Time Is Brain (2)

My voice was strangely calm.

Maybe the insane things I’d been through over the past few days had trained my mental state without my realizing it.

"Hello, ma'am. I'm an emergency medicine doctor, so please don't be too startled. I'll quickly check a few things. Is that okay?"

The grandmother looked at me with anxious eyes and barely nodded.

The other passengers on the bus began whispering and looking over this way.

I took my phone out of my pocket and turned on the flashlight. I didn't have a penlight, so this would have to do.

"Ma'am, look at me. Could you open your eyes wide for me?"

I gently lifted the grandmother's eyelids and quickly shone the light into both pupils.

Both pupils constricted symmetrically and well. But the left eye was deviated slightly outward.

A deviation. An ominous sign that something was wrong with one of the cranial nerves.

"Ma'am, could you squeeze both my hands once? As hard as you can."

I placed both of my hands in hers, one in each.

I could feel a fairly firm grip from her right hand, even considering her age.

But the left hand was different. No strength went into it at all. It slipped away limply. A clear left hemiparesis.

I was certain.

This was unmistakably a stroke.

I realized there was no more time to waste.

I shot up from my seat and shouted toward the front of the bus with every ounce of voice I could muster.

"Driver!! Please pull over for a moment!! There's a stroke patient on board!!"

My desperate shout sent shock through everyone on the bus.

The bus driver glanced at me in the rearview mirror, then immediately yanked the wheel and pulled the bus over into the outermost lane.

With a shriek of grinding friction, the bus came to a stop.

I pulled out my phone with trembling hands and dialed 119.

After two rings, a calm voice came on the line.

[119 General Situation Room.]

"Ah, yes. Thank you for your hard work. I'm a first-year emergency medicine resident."

[Yes, doctor. What's the matter?]

"I'm reporting a suspected stroke patient on the bus. She's a woman estimated to be in her 70s, and her level of consciousness is alert

(* lucid)

However, communication is not smooth. The onset is estimated at about 15 minutes ago. On physical exam, facial palsy, left hemiparesis, and severe dysarthria are all positive findings. I don't know her underlying conditions, but acute cerebral infarction is the most strongly suspected diagnosis."

[Yes, a stroke. Could you tell me which bus number it is and which direction you're headed?]

I looked out the bus window. A familiar sight.

"It's bus 1005, and we've just passed Yeonsan Intersection. We're stopped in the far right lane on the road heading toward the baseball stadium. The bus is stopped now."

[Ah, Yeonsan Intersection. Understood. The nearest ambulance crew has been dispatched. They're expected to arrive within 5 minutes. Doctor, if a call comes in from an unknown number while we're en route, it may be the responding crew, so please be sure to answer.]

"Yes, thank you."

After hanging up, I crouched back down beside the grandmother.

'I've done everything I can, right?'

I called 119, identified myself, and conveyed the patient's condition as accurately as possible.

Yes, the most important part of my job on scene was done.

First, I needed to lay the grandmother down and make her comfortable.

I asked the woman beside her for permission, and with the passengers' help, I carefully laid the grandmother down. I took off my bag and propped it under her head, then turned her head slightly to the side so it wouldn't block her airway.

That was all.

What I could do right now.

I couldn't give thrombolytics, I couldn't get a CT, and I couldn't control her blood pressure.

I was just a doctor with empty hands, waiting for the ambulance to arrive.

Just then, the familiar temptation began to creep up.

The Gallery. The temptation to cross-check.

My diagnosis was clear. Facial palsy, hemiparesis, dysarthria.

This is the sort of thing you see on page 1 of the textbook.

Asking the Gallery about something like this would just mean doubting myself and advertising to those insane ghosts, 'I'm the kind of idiot who can't even be sure about this.'

...No, let's not.

I shook my head. This was the time to trust my judgment.

But.

...No. Last time, there was that mala xiangguo patient pretending to have a myocardial infarction.

The memory came back vividly. Classic chest pain. Textbook symptoms.

I got completely fooled by that textbook presentation and spent two hours going down the wrong path.

If I'd even slightly suspected it then and asked the Gallery about other possibilities, maybe that huge farce could have been avoided.

Last time I didn't use the Gallery because it looked too textbook, and I paid dearly for it.

Overconfidence was out of the question. Especially right now, when one person's brain cells were dying in real time.

Should I do a cross-check?

Yeah, this isn't me doubting my own skill.

This is a double-check. The safest choice for the patient.

I rationalized it that way and opened the blue window in my head.

Title : I'm on a bus, 70s/F, suspected stroke. Anything else to rule out?

Author : HellJoseonSlave1

Sudden-onset Lt. side facial palsy

(* left facial paralysis)

, Lt. side motor weakness

(* left-sided weakness)

, dysarthria.

(* slurred speech)

I already called 119. If there's anything I'm missing or anything else I can do on scene, please advise.

I pretended to take the grandmother's pulse and scanned the comments floating up in front of my eyes.

HematomaIsHell : Nice job. That's a 100-point response for on-scene care. There's nothing else you can do. Just keep checking her vitals until the ambulance gets here.

