Chapter 11
Once, the people who might have been called the hands of God in their own fields were going wild over a mere diagnosis from a first-year resident, even after death.
Were they that starved for real patients and clinical practice?
These insane workaholic ghosts.
That moment brought back the image of me stitching up a child's forehead earlier.
That crooked, disastrous suture.
What would have taken other seniors five minutes took me twenty minutes of straining just to barely finish.
In the end, even Senior Choi Soomin couldn't bear to watch and came over to finish it, saying, “Hyunjae, you still need more practice with your procedural skills.”
I could borrow a brain, but I couldn't borrow hands.
I impulsively started writing a post in the gallery.
Title : But, guys, seriously
Author : HellJoseonSlave1
How do I get better at manual dexterity? It takes forever even to suture the forehead of someone who fell down. Any tips?
Posted.
After posting it, regret came rushing in.
Ah, fuck.
Did I post this for nothing?
What if they mock me, saying, 'A clumsy-handed idiot should quit being a doctor'?
***
I closed the gallery window.
I was the idiot for expecting anything.
Anon (14.52) : Keep at it and you'll improve.
Back-in-my-day : Buy some pig skin and practice stitching it at home every day. Back in my day, that's how we all did it.
In-the-OR-corner : These days there are tons of suturing lectures on YouTube. Go look those up instead. Don't just sit there like an idiot.
Scalpel God : Hands are a matter of talent. If you can't do it, you can't. You're better off using your head.
...Fuck.
I laughed bitterly and leaned my head against the wall. This godforsaken gallery didn't even download hand skills for me.
Ha, maybe there'd be a use for possession instead.
Will the day ever come when I gather 5,000 LP and can summon Scalpel God to possess my body for 30 minutes?
That was when I was wallowing in self-loathing.
The automatic doors at the emergency room entrance slid open softly, and an entirely unexpected person appeared.
It was Professor Choi Young-joon from rheumatology, whom I'd met a few days earlier because of the VEXAS syndrome patient.
My heart sank.
Why now?
Why the ER, of all places?
Don't tell me he's here to chew me out because it wasn't VEXAS?
Professor Choi Young-joon walked straight toward me without even looking around.
“Han Hyunjae.”
“Yes, Professor! What brings you here!”
I sprang to my feet reflexively and bowed.
Professor Choi returned my greeting with a light nod, then shoved the tablet PC he was holding in front of my eyes.
“I was just passing by while checking the patient's progress, and today's bone marrow test results were a little interesting, so I stopped by.”
The screen showed a test report crammed full of all sorts of English abbreviations and numbers.
Bone marrow biopsy result : Hypercellular marrow with prominent erythroid and myeloid dysplasia… prominent ring sideroblasts(18%)…. UBA1 somatic mutation confirmed.
(*Bone marrow biopsy result: Marked erythroid and myeloid dysplasia observed in the hypercellular marrow. Prominent ring sideroblasts (18%) confirmed. UBA1 somatic mutation confirmed.)
“Han, seeing this result, does anything come to mind? You said you were interested in rheumatic diseases, right?”
Since it's a VEXAS patient's result, of course it must be related to VEXAS.
But I had no fucking clue what these numbers and terms actually meant.
Fuck. Code red.
My mind went blank. Since the UBA1 mutation had been confirmed, the VEXAS diagnosis was certain.
But there was no way a first-year like me would know the clinical significance of the other findings. Besides, I'm an emergency medicine doctor, not an internist.
Either way, to avoid wrecking my image, I had to desperately stall for time.
I put on the most intelligent expression I could and pretended to stare at the tablet screen.
At the same time, the gallery window was opening at lightning speed.
Title: Guys what is this urgent;;; VEXAS patient bone marrow test result
Content: (photo scan) What the hell does this mean? Hypercellular marrow, dysplasia, ring sideroblasts 18%?
At the same time, I opened my mouth and started bullshitting to buy time.
“Uh, Professor. Could I have a moment? In my view, when you take these bone marrow findings and the genetic markers together, it's hard to regard this as just a sign of an autoinflammatory disease...”
I strung words together and spewed nonsense into the air.
