Chapter 138
Rehabilitation Project, Day 3.
A notification sounded in the group chat.
[Kim Ji-hoon Bastard]
(Video: 1 minute 50 seconds)
Press.
[Play Video]
“Now, Seongja. Watch closely. Male in his 20s. He got drunk and fell. Came in because his elbow hurt, but this is what the X-rays look like. We took both the front and side views. What do you think it is?”
The camera pointed at the X-ray monitor.
Park Seong-jeong's voice trembled.
“Ah... Yes. First of all, there isn't any clear fracture line in the bone. No sign of dislocation either. But the soft tissue swelling looks pretty severe. A joint issue...?”
Park Seong-jeong stared into the monitor as if he were about to crawl inside it.
“If we really want to distinguish it clearly, one option would be to think about a CT scan....”
“If you can't diagnose him with an X-ray and a physical exam, are you just going to shove him into a CT scanner?”
“No!”
Kim Ji-hoon pointed his finger at a tiny part of the monitor.
A faint dark shadow visible before and after the elbow joint.
“Look here. Can't you see this? The black part. You can see the fat pad sign, right? If this is there, what did I say? Even if you can't see a fracture line, it means blood has collected and pushed the fat layer aside, so there's definitely a hidden fracture, right?”
“Ah...!”
“Then why are we doing a CT? The treatment's the same anyway. Just put him in a half-cast and arrange orthopedics follow-up. Are you planning to waste the patient's money and time on a CT?”
“No, sir.”
Kim Ji-hoon paused for a moment, then issued a terrifying order.
“Lie down.”
“Pardon?”
Park Seong-jeong's pupils widened.
“I'm kidding. Bow down in your heart. Go study again. Summarize every chapter on occult fractures in children and adults from the book. By tomorrow morning.”
“Yes, sir!”
The video ended with Park Seong-jeong bowing at a full 90 degrees.
I put down my phone and muttered,
“He's ruthless. Seriously ruthless.”
Even though he was the one who couldn't spot the fat pad sign and asked me about it back when he was a first-year.
Of course, I couldn't see it either, so I had to ask the gallery.
But one thing was clear: Park Seong-jeong was changing.
He was now ashamed of his ignorance and had developed a fierce drive to learn.
Getting yelled at, broken down, and studying all night long.
***
Rehabilitation Project, Day 6.
On a lazy afternoon, the group chat caught fire.
[EM Dr. Lee Minjae]
Hey, did this kid run off? Why can't I see him? - 15:31
[EM 4th-Year Choi Soo-min]
? What did you do, sir? Did you scold him again? - 15:31
[EM Dr. Lee Minjae]
No? I didn't do anything. I was just passing by and, out of curiosity, tossed him a question? - 15:32
I saw the ECG looked a little weird, so I asked what the distinguishing point was between Brugada and simple RBBB? - 15:33
[EM 4th-Year Choi Soo-min]
Who asks a first-year that, though;; - 15:34
Did he really run away? Is he quitting training because his mental state broke? - 15:35
Choi Soo-min's chat carried a sense of urgency.
A resident running away is a disaster for the department.
[EM Dr. Lee Minjae]
No, but he answered me!!! He said, “It looks like Brugada pattern type 1.”!! - 15:36
He got it right!!! Seriously!! I even praised him!! I'm the one being wronged here!! - 15:36
[JoSIUUUyeon]
Sir. Seong-jeong is in the procedure room doing a reduction right now. - 15:41
[EM Dr. Lee Minjae]
My bad. - 15:42
There was another little incident like that.
Park Seong-jeong had solved the insanely difficult question Lee Minjae threw at him and then coolly gone back to work.
Hearing that, we watched his growth with satisfaction.
We thought training was going pretty well.
We even thought he'd risen to around a normal second-year resident's level...
***
Rehabilitation Project, Day 11.
The incident erupted without warning.
My phone rang while I was lounging around at home on my day off.
[EM Dr. Lee Minjae]
He nailed BAO just by looking at the uvula? - 09:16
I rubbed my eyes and looked at the screen again.
BAO.
Basilar Artery Occlusion.
A disease where the basilar artery, which supplies blood to the brainstem, gets blocked.
If that happens, the patient can be conscious but paralyzed from head to toe, or suddenly die if the respiratory center is paralyzed.
It's an ultra-emergency condition with an extremely high mortality rate.
The problem is that diagnosing it is pretty difficult.
Because the early symptoms are just dizziness, slurred speech, and double vision, it's easy to mistake it for peripheral vertigo like BPPV or vestibular neuritis.
So even ER doctors miss it sometimes.
