Chapter 12
The double-board rumor Senior Lee Minjae had started spread like a plague.
Before a full day had even passed, the rumor had spread throughout the entire emergency medicine department.
At dawn, when I woke from a catnap in the on-call room and was pulling on a fresh gown from the supply room, a voice came from behind me.
“Hyunjae?”
It was fourth-year Yoo Seonghun, with his usual face worn down by chronic fatigue.
“You’re really going to internal medicine?”
“Pardon?”
“Now’s the right time, though. There are guys who cut a deal and transfer around the fall of their first year. So what is it, giving up training? Or is it really the double board Minjae talked about?”
I squeezed my eyes shut.
In my mind, I replayed the last year of my life.
The days of getting cursed at and drenched in blood.
I’m not giving up.
Like hell would I do this again if I were insane.
The fact that I had to endure this hell for four years was already awful enough—go to another department and repeat this process for another three or four years? Double board? That wasn’t something a human being should do.
I answered in the firmest voice I could manage.
“No. I’m not transferring departments. I’m not giving up residency training.”
“Then double board?”
“No, I’m not doing double board either.”
“Hmm.”
Fourth-year Yoo Seonghun stared at me for a moment with a look that seemed to say he wasn’t sure whether to believe me, then shrugged and went on his way.
But this was only the beginning.
At the ER station, while I was entering orders, third-year Choi Sumin came over with a worried face.
“Hyunjae.”
“Yes, doctor.”
“You’re really doing double board? That’s a really hard path. You’ll wreck your body.”
I was practically on the verge of tears now.
“I told you I’m not, doctor. Who on earth started such ridiculous rumors….”
“Really? Well, that’s a relief. Anyway, don’t push yourself too hard.”
He patted my shoulder and left, but it didn’t comfort me at all.
You bastards, I’m not transferring departments….
And then, at last, it happened.
My classmate Jo Suyeon.
“Hyunjae!!”
“What? Why are you acting like this now?”
“You traitorous bastard! I knew it from the start! How dare you betray EM?! You were the one who suggested it first, and now you’re running off from EM?!”
I pressed hard on my temple.
My head was pounding.
No, that’s not it.
I’m not going.
I’m not doing it.
I kept shouting it over and over in my head, but by then no one believed a word I said.
I’m not going. I’m not doing it. I can’t do it.
All I want is to just finish my four years here and leave.
Please believe me, you bastards.
***
Friday, 1 a.m.
Our hospital’s regional emergency medical center, one of the busiest emergency rooms in South Korea, still wasn’t asleep at that hour.
“Suction ready! BP keeps dropping! 80 over 50!”
“Heart rate 140! Doctor, we need a C-line right now!”
In the resuscitation room, a war was raging to save a multiple-trauma patient brought in after a traffic accident.
All the senior residents, the staff doctors, and even the professors were throwing themselves into the fight.
I just sat at my station and quietly charted.
That wasn’t a place I could join yet. My best move was to handle the charts of the other low-acuity patients piling up at the station and ease my seniors’ burden even a little.
Then it happened.
Beep—beep—beep—beep—!
An alarm blared from a completely different direction.
Area B. It was where relatively stable patients stayed.
When I turned my head, the oxygen saturation reading for patient B-12 was flashing red on the station monitor.
85%
84%
83%…
“Fuck.”
I got up from my chair and ran toward the bed.
All the seniors were tied up with the trauma patient.
Lying in the bed was an elderly woman in her seventies. She had a history of chronic obstructive pulmonary disease and had come in yesterday afternoon with worsening dyspnea.
When she arrived, her oxygen saturation was low, so while we were giving her oxygen through a nasal cannula
(*Nasal cannula, a tube inserted into the nose for oxygen)
and monitoring her course, we had been considering discharge once her condition stabilized.
But the patient’s condition was completely different now.
Her face was pale, her lips were bluish. It didn’t feel like she was breathing properly. She was almost obtunded.
“Minjun! You were watching this patient, right? What happened?”
I shouted at first-year resident Choi Minjun, who was standing anxiously beside the patient.
“It suddenly dropped to sat-
(*Saturation, oxygen saturation)
uration, so I raised the oxygen first! It’s on a face mask at 10L right now, but it keeps dropping!”
Just as he said, the patient was wearing an oxygen mask, and the oxygen flow was set to 10L.
But the patient’s condition was getting worse and worse. Her consciousness was growing more and more clouded.
Choi Minjun shouted, almost in tears.
“What do we do? Should we max the oxygen out to 15L, or should we prepare for intubation
(*endotracheal intubation, insertion of a breathing tube)
right away?”
Oxygen is dropping. COPD patient. I’ve seen this before somewhere, haven’t I? I definitely learned it, and I even took the exam.
What was the exact mechanism again?
