off in between. At that moment, a small voice whispered inside me: “What are you seeing as a doctor? Images and numbers, or the person within them?”.

Before the afternoon consultations began, I went to the lounge for a moment. A junior resident standing next to the coffee machine saw me and greeted me. “Professor, I heard you saw a unique case in the outpatient clinic today?”. “Yes. A multiseptate gallbladder patient.”. “Oh, that. Our textbook only has a line or two about it... What's it like to see it in person?”.

I thought for a moment and then answered, “The image is beautiful. It's like a small work of art.. But the patient's anxiety is never beautiful.”. The junior resident nodded and took out a notebook to write something down. Watching him, I recalled my younger self. Back then, I used to record every case like a treasure. But as time passed, I became more attached to numbers like treatment processes and surgery success rates than to the patient's illness. Perhaps the reason I am writing the 'clinical diary' again now is to reclaim the mindset I had back then that I had forgotten.

As the afternoon clinic was ending, I leaned back in the examination chair and closed my eyes for a moment. The faces of the patients flashed by, one by one. The middle-aged woman who tried to stay calm after her cancer diagnosis, the young couple whose hands trembled while waiting for test results, and the multiseptate gallbladder patient I saw today. In the scenery of the hospital, people were fighting their own battles in their own ways. Some were fighting with their illness, some with fear, and some with time. And we, under the name of doctors, stood by their side.

I opened my notebook again. To write down the record that would conclude my day. “The hospital is always busy. But even amidst that busyness, I remember each patient's gaze. The image of the multiseptate gallbladder patient I saw today was textbook-like, but his anxiety could not be put into a textbook. I realize once again. What a doctor sees is not just an image, but the human being reflected within it.”.

Outside the window, the sky was already tinged with the color of the sunset. The day was ending, but another day would soon begin. The hospital never stops. And my clinical diary will not stop either.

Chapter 3 – Anatomy and Pathophysiology of Multiseptate Gallbladder

The gallbladder seems like a simple organ. It's a small pouch, about 7 to 10 cm long, with a capacity of about 50 mL. However, even within this small structure, many secrets are hidden. One of them is the multiseptate gallbladder, which I intend to record today.

1. The Moment of Explanation to the Patient

“Doctor, what exactly does the gallbladder do?”. When the patient asked, I couldn't just recite an anatomy textbook. The patient’s eyes held a desire to understand what was happening inside their body, beyond simple knowledge.

I closed the chart and leaned back in my chair. “The gallbladder is a small pouch that stores bile secreted by the liver. When we eat, especially fatty foods, the gallbladder contracts and sends the bile to the small intestine. Bile is essential for digesting fats. The patient nodded. I paused for a moment and took out a diagram to show him. “Normally, the gallbladder is one large space, but in your case, the inside is divided into several compartments. The wall-like septa divide the gallbladder. He looked at the drawing and said cautiously, “So, the bile can't flow out properly?” I smiled and answered, “That’s right. Some of the septa are not completely blocked, so bile does flow, but the flow might not be smooth. That's why you might feel indigestion or abdominal discomfort.”.

2. Anatomical Origin

After explaining to the patient, I organized my thoughts in my notebook alone. Where does a multiseptate gallbladder originate?. In the 4th week of gestation, the liver, gallbladder, and bile duct develop from the foregut. At this stage, the gallbladder exists as a fine tubular structure, which gradually undergoes recanalization to form a single lumen. However, if this process is incomplete, residual septa remain inside. This is known as the embryological mechanism of multiseptate gallbladder formation. Sometimes, the fibromuscular layer of the gallbladder wall develops excessively, forming septa. This causes the gallbladder to have a 'honeycomb' shape. I often emphasize this fact to junior residents: “The background of the images we see is always embryology. It’s not enough to just see an abnormal structure. Only by understanding 'why it became that way' is medicine truly complete.”.

