Chapter 132
After the nephrology fellow took the patient up to the dialysis room, the ER was peaceful again.
With the diagnosis and treatment done, maybe because the tension had finally eased, it was so quiet I could feel my shoulders getting stiff.
Then I sensed a hesitant presence beside me.
It was Baek Eun-seo.
She was still standing there with a complicated expression, a mix of regret and self-reproach.
“Doctor.”
“Yeah.”
“I... I really thought it was a brain problem.”
Baek Eun-seo confessed honestly, her lips trembling slightly.
“The patient's breathing pattern and the fact that she was completely out of it mentally were so similar to the central hyperventilation we saw in textbooks that I didn't even think about drugs.”
Her voice was obviously subdued.
It had been a very sharp line of reasoning, but the fact that it had turned out wrong seemed to bother her quite a bit.
I turned my chair to face her.
“Well... yeah, that can happen. It’s perfectly understandable. Honestly, if I hadn’t gotten the hint that it was aspirin in that situation, I would have suspected meningitis first too.”
I said, mixing comfort and facts in equal measure.
“The mechanism itself is similar.”
“R-right?”
“Like you said, meningitis or encephalitis raises intracranial pressure or causes inflammation that physically affects the respiratory center. Salicylate poisoning, on the other hand, chemically attacks the respiratory center in the medulla directly and stimulates it.”
I tapped the back of my head with my finger.
“In the end, the final result is the same, isn’t it? The brain is telling you to breathe. So it’s only natural that it’d be hard to distinguish from the clinical picture alone. And with a high fever on top of that, suspecting an infection was a very reasonable conclusion, wasn’t it?”
“Ah... yes. Right.”
Baek Eun-seo nodded.
It seemed my explanation had comforted her a little.
“The difference is that hyperventilation from increased intracranial pressure is usually accompanied by irregular breathing or Cushing’s reflex, with a slow pulse. But this patient had a fast pulse and very mechanically regular breathing. And most of all, the neck was supple.”
“Ah! Right. I missed that detail.”
Baek Eun-seo slapped her palm.
“I shouldn’t have judged it based on hyperventilation alone. I should have looked more carefully at the pattern and the accompanying symptoms, but I think I jumped to a conclusion too quickly.”
“It’s just a matter of experience. Next time a similar patient comes in, you’ll get it.”
“Yes! Thank you, doctor.”
Baek Eun-seo’s eyes lit up again.
Just moments ago she’d looked dejected, but now her passion was blazing; I had to admit her resilience was truly something.
She carefully adjusted the thick stack of papers she was holding in her arms.
They were the English papers the chief had dumped on her earlier as a "gift."
“I’ll definitely study them! I’ll organize everything from this case so I never forget it, and I’ve got these papers the chief gave me too!”
Baek Eun-seo said solemnly, lifting the stack.
It was quite thick.
If she had to read all that and give a summary presentation too, she’d be giving up sleep for the entire week.
If it were me, I’d have cursed the moment I got it.
“...Uh. Um... Are you really okay with that? All that material?”
I asked, genuinely worried about Baek Eun-seo.
Can she really organize all that and give a presentation?
“The contents are probably pretty difficult too. Isn’t it too much to squeeze in between shifts?”
Then Baek Eun-seo smiled brightly and answered,
“I’m fine! If anything, it’s great. Rare cases like this don’t really sink in from books alone, but if you see the patient yourself and then read the papers, it goes straight into your head.”
Her eyes sparkled.
“And if I think about how hard Dr. Han must have studied, no, even harder than this, I know I’ll be fine!”
“...Huh?”
“Earlier, when I saw you talking with the nephrology fellow, I got chills. Seeing you know even the dialysis settings by heart, I can’t even imagine how hard you must have studied. If I want to become like you, this is the bare minimum!”
Admiration filled Smart Baek’s eyes.
She seemed to think of me as some kind of walking medical dictionary, or a human UpToDate.
“...”
My conscience pricked me.
No, Eun-seo.
I didn’t study.
I’m just... able to eavesdrop on the noisy ghosts living in my head.
It’s not that I memorized the dialysis settings; it’s just that I kept hearing the nonstop chatter of the internal medicine ghosts, nephrology included, and that’s how I ended up like this.
But I couldn’t say that.
I muttered, awkwardly looking away.
“I didn’t study that much...”
“Aww. You’re being too modest.”
Baek Eun-seo didn’t believe me.
Instead, she seemed to take it as me downplaying myself and valued me even more highly.
“Then maybe... your brain really is exceptional, so you didn’t need to do homework? A natural genius?”
“No, that’s even less true...”
“Or maybe it’s some new program for the first-year doctors that started this year? Did the chief beef up the training curriculum? Whatever it is, I think it’s great! It helps improve personal skills.”
Baek Eun-seo answered cheerfully, looking genuinely happy.
That’s not normal.
For better or worse, she was outside the bounds of ordinary human beings.
“A mutant. A mutant.”
I shook my head and muttered under my breath.
“Huh? What did you say?”
“Nothing. Do your best. I’m counting on you, Smart Baek.”
“Yes, sir! Have a good shift!”
Baek Eun-seo gave a crisp greeting and went back to her seat, papers in hand.
Even from behind, she seemed to radiate excitement at the thought of studying.
I spun my index finger around at my temple
and made a gesture that said, “What the hell is her brain made of?”
