Chapter 20
After the myocardial infarction patient had been taken away, a brief calm settled over the ER. I was just sitting in an empty chair, staring blankly with a thoroughly burned-out look.
I got double praise from Cardiology and Thoracic Surgery.
Heehee.
Right, I think another shop point came in a little while ago. I was just about to check how much had come in when...
But the peace was shattered in no time.
“Male patient in his 30s, vomiting
(*Vomiting, emesis)
continues!”
Along with the paramedics’ loud shout, the automatic ER doors opened once again.
The stretcher wheels screeched as they raced down the hallway. On top of it, a man who looked to be in his thirties was lying on his side, clutching his stomach and groaning.
I reflexively got up and moved to the side of the stretcher.
“Are you alert? What’s bothering you?”
The patient seemed to have no strength left even to answer. He looked at me once, then immediately buried his face back in the plastic bag and started retching violently again.
“Uweeeek!”
The paramedic standing nearby answered for him with an awkward look.
“According to the patient, for dinner tonight he... uh, ate a whole bag of dried seaweed.”
My brain froze for a moment.
“...”
Did I hear that wrong? Dried seaweed? The stuff you soak in water when you make soup?
I doubted my ears and asked again.
“You ate dried seaweed?”
“Yes... uweeeek...”
The paramedic added sympathetically,
“It was crunchy, so he just ate the whole bag.”
It was the first chief complaint I’d ever heard in my life.
Dried seaweed gastronomy.
Is this guy actually insane?
“So what are the vitals?”
“At the scene, his blood pressure was 140 over 90, pulse 110, respiratory rate 24. He was conscious and alert. It took 15 minutes to reach the scene, and he kept vomiting during transport. It’s been about 25 minutes since hospital arrival.”
His blood pressure was a little high, and his pulse and respirations were fast.
If you take it as a typical reaction to pain and dehydration, it’s normal.
He wasn’t in immediate danger of dying, but it was that awkward in-between state where we couldn’t just leave him alone either.
“Hiss... let’s lay him in Area A for now.”
Such persistent vomiting could cause severe dehydration and electrolyte imbalance.
So we decided to move him to a bed in Area A first.
Once the patient was moved to a bed in Area A, he curled up like a shrimp as soon as he lay down and kept on vomiting.
I put on latex gloves and palpated his abdomen. It was bloated all over, and he frowned every time I pressed down.
‘Could this be bowel obstruction?’
The worst-case scenario formed in my head.
Dried seaweed absorbs water and swells to dozens of times its size. Maybe that huge mass of seaweed had passed through the stomach and blocked the narrow small intestine.
If so, this wouldn’t be a simple mishap; it could be a surgical emergency requiring immediate surgery.
“Doctor! Get two IV lines in this patient, and I’ll put out an order for fluids. Also, send abdominal X-rays, both supine and standing! Get the basic labs right away too!”
***
A little later, the X-ray results appeared on the monitor.
I scanned the screen with my eyes wide, looking for the classic signs of bowel obstruction.
“Nothing?”
The X-ray was clean.
No, not exactly clean—aside from the stomach being distended, there were no findings suggesting bowel obstruction at all.
The blood test results were also all within the normal range except for slight signs of dehydration.
The radiology read that arrived soon after said the same thing. No signs of bowel obstruction.
Ah.
This wasn’t bowel obstruction.
This was just...
the seaweed had swollen up like crazy in his stomach.
It hadn’t been blocked in the small intestine; it had already become saturated in the stomach.
That meant the seaweed, swollen to dozens of times its size inside his belly, was pressing against the stomach wall, and the brain was ordering the body to vomit in order to expel the foreign object.
I looked at the patient, who was still clutching the plastic bag and gagging miserably, with a hollow expression.
Damn it.
Bowel obstruction, my ass.
Still, it was a relief. If it had been a bowel obstruction, we’d have had to call surgery and kick up all kinds of chaos, and the patient would have been in that much more pain.
“Doctor, um... am I going to die...”
The patient asked between hacking breaths.
I looked at the pitifully asking patient with sympathy.
Die? Why would you die?
It was just a seaweed party in his stomach.
The problem was how to end that party.
The first thing that came to mind was a Levin tube
(*Levin tube, a tube inserted through the nose into the stomach)
It was a primitive but reliable method: shove a thick tube through the nose until it reached the stomach, then connect it to a suction machine and suck out the stomach contents.
‘Could it work?’
I imagined it.
The scene of me shoving a Levin tube into the patient’s nostril with my own hand.
The tube would touch the stomach wall, and suction would start. But what got sucked through the end of the tube wouldn’t be pale gastric juice.
It would surely be a green clump of seaweed, soaked in water, sticky and slimy, its shape no longer even recognizable. The moment that clump blocked the mouth of the tube, the suction machine would probably just scream and stop.
It might injure the gastric mucosa, and gastrointestinal bleeding could occur.
The result would be utterly disastrous.
The patient would be in pain, and I’d be staring blankly at a tube covered in seaweed in my hand.
This is not something I can handle.
But just in case, I stared into space for a moment to gain confidence in my judgment.
Title: Hey, can you do gastric lavage with an L-tube for a patient who got brought in after eating dried seaweed?
