Chapter 14

Episode 14 Special Tutoring (2)

I just wanted to collapse onto the bed like this and sleep like a stone. However, before that, I had one last thing left to do. Stumbling over, I threw myself onto the sofa and opened the Dead Medic Gallery again.

Title: Guys, give me some bedtime greetings, I'm going to sleep now

Author: Korean Slave 1 (Male)

I'm going to sleep, yeah. Give me some bedtime greetings.

Now, it is goodbye to these tedious ghosts.

Please don't look for me until tomorrow morning.

Just as I was about to close my eyes while praying for peace that way, the comment notifications started ringing relentlessly.

Latte is Mine: ??

Hippocrates' Descendant: ?? O living one, what is that sound?

Hematoma is Hell: ?? Sleeping? Now?

The atmosphere was strange.

Latte is Mine: Because I sutured, now it's our turn.

Endocrine Master: Where do you think you're going to sleep? Sit down.

Cardiology Ghost: Shall we start with the EKG?

Fuck. What is this? Had these bastards ambushed me in a group?

Korean Slave 1 (Male): No, I'm really tired, so...

My explanatory comment was completely ignored. Not long after that explanatory comment was posted, the first question came up.

Cardiology Ghost: A 68-year-old man says he has been feeling nauseous and seeing things in yellow for a few days. He visited the Emergency Room this morning due to a loss of consciousness. The EKG shows findings of an atrioventricular block (*a type of arrhythmia). The blood test shows K 6.8 mEq/L (*blood potassium level, normal value is 3.5–5.0). What is the drug intoxication that should be suspected first, and what drug must absolutely not be administered to this patient? I'll give you 1 minute.

My head throbbed. Xanthopsia, bradycardia, hyperkalemia. I had seen this in a textbook. Cardiac glycoside. I left an answer without hesitation.

Korean Slave 1 (Male): Digoxin (*Digoxin, a type of cardiotonic agent) intoxication. When accompanied by hyperkalemia, calcium gluconate administration is contraindicated. Rather, it can induce ventricular fibrillation.

As expected, it was the correct answer. A classic case that is perfect for killing a patient if you don't know it.

Cardiology Ghost: Correct.

Hippocrates' Descendant: It seems the living one has studied internal medicine quite a bit!

Immediately, the second question flew in.

Nephrology Geezer: A 45-year-old woman had a history of alcoholism. She visited due to decreased consciousness after 3 days of binge drinking. On the blood test, Na was 108 mEq/L (*blood sodium level, normal value is 135–145). The cause of the decreased consciousness is judged to be hyponatremia. Tell me the treatment plan. How, and how quickly, will you correct it?

This one is easy too. Decreased consciousness due to hyponatremia. Since there are symptoms, it needs to be corrected quickly.

Korean Slave 1 (Male): Since it is severe hyponatremia accompanied by symptoms, IV infusion of 3% hypertonic saline. Correct it quickly at a rate of 1–2 per hour to improve symptoms.

The moment my reply was posted, the gallery was enveloped in a chilling silence. And soon, a bomb of replies began to appear.

Nephrology Geezer: Lmao, this guy is going to catch a person.

Latte is Mine: I knew it would be like this, tsk tsk. Kids these days don't have the basics down. The speed is the problem, you quack.

Hematoma is Hell: While trying to save the patient, he paralyzes the brain. It's a very creative way to murder.

What, what is the problem? Flustered, I racked my brain. It's right to correct it quickly. If not, what... Ah. Fuck. Central Pontine Myelinolysis. CPM. Central pontine myelinolysis. If sodium is corrected too quickly, the center of the brain melts down, and the patient can fall into a permanent vegetative state. It was something I had memorized by heart. For a moment, with the thought that I had to correct it quickly, I almost did something crazy.

Infectious Disease Ghost: Solve the next problem. A 50-year-old man and a chronic alcoholic. After sobering up, his consciousness is not clear, he keeps rambling, and he cannot move his eyes properly. His gait is also staggering. What vitamin must be administered first to this patient before giving glucose as an IV fluid? Reason?

I can get this right. Thiamine. Vitamin B1.

Korean Slave 1 (Male): Thiamine. Alcoholics are highly likely to be in a thiamine-deficient state, and if glucose is administered first in this state, it can induce acute Wernicke's encephalopathy.

Infectious Disease Ghost: Correct. You got this one right.

Thank goodness. However, there was no time to rest. The fourth question popped out from an unexpected area.

Rheumatology Old Woman: A 35-year-old woman of childbearing age. She visited due to intermittent high fever, polyarthralgia, and a butterfly-shaped rash on her face for the past month. On the blood test, pancytopenia was observed along with proteinuria and hematuria in the urinalysis. What is the suspected disease, and what are the three specific blood antibody tests that must be performed first to diagnose this patient?

