Chapter 1

Episode 1: Vexas Syndrome (1)

Hell.

People called our hospital's Emergency Medical center that way. And I, Han Hyeonjae, am an existence within that hell—a 1st-year Emergency Medicine resident.

"Slurp—"

"Fuck, eat quietly, will you? It looks fcking disgusting."

"Hey, isn't it a miracle this is even going down my throat right now? Huh? I just came back after doing 30 minutes of CPR on a newly admitted MI patient. I should be grateful that this cup ramen at least tastes like beef bone soup."

My junior, Kim Jihun, spoke with a face drenched in sweat. We were sprawled out like corpses in a corner of the Duty Room, somehow scraping together a meal with cold convenience store lunchboxes and cup ramen.

The outside started to get noisy.

Oh, please. Don't let it be.

"Doctors! Arrest in the Resusc!"

Fuck.

"Ah, fuck, seriously."

Kim Jihun stopped chewing his noodles, spat out a curse, and jumped up from his seat. I also stood up halfway mechanically. My body, which had felt like a ton of bricks just a moment ago, reacted to a single Alarm Sound like a cursed Pavlov's dog. It was the only talent I had acquired while rolling through this hell.

The moment I kicked open the door to the Resusc, the air—a mixture of the smell of blood, disinfectant, and human despair—pierced my nose.

"Patient is a 58-year-old male! Found in a state of loss of consciousness! It has been 11 minutes since he was first found, and his BP and pulse are not catching!"

"Give Epi and start pressure immediately!"

"Starting pressure! One, two, three, four..."

Everything moved in an orderly yet, at the same time, crazily chaotic manner. Someone climbed onto the patient's chest and compressed it as if to crush the ribs, while someone else squeezed the Ambu bag to forcibly shove oxygen into the lungs. I watched the scene blankly for a moment.

An old Mr. holding the doorknob to the afterlife. Will all this stuff we are doing really be able to pull that old man this way?

Skepticism. Yes, skepticism. What at all am I doing this for?

It was at that moment.

Right before my eyes, in the void, it seemed as if a rainbow-colored noise crackled and flared up for a very brief moment.

'...Am I seeing things because I'm tired?'

I rubbed my eyes.

However, it did not disappear. The noise soon started to take a clear shape. Like a translucent system window one might see in a sci-fi movie.

『Congratulations! You have achieved the qualification of a Savior.』

『A special skill will be provided. The skill you received is [Gallery Pass]!』

What kind of bullshit is this, fuck.

I thought I had finally gone crazy. Overwork and stress must have melted a specific part of my brain. Can only I see that? I almost asked the nurse who was catching an IV fluid line next to me, "Excuse me, by any chance, can you see that blue text over there?"

If I did that, I would probably go straight to the psychiatric closed ward.

"Checking the rhythm! It's VF!"

Whether it was good luck or bad luck, that ridiculous system window disappeared without a trace in a second. As if it was not there from the beginning.

'Right, it's just an illusion.'

When I snapped out of it, a defibrillator paddle was in my hand before I knew it.

"Everyone move! Charge, 200 Joules!"

"Clear!"

"Shot!"

Thump! The patient's body bounced up like a bow. The EKG graph on the monitor was still a mess. It didn't look like it had any intention of returning. Another 30 minutes flowed by like that.

Eventually, everything finished with the attending professor's declaration of ending CPR.

Sweat and effort vanished in vain into the air.

Rest in peace.

I headed back to the Duty Room. The moment I threw my body onto the bed, that message I saw earlier popped up again.

Gallery Pass?

"What am I supposed to do."

Is this like those web novels that are popular these days? Status window? Skill? Hunter? Just in case, even though it felt really stupid, I shouted in my mind once.

'Gallery!'

Nothing happened.

Pfft.

A hollow laugh escaped me. Right, as if I'm some kind of main character. It's just a trick my brain is playing because I'm tired. I closed my eyes and tried to force myself to sleep, but my mind was complicated. Gallery... Gallery... Could it be that the word 'Gallery' means that gallery?

At that moment, a translucent window popped up before my eyes again like a pop-up. This time, it was different. It wasn't a simple message window like before.

"...What is this screen?"

What spread out before my eyes was an interface that was an exact replica of a site I had visited at least once—one that was very familiar. A gloomy blue color. A clumsy UI. And the name of the Gallery stamped on the top left of the screen.

[Dead Medic Gallery]

"Pfft!"

I laughed out loud without realizing it. Dead Medic Gallery? Ah, that kind of setting? My brain has really gone out of its mind after all this. It was a pretty plausible B-grade sensibility for a delusion created by the brain of a mere doctor drenched in overwork.

'Right, my brain is throwing a whole fit. Then let's see you solve this.'

Just then, a patient who had just arrived at the Emergency Room came to mind. It was a patient who had been suffering from a high fever of unknown origin for several days and had been bouncing around other hospitals before coming here. On the bundle of charts from the previous hospital that the nurse had handed over a moment ago, all sorts of test results were plastered everywhere, but they were all useless statements like 'no specific findings.'