Of course, I did it behind her back where she couldn’t see.
“Scary girl.”
I returned to my seat and flopped down.
Watching Baek Eun-seo’s passion made me feel tired for no reason too.
But at the same time, it was reassuring.
The fact that a monster of a junior like that was growing so well.
Of course, it’d be even better if she just asked me a little less.
***
“Doctor, could you please see one noncritical patient?”
I heard the nurse calling from beyond the station.
Judging by her tone, it seemed the patient wasn’t truly urgent, just someone who needed to be processed and sent on their way quickly.
“Ah, yes~ I’m coming.”
I stretched and stood up.
I looked at the clock. The hour hand was awkwardly pointing somewhere between 4 and 5.
4:12 a.m.
The drunks who’d been pouring in since the previous evening had all but gone home to crash, and the people who start showing up once morning activities begin still hadn’t arrived.
This was the quietest time, when the ER’s biorhythm was at rock bottom.
And it was also that awkward final stretch of the shift.
If we could just get through another hour or two here without anything happening, the sun would rise and the next team would come in.
“Not bad.”
A mild fever patient coming in at 4 in the morning.
Probably just a cold or gastroenteritis.
Most likely an easy patient I could give a single acetaminophen shot and send home.
Still, I couldn’t let my guard down.
Even so, I headed toward the chair near the triage area with relatively light steps.
The patient was a man in his twenties.
Round glasses and messy hair.
And he had a smartphone in one hand and a thick notebook clenched in the other.
He was wearing his mask pulled up snugly to just under his eyes, and his gaze was oddly bright.
“Hello. I’m the doctor in charge of you. What seems to be the problem?”
I tossed out the standard question as I hung my stethoscope around my neck.
“Ah, doctor! Hello!”
The patient sprang up to greet me as if he’d been waiting for this.
“My throat’s a little scratchy and I’ve got a feverish feeling, so I think I might have COVID. First, what was it? What do you call it again? Ah! I haven’t done that self-test kit yet, but I’ve had COVID before. This sore throat is exactly like COVID...”
“Is that so? How high is your fever?”
“About 38 degrees when I measured it at home...?”
“Hmm, the temperature we measured in the ER is 37.8 degrees. It is going around these days. Let’s check your temperature and do flu and COVID tests first.”
A typical respiratory patient.
I turned to the monitor to enter orders into the chart.
Then it happened.
“Oh, and one more thing! Nice to meet you, doctor.”
He suddenly pulled out what looked like a business card—no, the notebook he’d been holding—and opened it up.
“I’m currently a web novel author serializing a very realistic medical novel about the ER on some platform. It’s a story where the genius doctor protagonist solves everything!”
“Y-Yes...?”
I stopped typing on the keyboard, midway through entering his symptoms into the EMR.
A suspected COVID patient, and suddenly he’s introducing himself?
And a web novel author at that?
“Could he be some kind of guy like me?”
I do scribble stuff myself, pretending to write while hanging around the gallery.
Did I just meet a fellow practitioner(?)?
But what he said next made my pupils quake.
“Anyway, since I’m already sick and came all the way here, I thought I’d interview you a bit, doctor! I need the firsthand accuracy only a practicing doctor can provide!”
“Huh?”
This was disconcerting.
“Could you maybe share just one story about the most memorable patient you’ve ever had? Do real gangsters ever come in and cause trouble? Ah, and romance! Where do doctors usually date nurses...?”
For someone who was sick, he was awfully chatty, and more than anything, it felt like his spray was about to come right through the mask.
Was being sick just an excuse and he’d actually come to do research?
No, he does have a fever, so he really is sick.
What was I supposed to do with this guy, so thoroughly possessed by his profession?
My brain cells quickly assessed the situation.
This patient has symptoms suspicious for COVID.
Patients suspected of having an infectious disease must be isolated.
And above all, this guy was extremely annoying right now.
I cut him off firmly.
“Sir.”
“Yes! Ah, were there too many questions? Should I ask one by one?”
“No. That’s not it.”
I raised a finger and pointed to the room tucked away in the far corner.
“You see that general isolation room over there?”
“Uh... yes. I see it.”
The patient looked toward where I was pointing, wearing a bewildered expression.
“For now, go in there, close the door, and wait.”
“Huh? What?”
“Feverish respiratory patients must be isolated. We don’t lock you in negative-pressure rooms like before, but at least go into the general isolation room. If you stay out here like this, you’ll spread it to the other patients. You need to stay over there until the test results come out.”
“Wait, doctor! Just one question!”
“Doctor! Please show the patient to the isolation room! Don’t worry, sir. We’ll swab your nose without hurting you.”
I called the nurse without mercy.
The explanation about the PCR test was a bonus.
A nurse promptly came over and escorted the patient away.
“Hey, doctor! Just one real story for material! Aaaah!”
Even as he was being dragged toward the isolation room, the patient reached out pitifully toward me.
Go.
Please go into that room and write your own novel.
Only after the glass door closed did peace return to the ER.
“I’ve seen all kinds of patients, but this is the first time one has walked in on his own and tried to interview me.”
I pinched the bridge of my nose as I ordered the PCR test in the chart.
“Hoo...”
I’m drained.
I thought I’d seen every kind of patient, but the ER was still supplying me with new lunatics.
This shift is going to be rough to the very end.