ㅇㅇ (118.235) : Bell's palsy

(* idiopathic facial nerve palsy)

There is also the possibility of a stroke mimic caused by hypoglycemia.

(* a condition that can present with symptoms similar to a stroke.)

But when it's accompanied by sudden hemiparesis like this, it's right to treat it as a stroke.

ㅇㅇ (39.7) : Good job, first-year. But are you okay mentally right now? The first time you see something like that outside the hospital, your hands usually shake like crazy.

Reading their comments, I felt a faint sense of relief.

It felt like I was getting confirmation from dead experts that my judgment hadn't been wrong.

Well, not just like it—I really was getting it confirmed.

Anyway.

I kept checking the grandmother's level of consciousness and whether she was breathing properly, and I watched her pulse to make sure it stayed regular.

But at the same time, a vicious sense of helplessness came over me again.

There was nothing I could do.

All the knowledge I had, all the drugs I'd memorized, and all the procedures I'd practiced were useless inside this bus.

'I'm just... a bystander.'

Self-loathing welled up in me. Right then.

Wee-woo-wee-woo-

From far away, I could hear a faint siren beginning to approach.

The sound grew closer and closer.

No. Get a grip.

I shook my head, brushing off the defeatist thoughts. I wasn't a bystander.

Because I was here, the bus had stopped, and because I was here, that siren was now racing toward us.

The siren stopped right in front of the bus. The door opened, and two paramedics in familiar orange uniforms ran in carrying an emergency kit.

"Where is the patient!"

I stood up from my seat and said to them.

"Right here."

"Doctor, what happened?"

"Sudden-onset left hemiparesis, facial palsy, and dysarthria. Her consciousness is still alert. Acute cerebral infarction is the most strongly suspected diagnosis."

While listening to my brief report, the paramedics wrapped a blood pressure cuff around the patient's arm and clipped a pulse oximeter onto her finger.

Their movements were as smooth as flowing water.

As one paramedic searched for a vein and tried to secure an IV line, I kept watching the grandmother's condition from the side.

The one who seemed to be the senior paramedic gave me a troubled look and said,

"Doctor, there's no guardian here and the patient's condition could still change, so could you ride with us until we get to the hospital and hand her over? I think it'd be best for the patient if a medical professional is with her."

Ah.

I could hear the sound of all the after-work plans I'd imagined while waiting at the bus stop shattering to pieces in my head.

A warm shower, a can of beer left in the fridge, and falling asleep while mindlessly watching short-form videos—my simple happiness.

And in the end, I ended up riding along after all.

"Yes. I'll do that."

An answer completely beyond my control slipped out of my mouth.

***

The ambulance's rear doors closed.

The paramedics were moving briskly. They secured an IV line in the patient's arm and connected normal saline.

On the portable monitor, the grandmother's ECG, blood pressure, and oxygen saturation appeared in real time.

I called toward the driver's seat.

"Which hospital are you taking her to?"

"We're heading to the nearest regional cardio-cerebrovascular center! Cheongjin!"

Ah.

Ah, shit.

Cheongjin Medical Center.

My workplace. The very hell I'd just escaped from.

I was now being hauled back to that hell of my own accord.

I gave up on everything and took out my phone.

"Ah, then since it's our hospital, I'll call for you."

I dialed a familiar number.

Emergency Medical Center.

Brrr-r-r-r-

"Yes, this is the Emergency Medical Center."

The one who answered was our ER's veteran head nurse, and I could tell who she was just from her voice.

"Yes, hello, nurse. This is Han Hyeonjae."

"Ah, huh? Yes? Yes, doctor. What is it? Did you leave something behind..."

Her voice made it obvious she was thinking, 'Why the hell is an off-duty guy calling and making a fuss?'

"No, it's not that... I'm on my way to the hospital in an ambulance right now."

"...Yes?"

"Stroke, or rather... anyway, I happened to end up riding along in the ambulance, and I'm calling to give you a heads-up on the patient's condition."

I adjusted my grip on the phone and started pouring out everything I'd organized in my head over the past 30 minutes.

"The patient is a woman in her 70s. Onset

(* time of symptom onset)

is estimated to have been about 30 minutes ago. Her consciousness is currently alert and slipping toward stupor

(* stuporous)

At first I thought it was hemiplegia, but for now a clear left facial palsy and left hemiparesis

(* left hemiparesis)

were observed, and motor grade

(* muscle strength grading)

seems to be around 2 to 3. The dysarthria is severe as well."

I took a breath and added the most important thing.

"Please contact the neurology on-call doctor and radiology in advance so they can get ready for a CT. Our ambulance ETA

(* estimated time of arrival)

is 5 minutes."

There was no answer for quite a while from the other end of the line. Only the frantic voice calling for another nurse and the sound of keyboards clacking could be heard. A moment later, the nurse asked back in disbelief,

[Understood, doctor. We'll get everything ready. But... are you really in the ambulance?]

"...Yes."

After hanging up, I looked out the window.

Far ahead, the silhouette of a familiar building began to appear.

Our hospital's Emergency Medical Center.

Fuck. So much for clocking out.