Chapter 45

Episode 45 Migraine (4)

Just then, behind my back, a panicked voice called out to me.

It was Choi Sumin.

Seeing me standing frozen by the station phone, pale as a ghost and completely out of it, she seemed to instinctively realize that something catastrophic had happened.

"What's wrong? Why is your face like that? Who are you on the phone with?"

Choi Sumin approached me, her face etched with worry.

Holding the handset, I silently raised one hand.

‘Just a moment.’

And without making a sound, using only my mouth, I clearly formed three letters that carried all the terror and urgency of my entire life.

T. T. P.

I watched intently as Choi Sumin’s eyes filled first with confusion, and then, a split second later, with sheer horror.

Naturally, she understood perfectly the terrifying weight of hell that those three letters implied.

Right at that moment, the fax machine in the corner of the station let out a loud noise as a single sheet of paper slid out.

It was the lab results.

Still gripping the phone, I snatched the paper from the machine and thrust it before Choi Sumin's eyes.

At the bottom of the results sheet, the words scribbled in red pen by the lab technician were clearly visible.

[Schistocytes : 3 observed, suggest TMA rule out, esp. TTP]

Choi Sumin didn’t ask anything more.

"Nurse Jeong! Move the B-9 Patient to the bed in Area A right this second! Reconnect vital monitoring, check blood pressure every 15 minutes—no, make it every 5 minutes! Keep checking consciousness state, and start tracking urine output hourly by inserting a Foley catheter!"

At that command, the entire station sprang into a flurry of motion.

Nurses ran around busily, preparing to move the patient.

In the center of that chaos, Choi Sumin picked up another phone.

"Is this the MICU? This is Choi Sumin, 3rd year EM. We have a suspected TTP patient in the ER right now. Can we clear an ICU bed immediately?"

"Yes, TTP. Thrombotic Thrombocytopenic Purpura. I think we need to start plasmapheresis right away. We have to move her right now if we want to save her. Please hurry as fast as possible."

Leaving that battlefield behind my back, I focused on the crisis right in front of me.

On the other end of the line, Jin Sehui was already pouring out all sorts of instructions to me.

[...Start IV high-dose steroid therapy right now, and contact the blood bank in advance to secure at least 20 units of fresh frozen plasma needed for plasmapheresis. Also, call Nephrology ahead of time to tell them to prepare the plasmapheresis machine and staff. I’m heading down right now.]

"Yes, Teacher. I understand."

The call ended.

I put down the handset and looked at Choi Sumin, who had just finished her call with the ICU.

"The fellow says she's coming down right now."

"I know. I heard."

The war had begun.

"Load 1 gram of Solu-Medrol and contact the blood bank again to request an emergency release of at least 20 units, up to 30 units of FFP right now. Call Nephrology again and tell them to prepare for plasmapheresis! Quickly! Quickly!"

The station was an absolute madhouse.

Nurses ran around, and the telephone rang without rest.

The complacent thought that it was just ITP.

My ignorance in trying to just monitor the situation while giving steroids.

If it weren’t for the crazy ghosts in the gallery, I would probably be writing this patient's death certificate by now.

"Han Hyeonjae! Get your head in the game!"

At Choi Sumin's shout, I snapped out of my daze.

Now was not the time for self-reproach.

I had to make up for my mistake.

"Go to the patient right now and explain again. How serious the situation is right now. Is the guardian here?"

"No, not yet."

"Then tell them to come right this second. And tell the patient that she'll be moving to the ICU from now on. Tell her we're going to do everything we can, and then come back."

I took heavy steps toward the bed of the patient who had just been moved to Area A.

The patient was staring anxiously at the ceiling, her face even paler than a moment ago.

She probably had a vague idea of why everything around her had suddenly become so hectic.

"Patient."

I wiped my face with my hand for a moment.

"The situation... has become much more serious than we initially thought."

My voice was stiff and rigid.

There was no time for a detailed explanation, nor any luxury to reassure her.

"It appears to be a much more urgent and dangerous illness than we first suspected. It’s not simply a problem of the bleeding not stopping... In the tiny blood vessels inside your body, countless blood clots are being formed at this very moment. And those blood clots are attacking very important organs like your brain and kidneys."

