Chapter 12

Episode 12 Respiratory Failure

The delusion called Double Board spread by Senior Lee Minjae propagated like a contagious disease. Before even a single day passed, the rumor had spread to the entirety of Emergency Medicine.

At dawn, when I woke up from a short nap in the Duty Room and was pulling out a New Gown from the Supply Room, a voice was heard from behind.

"Hyeonjae?"

It was the 4th Year Sung-hoon Yoo. As always, his face was thoroughly soaked in chronic fatigue.

"Are you really going to Internal Medicine?"

"Pardon?"

"Well, now is a good time. There are occasionally guys who make a deal and transfer around the autumn of their 1st Year. So are you quitting residency? Or is it really a Double Board like Minjae said?"

I tightly closed my eyes. In their minds, My appearance over the past year flashed by. The days of getting cursed at and being covered in blood.

I'm not quitting.

And as if I’m crazy enough to do this again.

The fact that I had to endure this hell for four years was already horrible, but to go to another department and repeat this process for three to four more years? Double Board? That was not something a human being should do.

I replied with the most firm voice possible.

"No, sir. I have no intention of changing departments. I will not quit residency."

"Then Double Board?"

"No, I'm saying I'm not doing a Double Board either."

"Hm."

The 4th Year Sung-hoon Yoo stared at me for a moment with a look that questioned whether he believed my words or not, and soon shrugged his shoulders and went on his way.

However, this thing was just the beginning.

While I was issuing orders at the Emergency Room Station, the 3rd Year Choi Sumin approached with a worried face.

"Hyunjae."

"Yes, Teacher."

"Are you really doing a Double Board? That is a truly difficult path. You'll ruin your health like that."

By now, my feeling was almost at the point of wanting to cry.

"I said I'm not doing it, Teacher. Who on earth started such an absurd rumor..."

"Is that so? If not, then I'm glad. Anyway, don't overdo it."

She patted my shoulder and left, but it was not comforting at all.

I'm not changing departments, you bastards...

And finally, the inevitable coming arrived. My Junior, Suyeon Cho.

"Hyunjae!!"

"Uh? What's wrong with you now?"

"You traitorous bastard! I knew it all along! How dare you abandon EM?! Even though you were the one who suggested it first, you're running away from EM?!"

I tightly pressed my temple. My head was throbbing.

No.

I'm not going.

I'm not doing it.

I shouted dozens of times in my heart, but already no one believed my words.

I'm not going. I'm not doing it. I can't do it.

Just filling my 4 years here and leaving is my only goal.

Please just believe me, you bastards.

Friday, 1 AM.

Our hospital’s Regional Emergency Medical Center, one of the busiest emergency rooms in South Korea, could not fall asleep even at that hour.

"Prepare suction! BP keeps dropping! 80 over 50!"

"Heart rate 140! Teacher, I think we need to catch a C-line right now!"

In the Resusc Room, a war to save a multiple trauma patient brought in from a traffic accident was in full swing. All senior residents, staffs, and even professors were clinging together, fighting a desperate battle.

I was silently charting at my spot. That was not a place for me to join yet. My best was to handle the charts of other mild patients piling up at the Station to lighten the burden on my seniors even a little bit.

It was then.

Beep- beep- beep- beep-!

An alarm burst out from a completely different direction. Area B. It was a place where relatively stable patients stayed. Turning my head, the oxygen saturation level of patient B-12 was blinking in red on the Station monitor.

85%

84%

83%...

"Fuck."

I got up from the chair and ran toward the bed. The seniors were all tied up with the trauma patient.

Lying on the bed was a grandmother in her 70s. As a patient with a history of Chronic Obstructive Pulmonary Disease, she visited the hospital yesterday afternoon due to severe dyspnea. At the time of arrival, her oxygen saturation was low, so she was under observation while being given oxygen through a nasal cannula, and because her condition had stabilized, she was a patient being considered for discharge shortly.

However, the patient's condition now was completely different. Her face was pale, and her lips were turned blue. It did not feel like she was breathing properly. Her consciousness was also in a nearly semi-comatose state.

"Minjun! You were watching this patient, right? What happened?"

I shouted toward the 1st Year Minjun Choi, who was fidgeting anxiously next to the patient.

"The saturation suddenly dropped, so for now, I increased the oxygen first! Currently, 10L is going in through a face mask, but it keeps dropping!"

Just as he said, an oxygen mask was placed over the patient's nose, and the amount of oxygen going in was pointing to 10L. However, the patient's condition was getting worse and worse. Her consciousness was fading more and more.

Minjun Choi cried out with an almost tearful face.