3. Pathophysiology: The Flow in the Honeycomb

The multiseptate gallbladder is not just unique in shape. Its structure leads to functional changes.

• Bile stasis: Due to the irregular division of the lumen by the septa, the bile flow is not smooth. This increases the risk of gallstone formation.

• Gallbladder contraction disorder: The septa can hinder the contraction and relaxation of the gallbladder. Therefore, bile secretion after meals may not be smooth, causing indigestion.

• Increased risk of inflammation: Bile stasis creates an environment for bacterial growth. This can lead to recurrent cholecystitis.

While explaining this pathophysiology, I always observe the patient's expression. Most nod their heads, trying to understand, but their real thought is simpler: “In the end, is this dangerous?”.

4. Epidemiology and Rarity

A multiseptate gallbladder is a very rare malformation. According to the literature, only tens to a few hundred cases have been reported worldwide. I sometimes ask myself: “Is it a stroke of luck or bad luck that I am seeing such a rare disease right now?”.

For a doctor, a rare disease has two meanings:

• Academic curiosity: The excitement of directly experiencing a disease only seen in textbooks.

• Clinical burden: The fear of having to make a treatment decision in a situation where there are no clear guidelines for the patient.

The patient I met today presented me with both of these meanings simultaneously.

5. The Process of Differential Diagnosis

While a multiseptate gallbladder can be clearly seen in imaging, it can sometimes be confused with other diseases.

• Multiple gallstones: The septa can be mistaken for small stones in the ultrasound.

• Gallbladder polyps: A localized shadow might look like a septum.

• Gallbladder tumors: Rarely, it can be confused with a mass shadow.

Therefore, an inexperienced doctor might unnecessarily suspect cancer or, conversely, dismiss it as a simple finding. I confirmed my conviction by repeatedly checking the patient’s images from various angles. “This is clearly a multiseptate gallbladder. It is neither gallstones nor a tumor.”.

6. Conversation with a Colleague

That evening, in the conference room, I reviewed the images again with the professor from the Department of Radiology. He looked at the screen and marveled, “It's a classic honeycomb appearance. It would be perfect for a paper.”. I laughed and said, “But for the patient, it's not a paper subject, it's a matter of life.”. He was silent for a moment and then nodded. “That’s right. For us, it’s a case, but for the patient, it’s their life.”.

7. A Doctor’s Reflection

I wrote in my notebook again. “Multiseptate gallbladder is an embryological coincidence and a clinical challenge. The septa, intertwined like a honeycomb within the small space of the gallbladder, are not just a malformation, but a mirror reflecting the patient’s anxiety and life. We see it in an image, but the patient feels it in their life.”.

The 'clinical diary' that began in the prologue was now slowly being filled with specific content. The words I explained to the patient, the lessons I shared with a junior, and the brief conversations I had with a colleague all came together as a single record within me. I realized once again: medicine is not knowledge, it is a story. The story begins in the patient's body, continues in the doctor's record, and returns to the patient's life.

Chapter 4 – The Patient’s Life and Illness

Every time I meet a patient, I don't just try to see their illness. I try to see the shadow of their life behind their face. An illness is not simply a tissue deformation or a physiological dysfunction. It always manifests within the patient's life and sometimes even changes the direction of that life.

Today, I think of that patient again. The 36-year-old man who sat before me with a rare name of a multiseptate gallbladder. What remained more deeply than the honeycomb shape of the ultrasound image was his gait as he left the examination room. A careful pace, yet with a sense of determination.

1. Illness at Work

A few days later, he came back to the outpatient clinic. This time, he was with his wife. I remember how he had answered my question about his job. “I work at an IT company. I sit all day coding, having meetings... To be honest, I don't get much exercise.”. I nodded for a moment. A sedentary lifestyle slows down the flow of bile. The symptoms can become even more severe if he frequently eats fatty foods.

