It's Not Psychosis (3)

Lee Minjae suddenly wedged himself between Hwang Juhyeok and Kim Jihun without anyone noticing when he'd arrived.

In his hand was a can of coffee, as always.

"Ah, Doctor."

Hwang Juhyeok flinched slightly at the sight of Lee Minjae.

Right, right—our EM's biggest lunatic, Dr. Lee Minjae, had shown up.

"Explain. Why is the patient still here? Didn't the diagnosis come back?"

As Lee Minjae asked, looking at Kim Jihun, Kim Jihun voiced his grievance.

"The teratoma was confirmed and the clinical symptoms fit, so I requested a neurology admission, but Dr. Hwang says the MRI is normal and that since it hasn't been confirmed, he'll hold off on admitting her."

Lee Minjae slowly turned his head toward Hwang Juhyeok.

"Oh, yes, Dr. Hwang from Neurology?"

"Yes."

"A woman in her twenties is showing full-on suspected encephalitis symptoms, and she's got the lump in her belly as the proof. And you're saying, 'The MRI is clean, so let's send her home'? Is that what I'm hearing?"

"I'm not saying to send her home. I'm saying we should watch her a little longer and be cautious until it's confirmed..."

"Ah, so you want to watch her. Then where? In the ER? For a neurology problem?"

Lee Minjae took a step closer.

"If we keep her here and she seizes and stops breathing, are you saying Dr. Hwang will take responsibility for that? Please be clear."

"That's..."

"You know if it progresses quickly, she'll go into respiratory failure and need a ventilator. If you waste the golden time worrying about your clock-out time and the patient ends up in the ICU, are you going to handle all of that?"

Hwang Juhyeok's face turned red.

"No, I'm not doing this because I want to get off work..."

"Then admit her."

Lee Minjae cut him off.

"The CSF results? Keep her admitted and wait. Have her wait on the ward while we give her steroids. If it's not that, then we can transfer her to psych. Is sitting around in the ER waiting for results and ending up killing the patient the medicine you learned?"

Lee Minjae drove the nail in.

"If you absolutely can't accept her, then I'll just call the neurology on-call staff. I'll say, 'The on-call resident is insisting the patient can't be admitted until it's confirmed, and I'm calling to get confirmation that if the ER keeps her and something goes wrong, it's not our responsibility.'"

Lee Minjae made a show of pulling his phone out of his pocket.

"A-ah... no!"

Hwang Juhyeok frantically waved his hands.

"Admit her now... I'll admit her. We'll coordinate with OB/GYN, set the surgery schedule, and move her up to the ward right away."

Only then did Lee Minjae smile.

"Yes, thank you. Then please take good care of her, Dr. Hwang."

"Yes..."

Hwang Juhyeok trudged out of the station with a shit-eating expression.

That was a perfect bit of traffic control.

I watched the scene from the corner and applauded in my heart.

As expected, you catch a mad dog with another mad dog.

That thug-like streak of Lee Minjae's is really reassuring at times like this.

Then, when I looked toward the sound of shoes from the opposite hallway, a doctor in a white coat over green scrubs was striding toward us.

It was Yoon Yuseon, a third-year OB/GYN resident.

"Where's the teratoma patient who was consulted on earlier?"

"Ah, Doctor! Over here."

Yoon Yuseon glanced at the patient's CT images and nodded.

"It's big... packed full of teeth and fatty tissue inside."

Yoon Yuseon turned her head and asked,

"It's a typical dermoid cyst. This caused encephalitis?"

"Yes. Neurology has already decided to admit her, and they think the symptoms will likely improve if it's removed surgically."

"Makes sense. Removing the cause comes first."

Yoon Yuseon coolly closed the chart.

"If she's admitted to neurology, we'll come in as a consult and schedule the surgery. If we take it out laparoscopically, it'll be over quickly. Where's the patient's guardian?"

"They're in the waiting room."

"I'll go get the surgical consent and explain everything. Let's get ready right away."

Clean, no-frills work.

It was on a completely different level from arguing with Hwang Juhyeok for over ten minutes.

The surgical departments really are so refreshingly decisive.

***

The patient's bed started moving.

I let out a long breath as I watched the bed disappear down the hall.

"Hoo..."

It was over.

Kim Jihun, who had been beside me, draped an arm over my shoulder.

"Hyeonjae, I'm really afraid of you."

"For what?"

Why the hell was he putting on such a show all of a sudden?

"Diagnosing a psychiatric patient with a gynecological disease and admitting her to neurology? Does that even make sense? It's not some medical drama."

"Exactly."

"When you said to order that abdominal CT earlier, I really thought you'd lost your mind."

"We're both crazy."

We chuckled as we headed back to the station.

Before I knew it, the clock was creeping toward quitting time.

My steps were light.

Because at the very least, it felt like I'd earned my keep for the day.

"Let's go eat. My treat."

"What the hell...? Did you eat something weird or something?"

"We handled a rough case."

We stepped out of the hospital and took a deep breath of the night air.

***

"...You're treating us to chicken?"

Kim Jihun asked in disbelief, looking at the plate in front of him.

"Of course it's chicken. Just look at the golden sheen of that olive oil."

I lifted a chicken leg and declared reverently,

"It's that ridiculously expensive chicken I wouldn't even order at home because the delivery fee feels wasteful..."

"Hey now, that's why you should be happy I'm splurging on this for you. Chicken tastes best when someone else pays."

