Chapter 192

Episode 192 Every Patient Lies (End)

“Whew… huff…”

Arriving at the station after sprinting down the Emergency Room hallway, I gasped heavily for breath. The full dash had left me completely suffocated.

“Yes? What in the…”

The General Surgery on-duty doctor, who was about to input an order in front of the monitor, looked up at me. Baek Eunseo, standing right next to him, was also startled by my shout.

I had to stop the General Surgery on-duty doctor before he made the wrong decision.

“That, the CT. Let me take a look at the CT scan.”

“Ah? Oh, yes…”

The General Surgery on-duty doctor seemed completely dumbfounded by my sudden appearance, shouting and demanding to see the screen, but he soon moved his mouse and turned the monitor so I could see it clearly from my position.

The black-and-white contrast CT image of the abdomen filled the screen.

‘Upload picture.’

I activated the Gallery interface in the void.

The axial and coronal images that entered my view were immediately transferred to the Gallery.

Korean Slave 1 (Male): (Picture) (Picture)

Korean Slave 1 (Male): ‘Need a judgment.’

Okay. The ghosts would automatically write comments once I finished looking at the CT. Especially someone like Mes of the God (Male), who was absolutely crazy about surgery.

While my eyes scanned up and down the monitor screen, the General Surgery on-duty doctor, who had been standing there dazed, cautiously spoke up.

“Um… Teacher?”

“Yes.”

“So, may I ask why you suddenly shouted for us to stop? It’s a matter that requires calling the professor to make a decision anyway…”

Ah. A resident from another department had suddenly slammed the emergency brakes on his surgical dilemma, so there was no way he’d be happy about it.

“Ah, yes. Well, you see.”

I began to explain calmly while rolling the mouse wheel.

“On the patient’s body, specifically around the lower abdomen, there’s a diagonal line drawn across. It looks like a safety belt sign left from trauma after a TA.”

“A TA? There was no history of a traffic accident in the records.”

The General Surgery on-duty doctor furrowed his brow.

“I checked the history again, and they said there was a minor fender bender yesterday morning. On the outside, the bruise was so faint that even the patient thought it was just a skin condition… But they were probably wearing a thick padding jacket or something, and the safety belt exerted force over it.”

At my words, the General Surgery on-duty doctor rubbed his jaw.

“So, this is a situation where bowel damage from blunt trauma is suspected.”

“But the signs of perforation aren't visible to the eye…”

The General Surgery on-duty doctor grabbed the mouse and quickly scrolled the screen up and down.

“As you can see on the CT screen right now, Teacher…”

“Yes, yes.”

“We’d need to see something like a bowel rupture or a hematoma from massive bleeding to strongly suspect a seatbelt injury, but this CT is relatively… clean. Though the lab results are a bit strange with the liver enzymes spiking.”

Hm.

‘…It’s swollen.’

The small intestines on the screen were swollen. They were swollen, but…

‘I can’t tell.’

Other than the swollen intestine, there was no sign of contrast medium pouring out into the open, nor was the abdominal cavity full of blood.

“It looks similar to findings seen in enteritis or an ileus. The image is too ambiguous to definitively call it a rupture from blunt trauma.”

“Even so, having liver damage findings makes it tricky. The numbers are…”

‘Find something. Please.’

I urgently opened the Gallery screen floating in the corner of my vision.

[Comments]

Mes of the God (Male): Mesenteric Injury.

JustWatchingImagesFromMyRoom: Highly agree with this point.

Mes of the God (Male): No, but why are there so many new fixed handles lately? I need to go initiate a cyber-execution. What is this?

Korean Slave 1 (Male): Don't fight. Where should I focus on looking?

Mes of the God (Male): Fat and Bowel Wall.

Latte is Mine: That's not what's important right now!! It's a newbie!!!

Hippocrates' Descendant: One must not be easily swayed by joy or sorrow. Stay calm.

A short and clear answer.

I turned off the Gallery screen.

“Give me the mouse for a second.”

I took over the mouse, finely adjusted the contrast of the image, and stopped the scroll at a specific slice.

“I think you need to look over here, near the root of the mesentery.”

