Chapter 191

Episode 191 Every Patient ( ) (3)

“You—tell me the moment the CT is done! And tell the surgery resident on-duty to come down! Tell them to look at this right now, no matter what!”

“Yes, teacher! I’ll call right away.” Baek Eunseo picked up the handset.

I stood up abruptly from the chair without looking back. Hurriedly slipping back into the gown I had taken off, I dashed toward Area B where the patient was.

AST, ALT in the triple digits. This was a value that could absolutely never come from simple bowel obstruction alone. Even if the intestine twisted and necrosis set in, or even if sepsis occurred, liver enzymes wouldn't spike so rapidly on their own like this. It meant the liver itself had taken a hit—whether physical or chemical.

‘If there’s no possibility of chemical drug poisoning, then what’s left is a physical blow.’

The mark on the abdomen that had left me feeling uneasy earlier. What if that was actually a sign of trauma? ‘If it is a trauma, everything is explained.’ Blunt abdominal trauma. Bowel damage caused by the impact leading to paralytic ileus, and a liver contusion or laceration.

Moving my feet quickly, I conjured a window into the void.

Pop—

The familiar blue, translucent window entered my field of vision. There was no time to agonize over this alone. I had to borrow the collective intelligence. And of course, writing it on my way would save a bit of time.

[Dead Medic Gallery]

@Mes of the God and other surgical ghosts, help! Help!

Author: Korean Slave 1

38-year-old male patient. Abdominal pain, nausea, and no gas passage starting from dawn. Small bowel obstruction is clear on abdominal X-ray. But lab shows AST 145 / ALT 112. Vitals are stable, but during the physical exam earlier, there was a faint diagonal mark on his abdomen. The patient says he hasn't hit anything, but what's the probability that diagonal mark is a trauma sign like a safety belt sign?

The moment I posted, the view count exploded crazily. Look at these ghosts; they must have been resting. Were they just waiting for me to drop a post? The comment notifications literally burst in real-time without me even needing to press refresh.

[Comments]

Mes of the God: If the liver enzymes spiked, you should obviously suspect liver damage. What are you sitting around asking for?

Thoracic Surgery Fossil: Traumatic damage is possible. With blunt trauma, the outside can look fine while the inside is turned to mush.

ㄴ Korean Slave 1: But during the history taking, the patient said there was no accident and nothing unusual. Can trauma manifest this late? He said it started hurting at dawn.

ㄴ Operating Room Ghost 3: It could be a delayed rupture or delayed bleeding.

ㄴ Korean Slave 1: There was absolutely no accident in the history taking.

ㄴ Mes of the God: Don't trust the patient.

Mes of the God: For now, go and show me that mark. We need to see what it is. Don't just use words; take a picture and bring it, a picture.

ㄴ ㅇㅇ(118.235): Yeah, quickly.

ㄴ Korean Slave 1: Ok ok, I'll go look quickly.

I pushed the Gallery window to the corner of my vision and hurried my steps. ‘Yes, you have to see it to know.’ The ghosts needed a picture too. And I needed to confirm that my eyes weren't wrong, that my uneasiness wasn't just a groundless delusion.

I approached Bed B-11. Taking a deep breath, I pulled back the curtain.

Chrarrrrk—

The patient, who had been lying on the bed receiving pain medication, opened his eyes in surprise.

“Ugh… Oh, teacher?” The patient looked up at me with dazed eyes.

I stepped right up to the side of the bed where the patient was lying. “Patient.”

“Yes, yes, teacher. Did the test results come out?”

“The results are out, but I came because there’s something more urgent we need to check first.” I pointed to the patient's upper garment. “There is something important, so I need to look at your stomach again for a moment.”

“What? My stomach? Didn't you already look earlier?”

“The thing you mentioned earlier, the one you said was a skin disease. I need to examine it more closely. Your liver enzymes are abnormally high, and this might be related.”

“My liver? I don't even drink alcohol that much…”

“Exactly. The liver of someone who doesn't even drink is getting damaged, so we have to check.” That's why we had to check. Even more so. “Is that alright with you?”

Overwhelmed by my momentum, the patient nodded his head in a daze. “Ah… yes. Well… go ahead.”

The patient clumsily rolled up his hospital gown. Thick hair grew around his belly button, and between them, a faintly visible blue area appeared.

‘This isn't enough.’ Just looking at it like this, it was impossible to tell whether it was a bruise, skin pigmentation, or just dirt. I had to see it clearly.

“Just a moment.”

I looked around. Just then, at the end of the hallway, I spotted a nursing student passing by, pushing a dressing cart. Taking wide strides with my long legs, I approached and opened the container of alcohol swabs sitting on the student's cart.

“Huh? Teacher?”

“I’ll just use one. Sorry.”

After lightly swiping an alcohol swab from the passing nursing student like that, I returned to the patient.

“It’s going to be a bit cold.”

Holding the alcohol swab in my hand, I pressed down firmly on the problem area on the patient’s abdomen. ‘Applying strength to the swab… rubbing it hard, alternating against the direction of the hair and then with it…’

“Ugh, that’s cold.” The patient tensed his abdomen.

As the oil and dead skin on the surface were wiped away and the wet hairs stuck to the skin, the true color that had been hidden began to reveal itself.

‘I see it.’ The mark that had been ambiguous earlier. After wiping it with alcohol and tilting the angle under the light, it became unmistakable. Skin disease, my foot. It was a perfectly honest, diagonal subcutaneous hemorrhage.

‘Unchangeable proof.’

Now it was time to transmit this evidence to the experts on the other side. I activated the Gallery interface.

