Chapter 135
Yeah.
So... where do I even start explaining this.
To retrace how this mess happened, we have to go back just five minutes.
Let's infer why I was angry from what happened earlier.
***
The station was wrapped in a peaceful silence as quitting time approached.
I wasn't sure whether it was because her shift was almost over or whether she was just naturally cheerful, but in any case, the ER chief resident, Choi Soo-min, sat beside me with a faint smile, calmly reviewing charts.
Ring-ring—
A phone rang, breaking the silence.
Since calls from the ER are commonplace, Choi Soo-min answered in a very gentle voice, not thinking much of it.
“Yes, this is Choi Soo-min in Emergency Medicine.”
It sounded like the call was from radiology.
“Yes.”
At first, everything was calm.
But as Choi Soo-min listened to the voice on the other end, her eyebrows twitched and her brow gradually furrowed.
“...Yes?”
Choi Soo-min's voice shot up an octave.
She was clearly flustered.
“No, I didn't order the CT. Yes, it wasn't me who ordered it. Yes. I checked. Just a moment....”
Choi Soo-min's gaze rapidly swept across the monitor.
Her pupils shook as if an earthquake had hit when she confirmed something.
“Contrast? You ordered it with contrast? Venography?”
…
“The creatinine level? Why? ...Ah.”
The color drained from Choi Soo-min's face.
It was the kind of expression that perfectly matched the phrase “turned white as a sheet.”
“N-no, no! We won't do it! Yes, yes, I'm sorry! The order went out wrong! Please send it back to the ER. Yes, yes! Don't scan it! Absolutely don't scan it! Really, yes, yes... yes... I'll make sure they get proper training.”
With that, she hurriedly shouted and wrapped up the call.
It looked like an angel crashing to the ground and rolling around.
Thud.
The call ended.
Choi Soo-min's hand trembled violently as she set down the receiver.
Then she let out a deep sigh.
That sigh was laced with deep irritation and murderous intent.
At least, that's how it felt to me.
The ER's angel—or rather, the fallen angel—slowly turned her head and looked at me.
“Hyeonjae.”
“Yes? Yes, Doctor.”
“Go check where Seong-jeong is.”
“Uh... yes.”
“Bring him here. Before I kill him.”
...
Not long after I reported Park Seong-jeong's location, that 'Do you want to get your ass kicked with Tintinalli?' line came out.
That was the whole story behind this murderous situation.
And this was the problematic patient chart Choi Soo-min had shoved into my hands, now in my grip.
'Haa....'
As I walked, I skimmed the chart's past history and blood test result sections.
[History]
DM (* diabetes), HTN (* hypertension), CKD (* chronic kidney disease) stage 4
[Lab Result]
BUN / Cr : 68 / 4.2
eGFR : 13
“Haa...”
A sigh escaped my mouth.
Cr, that is, creatinine, is 4.2.
Normal is under 1.2, and it's 4.2.
It means the kidneys have almost completely lost function and are barely hanging on.
These are kidneys standing on the edge of whether to start dialysis or not.
And they wanted to pour in a highly nephrotoxic contrast agent straight into those kidneys and then do a CT?
And not just any CT, but a CT angiography that blasts contrast in under high pressure?
I could only inwardly applaud Park Seong-jeong, who was working so hard to make this look less like a test and more like a finishing blow.
What a crazy bastard.
So you wanted to say, “Patient! I'll burn away every last bit of kidney function you have left and make sure you live with a dialysis machine for the rest of your life”?
It made sense why radiology had called.
They probably called to confirm because something seemed off.
It was also because, unfortunately, the first-year's order hadn't been double-checked.
Because it had been pretty busy.
But why the hell was that bastard just blasting it out without even getting confirmation?
What on earth was he thinking?
If they had gone ahead and scanned it as is and the patient had ended up with acute renal failure and permanent dialysis, that would be clear medical malpractice.
That's lawsuit material.
“What do I do....”
You bastard, Park Seong-jeong.
I'm taking back all the praise I gave you earlier when you caught the compartment syndrome.
You're just nuclear waste.
Plod, plod.
I headed to the B-zone treatment room with heavy steps.
I hadn't walked far, but as soon as I turned the corner, I could see Park Seong-jeong in the distance.
Park Seong-jeong, unaware of anything, was earnestly talking about something with a nurse.
“Seong-jeong.”
I called him, suppressing my emotions as much as I could.
“Yes, Doctor?”
Park Seong-jeong turned around.
“That... patient in bed B-15. Why did you order a CT?”
“Ah! Yes... let me explain. Well... the patient’s leg was a bit swollen, and one side was especially swollen and painful. I calculated the Wells score, and it looked like there might be a possibility of deep vein thrombosis.”
The logic sounds plausible.
If DVT is suspected, you can get a CT to confirm it.
Sure, that can be done, but...
Why the hell didn't you use ultrasound?
“But why did you order it with contrast? Why?”
“Well... to see DVT, you need venography for the clot to show up well. I also thought that was probably the protocol. At least, as far as I know....”
Yeah, so you studied the theory hard.
Though whether you studied it properly is another matter.
But you missed the most basic thing of all.
“Seong-jeong.”
I let out a long sigh and asked.
“Did you check the history?”
“Huh? The history? Well... I saw they had diabetes and hypertension...”
“The labs.”
“The labs? I haven't checked everything yet....”
I tossed the chart I was holding onto the desk.
Thud.
The stack of papers made a dull sound.
“Read it.”
“Ah... yes... well...”
Park Seong-jeong picked up the chart.
