Doctor’s Clinical Diary 11 – An Unexpected Discovery
An Unexpected Discovery
Prologue: The Weight of Hope and Despair
September 29, 2025. Monday.
A cloudy sky, with a chill breeze seeping beneath my white coat. Fifteen years. That is how long I have spent as an oncologist at the cancer center. If someone were to ask me what those years have been, I would answer: fifteen years of precariously balancing on a vast scale between hope and despair.
The door to my office is a threshold between two worlds. Beyond it lies the noise of daily life, filled with ordinary worries. But the moment a patient and family step inside, this small room becomes an entire universe where the heaviest and most fundamental questions of existence are asked: life and death. Clad in my white coat, I am but a clumsy navigator sailing through that cosmos.
A cancer diagnosis falls upon a patient’s life like a meteorite. A once peaceful routine is shattered, the future swallowed by dense fog. For some, I may become a ray of light; for others, the bearer of their final verdict. A faint shadow on a CT image, a single word on a biopsy report—these decide the fate of countless lives. Even after fifteen years, the weight of it is still staggering.
That is why I write these diaries. Charts cannot contain the weight of my emotions, nor the lessons I learn from those who sit before me. This clinical diary is not merely a record of medical observations, but my confession as a human being standing behind the stethoscope.
Today again, I step onto the scale. To one person I may hand hope, to another despair. Yet I believe this: even in the deepest pit of despair, a seed of hope can still take root. And sometimes, in the most unexpected places—in the mysterious secrets the human body keeps—we discover comfort and awe beyond measure.
This diary is about such unexpected discoveries. It is time to open the door to yet another universe.
Chapter 1: The Shadow of Silence
“My father is so stubborn. I practically had to drag him here.”
Even behind her mask, her fatigue and worry were unmistakable. The woman, perhaps in her late thirties, gave an awkward smile as she glanced at the middle-aged man sitting beside her. My first patient of the day: Mr. Jung-Hoon Lee, fifty-one years old. Were it not for his daughter, he might never have stepped inside a hospital. His lips were tightly pressed together, his eyes wandering around my office with a mixture of wariness and resignation.
“Mr. Lee, could you tell me in your own words what brings you here today?”
I kept my voice as gentle as possible. Allowing a patient to narrate their own story—that is the first step of every consultation. He glanced at his daughter, sighed as if giving up, and answered curtly.
“It’s nothing serious. Just a cough that won’t go away. But my daughter insisted I come…”
“How long have you had this cough? Any phlegm or other symptoms?”
“Three… maybe four months. It’s a dry cough, no phlegm. I figured it was just from all those years of smoking.”
His daughter, unable to contain herself, interrupted.
“Doctor, it’s not just the cough. He’s lost a lot of weight lately, says he’s lost his appetite. In the evenings he’s too exhausted to get out of bed.”
I studied Mr. Lee’s face more carefully. Deep lines etched by years of labor, sun-darkened skin. Yet beneath it lingered a pallor, a subtle weariness. His daughter’s words echoed familiar warning bells in my mind—three months of persistent dry cough, weight loss, loss of appetite, fatigue. For us oncologists, this was a constellation of ominous signs.
“Mr. Lee, how long have you smoked, and how much a day?”
“Since I was twenty… at least a pack a day.”
More than thirty years of smoking. I quietly recorded it, then asked,
“Any chest pain? Shortness of breath? Hoarseness? Trouble swallowing?”
“No, nothing like that.”
His calm response did not ease my concern. The most likely suspect hovered in my mind: lung cancer. These were the textbook signals. Other possibilities—esophageal cancer, another thoracic malignancy—could not yet be ruled out.
“How much weight do you think you’ve lost?”
“Maybe five kilos. But you sweat in the summer, work hard—it happens.”
He tried to dismiss it, yet his eyes flickered. He knew something was wrong, but fear had kept him from facing it.
“Your daughter’s care for you is very evident. Many might ignore such symptoms, but bringing you here was the right choice.”