"But for something you're treating us to, the portion size is kind of... You should at least have bought enough to butcher a whole cow."

Kim Jihun grumbled as he grabbed a chicken wing.

"Shut up. I had my pay docked even as a first-year, so I have less money than you. My bank balance is at an adorable level."

"No lies, Hyeonjae. Word is, you used to make a ton of money as an assistant for online lecture instructors. Where'd all that money go?"

Kim Jihun shot me a suspicious look.

"Hey now, I already blew it all on the romance of my pre-med days."

"That wasn't romance. That was waste."

We chuckled and clinked our glasses.

The cold carbonation sliding down my throat felt like it washed away some of the fatigue and tension I'd built up all day.

So we talked for a long while.

The usual everyday stuff—like how one professor had gotten extra hysterical lately, or how next month's duty roster was hell.

That was around when half the chicken had disappeared and the beer glasses were starting to empty.

"Hyeonjae."

Kim Jihun suddenly spoke up.

"Yeah."

"You know that mortality

(* Mortality, death case)

case from last week, right?"

"...Yeah. I know. What case was that again?"

I paused in the middle of tearing apart the dry chicken breast.

"That... elderly patient who came in with abdominal pain."

Kim Jihun gave a bitter smile.

"He just said his stomach hurt a little. He had some diarrhea too. His vitals were stable, there was no tenderness, and the inflammatory markers in his bloodwork weren't that high. So we thought it was just acute gastroenteritis. We gave him painkillers and fluids and watched him for a bit, and when the pain seemed to ease up, we were going to send him home."

Hmm, I half remember it.

"But then he suddenly collapsed. He went into arrest, and after CPR we barely got ROSC. When we did a CT... it was superior mesenteric artery thrombosis. His bowel had already gone completely necrotic, so he ended up dying without even making it to the operating room."

Superior mesenteric artery thrombosis.

It's a disease where a blocked blood vessel causes the bowel to die, but in the early stages the test results are normal and the symptoms are vague, so it's notoriously brutal to diagnose.

The thing about it is that the abdominal pain is wildly out of proportion to the test findings, but when elderly patients just say it feels like indigestion, it's hard to catch.

"No, I don't know. Seriously."

Kim Jihun lowered his head.

"Whoa, why are you making such a scene out of nowhere? I thought I'd gotten somewhat numb to death. The professors said there was nothing they could have done."

"No, that's part of it, but..."

Kim Jihun fiddled with his beer glass.

"What really got me thinking was..."

Kim Jihun lifted his head and looked at me.

"Wouldn't you have been able to save him? That's what I thought."

"What?"

"If it had been you, wouldn't you have saved that old man? Just like you found the ovarian teratoma today. Just like when you saved someone with an SGB on that helicopter. If it had been you, wouldn't you have picked up on something off about that vague abdominal pain patient and ordered a CT?"

I couldn't say anything.

"Isn't it funny? Thinking that way about a resident in the same year as you. I'm not talking about some famous doctor or professor on TV. I'm talking about looking at you and thinking that."

Kim Jihun burst out laughing.

Well, I don't know if you could really call that laughter.

"I followed the textbook and missed the patient, while you think of things not even in the manual and save the patient. That difference felt way too big. So I ended up feeling sorry for that old man, like he died because he met me instead of you."

"No, hey. Don't say that. That's not right."

I hurriedly cut him off.

My heart dropped.

"They even said later that even the staff would have had a hard time saving him. They said it was one of the nastier kinds of thrombosis. Why are you pushing the guilt onto yourself? Do you think I know everything? I miss things too."

"No, I really... haah..."

Kim Jihun rubbed his face with both hands.

...What could I say?

I shut my mouth.

I couldn't force out any words of comfort.

Because whatever I said would feel like deception.

'Wouldn't you have been able to save him?'

The weight of those words pressed down on my shoulders like a thousand tons.

In truth, Kim Jihun was among the sharper second-years in our department.

He had good intern grades, and studied hard.

He read papers diligently and did procedures cleanly, by the book.

For an ordinary doctor, he'd be the kind of talent people would call an ace.

And yet, because of me.

Because of all those absurd cheat-code plays the countless veteran ghosts had shown through my body, Kim Jihun—who was working hard the orthodox way—was feeling relative deprivation and self-loathing.

I was no different from using cheat codes myself.

But I can't tell the truth.

I can't exactly say the ghosts in some community were giving me pointers.

I lifted my beer glass and drank.

The bitterness lingered in my mouth.

I set down the empty glass and said,

"You're doing well enough. I was just lucky too."

"They say luck is a skill too."

"No, it was really luck. And..."

After hesitating for a moment, I spoke honestly.

"I don't know. How can I be sure I'd have saved him?"

"..."

"If it had been me, I might have just given him stomach medicine and sent him home too. How are you supposed to get it right every time unless you're a god? We're not gods. We're just people on a paycheck."

I poked through the remaining pieces of chicken with my chopsticks.

"We can only... do the best we can within what we can do, and accept the outcome."

Kim Jihun stared at his beer glass without saying anything.

The noisy clatter of the chicken place swirled around our table.

Kim Jihun's self-loathing wouldn't go away easily.

And the guilt I felt over my own genius didn't seem like it would go away easily either.

"We just save as many as we can, within what we can do."

"...Yeah."

We wordlessly went back to tearing at the chicken.

For some reason, the chicken felt especially hard to swallow today.

"Ah, it's the tough breast meat."