Chapter 11

Episode 11 Strange Guy (4)

People who might have once been called the God's Hand in their respective fields were now enthusiastic after dying over a mere 1st Year Resident's minor diagnosis. Were they really that starving for a real patient and clinical practice? These crazy workaholic ghosts.

At that moment, my appearance from earlier came rushing in, when I was sowing a child’s forehead. The suturing was crooked and a complete mess. Something other seniors would have finished in 5 minutes took me 20 minutes of struggling just to barely wrap up. In the end, Senior Choi Sumin, unable to just watch, came over to finish it up and even said, "Hyunjae, you need more practice with your procedures."

I could borrow their minds, but I couldn't borrow their hands. On an impulse, I started writing a post in the Gallery.

Title: But guys, for real

Author: Korean Slave 1 (Male)

How do you improve your hand skills? Seriously, it takes me ages just to suture the forehead of someone who fell. Tips please.

The moment after posting it, regret came rushing in. Ah, shit. Should I not have posted it? What if they mock me, saying, "If your hands are garbage, quit being a doctor"?

I closed the Gallery window. I was the idiot for expecting anything.

ㅇㅇ (14.52): You get better as you keep doing it.

Latte is Mine: Buy some pig skin and practice sowing at home every single day. Back in my day, that’s how we all did it.

StuckInTheCornerOfTheOR: These days, YouTube is flooded with suturing lectures. Look up stuff like that. Don't just sit there blankly like a fool.

Mes of the God (Male): Hand skills are a matter of talent. Those who can't do it just can't. It's right for you to just use your head.

…Oh, fuck this.

I laughed hollowly and leaned my head against the wall. This damn Gallery didn't let me download hand skills. Sigh, would there ever even be a reason to use possession? Will the day ever come when I can gather 5,000 LP and manifest Mes of the God into my body for 30 minutes?

It was right when I was drowning in such self-pity.

The automatic door at the Emergency Room entrance slid open, and a completely unexpected person showed up. It was Professor Choi Youngjun from the Rheumatology department, whom I had run into a few days ago because of the Vexas Syndrome patient.

My heart dropped. Why at this hour? Why of all places the Emergency Room? Don't tell me it wasn't Vexas and he came to chew me out?

Professor Choi Youngjun didn't even look around and walked straight toward me.

"Teacher Han Hyeonjae."

"Yes, Professor! What brings you here!"

I jumped up reflexively and bowed. Professor Choi acknowledged my greeting with a light nod and thrust a tablet PC right before my eyes.

"I just happened to be passing by while checking on the patient's progress, and today's bone marrow biopsy result was quite interesting. So I stopped by for a moment."

The screen displayed a test result sheet crammed with all sorts of English abbreviations and numbers.

Bone marrow biopsy result: Hypercellular marrow with prominent erythroid and myeloid dysplasia… prominent ring sideroblasts (18%)…. UBA1 somatic mutation confirmed.

"Teacher Han, does anything come to mind looking at this result? You said you were very interested in rheumatic diseases, didn't you?"

Since it was the result of the Vexas patient, it was obviously related to Vexas. But I didn't know shit about what these specific numbers and words meant. Fuck. Emergency. My mind went completely blank. Since the UBA1 mutation was confirmed, the Vexas diagnosis was certain. But there was no way a 1st year like me would know the clinical significance of the other findings. Besides, I am an emergency medicine doctor. Not an internal medicine doctor.

Anyway, to keep from destroying my image, I desperately needed to buy time. Putting on the most intellectual expression possible, I pretended to stare at the tablet screen. At the same time, a Gallery window was opening at the speed of light.

Title: Guys what is this urgent;;; bone marrow biopsy result of a Vexas patient

Content: (Picture scan) Hypercellular marrow, dysplasia, ring sideroblasts 18% what does this mean?

Simultaneously with uploading the post, I opened my mouth and started bullshitting to buy time.

"Uh, Professor. Could you give me just a moment? In my opinion, when comprehensively considering these bone marrow biopsy findings and genetic markers, there are parts that make it difficult to view this simply as an autoinflammatory disease finding…"

I jumbled words together and spouted nonsense into the void. Professor Choi Youngjun watched me with an interested gaze, his arms crossed.

Please, just one comment!

