Chapter 70
Baek Eun-seo's saying it was quiet was more powerful and immediate than any curse from an ancient god.
Even if I spewed curses at God, Buddha, and Allah all at once, it probably wouldn't be a curse this intense.
The ER's brief peace shattered.
As soon as the nurse picked up the receiver, frantic, unintelligible shouting seemed to pour out from the other end.
The nurse's face soured little by little.
“Yes, yes. The location? Truck versus sedan... yes... the patient's condition? Yes, hold on a second. I'll connect you to the doctor right away.”
Truck versus sedan?
I needed to get the information somehow, even here.
Was it the truck driver being brought in, or the sedan driver?
Was there a passenger?
“Dr. Han! You take it! It's a trauma call!”
I brought the receiver to my ear, my heart trembling.
“Yes, this is Han Hyeon-jae from Emergency Medicine.”
[Yes, doctor! This is the Dongnae Sajik EMS crew! There's been a truck-vs-sedan TA at the entrance to Mandeok Tunnel!]
Sirens and all kinds of noise mixed together over the receiver.
Sounds like a pretty big accident.
“How old is the patient? How long did it take to extricate them? Were they pulled out right away?”
[Male patient in his twenties, the sedan driver! He was trapped in the vehicle and extricated after 20 minutes]
Instinctively, I grabbed a pen and started furiously scribbling everything I'd heard onto the blank sheet of A4 paper in front of me.
“What’s the patient’s condition? What are the vitals?”
[Patient mental status: stupor
(* stupor)
and BP is 70 over 40, pulse over 140! Open pelvic fracture
(* open fracture)
suspected, with severe bleeding! GCS on scene was E1V2M4, 7 points! ETA is 5 minutes!]
GCS 7.
Almost comatose.
Blood pressure 70/40.
Mm-hmm, shock.
And an open pelvic fracture.
Worst of the worst.
Could the aorta or a major vein have been damaged?
Oh.
A hellish injury with a mortality rate that easily exceeds 50 percent.
This is bad. Really bad.
My hand flew across the paper.
- Open Pelvic Fx / GCS 7 / 70/40, HR 140+ / ETA 5min
While I was writing those letters, I saw the first-years beside me staring at the sheet with serious expressions.
Yeah, welcome to the ER, babies.
I tore off one corner of the paper and scribbled on it.
'Call any specialist, fast.'
Then I wordlessly shoved the paper into Park Seong-jeong's hand.
He stood there blankly for a moment, then quickly grasped my intent and ran like mad toward the resident room.
Keeping the receiver to my ear, I began hammering at the keyboard with my other hand.
Let's see... ICU... ICU...
[Trauma Intensive Care Unit (TICU-01)]
[19/20]
'ICU... there's one TICU bed open. Okay. The OR... no emergency surgeries in progress right now.'
I fired questions at the paramedic while picturing the worst-case scenario in my head.
“Do you have lines in both arms? How much fluid has gone in?”
[We got one line in one arm with an 18-gauge, and we're running a liter of fluids wide open, but there's almost no blood pressure response!]
Right then, Lee Min-jae ran into the station.
Silently, I slid over the note I'd scribbled on.
Lee Min-jae's face stiffened. Then he looked back and forth between me and the screen I had pulled up.
With my pen, I wrote two short words in the margin of the note.
'Can we take him?'
Lee Min-jae didn't hesitate even for a second. He immediately looked at me and gave one nod.
I brought the receiver back to my mouth.
“Yes, we'll take the patient.”
The moment I set the receiver down, I looked at Lee Min-jae standing behind me.
“Patient arriving in 5 minutes! We're forming the team now? I'm taking the lead. I'm the team leader, and I'm assigning roles now!”
His finger started pointing out each person one by one with precision.
“Han Jae-eon!”
“Yes, doctor.”
“Since you're the most senior, you're on Airway
(* airway)
When the patient comes in, protect the C-spine
(* cervical spine)
while checking the airway first, and if needed, don't hesitate—prepare for intubation right away.”
“Understood.”
Han Jae-eon gave a brief reply and began checking the laryngoscope and tubes needed for intubation.
“Han Hyeon-jae!”
“Yes, doctor.”
“You're on Circulation
(* circulation)
. When the patient comes in, work with me on either side and stop the visible bleeding first. And while I do the FAST
(* ultrasound)
exam, help maintain blood pressure by pressing on the abdomen or pelvis. Stay sharp.”
“Yes!”
“Baek Eun-seo!”
“Yes, doctor!”
Baek Eun-seo, who had just become a first-year resident, was pale with extreme tension.
“You handle procedures. Get ready to place 18-gauge IVs in both arms, and prepare the ABGA
(* arterial blood gas analysis)
kit, Foley
(* Foley catheter)
catheter sets ready in advance. Execute everything we tell you to do immediately. Got it?”
