Chapter 15
Back in My Day : What are you happy about? Sit down.
Cardiology Wraith : Morning? Cut the crap and open the book. Start by reviewing the Wellens syndrome you got wrong yesterday.
Nephrology Boomer : I let you sleep yesterday, and now you're climbing over me? No chance today. Prepare yourself.
Rheumatology Hag : Come on in, my little quack. Today let's memorize the serologic diagnostic criteria for lupus perfectly. If you can't, I'll make it as if lupus encephalitis has taken over your brain.
Damn it. These bastards don't sleep, do they?
No, they were dead, so of course they didn't sleep.
Damn it.
Hell Joseon Slave 1 : ?
Hell Joseon Slave 1 : I'm off today.
Yeah, today was a heaven-sent holiday. I was off.
But it seemed the gallery bastards didn't care about my day off.
Back in My Day : Off or whatever, not our problem.
Respiratory Ghost : What's with the day off? You're a doctor—if you rest, do patients stop getting sick? Study.
Scalpel God : Hands stiffen if they rest. Brains rot if they rest. Shut up and get started.
I was flabbergasted.
These crazy workaholic ghosts didn't even know the concept of rest.
"Fine, let's do it. Go on, you bastards."
And so my sacred day off was turned into a forced study group run by doctors from the afterlife.
***
How much time had passed?
Dozens of ECG waveforms flashed through my mind. The Cardiology Wraith kept pushing all sorts of bizarre, atypical EKGs at me.
Cardiology Wraith : What's this! Brugada syndrome
(*Brugada syndrome, a genetic heart disorder)
Easy! The ST segment is rising in a curved pattern! And this? WPW
(*Wolff-Parkinson-White syndrome, a pre-excitation cardiac disorder)
What! Can't you see the delta wave? Are your eyes just decoration?
ㄴ Hell Joseon Slave 1 : I know!!
"Yes, yes! I can see it! I can see it!"
No sooner had my scream ended than the Nephrology Boomer took the baton.
Nephrology Boomer : Electrolyte imbalance looks easy? Here, DKA
(*Diabetic ketoacidosis, DKA)
patient. I gave insulin, and the serum phosphate level plummets. Why? What's the treatment? If you can't answer, I'll rip the phosphorus right out of your bones.
"Hypophosphatemia caused by insulin dragging glucose and phosphate into cells together! Treatment is phosphate replacement orally or intravenously!"
I typed the answer while practically howling.
Before I knew it, Rheumatology Hag was barking at me to recite the antibodies for rare autoimmune diseases, and before I could catch my breath, Respiratory Ghost was throwing dozens of arterial blood gas reports at me and forcing me to interpret them.
In between, Scalpel God ordered me to bring pig skin.
Scalpel God : You're still not there yet. This time it's subcutaneous suturing practice. It's the technique of stitching beneath the skin so no scar remains. Record a video and report every five minutes. If you go crooked, I'll make your facial skin look like that.
I staggered to the table and grabbed the needle again.
My hands were just a little better than yesterday.
How much time had passed?
Right before my soul was about to separate from my body.
Back in My Day : ...That should do it!
Cardiology Wraith : Hm, you're a bit better than yesterday. Looks like your brain got one or two wrinkles.
Nephrology Boomer : Remember this. Patients don't come like textbooks. Always think worst-case.
Scalpel God : That's it for today!
Scalpel God said magnanimously.
Hell Joseon Slave 1 : Yeah, everyone worked hard.
I barely managed to type a reply.
Phew... finally I can rest.
At last, it was over.
Relief.
I pushed my battered body upright. Outside the window, darkness had already fallen.
I picked up my phone in a daze.
What time is it?
And the moment I checked the number on the screen, my brain froze.
[7:13 PM]
PM?
Seven o'clock?
I roared in rage, shaking the officetel to its foundations.
"You goddamn fucking ghost bastards!!!!!!!!!!!!!!!"
.
.
.
***
I opened my eyes to the noisy alarm waking me up.
Ding-ding-ding.
Good morning.
Ba-ba-ba-ba-ba ba-ba-ba-ba.
"Shit...."
A hoarse voice burst out.
Yesterday's day off wasn't a day off. It was torture, conditioning, and nothing more than a hellish study group.
I got up like a zombie and staggered to the bathroom. In the mirror stood a first-year slave whose appearance was no better than yesterday—if anything, even worse. I flipped off that hollow-eyed face.
Fuck.
‘Those bastards... give me back my day off.’
