Chapter 56

Episode 56 Chaotic First Academic Conference (5)

We moved with heavy steps and walked into the crowd waiting for us. Like Moses' Miracle, people opened a path for us.

Shit. This is too much pressure.

Every single gaze pierced into Kim Jihun (Male) and me.

"They're here."

"Is that person Doctor Han Hyeonjae (Male)?"

"He's much younger than I thought."

"Of course he is, he's a 1st-year resident."

I tried my best to look composed as I stood in front of the poster with my name on it. Kim Jihun (Male) stood in front of his poster in a state where his mind was almost halfway gone.

"The patient's final diagnosis was Right Coronary Artery Obstruction, but could you explain the correlation with the Sore Throat symptom in a bit more detail?"

"Yes, the Right Coronary Artery is an important blood vessel that supplies blood to the Inferior Wall and the Right Ventricle of the heart. Ischemic pain in this area is often characterized by radiating to the neck, jaw, and back. This phenomenon occurs because the pathways of the vagus and sympathetic nerves governing the heart and neck partially overlap in the thoracic spinal ganglion..."

I fluently recited the contents of the paper I had memorized all night as if it were my own knowledge. It was a model answer that I had prepared in advance and had reviewed dozens of times by the ghosts. The doctor who threw the question nodded as if satisfied.

The initial atmosphere was not bad. The questions were within the expected range, and I spat out the answers accurately. It seemed like it would end safely if things just kept going like this.

Just then, Professor Kim Hyuk-jae (Male) of Ohseong Seoul Hospital, who had been keeping an eye on me in the seminar room earlier, raised his hand.

"Doctor Han, I enjoyed your presentation. It's a very interesting case. However, I have one curiosity."

Thump. What at all could it be?

"Like your case, under conditions of extreme physical stress such as a Myocardial Infarction, ischemic damage can rarely be accompanied in other organs as well. Especially for a patient with underlying vascular disease, didn't you consider the possibility that Non-occlusive Mesenteric Ischemia due to reduced cardiac output could manifest as an atypical discomfort in the laryngopharyngeal area? If those two things came at the same time, what would have been the core clinical clue to differentiate them at the Emergency Room scene?"

Silence flowed.

...Mesenteric... what did you say?

My brain completely stopped.

NOMI? Non-occlusive Mesenteric Ischemia?

Of course, I had seen it in a textbook. However, I had never once thought that a question asking to differentiate that in a Myocardial Infarction patient who presented with a Sore Throat would come up.

This isn't a question a 1st-year resident can answer, Professor.

I couldn't say anything and just opened and closed my mouth. Cold Sweat flowed down my spine.

"Uh..."

I barely squeezed out a voice.

"Could... could I answer after thinking for a moment?"

In that way, I declared surrender in front of the worst crisis of my Doctor's Life.

Gallery, Gallery. Please.

The sound of murmuring was heard.

"Where is he looking? The void?"

"What's wrong with him? Did he suddenly lag?"

"Hmm, I did hear that geniuses are definitely a bit strange somewhere, but I guess it was true."

Korean Slave 1 (Male): Hey!! Right now the Ohseong Hospital professor is asking something weird!! He's asking if mesenteric ischemia or whatever can come together in a myocardial infarction patient, what kind of bullshit is this!!! Differential Point quickly!!!! I give you 10 seconds!!!!! If you don't tell me, I'm just going to declare suicide right here and run away!!!!!

At my desperate threat, the Gallery began to move urgently.

Latte is Mine: You crazy bastard, calm down! NOMI! That's a very shitty disease!

Mes of the God (Male): The Differential Point is abdominal examination and Lactate Level!

Cardiology Ghost: If it's mesenteric ischemia, the stomach doesn't just hurt, it hurts to death! There is abdominal distension, rebound tenderness when pressed, or as the intestine rots away, metabolic acidosis occurs, so the Lactate Level jumps like crazy! Your patient's stomach was fine and the lactate was normal in the lab too! Say that!

"Ah, yes. I will answer."

At my calm voice, the murmuring around me became quiet again.

"Thank you deeply for the professor's question. Under extreme stress situations like an Acute Myocardial Infarction, I think the possibility of being accompanied by Non-occlusive Mesenteric Ischemia is definitely an important differential point to consider. Especially if the patient was elderly or had underlying vascular disease, it would have been even more so."

Whew, let's calm down. My voice trembled a little.

"However, in the case of the patient I was in charge of, there were no signs of peritoneal irritation such as abdominal distension, specific tenderness, or rebound tenderness in the abdominal physical examination performed upon arrival. In addition, no significant elevation of the Lactate Level indicating metabolic acidosis was observed in the initial blood tests."

Now is the timing for the conclusion to come out.

"If both diseases manifested at the same time, I think it is highly probable that a sharp rise in the Lactate Level due to intestinal ischemia would have been accompanied along with the rise in Myocardial Enzyme Levels. Therefore, in the situation at that time, synthesizing the patient's clinical symptoms and lab results, I tentatively judged that the possibility of NOMI was low."

As my words ended, silence flowed once again. Professor Kim Hyuk-jae (Male) burst into a hearty laugh as if very satisfied with my answer.