His eyes ran down the lab results.
The moment his normally calm eyes stopped on the Cr value, they began to shake as if an earthquake had struck.
“Uh...?”
“No. Not 'uh?' I asked if you checked the labs. That's what I'm asking you right now. What the hell were you thinking?”
I lowered my voice.
“Creatinine is 4.2. eGFR
(* glomerular filtration rate)
13. This patient's kidneys are barely hanging on by a thread. And you're going to ram contrast into them?”
“Ah, well, you see, Doctor. I just thought the swelling was severe and that we needed to diagnose it urgently....”
“There was an alternative: ultrasound! Who confirms it with CT?”
“Doctor, I... I wanted to check at once whether there was a large clot in the iliac vein....”
“Is this a test worth risking kidney damage for? Is this patient going to die in one minute if we don't confirm the leg clot right now? Is he gasping out his last breath from a pulmonary embolism?”
“No, Doctor. In my judgment, it's not like that, but....”
“What is this, some rAAA
(* ruptured abdominal aortic aneurysm)
suspected case? Is their belly bursting open and blood spraying everywhere so you have to save them first, kidneys be damned? No, right? It's just a little leg swelling. And you destroyed the patient's kidneys just to check that one thing?”
Park Seong-jeong's face turned white as paper.
Contrast-induced nephrotoxicity.
It had been a chilling moment when a doctor nearly ruined a patient's organ.
“If radiology hadn't called and they'd gone ahead and scanned it, the patient would have ended up in the dialysis unit. You're really off your rocker.”
I pointed toward the station with my finger.
There, Choi Soo-min, already bristling with anger, was glaring this way.
“Go.”
I said coldly.
“Go. Don’t make excuses. Just assume you’re dead and keep repeating that you’re sorry. Whether you die from being beaten with Tintinalli or from getting cursed out and stressed to death, that’s your fate.”
Park Seong-jeong trudged toward the station with a more pitiful expression than a cow being led to the slaughterhouse.
Watching his retreating back, I shook my head.
As expected.
I had a bad feeling about today.
And sure enough, he had to set off a nuclear bomb right before clocking out.
I quietly shoved my hands in my pockets and followed Park Seong-jeong.
The air in the station grew heavy.
There was Choi Soo-min sitting quietly, Park Seong-jeong beside her with his hands respectfully folded, and me as well, keeping an ear open while monitoring in case anything happened.
At the center of that silence was Choi Soo-min.
She wasn't angry.
She didn't shout or throw the chart.
She just leaned back in her chair with her usual languid, gentle expression, looking up at Park Seong-jeong.
“Seong-jeong.”
“Yes. Yes, Doctor.”
Park Seong-jeong was trembling uncontrollably.
Cold sweat ran down his temples and soaked the straps of the surgical mask he was wearing.
“What is this?”
Choi Soo-min tapped a corner of the monitor screen with her finger.
“This number. 4.2.”
“It's the creatinine level....”
“Right. Creatinine. When our Seong-jeong was in school, did he study nephrology? He must have. Then you know what the number 4.2 means, right?”
“Yes... it means impaired kidney function.”
“Exactly. It means the kidneys are in very bad shape.”
Choi Soo-min pointed out the mistake in a very gentle tone, like a teacher explaining addition and subtraction to a kindergartner.
That languid voice was in complete contrast to the content, which was grinding away at Park Seong-jeong's bones...
“But Seong-jeong. I really just don't understand. No matter how much I think it over or try to look at it positively, I can't make sense of it.”
Choi Soo-min tilted her head.
“Do you hate the patient?”
“Yes?... No, that's not...”
“Did the patient spit on you or something? Or are they your parents’ sworn enemy? So you had some revenge fantasy of legally destroying this person's kidneys and making them cling to a dialysis machine for the rest of their life?”
“N-no! Absolutely not!”
“If not that.”
Choi Soo-min's eyes curved into crescents.
“What kind of guts made you think you could pour contrast into a patient whose kidney numbers are this bad? Did our Seong-jeong think contrast would act like vitamins once it got into the kidneys and make them come back to life or something?”
“I'm sorry, Doctor. I failed to check....”
“You didn't check?”
Choi Soo-min's smile vanished completely.
“It takes one second to open the chart. Three seconds to check the labs. You were so busy you couldn't spare even four seconds? If the CT room hadn't sensed something off and called, you wouldn't be getting scolded by me here—you'd be getting scolded by a detective at the police station.”
“Yes. I'm sorry....”
I stole a glance.
Choi Soo-min let out another deep sigh.
Ah, I need to file this patient's admission paperwork.
Even while watching the scolding, I still had work to do.
“Then why didn't you ask? You could at least have asked. Is that really so hard?”
“The professor obviously looked too busy... and Doctor Han Hyeonjae too, and you, Doctor, looked extremely busy...”
Choi Soo-min looked like she was about to scold him, but then only her lips twitched as she fell speechless.
“Haa... if it were up to me, I'd like to kick you in the shins. Go look up the chapters on contrast-induced nephrotoxicity and acute renal failure in your textbook, all right? Copy them by hand, word for word, and study them. Copy everything and put it on my desk. Do that at least, if you want to get your head straight.”
“That...”
“Hey!!”
“Yes. Understood!”
“Now get out. Scram. And pull yourself together, seriously.”
Choi Soo-min sank back into her chair again and closed her eyes.
Park Seong-jeong fled the station as if running for his life.
Watching that miserable back, I swallowed a quiet sigh.
That was the first time I'd ever seen the chief resident shout.