I, Aki Tomoya, will not be a simp.

"Then your worries might not be unfounded. Wait for me."

Aki Tomoya rolled out of bed and got dressed. He remembered that Moriyama was on duty tonight.

He rushed into the department, and his appearance puzzled Dr. Moriyama and Majima, who were on duty with him.

"It's so late, why aren't you resting? What are you doing in the department?"

Moriyama looked at Aki Tomoya in front of him and asked in confusion.

Meanwhile, Majima on the other side also cast a questioning glance, thinking that Aki Tomoya shouldn't be on duty tonight.

"Dr. Moriyama, may I ask you a question?"

"...Well, what's wrong?"

"If an aortic dissection ruptures again a year after surgery, the left recurrent laryngeal nerve will be compressed, which would cause symptoms of vocal cord paralysis, right?"

Dr. Moriyama was taken aback. Although he was puzzled as to why Aki Tomo would ask him such a question at this time, based on his past experience, he subconsciously gave an answer.

"Depending on the extent of the dissection, the peripheral arterial pulse may disappear. When the left recurrent laryngeal nerve is compressed, vocal cord paralysis may occur. At the same time, when the dissection penetrates the trachea and esophagus, hemoptysis and hematemesis may occur... Why are you asking these questions? Has any patient had any problems?"

He asked with some concern, wondering if one of their patients had experienced a similar situation.

If this is the case, treatment must be initiated as soon as possible.

However, at this moment, Aki Tomoya gave him a reassuring look.

“He is not a patient of our hospital. I just heard about him from another place. His past medical history includes hypertension and aortic dissection. He had surgery a year ago. Now he has a sore throat and was admitted to the ENT department of the hospital, but was only diagnosed with acute laryngitis and vocal cord paralysis.”

"...Vocal cord paralysis, how did they explain that?"

Upon hearing this, Moriyama frowned. "Vocal cord paralysis is difficult to explain by inflammation alone; it should be analyzed using the existing medical history data."

Furthermore, Aki Tomoya himself stated that he had aortic dissection in his past medical history, and even though he had undergone surgery, there was still a possibility of it rupturing again.

This is not as simple as a missed diagnosis or misdiagnosis; it involves human lives.

“I don’t know if the patient provided his past medical history to the attending physician, or if the attending physician asked about it, but when I was a classmate at Southeast University Affiliated Hospital, I learned about this and suggested a follow-up examination to his supervising physician, but it was rejected.”

Aki Tomoya said helplessly, "Even without a history of aortic dissection, vocal cord paralysis is hard to explain with just inflammation."

Moreover, the problem now is that there is already a history of aortic dissection, but the cause of vocal cord paralysis has not been analyzed, and only symptomatic treatment such as anti-infection, cough suppressant, and expectorant has been given.

If there is indeed a possibility of re-rupture after aortic dissection surgery, then there could be serious problems.

After Takagi told him about the situation, Aki Tomo also thought of these things, and now he came to ask Moriyama to confirm his worries.

"I think it's necessary to remind the University of Tokyo Affiliated Hospital to conduct a follow-up examination for aortic dissection on that patient. What do you think, Dr. Moriyama?"

Aki Tomoya thought that, if possible, they should have reminded them.

But to his surprise, Moriyama hesitated at this moment.

"The matter at the university hospital..."

Moriyama frowned, his eyes flickering with hesitation, clearly reluctant to get involved in the university hospital's problems.

His expression became very strange after Aki Tomoya mentioned that the matter originated from the University of Tokyo Affiliated Hospital.

Chapter 449 Are we doctors?

Moriyama hesitated, and his hesitation was not incomprehensible to Aki Tomoya.

He didn't want to get involved in matters concerning the university hospital; for this man, the existence of the university hospital was perhaps a thorn in his side.

A complaint from Takagi, a friend from the same period, about the condition of a patient, made Aki Tomo uneasy.

The patient has a history of aortic dissection and underwent surgery in Chiba last year. Yesterday, the patient was admitted to the hospital due to a sore throat, but only a fiberoptic laryngoscopy was performed. The aortic dissection was not re-ruptured after the surgery.

After the rupture, the cause of vocal cord paralysis is most likely due to compression of the left recurrent laryngeal nerve, which is not simply an inflammation.

"He didn't want to be this good person..."

Aki Tomoya thought to himself with some mixed feelings.

Being a good person isn't so easy, and that's probably what Moriyama was considering.

What university hospitals do is their business; it's none of the business of private hospitals.

