Chapter 49
After a hellish commute home, I arrived at my tiny officetel like a corpse.
I flung my bag onto the floor, yanked off my tie, unbuttoned my wrinkled shirt, and headed for the sofa.
Haaah…
Ah… I'm exhausted…
I closed my eyes.
But sleep wouldn't come.
The cursed phrase 'autumn academic conference' drifted behind my eyelids.
Deadline: midnight Friday.
Draft due by noon tomorrow.
Professor Cheon Eunjeong's bright, devilish face came to mind.
I forced myself to sit up.
First… where should I start? PubMed? Or… the gallery?
PubMed.
The holy land of medical researchers, and an endless sea of information.
I shook my head.
No.
I have that cheat-level compass. Its personality is crap, but its performance is solid.
[Dead Medical Scholar Gallery]
===============
Title: Please save me… (paper-related)
Author: HellJoseonSlave1
My professor suddenly told me to write a poster abstract for the fall conference by noon tomorrow. The topic is a case of acute myocardial infarction presenting as a sore throat. Guys, what paper should I even start with? Please at least give me some keywords. Please.
===============
Yup (210.94) : ??
Operating Room Phantom 3 : Is this even a question? Is this even a question? Is this even a question?
Back in My Day : It's your case, isn't it? Then you can find the search terms yourself. You're a first-year now—shouldn't you be able to look up papers on your own by now? How long are you going to keep asking to be spoon-fed?
God of the Scalpel : Boo.
I knew it, you goddamn ghost bastards.
Tsk, tsk. Poor bastard. Listen carefully. The first thing you need to do is choose your keywords. But you know what mistake idiots like you make? You search something stupid like 'sore throat MI.' You think that'll get you proper papers?
What the hell are you supposed to search for, then?
I quietly waited for the next comment.
'Atypical symptom'—in other words, 'atypical presentation' or 'atypical symptom.' That's the key keyword. And what do you call pain caused by myocardial infarction that's not chest pain but pain in another part of the body? You call it an 'anginal equivalent.' Start your search by combining those two.
I shot to my feet, rushed to my desk, and turned on my laptop.
Cardiology Phantom : Then you need to apply filters. What's the point of reading papers from twenty years ago? Stick to the last five years, and look at reviews and meta-analyses first. Filter out case reports for now.
Yup (39.7) : Medical journals have tiers too. NEJM, Lancet, Circulation, JACC. It's best to prioritize papers published in journals at least at that level, yeah.
I hammered the keyboard and clicked the mouse like a madman.
Hematoma Is Hell : First, prevalence. What percentage of patients complain only of atypical symptoms without chest pain? And among them, how rare is it for the sore throat to appear on its own?
Hematoma Is Hell : Second, mechanism. You need to present the neurophysiological basis for why a hurting heart makes the throat hurt. Find papers that explain the principles of referred pain.
Hematoma Is Hell : Third, prognosis. Patients with atypical symptoms like yours are usually diagnosed late, so there'll be plenty of data showing their prognoses are worse than those of typical chest-pain patients. Find comparative studies and conclude that early detection is crucial.
Finally, God of the Scalpel, who had been quietly watching, tossed in a remark.
God of the Scalpel : So, did you check which coronary artery was blocked in that patient? When the right coronary artery is the problem, referred pain often radiates to the jaw or throat. Don't forget to check the coronary angiography report again and consider the link between the blocked vessel and the sore throat.
I still hated those ghost bastards, and they were still obnoxious, but at the same time, I respected them.
Their relentless thirst for learning that didn't cool even in death, and that twisted drive to teach their juniors—though I didn't really want to think of myself as one.
I sat in front of the laptop, wringing my empty brain for a plan.
Prevalence, mechanism, prognosis.
If I build the paper's framework around those three, that'll do.
What now?
Once the skeleton is set, you need flesh.
My case. My patient's data.
Oh, right. The EMR.
Shit.
EMR. Electronic medical record.
You can only access it on the hospital intranet.
And right now I'm sitting at my officetel desk.
Ha… what do I do?
Who was on night duty today again?
