Chapter 2: What Do Interns Know About Treating Diseases?
As soon as David said this, even Chase, who had just been somewhat protective of him, frowned.
Because the order to scan the brain CT had been his call.
David saying they'd scanned the wrong location was essentially slapping him in the face in front of everyone.
"What? If a patient has a brain-related illness, shouldn't we scan the brain first to assess the situation?"
Foreman sneered, clearly dismissive:
"Alright, don't listen to this nonsense. Young guys always want to make some grand statement to stand out.
House has real talent and experience. As for him?" Foreman gestured at David. "Forget it."
Cameron, the only female doctor among the three fellows, also disagreed with David's bold claims.
"David, you should focus on learning and observing first. There's absolutely nothing wrong with Chase's decision to order a brain CT initially."
Facing their unified skepticism, David only looked at House—the only person who could actually make the final call.
House studied David's finger pointing at the lightbox with genuine interest.
"Since you think we don't need to scan the brain, which part do you want to scan?"
David smiled confidently. Of course, he couldn't just blurt out the conclusion without any reasoning—that would only make people trust his judgment even less.
But if it was a result deduced through logical analysis, that would be different.
"First of all, what I said was that we haven't found the right location yet, not that ordering a brain CT was incorrect.
With a brain CT image, any licensed physician can determine whether she has a brain tumor.
She wouldn't need to be transferred to Princeton-Plainsboro for that.
But other possibilities still exist—aneurysms, strokes, various ischemic syndromes, and so on.
However, for the same reason, if it were any of those diseases, they could also be diagnosed and treated at other hospitals.
So her case being sent here means it's atypical. It could be cerebral vasculitis, or possibly neurocysticercosis.
As for which rare condition it actually is, we need more evidence to support a diagnosis.
I think a full-body CT scan is necessary to find the real cause, not just a brain CT."
After speaking in one breath, David picked up the coffee mug with lipstick marks that was sitting on the conference table and drank it down.
After saying all that, these people should at least give him some credit and let him proceed with the workup, right?
But clearly, David's deduction didn't receive the support he'd hoped for.
Because he was just an intern.
Foreman directly shook his head:
"You want the patient to undergo a full-body CT scan right off the bat?
Have you thought about how much that costs? Unless absolutely necessary, we don't want to put a patient through that immediately.
You should know that if the patient files a complaint about the hospital overcharging afterward, your career will be completely finished before it even starts.
Kid, this is advice from someone who's been there. Remember it."
Chase nodded in agreement:
"He's right. You said a lot just now, and it only proves that your theoretical knowledge from med school is solid.
But it doesn't actually help us treat this patient."
Cameron said nothing at first. She just shot David an annoyed look, then took the coffee mug from his hand:
"That's mine. Remember to get your own drinks from the break room next time."
David chuckled but said nothing more, simply waiting for House's verdict.
House didn't mock David. Instead, he actually seemed to consider the suggestion seriously. But in the end, he still said:
"Deduction is always just deduction, and a full-body CT isn't impossible.
But it needs to happen after the MRI. We need to confirm there's nothing else going on in the brain first."
Seeing House make his decision, the three fellows stopped debating and began contacting the imaging department to schedule the MRI.
House, leaning heavily on his cane, turned back to the group before leaving the diagnostics conference room:
"Oh, and by the way—bring the intern along. Let him get some hands-on experience. He's got interesting ideas. I like him."
With that, House limped toward the elevator, heading down to the outpatient clinic.
He still owed the hospital a total of two thousand and fifty-four hours of clinic duty.
He really couldn't afford to slack off—not with Cuddy breathing down his neck.
Soon, the four of them gathered in the MRI suite.
Watching Foreman draw up the contrast agent, David, who knew exactly what was about to happen, couldn't help but speak up:
"What if she's allergic to the contrast agent?"
Foreman stopped mid-draw and looked at David seriously:
"So this is what you need to learn—communication.
Talking to the patient beforehand is crucial. She told us she's never had any allergic reactions to anything. That's enough."
Hearing Foreman's answer, David understood why House always kept saying that everybody lies.
Patients always inadvertently omit critical information.
And that information could be fatal.
David took a deep breath, mentally preparing to save someone's life in the next few minutes.
After injecting the contrast agent, the four of them moved into the adjacent control room with the observation window.
The scan began.
The patient, Rebecca Adler, was moved into the MRI machine by the automatic sliding table.
As the technician pressed the button, the loud, rhythmic banging—like a jackhammer pounding concrete—filled the room.
Feeling the pressure building in her head, Rebecca suddenly spoke through the intercom:
"I feel a little uncomfortable. I'm kind of scared."
Chase, who was already used to this reaction, spoke soothingly into the microphone:
"It's okay, that's completely normal. Just hang in there a little longer. We're almost done."
But a strange gurgling sound suddenly came through the speaker.
Cameron, sensing something was wrong, glanced at David and tried calling out:
"Rebecca? Rebecca? Can you hear me?"
But Rebecca didn't respond.
David immediately understood what was happening—Rebecca was experiencing laryngeal edema from an allergic reaction to the contrast agent, leading to airway obstruction.
"Get her out now. She's having an allergic reaction."
Chase said calmly:
"Relax. It's normal for you as an intern not to have seen this before.
Once you've been doing this as long as we have, you'll understand—she probably just fell asleep.
She's exhausted."
"No, that's not right."
Chase's dismissal was contradicted by Cameron, who'd been paying attention to David's concerns:
"She was showing symptoms of claustrophobia ten seconds ago. There's no way she fell asleep that quickly!
Get her out now. If she's allergic to the contrast, she could die!"
Chase spread his hands and reluctantly pressed the emergency stop button:
"We were only one minute away from finishing. Great. If you insist, fine.
But you'll have to explain the incomplete scan and wasted time."
Cameron didn't bother responding.
She rushed into the MRI room right behind David to check on Rebecca, who was being automatically slid out of the machine.
David, who'd been ready for this, immediately knelt down and checked Rebecca's breathing.
As expected, she wasn't breathing.
He called out to Cameron across from him:
"She's stopped breathing. I need epinephrine, point-five milligrams! Now!"
Cameron was momentarily stunned. Shouldn't she be the one taking charge here?
But the situation was critical and she didn't have time to think about it. Her training kicked in and she immediately handed the epinephrine to David.
David expertly pushed the epinephrine into Rebecca's IV line, then grabbed the bag-valve mask and began manual ventilation.
But he quickly realized this approach wasn't working.
"Her laryngeal edema is too severe. The airway's completely blocked. I need a cricothyrotomy kit."
A clear look of doubt appeared on Chase's face as he walked in from the control room.
Performing an emergency cricothyrotomy required a doctor to have keen observational skills, steady hands, and nerves of steel.
Could an intern who'd never done one before actually pull it off?
"Wait—you want to do a cric? Have you ever even performed one?"
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