He confided in me, “I often eat fried chicken or ramen late at night because of late-night work. I just skip breakfast. My father always said his illness came from these habits, and I wonder if I'm following in his footsteps.”. I had to explain it medically. But at that moment, I could read the generational fear he felt. His father's medical history was not just a past event; it was a shadow cast over his future.

2. The Family’s Perspective

His wife, sitting next to him, didn’t say much. But her eyes held a deeper anxiety than her husband’s. “Doctor, could this illness become serious? Our child is still young, and if my husband gets sick...”.

I took a moment to compose myself and answered, “There is no major risk at the moment. However, if the discomfort continues, surgery may need to be considered. If there are no symptoms, it is sufficient to just observe.”. She smiled with relief, but a tension lingered behind that smile. As a patient accepts an illness, the family’s anxiety forms another layer. Just as the patient's septa divided the inside of the gallbladder, the family's emotions are also divided in the face of illness.

3. A Variation in Daily Life

After the consultation, the patient resolved to change his eating habits. “From now on, I’ll reduce late-night snacks and eat salads instead of fatty foods for lunch. I'll also try to exercise a bit.”. His voice was mixed with both determination and a hint of fear. I know well. It’s not easy to change life habits. Especially for an office worker, fried chicken and beer after a late night at work are not just food. They are a ritual to soothe fatigue and a bond with colleagues. Could he really break up with all of that? I didn't know. But what was important was that he showed the will to 'try'. Illness sometimes has the power to change a person.

4. Illness and Anxiety

A few days later, he sent me an email. “Doctor, is there a possibility that this could develop into cancer?”. I wrote a reply directly to him. “According to current knowledge, a multiseptate gallbladder is not directly linked to cancer. However, since bile stasis can cause gallstones or inflammation, it is good to have regular check-ups.”.

After sending the email, I still thought about the anxiety in his mind. Rarity is sometimes a double-edged sword. Being rare means being special, but it also means there is little information. Patients search the internet, look through medical papers, and fill those gaps with anxiety. I wrote it down. “A rare disease is fear itself for the patient. The lack of information causes greater anxiety than the disease itself.”.

5. Balancing Illness and Life

One day in the outpatient clinic, he said, “Doctor, my discomfort is not a big problem, actually. But I'm worried that this illness will shake my whole life. I have a lot of pressure at work to perform well, and I’m afraid people will say I can't concentrate because of my illness...”.

I looked at him and answered, “An illness comes into life, but it doesn't take over all of life. We have to learn how to live with the illness.”. At that moment, I realized. That small structure, the multiseptate gallbladder, was shaking a person's daily life, dreams, and even their future.

6. A Doctor’s Inner Monologue

After the patient left the examination room, I looked out the window. I could hear the laughter of children playing in the hospital garden. A thought suddenly crossed my mind : “An illness is in our body, but its ripple effect spreads to the whole family and society.”. I wrote in my notebook again. “The multiseptate gallbladder of the 36-year-old male patient is not a simple anatomical malformation. His life habits, his family's anxiety, his work pressure, and his fear of the future are all reflected in the honeycomb structure of this small gallbladder. Illness is life, and life is illness.”.

After this day, I didn't just record that patient as a 'rare case'. I recorded his life, his fear, and his resolution with him. A clinical diary, after all, is not just about recording the illness, but about recording the story of the person living with that illness.

Chapter 5 – Diagnosis and Differential

The essence of medicine, in the end, is the act of distinguishing. It is the act of sifting through countless symptoms and imaging findings to determine what is the essence and what is the shadow. The precision of this distinction determines the patient's life.

Today, too, I looked at the ultrasound image, trying to interpret what those faint lines meant. It was clearly a multiseptate gallbladder. But I asked myself again, "Is this really a multiseptate gallbladder? Am I missing another disease?".

1. The Beginning of Differentiation: The Maze of the Ultrasound

What is visible in the ultrasound image is just a combination of black shadows and faint lines. But countless possibilities are hidden within that simple image.

• Are these thin lines septa?

• Or are they the traces of small gallstones leaving ultrasound shadows?

