Chapter 15

Episode 15 Special Tutoring (3)

Latte is Mine: What do you mean you're glad to see us? Sit down.

Cardiology Ghost: Morning? Cut the crap and open your book. We’re starting with a review of Wellens' syndrome, which you got wrong yesterday.

Kidney Disease Old Man: I let it slide when you fell asleep yesterday, and now you're getting cocky. Not today. Brace yourself.

Rheumatology Old Woman: Welcome, my little quack. Today, let’s perfectly memorize the serological diagnostic criteria for lupus. If you can’t, I’ll make your brain feel like it’s suffering from lupus cerebritis.

Fuck. Don't these bastards ever sleep?

No, they're dead, so of course they don't sleep.

Damn it.

Korean Slave 1 (Male): ?

Korean Slave 1 (Male): It's my day off today.

Yes, today was a god-given holiday. It's off. However, it seemed my day off was none of the gallery members' business.

Latte is Mine: Day off or not, we don't give a damn.

Respiratory Ghost: Since when do doctors get days off? Do patients stop hurting just because you're resting? Let's study.

Mes of the God (Male): Hands stiffen if they rest. Brains rot if they rest. Shut up and start.

I was utterly speechless. The concept of rest simply did not exist to these crazy, workaholic ghosts.

"Fine, let's do it. Let's do it, you bastards."

And that was how my sacred day off devolved into a forced study group run by otherworldly master physicians.

How much time had passed?

Dozens of EKG waveforms brushed past my mind. The Cardiology Ghost pushed me to the brink, throwing all sorts of bizarre and atypical EKGs at me.

Cardiology Ghost: What is this? It's Brugada syndrome! The ST Segment is elevated in a curved type! What about this? It's WPW! Can't you see the delta wave? Are your eyes just decorations?

ㄴ Korean Slave 1 (Male): I get it!!

"Yes, yes! I see it! I see it!"

The moment my scream ended, the Kidney Disease Old Man took over the baton.

Kidney Disease Old Man: Do you think electrolyte imbalance is a joke? Alright, here's a DKA patient. You gave them insulin, and their blood phosphate level plummeted. What is the reason? What is the treatment? If you can't answer, I'll extract all the phosphorus from your bones.

"Hypophosphatemia, which occurs because insulin draws glucose and phosphate into the cells together! For treatment, phosphate must be replenished orally or intravenously!"

I practically wailed as I typed out the answer.

Before I could even gather my wits, the Rheumatology Old Woman was barking at me to recite the types of antibodies for rare autoimmune diseases. Without giving me a moment to catch my breath, the Respiratory Ghost shoved dozens of arterial blood gas analysis results in front of me, demanding an interpretation.

In between all this, the Mes of the God (Male) ordered me to bring out some pig skin.

Mes of the God (Male): You still have a long way to go. This time, it's practice for subcutaneous suturing. It's a technique to sew beneath the skin so no scar is left behind. Take a video and report back every five minutes. If it's crooked, I'll make the skin on your face look just like it.

Stumbling, I crawled over to the dining table and grabbed the needle again. My hands were just a tiny bit better than yesterday.

How much longer did this go on? Just as my soul was about to detach from my body—

Latte is Mine: ...This should be enough!

Cardiology Ghost: Hm, a bit better than yesterday. Looks like a wrinkle or two finally formed in your brain.

Kidney Disease Old Man: Keep this in mind. Patients don't walk in looking like a textbook. Always expect the worst.

Mes of the God (Male): You can leave for today!

The Mes of the God (Male) spoke as if throwing me a bone.

Korean Slave 1 (Male): Yeah, good work, everyone.

I barely managed to leave a reply.

Whew... I can finally rest.

It was finally over. A sense of liberation washed over me. I dragged my battered body up. Outside the window, a thick darkness had already settled in. Dazedly, I picked up my cellphone.

What time is it?

And the moment I checked the numbers on the screen, my brain froze.

[7:13 PM]

PM?

Seven o'clock?

I roared with absolute rage, making the entire officetel echo.

"You fucking piece-of-shit ghost bastards!!!!!!!!!!!!!!!!"

.

.

.

I opened my eyes to the loud alarm sound waking me up.

Ding, ding, ding.

Good morning.

Pa-pa-pa-pa-pa, pa-pa-pa-pa.

"Fuck..."

A hoarse voice squeezed out. Yesterday's holiday had been no holiday at all. It was torture, it was taming, it was nothing but a study group from hell.

Rising like a zombie, I stumbled toward the bathroom. Standing in the mirror was a 1st-year slave, looking even worse—not a single bit better—than yesterday. I raised my middle finger at those hollow eyes.

