Chapter 136
After quitting time had passed, I took Park Seong-jeong to a bench where people rarely went.
I pulled a canned coffee and placed it in Park Seong-jeong's hand.
“Drink.”
“…Yes.”
Right before quitting time, after Professor Cheon Eun-jeong had dragged Park Seong-jeong out and chewed him out for a full 30 minutes, he fidgeted with the can in his hands and couldn't even pop it open.
“Seong-jeong.”
“Yes, Doctor.”
I sat on the bench and asked.
“Why did you do that?”
I was genuinely curious.
Where had the sharpness he showed when he found compartment syndrome gone?
What on earth had he been thinking to miss even the most basic labs, like some amateur?
“I... well, the thing is...”
Park Seong-jeong hesitated.
“Well... like compartment syndrome, DVT(*deep vein thrombosis) is also a disease you can't afford to miss, and since the Wells score came back high, I thought I needed to diagnose it quickly...”
“No, that's not what I mean.”
I cut him off.
I didn't want a medical excuse.
“You're driving me crazy. That's the thought process in your head. What I'm asking is the fundamental reason. Why didn't you look at the labs at all? You're not normally that scatterbrained. You even mixed up left and right this morning, so why have you been like this all day?”
Under my interrogation, Park Seong-jeong hung his head. After a long silence, he spoke in a tiny voice.
“Well, Eun-seo and... Dr. Han Hyeonjae.”
…?
At those sudden names, I frowned.
Has he lost his mind or what?
“What do you mean, Eun-seo and me? Did we tell you not to check the labs? Why do you keep changing the subject? What are you trying to do right now? Can't you get a grip?”
“It's not that...”
Park Seong-jeong fumbled, fiddling with the lid of his canned coffee.
“I mean, we're around the same year, and Eun-seo is a first-year resident, but she already figured out that difficult salicylate poisoning differential last time. And you, Doctor, are in your second year, but you diagnose things at almost fellow level...”
Ha. Setting aside the fact that he got the subject of the salicylate poisoning differential wrong for now.
“Hey. Speak properly. You're frustrating me.”
“I—!”
Park Seong-jeong suddenly lifted his head and shouted.
“I thought the patient might need a CT. If there had been a clot in the iliac vein or something and I found it right away and made the diagnosis...”
Park Seong-jeong's eyes wavered.
“So... I got so impatient that I forgot to check the labs.”
I stared blankly at Park Seong-jeong.
So that was it.
“But why did you bring up me and Eun-seo?”
“Well, it's because both you and Eun-seo nail difficult differential diagnoses so easily, and I feel like I'm falling behind and I'm the only idiot who doesn't know anything...”
“Seong-jeong.”
Hah.
I let out a deep sigh.
Self-loathing.
Comparison.
Impatience.
Those had narrowed his field of vision.
They'd made him obsess over making a diagnosis and forget the basic principle of patient safety.
Tunnel vision.
The phenomenon where you focus on a single target and run straight ahead, ignoring all the warning signs around you.
“Seong-jeong. I get what you're trying to say, but...”
I popped open the canned coffee.
“Checking the labs is basic. Aren't you a doctor? Your tunnel vision has gone somewhere weird... Hah.”
“Yes. I'm sorry...”
The guy looked like he was about to cry.
Even he must have thought he was pathetic.
Because he had nearly ruined a patient's life over nothing more than a desire for recognition.
“Seong-jeong. Seriously, when I looked at the chart earlier, I really wanted to kill you. I was going to smash your head with the chart and curse you out with every foul word in the book.”
“Yes...”
“But I'll be nice and just curse you out a little. I think I get how you feel.”
“Yes.”
I looked straight into his eyes.
“Are you an idiot?”
“What?”
“If you don't have the basics down, it doesn't matter how difficult the diagnosis is or how brutal the disease is—finding it won't mean anything.”
“Ah...”
“If that patient earlier had really been a DVT case, do you think they'd go, 'Oh, thank you, doctor!'? Get a grip. If you damage the kidneys just to find a clot, is that supposed to be a good job? The patient would have to live with a dialysis machine for the rest of their life.”
Park Seong-jeong couldn't lift his head.
“What department are we?”
“Emergency... medicine.”
“What's our role? Are we detectives like House, hunting down rare diseases? Or some kind of god of surgery? Do you think you're Kim Sabu?”
“No.”
“Say it. Our role.”
Park Seong-jeong answered hesitantly.
“We set the diagnostic direction and provide initial treatment and stabilization for acute patients... and, if necessary, perform resuscitation before admitting them to the appropriate specialty or transferring them out.”
“You know it well.”
I gave his knee a light tap.
“Then why the hell were you doing that stupid nonsense?”
“…Ah.”
“Our number one priority is keeping the patient alive. Diagnosis comes after that.”