• Or are they polyps on the gallbladder wall that are being seen incorrectly?

I repeatedly confirmed the image by rotating the transducer from various angles. The septa remained in the same position even when the location was changed. If they were stones, they would have moved. If they were polyps, they would have appeared as dots protruding from the wall. But this was different. Thin lines were dividing the lumen of the gallbladder, creating a structure that was both regular and irregular.

I wrote in the chart. “Multiple septa observed throughout the gallbladder lumen. No change in location. Gallstones excluded.”.

2. The Boundary with Gallstone Disease

Gallstones are the most common gallbladder disease. Therefore, a doctor always suspects gallstones first. However, gallstones move with gravity and leave an acoustic shadow. The patient's image I saw today had none of those characteristics.

I explained to a junior resident, “Gallstones block light and leave a shadow behind them. But septa connect to the gallbladder wall with the same echo. You have to see this difference.”. He nodded and checked the screen again. Medicine is always distinguished by such detailed observation. A little inattention can change a patient’s life.

3. Distinguishing from Gallbladder Polyps

Polyps are small growths that grow on the gallbladder wall. Sometimes, small polyps of less than 1 cm can look like septa on an ultrasound. However, polyps always protrude from the wall. On the other hand, the septa of a multiseptate gallbladder traverse the gallbladder lumen. I also explained it simply to the patient, “It’s not a growth like a lump, but rather partitions inside the gallbladder.”. He looked at the diagram again and nodded.

4. The Shadow of Gallbladder Carcinoma

Above all, what I was most wary of was gallbladder cancer. Gallbladder cancer does not appear as a clear mass in the early stages and can appear as wall thickening or an irregular shadow. If it is confused with a rare multiseptate gallbladder, it could be a fatal misdiagnosis.

I magnified the image and measured the thickness of the gallbladder wall in detail. 2 mm. It was within the normal range. There was no blood flow signal either. There were no signs of inflammation or a tumor. I breathed a sigh of relief and wrote it down. “No signs suggesting gallbladder cancer. Normal wall thickness. No blood flow.”. But at the same time, I made a promise to myself: “This conviction will determine the patient’s future. Therefore, I must not completely abandon my doubts.”.

5. Rarity and Uncertainty

Because a multiseptate gallbladder is so rare, there are no clear standardized diagnostic guidelines. A few case reports in the literature are all that exist. I reviewed the image once more with my colleague, the radiology professor. He said, “This is a classic multiseptate gallbladder. A CT would make it more certain, but it can be diagnosed sufficiently with just an ultrasound.”. I nodded, but a sense of uncertainty still remained in my mind. The diagnosis of a rare disease always requires a 'conviction without certainty'.

6. Conversation with the Patient: Sharing Uncertainty

The patient came back into the examination room. He looked a little more at ease than the last time, but his eyes were still wavering. “Doctor, can you be sure what this is?”. I looked at him for a moment and then answered honestly, “The word 'certain' is always difficult in medicine. But the image we see now is almost certainly a multiseptate gallbladder. It is not gallstones or cancer.”. He breathed a sigh of relief but at the same time asked, “Is there a possibility that it could be wrong?”. I nodded. “Yes, there is a possibility. That’s why it is necessary to have regular check-ups and observe it.”. There was still anxiety in his expression. But I knew. What the patient wanted was not absolute certainty, but a doctor's attitude to bear the uncertainty with him.

7. Inner Monologue: The Weight of Diagnosis

After the patient left, I sat in my examination chair and closed my eyes. Diagnosis is not just about giving a name. It is the act of designing a patient’s future. I wrote in my notebook. “Multiseptate gallbladder - a rare name. But this one name casts a shadow over the patient's life. Diagnosis is not knowledge; it is a promise. We have to bear the weight of that promise.”.

