Chapter 10
Senior Lee Min-jae's prophecy became a curse and came true exactly as foretold.
From that day on, my standing in the emergency medical center changed completely.
Of course, I should probably say it wasn't a positive kind of standing.
No, maybe you could even say this was positive standing, in a way.
One thing was certain: for me, it certainly wasn't a particularly positive situation.
Of course, it was good for my classmates and juniors. After all, the reason my standing had risen in the first place was partly because of them.
But the seniors shouldn't be happy about it, should they? I know it might be a hassle to come ask me yourselves, but come on, you old bastards.
Even so, the first-year is busting his ass right now. At least look at me once in a while, would you?
In any case, I was no longer a mere first-year scrub; I had become an embarrassing, pressure-filled figure with titles like “the god of diagnosis,” “a walking UpToDate,” and “the juniors' savior.”
And the price was horrific.
“Dr. Han Hyeon-jae! Wait a moment!”
At 3 a.m., just as I was growing dazed from handling the flood of patients, one intern ran up to me with a pale face. He was holding the EKG printout he'd just taken.
“There's a 78-year-old female patient who's been complaining of epigastric pain and nausea, and it seems like simple indigestion, but I ran an EKG just in case, and it's a little ambiguous...”
The intern's voice was almost a whisper.
I sighed inwardly and took the EKG.
At first glance, it didn't look much different from a normal ECG. But as the intern had said, the ST segments from V1 to V3 were minutely depressed by about 0.5 mm. If I were in the early days of my first year, I'd probably have brushed it off as “within the margin of error” or “a nonspecific change.”
I held the EKG and stared at a point in the air for a moment.
‘Access the gallery.’
Title: 78/F, epigastric pain, nausea. Slight ST depression in V1-V3 on EKG. Differential?
Author: HellJoseonSlave1
Half a second after I posted it, that 118.235 IP showed up again.
Anon (118.235): Posterior MI
(*Posterior Myocardial Infarction, posterior wall infarction)
Suspected. Get leads V7-V9, idiot.
I checked the answer and turned my gaze back to the intern.
“Given the patient's age and symptoms, we can't rule out atypical myocardial infarction. In particular, this could be a posterior wall infarction, so attach extra leads V7 through V9 to the patient's back and redo the EKG. And send troponin
(*Troponin, a protein found in heart muscle)
and cardiac enzyme labs out right away, and notify me when the results are in.”
“What? Posterior wall infarction? Ah! Got it!”
A moment later, the additional EKG the intern brought showed clear ST-segment elevation in leads V8 and V9.
A textbook posterior myocardial infarction. I immediately called the on-call cardiologist, and the patient was rushed off for an emergency procedure.
I had nearly let another patient be left as simple indigestion until his heart muscle rotted away.
Proud.
***
Things like this repeated several times a day.
“Hyeon-jae, take a look at this patient. He's a 25-year-old man, the X-ray is completely normal, but he's had a dry cough and a fever for a week. Something feels off.”
My classmate Kim Ji-hoon scratched his head and asked me.
‘Access the gallery. [25/M, dry cough, fever. Chest PA normal. R/O?]’
Anon (14.52): Mycoplasma pneumoniae
(*Mycoplasma pneumonia, a type of atypical pneumonia)
Exactly. Atypical pneumonia usually doesn't show up well on X-rays. Azithromycin
(*a type of antibiotic)
Put him on it.
“...Hmm, even if the X-ray is clean, it could still be atypical pneumonia. Since Mycoplasma infection is a possibility, I think it'd be best to start azithromycin empirically for now.”
“Ah, right! Atypical pneumonia! I almost sent him home with cold medicine.”
Kim Ji-hoon was genuinely impressed and slapped my shoulder.
‘The guy who, whenever you ask him something, suddenly stares into space, thinks hard for a bit, and then gives you a brilliant answer a moment later.’
That was my new nickname.
To the intern who said he'd twisted his ankle and there was an ambiguous bone fragment on the X-ray, I told him, “That's an accessory bone
(*an extra bone fragment attached to normal bone)
so just leave it alone,” and to the classmate who said a child kept tugging at his ear and fussing, I advised, “If there's no redness on the eardrum, a bug may have gotten into the ear canal, so look in with an otoscope.”