But how the hell did this bastard even pass the licensing exam?
Anyway, that’s not what matters right now.
My mind was going blank.
I definitely knew this, didn’t I?
‘Gallery!’
I pressed the stethoscope to the patient’s chest, pretending to listen to her breathing, and brought up the blue interface before my eyes.
Title : Urgent COPD Patient in Her 70s
(*Chronic Obstructive Pulmonary Disease, COPD)
patient. Dyspnea
(*Dyspnea, shortness of breath)
came in. I’m giving 10L of O2, but why did consciousness suddenly drop and the saturation fall?
Author : Hell Joseon Slave 1
After posting it, I shouted at Choi Minjun.
“First, lift the patient’s chin and secure the airway!”
As I bought myself time like that, I could see a comment pop up at the edge of my vision.
RespiratoryGhost : You dumbass, it’s CO2 retention
(*CO2 retention, carbon dioxide retention)
You know that, right? If you blast high-concentration O2 into a COPD patient, it suppresses the respiratory center and they stop breathing? hypercapnia
(*Hypercapnia, excess carbon dioxide in the blood)
Hypercapnic narcosis
(*Narcosis, a comatose state)
had set in. Lower the O2 right now and draw an ABGA
(*Arterial Blood Gas Analysis, arterial blood gas analysis)
to check the pCO2. If necessary, get BiPAP
(*Bi-level Positive Airway Pressure, a type of ventilator)
ready.
Everything had fallen into place.
I hung the stethoscope around my neck and shouted at Choi Minjun.
“Minjun! Lower the oxygen! Drop it to 2L right now!”
“What? Lower it? The saturation isn’t even reaching 80 right now! The patient will die, Hyunjae!”
“This patient is a COPD patient! Did you forget the history?! Didn’t you take the board exam?! If you give him more oxygen here, his heart will just stop, you bastard!”
“…Ah!”
I shoved Choi Minjun’s shoulder aside and personally twisted the oxygen dial roughly.
Then I shouted at the nearest nurse.
“Doctor! I need an ABGA kit and a heparinized 1cc syringe, quickly! I’m going to draw from the radial artery right now!”
“Yes, doctor!”
“And Dr. Lee Sujin! Please bring a portable X-ray and the BiPAP machine right now!”
The nurses moved in perfect coordination.
Then I gave the panicked Choi Minjun a quick smack on the back and handed him the Ambu bag.
Soon after, using the kit the nurse brought, I drew the arterial blood. Only after confirming bright red blood was entering the syringe could I finally catch my breath.
“Take this straight to the lab! STAT
(*statim, immediately)
please have them run it right away!”
At that moment, a nurse and a respiratory therapist came running, dragging the hefty BiPAP machine.
“Doctor! We brought the BiPAP!”
The respiratory therapist asked me.
“Doctor, what should the initial settings be? IPAP
(*inspiratory pressure)
and EPAP
(*expiratory pressure)
please tell me.”
“….”
My mind went white again.
Fuck.
Settings? How was I supposed to know that?
I only knew BiPAP was needed thanks to Gallery.
But I had absolutely no idea how to set the specific numbers.
Should I just go with 10 and 5?
What if that ended up damaging the patient’s lungs?
“Doctor?”
The respiratory therapist urged me on.
Minjun and the nurses were all staring at my mouth.
Sweating cold, I desperately racked my brain to buy time.
“Just a moment. I think I need to check the patient’s consciousness and chest movement once more before deciding.”
I made that excuse and pretended to approach the patient.
Then, while pretending to check pupillary reflexes by pulling back the patient’s eyelids, I opened the Gallery window again.
Title : [Urgent 22] Need BiPAP initial settings!!
Author : Hell Joseon Slave 1
No sooner had I hit post than that respiratory ghost from earlier immediately took the stage again.
RespiratoryGhost : Start with IPAP 12, EPAP 5. RR
(*Respiratory Rate, breaths per minute
) set to around 14. After 30 minutes, draw another ABGA and see how much the CO2 drops before adjusting the pressure. I laid out the whole meal for you and you can’t even use a spoon.
The abuse stung, but that wasn’t important right now.
“Initial settings: IPAP 12, EPAP 5, respiratory rate 14.”
“Yes, understood.”
The respiratory therapist skillfully operated the machine.
A moment later, one of the nurses shouted toward us.
“B-12 patient’s ABGA results are in!”
My heart pounded.
“Doctor! pH 7.15, pCO2 92, bicarbonate 30!”
“…Good!”
I clenched my fist without realizing it.
“Okay, keep the BiPAP settings as they are, and in 30 minutes, follow-up
(*Follow-up, observation for tracking)
ABGA again! Please keep checking every 10 minutes to see if the patient’s mental status is deteriorating!”
I did it.
Again.
With the help of this crazy Gallery, I saved the patient.