Not to mention, most of the patients in the cardiac surgery department of Kanto General Hospital, affiliated with the University of Tokyo, came from there. As for whether they feel a sense of belonging to that place, it's hard to say; it depends on the individual.

The obvious hesitation shown by Dr. Moriyama in front of him made Aki Tomoya feel disheartened.

"We only need to suggest they have one enhanced arterial angiography to know the condition of the aortic dissection."

Aki Tomoya whispered a sermon to Moriyama.

"...Why don't you have your colleague mention it to the attending physician again?"

"If it would make them take it seriously, I'd be willing to remind them, but would they listen to us?"

Aki Tomoya was also very disappointed by Moriyama's words.

He knew what Moriyama was worried about, and even the kind-hearted Aki Tomoya couldn't ask him to take the position at this moment.

He could offer reminders if possible, but only if someone would listen to them.

With a pleading look in his eyes, Aki Tomoya finally asked, "Dr. Moriyama, we're doctors, aren't we?"

"...It's not your turn to be on duty tonight, go home and rest, An Yi-kun."

He ultimately decided not to get involved.

Considering that it was a matter within a university hospital, Moriyama, who also came from the University of Tokyo affiliated hospital, had no intention of interfering.

Whether it was cowardice or some kind of inner conflict, Aki Tomoya didn't want to comment further.

If someone doesn't want to do something, then so be it. There's no way to force them to do something they don't want to do, so let's leave it at that.

"Excuse me, I'll be going now."

Aki Tomoya turned and walked out of the department without looking back, his hands clenched into fists, his face expressionless.

Less than half a minute after he left the department, Majima chased after him.

"An Yi, are you alright?"

He looked at Aki Tomoya with concern.

"...Majima, do you think I'm being too arrogant, going to all this trouble when it's none of our business?"

In the hospital corridor, Aki Tomoya whispered.

Moriyama's hesitation made him wonder if he had been too arrogant.

He's going to meddle in other people's business just because of one of Takagi's complaints.

Perhaps he should be the one reminding Takagi not to meddle in other people's business.

but……

Things shouldn't be like this.

"The overly arrogant person must be from the University of Tokyo."

"Heh, don't say that. Speaking of Tokyo University, you and I both came from Tokyo University. We're both a bunch of arrogant people."

Aki Tomoya scoffed.

Majima's words did not comfort him at all; on the contrary, they made him feel that this whole thing was incredibly messed up.

He could even imagine what the consequences would be if the ENT department at the University of Tokyo Affiliated Hospital continued to treat only laryngitis and vocal cord paralysis, while the patient's aortic dissection actually ruptured.

"When the dissection penetrates the trachea and esophagus, hemoptysis and hematemesis occur. After the dissection compresses the superior vena cava, vena cava syndrome occurs, which in turn compresses the trachea..."

He murmured softly.

"Prolonged compression of the esophagus by aortic dissection led to degeneration and necrosis of the esophageal wall, which in turn compressed the recurrent laryngeal nerve, causing vocal cord paralysis. Eventually, the aneurysm continued to enlarge, breaking through the degenerated and necrotic esophageal wall and rupturing and bleeding..."

What will happen in the end?

What are the possibilities?

"Aortic dissection ruptured and penetrated the esophagus, causing massive bleeding that led to respiratory and circulatory failure and death."

Aki Tomoya somewhat coldly expressed his imagination.

"I can understand that the ENT doctors at the affiliated hospital of Southeast University lack knowledge about aortic dissection, ignore the symptoms of Stanford type A aortic dissection, and are inexperienced, which leads to misdiagnosis. But we are in the cardiac surgery department, right?"

The patient has a history of hypertension and hyperglycemia, has Stanford type A aortic dissection, and has undergone ascending aortic replacement and aortic arch and descending aortic stent implantation.

It's understandable that attending physicians in otolaryngology departments lack knowledge about aortic dissection.

However, Aki Tomoya, who works in the cardiac surgery department, cannot ignore this point after learning about the patient's medical history mentioned by Takagi.

He knew very well that if the aortic dissection ruptured again, causing compression of the left recurrent laryngeal nerve and resulting in vocal cord paralysis, this was a dangerous signal from his body.

Majima silently observed Aki Tomoya. He didn't seem like a resident doctor who had only been doing his training for almost six months; he seemed more like an experienced cardiac surgeon.

He admired his friend's abilities, but he didn't know how to comfort him about his friend Aki Tomoya's feelings at this moment.

Because Moriyama, who was still on duty in the department, was also a doctor who graduated from the University of Tokyo, he had reservations about reminding them because the matter involved a university hospital.

As for them...

They are only medical trainees, so there's not much they can do.