Chapter 46

Episode 46 What Went in There? (1)

After sending the TTP patient up to the intensive care unit, I buried myself deep in the station chair. As the tension in my entire body released, a bizarre wave of confidence flowed through my veins along with intense fatigue. Yes, I pulled it off again! Although the help of the Gallery Ghosts was absolute, in the end, it was I who made the judgment, shouted, and acted at the final moment. Performing a laparotomy, getting dragged to the Disciplinary Committee, and diagnosing a TTP patient. In just a few days, I had experienced every single incident that other 2nd Year residents might experience only once, if at all, throughout their entire training period.

Haha! I am a crazy bastard! A hospital-certified crazy bastard!

I wore a rather satisfying smile and waited for the next patient. Just then, the triage nurse called me through the intercom. There was a subtle awkwardness in the nurse's voice that was different from usual.

“Teacher Han, a… um… somewhat… serious patient has arrived in Area B. I think you need to take a look.”

A serious patient? I reflexively tensed up. What broke loose this time? However, the nurse's voice did not sound all that urgent. In the first place, if it was serious, why did they assign the patient to Area B? I stood up from the chair and headed toward Area B. As I approached the curtained bed, the groaning sound of a man suffering inside was heard. I took a deep breath and opened the curtain.

On the bed, a man who looked to be in his 30s was lying on his side, curled up. His face was flushed red with pain.

“How did you come here? Where does it hurt?”

At my question, the man could not bring himself to meet my eyes and mumbled while just clutching the blanket.

“Uh… Teacher… I, by mistake… into my buttocks… something went in.”

…

Yes. I doubted my own ears. What did he just say? His buttocks?

“Can… you do something about it? It really went in by accident.” The man asked, nearly crying.

I froze for a second. The differential diagnosis list for all sorts of fatal conditions that I had run through my head countless times over the past few days disappeared like white smoke. It felt like my brain was being reset.

'Ah. That's it.'

The exact case that had only passed down as an Emergency Room legend. My newfound confidence and medical contemplation were completely useless in front of this primitive problem. Why at all did you put that kind of thing in there, shit. I raised the corners of my mouth as much as possible and flashed a gentle smile toward the patient.

“Ah, yes… Just a moment, patient. We will take care of it for you quickly. Please wait just a moment.”

I pulled the curtain closed again and walked outside. Fuck. Oh my God. Please. And I began to scan the Emergency Room with sharp eyes. Hmm. Let's see. Aha! Found him! My radar caught a fresh intern who was diligently charting in the corner of the station. His name was… right, Park Seongjeong.

“…Um, intern? Where did the intern go?” I mumbled slyly to myself as I approached precisely behind the intern's back. Then, I gave Park Seongjeong's shoulder a very friendly tap.

“Seongjeong.”

“Yes? Teacher Han Hyeonjae?”

Park Seongjeong turned around in startle, his eyes full of pure passion, not yet knowing the bitter taste of the world. Yes, that gaze. With that gaze, I could leave it to him. I put my hand on his shoulder with the smile of a very benevolent senior.

“Seongjeong, a patient just arrived at bed number 8 in Area B, and the case is highly educational. It’s a very rare case that is hard to see even once in a lifetime unless you're an intern. Do you want to take charge of it? Of course, I'll oversee everything right by your side.”

“Yes? Really? What kind of case is it?” Park Seongjeong's eyes sparkled with curiosity.

“A rectal… foreign body.”

“…Pardon?”

The pure passion vanished from Park Seongjeong's face in an instant, and despair of 100% purity bloomed in its spot.

“I'm counting on you.” I squeezed Park Seongjeong's shoulder firmly once more. Yes, work hard, Seongjeong. Fighting.

“Yes? Teacher Han Hyeonjae? No, I mean, wait a minute!”

Leaving behind Park Seongjeong's bewildered shout, I forcefully threw words of encouragement.

“Right, Seongjeong, you can do it! Fighting!”

Quickly. I left that spot with the fastest steps of my life. From behind my back, a scream that was close to a cry was heard.

“H-Han Sam!”

I'm sorry, Seongjeong. But it can't be helped. That is precisely the destiny of an intern. Since I'm now a 2nd Year who needs to see the bigger picture. I rationalized myself that way and leisurely walked toward the station.

