Chapter 5
The chief's hearty laughter echoed.
After his heavy hand patted my shoulder a few more times, the chief finally left with the fellow doctor, wearing a satisfied expression and saying, “Yeah, keep working that hard.”
I didn't straighten my back from the ninety-degree bow until they had completely disappeared from view.
Senior Choi Su-min was giving me a complicated smile mixed with shock, sympathy, and a little admiration.
“Hyunjae... you really know how to navigate office life....”
I could only offer a weak smile.
On the corner of my vision, the quest window was still blinking, shouting, 'Remaining time : 00:52:17'.
I had already blown eight precious minutes on socializing with the chief.
I gathered up my tattered nerves and pulled over an empty station chair to sit down.
I need to find a patient.
Area A, resuscitation room, isolation room.
All of the severe-care areas in the ER were empty.
Then there was only one possibility left. A patient classified as mild or moderate by triage, but whose condition was actually rapidly worsening.
There had to be a patient the doctors or nurses had missed and left unattended.
I logged into the EMR system. Along with the familiar hospital logo, a list of every patient currently staying in the ER appeared on the screen.
I scrolled the mouse wheel down and started opening the charts of the patients lying in Area B, the general beds, one by one.
First patient. 24-year-old woman, chief complaint: abdominal pain.
She came in saying her lower belly had been hurting a little since last night.
Vital signs stable.
All blood test results normal.
In the initial physician's charting, it said 'R/O
(*R/O, rule out)
simple gastroenteritis.'
Suspected simple gastroenteritis.
This is just constipation or menstrual cramps. Pass.
Second patient. 38-year-old man, chief complaint: common cold.
Cold?
A cold?
Two days of runny nose, cough, and a slight fever. When I asked why he came in, he said his office was nearby, so he stopped by after work.
This is a tertiary-care emergency center, you know.
Do you even know how much your bill balloons when you come here?
You could've just gone to a neighborhood hospital's ER. If it were me, I'd never come. I couldn't bear to waste my own money.
I was boiling inwardly as I moved on to the next chart.
Third patient. 45-year-old man, chief complaint: intoxication.
The police brought him in after finding him collapsed on the street.
Blood alcohol concentration 0.25%. Vital signs stable. He's just sleeping. Pass.
Fourth, fifth, sixth....
Flu, body aches, headache, indigestion, dizziness, flu, flu, flu.
“Ha... fuck.”
The curse slipped out before I knew it.
My fingers kept losing strength as they scrolled across the screen.
Something was wrong.
Not a single one of these patients was dying.
Most of them were actually people who could be discharged right now without any problem.
I stopped the mouse and leaned my stiff neck back. The red quest window filling my vision looked even clearer.
'Remaining time : 00:41:03'
Time was passing, but instead of clues, only my suspicion was deepening.
Grr.... Is the status window lying to me?
Maybe all of this is just an elaborate show playing out in my head.
The VEXAS syndrome diagnosis was just a lucky coincidence, and this emergency quest is a fake lure the system threw at me to mock me.
Isn't that a reasonable suspicion?
But... but that reward of '1,000 LP' and 'unlocking a hidden trait' was just too tempting.
And what if there really was a patient I'd missed?
'Again, from the beginning.'
I swallowed my private doubts and scrolled back to the top.
The patient's age, sex, underlying illnesses, current medications, allergies....
I compared each blood test value one by one with the normal range, and compared them with previous test results to check the trend of change.
I reopened the X-ray and CT reports, eyes wide open, checking whether radiology might have missed any tiny lesion.
But the result was the same.
Clean. Far too clean.
A procession of textbook mild cases.
Nowhere was there even a shadow of death.
In the end, I slumped back in my chair, crestfallen.
Time was slipping away mercilessly, and now less than 30 minutes remained. My adrenaline had been completely drained, leaving only deep fatigue and defeat in its place.
Where the hell is it?
'A patient left unattended in the hospital, dying.'
The quest's sentence kept circling in my head.
Was I missing something very basic?
Or was the patient not in the emergency room to begin with?
In the end, I closed the EMR window.
The words and numbers on the screen alone couldn't find the answer.
I stood up and slowly started walking through the emergency room.
I scanned the beds in Area B one by one, looking around. The quest's remaining time was now only about 20 minutes.
Anxiety was choking my throat, but on the surface I tried my best to look calm, casually acting like I was making
(*Rounding, ward rounds)
the rounds like a doctor.
I approached one bed and abruptly pulled back the curtain of the sleeping patient.
A woman in her twenties, sleeping soundly, jolted awake in surprise.