As if the scream in my heart had reached through, a small notification finally flashed in the corner of my vision.

Hematoma is Hell: Aside from the UBA1 mutation, the MDS (Myelodysplastic Syndrome) findings are clear. If ring sideroblasts are over 15%, it's a high-risk group. It means the Vexas is progressing into MDS. It means the prognosis is crazy bad, and from now on they need to set up a plan for chemotherapy or hematopoietic stem cell transplantation with Hemato-Oncology. If not, it will turn into leukemia within a few years.

All the fog in my head cleared away.

"Professor, I will start with the conclusion."

Professor Choi Youngjun's eyes widened slightly.

"It is judged with a very high probability that this patient is already progressing into Myelodysplastic Syndrome, which is a pre-stage of blood cancer."

I pointed with my finger to the 'ring sideroblasts 18%' part on the tablet.

"Particularly, it shows high-risk findings with the ring sideroblast count exceeding 15%. At this rate, there is a very high possibility it will transition into acute myeloid leukemia within a few years. I believe we need to contact Hemato-Oncology right away to establish a new treatment plan that considers chemotherapy, and in the long term, even allogeneic hematopoietic stem cell transplantation."

As my words ended, a heavy silence flowed over the Emergency Room station. Professor Choi Youngjun was staring at me with a look of disbelief, his mouth slightly open. At first, it seemed like intellectual curiosity. An expression that seemed to say, 'Oh, you're pretty good?' But as my explanation continued, the professor's gaze turned into utter shock.

Professor Choi stared at me blankly with his mouth open for a long time. During that time, I felt like I was almost suffocating. Did I go too far? Did I pretend to know too much for a mere 1st year? Did it look arrogant to encroach on the territory of Hemato-Oncology?

"Teacher Han."

"Yes, Professor."

"By any chance, are you preparing for a Double Board in Internal Medicine?"

…?

"…Pardon?"

A dumbfounded sound popped out of my mouth. Double Board. One doctor earning two specialist licenses. But he was asking me that?

Seeing my dumbfounded expression, Professor Choi Youngjun soon shook his head with a smirk, as if he also thought his own question was absurd.

"Ah, no. Right. I suppose my thoughts went too far as well. A truly great talent has entered our hospital's Emergency Medicine department."

Professor Choi patted my shoulder lightly with genuine admiration.

"I learned a lot today thanks to you. I'll make sure to pass the word along well to your Section Chief."

With those final words, Professor Choi Youngjun turned around with a relieved expression and left the Emergency Room.

Wait a minute, what? Section Chief? What the hell are you passing along to the Section Chief? Hey, what the fuck?

I could feel through my skin that the surrounding gazes had changed. While standing there blankly in that awkward silence, a giant shadow loomed over me from behind. I turned around very slowly.

Head of Doctor's Office Lee Minjae, the Emergency Medicine senior, was staring at me with his mouth wide open, wondering how long he had been standing there. He must have heard everything, from start to finish, of the conversation between Professor Choi Youngjun and me. Judging by that expression.

The chief, looking as soul-less as someone who had seen a ghost, looked alternately between the direction where Professor Choi had vanished and me.

"You crazy bastard!"

Grab!

Senior Lee Minjae grabbed both of my shoulders. No, why this time again? Why are you trying to torment me again?

"You… you punk! You're preparing for a Double Board without me knowing?! No wonder! No wonder something felt unusual about you!"

I couldn't snap out of it under the chief's roar.

"Hey! Is that why you were so well-versed in internal medicine cases? Huh? You had all these rare diseases we don't even know down pat just as groundwork to skip over to Internal Medicine?! Was Emergency Medicine just a passing phase for you! Were you planning to betray us, the comrades of this Emergency Room, and run off to Internal Medicine, you traitor?!"

The chief's scream had already crossed the river of misunderstanding and was heading toward the ocean of delusion. All I could do was just stand still and sway. My head was gradually starting to feel dizzy, but even so, I kept my mouth shut.

An explanation? What could I possibly say? It's not like that gentleman would care about what I say anyway.

Fuck, senior, what kind of 1st year prepares for a Double Board. I am just a low-ranking rookie whose only goal is to survive day by day without getting chewed out and without killing patients. Double Board my ass. My only wish right now is to eat a double cheeseburger and get some sleep, holy shit.