Chapter 20

Episode 20 Today, Again, the Peaceful Emergency Room (1)

After sending off the Myocardial Infarction patient, a short peace came rushing in to the Emergency Room. I was just sitting blankly on the empty chair, looking with a look of utter reality check.

I received double compliments from Cardiology and Thoracic Surgery.

Hehehe.

Oh, right. I think Store points came in again earlier. How much would have come in this time? It was just the moment I was gradually trying to check.

However, the peace was broken soon.

"30s male patient, continuously vomiting!"

With the loud shout of the ambulance crew, the automatic door of the Emergency Room opened once again.

The stretcher wheels made a noisy sound and dashed through the hallway. On top, a man who looked to be in his 30s was lying on his side, groaning while holding his abdomen.

Reflexively, I stood up from my seat and stuck to the side of the stretcher.

"Are you conscious? Where does it hurt that made you come here?"

The patient seemed to have no energy to even answer my question. The patient looked at me once, and then immediately buried his face back into the plastic bag and started gagging violently.

"Uweeeeek!"

The ambulance crew member standing next to him answered instead with an embarrassed face.

"According to the patient, this evening... uh, he said he ate a whole bag of dried seaweed."

My brain stopped for a moment.

"..."

Did I hear wrong? Dried seaweed? Dried seaweed? That thing you soak in water before boiling soup?

Doubting my ears, I asked back.

"You said he ate dried seaweed?"

"Yes... Uweeeek..."

The ambulance crew member added, as if feeling sorry for him.

"Uh, since it was crispy, he said he just ate a whole bag."

It was a chief complaint I had never heard before in my life.

Dried seaweed gastronomy.

Is he a crazy bastard, seriously?

"So, what about the vitals?"

"At the scene, blood pressure was 140 over 90, pulse 110 times, respiratory rate 24 times. Consciousness is clear. It took 15 minutes to arrive at the scene, and he continuously vomited during transportation. Adding the time to arrive at the hospital, about 25 minutes have passed now."

Blood pressure is slightly high, pulse and breathing are fast.

If you consider it a typical reaction due to pain and dehydration, it's normal.

It's an ambiguous state where he is not about to die right away, but we can't just leave him alone either.

"Sigh... For now, let's lay him down in Area A."

That level of continuous vomiting can cause serious dehydration and electrolyte imbalance. So for now, I decided to lay him down on a bed in Area A.

As soon as he was moved to the bed in Area A, the patient curled his body like a shrimp and continuously vomited again.

I put on latex gloves and felt the patient's abdomen. The abdomen was bloated all over, and he frowned every time I pressed.

'Isn't this intestinal obstruction?'

The worst-case scenario was drawn in my mind.

When dried seaweed absorbs water, it swells up dozens of times. The possibility that that tremendous amount of seaweed passed the stomach and blocked the narrow small intestine.

If that is the case, this is not a simple happening but a surgical emergency situation that might require immediate surgery.

"Teacher! Let's get two intravenous lines for this patient, and an IV fluid order will go out. And for the abdominal X-ray, both lying down and standing up shots will go out! Please send the lab right away too!"

After a while, the X-ray result popped up on the monitor.

With wide eyes, I scanned the screen to see if the characteristic findings of intestinal obstruction were visible.

"There isn't any?"

The X-ray was clean.

No, to be precise, rather than clean, except for the stomach being dilated, no findings suggesting intestinal obstruction were seen at all.

Except for a slight dehydration finding, everything in the blood test results was also within the normal range.

The interpretation opinion from Radiology that arrived soon after was the same. No findings of intestinal obstruction.

Ah.

This is not intestinal obstruction.

This is just...

The seaweed swelled up like crazy in the stomach.

It didn't get blocked in the small intestine, but it had already reached a state of saturation from the stomach.

It means the seaweed, swollen dozens of times inside the stomach, is putting pressure on the stomach wall, and the brain is commanding the body to vomit in order to send out the foreign object.

With a hollow expression, I looked at the patient who was still holding onto the plastic bag and sobbing.

Good grief.

Intestinal obstruction, my foot.

Rather, it was a relief. If it were intestinal obstruction, we would have to call general surgery and make all sorts of fuss, and it would be just as painful for the patient.

"Teacher... do I... die...?"

The patient asked between his sobbing breath.

I looked at the pathetically asking patient with pity.

Why would you die?

It's just that a seaweed party opened inside your stomach.

The problem is, how to end that party.

The thing that came to mind first was a Levin tube (a tube inserted through the nose to the stomach). A primitive but certain method of shoving a thick tube through the nose to reach the stomach, and then connecting it to a suction machine to suck out the stomach contents.

'Is it possible?'

I imagined it.

The scene of shoving a Levin tube into the patient's nostril with my own hands.

The tube touches the stomach wall, and suction starts. However, the thing being sucked into the end of the tube wouldn't be clear gastric juice.

Surely, it would be a green lump of seaweed whose shape cannot be recognized, slimy and slippery from being soaked in water. The moment that lump of seaweed tightly blocks the tube entrance, it was obvious the suction machine would only scream and stop.

It might cause injury to the stomach mucosa, and it might cause gastrointestinal bleeding.

The result would be nothing short of disastrous.

The patient would be painful as a patient, and I would be in a daze holding a tube covered in seaweed in my hand.

This is not a level I can handle.

However, just in case, I stared into the void for a moment to get confirmation about my judgment.

Title: Hey, is gastric lavage possible with an L-tube for a patient who was brought in after eating dried seaweed?

