Chapter 26

Episode 26 TIME IS BRAIN (3)

My voice was strange to the point of being calm. Perhaps all sorts of crazy things I had experienced over the past few days had strengthened my mental state before I even knew it.

“Hello, ma’am. I’m an Emergency Medicine doctor, so please don't be too startled. I'm just going to check a few things quickly. Is that alright?”

The patient looked at me with anxious eyes and barely managed to nod. While they did, other passengers on the bus started whispering and looking our way.

I pulled my cellphone out of my pocket and turned on the flashlight. Since I didn't have a penlight, this would have to do.

“Ma'am, look at me. Can you try opening your eyes wide for a moment?”

I lightly lifted the patient's eyelids and quickly flashed the light into both pupils. Both pupils constricted well and symmetrically. However, the left pupil was faintly deviated outward.

Deviation. An ominous sign that there was an issue with part of the cranial nerves.

“Ma'am, could you try squeezing both of my hands tight? With all your strength.”

I placed my hands into each of the patient's hands. Even considering her age, I felt a fairly firm grip strength from the patient's right hand. But her left hand was different. No strength entered it at all. It just limply slipped away. Clear left hemiplegia.

I was certain. This was, without a doubt, a Stroke.

I realized there was no more time to waste. I stood right up from my seat, turned toward the front of the bus, and shouted with every bit of strength in my voice.

“Driver!! Please pull the bus over for a second!! There is a Stroke patient on board!!”

At my desperate shout, all the passengers inside the bus were horrified. The bus driver looked at me through the rearview mirror once, then immediately turned the steering wheel to pull the bus into the far lane. With a sharp screeching sound of friction, the bus came to a halt.

With a shaking hand, I pulled out my cellphone and pressed 119. The ring tone rang twice, and a calm voice was heard.

[This is the 119 Emergency Medical Center.]

“Ah, yes, thank you for your hard work. I'm a 2nd Year Resident in Emergency Medicine.”

[Yes, Teacher, what is the situation?]

“I'm calling to report a suspected Stroke patient inside a bus. She is a female estimated to be in her 70s. Her mental status is alert, but she is currently unable to communicate smoothly. Onset time is estimated to be within the past 15 minutes or so. Physical examination shows positive findings for facial palsy, left hemiplegia, and severe dysarthria. Her underlying conditions are unknown, but acute cerebral infarction is most strongly suspected.”

[Yes, a Stroke. By any chance, could you tell us what bus number it is and which area you are passing?]

I looked out the bus window. A familiar scenery.

“It’s bus number 1005, and we just passed Yeonsan Intersection. We are pulled over in the far lane of the road heading toward the baseball stadium. The bus has stopped now.”

[Ah, yes, Yeonsan Intersection. Understood. The closest ambulance crew has been dispatched. They are scheduled to arrive within 5 minutes. Teacher, a call coming from an unknown number might be the dispatched ambulance crew, so please make sure to answer it.]

“Yes, thank you.”

After hanging up the phone, I squatted down next to the patient again.

‘I've done everything I can, right?’

I reported it to 119, stated my identity, and conveyed the patient's condition as accurately as possible. Yes, I had finished the most important role I could perform on the scene. For now, I needed to lie the patient down and make her comfortable.

I asked the lady in the next seat for her understanding, and with the help of the passengers, carefully laid the patient down. I took off my bag to prop it under her head, and turned her head slightly to the side so as not to block her airway.

This was everything. Everything I could do right now.

I couldn't administer thrombolytics, I couldn't get a CT scan, and I couldn't control her blood pressure. I was just a bare-handed doctor waiting for the ambulance to arrive.

Just then, a familiar temptation started coming over me. The Gallery. The dilemma of whether to cross-verify.

My diagnosis was clear. Facial palsy, hemiplegia, dysarthria. This was the kind of stuff that appears on page one of a textbook. Asking the Gallery about something like this would be nothing more than a lack of self-trust, and advertising to those crazy ghosts that ‘I am a dumbass who can't even be sure of this.’

…Sigh, let's not do it.

I shook my head. This was a time when I had to trust my own judgment.

However.

…No, wait. That Malaxiangguo patient from last time who was disguised as a Myocardial Infarction. The memory came back vividly. Typical chest pain. Textbook symptoms. I was completely baited by that 'typicality' and spent two hours barking up the wrong tree.

If I had doubted it even a little bit back then and asked the Gallery about other possibilities, maybe that giant farce could have been avoided. Because I didn't use the Gallery last time just because it was too typical, I went through hell.

Overconfidence is forbidden. Especially at this very moment when a person's brain cells are dying off in real-time.

Should I just do a quick cross-check? Yes, this isn't doubting my own skills. This is a double-check. The safest choice for the patient.

Rationalizing it to myself that way, I opened the blue window in my mind.

Title: I'm on a bus, 70s/F, suspected Stroke. Anything else to differentiate?

Author: Korean Slave 1 (Male)

Sudden onset Lt. side facial palsy, Lt. side motor weakness, dysarthria. Already called 119. Please give some advice if there's anything I'm missing or if there's anything more I can do on scene.

Pretending to check the patient's pulse, I scanned the comments that popped up in my eyes.

