Chapter 111
Chirp chirp. Chirp-chirp-chirp.
The warm midday sunlight slipped through the gap in the ER's automatic doors.
I slouched in the station chair and nudged my co-resident Kim Jihoon, who was staring blankly at the monitor beside me.
“Jihoon.”
“What?”
Kim Jihoon answered without even turning to look.
“There's a Chinese buffet that opened in front of the hospital—want to go sometime?”
At my suggestion, Jihoon's pupils moved ever so slightly.
Hospital food—convenience store lunch boxes—delivery food.
A word that stirred the taste buds of a resident worn down by this endless, miserable triangle.
“Chinese?”
“Yeah. Jjajangmyeon, jjamppong, fried rice, sweet-and-sour pork. I heard they even have chili shrimp. What do you think?”
“How much?”
The most important question.
For us, with so much money going out of our salaries, value for money was life itself.
“9,000 won.”
At last, Kim Jihoon turned to look at me.
The dead-fish eyes finally came alive.
“Damn cheap. Let's go.”
“When do you want to go? After work today?”
“Deal.”
Simple happiness.
To think I could get this excited over a 9,000-won Chinese buffet.
It was also proof of how ruined our lives had become, but whatever.
They said the sweet-and-sour pork was all-you-can-eat.
With all the mild cases, the work was physically exhausting, but with no critical patients, things had been relatively easy mentally.
Just as we were about to move on to a serious debate over whether sweet-and-sour pork should be eaten poured over with sauce or dipped on the side.
“Someone's trying to kill me!!!! Help!!! Aaaah!!!! Wah!! Eek!! Ugh!!!!!!!”
A shrill scream that seemed ready to tear our eardrums came from the parking lot outside the ER.
“…What was that?”
Kim Jihoon frowned.
The very next moment, I sprang to my feet without even realizing it.
Bang!
Faster than the ER's automatic doors could open, a stretcher cart rammed into them and burst inside.
“Doctor! We need restraints on this patient! Can we fit her on the stretcher?!”
The paramedic's urgent cry.
And two uniformed police officers following behind them.
They were drenched in sweat as they struggled to restrain a woman flailing madly on the stretcher.
“Let go!! I said let go!! Those people are trying to kill me!! Aaah!!”
She looked to be a woman in her early twenties.
Her hair was a mess, covering her face, and her eyes were rolling wildly.
Foam clung to the corners of her mouth.
Like someone possessed by a demon, she writhed and thrashed as if she might fling herself free even with three adult men holding her down.
“Gah! Bite! You won't let go?!”
“Patient! Calm down! This is a hospital! We're trying to help you!”
“Shut up! You're all in on it too! I know it! You're trying to take out my organs! Aaaah!”
Paranoia.
Violent behavior.
Risk of self-harm and harm to others.
The nurses and emergency medical technicians beside me sprang into action reflexively.
“Bring the restraints! Hurry! Four-point restraints!”
“Should we prepare a sedative, doctor?”
In an instant, the middle of the ER turned into chaos.
Other patients recoiled in alarm, and some even turned on their phone flashlights as if they were watching something fascinating.
I let out a deep sigh at the sight.
They shattered the sweet fantasy of a Chinese buffet.
What a sad thing that was.
“Ah, shit.”
The curse slipped out on its own.
Patients who are beyond being talked to are pretty troublesome.
They're the ultimate in physical labor: you have to pin them with your whole body, get the needle in, and restrain them.
“Psychiatric emergency.”
Kim Jihoon shook his head with a tired look.
Seeing that the police had come too, she must have been forcibly brought in after causing a scene on the street or in some public place.
For a patient like that, if you don't calm them down first, you can't even begin the exam.
And if you screw up, you're likely to get hit or bitten.
“Let's go.”
I got to my feet.
To protect my lunch sweet-and-sour pork, I had to quell this ruckus as fast as possible.
Wait for me, dipping-sauce sweet-and-sour pork.
I put on gloves and walked toward the bed where the screaming was echoing.
“Let go! Let go of this! There's a ghost over there! It came to rip out my eyes!”
The patient screamed, clawing at the air.
Person, place, time.
A state where none of them are properly recognized.
Disorientation.
Check, first.
On top of that, there were clear auditory and visual hallucinations, along with an uncontrollable state of extreme agitation.
It was the textbook picture of acute psychosis.
“Ativan, please! Four milligrams! Right now!”
Kim Jihoon cried out urgently as he held the patient's arm down.
The nurse expertly snapped open the ampoule.
“Ativan 4 mg IV going in!”
Ativan.
Generic name: lorazepam.
A benzodiazepine sedative.
A drug that calms the brain's excitement; in the ER, it's basically the emergency stop button for rampaging patients.
Usually, if you push this much into a vein, even the most feral drunk would turn into a meek lamb and be out cold within five minutes.
“Ugh! What is this! Did you put poison in my body just now?! You bastards are trying to poison me!”