Acknowledging their effort is always important. Trust is as vital as diagnosis.
“To understand what’s happening, we need to look inside more closely. The most accurate test would be a chest CT scan. It allows us to capture the lungs and chest organs in thin, detailed slices.”
At the word CT, tension flashed across both faces. To most, CT scans mean one thing: cancer.
“Is that really necessary? Couldn’t an X-ray be enough?”
Mr. Lee’s voice betrayed unease.
“X-rays are useful for bones and larger changes, but they often miss small or early problems in the lungs or esophagus. CT scans, however, let us see with far greater clarity. In medical terms, this is to ‘rule out occult malignancy.’ It may be nothing—but if there is a serious problem, finding it early is crucial.”
I spoke carefully, the term malignancy deliberately chosen. Such language, while heavy, conveys both the seriousness and necessity of the test.
His daughter gripped his arm firmly.
“Dad, let’s just do it. It’s only to make sure. Better safe.”
I scheduled the earliest available CT and guided them to the lab for bloodwork. When the door closed, I leaned back in my chair. A familiar weight pressed on me. The beginning of another story heavy with uncertainty. I prayed that my fears would be unfounded, that Mr. Lee’s CT would reveal nothing but a field of clean, gray images. Yet fifteen years of experience had taught me: miracles are rare.
Chapter 2: Light and Shadows in the Reading Room
A few days later, a notification blinked across my computer screen: Mr. Lee’s CT results had arrived. I set down my coffee and drew a slow breath. No matter how many times I had done this—hundreds, perhaps thousands—the moment before opening a scan always carried the same tension. In a fraction of a second, an entire life might be altered.
I checked his name and ID once more, then pressed Enter. Out of the darkness, the black-and-white images began to appear. With practiced motion, I scrolled through hundreds of cross-sectional slices, from the lung apices downward: bronchi, hilum, lung fields…
Hmm…?
Something was missing. There was no sign of the expected mass—no irregular consolidation, no invasive shadow. Neither pneumonia nor bronchiectasis appeared. A quiet sigh of relief escaped me. But symptoms rarely exist without a cause. I slowed my pace, eyes sharpening, pixel by pixel.
I moved past the lungs to the mediastinum: the heart, aorta, esophagus, lymph nodes.
“What is this…?”
The words slipped out before I could stop them. Just beneath the aortic arch, beside the pulmonary artery, was a structure that did not belong. At first glance it resembled an enlarged lymph node, the kind we fear as a sign of metastasis. My heart sank—lymphatic spread could mean advanced disease.
But something felt different. With contrast enhancement, this structure lit up white, just like the great vessels around it—bright, uniform, filled with blood. Lymph nodes never do this.
Switching views—axial, coronal, sagittal—the scattered dots and lines aligned into a coherent shape.
It was a vessel. Undeniably a blood vessel. The left subclavian vein and internal jugular vein had united, not crossing rightward in the usual way to form the superior vena cava. Instead, a persistent channel descended beneath the aortic arch, curving across to join the right superior vena cava.
“Persistent Left Superior Vena Cava…?”
A term from my student days surfaced—half-buried in anatomy textbooks. A rare congenital anomaly, found in only 0.3–0.5% of the population. In the womb, both right and left superior vena cavae exist. Normally, the left regresses, leaving only a remnant. But in Mr. Lee, the left remained, silently carrying blood for more than fifty years.
Excitement replaced dread. This was no malignancy, no death sentence—just a different blueprint of the human body. As harmless as being left-handed in a world of right-handers.
What made his case rarer still was the drainage route. Most persistent left superior vena cavae empty into the coronary sinus behind the heart. His, however, joined directly with the right superior vena cava—a variation documented only in a minority of such cases.
Under the sterile glow of the reading room monitor, I sat transfixed. After years of chasing cancer’s dark shadows, here was a glimpse of the body’s wonder. Each human frame, more unique than any textbook, carries its own secret architecture—its own small universe.
