Chapter 17

Episode 17 Is It Not a Cold? (1)

A few days flowed by.

The forced study sessions with the Gallery Ghosts opened without fail every single time I had an off-day.

My days off were no longer days off.

However, strangely enough, after experiencing that hell, hospital life became a tiny bit easier.

Of course, it was still fuck. That was an unchanging truth.

But at least, I was not in a state of trembling in fear in front of every situation like before. In their minds—or rather, in my mind—a minimal framework had now faintly taken shape.

Of course, that framework did not reduce the total amount of my hospital life's fuckery.

“Hey, Doctor! I’m telling you, it feels like my heart is about to burst right now! Forget the EKG or whatever, shouldn't we quickly do an Echocardiogram? The son of Kim next door said his chest hurt like this too, so they did an echocardiogram and he immediately got a Stent Procedure or something!”

Today's first trouble maker was a man in his 50s.

He was a patient who had come to the Emergency Room in the morning, claiming his stomach was burning after heavy drinking last night.

It was a classic symptom of Gastroesophageal Reflux Disease, and his EKG was clean.

However, this gentleman firmly believed that he must be an Acute Myocardial Infarction patient who might die at any moment.

“Patient, on the EKG, there are no findings suggesting an Acute Myocardial Infarction. For now, get an injection and we will check your progress…”

“I heard doctors these days don't listen to a word the patient says! I searched it all up on the internet! There’s a high probability that symptoms like mine are an atypical Myocardial Infarction!”

I pressed my temple firmly.

Here comes an internet medical doctor. It's always gentlemen like him who, when they are actually sick later on, hold out and don't come to the hospital saying, ‘The internet said it was fine,’ missing the entire golden time.

In the end, after a long struggle, it was only after showing him the lab result sheet stating his Cardiac Enzymes level was normal that this gentleman reluctantly received the injection. And 30 minutes later, with a face that seemed completely fine as if nothing had happened, he walked out burping loudly.

Just when I had defeated one trouble maker, this time, an internal enemy appeared.

Nam Joo-hyun (Male), a 2nd Year resident in Emergency Medicine.

Today, 2nd Year Nam Joo-hyun was exceptionally on edge. From the morning, he had been chewing out an intern as if he were going to eat them alive, and that arrow finally aimed toward me.

“Han Hyeonjae.”

“Yes, Teacher.”

“The patient in B-21, who put in the CT order?”

“Ah, I put it in. She is an 80-year-old female patient, and since she continuously complained of headaches and dizziness after a fall, I wanted to differentiate a possible intracranial hemorrhage…”

“With whose permission?”

“No, a moment ago, Teacher, you said that for elderly patients in Area B, if they fell, even if the symptoms are vague, lower the threshold for CT and actively take them…”

“When did I tell you to just take them on your own whim? You should report to me, consult with me, and then put in the order under my name! Who do you think you are to just order a brain CT? If they sue saying they got cancer from the radiation, are you going to take responsibility?”

I lost my words.

Fuck, you told me to put in the orders, you bastard.

The inner me poured out curses, but the reality of me just slumped down my head.

In the first place, all trauma patients from falls get them as a routine, fuck.

That human just wanted to bite someone today. And I, being an easy target, got caught. That is the physiology of this fucking hospital floor.

“Sorry. From next time, I will definitely report first.”

“There is no next time.”

Nam Joo-hyun snapped coldly and went on his way.

I flipped the middle finger toward the void, then returned to my spot.

Fuck. Today is exceptionally more of a fuck.

It wasn't that there were only fucking things happening. The Emergency Room was a hell, but at the same time, it was a place full of the most interesting spectacle in the world.

A college student who was carried in, saying his shoulder dislocated while playing basketball. His right shoulder was slumped down at a bizarre angle even at a glance. A 2nd Year from the Orthopedic Clinic was called down.

“Argh! It hurts! I think I'm going to die!”

“Just endure a little bit. Relax and try to breathe out, whoo~.”

The OS 2nd Year made the patient lie prone on the bed and let his arm hang down below the bed. Then, he hung a 5kg weight on his wrist.

It was a method of naturally reducing it with the force of gravity while waiting for the muscle to relax.

I watched each and every movement from the side with interest. So that is what a procedure is.

Had about 10 minutes passed? As the OS 2nd Year grabbed the patient's arm and gently rotated it, with a dull thump sound, the patient's shoulder found its place and went in.

“Uh… uh? It doesn't hurt!”

Color returned to the face of the patient who was screaming that he was dying just a moment ago.

Without realizing it, I let out a small exclamation of admiration. How many shoulders do you have to insert and fit to have that kind of hand skill?

1:00 PM.

The war-like time that continued throughout the morning ended, and finally, lunchtime arrived.

Kim Jihun (Male) tapped my shoulder.

“Hey, let's go eat.”

“Uh, yeah.”

I rolled my stiff neck and stood up from my seat.

Before heading to the restaurant, out of habit, I scanned the entire patient list on the EMR screen from top to bottom.

Checking who the new patients were, whether the test results of the patients I saw had come out, and if there were any unusual matters—it was now an almost reflexive action.

The scroll wheel turned rapidly.

Cold, enteritis, simple contusion, drunkard… a peaceful list.

Without much thought, I was about to turn my body while scrolling past the screen.

It was at that exact moment.

My eyes stopped right on one line of the monitor.

Uh?

Hold on.

Kim Jihun rushed me.

“What are you doing? Aren't you coming?”

I stopped scrolling and moved the mouse to rest the cursor on that patient's chart.