I had also skimmed through the chart and passed it over, thinking, 'Hmm, well, there's nothing strange.'

'How do I write a post? Do I just imagine typing on a keyboard?'

When I pretended to tap a keyboard in my mind, text began to be entered into the gallery writing window before my eyes like magic. Oh, fuck. This is real.

Title: It's an FUO patient, someone take a look please

Writer: Korean Slave 1 (Male)

68-year-old male patient. High fever exceeding 38.5 degrees sustained since 2 weeks ago. Rash present.

Looked at the copy sent from the previous hospital; CBC, LFT, CRP, Chest PA, Abdomen CT, and even blood culture tests were all done, but everything is normal. Rheumatoid factor is also negative.

The patient keeps running a fever and is flagging, but I don't know the cause. What more should I look at?

Done. This should be enough. I uploaded the post by thinking of the register button. Who on earth would leave a reply in this crazy delusion?

That thought was shattered in less than a second.

[A new comment has been posted.]

ㅇㅇ (118.235): Are you an idiot? Seems like VEXAS, send out a test

I was impressed by the dedication to hurl a curse as soon as the comment was posted. Seeing that even the IP address showed up, it was a delusion with vivid details. If it's 118.235, isn't that a Korean IP?

But Vexas?

"What the fuck is Vexas?"

It was a disease name I had never heard of in my life. My brain is truly amazing for making up this kind of thing. A hollow laugh came out because it was absurd, but my fingers were already lifting my cellphone without my knowledge to access 'Up-to-date,' which is like the bible for doctors.

I typed 'VEXAS' into the search window.

And, the moment the search results appeared on the screen, I heard the sound of my heart dropping to the floor with a thud.

[VEXAS syndrome]

Vacuoles E1 enzyme X-linked Autoinflammatory Somatic syndrome

An adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene.

Major symptoms include recurrent high fever, hematologic abnormalities such as anemia, skin rash, chondritis, vasculitis...

I stopped breathing. The words on the screen and the contents of the patient's chart that I had carelessly passed over a moment ago began to mix like a storm in my head.

'The patient had an erythematous rash on his face.'

'In the CBC results, everything else was normal, but the red blood cell count was subtly low. Mild anemia.'

'He complained that the cartilage area of his ear was red and swollen.'

Fuck.

Fuck.

Fuck!

No other words besides curses could come to mind. The words 'VEXAS Syndrome' floating on the cellphone screen were so vivid they seemed to burn my retina. And the thing that told me that was the crazy delusion in my head called [Dead Medic Gallery].

I picked up the intercom immediately. The patient's primary doctor wouldn't be me in Emergency Medicine, but Internal Medicine, which would handle the hospitalization procedures. A Rare case like this obviously had to be discussed and proceeded with Internal Medicine.

The procedure was clear. Internal Medicine integrated duty, R3 Nam Seunghyun (Male). He was a person famous for being prickly and like shit even normally.

Ring, ring, ring—

Ring, ring, ring—

A sharp voice pierced through the handset and flew in.

"Who is this."

"Ah, Teacher! Hello! I am Han Hyeonjae, a 1st-year resident in Emergency Medicine!"

I spoke as politely as possible, lowering my voice, with the feeling of a private calling the division commander in the military.

"EM? Why at this hour. Just keep it brief."

"It's nothing else, but I'm calling to ask for a consult regarding the FUO patient who just entered the ER. He's a 68-year-old male patient, and when synthesizing the records from the other hospital and our initial test findings..."

I swallowed my saliva once and spat it out.

"Vexas Syndrome is strongly suspected."

"...."

Silence flowed across the handset.

1 second, 2 seconds, 3 seconds.

That short time felt like an eternity. Soon, Nam Seunghyun let out a scoff and spoke.

"What? What did you just say?"

"I mentioned... Vexas Syndrome."

"Hey, Han Hyeonjae. Are you playing games with me right now?"

His voice sank coldly.

"A crazy bastard who picked up some weird case report and is calling is right here. Ha, fuck. This is absurd."

"However, Teacher, the patient's symptoms are textbook identical. Recurrent high fever, skin rash, mild anemia findings, and cartilage..."

"Hey!"

Nam Seunghyun cut off my words. His voice contained blatant contempt.

"Bastards like you are the biggest problem. Someone who hasn't even learned properly picking up a name of a rare disease somewhere and writing a novel holding onto a patient. Don't you dare blabber that kind of stuff to the patient's family. Rule out the typical infectious diseases first. Rerun the virus markers and autoimmune antibody tests, and contact me when the results come out. No, don't contact me. Just note it on the handover sheet. Hang up."

"No, Teacher, when looking at the chart from the previous hospital..."

Click.

The phone was cut off unilaterally.

"...Fuck."