[Camera]

I leaned over, finding the optimal angle where the light wouldn't reflect. Now… raising the window in the void to frame the shot… The exact moment when the red, swollen skin and the dark blue bruise underneath were most visible.

Click—

A virtual shutter sound echoed in my head.

[Image Upload Complete]

Done.

Korean Slave 1: [Picture]

The moment the picture was transmitted, the comment section exploded as if it had been waiting. These ghosts definitely spend their daily lives doing nothing but pressing refresh.

[Comments]

Mes of the God: Anyone want to differentiate this skin disease? Any dermatologists out there?

ㄴ DoYouKnowDermis: Hello. Dermatology here. I, I don't think that's a skin disease. The boundary of the lesion can't be that mechanical. Rather than pigmentation, it looks closer to hemosiderin deposition…

ㄴ Mes of the God: What is this? New fixed-nicks deserve a hazing, but the matter is urgent, so I'll let it slide. So, the conclusion?

ㄴ DoYouKnowDermis: It's trauma.

ㄴ Mes of the God: OK. From what I see, it's a safety belt sign too. That's the exact angle you get when you wear a belt in the driver's seat.

“Okay.”

I was certain now. A dermatology specialist and a surgical specialist ghost who had sliced open abdomens tens of thousands of times had simultaneously confirmed it. This was trauma.

If so, the patient was either lying, didn't remember, or felt it was too trivial to be worth mentioning. It had to be one of those three cases.

I closed the Gallery window and looked into the patient’s eyes. “Patient.”

“Yes… yes?” The patient shrank his shoulders, seemingly intimidated by my gaze.

“Was there really no accident? Think carefully. No matter who looks at it, this is a mark from being pressed hard by something.”

“An accident? No… as you can see, I'm completely fine like this…” The patient lifted his limbs as if to show his unfair treatment.

True, with no broken limbs and no bleeding from the head, he might think he was perfectly fine. But internal injuries are invisible to the eye. I cut off the patient's words and pressed relentlessly.

“When we say a car accident, we don't just mean a massive crash where the car is totaled and the airbags deploy.” I continued my explanation, vividly depicting an accident with my hands. “Even a really minor accident. Like a fender bender while parking, or jamming on the brakes on the way to work so your body jolts forward. Or bumping into a subway screen door. Is there really nothing like that?”

“Uh…” The patient's eyes wavered. He had a look that showed something had come to mind. “Come to think of it, there was a minor fender bender yesterday morning.”

“A fender bender?”

“Yes. It was my fault, but while waiting for the light, I spaced out for a second and hit the brakes late, bumping the rear of the car in front…” The patient scratched the back of his head sheepishly. “But really, it was just a tiny tap. To the point where there were barely any scratches on the bumper. My body didn't hurt at all either, so I just handled it through insurance and wrapped it up. I didn't think it was an accident that could make my body hurt, so I didn't mention it…”

‘Ah, eureka!!!!!!!!!!’ My inner thoughts almost burst out loud without me realizing.

‘Every patient lies.’ It was a famous line from a certain American TV show. Whether intentional or unintentional, whether they knew it or not, a patient can speak falsely. Therefore, a doctor must not rely solely on the patient’s statements.

‘In any case…’ I found it.

A "tiny tap" was merely the patient's subjective feeling. ‘Especially if they were wearing something like a padded jacket because the weather was chilly…’ The inertia generated when a car suddenly stops is transmitted entirely to the occupant. The body tries to fly forward, and to prevent that, the seatbelt instantly locks, striking the abdomen. At that moment, the pressure inside the abdominal cavity rises sharply, which can tear the fragile mesentery or cause injury as the liver gets squeezed between the intestine and the spine.

‘Delayed bleeding, or delayed bowel injury.’ Immediately after the accident, he wouldn't have felt pain due to the adrenaline, and the degree of damage would have been minuscule. However, as a day passed, edema formed, inflammation spread, and paralytic ileus set in—ultimately creating the current bowel obstruction and elevated liver enzymes.

If so, everything was explained. This was not an internal medicine disease; it was a surgical emergency.

“Ah, yes! Thank you, patient! Please wait right here! Absolutely do not move!”

“Huh? Yes? Teacher? Where am I going…”

Leaving the patient's questions behind, I swept the curtain open. There was no time to leisurely explain right now. I had to stop the on-duty surgery resident, who was unaware of this fact, before they made the wrong judgment.

I walked toward the station at a pace that was practically a run. In the distance, in front of the monitor, I could see Baek Eunseo and the summoned on-duty surgery resident. The surgery resident was flipping through the CT images with an incredibly exhausted expression.

“For now, there doesn't seem to be any liver damage,” the surgery resident said indifferently.

“True. I don't see anything major either. However, the rise in AST and ALT is bothering me quite a bit,” Baek Eunseo agreed, nodding her head.

It seemed that no distinct rupture or hematoma was visible in the liver parenchyma on the CT. It might be a minor contusion, or an injury that hadn't quite caught on the images yet. But that wasn't what was important. What mattered right now was why the bowel was blocked.

“It doesn't look like a simple adhesion, and I don't know the cause… but since his abdomen is quite distended, an immediate laparoscopy attempt would be difficult… The patient’s condition seems a bit poor, but I think Gastroenterology could take a look at him first,” the surgery resident concluded. “The spiking liver enzymes are a bit nagging, but there's no jaundice and the bilirubin is normal, so we can admit him, keep an eye on him, or perform a laparoscopy if needed…”

No. Internal medicine admission? A laparoscopy later? Absolutely not. I couldn't sit by and watch a missed history kill a person.

“STOOOOOOOOOP!!!!!!!!!”