“Hey, Han Hyeonjae!”

“You go first. I have something to check. I'll go later.”

Every sense in my body was screaming.

That patient.

Something.

Something is very wrong.

Swallowing my dry saliva, I moved the mouse cursor to open that patient's chart.

[Patient: Park Jin-soo (M/54)]

[Arrival Time: 12:10]

[KTAS: Level 5]

[Chief Complaint: Sore Throat]

Up to here, there is no problem.

A 54-year-old man. Came because his neck hurt. KTAS Level 5.

It's a case commonly seen in the Emergency Room. Patients like this pour in like a conveyor belt by the dozens every day.

I scrolled down to check the initial examination record. The writer was my junior, Jo Su-yeon.

[Initial Exam Record]

Complained of sore throat that started 3 days ago and took over-the-counter cold medicine, but no improvement. Complained that the pain intensified from this morning, making it difficult to speak or swallow saliva.

Vital signs: BP 130/80, HR 88, RR 20, BT 36.8℃, SpO2 99%

Pharynx & Larynx: no erythema, no swelling, no exudate. Tonsil symmetric, not enlarged. Uvula midline.

[Assessment & Plan]

R/O) Acute pharyngitis, Common cold

Plan) IV fluid hydration & Symptomatic control

From my perspective as a 1st year, Jo Su-yeon's charting was perfect.

It was textbook, and there was nothing to find fault with.

In accordance with the patient's chief complaint, she performed the necessary physical examination without omission, and based on the results, made the most rational presumptive diagnosis.

And she started the most appropriate management for it.

The most standard play that could be done for a patient with suspected simple acute pharyngitis, KTAS Level 5.

But.

Fuck, but.

The warning light in my head is howling like crazy.

The larynx is clean?

It's not that the charting is wrong. Jo Su-yeon probably wrote exactly what she saw.

The patient's throat has absolutely no medical abnormalities. No erythema, no swelling, no pus. Everything was clean.

But he complains that his neck hurts terribly?

This is the point that makes no sense.

It's not a level where the throat is just a bit scratchy from a cold and body aches. It's a pain to the extent that it's hard to speak or swallow saliva.

With this level of pain, it's normal for the throat to be swollen bright red, or for a giant abscess to be formed on the tonsils, or at the very least, for white pus to be stuck there.

But there is nothing. Nothing at all.

There is a giant gap between the objective findings and the subjective symptoms the patient complains of.

I scanned the chart up and down again. The vital signs are also stable. He doesn't even have a fever.

If it were pharyngitis due to a viral or bacterial infection, it would usually be accompanied by at least a mild fever.

Is it… not a cold?

Then where is this dreadful pain coming from? What if it's not a problem of the neck itself?

…Is this radiating pain?

My heart dropped.

Radiating pain.

Pain felt in a completely different area, not the source of the pain.

The human nervous system is intricately tangled, so the brain often gets confused about the origin of the pain.

And the most terrifying, most fatal disease that radiates to the neck, which an Emergency Room doctor must wake up from sleep to differentiate, is…

Ha, fuck.

Hold on.

The puzzle pieces started to fit together in my head.

A 54-year-old man. Middle-aged. An age where the risk of cardiovascular disease rapidly rises.

He took cold medicine, but there is no improvement. Of course. Because the cause is not a cold.

His neck hurts. An atypical radiating pain of a myocardial infarction that extends to the jaw, shoulder, or back.

Right?

Without realizing it, I licked my dry lips. Jo Su-yeon is not at fault. Anyone would have thought that way looking only at the patient's symptoms and KTAS level. This is a hidden trap.

Right?

If my expectation is right, that patient is currently lying on a bed in the corner of the Emergency Room, receiving IV fluids while his heart muscle is slowly rotting away.

He is not a KTAS Level 5, but a KTAS Level 1 patient who needs monitoring started right now and must go to open up the blood vessel.

I stood up from my seat. We must take an EKG right now.

We must check the Myocardial Enzyme Levels as well.

But before that, confirmation is also needed. Because if by any chance my expectation is wrong, I will become a dumb shit who makes a fuss holding onto a perfectly fine cold patient.

I started to write a post as I walked toward the patient.

For now, I should upload a post to the Gallery and then put in the lab orders.

Title: [URGENT] Sore throat patient, is this right?

Author: Korean Slave 1 (Male)

50s/M. Chief Complaint: Severe sore throat, no improvement even after taking cold medicine. But on exam, larynx and pharynx are clean. No fever either. Do I have to view this as an atypical symptom of ACS? In my mind, I think it's right.

At the same time as pressing the register button in my mind, I arrived in front of bed B-28 where the patient was lying.

The patient had started to break out in a cold sweat and was faintly groaning while looking at the ceiling.

As I approached, the patient opened his eyes with difficulty.

“Teacher, my neck feels like it's burning…”

A burning pain.

It is one of the typical chest pain patterns of a myocardial infarction. That was currently appearing in the neck.

I firmed up my resolve.

“Patient, please wait a moment. We need to do an important test.”

I ran to the nearest computer.

The fingers logging into the EMR trembled minutely.

“Nurse! For patient Park Jin-soo in B-28, we will take an EKG right away! Please bring the portable machine this way immediately, and at the same time, we will draw a cardiac marker lab including myocardial enzymes right away!”

At my urgent shout, the air of the station, which had been languid ahead of lunchtime, instantly froze.

“Yes? The patient in B-28? That cold patient…?”

The nurse looked at me with a puzzled expression.

“It might not be a cold. Quickly.”