But then.
By looking at the uvula?
'Uvula deviation?'
Of course, if certain cranial nerves are paralyzed, the uvula can turn to one side.
But that's a sign that appears only when the stroke has progressed very severely or a specific area is involved.
Besides, how many doctors in the ER would open up a dizzy patient's mouth and check whether the uvula was deviated?
Usually they look at the pupils or whether the limbs are weak.
The group chat reacted the same way I did.
[EM 4th-Year Choi Soo-min]
? - 09:19
[JoSIUUUyeon]
? - 09:19
[Kim Ji-hoon Bastard]
? - 09:20
And I did too.
[Me]
? - 09:21
So, Seong-jeong...
That CT addict with tunnel vision, Park Seong-jeong.
He diagnosed that BAO—which you're supposedly unable to know before an MRI—using nothing but a stethoscope and a penlight, just from a physical exam?
[EM Dr. Lee Minjae]
A patient came in complaining of dizziness, and Park Seong-jeong said to get an MRI. So he explained it, and we got the MRI. - 09:24
What the hell is this supposed to mean, damn it.
***
The day my next shift overlapped with Park Seong-jeong's.
Shake, shake.
I grabbed Park Seong-jeong by the shoulders and shook him like a madman.
“Tell me straight. You've been hiding your skills all along, haven't you? You're actually a genius and pretending to be a regular person was just hard for you!”
Park Seong-jeong's head danced violently back and forth.
His eyes were spinning around.
“I-I... I'm dizzy... Dr. Han Hyeonjae... I feel like I'm going to throw up...”
“Say it!!! Why did you do such braindead loser bullshit!!! If you can identify BAO just by looking at the uvula, why were you trying to pour contrast into a patient with renal failure!”
“Sir, that's too harsh... gghh... and I think I heard something similar from Dr. Lee Minjae too...”
Park Seong-jeong was practically on the verge of passing out.
But I didn't stop.
Because it was far too shocking.
“So you were actually trying to run off to the brain department! You're a spy sent to snoop around our department!”
“Nooo, I wasn't...!”
I let go of Park Seong-jeong right away.
Then a chill ran down my spine.
I felt someone's gaze from behind me.
I slowly turned my head.
There stood Lee Minjae, wearing a smile a father might have while watching his child take his first steps.
“...”
“...”
Ah, fuck, wait a second.
This feels kind of déjà vu.
About this time last year.
I remembered how, when I was a first-year, Lee Minjae had grabbed me and shaken me while going completely berserk.
Only the one doing it and the one on the receiving end had changed.
Was I becoming like this guy?
Or was this department making people like this?
“Cough.”
I cleared my throat and straightened my clothes.
Because embarrassment had rushed over me.
“Anyway, good job. That was an excellent diagnosis. Nice work.”
“Yes, sir. Thank you. I thought I was going to die...”
Park Seong-jeong smiled, looking pale.
Either way, our goal had been achieved.
Park Seong-jeong Rehabilitation Project.
Successfully concluded.
He'd now gotten the basics down, gained confidence, and above all, learned to read patients.
And so I returned to my seat, feeling satisfied.
.
.
.
After a little while, Park Seong-jeong called me over in a hurry.
“Dr. Han Hyeonjae, I think you should come take a look for a moment.”
“Huh? Why? Got a tricky patient?”
Right, so he'd finally realized the importance of reporting.
That's a very commendable attitude.
“No. It's just that this patient is a bit...”
“What is it?”
I checked the triage record Park Seong-jeong was looking at.
[CC : Rt. Ankle pain (* right ankle pain)]
And the patient information section.
[Son Jongun / 28 M ]
“?”
Son Jongun?
That Son Jongun I know?
My med school classmate, now a second-year pediatrics resident.
And the con artist who was cosplaying as an angel in that documentary the other day?
“What the hell is this.”
I frowned.
Why is a pediatrician lying in the ER as a patient?
“Seong-jeong. I'll take this one. Where is he?”
“He's at bed B-17.”
Pitter-patter-patter.
I yanked the curtain roughly aside.
Swish!
On the bed was Son Jongun, grimacing while clutching his right ankle.
“...Oh. You're here.”
“What is this?”
I pointed at his ankle.
His ankle bone was pretty swollen.
“I just... twisted it coming down the stairs.”
Son Jongun mumbled, avoiding my gaze.
“I just fell from a low height. Landed wrong and sprained my ankle a bit. Haha.”
“...”
I crossed my arms and looked down at Son Jongun.
Fell from a low height?
Landed wrong?
And the time was just before lunch.
The puzzle pieces clicked together in my head.
