Chapter 24

Episode 24 Is it Not Heart Disease? (2)

I looked at the patient. His face was still pale with pain.

The possibility of malingering? That was acting? All of it, from that cold sweat and shallow, rapid breathing to his minutely trembling fingertips? If that was acting, this patient needed to go to Chungmuro right now and audition.

'No.' A remaining spark in my mind, not yet extinguished, whispered. 'There's something.'

Yes, fuck it. If it doesn't work once or twice, I just have to take it three or four times. Myocardial Infarction is a dynamic disease. Even if he is fine now, his heart could start screaming in 10 minutes. I made the decision to continue maintaining a follow-up EKG every 20 minutes that way.

At the same time, staring into the void, I opened the Gallery window in my mind.

Title: [HELP] Chest pain patient, but all tests are normal. But patient keeps saying it hurts.

Author: Korean Slave 1 (Male)

50s/M, typical ACS-suspected chest pain. But EKG follow-up every 20 minutes, X-ray taken, lab, and even troponin are all normal. Patient is continuously breaking out in a cold sweat and rolling around. Am I missing something right now? Or should I just discharge him?

It was just then, as I was posting my desperate question.

Sung-hoon Yoo (Male), who happened to be passing by, glanced at the monitor over my shoulder and clicked his tongue. "Are you still holding onto that patient? To watch him while continuing follow-up EKGs? Well, it is uncomfortable." Half sympathy and half mockery were mixed in his voice. "But in my opinion..."

The exact moment Sung-hoon Yoo (Male) opened his mouth, the first comment reflected on the blue interface in my field of vision.

Cardiology Ghost: You dumbass. Where in the world is an ACS with normal troponin. It's unstable angina. EKG can come out normal.

And that voice precisely overlapped with Sung-hoon Yoo (Male)'s voice coming from behind my back.

"...We can't rule out the possibility of unstable angina either. It's not to the extent of calling Cardiology right now to go into an emergency procedure, but..."

Fuck. I got goosebumps.

Sung-hoon Yoo (Male) straight away started giving new orders. "For now, follow-up troponin every 3 hours, and start Heparin Infusion... Ah, no. Just for now, if the chest pain continues, administer sublingual nitroglycerin and let's watch the progress. We'll have to keep watching."

I hurriedly entered the medication orders according to the instructions.

"But it might not be angina."

"Yes?"

No, even the ghosts say it seems like angina? Didn't you say it seems like angina yourself? Suddenly?

"Look at the time that has passed now. The patient had chest pain from an hour before coming to the hospital, and it's been nearly two hours since he arrived. If such severe unstable angina had continued, no matter how bad, the troponin level should have risen even a tiny bit, or an MI should have exploded by now for it to be normal. It's a bit... strange."

Looking at the clock hung on the station wall, I let out a groan, "Ah..." Sung-hoon Yoo (Male)'s words were right. Time. A variable that explained everything, while at the same time, plunging everything into a labyrinth.

As time passed that way, even our last hope disappeared. The troponin level checked again was still in a perfectly fine state. It was completely normal.

Because of the thought that I had to check what became of this patient, I couldn't even go to work—no, leave work—and kept sitting in my spot like a crazy bastard. In the end, I accessed the Gallery again. This time, it was with a pleading feeling.

Title: They say it's not angina either. Now what is it really.

Author: Korean Slave 1 (Male)

Cardiology Ghost, they say it's not that T_T The 3-hour follow-up troponin is also normal. Patient still says it hurts. Now what should I really do. Do I need to call Psychiatry and look into somatization disorder or something?

A comment was posted from an unexpected place. It was a new nickname I had never seen before.

Gastroenterology is Important: Have you thought about esophageal spasm? If it's not malingering, the probability of it being that is damn high. Just trust me this once, give him a shot of Ketorolac, prescribe a GI cocktail, and feed it to him. It will get dramatically better.

Looking at that comment, I went blank. Esophageal spasm?

'What is a GI cocktail, you nerd...'

I searched that word, which I was hearing for the first time in my life, on my cellphone. Gastrointestinal cocktail... No, American doctors use that, fuck. We don't give medicine in this kind of combination. This is South Korea. If you prescribe an ungrounded cocktail like that, a phone call will come from the Health Insurance Review and Assessment Service right away.

However... an esophageal spasm can actually cause symptoms almost identical to heart disease. And right now, in front of me, a mysterious chest pain patient whose heart tests were all normal was lying down.

It was worth a shot. I couldn't make that cocktail, but I could utilize its principle. A medication that loosens severe spasms of the esophagus.

Clutching at straws, I entered a new order. A powerful treatment for stomach cramps: a Tiropa injection. Yes. If it's not the heart, let's smash the esophagus. Please let just one thing hit.

In a near-despairing mind, I told the Nurse to prepare the injection. Please let this medicine work. Please let that patient just be a patient with severe stomach cramps. Even if I become a dumbass who put on a whole show for the past few hours, please just let it not be a fatal disease for that patient.

The Nurse connected the syringe to the patient's IV line and started injecting the medication slowly. I watched that sight anxiously.

Just then, far away, Cardiology's Park Woo-young was seen trying to leave the Emergency Room after finishing a consultation for another patient. In a flash, I grabbed him and started explaining the patient's history. Since he is a heart expert, wouldn't he catch some kind of vibe?

"...Could this possibly still be a heart disease, Teacher? Is there something I'm missing?"

Park Woo-young replied without even a single second of hesitation, "Isn't it just indigestion?" Leaving behind the one word, "Good work," he tapped my shoulder and passed by.

Indigestion. ...Is that so? I turned my gaze back to the patient.

Had about 2 to 3 minutes passed since the injection completely went in? A miracle happened.

