Chapter 148 Resident Physician Internal Medicine II
Edited by: Kanaa-senpai
”There’s something like a lump.”
”Where exactly?”
”In the chest.”
”…In your chest?”
”Yes.”
(Huh? Is this really something for internal medicine?)
Haruto frowned slightly, wondering why the patient had chosen to see him. A quick glance at her registration confirmed it—she had indeed requested internal medicine.
People often have mixed feelings about hospitals. For younger women in particular, departments like obstetrics and gynecology might feel embarrassing, while surgery can seem intimidating. Considering she looked to be in her twenties, she might have been unsure where to go.
It’s not uncommon. Many people don’t realize that breast-related issues fall under the surgery department—not obstetrics and gynecology. The appropriate specialist is usually found in a breast clinic or surgical unit.
”How long have you noticed it?” Haruto asked.
”About six months ago,” she replied.
”And you didn’t visit a hospital at the time?”
”I didn’t think much of it at first, but lately I’ve been getting a little worried…”
”You mentioned you requested internal medicine specifically?”
Though part of him hesitated, Haruto reminded himself of his duty and continued the consultation. Technically, breast exams—like mammography and ultrasounds—belong to breast surgery. In internal medicine, doctors typically perform a physical exam first. If something concerning is found, they refer the patient to surgery.
※ Mammography uses specialized X-ray equipment to examine the breasts.
※ An ultrasound uses high-frequency sound waves to visualize internal structures.
”I understand. If possible, I’d prefer to do an ultrasound instead of an X-ray,” she said quietly.
”That’s fine,” Haruto nodded. (Ah… maybe that’s why she hesitated to come earlier.)
Patients under forty are often recommended for ultrasounds rather than mammograms. Also, some people are simply uncomfortable with radiation-based tests—like CT scans, X-rays, and mammography.
※ CT scans provide cross-sectional images of the body.
※ An X-ray captures images of internal structures using radiation.
※ Exposure refers to receiving radiation during such tests.
Though modern equipment uses safe levels of radiation, it’s natural to avoid discomfort if possible. For this case, Haruto decided to proceed with palpation and ultrasound.
> Note: X-rays used in hospitals are nowhere near the radiation levels of historical events like atomic bombings. The doses are extremely low and medically safe.
By the way, an MRI uses powerful magnets and radio waves to create detailed images and doesn’t involve any radiation.
”Please remove your bra and lift your top.”
”Y-yes…”
Haruto knew she must have felt nervous being examined by a young male doctor. To ease her discomfort, he conducted the palpation gently, keeping her dignity in mind. Still, the ultrasound would require more exposure.
(Is this it?)
”Is this the lump you felt?”
”Yes…”
(Hmm… this seems like fibrocystic breast disease.)
※ Fibrocystic breast disease refers to benign hormonal changes in the breast. It can cause lumps, swelling, pain, or discharge.
Thanks to his experience, Haruto felt confident that the lump was benign—but he couldn’t declare that without going through the proper steps.
”Please take off your top and lie back on the examination table.”
”R-right…”
(There’s some nipple inversion…)
He noticed both nipples were retracted—a common benign trait. Carefully, Haruto used the ultrasound probe and gel to proceed with the exam, taking care not to cause discomfort.
Based on the shape, borders, and internal characteristics of the lump, Haruto made a mental note:
> Benign:
>
> * Often painful
> * Moves slightly when pressed
> * Has a rubbery texture
> Malignant (early-stage breast cancer):
>
> * Usually painless
> * Fixed in place
> * Hard, like a stone
”From what I can see on the ultrasound, this appears to be a case of fibrocystic breast disease. It’s benign, so there’s no cause for immediate concern.”
”Really!?”
The nurse beside him gave a surprised look. Normally, a diagnosis like this wouldn’t be made without further steps like a biopsy.
※ A biopsy involves extracting a small tissue sample to examine under a microscope.
”However, it’s important to monitor it closely,” Haruto added. “If the lump grows or changes shape, make sure to get it checked again.”
”Understood. Thank you so much!”
Seeing her relieved smile, Haruto couldn’t help but smile back.
But later that day, the nurse reported the case to the supervising physician. The ultrasound footage was reviewed by a breast surgery specialist to ensure proper protocol had been followed.
In the end, the hospital reached out to the patient and offered a formal apology, explaining that although the lump was likely benign, a biopsy would still be needed to confirm it.
As a result, Haruto’s solo examination privileges were suspended. From then on, all patient examinations required supervision.
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Edited by Kanaa-senpai.
Thanks for reading.
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