Chapter 3
Episode 3 VEXAS Syndrome (End)
An awkward silence flowed through the Emergency Room after Professor Choi Youngjun left.
Until just moments ago, the nurses had been glancing at me with thrilled looks that seemed to say, “That bastard is about to get torn to shreds like a dog.” Now, they were stealing glances at me with eyes mixed with awe and surprise.
What are you looking at, people?
I saw you all betting on exactly how badly I’d get torn apart. I’m a human being who possesses at least a modicum of situational awareness!
It felt like I could hear the whispering of the nurses and a few medical technicians all the way over here.
“Isn’t that crazy? He's not even in Internal Medicine. How does a 1st-year EM resident know about a rare rheumatologic disease?”
“It’s not like he’s an Internal Medicine resident on duty, either. He called a professor directly, and instead of getting chewed out, he got a compliment?”
“I heard Teacher Han Hyeonjae had good intern evaluations, so I knew he was something else, but to think he was this good.”
Quiet down, people.
And I can hear everything. I feel like I'm going to die of embarrassment right now, so please just be quiet.
I blankly stared toward the end of the hallway.
My body felt like lead now that the adrenaline had faded, but my brain was spinning more clearly than ever. Something hot that had been welling up from a corner of my chest now seemed to be warming the blood throughout my entire body.
Sizzle.
Is this passion?
“Good job.”
To think what that one word could do.
During my miserable past as a resident, the only words I ever heard were:
“You don’t even know this?”
“Get your mind straight.”
“If you’re going to do it like that, just quit.”
There were only words like these.
Of course, there were occasional compliments, but if you think about which words a clumsy 1st-year resident would hear more often, the difference in frequency was only natural.
However, today I heard a heartfelt compliment come straight out of a professor's mouth. Along with it came a heavy sense of accomplishment from the fact that I might have saved a patient's life.
And the start of everything was… this crazy delusion that popped into my head, probably.
[Dead Medic Gallery]
Avoiding the gazes around me, I crawled back into the corner of the Duty Room. As soon as I threw my body onto the bed, I closed my eyes and recalled that damn gallery again.
‘Gallery.’
With a ping sound, a familiar yet dingy blue interface spread across my vision. First, I needed to focus a bit more on this thing called a gallery. What exactly is its identity?
I stared intently at the screen.
Hmm, what kind of users are here? And what is this interface anyway?
It was a crude design that looked like it belonged in the early 2000s, but it looked incredibly similar to a certain site I knew. First of all, the interface was very intuitive. At the top of the screen, various gallery lists were lined up.
[Dead Medic Gallery]
[Dead Internist Gallery]
[Dead Surgeon Gallery]
[Dead Pediatrician Gallery]
[Dead Psychiatrist Gallery]
They had divided it up very meticulously by specialty. Among them, I had selected the [Dead Medic Gallery]. It seemed to be a sort of integrated bulletin board.
“Ha…”
A hollow laugh escaped me. Could this really be a delusion inside my brain? A sophisticated hallucination created by my subconscious because my stress had broken through its critical limit?
Lately, I hadn’t been able to sleep well, and my meals were irregular. It could be a psychotic symptom appearing as part of burnout syndrome.
‘Should I get a consultation at the Department of Psychiatry?’
It was absurd to give myself such a diagnosis. What would I even say? “Teacher, I see a community site where dead doctors gather before my eyes.”? It was obvious that I’d immediately get hit with a sedative and go straight to a closed ward.
However… if this really was a delusion, how could I explain VEXAS syndrome?
Not even in the smallest corner of my knowledge, nor at the very edge of my forgetting curve, did the disease name VEXAS syndrome exist. It was only after searching on Up-to-date that I found out it was a rare disease defined just a few years ago. The probability of me coming up with this on my own converged to zero.
If so, is this… a real gallery? Does it actually exist?
Holding my confused head, I started lurking through other posts. I scrolled through the list of recent posts.
Title: What do kids use to look at Neuroblastoma these days instead of N-myc?
Author: Pediatric Ghost 77
Back in my day, there was nothing to do but pump in chemo and pray. Are there no ALK gene mutations or other targets? Like a new drug that passed Phase 3 clinical trials.
Comments
ㅇㅇ (1.234): Back in your day? lol Looks like you've been dead for over 20 years. These days, they use Lorlatinib, which targets ALK. But even that causes resistance quickly, which is a headache.
ㅇㅇ (211.36): CAR-T is just the answer. Money is the problem. The clinical results of CAR-T targeting GD2 look good, but is it still not available in Korea?