Author: HellJoseonSlave1
My post set the gallery off in a blaze of mockery, and it flared into an entirely unexpected debate.
ㅇㅇ (210.94) : Fuck, in all my life this is the first time I’ve ever seen someone get hauled into the ER for eating seaweed, lol. Oh right, I’m dead already.
ScalpelGod: The seaweed chunk is probably bigger than the tube’s diameter. Yeah.
Hippocrates’ Descendant: Seaweed? What is that? Seaweed? Why would anyone eat that? I can’t understand Koreans.
ㄴ Hematoma Is Hell: Hey, you Yankee bastard, what do you know? Gim and seaweed are delicious and good for you. They’re rich in iodine and iron, so they keep your blood clean.
ㄴ Hippocrates’ Descendant: Such profound benefits! Then this patient is a martyr who nearly lost consciousness while eating seaweed for his health!
ㄴ Back in My Day: Martyr my ass. He’s just an idiot.
My prediction that the Levin tube would clog was confirmed, and at the same time I felt a wave of burnout at the fact that I was eavesdropping on those absurd doctors.
...Hiss. Should I call Gastroenterology?
Right. This is the gastroenterologists’ turf.
Gastroenterologists have an endoscope, after all. They can go in directly with that camera, see what’s going on inside the seaweed mass, and pull it out with all kinds of bizarre tools.
But a first-year resident calling the GI on-call doctor right away because “the patient ate a bag of dried seaweed like a snack and threw it up,” without even trying a Levin tube first?
I’d be lucky if I didn’t get cursed out over the phone.
In the end, I decided to go with the most traditional and safest method.
‘Senior SOS’
I left Area A and looked around the station.
Just then, fourth-year Yoo Seonghun was stretching out his stiff neck while charting.
I approached Yoo Seonghun with the most pitiful, serious, and desperate expression I could muster.
“Doctor.”
“What.”
Yoo Seonghun answered in his usual chronically exhausted voice.
“A male patient in his thirties came to Bed A-3 with nausea and vomiting, but the case is a bit unusual, so I’m reporting it.”
“How unusual could it be? Another drunk bastard who blacked out, right?”
“No, it’s not that... According to the patient, he ate a whole bag of dried seaweed like a snack.”
“...”
Yoo Seonghun froze.
Then he slowly turned his head to look at me. A very faint look of “what the hell did I just hear?” seemed to flicker through his eyes.
“What?”
“It’s dried seaweed. Dried seaweed. He ate a whole bag and has been vomiting and complaining of abdominal bloating ever since. At first we suspected bowel obstruction and took an X-ray, but there were no remarkable findings.”
I reported it as calmly and medically as I could.
After my report ended, Yoo Seonghun said nothing for a moment.
Then he let out a short “heh” and got up from his seat.
“Let’s go.”
Yoo Seonghun said he wanted to see the patient himself and headed for Area A.
I followed behind my senior.
Yoo Seonghun pressed on the patient’s belly a few times and listened with a stethoscope while the patient kept clutching the plastic bag and gagging, then turned back to me with a resigned look.
“What about the Levin tube?”
“I held off because I thought it’d probably clog.”
“Good thinking.”
After delivering that brief praise, he went back to the station and picked up the phone.
It was a call to the gastroenterology on-call doctor.
I held my breath beside him and listened in on the call.
“Hello, doctor. This is fourth-year ER resident Yoo Seonghun. Am I speaking with the gastroenterology on-call doctor?”
“....”
“Ah, yes, doctor. The thing is, there’s a patient in the ER right now whose case is a little ridiculous, so I’d really appreciate it if you could take a look.”
“....”
After the fellow on the other end asked something, Yoo Seonghun hesitated for a moment and then confessed.
“The patient says he ate a bag of dried seaweed raw.”
“...”
“Yes, doctor. Not soaked in water—just like a snack. The whole bag.”
Yoo Seonghun’s brow creased slightly.
“Yes, I know, doctor. It doesn’t make any sense. But he really did come in like that and he’s still vomiting. The X-ray doesn’t show bowel obstruction, but it looks like the stomach is completely blocked. I’m asking whether endoscopy could solve it.”
After a long call, Yoo Seonghun ended it with, “Yes, understood, doctor. We’ll be waiting.”
Then, as he set the receiver down, he said to me,
“Haa... There are all kinds of weirdos out there. The gastroenterology doctor says he’s coming down. When they do the endoscopy later, you come along and watch too. It’ll be a sight you won’t get to see again in your life.”
Of course, he probably didn’t literally mean for me to go watch the gastroenterologist perform the endoscopy. He just meant it was that absurd.
***
A little later, a visibly irritated gastroenterology fellow came downstairs.
He gave the patient a once-over, then said with the same resigned expression I’d seen on Yoo Seonghun earlier,
“Let’s get the endoscopy ready. Gastric lavage won’t even come close. We’ll have to go in and pull it out, I guess.”
In the end, the patient was hauled off to the endoscopy room under the unprecedented diagnosis of “suspected upper gastrointestinal obstruction due to acute dried seaweed ingestion.”
I stared blankly at the scene and thought,
The ER really does get every kind of person.