“Yes! Understood!”
“Lastly, Park Seong-jeong!”
“Yes, yes!”
Park Seong-jeong looked as if he was on the verge of tears.
Tough it out.
For the sake of your work-life balance, at least endure the hell of your shift.
“You're on documentation. Stand in front of that whiteboard. From now on, record every treatment we perform, the patient's vitals, the names and dosages of every drug we use, and the time down to the second. Okay?”
“Yes!”
And just like that, we who had looked like a ragtag bunch became a single team in an instant.
Everyone's roles were assigned.
I hurried to the resuscitation room corridor and put on the grimy lead vest.
Over that, I put on a vinyl gown, pulled on gloves, and finally fitted a face shield over my face.
Amid everyone's frantic movements, Lee Min-jae's bark of an order rang out.
“Hey, Park Seong-jeong! Face shield!”
“Ah, yes, yes! Sorry!”
Park Seong-jeong must have been so nervous that he'd forgotten even the most basic protective gear.
He fumbled for the face shield and put it on his head.
“Are you going to a battlefield without a gun? Get your head straight!”
The moment Lee Min-jae finished chewing him out, Baek Eun-seo shouted from the station while hanging up the receiver.
“Doctor! I just called the trauma surgery and orthopedics on-call doctors, and they said they'll come down as soon as they're done with what they're doing!”
“Good!”
The nurses hurried about and moved to their positions.
One pulled over the emergency cart, while another prepared IV fluids and transfusion sets.
Park Seong-jeong stood in front of the whiteboard with a deathly pale face, trembling even as he tried to open the marker cap.
Is Park Seong-jeong really going to make it as an emergency medicine doctor if he's already this scared?
Everything was ready.
As if on cue, we took our positions around Bed 1 in the resuscitation room.
Silence.
Not a single sound could be heard.
Only the faint siren of the ambulance heard from far away grew closer and closer, squeezing our hearts tighter.
Aaaaaaaaaaaaaaaaa—
The siren was now blaring right in front of the ER, as if it would tear our eardrums apart.
Whiiiiiir—
The automatic doors opened.
Screeeeech—BANG!
The stretcher cart was shoved into the resuscitation room with enough force to almost break the door.
“Male patient in his twenties! Truck TA! Extrication took 20 minutes, and his level of consciousness dropped once more during transport!”
The paramedic's urgent briefing.
The grinding roar of the stretcher wheels against the floor.
And the horrible groans intermittently escaping the patient's mouth.
“Ugh... ugh... ah... ah....”
Even the sharp mechanical beeps of connecting the monitor tangled with all those sounds, and the resuscitation room instantly turned into a hellish din.
“One, two, three!”
We moved the patient onto the bed.
“I'll suction right away—give me the suction tip!”
Standing at the patient's head, Han Jae-eon shouted, laryngoscope in hand.
“Breath sounds are decreased on the left! Portable chest
(* portable chest X-ray)
Hurry!”
Lee Min-jae shouted with the stethoscope pressed to the patient's chest.
“The pulse is really weak, and there's no peripheral pulse at all! The blood pressure keeps dropping!”
Baek Eun-seo shouted, almost crying, while holding the patient's wrist.
“Hey, hey! Get another line in! Stick it in through the femoral vein if you have to! Push the fluids in wide open!”
Together with the intern, I started cutting away the patient's blood- and dirt-soaked clothes with scissors.
What in the world? What is this?
Beneath the torn pants, I could see a pelvis with shattered bone protruding through the skin.
The area around it was already soaked with dark red blood.
And the patient's abdomen.
It was bruised blue all over.
It didn't look severely swollen, but it felt quite hard when I pressed on it.
“Shit... Open pelvic fracture
(* open pelvic fracture)
with massive hemoperitoneum
(* massive hemoperitoneum)
....”
A low curse burst from Lee Min-jae's mouth.
“MTP! MTP
(* massive transfusion protocol)
! Call the blood bank and tell them to send up four units of Rh-negative O blood right now and have ten more units on standby, now!”
Park Seong-jeong asked in panic.
“Doctor, we haven't even done the blood type test yet...”
“Forget cross-matching and all that nonsense—just tell them to send it! It's MTP! What are you going to do if you find out the blood type after the patient is dead!”
Everything was headed toward the worst possible outcome.
The patient's blood pressure kept dropping even though we were pouring in fluids.
One IV line we barely managed to get clogged up with backflow because the blood pressure was so low.
The portable X-ray machine hadn't even arrived yet because of another emergency patient.
“This is a total mess! Nothing is working!”
Lee Min-jae tore at his own hair with his surgical-gloved hands and shouted.
Senior, that thing's conta
(* contamination)
...minated... the glove...