Day 50: Fever That Won't Break on Rounds

Dialogue

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1. 1

   A 자, 다음 환자분. 72세 여자 환자분, 폐렴으로 입원하신 지 오늘로 닷새째죠? 이 선생, 열은 좀 떨어졌어요?

   Ja, daeum hwanjabun. 72se yeoja hwanjabun, pyeryeomeuro ibwonhasin ji oneullo datsaejjaejyo? I seonsaeng, yeoreun jom tteoreojyeosseoyo?

   Right, next patient. A seventy-two-year-old woman, today is day five since she was admitted with pneumonia, correct? Dr. Lee, has the fever come down at all?

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2. 2

   B 아니요, 교수님. 어젯밤에도 38.5도까지 올라갔습니다. 항생제를 쓴 지 사흘이 넘었는데도 그대로예요.

   Aniyo, gyosunim. Eojetbamedo 38.5dokkaji ollagatseumnida. Hangsaengjereul sseun ji saheuri neomeonneundedo geudaeroyeyo.

   No, Professor. It went up to 38.5 again last night. She's been on antibiotics for more than three days, and it's no better.

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3. 3

   A 그래요? 그럼 원인이 뭐라고 봐요? 이 선생 생각부터 들어 봅시다.

   Geuraeyo? Geureom wonini mworago bwayo? I seonsaeng saenggakbuteo deureo bopsida.

   Is that so? Then what do you think is causing it? Let's hear your view first, Dr. Lee.

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4. 4

   B 저는 내성균일 가능성이 높다고 생각합니다. 객담 배양 결과가 나오기 전이라도 항생제를 더 강한 걸로 바꿔야 할 것 같아요.

   Jeoneun naeseonggyunil ganeungseongi nopdago saenggakamnida. Gaekdam baeyang gyeolgwaga naogi jeonirado hangsaengjereul deo ganghan geollo bakkwoya hal geot gatayo.

   I think it's most likely a resistant organism. Even before the sputum culture comes back, I think we should switch to a stronger antibiotic.

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5. 5

   C 저는 생각이 좀 달라요. 백혈구 수치도 떨어지고 염증 수치도 좋아지고 있는데 열만 안 떨어지는 건 이상하잖아요.

   Jeoneun saenggagi jom dallayo. Baekhyeolgu suchido tteoreojigo yeomjeung suchido joajigo inneunde yeolman an tteoreojineun geon isanghajanayo.

   I see it a bit differently. Her white cell count is down and her inflammation markers are improving, so it's odd that only the fever won't drop.

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6. 6

   B 수치가 좋아지는 중이라고 해도 열이 계속 나는 걸 그냥 두고 볼 수는 없잖아요, 김 선생님.

   Suchiga joajineun jungirago haedo yeori gyesok naneun geol geunyang dugo bol suneun eopjanayo, gim seonsaengnim.

   Even if the numbers are improving, we can't just sit back and watch while the fever carries on, Dr. Kim.

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7. 7

   C 그러니까 항생제를 무작정 올릴 게 아니라 약물열 가능성부터 따져 보는 게 순서죠. 약 때문에 나는 열이면 항생제를 바꿔도 소용없으니까요.

   Geureonikka hangsaengjereul mujakjeong ollil ge anira yangmuryeol ganeungseongbuteo ttajyeo boneun ge sunseojyo. Yak ttaemune naneun yeorimyeon hangsaengjereul bakkwodo soyongeopseunikkayo.

   That's why, instead of blindly escalating the antibiotics, we should consider drug fever first. If the fever's caused by the drug, changing antibiotics won't help.

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8. 8

   A 허허, 둘 다 할 말이 많네요. 난 잠깐 듣기만 할 테니까 계속해 봐요.

   Heoheo, dul da hal mari manneyo. Nan jamkkan deutgiman hal tenikka gyesokae bwayo.

   Ha, you both have plenty to say. I'll just listen for a bit, so carry on.

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9. 9

   B 약물열이라기엔 발진도 없고 호산구도 정상이에요. 처음엔 약이 안 들으리라는 생각은 못 했지만, 지금은 내성균 쪽이 더 설득력 있다고 봐요.

   Yangmuryeoriragien baljindo eopgo hosangudo jeongsangieyo. Cheoeumen yagi an deureuriraneun saenggageun mot haetjiman, jigeumeun naeseonggyun jjogi deo seoldeungnyeok itdago bwayo.

   For drug fever, there's no rash and her eosinophils are normal. At first I never thought the drug wouldn't work, but now I find the resistant-organism explanation more convincing.

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10. 10

    C 그래도 배양 결과도 없이 광범위 항생제를 쓰면 나중에 정말 필요할 때 쓸 약이 없어져요.

    Geuraedo baeyang gyeolgwado eopsi gwangbeomwi hangsaengjereul sseumyeon najunge jeongmal piryohal ttae sseul yagi eopseojyeoyo.

    Still, if we use broad-spectrum antibiotics without culture results, there'll be nothing left for when we really need it.