I wrapped an arm around his shoulder.
“Eun-seo stands out because she's just different. Finding compartment syndrome earlier wasn't easy. You found it because you stuck to the basics—checked it, felt around, and examined it.”
“...”
“You can make mistakes. But those mistakes shouldn't be the kind of crazy shit that gets you the crap beaten out of you. So please, don't try to do flashy stuff—start with the basics. Check the labs. Check the history. Check the vitals.”
I said firmly, looking him in the eye.
“If something like this happens one more time, I'll beat you myself. Got it?”
“…I understand, Doctor.”
“Get back in there.”
“Yes!”
'This is hard. So hard.'
Now I even had to do junior-mental-health care.
Is this the burden of being a second-year?
***
Anyway, after that, with a lot on my mind, I gathered Kim Ji-hoon and Jo Su-yeon, the two I was especially close with among my classmates, in one place.
We usually got together whenever our days off happened to overlap to gripe about the hospital and complain about our lot in life, but today had a slightly different purpose.
Unlike before, when we had nothing to talk about and just idly chewed on straws, this time we had a very solid topic of conversation.
The lucky(?), or rather unlucky, one was Park Seong-jeong.
And also a first-year junior who barged in with, “I heard the seniors are getting together? I want to come too!” even though we hadn't called for him.
And so I was killing time at a corner seat in a chain coffee shop near the hospital on a lazy weekend afternoon.
[Dead Medic Gallery]
===================
What the hell do we do about that trash bastard?
Posted by: Hell Joseon Slave 1
A first-year almost ordered a contrast CT on a stage 4 CKD patient without checking the labs.
Got absolutely torn apart by the chief and the professor and my soul has left my body, so I'm looking for recommendations on how to give him a proper lesson, ㅇㅇ
===================
[Comments]
Operating Room Ghost 3: Looks like he wants to do better himself. Good motivation. We should set the stage for him.
ㄴ Let's Spin the Dialysis Machine: Shit, are you trying to kill somebody?
ㄴ Back in My Day: No, isn't Hell Slave supposed to get some special training or something? That's what I was talking about.
ㄴ Let's Spin the Dialysis Machine: Oh, really? lol, sorry, I had no idea what you were talking about.
ㄴ Hell Joseon Slave 1: What the hell, why the fuck would I do that.
God of the Scalpel: Okay, special training confirmed. We'll draw up the curriculum.
ㄴ Hell Joseon Slave 1: No. Someone might die.
ㄴ Back in My Day: Don't worry. I'll do only as much as was done to you.
ㄴ Hell Joseon Slave 1: He came to EM in the first place because he wanted work-life balance, remember?
ㄴ Descendant of Hippocrates: Then you must show him how fiercely he has to struggle to seize his own free life, living physician! For freedom comes with responsibility.
“These guys are at it again.”
I facepalmed.
I asked for help, and now they're telling me to be an instructor.
That was when it happened.
Ding-a-ling-
A clear bell rang from the entrance.
When I looked up, three familiar silhouettes were coming in.
Kim Ji-hoon looked haggard, and Jo Su-yeon had a resigned expression.
And between them, Baek Eun-seo, looking like a grade schooler who'd come to an amusement park alone.
“Uh, hi?”
When I waved, Kim Ji-hoon flopped down into the chair opposite me.
“You were here first? Take this one away quickly. Please.”
Kim Ji-hoon nodded toward Baek Eun-seo.
“This one?”
“Hello, senior! It's me!”
Baek Eun-seo greeted us cheerfully.
“…Uh.”
Jo Su-yeon, who was standing next to her, was silently mouthing, “Save me.”
“What the hell did you do on the way here?”
“I mean, during the ten minutes it took to walk from the hospital here, he asked me at least twenty questions. Can't you see my ears are bleeding?”
Kim Ji-hoon scratched at his own ear.
***
We ordered coffee and sat down.
Slurp.
“You get helicopter pay and the coffee you drink is just an Americano? Where the hell is your conscience...”
Kim Ji-hoon grumbled.
“Quiet for a sec. Anyway, today's agenda is what we do about him. That's the issue.”
I got to the point.
“Who? Seong-jeong?”
“Yeah. Park Seong-jeong. We can't leave him like this.”
“What's the problem? It's simple.”
Jo Su-yeon pointed at Baek Eun-seo, who was smiling brightly while shoveling whipped cream into her mouth.
“Make him like her.”
…
Kim Ji-hoon and I looked at Baek Eun-seo at the same time.
“Hmm. Park Seong-jeong would probably die, wouldn't he?”
I answered seriously.
“Tell him to suffer. Let's put him through the wringer once.”
Kim Ji-hoon whispered like a devil.
“Honestly, we don't need to make him work as crazily as that kid, but we should at least make him capable enough to function like a human being, right?”