The memory of that high schooler who'd come to our ER just a few days earlier, having climbed down the pipes just to get tonkatsu.
And the location of the pediatrics department.
Children's hospital, second floor.
“You don't mean...”
A grin spread across my face.
“What? Why are you looking at me like that?”
“Don't tell me you jumped out of the second floor to go to the cafeteria?”
“What bullshit are you talking about!!”
Son Jongun shouted, bristling.
The fact that his face had turned red was very suspicious.
“You crazy bastard! Do I look like a high schooler? Jump out a window just to eat?”
“Then what was it? You're not doing any dangerous work, so why else would you fall from the second floor?”
“I told you, no! I just missed a step on the stairs!”
“Sure, sure. Hanging around kids must've made your mental age younger too. It happens. You can regress to childhood, play around a bit, and get hurt. Big bro gets it.”
I patted Son Jongun on the shoulder.
“You little bastard...”
Son Jongun bit his lip in frustration.
But his ankle hurt too much for him to even have the strength to fight back.
“The X-ray looks fine. The bones look normal. Seems like you just stretched the ligaments a bit. It doesn't look bad enough to admit you—should I set up orthopedics follow-up?”
“...No. I'm going to a neighborhood clinic. Why would I get treated here and embarrass myself?”
Son Jongun shook his head.
“You're really coldhearted. Since you lie all the time, this is your punishment. I knew it from when you were acting like an angel in that documentary.”
“What bullshit are you always spouting? Just give me some painkillers. It hurts like hell.”
“Nope. Pain makes you grow.”
I shut the curtain with a flourish and walked out.
I could hear Son Jongun cursing behind me, but it sounded sweet to me now, like background music.
I went back to the station and called Park Seong-jeong over.
“Seong-jeong.”
“Yes?”
“He's faking it. No fracture on the X-ray; it's just a simple sprain. Put him in a splint, prescribe painkillers, and send him out quickly.”
“Yes, sir. Understood.”
Park Seong-jeong nodded, none the wiser.
A friend's suffering is my happiness.
***
A lazy afternoon after the morning had passed.
I was enjoying the drowsy calm with a cup of coffee.
Then Lee Minjae, who had been prowling around like a hyena, spotted Park Seong-jeong as if he'd found prey.
“Seong-jeong. Come here.”
“Yes? Yes, sir?”
Park Seong-jeong hurried over, as stiff as if military discipline were clinging to him.
“You've been studying hard lately, haven't you? You even got the BAO right. You're quite the model student, aren't you?”
“Ah, no. I was just lucky.”
“So modest. Then let's do a little skills test.”
Lee Minjae grinned.
“In a cardiac arrest situation, the patient is severely hypothermic. The body temperature is 28°C. In that case, what comes first between defibrillation and medication? And how many times should you try defibrillation, and when should you start giving drugs?”
“First, you prioritize CPR while raising the body temperature... defibrillation comes before medication!”
“Really? Then if there's no response after a shock, do you keep shocking? A hundred times? A thousand?”
“Well... you can try up to three times, and after that you have to wait until the body temperature rises above 30°C...”
Park Seong-jeong tried to answer, racking his brain.
But Lee Minjae's trap question was relentless.
“What about the medication interval once it goes above 30°C? How is it different between 28 and 30°C?”
“The... interval doubles..? Between 28 and 30, um...”
“Are you sure? Is it doubled when the temp is over 30°C, or is it completely contraindicated?”
“...I mean, under 30°C it's contraindicated...”
Park Seong-jeong's eyes wavered.
“Below 30°C, drugs are contraindicated. Between 30 and 35°C, the dosing interval is doubled! It didn't come to you right away! You still haven't memorized it exactly!”
Lee Minjae drew an X with his finger.
“Rehabilitation Project extended by one week!”
“Noooo!”
Park Seong-jeong's scream echoed through the ER.
…
“Ah.”
It seemed Park Seong-jeong wasn't actually a genius or some hidden talent after all.
He'd probably just gotten lucky and happened to be asked about the part he'd studied.
Even so.
The fact that he had guessed BAO from nothing but uvular deviation and pushed it all the way to an MRI must have been the result of those brute-force efforts he'd piled up over the past week, studying all night and never giving up even while getting cursed at.
Not a genius, but a hardworking average Joe.
That might actually be scarier.
“Hang in there. You'll be a second-year next year.”
I drained the rest of my coffee.
The ER was a mix of Park Seong-jeong's screams and Lee Minjae's laughter.
The end of second year, and the beginning of the approaching third year.
Might be a little noisier, perhaps.
- Part 2 Complete -