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11. 11

    A 좋아요, 둘 다 논리는 있어요. 그런데 오늘 아침에 환자분 몸을 직접 본 사람 있어요?

    Joayo, dul da nollineun isseoyo. Geureonde oneul achime hwanjabun momeul jikjeop bon saram isseoyo?

    Good, you both have logic on your side. But did either of you actually examine the patient this morning?

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12. 12

    B 네? 활력 징후랑 혈액 검사 결과는 새벽에 다 확인했는데요...

    Ne? Hwallyeok jinghurang hyeoraek geomsa gyeolgwaneun saebyeoge da hwaginhaenneundeyo...

    Sorry? I checked all her vital signs and blood test results early this morning...

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13. 13

    C 저도 차트는 꼼꼼히 봤습니다. 청진은 어제 저녁에 했고요.

    Jeodo chateuneun kkomkkomhi bwatseumnida. Cheongjineun eoje jeonyeoge haetgoyo.

    I went through the chart carefully too. And I listened to her chest yesterday evening.

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14. 14

    A 차트랑 화면만 봤다는 얘기네요. 자, 환자분, 실례지만 왼팔 소매 좀 걷어 볼게요.

    Chateurang hwamyeonman bwatdaneun yaegineyo. Ja, hwanjabun, sillyejiman oenpal somae jom geodeo bolgeyo.

    So you only looked at the chart and the screen. Now, ma'am, excuse me, I'm just going to roll up your left sleeve.

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15. 15

    B 아... 주삿바늘 들어간 자리가 빨갛게 부어 있네요. 만져 보니까 열감도 있어요.

    A... jusatbaneul deureogan jariga ppalgake bueo inneyo. Manjyeo bonikka yeolgamdo isseoyo.

    Oh... the IV site is red and swollen. It feels warm to the touch, too.

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16. 16

    C 정맥염이네요. 수액 줄을 언제 마지막으로 바꿨는지 바로 확인해 보겠습니다.

    Jeongmaegyeomineyo. Suaek jureul eonje majimageuro bakkwonneunji baro hwaginhae bogetseumnida.

    That's phlebitis. I'll check right away when the IV line was last changed.

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17. 17

    A 허허, 그럼 그렇지그려. 둘 다 폐 사진만 보느라 바로 눈앞에 있는 팔은 못 본 거예요.

    Heoheo, geureom geureochigeuryeo. Dul da pye sajinman boneura baro nunape inneun pareun mot bon geoyeyo.

    Ha, I thought as much. You were both so busy staring at the lung X-rays that you missed the arm right in front of you.

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18. 18

    B 죄송합니다, 교수님. 폐렴 환자라서 당연히 폐에서 나는 열이라고만 생각했어요.

    Joesonghamnida, gyosunim. Pyeryeom hwanjaraseo dangyeonhi pyeeseo naneun yeoriragoman saenggakaesseoyo.

    I'm sorry, Professor. Because she's a pneumonia patient, I just assumed the fever was coming from her lungs.

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19. 19

    C 저도 약물열에만 매달리느라 기본적인 진찰을 건너뛰었습니다. 부끄럽네요.

    Jeodo yangmuryeoreman maedallineura gibonjeogin jinchareul geonneottwieotseumnida. Bukkeureomneyo.

    And I was so fixated on drug fever that I skipped the basic examination. I'm embarrassed.

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20. 20

    A 두 사람 다 반만 맞았네그려. 이 선생 말대로 감염은 맞고, 김 선생 말대로 항생제를 무작정 올릴 일은 아니에요. 라인부터 빼고 카테터 끝은 배양 보내요.

    Du saram da banman majannegeuryeo. I seonsaeng maldaero gamyeomeun matgo, gim seonsaeng maldaero hangsaengjereul mujakjeong ollil ireun anieyo. Rainbuteo ppaego kateteo kkeuteun baeyang bonaeyo.

    You're each half right, you see. Dr. Lee is right that it's an infection, and Dr. Kim is right that we shouldn't just escalate the antibiotics. Take the line out first and send the catheter tip for culture.

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21. 21

    B 네, 알겠습니다. 바로 다른 쪽 팔에 라인을 새로 잡고 혈액 배양도 같이 보내겠습니다.

    Ne, algetseumnida. Baro dareun jjok pare raineul saero japgo hyeoraek baeyangdo gachi bonaegetseumnida.

    Yes, Professor. We'll put a new line in the other arm right away and send blood cultures as well.

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22. 22

    A 그리고 내일부터 회진 전에는 환자분 손부터 잡아 봐요. 진단의 답은 대부분 화면이 아니라 침대 위에 있으니까요.

    Geurigo naeilbuteo hoejin jeoneneun hwanjabun sonbuteo jaba bwayo. Jindanui dabeun daebubun hwamyeoni anira chimdae wie isseunikkayo.

    And from tomorrow, before rounds, start by taking the patient's hand. Most of the answers to a diagnosis are on the bed, not on the screen.

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