Chapter 1
Hell.
If hell existed in the mortal world, wouldn’t this damned ER be it?
My name is Han Hyunjae.
First-year resident in emergency medicine.
“Slurp-”
“Could you shut up and eat quietly? Jesus, you’re loud.”
Kim Jihoon, my co-resident, flipped me the bird, his face drenched in sweat.
The daily routine of lying like a corpse in the corner of the on-call room, scraping by on convenience-store lunch boxes and cup noodles that had gone stone-cold.
As I was grumbling to myself, the outside suddenly started getting noisy.
Please, no.
No way.
Clunk-
“TA(*traffic accident) patient ETA(*estimated time of arrival) is 8 minutes!”
Shit.
“Seriously.”
Kim Jihoon, in the middle of chewing noodles, spat out a curse and bolted to his feet.
I, too, got up almost mechanically.
My body, which had been as heavy as lead just a second ago, reacted to a single sound like Pavlov’s dog.
The only special talent I’d gained from all that grinding, I guess.
...
***
...
“Patient is a 58-year-old male pedestrian! It’s been 11 minutes since he was first found, and there’s no pulse!”
“Give me 1 mg of epi(*Epinephrine, emergency drug for activating the sympathetic nervous system)!”
“Starting compressions!”
“Dr. Yoon, Lucas!”
“Yes!”
Everything moved in perfect unison.
And at the same time, in chaos.
Someone climbed onto the patient’s chest and compressed it hard enough to crush the ribs; someone else squeezed the ambu bag, forcing oxygen into the lungs.
I stared blankly at the scene for a moment.
A middle-aged man with one hand on the doorknob to the underworld.
Could all this crap we were doing really pull that old man back to this side?
Doubt.
Right, doubt.
What the hell am I even doing this for?
It was then.
Right in front of my eyes, in the empty air, rainbow-colored noise seemed to crackle and flicker to life for a split second.
‘...Am I seeing things because I’m tired.’
I rubbed my eyes.
But it didn’t disappear.
The noise quickly began to take on a clear shape.
Like a translucent system window from a sci-fi movie.
『Congratulations! You have attained the qualifications of a savior.』
『A special skill has been granted. The skill you received is [Gallery Access Pass]!』
What bullshit is this.
I thought I’d finally gone insane.
There was no doubt overwork and stress had melted some part of my brain.
Is that only visible to me?
I almost asked the nurse beside me who was setting the line.
Like, ‘Excuse me, can you see the blue text over there?’
If I’d done that, I’d have gone straight to the psych closed ward.
“I’m checking the rhythm!”
Compressions stopped for a moment.
“It’s V-fib!”
Fortunately or unfortunately, that stupid system window vanished without a trace in one second.
As if it had never existed in the first place.
Right, it was just a hallucination.
By the time I came to my senses, defibrillator paddles were already in my hands.
“Move aside! Charge, 200 joules!”
“Clear!”
“Shock!”
Thwack!
The patient’s body jerked upward.
The monitor’s ECG line was still a total mess.
It didn’t look like it had any intention of coming back.
Another 30 minutes passed like that.
In the end, everything ended with the declaration to stop CPR.
...
***
...
Sweat and effort scattered uselessly into the air.
May he rest in peace.
I headed back to the on-call room.
The moment I threw myself onto the bed, the message I’d seen earlier came back to mind.
Gallery access pass?
“What am I supposed to do with this?”
Is this some kind of web novel trend these days?
Status window?
Skill?
Hunter?
Did a gate open here or something?
Just in case, I stupidly shouted inwardly.
‘Gallery!’
Nothing happened.
Pfft.
A dry laugh escaped me.
Right, like I’m some protagonist.
It’s just my brain pulling some bullshit because I’m tired.
I closed my eyes and tried to force myself to sleep, but my mind was a mess.
Gallery... gallery....
Gallery has a lot of meanings, after all.
The image app on a smartphone is a gallery.
And the art gallery we usually think of is also a gallery, but...
Access pass?
Could the ‘gallery’ mean that kind of gallery?
At that moment, a translucent window popped up in front of my eyes again.
This time, it was different.
It wasn’t just a simple message window like before.
“…What is this screen?”
What unfolded before my eyes was an interface that was a dead ringer for a site I’d visited once before.
