Chapter 189

Episode 189 Every Patient ( )s. (1)

Some time had passed since that incident.

Even after that day, we were trying... trying to live our lives just as we usually did.

Around the end of spring, the rain that had recently been pouring down as if a hole had been pierced in the sky finally began to taper off.

For days, the world visible through the automatic doors of the Emergency Room had been entirely gray, but now, a faint ray of light was piercing through the clouds.

I took my eyes off the monitor and pointed out the window.

"Eunseo. The sun is out."

"Huh? It really is. I guess it's finally stopping."

Baek Eunseo stretched and looked out the window.

However, that peace was shattered to pieces by the voice of the news anchor on the TV hanging on the wall of the Emergency Room.

[Typhoon No. 9, 'Bamboo', is moving north faster than expected and is projected to make landfall on the Korean Peninsula sometime this week. The Meteorological Administration states that the southern coast...]

A typhoon named Bamboo.

If that thing hits, my back is going to snap like bamboo.

"Ugh... I already feel dirty."

My forehead automatically furrowed.

The rain hadn't stopped; it was just a running start before a bigger monster arrived.

"What do you mean? The typhoon?"

"Yeah. My whole body already feels clampy. I've really grown to hate the rain lately. It would be fine if it just poured down refreshingly, but with a typhoon on top of this weather, the humidity in the ER is going to hit 100%."

I complained while vigorously flapping my gown back and forth like a penguin.

"It's hot in midsummer, and it's damp when it rains. I'm sick and tired of getting soaked every time I commute to work. This won't do. I need to buy a car quickly..."

"Huh? Teacher, are you going to buy a car?"

Baek Eunseo asked, her eyes growing round.

"I should get a car, turn on the AC, and commute all nice and dry. I can't keep doing this. Taxis are too expensive."

"What model are you looking at?"

"Just anything that rolls, pretty much."

At that moment, Baek Eunseo asked with a very pure gaze.

"Teacher, do you have a license?"

Ah.

"No."

"...."

Baek Eunseo smacked her forehead to the point that it made a loud slap.

"Ah, yes. I understand..."

A soulless reply.

It was a gaze that seemed to say, 'How can you talk about cars when you don't even have a license?'

"What, what, what do you understand! What! I can just get one! I got a doctor's license, so you think I can't get a driver's license?"

I shouted, feeling unjustly accused for no reason.

No, I couldn't get it because I was busy, not because I was stupid.

For something like the written test, I'd get a perfect score just by glancing through the workbook once.

"Yesss, of course you would... I truly pray you get one..."

Baek Eunseo gave a soulless reaction and turned her head back to the monitor.

She clearly didn't believe me.

Just you wait.

I'm registering for an academy right after work today.

It was then.

Far off by the ER exit, someone who had changed into civilian clothes was waving brightly toward us.

It was my junior, Jo Suyeon.

She had a very happy expression, with a spiteful smile playing on her lips.

For Jo Suyeon, the victorious survivor leaving work who was smiling brightly at us from afar, I quietly lifted my fingers.

With a very devout heart.

🖕 🖕

With both hands.

Double birds.

Flip off.

Flip off twice.

Seeing my double birds, Jo Suyeon cackled, flashed me two thumbs up, and leisurely disappeared.

Damn it.

If you're envious, you lose, but I've already lost.

I parked my buttocks back on the station chair.

It was while I was sitting blankly like that, looking through the patient list.

Tring~

With a clear notification sound, a pop-up window appeared at the bottom right of my monitor.

[Triage] There is a patient assigned to Han Hyeonjae.

B-11 / Hwang Yeongjin (M/38)

C.C: Acute onset Abd pain & Nausea

"Hm..."

Out of habit, I clicked the mouse and scanned down the patient's preliminary triage record.

A 38-year-old male.

A young patient.

Sudden abdominal pain.

[History: Abdominal pain started from dawn. Obstipation (+). Flatus (-). Stool (-)]

'Since dawn... and unable to pass gas...'

My eyes narrowed. It wasn't written as simple constipation, but Obstipation.

It meant even gas wasn't coming out.

Bowel obstruction? Or a twisted bowel?

What reason would a 38-year-old man have for his intestines to suddenly get blocked without any underlying disease?

Since there's no past surgical history, it wouldn't be an adhesion.

