Chapter 117
The PD turned a page in their notebook with a rather serious expression and picked the next question.
“Doctor, when is it hardest for you as a doctor?”
The camera lens closed in on my face.
I stared off into space for a moment.
The hardest time.
When a patient dies?
When a guardian grabs you by the collar?
Or when you collapse onto the on-call room bed after back-to-back shifts, only for the siren to go off five minutes later?
“...Right now?”
“....”
The PD's pen stopped.
The camera director flinched.
Silence fell.
Crap.
That was the kind of joke I'd make to my classmate Kim Jihun over drinks, not something to say on a nationally aired documentary.
The mood chilled in an instant.
“I'm joking.”
I hurriedly smiled and tried to salvage things.
“...You're joking, right?”
The PD asked back with a relieved look.
“Haha, of course. There was a camera in front of me, so I got nervous and unconsciously got a little greedy with the humor. Hahaha.”
I let out a hollow laugh and inwardly held my head in my hands.
‘...What's wrong with me lately.’
Am I seriously going crazy?
Lately, it feels like my personality's gotten weird.
I used to be timid, sure, but at least I was a polite young man who wore a perfect social mask. Now my inner thoughts keep spilling out without any filter.
Is this the influence of the God of Scalpels?
Is the soul of that personality-wrecked surgery ghost lingering in my brain like residue, contaminating who I am?
Or is it the other ghosts?
Always needling me and praising me.
When I think about being on that godawful medical gallery 24/7, with them training me with carrots and sticks and radiating cynicism itself, it's only natural I'd start getting assimilated without even noticing.
Come to think of it, even that bullshit I spouted at the conference last time about expanding emergency medicine's role....
No, that was exactly why I made such a bold claim.
Was I originally the ambitious revolutionary type?
No.
If anything, I'm more like an ordinary small fry who just wants to coast and steal a paycheck for as long as possible.
But somehow, before I knew it....
I just fell for the God of Scalpels' coaxing that emergency medicine shouldn't stop at simply being a gatekeeper that sorts patients and sends them on, but should expand into more active treatment.
[Hell-slave. You can save them with your own hands, but you're going to let them die because of regulations? Is that a doctor? That's a receptionist.]
I bought into that gaslighting hook, line, and sinker and ended up causing trouble with my own mouth.
And it's no secret that I was actually pretty on board with that argument myself.
Of course, after I got back to the hospital, I got raked over the coals for a week.
Because case reports sit at the very bottom of the literature hierarchy.
Ugh, just thinking about it.
‘Anyway, whatever.’
This isn't the time to be worrying about my identity.
The camera is still in front of me.
I should at least keep the interview going.
“So, do you have anything else you'd like to know?”
When I asked shamelessly, the PD cleared their throat and returned to a professional demeanor.
“Ah, yes. Um... it looks pretty crowded right now....”
The PD looked around the bustling ER.
I quickly checked the status board on the station monitor.
“Yes, it's around 8 p.m. now. There are about seven beds left. They'll probably all be full within an hour or two.”
“Pardon?”
The PD asked in surprise.
“There are still quite a few beds open, though? You're saying they'll be full already?”
“They fill up fast. Because...”
I pointed at the clock with my finger.
“This is exactly when people finish dinner and start drinking. And it's also when accidents start happening as they head out for round two. Besides, conditions that could be handled by a neighborhood clinic during the day come to the ER at night.”
No sooner had I finished explaining than the automatic doors opened as if on cue.
“Patient coming in!”
Rattle-
“Ah, one moment.”
I cut off the interview and turned around reflexively.
I could feel the camera trailing behind me as I ran toward the entrance.
The patient was a woman who looked to be in her early twenties.
She had walked in on her own, but she was practically being dragged along by the friend-like guardian at her side and the nurse.
“Huff... sob...!”
At a glance, the patient's condition was clearly not normal.
For one thing, she was clutching her chest and breathing in harsh, ragged gasps, and her face had gone white as a sheet.
“I... I can't breathe!”
The patient shouted as if screaming.
“My hands and feet are twisting up! Ugh... I can't straighten them....”
I looked at the patient's hands.
Both hands were stiff, curled inward.
And the skin around her lips was trembling.
‘Hyperventilation.’
The diagnosis flashed through my head in half a second, but a doctor should confirm before making a diagnosis.
“What happened? When did this start?”
I asked the triage nurse supporting the patient.
The nurse had already finished assessing the situation.
“She says she suddenly started having trouble breathing after arguing with a friend at a café ten minutes before coming in. No underlying conditions, and she's been under a lot of stress lately. SpO2
(* oxygen saturation)
is 100%, but her respiratory rate is over 40.”
“Oh, okay.”
Stress.
Fight.
Sudden shortness of breath.
Normal oxygen saturation.
And numbness in the hands and feet.
It's textbook hyperventilation syndrome.
“Let's put her on a bed in the B area. Lay her down now.”
I guided the patient to the B area.
The PD and camera followed close behind me.
As soon as the patient lay down on the bed, she started hyperventilating even more violently.
“Doctor! I feel like I'm going to die! I can't get air in!”
“Calm down. You aren't unable to breathe. It's because you're breathing too much. Right now your body isn't short on oxygen; it's because too much carbon dioxide has been expelled.”
I pressed my stethoscope to her chest to rule out any other possible causes.