“I can see he lacks basic skills in places. His tunnel vision is pretty bad too.”
I agreed.
“I happened to prepare something!”
Baek Eun-seo suddenly brightened and reached under the table.
“Heave-ho!”
Thud!
Something huge and heavy came up onto the table from the bag.
The café table wobbled.
“Tintinalli's~ and this too!”
Boom!
Two bricks were stacked there.
One was the bible of emergency medicine, [Tintinalli's Emergency Medicine].
The other was the eternal nemesis of internists, [Harrison's Principles of Internal Medicine].
“Even Harrison! I really came prepared.”
Baek Eun-seo tapped the books with a proud expression.
…
“Why on earth did she bring those to a café...”
Jo Su-yeon muttered with a disgusted look.
I was worried about Baek Eun-seo's shoulder joints, carrying those around in her bag.
“What Seong-jeong needs is the basics, right! So I thought—how about making cram-session materials by pulling out only the key sections a first-year absolutely needs to know from an internal medicine book and an emergency medicine practical text!”
Baek Eun-seo's eyes sparkled.
She was serious.
Single-mindedly determined to crush her fellow resident.
“You're really crazy.”
Kim Ji-hoon was impressed in more ways than one.
“Good. Let's do it. It's not like we have anything else to do anyway.”
And so we gathered in a corner of the café on a weekend afternoon and kicked off the Park Seong-jeong beatdown project.
The name of our precious study material, made with our laptops open and books spread out.
Also known as [Park Seong-jeong's Survival Emergency Medicine Crash Course Problem Book].
“Let's start by beating up the kidney section. That's the organ he screwed up this time.”
I kicked things off.
At that moment, a popup window briefly appeared.
[A comment has been posted]
It was the ghosts.
It was probably a pain to sneak glances at the floating interface while watching the other residents' reactions, but they seemed to be mulling over what to teach based on the previous post.
Back in My Day: For nephrology, questions about urine output and electrolyte balance calculations are probably important, right? If we're including the FENa formula, that is.
ㄴ Let's Spin the Dialysis Machine: Yeah. And we probably need a protocol for preventing contrast nephrotoxicity too, right? If we organize everything cleanly—including how much fluid to give, and even the controversial stuff about whether acetylcysteine works or not—then turning it into O/X questions would be neat.
ㄴ Hell Joseon Slave 1: Passing this along~
ㄴ Back in My Day: What.
“Hmm...”
I filtered out the ghosts' advice and spoke aloud.
“Guys. About the kidney section.”
“Why?”
“How about including the FENa calculation and the contrast nephrotoxicity prevention fluid protocol too, instead of just looking at the labs? So it can be used right away in real practice.”
Then Baek Eun-seo clapped like a seal.
“Wow! That sounds like a great idea! Then how about we add this too?”
Baek Eun-seo said, riffling through Harrison.
“If these two labs end up this far apart, you can also differentiate pseudo-renal failure...”
“Oh, Eun-seo! That's good. It's a little too deep, but it'd be useful to know.”
Kim Ji-hoon, who had been listening from the side, chimed in too.
“Hey, then let's add a surgery section too. Acute abdomen. He seemed to be mixing up appendicitis and diverticulitis.”
[A comment has been posted]
God of the Scalpel: We also need to put in CT and ultrasound differential images for surgical diseases. Go go go go go.
“Then I'll give my opinion too. Assuming there's no clear rebound tenderness, capture the CT slices and show them, then have them guess the diagnosis.”
“That's vicious.”
Jo Su-yeon laughed.
“And ECGs can't be left out either.”
And so, the combined efforts of countless ghosts, three second-year residents, and one overenthusiastic first-year resident produced something beyond imagination.
We typed like maniacs, captured materials, and made questions.
It's no secret that dopamine was gushing at the thought of tormenting someone.
***
The next morning.
Emergency Medicine Department call room.
Park Seong-jeong sat in his seat with hollow eyes.
“I'm dead...”
Bam!
I personally placed a heavy stack of documents on Park Seong-jeong's desk.
“Agh! You startled me!”
“Seong-jeong? This.”
“What is this?”
Park Seong-jeong picked up the stack of papers with trembling hands.
It was quite thick.
[Beloved Junior Seong-jeong's Emergency Medicine Core Summary and Problem Book, Returned from Hell (Ver. 1.0)] - Co-authors: Han Hyeonjae and Anonymous Angels -
“A gift.”
I gripped his shoulder tightly.
“It's handmade study material we spent all day yesterday making for you, one stitch at a time.”
“What?!”
“Solve all of it by this weekend.”
Park Seong-jeong's pupils wavered.
“Fighting.”
I clenched my fist, flashed it at him, and walked out of the station whistling.
Survive, Park Seong-jeong.
All of this is part of the struggle to win a work-life balance.