Scroll.

I rolled the mouse wheel.

[Past History]

DM/HTN/Tb/Hepatitis (-/-/-/-) Op Hx: None

"No past surgical history..."

Usually, bowel obstructions occur most commonly due to intestinal adhesions in people who have had abdominal surgery in the past.

But he's never had surgery?

Then it must be another cause.

Fecal impaction from simple constipation?

Or a tumor?

Or a hernia?

"Vitals are stable."

No fever, and blood pressure is normal.

This meant it wasn't an emergency situation on the level of a ruptured or necrotic bowel.

Scroll.

[Medication: None]

"No unusual medical conditions normally..."

A healthy male in his 30s suddenly develops abdominal pain and can't pass stool.

It's a typical case of acute abdomen.

It could be a urinary stone, it could be appendicitis.

Or he really could have just come in because he's packed full of stool.

However, the comment that gas isn't coming out makes me quite uneasy.

I stood up from my seat.

A pop sound came from my knees.

"Sigh, I'll be back."

As I closed the chart and hung the stethoscope around my neck, Baek Eunseo only poked her head out and replied.

"Have a safe trip!"

With a rustling sound, the curtain was drawn back.

"Ah, hello, Teacher."

The patient, who was lying on the bed clutching his stomach, lifted his head with difficulty.

A man in his late 30s.

Seeing him sweating profusely, it was definitely not malingering.

I stood beside the bed and offered a light nod.

"Yes, hello, patient. I am the doctor who will be in charge of..."

Rustle.

I drew the curtain on the opposite side completely to close off the space.

Because the Emergency Room is a place where privacy is not guaranteed.

"...you. First of all, you answered all the questions that the nurse out there asked you, right?"

"Yes, yes..."

"I might ask you things the nurse already asked just to double-check, so please understand. I'm asking twice because it's important."

"Yeees..."

The patient nodded meekly.

Compared to people who snap and ask why I keep asking things when they're dying of pain and just want medicine quickly, he was a total gentleman.

I shifted my gaze toward the patient's abdomen and began the formal history taking.

"First, where does your stomach hurt the most? When did it start like this?"

"Ah, yes... that. Exactly where it hurts, I..."

The patient rubbed his entire abdomen in a circle with his palm.

He can't pinpoint a specific area and points to the whole thing?

This makes things troublesome.

"You mean it hurts overall?"

"Yes, yes... and from early this dawn..."

"Yes. What is the nature of the pain? Does it feel like your stomach is squeezing, like wringing out laundry? Or how does it hurt?"

If it's pain from a bowel obstruction or enteritis, it's characterized by colicky pain, which is an intermittent squeezing pain.

However, the patient tilted his head.

"That... doesn't seem to be it..."

"Does it just hurt continuously? Without resting?"

"Yes. It just keeps aching. Heavily."

Hmm.

It doesn't seem like enteritis.

"Understood. You haven't had abdominal surgery in the past."

"Yes, never once. I'm a person who has never even broken a common bone before. Ha ha..."

"I'm envious."

I tossed out a short joke to form a rapport while racking my brain.

His past history is clean.

Adhesive bowel obstruction from surgery is out.

Then is it something he ate?

"You didn't vomit, right?"

"I didn't. I have a bit of nausea and things like that..."

No vomiting either.

There's a possibility it's not an upper gastrointestinal tract problem.

"Hmm..."

I pulled out my stethoscope and placed it on the patient's abdomen.

Gurgle.

The sound of intestines moving.

I should suspect an obstruction if the bowel sounds are decreased or if there's a metallic sound, but the sound is a bit ambiguous.

It's not that it can't be heard, but it's not active either.

'I need to feel it.'

Palpation is the answer.

After having the patient flex his knees, I rubbed my hands to warm them and placed them on his abdomen.

"I'm going to press a bit. Tell me if it hurts."

Starting from around the belly button, I slowly pressed the four quadrants.

Press.

"Does it hurt?"

"Ah, it hurts."

The patient grimaced.

Press.

"How about here?"

"Ah, it hurts."

Press.

"Ah, ah, it hurts."

"Hmm... it all hurts."

There isn't a single spot that doesn't hurt.

It's generalized tenderness.

It means it's either peritonitis, or simply that the entire bowel is bloated and swollen because the constipation is so severe.