"Haha! This guy is really something, something! For a 1st-year resident to be at this level, it can't even be compared to our times!"

At that extreme praise, other professors around also nodded their heads in agreement. I bowed my waist, smiling awkwardly amidst the pouring compliment baptism.

"Oh, it's an overpraise. Thank you."

"I am not joking, if you are interested in a critical care medicine subspecialty or a Fellow course later, definitely contact me. Ohseong is the best in this field, haha!"

"Thank you."

With my answer ending, the attention toward me subsided. A few residents threw a few more light questions, but it was not a big problem. I recited the model answers prepared in advance like a parrot.

As the questions for me ended, Professor Park Jooseong of Seoul Catholic University of Sacred Heart Hospital, who was one of the professors interrogating me, turned his gaze to the side.

"Who is this? Poster number P-116... Kim Jihun (Male)? Cheongjin Medical Center. Oh, a junior?"

Professor Park scanned Kim Jihun (Male)'s poster with an interesting gaze. The poster topic was 'A Case of Rhabdomyolysis Caused by Excessive CrossFit'. It was a smooth and educational case that could be very commonly seen in the Emergency Room these days.

Oh, Jihun. I'm sorry.

Because of my brilliant(?) debut match, the eyes of the judges had already risen like crazy. The professors might now be expecting that any 1st-year resident from Cheongjin Medical Center would be a crazy bastard like me. Kim Jihun (Male) is just a normal and diligent 1st-year resident.

Sure enough, Professor Park's mouth opened.

"Doctor Kim Jihun (Male). I enjoyed your presentation. The patient's CK level was very impressive at over 100,000. In such severe rhabdomyolysis, the most concerning complication is, after all, acute kidney injury."

What at all is he trying to ask?

"Here is a question. To prevent myoglobin coming out in the patient's urine from blocking the renal tubules, urine alkalinization therapy is commonly performed along with fluid therapy. Can you tell me your opinion on the controversy regarding whether this urine alkalinization therapy is truly effective in improving the actual patient's prognosis?"

Fuck. I spat out a curse inside.

That is not a level of question that can be thrown to an emergency medicine 1st-year resident. Go ask a nephrologist, this gentleman. Why at all are you asking Jihun this?

Kim Jihun (Male)'s face turned white. Kim Jihun (Male) rolled his head desperately, sweating cold sweat on his forehead.

"Ah... yes... that... Professor..."

Kim Jihun (Male) began to stutter.

"For rhabdomyolysis patients, um, uh, preferentially a sufficient amount of IV fluid... aggressively injecting to secure urine output is the most important thing."

It was content that appears on page 1 of the textbook.

"And... that... urine... alkalinization also... can be, uh, um, helpful... in preventing kidney damage..."

Kim Jihun (Male)'s voice crawled inward more and more, and his gaze anxiously headed toward the floor. Professor Park did first not question further. He just nodded his head faintly and shortly, then moved his steps toward another poster.

Like that, all the attention drained away, and only the two of us, Kim Jihun (Male) and I, were left in front of the posters. What a pitiful junior...

Kim Jihun (Male) called me.

"Hyeonjae."

"What."

"Am I... am I a fool?"

I couldn't bring myself to answer right away.

"Hmm..."

What should I answer? Would it be a comfort to say, 'No, you're not a fool'? Saying, 'Yeah, you're a fool' is just being a bastard.

"If it were you... you could have answered, right? What that professor asked."

"...No?"

I shrugged my shoulders as much as possible and put on a expression that showed I knew nothing.

"I don't know either?"

At my answer, Kim Jihun (Male)'s eyes went round. Boing.

"Eh? You don't know either? Really?"

"I don't know, you punk."

I tapped Kim Jihun (Male)'s shoulder.

"I only dug into my paper topic, that Myocardial Infarction that came as a Sore Throat, like crazy. I organized and memorized all the questions that could come up from there and even the expected answers. But rhabdomyolysis? The efficacy of urine alkalinization? How would I know that. It's not my specialty field."

At my sly acting, the shadow that had been cast over Kim Jihun (Male)'s face began to clear away gradually.

"Wow... this crazy bastard."

A curse containing awe burst out of Kim Jihun (Male)'s mouth.

"How hard did you at all prepare for an answer to come out right away without even blinking an eye in front of those professors? I thought my heart was going to explode. This guy is a total psycho."

"Oh, please."

I smacked Kim Jihun (Male)'s back hard.

"That's why you should have prepared well usually, my friend."

At my words, Kim Jihun (Male) could not make any refutation. He just looked at me with a gaze that seemed to say, 'That guy is truly a fierce one.'

I'm sorry, Jihun. This is the only way for us to survive together. I can't say that ghosts live in the community I use.

It was just when an awkward but warm camaraderie was sprouting between us.

"Oh, did you do well? There were a ton of people earlier!"

From far away, Professor Cheon Eun-jeong, who had been watching other presentations, was approaching us while waving her hand.

"I got completely destroyed, Professor."

And Kim Jihun (Male), loyally, turned all the credit to me.

"Hyeonjae carried everything alone."

"Oh, really?"

Professor Cheon looked at me with a very satisfied expression as if she knew it would be so. I just scratched the back of my head while laughing awkwardly.