‘No wheezing. So it's not asthma.’
‘Breath sounds are clear. Not a pneumothorax either.’
‘No heart murmur.’
Differential diagnosis complete.
There's no organic cause.
It's hyperventilation caused by psychological factors.
“Okay, ma'am. Look at me. Follow my breathing.”
I held the patient's shoulders and made her focus on my breathing.
“Close your mouth. Don't breathe through your mouth. Slowly through your nose. Inhale. Hold it! Hold it!”
“Huff... ugh...”
“Hold it. Don't breathe.”
Let's hang in there for a second.
“Hold it for three seconds. One, two, three. Now exhale slowly.”
In the past, we used paper-bag therapy, where you breathe into a paper bag, but these days it's not recommended because of the risk of hypoxia.
The best thing is for the doctor to control the breathing beside her and put on a mask that's not hooked up to oxygen.
The principle is to make them re-inhale their own exhaled air and raise the carbon dioxide concentration.
“Please give me a simple mask. Don't connect it to oxygen.”
I put the mask handed to me by the nurse over the patient's face.
“Okay, you're only breathing inside this mask. Slowly. I'll count for you, so match my rhythm. You're not going to die. The numbness will clear up quickly. Trust me.”
Maybe because of my confident voice and the carbon dioxide concentration slowly building up inside the mask, the patient's violently heaving chest began to calm down little by little.
“Phew... let's just run an ABGA.”
I wiped away my sweat and looked back.
The PD was nodding, impressed.
Only six beds left now.
***
I moved to the relatively quiet wall beside the triage desk for a quick interview.
Of course, quiet was only relative; patients were still piling up behind me.
The PD flipped through the notebook and asked with a curious expression.
“But Doctor, when you explained earlier, didn't you say B area is where moderate or mild patients go, people in relatively stable condition?”
“I did.”
“But that patient just now...”
The PD frowned and mimed clutching their own throat.
“Anyone could see she looked like she was about to stop breathing right then and there, and her hands and feet were twisted too.... Honestly, she looked like the most critical patient I'd seen today. So why did she go to the mild area...?”
A patient screaming, gasping, and writhing.
Visually, they look the most shocking and urgent.
But severity doesn't always scale with the decibels of the screams or the violence of the thrashing.
“Ah, well....”
I was about to explain while looking into the camera lens.
“Dr. Han!”
But before I could even finish explaining, a voice from the triage desk urgently called out to me.
“Ah, yes?”
When I stopped the interview and turned around, the triage nurse was calling to me, chart board in hand.
“This patient says they fell off an electric scooter and their head hurts a bit.”
“Really?”
Electric scooter.
My brow furrowed on its own.
“Just a moment.”
I asked the PD for a moment and approached the patient.
The patient was a sturdy young man in his early twenties, sitting in a wheelchair, and at first glance he looked perfectly fine.
Except for a few scrapes on his elbows and knees and some torn clothes.
He was clutching his head with both hands, but he seemed fully conscious.
“Sir, I'm a doctor. How did you get hurt?”
“Well... I was riding the scooter when it caught on a curb and I fell forward....”
The man trailed off sheepishly.
Articulation?
Clear.
Eye contact?
Good.
Conversation?
Very logical.
“Were you wearing a helmet?”
“No. It was... a short distance....”
“Where did you hit? Your head?”
“Yes. I hit the ground pretty hard, but now it's just a bump and I'm a little dazed, that's all...?”
He rubbed at his forehead.
“You didn't vomit or black out, even for a moment?”
“No, no. I just got right up and walked here.”
“And alcohol?”
“A can of beer? Earlier with a friend.... But I'm fine. I'm not drunk....”
I quickly checked the patient's pupils.
Both pupils were normal in size.
Light reflex normal.
Electric scooter.
No helmet.
Thud on the asphalt.
Drinking.
And saying he's fine now.
Hmm.
It's a trap.
“Did you feel like you blacked out, even for a split second right after the accident?”
“Uh... maybe one or two seconds? I was dazed, but... I don't think I fainted....”
“Don't turn your head at all! Keep looking straight ahead! Right there. Yes.”
I turned my head.
“How many beds are left in the A area?”
The triage nurse looked up hurriedly and answered.
“Three right now. Beds 2, 5, and 6 are empty.”
“Yes. We'll lay this patient down on A-2 right away. Hook him up to monitoring immediately, put on a neck collar, and let's bring in portable oxygen.”
“What?”
The patient widened his eyes in surprise, unable to move his head at all.
“I'm fine, though? I can walk....”
“From now on, don't move your head at all and lie down. Let's go.”
And so the nurses pushed the wheelchair toward the A area, the critical-patient area.
Watching that, the PD followed me and asked with an expression that said they couldn't make sense of it.
“Doctor.”
“Yes.”
“The person who was just gasping for air and complaining of shortness of breath went to the mild area, but this guy, who can talk and looks perfectly fine, is in the severe area? Is there some special reason for that...?”
To the PD, this would look like a contradiction.
The woman who looks like she's about to die goes to B, and the man who looks fine goes to A.
A question of what criteria a doctor uses.
Without breaking stride, I answered.
“The thing is.”
I watched the patient's back as he moved away.
“This one is much more dangerous.”
“What? That one? But he speaks just fine?”
“Yes. That's why he's more dangerous.”