"What should we do? Should we try increasing the oxygen to the maximum of 15L? Or should we prepare for intubation right away?"

Oxygen is dropping. A COPD patient. Where have I seen this a lot? Surely I learned it, and I even took an exam on it. What at all was the exact mechanism? No, but how on earth did this bastard pass the national medical exam?

Anyway, that was not what was important right now. For a moment, my mind was going blank. I clearly knew it, though?

'Gallery!'

Pretending to place a stethoscope on the patient's chest and listen to her breathing, I pulled up the blue interface in my pupils.

Title: Urgent. 70s COPD patient. Visited for Dyspnea. Giving O2 10L but suddenly consciousness decreases and saturation drops. Why is this happening?

Author: Korean Slave 1 (Male)

After posting the text, I shouted to Minjun Choi.

"For now, lift the patient's jaw to secure the airway!"

In that moment of buying time, I saw comments being posted in the corner of my vision.

Respiratory Ghost: You idiot, it's CO2 retention. Don't you know that if you blast high-concentration O2 into a COPD patient, the respiratory center gets suppressed so they stop breathing? They went into a coma due to hypercapnia narcosis. Lower the O2 right away, stab an ABGA, and check the pCO2. Prepare to hook up a BiPAP if needed.

All the puzzle pieces fell into place. Hanging the stethoscope around my neck, I yelled at Minjun Choi.

"Minjun Choi! Lower the oxygen! Lower it to 2L right now!"

"What? Lower it? The saturation isn't even hitting 80 right now! The patient will die, Hyeonjae!"

"This patient is a COPD patient! Did you forget the history?! Did you not take the national exam?! If you give more oxygen here, the heart will just stop, you bastard!"

"...Ah!"

I pushed Minjun Choi's shoulder aside and roughly turned the oxygen dial myself. Then I shouted toward the nearest nurse.

"Nurse! Get the ABGA kit and a heparinized 1cc syringe here quickly! I'll stab right into the radial artery!"

"Yes, Teacher!"

"And Nurse Sujin Lee! Please bring the portable X-ray and the BiPAP machine right this second!"

The nurses moved in perfect order. And I shoved an Ambu bag into the hands of the panicked Minjun Choi while giving his back a discipline smack.

Soon after, I proceeded with the arterial blood sampling using the kit the nurse brought. Only after confirming that bright red blood was entering the syringe could I catch my breath for a moment.

"Take this to the lab right away! Tell them to run it as a STAT!"

At that moment, a nurse and a respiratory therapist came running, dragging a heavy BiPAP machine.

"Teacher! We brought the BiPAP!"

The respiratory therapist asked me.

"Teacher, what should the initial settings be? Please tell me the IPAP and EPAP."

"...."

My mind went blank once again. Fuck. Settings? How would I know that.

I knew that BiPAP was needed thanks to the Gallery. However, I had absolutely no knowledge of how to set the specific numbers. Should I just roughly say 10 and 5? What if damage occurs to the patient's lungs because of that?

"Teacher?"

The respiratory therapist urged me. The eyes of Minjun Choi and the nurses were all focused on my mouth. Sweating a cold sweat, I desperately spun my brain to buy time.

"Just a moment. I think I need to check the patient's consciousness level and chest movement once more before deciding."

I made that excuse and pretended to approach the patient. Then, acting as if I was flipping the patient's eyelids to check the pupillary reflex, I opened the Gallery window again.

Title: [Urgent 22] Someone give me the initial setting values for BiPAP!!

Author: Korean Slave 1 (Male)

As soon as I pressed submit, that Respiratory Ghost from earlier immediately reappeared.

Respiratory Ghost: Start from IPAP 12, EPAP 5. Set the RR to around 14. Stab the ABGA again in 30 minutes to see how much CO2 is draining, then adjust the pressure. I set the whole table for you and you can't even use a spoon.

The insults cut to the bone, but that wasn't what was important right now.

"We will start the initial settings with IPAP 12, EPAP 5, and a respiratory rate of 14 per minute."

"Yes, understood."

The respiratory therapist skillfully operated the machine. After a while, a nurse shouted toward our side.

"The ABGA results for patient B-12 are out!"

My heart thumped.

"Teacher! pH is 7.15, pCO2 is 92, and bicarbonate is 30!"

"...It worked!"

Without realizing it, I clenched my fist tightly.

"Okay, maintain the BiPAP settings as they are, and a follow-up ABGA will go out again in 30 minutes! Please keep checking if the patient's mental state wakes up every 1, every 10-minute intervals!"

I did it. Again. With the help of this crazy Gallery, I saved a patient.