Mr. Lee’s persistent cough and weight loss were likely from chronic bronchitis or another benign cause. This venous anomaly may have been incidental, perhaps nudging a nerve or two, but hardly the villain we feared. The true revelation was this: the dreaded shadow of cancer had lifted.
I rose from my chair, buoyed by the thought of sharing the news. To offer not despair, but hope—and not just hope, but a story of medical wonder. For an oncologist, this was one of the rarest rewards. My steps back to the clinic felt lighter than they had in weeks.
Chapter 3: You Have a Left-Handed Vein
The door opened, and Mr. Lee entered with his daughter. Compared with their last visit, the air around them was heavy, damp with tension. Faces of patients awaiting results always carry the same look—a mingling of hope and dread, like defendants awaiting a verdict. Each time I see it, I am reminded of the gravity of my role.
“Please, have a seat.”
They sat side by side, eyes fixed on my lips as if nothing else existed. His daughter’s hand rested on her father’s knee, knuckles white with strain.
I did not prolong the suspense. In such moments, unnecessary silence is cruelty.
“Let me begin with the conclusion: there is no cancer. No tumors, no malignancy.”
The atmosphere shifted instantly. Time, frozen until then, began to flow again. Mr. Lee’s shoulders loosened visibly. His daughter lowered her head, biting her lip to contain tears, her small shoulders trembling.
I allowed them a pause for relief before turning the monitor toward them.
“Take a look here.”
On the screen, I pointed to the bright vessel coursing beneath the aortic arch.
“Your body holds something unusual—not cancer, but a unique anatomical feature.”
“Have you heard of the superior vena cava?” I asked. “It’s the large vein that returns blood from the upper body to the heart. Normally, people are born with just one, on the right.”
I gestured toward the anatomical model on my desk.
“But in your case, the left superior vena cava—something that usually disappears in the womb—remained. We call this a ‘Persistent Left Superior Vena Cava.’ It occurs in only three or four out of a thousand people.”
Their faces registered both relief and confusion. Strange medical words can spark new anxieties, even after good news.
“To put it simply,” I continued, “think of it like this: most people are born right-handed, but some are left-handed. This is not a disease, just a difference. Your vein is left-handed. You have lived this way all your life, and it will never cause you harm.”
At the phrase left-handed vein, Mr. Lee’s stern face softened into a faint smile.
“Well, imagine that. A left-handed vein, hiding in me all this time.”
“Yes. Most people never know until a scan reveals it by chance. And in your case, it’s even more special.”
I zoomed in on the image.
“Usually, this left vein drains into the heart’s coronary sinus. But yours joins directly with the right superior vena cava. That’s very rare—a remarkable variation.”
I wanted him to feel not merely relieved, but extraordinary—to see himself not as a patient, but as a bearer of the body’s hidden marvels.
His daughter, calmer now, wiped her tears and asked, “Then his coughing and weight loss… they aren’t from this?”
“A very good question. No, this anomaly is not the cause. More likely it’s chronic bronchitis from long-term smoking, or something similar. We’ll need to do more pulmonary tests. But the biggest fear—the possibility of cancer—is off the table.”
I finished writing a referral note for respiratory medicine.
“If your daughter hadn’t brought you here, we might never have discovered this hidden feature in your body—or had the chance to catch other conditions early. She’s done something very important.”
As they left, the transformation was striking. The grim faces that had entered now glowed with relief. Mr. Lee chuckled, “Turns out my vein is left-handed!” while his daughter bowed repeatedly in thanks, apologizing for her earlier alarm.
Alone again, I let the silence of the office settle around me. Sometimes my role is to fight cancer, to guide patients through grueling treatments. But other times, my role is to confirm the absence of cancer, to return peace to a family, and perhaps to remind them of the wonder that lives within their own bodies.
Today, I did not save a life—but I restored peace to two hearts. And for myself, I rediscovered the pure joy of medicine: the delight of exploration, the awe of discovery. That, too, makes a day meaningful.