I mentally ran through the schedule of my fellow first-years. Since Kim Jihoon and I were on days, nights would be…
First-year Jo Suyeon?
'Should I ask her to send me some data from the EMR?'
A devil's whisper rose up in my head.
'Wouldn't that be a no-go?'
But reason immediately stomped that whisper down.
'Hmm, right? It'd still be a no-go because of privacy concerns, though.'
Even without looking it up, it was clearly a violation of medical law.
I'd have to go through the proper procedure.
Right.
Give up tomorrow's day off, crawl back into the hospital, formally apply to view the medical records, and sort the data out at my desk. That was the only way.
But… just in case, I decided to make a post.
There might be some outlandish loophole known only to the ghosts that I didn't know about.
Title: Guys, I got home. Is it okay if I ask my co-resident for EMR data I need for a paper over KakaoTalk?
Author: HellJoseonSlave1
Yup (118.235) : Yep, you can. If you want the two of you to go to the slammer together.
…Huh?
Let's just look for papers today.
And tomorrow, on my day off… on my day off… let's go to the hospital….
Let's do this.
I sat back down in front of the laptop.
I started searching with the keyword Back in My Day had given me: 'atypical presentation of ACS'.
(* atypical presentation of acute coronary syndrome)
Hundreds of papers flooded in.
“Wow… how am I supposed to read all this?”
Cardiology Phantom : Quit whining and skim the titles first. Sore Throat
(* sore throat)
or Pharyngitis
(*
pharyngitis)
Look for words that are mentioned alongside them.
I followed his advice and scanned the titles.
I was scrolling like crazy through dozens of titles when one paper caught my eye.
‘Acute Myocardial Infarction Presenting as Isolated Sore Throat: A Case Series and Literature Review’.
“Oh! This one! This looks like it!”
HellJoseonSlave1 : Hey, how about this? 'Acute Myocardial Infarction Presenting as Isolated Sore Throat: A Case Series and Literature Review.' The title alone sounds damn plausible. Should I cite it?
Back in My Day : Check which journal it's from first. If it's some weird no-name third-rate journal, skip it. You do know what a journal impact factor is, right?
I checked the journal name.
The American Journal of Emergency Medicine.
It was a fairly prestigious journal in emergency medicine.
Yup (39.7) : It's an emergency medicine journal? The IF is over 3, too. Seems pretty good.
Cardiology Phantom : Yeah, then read the abstract first.
‘…After analyzing a total of 12 myocardial infarction patients presenting with sore throat, 75% were male, and the average age was 62…. Most had risk factors such as smoking or hypertension….’
HellJoseonSlave1 : Oh, this is good. There's data I can compare with my patient and cite. My patient is a man in his fifties with a smoking history.
Descendant of Hippocrates : Nice!
I went back to the search results. This time, I started looking for papers on the mechanism, just as Hematoma Is Hell had told me.
A review paper packed with anatomical diagrams and neural circuitry caught my eye.
It explained how pain signals starting in the heart travel up the spinal cord, then mix with sensory signals from the throat and jaw entering through the same spinal segment, causing the brain to misidentify the source of the pain.
HellJoseonSlave1 : This? Should I cite this part? It says the pathways of the vagus nerve and sympathetic nerves overlap.
Hematoma Is Hell : That'll be the scientific basis for your case. Dress that up nicely and use it as is so it looks impressive.
Back in My Day : Good! That's it! Starting to get the hang of it now?
With real-time coaching, I started collecting papers one by one.
Statistical papers showing that patients with atypical symptoms have worse prognoses, and other case reports where the diagnosis was delayed because they were mistaken for sore throat and sent to ENT.
Time flew by like crazy.
I even brewed and drank three more cups of coffee.
But strangely, I felt more of a strange exhilaration than fatigue.
I guess it felt like the scattered fragments of knowledge were slowly fitting together into one huge picture, with the ghosts' nagging and my case at the center.
By the time the clock read 1:31 a.m.
In my laptop folder, fifteen PDF reference files were neatly organized.
Huaaah… It's done….
I leaned all the way back against the chair and stared at the ceiling.
I had finally crossed one of the toughest mountains.