ㄴ Pediatric Ghost 77: What the fuck is CAR-T… All sorts of things have been created since I died. Give me the coordinates to the paper.
Title: Fuck, who is the bastard that prescribed fentanyl to my patient?
Author: Anesthesiology & Pain Medicine
Can’t you see they are a terminal renal failure patient? Even a medical student knows that the accumulation of the fentanyl metabolite, norfentanyl, causes respiratory depression. You should have used hydromorphone, you fucking quack. The patient went to the ICU because of you.
Comments
ㅇㅇ (101.11): I know that feeling well because I died while being under a guy like that. They just don't think.
ㅇㅇ (58.235): Since you’re dead anyway, why get so angry? Just stretch your legs and rest comfortably in the afterlife.
ㄴ Anesthesiology & Pain Medicine: Fuck, does this look like something not to get angry about? This was a patient I spent years painstakingly keeping alive.
…What the fuck.
I was at a loss for words as I looked at the screen. The tone was entirely that of a cheap community site overflowing with curses and slang, but the level of conversation taking place inside closely resembled a conference of active professors. All sorts of up-to-date knowledge and deep medical discussions were taking place.
Hmm…
I rested my chin on my hand and fell deep into thought. For now, am I the only living person here? Looking at the nuance of the posts and comments, everyone was using expressions like “When I died,” or “Back when I was alive.”
…At least that’s what it seemed like looking at the posts.
Wait a minute, if that's the case?
It felt like my heart dropped with a thump. With a trembling hand—no, with trembling thoughts—I went back to the post I had written. I scrolled down to check the comment section.
Below the last comment I had seen, which read “Are you an idiot? It looks like VEXAS, send out a test,” new comments had been posted.
ㅇㅇ (182.21): But isn't this bastard's post a bit strange? "It's a patient, so please take a look." This means he's looking at them right now.
ㅇㅇ (39.7): True. "The patient keeps having a fever and is flagging, but I don't know the cause." It's in the present progressive tense.
Operating Room Ghost 3 (Male): What? You're looking at that patient? Are you a living doctor?
Hippocrates' Descendant: ?? How do you see a patient and how do you put in orders? It's not like you're possessing them.
Bone Nerd 88 (Male): You're seeing a patient? Is there a patient in the afterlife? Is there an emergency room in the afterlife too?
Ah, fuck.
I’m screwed.
It felt as if the blood in my entire body was turning cold. Cold sweat flowed down my spine. I had carelessly written the post from the perspective of a living person. Among these dead souls, I alone had used the language of the present tense.
I was caught. My identity was exposed.
The fact that a living human existed in this crazy community of dead people was laid bare. What would happen now? Would I be forcibly kicked out? Or would this delusion disappear without a trace?
The moment all sorts of anxious thoughts flashed through my head, the atmosphere in the comment section began to turn into something strange.
ㅇㅇ (118.235): …Wait. Is that bastard really alive?
Hur Jun's Oriental Medical Thinking: Hul.
ㅇㅇ (210.94): Wow, shit. Really? That gentleman ‘Korean Slave 1 (Male)’ is an active, living practitioner?
Anesthesiology & Pain Medicine: ?? Wow, shit. To be able to see a patient in real-time, it's been a damn long time. (It's been 3 years since I died.)
Pediatric Ghost 77: Crazy, mf. Are you really alive? I asked if you're alive, shit. Answer me before I really beat you up. Are you sure you're alive?
Bone Nerd 88 (Male): Hey, then is a real-time broadcast of this VEXAS patient possible? You're going to do a bone marrow biopsy, right? Can't you show me the bone marrow slide? I'm fucking good at looking at bone marrow. Seriously, just let me see it once. I'll read it exquisitely for real.
Hippocrates' Descendant: Wow, then does this mean we don't have to suck new medical knowledge out of a freshly dead, warm gallery member anymore? We can just ask an active practitioner right away? Crazy;;
Operating Room Ghost 3 (Male): This is insane, shit. Is this the medicine of the living? Post author, quickly confess what laparoscopy machine your hospital uses. Did the latest version of Da Vinci come in? I'm telling you to share the surgical field, broad.
“....”
I couldn't believe the scene unfolding before my eyes.
The wariness and suspicion had turned into fanatical excitement and cheering in an instant. Like people discovering an oasis in a dry desert, these dead doctors were enthusiastic about the appearance of a living doctor.
They weren't rejecting me. Rather, they were craving me.
Alone in the empty Duty Room, looking into the void, I muttered to myself.
“This is a total jackpot, isn't it?”