[Medical Human Story – Episode 73]-Part I: The Storm Arrived Without a Single Warning

 

[MHS: Medical Human Story]-Episode 73

    Prologue | Part 1 | Part 2 | Part 3 | Part 4 & Epilogue

Part I: The Storm Arrived Without a Single Warning

 

Time Moves Differently in the Emergency Department


Time behaves strangely in an emergency department.

Sometimes a single minute feels as long as an hour.

At other times, an entire hour disappears in what seems like only a minute.

That day was no different.

I continued scrolling through the MRI images on my monitor.

Both occipital lobes.

The parietal lobes.

The subcortical white matter.

The imaging findings were almost textbook examples of Posterior Reversible Encephalopathy Syndrome (PRES).

Yet it was not the lesions that held my attention.

It was the patient's name.

Yoon-Hee Kim.

Fifty years old.

An ordinary homemaker.

The mother of two children.

There was little of significance in her medical history.

Hypertension.

A recent history of frequently missing her antihypertensive medications.

Several days of severe emotional stress.

And...

thrombocytopenia.

I slowly closed her chart.

Medical images do not lie.

But images alone can never tell the story of a person's life.

A physician diagnoses disease,

yet healing truly begins only after understanding the life behind the diagnosis.

In this patient, a sudden thunderclap headache developed against the background of severe hypertension and thrombocytopenia. CT and MRI demonstrated bilateral vasogenic edema predominantly involving the occipital lobes, accompanied by subarachnoid hemorrhage, findings that strongly suggested Posterior Reversible Encephalopathy Syndrome (PRES).


A Husband's Memory


"This morning was just like any other."

His voice trembled as he spoke.

"She made breakfast for the children..."

"She packed our youngest child's lunch..."

"...and she told me to come home early today."

He fell silent for a long time.

"...I never imagined that would be our last goodbye."

Hospitals are filled with words like these.

"Everything was normal."

"Nothing seemed wrong."

"It happened so suddenly."

Medicine is always searching for a cause.

Families are searching for a reason.

Why did this happen to us?

Why today?

Why now?

Yet no physician

has ever possessed a perfect answer to those questions.

A Small Promise Inside the Intensive Care Unit


I walked upstairs to the intensive care unit.

The patient was receiving intravenous antihypertensive medication through a slow infusion.

The cardiac monitor maintained its steady rhythm.

Beep—

Beep—

Beep—

As long as that sound continued,

there was still room for hope.

She slowly opened her eyes.

"...Is this..."

"...the hospital?"

"Yes."

"Please hold on just a little longer."

She smiled faintly.

"...My children..."

"...they must be worried."

I nodded gently.

"Your husband is taking care of them."

"...Doctor."

"...I'm not going to die, am I?"

I have heard that question countless times.

Yet

I have never become accustomed to it.

"The most important thing right now is to stabilize your blood pressure."

"And..."

"We still have time to turn this around."

[Insert Figure]


[Medical Insight]


The First Morning Rounds


Morning rounds began.

The neurologist.

The intensive care specialist.

Myself, the radiologist.

Residents.

Nurses.

More than ten healthcare professionals had gathered

for the care of a single patient.

"Let's review the CT again."

I displayed the images.

"Both occipital lobes."

"Symmetrical involvement."

"Vasogenic edema."

"Convexity subarachnoid hemorrhage."

The neurologist nodded.

"What about the DWI?"

"No diffusion restriction."

"ADC is elevated."

A brief silence filled the room.

"Excellent."

"That makes acute infarction much less likely."

Just then,

one of the residents cautiously raised a hand.

"Professor..."

"Can this still be PRES even though there is hemorrhage?"

I smiled.

"That's an excellent question."

A Lesson for a Young Physician


"Many people believe that PRES never causes hemorrhage."

"But..."

"real clinical practice tells a different story."

I enlarged the GRE images.

"Look here."

Tiny areas of susceptibility.

Convexity subarachnoid hemorrhage.

And multiple cerebral microhemorrhages.

"Approximately 10 to 20 percent of patients with PRES develop hemorrhagic complications."

"Petechial hemorrhages."

"Intraparenchymal hemorrhage."

"And..."

"Subarachnoid hemorrhage."

The resident looked genuinely surprised.

"So that's why GRE is so important."

I nodded.

"Exactly."

"FLAIR alone is not enough."

"GRE—and ideally SWI as well—must always be reviewed together."


[Insert Figure]


By the ICU Window


After morning rounds,

I stood beside the window.

Outside the hospital,

the cherry trees swayed gently in the wind.

Only a few days earlier,

they had been covered in blossoms.

Now,

one flower after another

drifted quietly to the ground.

It occurred to me then

that life resembles a blossom.

No one knows

when it will fall.

That is why

we must live today.

Love today.

Protect our health today.

Control our blood pressure today.

In the end,

medicine is not merely the science of preserving tomorrow.

It is the science of protecting today.

The Patient's Daughter


Around lunchtime,

a young woman,

perhaps twenty years old,

entered the patient's room.

Her eyes were already swollen from crying.

"Mom..."

She tightly held her mother's hand.

"Mom..."

"I'm here."

The patient slowly opened her eyes.

"Our..."

"...youngest..."

"...what about the exam?"

The daughter forced herself to smile through her tears.

"Mom..."

"The exam can wait."

"...I just need you to wake up."

The moment she spoke those words,

even the nurse standing beside the bed

quietly turned away.

Doctors provide treatment.

Families create miracles.

[Medical Insight]


[Medical Recommendation]




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