The patient convulsively twisted the moment the needle went in.
Kim Jihoon and the paramedic pinned her down with their whole bodies.
“It went in! I'll check the vitals now!”
As the nurse took the vitals, the monitor displayed the numbers.
[BP : 160/95 / HR : 128 / RR : 24]
“Uh... BP
(* blood pressure)
is a little high. Her pulse is fast too.”
“Isn't that just because she's excited?”
Kim Jihoon said nonchalantly, sweating buckets.
Come to think of it, if she were shouting and rampaging like that and her blood pressure were normal, that would be stranger.
Her sympathetic nervous system must be floored.
“No idea. For now, keep holding her. Watch her until the meds kick in. I'm going to go do some history-taking
(* patient history)
with the guardian.”
I handed the patient over to Kim Jihoon and went up to the middle-aged woman pacing at the ER entrance.
She seemed to be the patient's mother.
“Hello. You're the guardian, right?”
“Y-yes... Doctor, my child... my child right now... that...”
The mother, pale as a sheet, grabbed my sleeve.
“Please calm down, ma'am. I have a few questions. To make an accurate diagnosis, I need your help.”
I asked in as calm a voice as I could.
“Has the patient ever had any psychological trouble before, taken medication for depression, or... said she was seeing things or hearing anything unusual like today? Has she ever been to a psychiatry clinic?”
Checking whether there was a history of schizophrenia or bipolar disorder was the top priority.
If she had a preexisting psychotic illness, there was a high chance she had relapsed after stopping her medication.
But the mother shook her head vigorously.
“No... nothing like that at all. She was such a good, quiet kid. She went to school well, worked well... but then this morning all of a sudden she started screaming...”
“Does she drink often, or take diet pills or anything like that?”
“She can't even drink alcohol. She doesn't take any medication either.”
Even after the history-taking, I couldn't get a clear answer.
No past history.
No family history.
No medication history.
Social history unremarkable.
Nothing especially unusual.
“Hmm....”
I rubbed my chin.
First-episode psychosis?
Of course, schizophrenia often first appears in the early twenties.
But the guardian's account was too clean.
Was she saying the condition had deteriorated this drastically overnight, with no prodromal symptoms at all?
“Hmm... but a patient who goes to psychiatry might not disclose their medical history...”
Plenty of people secretly go to psychiatry or hide their pills and take them.
You can't trust the guardian's words 100%.
“Does the patient usually go to a specific hospital? Our hospital, or another nearby one?”
At my question, the mother thought for a moment and answered.
“Ah, here... she did come often. Whenever she had severe body aches or got really sick, she'd always come to this university hospital. Our home is right nearby.”
“Ah, yes, I understand. Please wait in the waiting room for now. We'll check the records and let you know.”
I guided the mother to the waiting room, then immediately walked toward the triage desk.
If she's a regular at our hospital, there should be something in the EMR, the electronic medical record.
This is one of the blessings of the 21st-century information age.
That is, being able to look up records right away without having to run around searching for them.
Anyway, if that patient had really come in before with related symptoms, there had to be something on file.
Such as a psychiatry consult note, or prescriptions for sleeping pills and the like.
“Nurse Jung, can you pull up that patient's EMR for me? I need to check her past history.”
“Yes, just a moment. The registration number is...”
Nurse Jung tapped away at the keyboard.
The patient's medical-record timeline popped up on the monitor.
…
“...Huh?”
I frowned at the monitor.
Clean.
Too clean.
Psychiatry?
No visit history.
Neurology?
None.
There were a few ER visits, but...
[2023.05.10 - Acute gastroenteritis (AGE)]
[2022.08.12 - Ankle sprain]
...
They were all minor conditions.
There was no history of psychotropic prescriptions either.
She really was just a normal patient who came in when she was sick, just as her guardian said.
And even looking at the most recent record at the top...
Ah, here it is.
Record from three days ago.
[Chief complaint: fever, sore throat, cough]
[Diagnosis: Acute Pharyngotonsillitis (* acute pharyngotonsillitis)]
[Prescription: Brufen tablets, Amoclan tablets, 3 days' supply]
[Attending physician: Park Se-young]
….
Her most recent visit history was just that she'd come to the ER three days ago with a bad cold.
Think, Han Hyeonjae.
Piece together all the memories of being chewed out, being run ragged, and the information.
..
A cold and pharyngitis.
And three days later, acute confusion and hallucinations.
I kept thinking of the fever on the monitor and the 37.8-degree reading I'd seen during the vitals check earlier.
This might not be ordinary psychosis.
What if a perfectly normal person went wild and started rampaging right after catching a cold?
‘..This is weird.’
What if there was something wrong with the brain itself, not just a psychiatric problem?
An organic cause.
Encephalitis.
A chill ran down my spine.
I turned my head back toward the ER.
Ah.
I think I've got it.