The most important thing is the moment I release it.

I pressed deeply and then abruptly snapped my hand away.

If a sound like 'Argh!' comes out...

"......"

The patient had no particular reaction.

'No rebound tenderness.'

It only hurts when pressed.

Fortunately, a surgical indication due to peritonitis doesn't appear yet.

I nodded and was about to pull his clothes down when I discovered something in the left corner of the patient's abdomen.

A faint mark leading from the lower left of the belly button toward the flank.

The reddish thing looked like a pressure mark or like a scratch from somewhere.

'What is this?'

I pointed to the area with my finger.

"Patient. What is this vague, slightly bruise-like mark running diagonally? Was it originally there?"

The shape is a bit peculiar.

Could it be shingles?

But I don't see any blisters.

"Ah, that?"

The patient looked down at his stomach nonchalantly.

"I have some skin disease, and it seems to be that..."

"A skin disease? Do you have something like atopy or psoriasis?"

"Well, I don't know the exact diagnosis, but sometimes this kind of thing comes up and goes down on my body. I'm actually applying dermatology medicine for it."

"Hmm..."

Something feels off.

To call it a simple skin disease, the location and shape are strangely bothersome.

It looks like trauma, a mark from an injury.

Just in case, I questioned the patient to double-check.

"Understood for now. Have you hit yourself hard somewhere or been injured recently? Like falling down, or bumping into someone."

"No, not particularly..."

The patient shook his head.

"No car accidents or anything either?"

"Yes. There were no big accidents or anything."

He didn't look like he was lying, nor did he seem unable to remember because he was distracted by the pain.

"Then in the past, did you have an accident, or was there something like pressure applied to cause this kind of irritation? Nothing like that?"

"I told you, there isn't. My stomach hasn't particularly been hurt."

So it's not traumatic for now...

"How about gas? Is it coming out?"

The final question to check for a bowel obstruction.

"Ah, this... I don't think it's coming out..."

The patient wore a troubled expression.

"I don't know if it's not coming out because I haven't eaten anything, or if it's because I'm originally the type who doesn't pass it much..."

"You mean it hasn't come out even once all day today?"

"Yes... it seems so."

He can't pass stool and can't pass gas.

But his stomach hurts overall.

He has no fever, and although the blood test hasn't come out yet, the impression is that his inflammatory markers won't be high.

'Is his stomach hurting because gas is trapped due to constipation? Or is it a real obstruction?'

I'll have to do an imaging study first to know.

Because I can only be certain once I see with my own eyes how much gas is trapped and how tightly the stool is blocked.

"Understood for now. Let's do a blood test and take an X-ray first, then I'll speak with you again. I'll have them set up painkillers and an IV fluid for you first. Do not ingest anything, including water."

"Yes, thank you, Teacher."

"First... we will probably take a CT as well. In cases where gas doesn't come out, there's a disease we suspect, but I'll explain this to you later when the imaging comes out."

I cleared the curtain, stepped out, and headed toward the station.

Plod, plod.

As soon as I sat down and grabbed the mouse, Baek Eunseo's voice was heard from the side.

"What kind of patient was it?"

Baek Eunseo asked as she organized the charts of the patients she was seeing.

"Well..."

I brought up the order window on the monitor.

"First, on physical exam, there is tenderness but no rebound. The history is a bit ambiguous. It feels like a simple ileus that came from severe constipation."

"Any trauma?"

"He says no. There is a strange mark on his stomach that looks like trauma, but he claims it's a skin disease."

I clicked the orders familiarly.

"For now, let's go with a lab and UA, and for imaging, I'm going to order a chest PA and abdomen erect and supine X-ray."

They are the most basic tests.

With this, I can check the gas pattern, see how full of stool he is, and then make a decision whether to give an enema or give medicine.

Click.

"And I'm going to order a CT too. It bothers me a bit that gas isn't coming out."

Since that mark from earlier is a bit unsettling and there are some questionable points, I'll take a CT if possible too.

Click.

"Han-ssam."

Baek Eunseo called me.

"Yeah?"

I took my hand off the mouse and turned my head.

Baek Eunseo, with her forehead slightly narrowed, was staring intently at the patient's basic information section on the monitor.

"Can I go over to the patient for a second?"