Chapter 46
After sending the TTP patient up to the ICU, I sank deep into the station chair.
As the tension drained from my whole body, a bizarre confidence flowed through my veins along with a terrible fatigue.
Yeah, I did it again!
The help from the gallery ghosts was absolutely crucial, but in the end I was the one who made the judgment, shouted, and acted.
I performed a laparotomy, got dragged before the disciplinary committee, and diagnosed a TTP patient.
In just a few days, I’d gone through every kind of incident other first-years might only see once during their entire training.
Haha!
I’m a madman! A hospital-certified madman!
I wore a fairly satisfied smile and waited for the next patient.
Just then, the triage nurse called for me over the intercom.
Her voice carried a subtle awkwardness different from usual.
“Dr. Han, there’s… um… a somewhat… serious patient in Zone B. I think you need to take a look.”
A serious patient?
I reflexively tensed my body.
What the hell happened now?
But the nurse’s voice didn’t sound all that urgent.
In the first place, if it was serious, why had they assigned the patient to Zone B?
I got up from my chair and headed to Zone B.
When I approached the curtained bed, I could hear a man groaning inside.
I took one deep breath and pulled the curtain open.
A man who looked to be in his thirties was lying on the bed, curled up on his side.
His face was bright red from pain.
“What brings you in? Where does it hurt?”
At my question, the man couldn’t bear to meet my eyes and only mumbled while clutching the blanket.
“Um… doctor… I, uh, accidentally… got something stuck… in my butt.”
…
Yes.
I couldn’t believe my ears. What did he just say? Butt?
“Can’t you… do something about it? It really went in there by accident.”
The man asked, almost in tears.
I froze for a full second.
In my head, the differential diagnosis list of every deadly disease I’d been running through countless times over the past few days turned to white smoke and disappeared.
It felt like my brain had reset.
Ah. So that’s what it was.
The very case that only ever lived on as an ER legend.
My new confidence and medical reasoning were useless before this primitive problem.
What the hell was he thinking putting something like that in there, damn it.
I gave the patient the gentlest smile I could manage, the corners of my mouth stretched as far up as possible.
“Ah, yes… just a moment, sir. We’ll take care of it right away. Please wait a moment.”
I pulled the curtain closed again and stepped outside.
Fuck. Oh my God. Please.
Then I began scanning the ER with sharp eyes.
Hmm.
Let’s see.
Aha! Found it!
My radar picked up one energetic intern diligently charting in a corner of the station.
His name was… right, Park Seong-jeong.
“…Um, intern? Where did the intern go?”
I played it cool, muttering to myself as I approached right behind the intern.
Then I gave Park Seong-jeong’s shoulder a very friendly tap.
“Seong-jeong.”
“Yes? Dr. Han Hyeon-jae?”
Park Seong-jeong’s eyes, as he spun around in alarm, were still full of pure passion, untouched by the bitterness of the world.
Yes, that’s the look.
With that look, I could trust him.
I placed a hand on his shoulder with the smile of a very benevolent senior.
“Seong-jeong, a patient just came to Bed 8 in Zone B, and this case is extremely educational. It’s the kind of rare case you might only see once in your life unless you’re an intern. Want to handle it? Of course, I’ll be right here watching over you.”
“What? Really? What kind of case is it?”
Park Seong-jeong’s eyes sparkled with curiosity.
“Rectal foreign body.”
“…Huh?”
The pure enthusiasm vanished from Park Seong-jeong’s face in an instant, and pure, one-hundred-percent despair bloomed in its place.
“I’m counting on you.”
I gave Park Seong-jeong’s shoulder one more hard squeeze.
Yeah, suffer through it, Seong-jeong. Fighting.
“Huh? Dr. Han? No, wait, hold on!”
Ignoring Park Seong-jeong’s flustered protests, I shouted encouragement.
“That’s right, Seong-jeong, you can do it! Fighting!”
Whoosh.
I left that spot at the fastest pace of my life.
From behind me came a cry that was almost a sob.
“D-Dr. Han!”
Sorry, Seong-jeong.
But it can’t be helped.
That’s the intern’s fate.
Because I’m a first-year, I have to look at the bigger picture now.
I rationalized it that way and strolled leisurely back toward the station.
***
I was savoring the sweet aroma of freshly brewed mix coffee and marveling at my own judgment.
Right, this was all for education.