Savoring the sweet scent of freshly brewed mix coffee, I was admiring my own judgment. Yes, this was strictly for educational purposes. One has to personally experience a primitive case like that to grow into a true doctor. Right now, as a 2nd Year, I am an excellent senior who provided a valuable learning opportunity to a junior. I felt proud of myself that way and took a sip of coffee. However, that peace did not last long.

“Han Sam!”

A moment later, intern Park Seongjeong, who had returned from Area B, called me with a heavily flushed face. Um, did something break loose? I welcomed him with a very benevolent and generous senior's smile.

“Oh, right, Seongjeong. How was it? Was it a very beneficial and rewarding experience? How is the patient?”

At my question, Park Seongjeong's lips trembled.

“Sam….”

“Yeah?”

“When I went and checked… only the history taking was done, and nothing else was set up….” Resentment was laced in his voice. “Even in the charting, only a single line saying 'R/O) Rectal foreign body' is written… and the patient keeps saying it hurts, but there are no orders at all… I didn't know what to do, so….”

Listening to the intern's protest, I replied without blinking an eye.

“Ah, really? I guess I was so distracted earlier that I forgot. Haha. I'm sorry, Seongjeong. It would have been trouble if you hadn't come and told me. As expected, I like you because you're smart.”

I tapped Park Seongjeong on the shoulder and naturally led him in front of the station computer.

“Now, Seongjeong. Have a seat. From now on, I will teach you one by one what kind of basic orders you need to place for these patients.” I had him stand next to me and opened the order window.

“First, Nil Per Os (Nothing by mouth). This is the most basic of basics. Why? Because we don't know yet whether we can pull it out by hand, or if an endoscopy or surgery will be required. A situation that requires anesthesia might come up, so we unconditionally make them fast.” I clicked the Nil Per Os (Nothing by mouth) order.

“Next is the IV line. Why would we give IV fluid? Because they can't eat. And to prepare for any potential emergencies, we secure a pathway for medications to enter in advance.” I placed the IV fluid order.

“And the most important thing. The exam.” I opened the radiology order window. “Now, Seongjeong. Do you know what the most important thing is in this kind of patient? It's perforation, perforation. Whether the intestine is torn or not.”

Park Seongjeong looked at me with a gaze that said, 'Do I look like an intern who doesn't even know this kind of thing,' but I deliberately ignored it.

“If a foreign body pierces the intestinal wall and feces spread inside the abdomen, it can immediately lead to peritonitis, septic shock, and death. That's why we take an abdominal X-ray. One taken lying down, and one taken with the patient standing up. Do you know why standing up is essential?”

“To… check the gas distribution in the intestines…?”

“Ding-dong. To be precise, it's to see if there is air floating under the diaphragm. If a hole forms in the intestine, a crescent shape appears right under the diaphragm, see? Right then, you just have to go 'Ah, fuck!' while calling general surgery and running to the Operating Room.”

Park Seongjeong looked at me again with a gaze that said, 'Do I look like an intern who doesn't even know this kind of thing.' Whatever, what about it.

“Yes…”

I wore a highly satisfied smile and entered the X-ray order.

A moment later, the X-ray result popped up on the screen. I tapped Park Seongjeong on the shoulder and said, “Now, come and look.”

We stood side by side and peered into the monitor. Fortunately, free air was not visible under the diaphragm. Meaning it wasn't a perforation. I let out a sigh of relief and scrolled down to enlarge the pelvic area. And. It was there. Inside the rectum, in a very clear and explicit silhouette. All sorts of medical knowledge and internet stories began to mix up in my head.

'Hmm, it's not a radiopaque material. It's not metal or glass. Looking at the density….'

This was… that… that thing. Ha, fuck. What at all does one have to do for that kind of object to go in by mistake? I could not hide my horror.

“Teacher… what is… that?” Beside me, Park Seongjeong asked with a pure voice. It seemed the intern had not yet recognized the identity of that sacred object.

I hesitated to answer for a moment. How was I supposed to explain this here? Just then, two female nurses passed by us while chatting. I flinched without realizing it. Somehow… somehow it was embarrassing. It was just my patient and not me, but I felt like I had to protect their dignity (?) somehow. I grabbed Park Seongjeong's shoulder and pulled him toward me. Then, very quietly in his ear, I whispered the very precise medical terminology (?).

“….”

As my whisper ended, Park Seongjeong's body froze right there. The intern's eyes dilated larger than any pupils I had ever seen in my life. The intern slowly turned his head to look at the X-ray screen again. Then, he looked at me again.

Yes, the Emergency Room is this kind of place.