Chapter 4: A Twenty-Nine-Year-Old’s Bucket List
The lighthearted afterglow of Mr. Lee’s “left-handed vein” lingered in my office for days, like a soft breeze after a storm. Few gifts are more precious to a doctor than watching a patient step back from the edge of despair into the warmth of everyday life. Yet time in a cancer center is never indulgent. One family’s happy ending often ushers in another’s tragedy, and sighs of relief are quickly drowned by the cries of those still waiting.
My last patient that afternoon was Ms. So-Yeon Park, twenty-nine years old. The referral note from another hospital was mercilessly brief: Gastric cancer, stage IV. Multiple liver metastases. Peritoneal seeding.
Twenty-nine. The very bloom of life. To see those numbers paired with “stage IV cancer” was almost unbearable.
She entered the room with a calm, luminous face that belied the grim diagnosis. Dressed in a white dress, her hair neatly tied back, she looked less like a patient and more like a visitor here to cheer someone else. Beside her stood a woman—her mother—whose face was a map of anguish, as if she might collapse at any moment.
“Ms. Park, welcome. Please, have a seat.”
I tried to keep my voice steady, though I wondered if it trembled. The hardest patients to face are the young. In their eyes you see not just illness, but the fading outlines of dreams and futures that should have been.
“I’ve reviewed the reports you brought. How are you feeling today? Any pain or discomfort?”
“Other than some indigestion… not much. Just a bit tired.”
She spoke as if describing someone else’s condition, steady and almost detached. But her mother’s silent tears betrayed the truth.
On the screen, her PET-CT glowed with scattered dark spots—cancer cells devouring glucose across the stomach, liver, peritoneum. Medically speaking, cure was impossible. All we could offer was palliation: to slow the disease, relieve symptoms, buy more time with quality.
“In this situation,” I explained carefully, “the best option is chemotherapy aimed at suppressing tumor growth and easing symptoms. We call it palliative chemotherapy. The side effects may be difficult—nausea, vomiting, hair loss, fatigue…”
I listed them one by one, bearing the duty of honesty. Usually, at this point, patients break down in tears, or ask the most impossible question: How long do I have?
But her response was different. She listened intently, then opened her bag and took out a small notebook. Its pages were filled with neat, rounded handwriting, almost childlike in its purity.
“Doctor, I have a few questions.”
She flipped to a page and read aloud.
“If chemo is every three weeks, does that mean I’ll have about one week at the end where I feel well enough to be up and about?”
“Yes,” I nodded. “Typically, two weeks are hard, and the last week is when strength begins to return.”
“Then… in that last week, could I travel to Jeju Island? Just a short trip. Would it be safe to fly?”
The question stunned me.
“And… I’ve always wanted to try pottery. Is it too risky, with infection concerns? Oh, and when my hair starts to fall, where’s the best place to get a nice wig?”
She asked these things quietly, almost cheerfully, like a girl planning an autumn picnic. On the page, her “bucket list” brimmed with modest dreams: Live in Jeju for a month with Mom. Make my own bowl. Take the best portrait of my life.
My throat tightened. She was not dwelling on death, but on life—how to spend what remained. The cancer had spread everywhere, but her spirit was untouched, radiant.
I looked into her eyes. They were clear, steady. There was sadness, yes, but not despair. Instead, there was fierce love for life, an unyielding will.
This, too, was an unexpected discovery. No scan could capture it, no biomarker measure it: the brilliance of a human soul that refuses to be extinguished.
“Ms. Park,” I said, “yes—you can fly, as long as you feel strong enough. Pottery is possible too, with gloves and care. And I will help with everything else. We’ll plan your chemo around your list. Let’s make it happen, one dream at a time.”
Her face lit up with a smile, bright as afternoon sun. Her mother, still weeping softly, managed to stop at the sight of her daughter’s courage.