I pointed at the monitor screen with my finger.

“It looks similar to an adhesive ileus or enteritis accompanied by simple edema, but if you look here…”

I pointed the mouse pointer at the fatty tissue surrounding the bowel.

“Localized mesenteric fat stranding is observed. The surrounding fatty tissue looks hazy, as if bruised due to inflammation or bleeding. Furthermore, only the bowel wall in this specific section is locally thickened.”

The General Surgery on-duty doctor leaned his face close to the monitor.

“If you compare this subtle finding with the patient history we just confirmed, it perfectly clicks if we assume the mesentery tore and blood vessels burst due to the rapid deceleration injury from the safety belt. This caused ischemia in that specific bowel segment, and necrosis is now progressing. The spiking liver enzymes are likely the spread of ischemic injury generated during this process, or a minor contusion.”

As my briefing ended, the General Surgery on-duty doctor staring at the monitor froze.

“Ah.”

A short gasp escaped his mouth.

“It’s a mesenteric tear.”

“Since it’s a TA patient, should we call Trauma Surgery regardless? Or will you just open them up in General Surgery?”

At my question, the General Surgery on-duty doctor hurriedly shook his head.

“Ah, ah, yes! That… I, I will handle it. GS is usually busy with regular surgeries… Since it’s a traumatic mesenteric tear anyway, it’s better to report to the professor at the Trauma Center…”

His voice trembled slightly.

Only then did the embroidery on the chest of the General Surgery resident, who had barely avoided a landmine, enter my eyes.

‘Ah, it’s Teacher Seong Juon.’

Seong Juon from General Surgery urgently pulled his cellphone from his pocket and began contacting someone.

“Yes, I am the 2nd Year General Surgery resident, Seong Juon. Yes, Professor. We have a male patient in his 30s in the Emergency Room with a TA history from yesterday morning. A mesenteric injury is suspected on the CT, and ischemia seems to be progressing. Yes. Yes, there is an abdominal seatbelt sign as well. The AST and ALT on the lab results also spiked.”

While Seong Juon was giving the briefing over the phone, I walked back to my spot and grabbed the mouse.

‘Modify diagnosis.’

Clack, clack, clack.

I cleanly sent out a formal Trauma Surgery consultation through the EMR.

Tap, tap.

This means ‘take a look at this,’ my General Surgery friend.

Only then did Seong Juon peer into the monitor.

“Ah, yes. If you check the consult request column, one went out under the name of Emergency Medicine. Yes. Yes. Understood. I will send him up immediately!”

Hanging up the phone, Seong Juon wiped the sweat from his forehead and turned to me.

“Teacher Han. Trauma Surgery says they're coming down right away. That almost turned into a disaster…”

“Let’s get the operating room ready first.”

“Let’s do that.”

And that way, the patient with the mesenteric tear went up to the operating room for emergency surgery.

Once the mesenteric damage patient left, I leaned my body deep into the back of my chair.

Today’s one lesson.

‘Everybody lies.’

— A certain genius doctor from an American TV show —

“Mhm.”

A wise saying indeed. It wasn't that the patient intended to deceive us, but they probably never imagined that a minor incident they experienced could be connected to their current, fatal pain.

A doctor must dig out those hidden pieces like a detective.

Before long, it was time to clock out.

“Good work today~”

“Yeah, you guys hang in there.”

I exchanged brief greetings with the night shift teachers and changed into my civilian clothes.

I shoved my wallet into my pocket roughly and was about to walk out the door when Smart Baek attached herself to my side.

“Oh? What is it.”

“Just because. I plan to walk with you, Teacher Han, since you’re a pedestrian today.”

“I’m taking the bus though?”

“Let’s walk for your health.”

Baek Eunseo blocked my path and made a bold suggestion.

“I don’t want to.”

“Can’t you just walk with me?”

I stared into the void as if it were absurd, but eventually let out a chuckle.

“I don’t want to.”

“Ah, I really just have nothing to do on the way home, seriously…”

“What do you usually do while walking home?”

“On the phone with a friend.”

Going home while talking on the phone with a friend… But choosing to go with me today meant.