Professor Choi Young-joon watched me with interested eyes, arms crossed.
Please, just one comment!
If my desperate plea reached him, a tiny notification finally flashed at the edge of my vision.
Heme-Onc-is-Hell : Besides the UBA1 mutation, the MD
S(*Myelodysplastic Syndrome, myelodysplastic syndrome)
findings are clear. If the ring sideroblasts are 15% or higher, that's high risk. It means VEXAS has progressed to MDS. The prognosis is fucking terrible, and from now on you need to work out chemo or hematopoietic stem cell transplant plans with hematology-oncology. Otherwise it'll turn into leukemia within a few years.
The fog in my head cleared all at once.
“Professor, I'll start with the conclusion.”
Professor Choi Young-joon's eyes widened slightly.
“This patient is very likely already progressing into myelodysplastic syndrome, in other words, the precursor to blood cancer.”
I pointed at the 'ring sideroblasts 18%' part on the tablet with my finger.
“Especially since the ring sideroblasts are over 15%, which is a high-risk finding, there's a very high chance it'll convert to acute myeloid leukemia within a few years. Right now, we need to contact hematology-oncology and set up a new treatment plan that includes chemotherapy, and in the long term, possibly even allogeneic hematopoietic stem cell transplantation.”
After I finished speaking, a heavy silence fell over the ER station.
Professor Choi stared at me in disbelief, his mouth slightly open.
At first, it seemed like mere intellectual curiosity.
An expression that seemed to say, 'Oh, not bad.'
But as my explanation went on, Professor Choi's gaze changed to shock.
Professor Choi stood there with his mouth open, staring blankly at me for a long time. During that time, I was almost choking.
Did I go too far? Was I showing off too much for a first-year? Was trying to barge into hematology-oncology territory making me look arrogant?
“Han.”
“Yes, Professor.”
“Are you preparing for double board certification in internal medicine, by any chance?”
…?
“...Pardon?”
A stupid sound escaped my mouth.
Double board.
One doctor earning two specialist certifications.
And he's asking me that?
Seeing my dumbfounded expression, Professor Choi soon seemed to realize his question was absurd, and he gave a small laugh and shook his head.
“Ah, no. Right. I guess I went too far. Our hospital's emergency medicine department really brought in a major talent.”
Professor Choi lightly patted my shoulder, clearly impressed.
“I learned a lot thanks to you today. I'll be sure to pass it on to the department head.”
With that, Professor Choi turned around with a relieved look and left the emergency room.
Wait, what?
The department head? What exactly are you going to tell the department head?
Hey, what the fuck?
I could feel the looks around me change.
While I stood there in that awkward silence, a huge shadow fell over me from behind.
I turned around very slowly.
There was Senior Lee Minjae, the emergency medicine chief resident, staring at me with his mouth hanging open—I had no idea how long he'd been standing there.
He must have heard every word of the conversation between Professor Choi Young-joon and me from start to finish. That expression said it all.
The chief kept glancing back and forth between where Professor Choi had disappeared and me, looking dazed as if he'd seen a ghost.
“You crazy bastard!”
Whoosh!
Senior Lee Minjae grabbed both my shoulders.
No, why this time? Why are you trying to bully me again?
“You... you bastard! You're secretly preparing for double board certification too?! No wonder! No wonder you seemed so off!”
At the chief's roar, I couldn't come to my senses.
“Hey! So that's why you were so sharp on internal medicine cases? Huh? All those rare diseases you rattled off that none of us knew were just groundwork for switching over to internal medicine? Emergency medicine was just a stepping stone? You were planning to betray us, the comrades of this ER, and switch over to internal medicine, you traitor!”
The chief's scream had already crossed the river of misunderstanding and was heading for the sea of delusion.
All I could do was stand there and sway. My head was starting to spin, but even so, I kept my mouth shut.
Explain?
What could I even say?
Besides, that guy looked like he wouldn't care no matter what I said.
Damn it, senior, a first-year isn't preparing for double board certification.
I'm just a lowly newbie whose only goal is to survive each day without getting chewed out and without killing any patients.
Double board? No way. Right now, I'd have no complaints if I could just eat a double cheeseburger and get some sleep, fuck.