Chapter 14
I wanted to collapse onto the bed and sleep like a stone.
But before that, there was one thing left to do.
I staggered over, threw myself onto the sofa, and opened the damned Medical Gallery again.
Title: Guys, drop a good-night emoticon, I'm going to bed now
Author: Hell Joseon Slave 1
I'm going to sleep, yeah. Drop a good-night emoticon for me.
Now it's goodbye to these wretched ghosts too.
Please, just don't come looking for me until tomorrow morning.
Just as I closed my eyes, praying for peace, the comment notifications started ringing insistently.
Back In My Day : ??
Descendant of Hippocrates : ?? O living one, what is that supposed to mean?
Hematoma Is Hell : ?? Sleeping? Now?
Something felt off.
Back In My Day : We've stitched things up, so now it's our turn.
Endocrine Master : Where do you think you're going to sleep? Sit down.
Cardiology Ghost : Shall we start with an ECG?
Fuck.
What the hell.
Were these bastards all lying in ambush together?
Hell Joseon Slave 1 : No, I'm seriously tired, though...
My explanation was mercilessly ignored.
Not long after I posted my explanation, the first question came in.
Cardiology Ghost : 68-year-old man. For several days, he's had nausea and says things look yellow. This morning he became confused and came to the ER. ECG shows atrioventricular block
(*a type of arrhythmia)
Finding noted. Blood tests show K+ 6.8 mEq/L
.(*blood potassium level, normal range 3.5~5.0)
Which drug poisoning should you suspect first, and which medication must absolutely not be given to this patient? You've got one minute, yeah.
My head went blank.
Xanthopsia, bradycardia, hyperkalemia.
I'd seen this in a textbook before. Cardiac glycoside.
I answered without hesitation.
ㄴ Hell Joseon Slave 1 : Digoxin
(*Digoxin, a type of cardiac glycoside)
poisoning. Calcium gluconate is contraindicated when hyperkalemia is present. It can actually trigger ventricular fibrillation.
As expected, that was correct. A classic case that'll kill the patient if you don't know it.
ㄴ Cardiology Ghost : Correct.
ㄴ Descendant of Hippocrates : The living one seems to have studied internal medicine quite a bit!
The second question came flying in right away.
Nephrology Boomer : 45-year-old woman with a history of alcohol dependence. Presented with decreased consciousness after three days of binge drinking. Blood tests show Na+ 108 mEq/L.
(*blood sodium level. Normal range: 135~145)
Decreased consciousness is judged to be due to hyponatremia. State your treatment plan. How, and how quickly, will you correct it?
This one's easy too.
Decreased consciousness due to hyponatremia. Since there are symptoms, it needs to be corrected quickly.
ㄴ Hell Joseon Slave 1 : Severe symptomatic hyponatremia, so administer 3% hypertonic saline IV. Correct rapidly at 1–2 mEq/L per hour to improve the symptoms.
The moment my reply went up, the gallery fell into a cold silence.
And soon, a barrage of replies started coming in.
ㄴ Nephrology Boomer : Hahahahahahahahahahaha this bastard's gonna kill someone.
ㄴ Back In My Day : I knew it would be like this. Tsk tsk. Kids these days don't even know the basics. It's the speed that's the problem, you quack.
ㄴ Hematoma Is Hell : Trying to save the patient and ending up paralyzing their brain. That's a very creative murder method.
What, what's the problem?
I panicked and started racking my brain.
Correcting it quickly was right, wasn't it?
Then what else….
Ah.
Shit.
Central Pontine Myelinolysis. CPM. Central pontine myelinolysis.
If sodium is corrected too quickly, the center of the brain can dissolve, and the patient can fall into a permanent vegetative state.
It was something I had memorized by heart.
For a moment, I almost did something insane because I was fixated on correcting it quickly.
Infectious Disease Ghost : Then solve the next question. A 50-year-old man with chronic alcoholism. Even after sobering up, he isn't fully clear-headed, keeps rambling, can't move his eyes properly, and his gait is unsteady. Which vitamin must be given before administering glucose IV to this patient? Why?
I can get this one. Thiamine. Vitamin B1.
ㄴ Hell Joseon Slave 1: Thiamine. Patients with alcohol dependence are likely to be thiamine-deficient, and if glucose is given first in that state, it can trigger acute Wernicke encephalopathy.
ㄴ Infectious Disease Ghost: Correct. You got that one right.
Thank goodness.
But there was no time to rest.
The fourth question came from a place I never could have imagined.
Rheumatology Hag : 35-year-old woman of childbearing age. She came in with intermittent high fevers and polyarthralgia over the past month, along with a butterfly-shaped rash on her face. Blood tests show pancytopenia, and urinalysis reveals proteinuria and hematuria. What disease do you suspect, and what are the three specific blood antibody tests that should be done first to diagnose her?