“Your friend is busy today?”

“Ding dong deng~”

“Sigh, alright, let’s walk, let’s walk.”

A 20-minute walk. It was a distance that didn't matter even if I walked. In the first place, I occasionally walked to empty my head anyway. The weather had turned cool since it was evening, and there was no reason to refuse when she was offering to keep me company.

Walking side by side down the street, we shared trivial stories from outside the hospital. The topic of conversation naturally drifted toward heroic tales of our past days.

“Ack, Teacher Han, you almost got held back a year?”

Baek Eunseo’s eyes went wide in pure shock. She had an expression like a priest who had just heard blasphemy.

“Yeah. Why, what about it.”

“No, that's completely strange?! You, Teacher Han?”

“Is it really that strange of a story…?”

In medical school, the crisis of flunking a year comes to anyone. I also barely scraped by and advanced during my medical undergraduate years.

“No, the greatest genius since the opening of the Emergency Medicine department at Cheongjin University Hospital… Well, I don't know about that, but anyway, the smart Teacher Han!”

Baek Eunseo made a big fuss, pointing at my arm as if she couldn't believe it.

“Are you teasing me?”

“No. I’m genuinely surprised. That’s a bit unexpected…”

“Well, things like that can happen.”

It was right when we were exchanging light jokes while walking side by side like that.

Bzzzz—

Bzzzz—

A violent vibration rang from inside my pocket.

[Sohn Jong-Sohn Jong-Sohn Jang-Woon]

“Oh, hold on. I got a call.”

Checking the caller ID, I narrowed my eyes. Pediatrics chief, Sohn Jongwoon. Why was this bastard, whom I had just crossed paths and chatted with at the hospital yesterday, calling at this hour?

I stopped walking and pressed the call button.

“Hello?”

– Hyeonjae. By any chance, do you have time right now?

“No, I don't.”

It hasn't even been 10 minutes since I clocked out, you crazy bastard.

– No, it’s, it’s because it’s related to a patient.

“What patient. Our department doesn't have an attending physician.”

The Emergency Medicine department does not take charge of admitted patients after clocking out. Once we treat them in the ER and send them up to their respective departments, that’s the end of it. Though there is an emergency-exclusive inpatient ward… well.

Through normal routes, there was absolutely no reason for a Pediatrics chief to call a clocked-out Emergency Medicine resident regarding a patient issue.

– No, it’s, I mean… you know that rumor going around about you.

Sohn Jongwoon stammered.

“Rumor? What rumor. That bullshit about me dating?”

– No, not that crap, you bastard! Agh, seriously. That rumor about you doing an Internal Medicine double board or whatever!

Sohn Jongwoon shouted urgently.

– Because of that, I’m seriously contacting you with a mindset of grasping at straws, okay? It’s a patient from our department. A 6-year-old kid…

Desperation practically dripped from his voice.

Grasping at straws? A 6-year-old?

I didn't know what it was, but if it was a case of that gravity, a report should have gone up to the professor. Yet, he was asking another department for help.

Either there was no professor available. Or even the professor couldn't solve it.

“Okay, I’m coming right now.”

Though I didn't know the circumstances, I had to at least give it a shot.

Click.

I hung up the phone and shoved it back into my pocket. Then, I spoke to Baek Eunseo, who was looking at me with a bewildered expression from my side.

“Sorry, shall we call it a day for our talk?”

Sensing the urgency of the situation, Baek Eunseo nodded her head without a word of complaint.

“Yes, sir!”

I immediately turned on my heel and began running toward the hospital along the path we had just walked.

Baek Eunseo stood frozen on the spot where she had been walking side by side with Han Hyeonjae, looking back at the now empty sidewalk.

The back of the retreating Han Hyeonjae quickly grew faint. A person who ran right back to the hospital without even looking back following a single phone call the moment he left work.

Baek Eunseo didn't hold back the laugh that escaped her lips.

Then, with a bright smile, she turned around again and headed toward her house.

Ring~ Ring~

Ring~ Ring~

“What are you doing?”

– Give me a good reason. Why are you just calling now, seriously.

“Ah~ well, something came up.”