Fuck you.

'Bastards... give me back my day off.'

After changing my clothes, I boarded the bus to the hospital with a rotten expression. I thought this was a cheat key, but I never expected it to turn into one of the factors ruining my life. These crazy bastards were dead serious about education.

For a moment, I wondered if I should open the shop and buy a fatigue recovery potion, but since acquiring a possession skill was my top priority, I closed the window right away.

8 AM.

The Emergency Medicine conference room.

I was tucked away in the most cornered seat to avoid drawing any attention to myself.

"Alright, I will start then. This is a case from last week."

The presenter was the 4th-year resident and Head of Doctor's Office, Lee Minjae (Male).

"A 48-year-old female patient. She presented with a high fever of over 39 degrees Celsius, muscle pain, and joint pain that persisted for a week. Initial lab tests showed no specific findings other than elevated white blood cell counts and liver enzymes, and blood cultures and imaging failed to find a clear cause of infection. It was a classic case of FUO, fever of unknown origin."

The screen was packed with the patient's complicated test results and chart records. The chief logically explained the process of ruling out various differential diagnoses one by one without stumbling even once.

The presentation was crisp and clean. That man might be an EKG pervert with a slightly eccentric personality, but when it came to skills among the residents, he was the real deal.

"...Therefore, based on the extreme elevation of ferritin levels to over 20,000 on the blood test and the characteristic clinical symptoms, we ultimately diagnosed this patient with AOSD and initiated high-dose steroid therapy. Currently, the patient is showing dramatic symptom improvement and is being treated stably in the rheumatology ward."

As the presentation ended, Chief Park Uong, who had been sitting in the front row with his arms crossed quietly listening, spoke in a low voice.

"Good presentation. It's a nice case. The ferritin level served as a crucial clue in diagnosing AOSD."

The Section Chief nodded in satisfaction, then suddenly turned his head to scan us juniors. My heart dropped. I knew that gaze. It was the omen of a pop quiz.

Please, just not me. Please.

"It's well known that ferritin rises abnormally in AOSD. However, in an emergency room environment, when you see such extreme hyperferritinemia exceeding 20,000, there are a few other life-threatening diseases you must differentiate. This is something you absolutely must know as an emergency physician."

The Section Chief's gaze wandered through the air before locking squarely onto my eyes.

"Dr. Han Hyeonjae (Male)."

Ah, fuck.

"Why don't you give it an answer? What else could there be?"

Every eye in the meeting room swiveled toward me. My mind went completely blank. Ferritin? Hyperferritinemia? I've definitely heard of it. But to list multiple other diseases besides Still's disease? Right now?

My mouth went bone dry. Cold sweat flowed down my back. Seeing my panicked expression, a look of pity flashed across the chief's face.

...?

Uh?

Hold on.

Ferritin... hyperferritinemia...

Didn't one of those ghost bastards ream me out over this yesterday? Was it the hemato-oncology ghost? I think he emphasized the importance of ferritin levels while throwing all kinds of cancer patient cases at me.

'You idiot! If ferritin jumps into the tens of thousands, what should you think of first! It means the patient in front of you is dying while triggering a cytokine storm throughout their entire body!'

The memories of yesterday began to faintly surface. I opened my mouth, stammering.

"Uh... first, we must consider systemic inflammatory response syndrome accompanied by sepsis."

The Section Chief's eyebrows raised slightly at my answer.

"And... uh... ferritin levels can also rise drastically in MAS. Especially in patients with rheumatic diseases..."

The fragments of memory began to click into place one by one. To think that the knowledge those ghosts shoved into my brain yesterday was saving me now in the conference.

"Additionally, hematologic malignancies such as lymphoma or leukemia can cause tumor cells to release massive amounts of ferritin. Also, in cases of severe hepatocellular damage like fulminant hepatic failure, a large amount of ferritin stored in the liver can leak into the blood."

Silence fell over the meeting room as I finished speaking. Holding my breath, I waited for the Section Chief's reaction.

Please, is it right? Just let me live.

The Section Chief stared at me intently for a moment, then nodded with a satisfied smile.

"Yes. That's correct. Very excellent. Mentioning MAS in particular deserves a compliment."

Whew.

All the strength drained from my body. The chief was looking at me with his mouth slightly agape, and the eyes of the other seniors and juniors were filled with astonishment.

It felt like my hellish day yesterday was finally being rewarded. Of course, it would come with the shitty side effect of making those people absolutely certain that I am 'a crazy bastard preparing for an internal medicine double board.'