You have to go through primitive cases like that yourself if you want to grow into a true doctor.
As a first-year, I was a great senior who’d given a junior a precious learning opportunity.
Thinking so proudly of myself, I took a sip of coffee.
But that peace didn’t last long.
“Dr. Han!”
A moment later, intern Park Seong-jeong, returned from Zone B, called me with a highly flushed face.
Hm, had something happened?
I greeted him with the smile of a very kind and generous senior.
“Oh, right, Seong-jeong. How was it? Was it a very useful and rewarding experience? How’s the patient doing?”
At my question, Park Seong-jeong’s lips trembled.
“Dr. Han….”
“Hm?”
“When I went there… all that had been done was history taking. Nothing else.”
His voice was full of resentment.
“The chart only said R/O) Rectal foreign body
(* Suspected rectal foreign body)
and that was it… the patient kept saying he was in pain, but there weren’t any orders at all… I didn’t know what I was supposed to do….”
Listening to the intern’s protest, I answered without even blinking.
“Oh, really? I must’ve forgotten because I was so out of it earlier. Haha. Sorry, Seong-jeong. If you hadn’t come to tell me, that would’ve been a disaster. You’re smart, as expected. I like that.”
I patted Park Seong-jeong on the shoulder and naturally led him over to the station computer.
“Now, Seong-jeong. Sit down. I’m going to teach you, one by one, what basic orders you should give for a patient like this.”
I stood him beside me and opened the order window.
“First, NPO
(* fasting)
. This is the most basic of basics. Why? Because we still don’t know whether we’ll be able to pull it out by hand or whether endoscopy or surgery will be needed. He might need anesthesia, so we have to keep him NPO no matter what.”
I clicked the NPO order.
“Next is an IV line. Why give fluids? Because he can’t eat. And it secures a route for medication in advance in case of an emergency.”
I entered the fluid order.
“And the most important thing: tests.”
I opened the radiology order window.
“Now, Seong-jeong. Do you know the most important thing with a patient like this? Perforation. Perforation. Whether the bowel tore or not.”
Park Seong-jeong looked at me with an expression that said, “Do I look like an intern who wouldn’t know that?” but I deliberately ignored it.
“If the foreign object breaks through the bowel wall and fecal fluid spills into the abdomen, the patient can go straight into septic shock from peritonitis and die. That’s why we take abdominal X-rays. One just lying down, and one with the patient standing up. Do you know why standing is essential?”
“To… check the gas distribution in the intestines…?”
“Ding-ding-ding. More precisely, we’re checking whether there’s air under the diaphragm. If there’s a hole in the bowel, you’ll see a crescent shape under the diaphragm. Then it’s just, ‘Oh, we’re screwed!’ and you call surgery and run to the OR.”
Park Seong-jeong gave me that same “Do I look like an intern who wouldn’t know that?” look. So what.
“Yes…”
I entered the X-ray order with a very satisfied smile.
***
A little while later, the X-ray results appeared on the screen. I tapped Park Seong-jeong’s shoulder and said,
“Come here and take a look.”
We stood side by side and peered at the monitor.
Fortunately, there was no free air under the diaphragm.
Meaning there was no perforation.
I let out a sigh of relief and scrolled down to enlarge the pelvic area.
And then.
There it was.
In the rectum, in a very clear and unmistakable silhouette.
All kinds of medical knowledge and internet rumors began to mix together in my head.
“Hmm, it’s not radiopaque. Not metal or glass. Judging by the density….”
This… that… that thing.
Fuck.
What on earth had to happen for something like that to end up in there by accident? I couldn’t hide my shock.
“Doctor… what is that…?”
Park Seong-jeong asked beside me in an innocent voice.
The intern still didn’t seem to know the identity of that sacred object.
I hesitated for a moment before answering.
How was I supposed to explain this here?
Just then, two female nurses walked past us, chatting.
I flinched without meaning to.
It was somehow… embarrassing. It was just my patient, not me, but somehow I felt like I had to preserve some dignity(?) here.
I grabbed Park Seong-jeong’s shoulder and pulled him toward me.
Then I whispered the very quiet, and very precise, medical term(?) into his ear.
…
As soon as my whisper ended, Park Seong-jeong’s body froze completely.
The intern’s eyes widened more than any pupils I’d ever seen in my life.
The intern slowly turned his head to look back at the X-ray screen. Then he looked at me again.
Yes, this is what the ER is like.