Chapter 134
I was checking to see whether the CT results had come back for the vague abdominal-pain patient I'd noticed during handoff earlier.
Then unfamiliar text flashed across the monitor.
[Consult : General Surgery]
[Reason : r/o Ileus (* suspected bowel obstruction)]
“Huh?”
I narrowed my eyes.
They consulted surgery?
For bowel obstruction?
When I glanced over earlier, the patient's belly had been a little distended, but he was passing gas fine and said he'd had a bowel movement yesterday, too.
I immediately pulled up the abdominal CT images for the patient Park Seong-jeong was looking at on my screen.
“...”
What filled the CT screen wasn't a tightly blocked bowel or a twisted one.
It was a colossal, majestic...
Poop.
It was just constipation.
The colon was packed with stool, and that was what was causing the pain.
An enema and some laxatives would solve it, so why on earth had he called us?
If he called surgery over for this and the resident who came down grabbed him by the collar, he'd have nothing to say for himself.
On top of that, the radiology read still hadn't even come back yet.
Did he just think, 'Huh? There's a lot of poop. Is it blocked? Obstruction?' and fire off a consult right away?
What kind of judgment is that?
It was like sending a bullpen pitcher allowing more than two baserunners per inning into a bases-loaded, no-outs situation.
I broke out in a cold sweat.
“Seong-jeong.”
“Yes, doctor?”
Park Seong-jeong looked at me with innocent eyes.
“Why did you request a consult for bowel obstruction...?”
“Huh? Ah! There was a lot of gas on the X-ray, and on the CT the bowel looked distended, so I thought it might be blocked.”
“At a glance, it's clearly just packed with stool, and the official radiology read still hasn't even come back yet... I-is that really right, Seong-jeong?”
“Ah... I'm sorry. I requested the consult too hastily. I should have checked the read first before putting it in. I'm sorry.”
“No, the read isn't the problem—this is obviously just constipation. If the surgery doctor comes down for this, you're really going to get chewed out. They'll curse you out for calling them over to clean up poop.”
“Ah!”
“Cancel it quickly. Before surgery on-call calls back.”
“Yes! Yes, sir!”
Park Seong-jeong clattered away on the keyboard and canceled the consult request.
Luckily, the seen status still hadn't appeared, so at least Park Seong-jeong wouldn't get beaten to death by an enraged surgeon.
“...Haa.”
I rubbed my face.
Something's weird.
Baek Eun-seo is noisy and bombards me with questions, but at least there are no accidents.
More precisely, Baek Eun-seo asks me first before doing anything and gets my confirmation.
Like, “Doctor, doesn't this look like bowel obstruction? Should I put in a consult?”
Then I could shut that down with, “That's just poop.”
But Park Seong-jeong...
He was quiet.
He didn't ask.
He just thought things through on his own, judged on his own, and went ahead on his own.
The most frightening type.
“...What?”
A chill ran down my spine.
I realized that the peace and boredom I'd felt earlier had actually been because I was in the eye of the storm.
I pulled my chair closer to Park Seong-jeong.
A bad feeling came over me that today I'd have to keep my eyes on that guy's fingers instead of the monitor.
***
Chest pain
(* chest pain)
patient! A 52-year-old man, and he's been sweating buckets nonstop! BP is...
The urgent shout from the 119 ambulance crew filled the ER.
“Yes! Let's move him to Area A right away! Uh... Bed 3! We'll bring him straight in there!”
I reflexively shot to my feet.
It could be a myocardial infarction.
It was a race against time.
Rushing over, getting an EKG, preparing nitroglycerin, and checking troponin all flowed smoothly, almost mechanically.
….
“The patient had a shoulder dislocation... well, this is what people usually call a dislocation. Nothing was wrong with the bone, so we reduced it in the ER for now, you know?”
I explained to the patient resting an arm on the armrest, wiping the sweat from my face.
My shoulder almost came out of its socket fitting the bones back in on such a huge patient.
“Next time, please get an outpatient appointment with orthopedics and have an MRI or whatever else is needed to check for ligament damage. It'd be better if you came to our hospital, or at least went to orthopedics at a general hospital. It could lead to recurrent dislocations, so for now absolutely don't use that arm.”
“Thank you, doctor. Oh, that feels so much better.”
….
Trrr-rrr-rrr-
“This is Han Hyeonjae, second-year emergency medicine resident. Nephrology on call? Yes, yes.”
I tucked the phone between my shoulder and ear and answered quickly while looking at the monitor.
“A patient currently on dialysis at our hospital came in saying he was suddenly short of breath. The X-ray shows pulmonary edema, and the potassium is 6.8. Yes... yes... no, the EKG shows peaked T waves, but there's no arrhythmia yet. Yes. I think we need emergency dialysis. Do you have a bed?”
….
Before I knew it, time had passed in a blur.
The afternoon ER was a battlefield.
Patients kept pouring in nonstop, alarms ringing everywhere, and the barrage of questions from family members was just a bonus.
Even in that hectic ER, I kept sneaking glances to the side.
Looking over at Park Seong-jeong, I saw that he was quietly working.