8. Conclusion: The End and Beginning of Differentiation

Today, I learned again. Differential diagnosis is not just the process of distinguishing between diseases. It is the process of finding a path within the patient's life. Gallstone disease, polyps, cancer. These three words become destiny for a patient. A single line of diagnosis I make in front of them can save their life or destroy it. Therefore, I always ask myself, “Did I choose the right path?”. Today's answer was a multiseptate gallbladder. But that answer is not the end; it is just the beginning of new questions that will continue to arise.

Chapter 6 – The Crossroads of Treatment

Just because a disease is diagnosed doesn't mean everything is over. Diagnosis is rather a new beginning. The same question always follows: "How should we treat it?". Multiseptate gallbladder is a rare disease, but most are found incidentally without symptoms. Therefore, textbooks say simply: "If there are no symptoms, no treatment is needed. If there are symptoms, consider cholecystectomy.". A short, simple sentence. But applying that sentence to a real patient's life was by no means simple.

1. The Patient Returns

The 36-year-old male patient came back to the examination room a few weeks later. His face looked paler than the last time. “Doctor, my right upper abdomen feels heavier these days. It seems to get worse after I eat.”.

I immediately checked the ultrasound again. The septa were still clear. There were no gallstones. The gallbladder wall was also a normal thickness. However, the patient's discomfort was clearly getting worse. “Do you have any fever or symptoms like vomiting?”. “No, but it keeps bothering me so much that it's hard to live a normal life.”. His words were not a simple symptom report. They contained a desperate message of “don't you think it’s time to make a decision?”.

2. A Family Meeting

A few days later, the patient came to the hospital again with his wife. This time, his mother also accompanied them. The examination room felt like a small conference room. His wife spoke first. “Doctor, my husband is having such a hard time these days. I'm worried just watching him. Wouldn't it be better to have surgery?”. The patient lowered his head for a moment. “To be honest, I'm scared. My child is still young, and I don't want to have surgery. But if this discomfort continues, it will be difficult to work and I will feel like a burden to my family.”. His mother, sitting next to him, said firmly, “Our family has suffered a lot because of gallbladder problems. Your father also had surgery for gallstones. I think it’s better to have surgery sooner rather than later.”.

At that moment, the air in the examination room became heavy. Everyone had a different fear, but their gazes toward me were the same. “Doctor, which path should we choose?”.

3. Discussion with Colleagues

I couldn't make this decision alone. At lunchtime, I brought the case up at the surgeons' meeting. “36-year-old male, multiseptate gallbladder, recurrent right upper abdominal discomfort. No gallstones. Need to discuss whether to operate.”.

One of the surgeons said, “If there are symptoms, surgery is the right answer in the end. Cholecystectomy is a standardized surgery, and complications are rare.”. Another professor shook his head. “But the patient is still young, and there are no clear complications that would require surgery. Deciding on surgery based solely on discomfort could be overtreatment.”. I took notes on their opinions and asked myself, “What is the right path for the patient?”.

4. An Honest Conversation with the Patient

A few days later, I sat with the patient and had a long conversation. “Surgery can be a fundamental solution. The discomfort is likely to disappear if the gallbladder is removed, but at the same time, surgery involves a recovery period and the risk of complications.”. He asked seriously, “What kind of complications are you talking about?”. “Rarely, there can be bile duct injury, bleeding, or infection. But most people recover without major issues.”.

He was silent for a long time. Then he said in a low voice, “Doctor, if it were you... what would you do?”. I paused at that question. It is one of the most difficult questions a patient can ask a doctor. I answered calmly, “If I were the patient, I would consider surgery if the discomfort was severe enough to affect my daily life. But the decision is ultimately something you and your family must make together.”.

5. A Doctor’s Inner Conflict

After the patient left, I stared at the ultrasound image on my computer monitor for a long time. The thin septa inside the gallbladder were tangled like the lines of conflict in my own mind. I wrote it down. “The path of treatment is always two-pronged: to observe or to intervene. The patient’s discomfort and fear cannot be quantified. In the end, a doctor's role is not to give the answer, but to find the way together with the patient.”.