Thanks to this gallery, I had to keep spitting out knowledge far beyond my training year at every turn.
Most of them were things that, once you had even a little experience, were supposedly easy to differentiate and easy to think of.
Of course, since I was a lowly first-year bastard, I couldn't properly recall most of those cases.
Before I knew it, it was past 5 a.m.
Worn ragged by the endless barrage of questions, I hid in a corner of the supply room, out of everyone's sight.
As I leaned my head against the cold wall, my eyes slowly closed.
Please, let no one come looking for me for even just one minute.
Fuck. Please just ask the senior residents.
Don't come to me; go ask those third- and fourth-year residents sitting over there, you bastards.
I don't know either.
I'm just a first-year too, just like you guys.
***
With my head against the cold supply-room wall, I opened the system window to check the reward for my labor.
For the past few hours, I had been moving nonstop, thinking nonstop, and giving answers.
I had become the savior of interns and classmates, preventing their mistakes. What, exactly, was my reward for that?
I clicked the LP acquisition history. A small list appeared on the screen.
[Posterior wall infarction diagnosis assistance: +10 LP]
[Atypical pneumonia diagnosis assistance: +5 LP]
[Accessory bone differential diagnosis assistance: +2 LP]
[Ear canal foreign body differential diagnosis assistance: +2 LP]
[Urinary tract infection diagnosis assistance: +3 LP]
…
That's it? What the fuck?
All together, it was 22 LP. My total LP had reached 622 points. I let out a hollow laugh.
Damn, they're all tiny cases, and the ones I confirmed don't count as cases I treated myself, so LP barely piles up at all.
The system was cold. Diagnostic assistance was just assistance; it didn't grant a full reward.
Only when I personally took the patient's history, made the diagnosis under my own responsibility, and started treatment with my own orders did proper points come in.
As things stood, acting as a human consultant who just cleaned up other people's messes, it would take me several months just to gather 1,000 LP, let alone 5,000.
I irritably closed the LP window and switched to the main screen of [Dead Doctors Gallery].
I wanted to see what kind of meaningless nonsense those ghost bastards were spouting now.
And then I couldn't believe my eyes.
The gallery's popular-posts list was plastered with stories about me.
Title: HellSlave1 absolutely nailed the Posterior MI diagnosis, lol
Author: Anesthesiology & Pain Medicine
That intern kid almost brushed it off as simple indigestion, but HellSlave1 came to the gallery to ask about it and caught the posterior wall infarction. Pretty good. Keep coming by to ask us, kid.
Title: Today's HellSlave1 atypical pneumonia case, Doxycycline instead of Azithromycin
(*Doxycycline, a type of antibiotic)
would that have been okay?
Author: BackInMyDay
Azithromycin is a good choice too, but if it were me, I think I would have used Doxycycline. What do you guys think? Let's have a discussion on this topic.
Title: Thanks to Lord HellSlave1, the gallery's been fun lately
Author: BoneNerd88
Thanks to this guy, even after dying I can keep up with the latest cases and feel like I'm watching patients in real time, which is fucking great. How should I put it? It's got this insanely fresh feel to it. Hard to explain, but that's the vibe.
I stared blankly at the screen, dumbfounded.
These ghost bastards were watching my hellish labor in real time on the gallery and even holding discussions about it.
To these crazy gallery bastards, I was no longer just an ordinary living doctor, but more like the streamer of a 24-hour live broadcast channel, soothing the boredom of these insane ghosts.
I opened one post and checked the comments.
Anon (14.52): They're all easy-as-hell cases, but doesn't it still feel good, like you're actually seeing real patients?
ㄴ PediatricGhost77: For real, lol. And when they make diagnoses while referring to our posts and come back to report it, it really feels like we're participating in the treatment process, doesn't it?
DescendantOfHippocrates: Savages. To think you'd be delighted by such petty cases. Still, it is true that it's a little enjoyable.
These lunatics are treating my patients like a leisure activity.