After changing clothes, I boarded the bus to the hospital with a rotten expression.
I thought this was a cheat code, but I never imagined it would be one of the things that would screw my life up in reverse. These insane bastards are dead serious about training, too.
I briefly considered opening the shop and buying a fatigue recovery item, but since getting a possession skill was priority number one, I closed the window again right away.
***
8:00 AM.
Emergency Medicine conference room.
I was tucked into the most corner seat possible so I wouldn't stand out.
"All right, then let's begin. This is last week's case."
The presenter was Lee Minjae, a fourth-year chief resident.
"A 48-year-old female patient came in complaining of a week-long high fever over 39 degrees Celsius, muscle pain, and joint pain. Other than elevated white blood cell counts and liver enzyme levels on the initial tests, there were no notable findings, and blood cultures and imaging studies couldn't find a clear cause of infection. It was a textbook FUO, fever of unknown origin, case."
The screen was packed with the patient's complex test results and chart records.
The chief logically explained how each differential diagnosis was ruled out one by one without missing a step.
The presentation was also clean and concise. That guy's an EKG freak and a bit of a weirdo, but among the residents, the skill really is the real deal.
"...So, in the end, by combining the blood test finding of ferritin
(*Ferritin, an iron-storage protein)
levels having skyrocketed to over 20,000 with the characteristic clinical symptoms, we diagnosed this patient with AOSD
(*Adult-Onset Still's disease, AOSD)
and started high-dose steroid therapy. The patient is currently showing dramatic improvement and is being stably treated in the rheumatology ward."
As soon as the presentation ended, Department Chief Park Woong, who had been sitting in the front row with his arms crossed and listening quietly, spoke in a low voice.
"That was a good presentation. Good case. Ferritin was an important clue in diagnosing AOSD."
The department chief nodded as if satisfied, then suddenly turned and swept a look over the juniors.
My heart sank.
I know that look. It's the sign of a surprise question.
Please, not me. Please.
Ferritin is well known to rise abnormally high in AOSD. But in an emergency room setting, when you see hyperferritinemia this extreme—over 20,000—you have to consider a few other lethal diseases as well. That's something an emergency medicine doctor absolutely has to know.
The department chief's gaze drifted through the air before landing squarely on me.
Dr. Han Hyunjae.
Ah, shit.
Why don't you answer? What could it be?
Every gaze in the conference room turned to me.
My mind went completely blank. Ferritin? Hyperferritinemia? I was sure I'd heard of it.
You want me to rattle off a bunch of diseases other than Still's disease? Right now?
My mouth went bone-dry. Cold sweat ran down my back.
A hint of pity crossed the chief's face at my flustered expression.
...?
Huh?
Wait.
Ferritin... hyperferritinemia....
Didn't one of those ghosts chew me out about this yesterday?
Was it the hematology-oncology ghost? I think it shoved all kinds of cancer patient cases at me while stressing the importance of ferritin levels.
‘Idiot! If ferritin shoots up into the tens of thousands, what should you think of first? It means the patient in front of you is going down in a full-body cytokine storm
(*Cytokine storm, an acute immune overreaction)
and is dying from it!’
Fragments of yesterday's memory began to surface faintly.
I opened my mouth, fumbling for words.
"Uh... first, we need to consider a systemic inflammatory response accompanied by sepsis."
At my answer, the department chief's eyebrows rose slightly.
"And... uh... MAS
(*Macrophage Activation Syndrome, MAS)
can also cause ferritin levels to rise extremely high. Especially in patients with rheumatic diseases..."
The fragments of memory began to fit together one by one.
To think the knowledge those ghosts shoved into my brain yesterday was saving me at the conference.
"Also, in blood cancers like lymphoma or leukemia, tumor cells can release ferritin in massive amounts, and in severe hepatocellular damage such as fulminant liver failure, ferritin stored in the liver can also spill into the bloodstream in large quantities."
Once I finished speaking, silence fell over the conference room.
I held my breath and waited for the department chief's reaction.
Please, was I right? Just save me.
The department chief stared at me for a moment, then nodded with a satisfied smile.
"Yeah. That's right. Excellent. Especially mentioning MAS is worth praising."
Phew.
All the strength drained out of me.
The chief was looking at me, mouth slightly open, and the other seniors and co-residents all looked surprised.
It felt like yesterday's hellish day was getting rewarded.
Of course, the shitty side effect was that they'd end up convinced I was 'that crazy bastard preparing for an internal medicine double board.'