Butterfly rash? Pancytopenia? Proteinuria?
What the fuck is this.
Lupus? Systemic lupus erythematosus?
I guess so, but....
Three specific antibody tests?
Anti-dsDNA? Anti-Sm?
And what was the third one again?
My mind went blank. This wasn't my field. How was a first-year emergency medicine doctor supposed to know this?
'No, I'm not an internal medicine doctor, damn it. I don't need to know this much...'
I couldn't post any answer.
ㄴ Rheumatology Hag : Time's up. The answer is SLE
(*Systemic Lupus Erythematosus, systemic lupus erythematosus)
. The tests are anti-dsDNA, anti-Sm, and C3/C4 complement. Isn't this common knowledge? Was he just going to stand there blankly while the patient's whole body was falling apart?
Common knowledge, she says.
It's common knowledge for that damn old hag, I guess.
I just closed my eyes.
And a little while later, the fifth question appeared.
Cardiology Ghost : All right, last one. A 55-year-old man came in complaining of chest pain. ECG shows deep, symmetric T-wave inversions in leads V2 and V3. Cardiac enzyme levels are normal. The patient says he has no pain right now. What is the name of this finding, and what is the treatment plan going forward?
T-wave inversion... myocardial ischemia?
But the enzymes are normal, and he isn't hurting now?
Then should I just observe him?
ㄴ Hell Joseon Slave 1: T-wave inversion suggests myocardial ischemia, but since he currently has no symptoms and the cardiac enzyme levels are normal, just observe him and do follow-up testing for now.
The moment my answer went up, the gallery erupted into its biggest festival of mockery yet.
ㄴ Cardiology Ghost : This fucking moron is really determined to kill a patient!!!!!!
ㄴ Back In My Day : You see that and say to just observe? That's the same as looking at a time bomb and saying you're going to watch it blow!
ㄴ Cardiology Ghost : Wellens' syndrome
(*Wellens' syndrome, an ECG finding seen in patients with unstable angina)
That's what it is, you crazy bastard!!! It's a time bomb! The moment you see that ECG, even if the patient has no symptoms, you're supposed to rush them to angiography and place a stent!
Crash.
So that day, I got two right and missed three. Two of those were fatal mistakes.
Hell Joseon Slave 1 : No, you fucking bastards, the questions are way too hard. I'm in EM, not internal medicine.
Right, I'm an emergency physician.
Fine, I can handle EKGs, but I'm not obligated to know every deep, detailed piece of internal medicine like this. This is too much, isn't it?
ㄴ Nephrology Boomer : Yeah, I know that. So what? If you're EM, you're the first one to see them, aren't you? Then you need to know more. Does a patient walk in saying, ‘I'm a nephrology patient’? Do they collapse saying, ‘I'm a cardiology patient’? Every random case goes to you first. Then you're the one who has to make the first differential and do the first treatment. Isn't it only natural to know as much as an internal medicine specialist? If you can't, quit.
What?
…
Silence.
I realized that the ghost's words were logically, perfectly correct.
The ER is the front line of every disease.
You can't pick and choose patients. That's why you have to know more broadly and more deeply than anyone else.
Ah.
I'm tired.
Really….
I collapsed right there.
Leaving behind the mess of a table, the shredded pig skin, and my miserable test results.
***
My head felt like it was about to split open.
“Urgh….”
I let out a groan and sat up.
My shoulders, lower back, wrists, every joint in my body creaked. It was the aftermath of last night's suturing practice and the price of taking a quick nap on the floor.
Fuck, my life.
What a piece of shit.
I stared at the table with hollow eyes. The brutally butchered pig skin, empty drink cans, and surgical instruments scattered everywhere were a complete mess.
'...Still.'
The sense of defeat from yesterday was nowhere to be found.
Instead, a strange stubborn streak, one I had no idea where it came from, was burning in a corner of my chest.
At this point, I decided to squeeze those crazy ghost bastards for everything they were worth.
I staggered to my feet and splashed my face with cold water. In the mirror stood an unmistakable hospital slave with dark circles under his eyes.
I grinned at that stupid-looking face.
Good. Let's play again today.
I sat on the sofa and, like an office worker clocking in for work, casually opened the damned Medical Gallery again.
And as brightly and energetically as I could, I posted a new thread as if I had forgotten yesterday's disaster completely.
Title: Hey, gallery bros! Good morning, strong and mighty!
Author: Hell Joseon Slave 1
Keep the greeting light.
But my hopes were mercilessly shattered by the very first comment.
Back In My Day : What's there to be happy about? Sit down.
Yeah, that's more like it, you guys.