The patient's eyes widened in shock.

"Please contact your guardian right away and ask them to come. We are going to move you to the Medical Intensive Care Unit immediately. To save your life, we need to start a treatment there called plasmapheresis, which replaces all the blood in your body. From now on, it is truly a race against time."

Unable to say anything more, I met the patient's trembling eyes.

Guilt and regret came rushing in like a wave.

Leaving the patient after spitting out words that were no different from a death sentence, I paused on my way back to the station.

In the midst of all this chaos, was there something I was missing?

Rationally, the things I needed to do were organized, but deep in my heart, anxiety still swirled.

In the end, I opened that forbidden window once again.

Korean Slave 1 (Male): I'm pouring in steroids right now and preparing for plasmapheresis. The platelets are in the 30,000s, should I prepare a platelet transfusion just in case?

My question seemed perfectly common-sensical.

Since platelets are low, shouldn't we give platelets?

But the moment that question went up, the gallery was once again engulfed in flames of anger.

Hematoma is Hell: This crazy bastard is really determined to kill the patient until the very end!!!

Latte is Mine: How did an idiot like that become a doctor? Every single professor who let that guy graduate medical school needs to reflect on themselves. To not know the pathophysiological mechanism that is the enemy of TTP.

Cardiology Ghost: HEY!!!!!!!!!!! Transfusing platelets to a TTP patient is the exact same thing as pouring gasoline on a burning house, you crazy bastard!!!!!!!!!!

Hematoma is Hell: Are you saying you want to pour more fuel into a blood clot factory? Platelets are sticking together like crazy in the patient's body right now to make blood clots, so what do you think will happen if you put new platelets in there?

Hematoma is Hell: Bigger, more, and stronger blood clots will be made and completely plug up the patient's cerebral blood vessels! Absolutely! Platelet transfusion is absolutely contraindicated! Unless the patient is dying from massive hemorrhage!

Hematoma is Hell: (Emoticon of a dumpling spontaneously combusting)

Ah...

Just then.

"I'm from Hemato-Oncology!"

A crisp, sharp voice was heard from the entrance of the Emergency Room.

It was the Hemato-Oncology fellow, Jin Sehui.

"Where is the patient?"

"Ah, we moved her to Area A over there."

"Guide me."

Jin Sehui didn’t give me a single moment of leeway.

Overwhelmed by her dominant aura, I began the briefing almost mechanically.

"A 28-year-old female patient, strongly suspected of TTP. Chief complaint upon admission was a headache, and lab results confirmed a platelet count of 35,000 and 3 Schistocytes on the PBS. LDH and bilirubin levels show elevation, and kidney function is still within normal range. Currently, high-dose IV steroid therapy has been initiated, and we are preparing 20 units of FFP and plasmapheresis. Patient's consciousness is still clear, and vitals are stable."

While listening to my report, Jin Sehui silently nodded her head.

"Good job," she said briefly.

"For a 1st year EM resident, this is a very excellent initial response. Passing over the 2nd year and calling me directly was also a very good judgment."

I was dumbfounded by the compliment.

I thought I was going to get chewed out.

"I'll take over from here."

With those final words, she headed toward the patient.

Watching her back, she looked insanely dependable and reliable, like an elite special forces soldier arriving on the battlefield via parachute in a desperate situation where all the squad members were about to die.

Wow, so this is what an Internal Medicine doctor is.

So damn cool.

Uh-oh, even thinking this internally is forbidden.

If I accidentally blurted these thoughts outside, the backlash I'd hear from Lee Minjae would be terrifying.

Jin Sehui checked the patient's condition herself and began shouting out orders like a storm.

"Get ready to place a C-line immediately. We need to insert a dual-lumen catheter into the femoral vein for plasmapheresis, so bring the kit. Keep checking the blood pressure, and if it shows signs of dropping, get ready to hook up norepinephrine right away."

All the responsibility shifted from my shoulders to Jin Sehui's shoulders.

Only then could I let out a long sigh.