Author: Korean Slave 1 (Male)

At my question, the gallery burned up with a discussion in a completely unexpected direction along with explosive mockery.

ㅇㅇ (210.94): Fuck, in all my life, it's the first time I see someone brought to the ER after eating seaweed, hahahahahaha. Oh, right, I'm dead.

Mes of the God (Male): The seaweed pieces will probably be bigger than the tube diameter. Yep.

Hippocrates' Descendant: Seaweed? What is that. Seaweed? Why do they eat such a thing. Koreans are beyond understanding.

↳ Hematoma is Hell: Hey, you Yankee bastard, what do you know to make a fuss. Do you know how delicious and good for the body laver and seaweed are? It purifies the blood because it's rich in iodine and iron.

↳ Hippocrates' Descendant: Such a profound effect! Then that patient is a martyr who almost lost consciousness while consuming seaweed for health!

↳ Latte is Mine: Martyr, bullshit. Just an idiot.

My expectation that the Levin tube would get blocked became a certainty, and at the same time, reality check came rushing in at the fact that I was peeking at the pathetic discussion of doctors from the other world.

...Sigh. Do I have to call Gastroenterology?

Yes. This is the domain of stomach experts.

Because Gastroenterology doctors have a tool called an endoscopy. They will be able to go in directly with that camera, check the actual state of the seaweed field, and pull it out with all sorts of extraordinary tools.

However, a 2nd Year rookie calling the Gastroenterology on-duty doctor directly without even trying to put in a Levin tube for the reason that 'the patient vomited after eating dried seaweed like a snack'?

It's a relief if double curses don't fly over the handset.

In the end, I decided to choose the most traditional and safe method.

'Senior SOS'

I left Area A and looked around the station.

Just in time, the 4th Year Sung-hoon Yoo was turning his stiff neck while charting.

Equipped with a look that was as pitiful, serious, and urgent as possible, I approached Sung-hoon Yoo.

"Teacher."

"Why."

Sung-hoon Yoo answered with a voice soaked in chronic fatigue, as always.

"A 30s male patient came to the A-3 bed with nausea and vomiting, and I'm reporting because the case is a bit unusual."

"No matter how unusual it is. Isn't it another trouble maker who blacked out after drinking alcohol again?"

"No, it's not that... According to the patient, he ate a bag of dried seaweed like a snack."

"..."

Sung-hoon Yoo's movement stopped.

And then very slowly, he turned his head and looked at me. In his eyes, a very faint emotion of 'What did I just hear?' seemed to pass by.

"What?"

"It's dried seaweed. Dried seaweed. He has been continuously vomiting and complaining of abdominal bloating since after eating a whole bag of that. At first, I suspected intestinal obstruction and took an X-ray, but there are no unusual findings."

I reported as calmly and medically as possible.

When my report was over, Sung-hoon Yoo didn't say anything for a moment.

And then soon, making a short chuckle with a "Ha", he stood up from his seat.

"Let's go see."

Saying he would see the patient himself, Sung-hoon Yoo headed to Area A.

That way, I followed behind the senior.

Sung-hoon Yoo pressed the abdomen of the patient, who was still holding the plastic bag and sobbing, a few times and put a stethoscope on it, and then turned back to me with a resigned expression.

"What about the Levin tube?"

"I put it on hold because I thought it would get blocked anyway."

"Good thinking."

Leaving such a short message of compliment, he returned to the station again and picked up the handset.

It was a call to the Gastroenterology on-duty doctor.

Holding my breath by the side, I overheard the contents of that call.

"Hello, Teacher. This is the 4th Year Emergency Medicine, Sung-hoon Yoo. Is this the Gastroenterology on-duty teacher?"

"..."

"Ah, yes. Teacher. It's nothing else, but there is a patient in the ER right now, and the case is a bit absurd, so I think Teacher needs to come down and take a look."

"..."

When the fellow over the handset asked something, Sung-hoon Yoo hesitated for a moment and then confessed.

"They say the patient ate a bag of dried seaweed raw."

"..."

"Yes, Teacher. Not soaked and eaten, but just like a snack. A whole bag."

Sung-hoon Yoo's brow furrowed slightly.

"Yes, I know too, Teacher. That this makes no sense. But he really visited the hospital that way and is continuously vomiting. It's not intestinal obstruction on the X-ray, but the stomach seems completely blocked. I'm inquiring if it could be resolved with an endoscopy."

After a long call, Sung-hoon Yoo hung up the phone saying, "Yes, I understand, Teacher. I will be waiting."

And putting down the handset at the same time, he spoke toward me.

"Ha... What a strange gentleman exists. The Gastroenterology teacher says he is coming down. Later when they do the endoscopy, you follow them in too and watch. Because it'll be a scene you cannot see never again in your life."

Of course, it probably didn't mean to really go and observe the Gastroenterology doctor doing the endoscopy. It probably meant it was that absurd.

After a while, the Gastroenterology fellow with a face full of annoyance came down.

He glanced at the patient once, and then said with a resigned expression like the one seen on Sung-hoon Yoo's face earlier.

"Let's prepare for the endoscopy. Gastric lavage won't even be enough. We have to go in and pull it out, what else."

In the end, under the unprecedented diagnostic name of 'Suspected upper gastrointestinal obstruction due to acute dried seaweed ingestion', the patient was dragged to the Endoscopy Room.

Looking at that scene blankly, I thought.

All sorts of humans really come to the Emergency Room.