“What's wrong, doctor...?”
Her eyes were full of wariness, as if to say, 'What kind of lunatic is this?'
I scanned her face and the vital signs on the monitor beside the bed for a second. Stable heart rate, normal oxygen saturation. No problem.
“…Uh, no. I came to check whether your blood pressure is stable. Just keep sleeping....”
I awkwardly bluffed and hurriedly drew the curtain shut again.
My face burned at the absurd look I could feel from behind me.
I repeated that insane stunt a few more times.
I lightly pinched the foot of a drunk man sleeping off his booze to see how he'd react, or walked up to a patient complaining of a headache and suddenly shined a light into their eyes to check the pupil reflex.
The patients' complaints and the nurses' puzzled looks stabbed into my back like knives.
As I wandered around the emergency room like that, my footsteps stopped in front of Bed 17 in Area B.
A middle-aged man who looked to be in his mid-50s was lying there groaning. Cold sweat beaded on his forehead, and his face was pale. He looked like a textbook acute gastroenteritis patient.
It was the patient I'd seen in the EMR earlier.
He had come in with vomiting and abdominal pain, and was being given IV fluids and observed for suspected food poisoning.
Hmm, was there anything special about this patient....?
I took out my phone from my pocket and opened the EMR again to check the chart.
54-year-old man. Chief complaint: vomiting, diarrhea, abdominal pain. R/O Acute gastroenteritis
(*Suspected acute gastroenteritis)
His vital signs were stable, and there was nothing unusual in the blood tests besides a slight sign of dehydration.
Literally nothing special. A textbook case. There was no way a patient like this could be dying.
Just as I was about to turn away in disappointment, the man called out to me weakly.
“Hey... doctor.”
“Yes, sir. Are you all right? Is your stomach hurting badly?”
“No, not that. It's just a little hard for me to get up, but could you bring me a glass of water? I'm really thirsty....”
Well, the water dispenser was right near the station, so that much I could do for him.
I nodded and headed for the water dispenser. I filled a paper cup to the brim with cold water.
I carried the cup of water back to the patient and handed it over.
“Here you go. Drink slowly.”
The man bowed his head as if to thank me, took the cup, and drank a sip. Then he said something very strange.
“...Ah! Doctor, you could've given me cold water instead of warm water, haha. Anyway, thanks.”
“......?”
I couldn't believe my ears.
Warm water?
Something was off.
I was sure I'd pressed the blue cold-water button on the dispenser.
I hadn't tried it myself, but just from the droplets beading on the cup, this was clearly cold water.
And yet the patient thought this was warm water.
“Sir, does the water feel hot to you?”
“Huh? No, not like lava-hot or anything. Just lukewarm. I like cold water better, that's all. Heh heh.”
The man smiled it off as if it were nothing.
But I couldn't smile.
Warning lights started going off in my head.
For now, I muddled through the situation and said, “All right. I'll bring you cold water next time,” before heading back to the station.
My heart started pounding again.
I went straight over to Senior Choi Su-min and explained what had just happened.
“Senior, it's the B-17 patient. He's a gastroenteritis patient, but when I gave him cold water, he said it was warm water. I think there may be something wrong with his temperature sensation.”
Senior Choi Su-min's eyes sparkled with interest.
The senior reopened the EMR and carefully reviewed the patient's chart once more.
“A temperature-sensation abnormality.... That's a pretty unusual symptom, but it's hard to do anything with just that. Severe dehydration or an electrolyte imbalance could cause temporary sensory abnormalities.... Or in very rare cases, it could be a neurological issue.”
The senior rested his chin on his hand and thought for a moment before finally reaching a textbook conclusion.
“For now, let's run
(*Lab, blood test)
the labs again, and maybe put in a neurology consult? Let's ask the on-call neurologist to take a look at the patient.”
As expected.
There really wasn't much of a solution.
The symptoms were too vague and nonspecific to suspect and dig into immediately.
I said, “Yes, sir, understood,” but inside I felt like I was burning up.
'Remaining time : 00:08:43'
How long would it take to send the neurology consult, see the patient, run the tests, and find the cause?
By then, would this patient—and my quest—still be okay?
I stood alone in a corner of the station, anxiously staring at Bed B-17.
Ah, for some reason, I feel like it's that patient.... What should I do....
Should I post about it in the 'Dead Medical Scholar Gallery' in my head? But what should I even write?
‘54-year-old man showing temperature-sensation abnormality along with gastroenteritis symptoms. What do you think?’ Like that? There was no guarantee I'd get a clear answer back like I did with VEXAS.
....Forget it.