6. A Small Turning Point

At the next consultation, the patient came in with a determined look. “Doctor, I’ve discussed it with my family. I will have the surgery.”. I saw both anxiety and relief in his eyes. Surgery was a fear, but it was also a choice to end the uncertainty. I wrote in the chart. “Surgical consent. Laparoscopic cholecystectomy planned.”.

7. Passing the Crossroads of Treatment

The path of treatment is always a crossroads. On that path, the patient, the family, and the doctor all carry their own anxieties. Surgery is not a simple medical act. It is a moment when a person chooses how to live their life. I wrote in my clinical diary again. “Today, a patient made a decision at the crossroads of treatment. The courage with which he chose the path of surgery will lead his life in a new direction. The doctor’s role is to stand with him on that path.”.

Chapter 7 – Recovery and Reflection

1. The Day of Surgery

The air in the hospital's operating room is always filled with tension. The 36-year-old male patient entered the operating room, accompanied by his family. His expression was tense, but I could see a firm resolve. “Doctor, I’m in your hands.”. It was a short sentence, but it contained the meaning of entrusting his future to me.

Laparoscopic cholecystectomy is a relatively standardized surgery. But I always approach it with the same tension. This patient, in particular, had a rare multiseptate gallbladder. Since the gallbladder was divided into multiple septa, the dissection could be a bit tricky.

General anesthesia was administered, and the patient fell into a deep sleep. I cautiously made the first incision. As expected, the gallbladder on the screen showed a complex structure. The septa, divided like a honeycomb, were still there. However, the surgery proceeded calmly, and the gallbladder was successfully removed.

The moment I finished the last suture, I breathed a sigh of relief. “It's over. It's done well.”.

2. The Beginning of Recovery

The morning after the surgery, the patient was lying in a hospital bed. His face was pale, but his eyes were clear. “Doctor, it hurts less than I thought it would.”. I smiled. “That’s good, because it’s a laparoscopic surgery, the recovery is fast. You will be able to be discharged in a few days.”. His wife, who was next to him, had tears in her eyes. “Thank you so much. I'm so relieved to see my husband smiling again.”.

I wrote in the chart. “Day 1 post-op, stable vital signs. Pain controlled. Good recovery.”.

3. A Scene from the Ward

For a few days, I often visited the patient's room. He gradually regained his strength and began to take short walks. His footsteps as he walked to the end of the corridor and back carried a meaning beyond simple exercise. One day, he told me, “Before the surgery, my right upper abdomen always felt heavy and stuffy, but now that discomfort is gone. My body feels much lighter.”. His expression was calm, and his voice was filled with relief. I thought to myself, “This is the reward of being a doctor: the moment a patient overcomes pain and returns to their daily life.”.

4. The Family’s Relief

A family visit was held before his discharge. His mother held her son’s hand tightly and said, “It was good that you had the surgery. Now you can live with peace of mind.”. His wife nodded from beside him. “Doctor, you have truly bestowed a great kindness upon our family.”. I smiled quietly. A doctor's work is sometimes met with criticism, and sometimes with gratitude. But the essence is the same: to stand with the patient in their life.

5. A Doctor’s Reflection

After the patient was discharged, I opened my clinical diary again. “36-year-old male, multiseptate gallbladder. Good recovery after laparoscopic cholecystectomy. The patient has found peace, freed from pre-surgery anxiety. The disease was rare, but the joy of recovery is universal.”. I thought. Medicine is not simply a technique for curing diseases. It is a process that allows people to overcome their fears and live their lives again.

6. The Traces Left by Recovery

The surgery was a success, and the patient regained his health. But the event also left a mark on my heart. I realized. The rarer the illness, the greater the academic curiosity for the doctor and the greater the anxiety for the patient. And what fills that gap is the trust built during the process of treatment.