After she left, I sat staring at her chart. The grim black dots of her scans blurred into the image of her round handwriting, her radiant smile. My role was no longer just to fight cancer cells—it was to help her fulfill her dreams.
Chapter 5: A Voyage for Travel
The chemotherapy ward is a silent battlefield. Patients sit tethered to IV poles, their bodies waging war against an invisible enemy. The steady beeping of infusion pumps, the cold stream of drugs seeping into veins, and the heavy silence of endurance—all mingle in the air, charged with both hope and resignation.
On the day of Ms. Park’s first chemotherapy, she chose a seat by the window. A nurse slid the needle gently into the vein of her slender arm. Soon, the first drug—oxaliplatin—began dripping into her bloodstream. This was the opening salvo of the FOLFOX regimen, the standard treatment for advanced gastric cancer.
I made my rounds and approached her.
“How are you feeling? Any chills or pain at the injection site?”
“I’m fine, doctor. It just feels… as if a ship is quietly sailing into my body.”
“A ship?” I asked, intrigued.
“Yes,” she smiled faintly at the IV line. “This medicine feels like a fleet arriving to fight the bad guys inside me. They might cause a little seasickness with all their noise and commotion, but they make me feel less alone.”
I couldn’t help but smile at her imagination. To call chemotherapy a fleet! She had reframed her ordeal into a story of courage.
“You’re right,” I said. “Oxaliplatin and 5-FU are like two generals leading a strong fleet. They target fast-dividing cells, stopping them from multiplying. The downside is, healthy cells that divide quickly—like hair and mouth lining—also get caught, causing side effects.”
I added, “The hardest part will probably be nausea—like seasickness. We’ve already given you antiemetics, but if it gets worse, tell us. We’ll help.”
She nodded firmly. “Don’t worry. I’ll eat well, rest well, so the fleet can fight its best.”
Her mother sat beside her, silent, clutching her hand, tears glimmering in her eyes. She bore the weight of fear and grief her daughter seemed to defy.
Hours later, as the drip neared its end, Ms. Park opened her notebook again. Her face was paler now, but her eyes still bright.
“Doctor, I booked tickets to Jeju,” she said with a small smile. “We’ll be back three days before my next cycle.”
“Already? That’s impressive.”
“And I bought matching dresses for me and Mom. We’ll take lots of photos. You said the rest week is like a vacation, right? I’ll treat it as a gift, my school holiday between terms. I want to do my homework well so I’ll have strength for the next semester.”
To her, chemo was not a march toward death, but a voyage—storms endured for the promise of another shore. My role was to light a beacon, to prepare safe harbors, to keep her voyage steady.
When the infusion ended, the nurse withdrew the needle. Ms. Park stood, weary but unbowed, her eyes still sparkling.
“Thank you, doctor. In three weeks, I’ll return healthy, with photos from Jeju to show you.”
I smiled back. “Yes. Have a wonderful holiday. Don’t overdo your homework.”
As I watched the mother and daughter leave, I thought: fighting cancer is not just about extending days or months. It is about how each moment of borrowed time is lived. That day, a young warrior finished her first battle, and with courage set sail toward the trip of her dreams. With every page she filled in her notebook, my role diminished, and hers grew stronger.
Chapter 6: A Letter from the Canola Fields
Three weeks pass differently for each soul. For some patients, it is a stretch of suffering, endured hour by hour. For others, it is a treasure chest of fleeting joys. For Ms. Park, those three weeks belonged to the latter.
While she was away, my own days blurred into a rush of patients, protocols, and urgent decisions. Yet in quiet moments, I found myself looking out the window, imagining the skies over Jeju Island. I hoped she was standing under that same blue expanse, feeling sunlight on her face, the sea breeze in her hair. I hoped she was living not as a patient, but as a twenty-nine-year-old woman tasting the fullness of youth.