A dreary blue.
A clunky UI.
And the gallery name stamped in the upper-left corner of the screen.
[Dead Medic Gallery]
Pffft!
I laughed out loud without meaning to.
Dead medic?
Oh, that kind of setup?
Looks like my brain really has gone off the rails after all.
For a hallucination conjured by the brain of some overworked doctor nobody, it had a pretty convincing B-movie vibe.
‘Yeah, my brain’s going absolutely apeshit. Fine, let’s see you solve this.’
I happened to think of a patient my internal medicine friend had been worrying over for a while recently.
After texting that friend to find out the patient’s chart number, I decided to try posting the details in the gallery.
‘How do I write? Do I just imagine typing on a keyboard?’
As I pretended to type on an imaginary keyboard in my head, letters began appearing in the gallery’s post window before my eyes as if by magic.
Oh.
It works.
Maybe my imagination was better than I thought.
[Dead Medic Gallery]
===============================
I have a FUO(*Fever of Unknown Origin, fever of unknown cause) patient—can someone take a look?
Author: Hell-Joseon Slave 1
68-year-old male. A high fever above 38.5°C has persisted for 4 weeks. He has a rash. Being treated under suspicion of relapsing polychondritis, but he’s not improving.
===============================
Then I copied the lab results below it verbatim.
===============================
The patient keeps running a fever and looks like hell, but I don’t know the cause. What else should I check?
===============================
Done.
This should be enough.
I submitted it by imagining the submit button.
I wondered who in this crazy hallucination would even bother replying.
That thought was shattered in less than a second.
[A new comment has been posted.]
ㅇㅇ (118.235): Autoimmune? I think it might be VEXAS, get it tested.
The fact that even the IP address showed up meant the delusion’s details were alive and well.
118.235 is a Korean IP, isn’t it.
But VEXAS?
“What the hell is VEXAS, for fuck’s sake.”
I’d never even heard of that disease before.
My brain was impressive, making up crap like this.
I laughed dryly, but without even realizing it, my fingers were already picking up my phone and opening UpToDate, the doctors’ bible.
I typed ‘VEXAS’ into the search bar.
And the moment the search results appeared on the screen, my heart dropped with a thud.
[VEXAS syndrome]
Vacuoles E1 enzyme X-linked Autoinflammatory Somatic syndrome
Surprisingly, this search result matched the condition my co-resident was worrying over.
An adult-onset autoinflammatory disease caused by a somatic mutation of the UBA1 gene.
The main symptoms are recurrent fever, hematologic abnormalities such as anemia, skin rash, chondritis, vasculitis...
I held my breath.
The screen text and the patient chart details I’d just casually skimmed over started swirling together in my head like a storm.
‘The patient has an erythematous rash on his face.’
‘CBC results: everything else was normal, but the red blood cell count was slightly low. Mild anemia.’
‘He’d also complained that the ear cartilage area was red and swollen.’
‘Shit?’
No other word came to mind besides a curse. The words VEXAS Syndrome on my phone screen were burning so brightly they seemed to sear my retinas.
And what had told me that was the insane hallucination called [Dead Medic Gallery] inside my head.
I immediately picked up my phone.
[Internal Medicine (but doesn’t know internal medicine) R1 Kang Taejin]
beep-
Brrrrrrr-
Brrrrrrr-
click-
“Hello?”
[Hey, why? Hyunjae, what’s up, something happen?]
“You know that patient you were complaining about last time.”
When I asked, Kang Taejin looked puzzled and asked me back.
[Which patient? Damn, I’ve got so many patients. Patients I can actually look at are...]
“The patient you said was suspected of Sweet syndrome(*a type of skin disease) with vasculitis! You said not long ago that relapsing polychondritis was suspected too.”
[Ah... oh. That patient. Why? Did something... happen? It’s not a patient who’d be in the ER, is it?]
“No, it’s just....”
Damn it.
What the hell am I supposed to say?
I think I know the definitive diagnosis for the patient admitted to your department, but actually it was told to me by something that’s probably a figment of my hallucinating brain...
I probably shouldn’t say that.
“I found it while looking through a paper. It seems to match that patient’s diagnosis, so.”
[What is it? What disease is it?]
“VEXAS syndrome.”