The patient has returned to his daily life, but I still remember the honeycomb-shaped gallbladder in that ultrasound image. That structure is no longer a simple anatomical malformation. It was a symbol that held the patient's anxiety, the family's tears, the tension of the operating room, and the smile of recovery.

7. Inner Conclusion

I wrote the last line in my clinical diary. “Recovery is not just stability after surgery. It is a process of reflection in which both the patient and the doctor overcome anxiety. The multiseptate gallbladder was a rare case for me, but through it, I realized the true essence of medicine. Medicine is the work of restoring a person, and the work of making a doctor reflect on themselves.”.

Chapter 8 – The Meaning of a Clinical Diary

Every day when I close the door to the examination room, I recall the faces I encountered that day. Some left with a smile, while others left with worry. Every one of those expressions leaves a mark on my heart, and those marks eventually become words. That is my clinical diary.

What I Learn from the Patient’s Story

A clinical diary is not just a record of test results or prescriptions. It is the work of capturing the patient's voice, expression, and even the unspoken sighs they left with me. Through that process, I realize once again that illness is not just a medical phenomenon; it is deeply connected to the core of life.

A Record of My Learning and Reflection

Living as a doctor, I often feel inadequate. There are days when I am anxious about a delayed diagnosis, and days when I worry about a different treatment response. The clinical diary is a place to honestly face those moments. “Why did I make that judgment?”. “Would the patient have been better off if I had chosen a different path?”. When I ask myself these questions and write, I learn and mature again. The clinical diary is a record for the patient, but at the same time, it is a writing that trains me.

A Promise to the Patient

The short sentences written next to a patient's name contain their life. Recording it with sincerity is a promise that “I will not forget you.”. The brief moment of consultation continues in the record, and that record, in turn, makes me remember the patient. In that process, an invisible bridge of trust is built between the patient and me.

A Mirror Reflecting the Times

The clinical diary goes beyond being a personal writing; it becomes a mirror of the times. The sentences I leave might later serve as a testimony to the medical reality of this era. The time when an infectious disease swept through the hospital, the moment a new treatment was introduced, the days when patients and medical staff shared hope and fear together. The clinical diary is at once a medical history and a social record.

A New Clinical Diary in the Digital Age

Nowadays, records are left on electronic charts instead of paper notebooks. Artificial intelligence learns from countless clinical data to open up the future of medicine. But I still write down a patient’s single word on a small memo pad. Because what a machine cannot replace is a heart for people. The essence of the clinical diary is always the same: to record the genuine encounter between the patient and the doctor.

To Conclude

Although I am a doctor, in the end, I am just a person living the same life as my patients. Writing a clinical diary is a process of not forgetting the patient, of looking back at myself, and of vowing to become a better doctor. I hope that one day, these records will accumulate and remain as a small light for me, for the patient, and for society as a whole. A clinical diary is, in the end, a record of life written together by the patient and the doctor.

Epilogue – The Unfinished Record

The hospital always greets me with the same light. Whether it’s dawn or the middle of the night, I have taken countless steps under the cold, bright fluorescent lights. But the path I have walked under that light has never been the same. A single glance from a patient, a single tremble in a family member's hand, changed my day and shook my heart.

I am now closing the final chapter of my clinical diary. But this record is by no means the end. Tomorrow, another patient will open the examination room door, and I will write down their story again. To record it in writing is a commitment to remember and a promise not to forget.

A doctor recording a patient is the same as a human being recording another human being. What lasts longer than a diagnosis is the patient’s expression, and what is remembered more vividly than the surgical result is the family's tears. All of those moments taught me and led me to deeper reflection.

I know now. The clinical diary was a record for the patient, but at the same time, it was a record for me. It was a shared diary written together by illness and life, fear and hope, and doctor and patient.

Outside the window, a new dawn is breaking again. The light seeping through the trees in the hospital courtyard tells me that a new story will begin today. The clinical diary stops here for a moment, but the diary of life never ends. And on that path, I will remain as the one who records.

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