Hematoma is Hell: Good job. At the scene, that level of response is a 100-point score. There's nothing more you can do. Just keep checking her vitals until the ambulance crew arrives.

ㅇㅇ (118.235): There is a possibility of Bell's palsy or a Stroke mimic caused by hypoglycemia, but in a case like this where it's accompanied by sudden hemiplegia, it's correct to view it as a stroke.

ㅇㅇ (39.7): Good job, 1st year. By the way, is your mental state okay right now? Usually, when you see something like that outside the hospital for the first time, your hands shake like crazy.

Looking at their comments, I felt a faint sense of relief. It felt like having the fact that my judgment wasn't wrong reconfirmed by dead experts. Ah, well, not just a feeling—it was reconfirmed.

At any rate, I continuously checked the patient's consciousness level and examined whether she was breathing properly and if her pulse was regular. But at the same time, a terrible sense of helplessness washed over me again.

There was nothing I could do. All the knowledge I knew, all the medications I had memorized, and all the skills I had practiced were of no use inside this bus.

‘Am I just… a bystander?’

A sense of self-reproach crept in. Just then, a siren sound faintly started coming from far away. The sound grew closer and closer.

No, snap out of it. I shook my head to throw off the defeatist thoughts. I wasn't a bystander. Because I was here, this bus stopped, and because I was here, that siren sound was racing toward this spot right now.

The siren sound stopped right in front of the bus. The doors opened, and two members of the ambulance crew wearing familiar orange clothes ran inside holding an emergency kit.

“Where is the patient!”

I stood up from my seat and spoke toward them.

“Over here.”

“Teacher, what happened?”

“Sudden onset left hemiplegia, facial palsy, and dysarthria. Her consciousness is still alert. Acute cerebral infarction is most strongly suspected.”

While listening to my short briefing, the ambulance crew wrapped a blood pressure cuff around the patient's arm and placed an oxygen saturation monitor on her finger. Their movements flowed like water.

While the ambulance crew struggled to find the patient's blood vessel and secure an IV line, I kept examining the patient's condition by her side. The one who appeared to be the senior member of the ambulance crew looked at me with a troubled expression and said, “Teacher, there is no guardian present right now, and the patient's condition could keep changing. Could you ride along with us until we arrive at the hospital and hand her over? Having a medical professional present would probably be best for the patient.”

Ah.

In my mind, I heard the sound of all my post-work plans—which I had happily imagined while waiting for the bus at the bus stop—shattering into pieces. Showering with warm water, drinking a can of beer left in the refrigerator, and falling asleep while mindlessly watching short-form videos... my simple happiness.

And in the end, I unintentionally ended up riding along.

“Yes. I will do that.”

An answer completely unrelated to my actual will flowed out of my mouth.

The back doors of the ambulance closed. The ambulance crew moved busily. They secured an IV line in the patient's arm and connected normal saline. On the portable monitor, the patient's EKG, blood pressure, and oxygen saturation levels popped up in real-time.

I asked toward the driver's seat, “By any chance, which hospital are we going to?”

“We are going to the nearest Regional Cardio-Cerebrovascular Center right now! Cheongjin!”

Ah. Oh, shit. Cheongjin Medical Center. My workplace. The exact hell I had just escaped from. I was now voluntarily being escorted back to that hell of my own accord.

I resigned myself to everything and pulled out my cellphone.

“Ah, then since it's our hospital, I'll contact them instead.”

I dialed a familiar number. Emergency Medical Center.

Ring-r-r-ing—

“Yes, Emergency Medical Center.”

The person who answered the phone was a senior Nurse in our emergency room, whom I could recognize just by her voice.

“Ah, yes, hello Nurse. I'm Han Hyeonjae.”

“Ah, oh? Yes? Yes, Teacher. What's the matter? Did you leave something behind…”

Her voice was clearly thick with annoyance and the question of ‘Why is a guy who off-dutied calling and acting up?’

“No, it's not that… It's just that I'm currently heading to the hospital in an ambulance.”

“…Yes?”

“A stroke, no, well… anyway, I happened to ride along in an ambulance by chance, so I'm calling to give a pre-notification about a patient's condition.”

I adjusted my grip on the handset and began pouring out all the information that had been organized in my head over the past 30 minutes.

“She is a female patient in her 70s. Onset is estimated to be about 30 minutes ago. Currently, her consciousness was alert but is now in a state of transitioning into a stupor, and her GCS is checked at around 11 points. Vitals are maintaining at BP 160/90, HR in the 60s, and SpO2 at 99%. At first, I thought it was just hemiplegia, but for now, she showed clear left side facial palsy and left side hemiparesis, and her motor grade looks to be around 2 to 3. Her dysarthria is also severe.”

I took a breath and added the most important words.

“Please contact the on-duty neurologist and radiology in advance so they can prepare to take a CT scan. Our ambulance ETA is 5 minutes.”

There was no answer from the other side of the handset for a long time. Only the urgent voice of her calling another nurse and the sound of typing on a keyboard were heard. After a moment, the Nurse asked back in a voice of disbelief.

[Understood, Teacher. We will be preparing like that. But… are you really inside an ambulance?]

“…Yes.”

After hanging up the phone, I looked out the window. The outline of a familiar building started coming into view in the distance.

Our hospital's Emergency Medical Center.

Shit. My clock-out.