The patient's distorted forehead slowly started to unfurl. The rough breathing sound gradually changed stably. The patient loosely released his hand that was clutching his chest, then blankly looked into the void.

"Uh...?" The patient took a deep breath greatly, as if he couldn't believe it. "Teacher. ...It doesn't hurt."

Chest pain disappeared. ...

I couldn't say anything for a moment. That hellish chest pain disappeared like a lie with a single shot of medicine. It wasn't a heart problem.

With a hollow laugh, I pulled a chair next to the patient and sat down. "Patient, by any chance, what did you eat yesterday?"

At my question, the man scratched his head as if he finally came to his senses now and replied, "Yesterday... I had quite a heavy meal."

"Yes, what did you eat?"

"That... what's popular these days, called Mala Xiang Guo... with that, I drank quite a lot of Kaoliang liquor with a friend. About three bottles..."

Mala Xiang Guo. Kaoliang liquor. It was a fantastic combination from the start. Surely those three bottles weren't consumed alone.

"And when I came home, before going to sleep, my stomach was burning a bit... so I did some hangover cure with a bulgogi burger set that was in the refrigerator before sleeping."

I pressed my temple hard. Greasy Mala Xiang Guo, strong Kaoliang liquor, and cold cola and hamburger. Even if you pour this into a sewer instead of an esophagus, it blocks.

"Did you happen to do any exercise yesterday?"

"Ah! I went to the gym yesterday!" A bright color spun on the man's face. "No wonder my chest was a bit stiff! I did bench presses a bit heavier than usual!"

It was verified. Every puzzle piece was put together. So, muscle pain and stomach cramps...

Gastroesophageal Reflux Disease and esophageal spasm due to greasy, stimulating food and alcohol. And chest muscle pain due to excessive chest exercise. These two created a fantastic synergy, creating symptoms completely identical to an Acute Myocardial Infarction.

I scheduled Gastroenterology and Orthopedic Clinic outpatient appointments for the patient and wrote a prescription. And after observing the progress for about another hour, I discharged him only after confirming that the pain had completely disappeared.

The patient left while bowing his waist, saying, "I survived thanks to you, Teacher! As expected, a big hospital is different!" I showed an awkward smile toward the patient.

...

With a hollow laugh, I returned to the station. And as soon as I sat on the chair, I opened the Gallery window to announce the conclusion of this unreasonable happening.

Title: Hey, that chest pain patient from earlier was just indigestion lol

Author: Korean Slave 1 (Male)

He was an uncle who smashed Mala Xiang Guo and Kaoliang liquor, cured his hangover with a hamburger, and then smashed bench presses. He walked out perfectly fine with one shot of Tiropa. It was no big deal lol. In the future, if it's atypical, I should suspect the gastrointestinal side first. Cardiology Ghost was wrong this time lol.

Pressing the register button, I thought, 'With this, those ghosts will be a bit deflated too.'

However, contrary to my expectation, the reaction of the Gallery was chilling.

Cardiology Ghost: What the fuck did you just babble?

It was unusual from the first comment.

Latte is Mine: This case was no big deal indeed lol. What? Suspect what first in the future?

Cardiology Ghost: You 1st-year newbie piece of shit. You don't know how scary a disease unstable angina is, do you? 'It was no big deal lol' you do this bullshit? You luckily matched an esophageal spasm, but by any freak chance if it was real angina, that patient would have died on the street on his way home while sucking on the stomach medicine you prescribed. What, differentiate the gastrointestinal side first in the future?

I lost my words at the anger filling the screen. No, what did I do so wrong? In the end, it wasn't. The test results were perfectly fine too. Before my unfairness could even fade, Cardiology Ghost's comments continued.

Cardiology Ghost: I will make you realize how ignorant you are. Here is a problem. A 45-year-old male, smoker. The day after drinking alcohol, he woke up in the dawn feeling a chilling sensation in his chest, then became okay in 30 minutes and went back to sleep. Waking up in the morning, he was perfectly fine so he went to work, but the exact same pain occurred again in the afternoon, so he visited the Emergency Room. Upon arrival, pain disappeared. EKG normal, troponin normal. What are you going to do with this patient? Answer me.

...What is this. I furrowed my brow. No symptoms, and tests are all normal too?

ㄴ Korean Slave 1 (Male): If there are no symptoms and tests are normal, shouldn't you reassure him for now, guide him to make an appointment with Cardiology as an outpatient for a detailed examination, and take discharge measures?

The moment my reply went up, the Gallery exploded once again.

Cardiology Ghost: LMAO you are just handing out licenses to kill left and right!

Mes of the God (Male): (Don't know what it is)

Cardiology Ghost: It's variant angina, you quack bastard! Don't you know coronary artery spasm? You have to hospitalize him right now, hook up 24-hour monitoring, do a provocation test, or immediately run a CAG to confirm the diagnosis and use calcium channel blockers! Sending him home? That patient dies of a heart attack while sleeping the next day in the dawn!

In my mind, it went blank. Ah.

ㄴ Korean Slave 1 (Male): No, fuck, how am I supposed to know this. Am I a Cardiology specialist.

Latte is Mine: If you didn't know, you should have asked lol.

Operating Room Ghost 3 (Male): That's why we are here, isn't it.

Respiratory Ghost: If you are confused, uncomfortable, or if it's shitty, just unconditionally ask us.

Cardiology Ghost: (Emoticon of a frog character clenching its fist)

I couldn't make any response.

ㄴ Korean Slave 1 (Male): Ao, got it.

I barely managed to leave a single line of reply. Closing the Gallery window, a severe fatigue rushed in.

...

Staring at the empty Area A bed, I spat out a monologue to myself.

"I still have a hell of a lot to learn."

...Even so, it's a relief. That it wasn't heart disease.