Two days before her second round of chemotherapy, she returned. Thinner, yes—but her skin had been kissed by the sun, her expression calmer, freer. Most striking of all was her hair. Where strands had begun to fall, she had cut it into a short, stylish crop and crowned it with a jaunty beret. She had taken what could have been a symbol of despair and transformed it into her own badge of dignity.
“Doctor, I’m back.”
She opened her bag and placed a small photo album on my desk.
“I wanted you to see these first.”
On the first page: a field of golden canola blossoms in full bloom, with her at the center, dressed in a matching outfit with her mother, both smiling as if the world belonged to them. In photo after photo, she was radiant—holding a lopsided handmade teacup, running hand in hand toward the sea, scrunching her nose over a feast of seafood. Each image was a testament to her fierce resolve to love and live every fragment of time.
“These are… extraordinary,” I murmured, pointing to the canola field picture. “This one looks like it belongs in a gallery.”
“Doesn’t it?” she laughed. “Mom took it. My best photo yet. I think the chemo fleet gave me this gift. It wasn’t easy—the seasickness was rough—but it was worth it.”
Her mother only nodded silently, watching me turn the pages with trembling hands. The broken look she had worn weeks ago had softened; joy and memory had become her strength.
“And during the trip,” Ms. Park added, “I ate well, I slept well. The medicines you gave me worked.”
I checked her lab results. To my relief, her blood counts and liver function were stable enough for the next cycle. Against all odds, her body was rebounding, as if her positivity itself fueled her resilience.
“Excellent,” I said. “You’re ready for round two. The fleet will sail again tomorrow.”
She grinned. “Perfect. Then I’ll fight this battle and be back in time for my next holiday. I already wrote my next assignment: See the autumn leaves at Mount Naejang.”
Her notebook had a new dream inscribed, waiting to be fulfilled.
As she left, I lingered on her words. Medicine weighs tumors in centimeters, measures markers in decimals. Yet there are things beyond numbers—the weight of a will to live, the density of love, the depth of moments shared.
Her photo album felt like a letter—one written not in ink, but in light and color. A letter from the canola fields, whispering this truth: even in despair, life can still bloom. Existence is worth living, even until the very last page.
I tucked that letter deep into my heart, to be opened again when the shadows return.
Epilogue
After that day, she never returned.
Each time her next appointment drew near, my heart sank with foreboding. When the date passed without a call, I understood. She had chosen her own course—not another battle, but her final holiday. The twenty-nine-year-old warrior had anchored her ship at the brightest harbor she could find, on her own terms.
As her doctor, my duty had been to extend her life for as long as possible. Yet she taught me a greater truth: the length of life may be measured in numbers, but its depth is measured in love, dreams, and will. Her days were few, yet fuller and more luminous than many who spend decades adrift in despair.
A few days later, her mother arrived at my office carrying a small parcel. She no longer wept as before; instead, a faint but peaceful smile lingered on her face. Inside the parcel lay a photograph from the canola fields and a small ceramic teacup, uneven but warm to the touch.
“Thanks to you, Doctor, So-Yeon lived her last days with no regrets. She laughed, worked with clay, and cherished every moment. She wanted you to have this teacup—it was her wish, even until the end.”
She placed it gently on my desk and departed.
The cup was humble, almost rough, yet in its curves I felt the imprint of the most delicate hands, the warmth of a life fiercely lived.
Holding it, I gazed out the window. Once, I had been only a hunter of shadows, an oncologist chasing cancer across bodies. But Mr. Lee’s “left-handed vein” had reminded me of the body’s mysteries, and Ms. Park’s bucket list had taught me the meaning of life itself.
This diary is more than medical observation—it is a chronicle of my fragile balance upon the great scales of hope and despair.
My office door remains the threshold between two worlds. Today, as always, I will open it and step into another universe, searching among the shards of fate for unexpected discoveries. Perhaps I will not always cure disease. But if I can protect dignity, preserve hope, or return peace—that, too, is my calling as a clumsy sailor in a white coat.
And so, with tea in her cup, I climb once more onto the scales.
—The End
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