A butterfly-shaped rash? Pancytopenia? Proteinuria? Fuck, what is this? Lupus? Systemic lupus erythematosus? It seems like it... Three specific antibody tests? anti-dsDNA? anti-Sm? And what was the other one? My mind went completely blank. This isn't my area. How is a 1st-year emergency medicine doctor supposed to know this?

'No, I'm not an internal medicine doctor. There's no need to know this far...'

In the end, I couldn't write any answer.

Rheumatology Old Woman: Time out. The answer is SLE (*Systemic Lupus Erythematosus, systemic lupus erythematosus). The tests are anti-dsDNA, anti-Sm, and C3/C4 complement. Isn't this level of common sense? Were you planning to just stare blankly while the patient's entire body is being ruined?

She calls it common sense. To that damn old hag, it must be common sense. I just closed my eyes. And after a while, the fifth question was posted.

Cardiology Ghost: Good, last one. A 55-year-old man came complaining of chest pain. On the EKG, deep and symmetrical T wave inversions are observed in the V2 and V3 leads. Myocardial enzyme levels are normal on the blood test. The patient says he has no pain now. What is the name of this finding, and what is the future treatment plan?

T wave inversion... Is it myocardial ischemia? But the enzyme levels are normal, and he doesn't hurt now? Then can we just monitor him?

Korean Slave 1 (Male): T wave inversion suggests myocardial ischemia, but since there are currently no symptoms and myocardial enzyme levels are normal, for now, we observe the progress and perform follow-up tests.

As soon as my answer went up, the biggest festival of mockery opened in the gallery.

Cardiology Ghost: This fucking idiot has really made up his mind to kill a patient!!!!!!

Latte is Mine: Looking at that and observing the progress? That's the exact same thing as saying you'll watch a time bomb!

Cardiology Ghost: It's Wellens' syndrome (*Wellens' syndrome, an EKG finding appearing in patients with unstable angina), you crazy bastard!!! It's a time bomb! The moment you see that EKG, even if there are no symptoms, you have to run an angiography immediately and put in a stent!

Crash. That way, that day, I got two right and three wrong. Among them, two were fatal wrong answers.

Korean Slave 1 (Male): No, you motherfuckers, the level of the questions is too high. I'm EM, not internal medicine.

Yes, I am emergency medicine. Even if the EKG is one thing, I don't have an obligation to know all such deep and detailed internal medicine knowledge. This is too much.

Nephrology Geezer: Yeah, we know? So what. If you're EM, don't you see them first? Then you should know more. Does a patient walk in saying, 'I am a nephrology patient'? Does a patient collapse saying, 'I am a cardiology patient'? All sorts of miscellaneous cases go to you first. Then you should differentiate first and treat first. Isn't it natural to know at the level of an internal medicine specialist? If you can't do that, quit.

What?

...

Silence.

I realized the fact that the ghost's words fit perfectly logically. The emergency room is the front line of all diseases. You cannot pick and choose patients. Therefore, I had to know wider and deeper than anyone else.

Ah. I'm tired. Really...

I collapsed just like that. Leaving behind the messy dining table, the tattered pig skin, and my disastrous test result sheet.

My head felt like it was going to split.

"Ugh..."

With a groan, I raised my upper body. My shoulders, back, wrists, and every joint of my body creaked. It was the aftereffect of last night's suture practice and the price of taking a nap on the floor.

Fuck, my life. What a piece of trash.

I looked at the dining table with hollow eyes. The miserably hacked pig skin, empty drink cans, and randomly scattered surgical instruments were littered messily.

'...Even so.'

Yesterday's sense of defeat was nowhere to be found. Instead, a strange stubbornness, which I didn't know why it even formed, was burning in a corner of my chest. A malice that since things turned out this way, I should squeeze those crazy ghost bastards dry.

Stumbling, I got up and washed my face with cold water. In the mirror stood a perfect hospital slave with dark circles hanging down. I grinned toward that pathetic appearance.

Good. Let's play again today.

Sitting on the sofa, I opened the Dead Medic Gallery familiarly, like an employee punching a time clock. And as if I had forgotten all about yesterday's disaster, I posted a new thread as brightly and energetically as possible.

Title: Glad to meet you, gallery members! A powerful and strong morning!

Author: Korean Slave 1 (Male)

The greeting is light. However, my expectation was miserably shattered by the very first comment.

Latte is Mine: What do you mean glad to meet you. Sit down.

Yes, this is more like you guys.