But he wasn't just standing still.
He was running around suturing torn wounds, squeezing between curtains to take histories, and answering the nurses' calls with a short “I'm coming!” before hurrying off.
Was it because he was so on edge after the left-right mix-up and the constipation incident this morning?
He was working quite diligently, and without making mistakes.
So, at least in my eyes, there were no mistakes.
‘Maybe I was worrying for nothing.’
Maybe I had been too sensitive.
People can make mistakes, after all.
I got called a total klutz a lot when I was a first-year, too.
Park Seong-jeong might just be a quiet person who's a little awkward at expressing himself.
Not flashy like Baek Eun-seo, but maybe the type who quietly does their job.
It was then.
“Dr. Han!”
From over in the treatment room, I heard Park Seong-jeong's frantic voice.
It wasn't his usual voice that always sounded like it was shrinking inward.
“What is it?”
I stopped what I was doing and turned my head.
“Suspected compartment syndrome! It's a shin fracture patient, and the pain is far too severe!”
“What?”
My eyes flew wide open.
Compartment syndrome.
A surgical emergency in which pressure builds inside the fascia around the muscles, compressing blood vessels and nerves and causing necrosis.
If you don't cut it open and relieve the pressure quickly, you may even have to amputate the leg.
But because it just looks like swelling from the outside, it's also one of the easiest traps for rookie doctors to miss.
Rat-a-tat-tat.
I ran to the treatment room in a single stride.
The patient was a man in his twenties whose shin bone had been broken in a traffic accident.
Even with a cast on, he was screaming.
“Agh! It hurts! Seriously... Agh! Aaaagh!”
Park Seong-jeong had already loosened the patient's cast halfway.
“Even after we gave narcotic painkillers, the pain isn't controlled. And the dorsalis pedis pulse is hard to find, and he says the sensation in his toes is numb. The skin is tense too.”
Park Seong-jeong had accurately pointed out the signs of compartment syndrome.
I felt the patient's leg.
It was hard as a rock.
When I bent the toes back, the patient shrieked.
“Aaaagh!”
No question about it.
“Good catch. This is compartment syndrome.”
I gripped Park Seong-jeong's shoulder tightly.
“Call the professor and orthopedics right away. Tell them we need an emergency fasciotomy. I'll keep an eye on the patient's vitals.”
“Yes! Understood!”
Park Seong-jeong rushed to the phone.
…
Right.
I was wrong.
Not quite on Baek Eun-seo's level, but he's pretty good.
It's not easy for a first-year to spot compartment syndrome with that much confidence.
Usually they'd just think the fracture was that much worse and keep giving painkillers until they miss the golden window.
Definitely.
I clearly thought he was a bad seed, but he turned out to be a gem buried in the mud.
The morning mistake was just because he still hadn't loosened up yet.
‘Sorry, Seong-jeong. I misjudged you.’
I apologized to Park Seong-jeong in my head and spent the rest of my shift feeling pleased.
***
….
And then.
About 30 minutes before clock-out.
That peaceful time when I was just organizing the handoff sheet and already bouncing in my seat at the thought of dinner.
“Hyeonjae.”
A low, chilly voice came from behind me.
Was that eerie breeze just my imagination?
“Yes? Yes, doctor.”
I turned around cheerfully.
There stood the angel of our department, Chief Choi Soo-min.
The Buddha of the ER, always smiling warmly while pointing out the juniors' mistakes.
But.
There was no smile on Choi Soo-min's face right then.
To be exact, there was no expression at all.
Blank-faced.
Choi Soo-min was holding a thick stack of charts, gripping the papers so tightly they were crumpling.
“Go ask Seong-jeong.”
Choi Soo-min opened his mouth.
His voice was trembling.
The muscles in his jaw twitched.
“Ask him whether he wants to get beaten with Tintinalli until he's on the verge of death.”
“...What?”
I couldn't believe my ears.
Tintinalli.
The textbook hailed as the bible of emergency medicine.
A brick of a book over 10 cm thick and nearly 3 kg in weight, practically a weapon.
He wants to get beaten with that?
Nine times out of ten, the answer is no.
A violent choice of words—coming from the mouth of an angel, no less.
“D-Doctor? I mean, did Seong-jeong do something wrong earlier...?”
“Go ask him. Ask whether his head is just decoration, or whether he left his brain at home when he came to work.”
Choi Soo-min slammed the stack of charts onto my desk with a bang.
“Go bring him here. In front of me. Right now.”
Seong-jeong.
When I found the compartment syndrome earlier, I said you were a gem, didn't I?
Scratch that.
You were not a gem. You were a ticking time bomb.
A nuclear bomb, at that.
I got my trembling legs moving.
It didn't take much for an angel to turn into a demon.
All you had to do was do something beyond common sense—something utterly unforgivable.
‘Why am I...’
As I went looking for Park Seong-jeong, I cursed the heavens.
‘Why do I have to watch the ER's angel fall into darkness in real time?’
Thirty minutes before clock-out.
The gates of hell swung wide open on my peaceful commute home from work.