Chapter 81
I immediately sensed the biggest crisis of my medical career in front of Baek Eun-seo's earnest, sparkling eyes.
The day had come.
She was definitely going to ask me to teach her some ridiculous technique beyond my abilities, or suggest a rare-disease case study together.
How was I supposed to handle this enormous image she'd built up of me because of REBOA?
I swallowed hard, preparing to back away as naturally as possible.
“What? What do you need help with?”
But then.
It was, surprisingly, just a simple favor.
Baek Eun-seo adjusted their glasses and pointed with a finger to a bed in the B section over there.
“Ah, the patient who just arrived at bed B-3 seems to have a dislocated finger. We took an X-ray, but I'm still a little lacking. I wanted to get some tips on reduction….”
…
“Reduction?”
“Reduction for a dislocated finger?”
“Oh, you meant you wanted help with the reduction?”
I let out a sigh of relief without realizing it.
A mere finger dislocation, not even a shoulder dislocation or an elbow dislocation.
This was such a basic procedure it barely counted as one, something even interns occasionally did.
“Yes, doctor! I saw it a few times during internship.”
This much is easy.
All the anxiety inside me melted away like snow.
I could do this.
Even if my hands were God-cursed clumsy hands, putting one out-of-joint finger bone back in place was nothing.
I mean, I'd seen posts like [Dislocation Reduction Tips.txt] on the gallery more than a few times.
The angle for pulling the finger, anesthesia methods, the post-reduction splinting method.
I already had the perfect theory loaded in my head.
I hadn't actually reduced many patients myself... but still.
Still! Even with my clumsy hands, it was a procedure I could probably manage.
A procedure incomparably safer and simpler than cutting open a stomach or shoving a balloon into the aorta.
I was confident I could handle this.
“Really? Got it. Let's go together. So what kind of patient is it?”
“Ah, as for the patient…”
As if she'd been waiting for it, Baek Eun-seo unfolded the small note in her hand and began the briefing.
“He's a 35-year-old male. He said he was playing basketball today and got hit wrong on the finger by the ball, and since then his fourth finger hasn't been able to bend. If you look at the X-ray….”
Baek Eun-seo pulled up the EMR screen and showed me the fresh X-ray image that had just been taken.
In the image, the middle phalanx of the fourth finger was completely displaced, one bone clearly riding up over another.
A textbook case, isn't it?
“Got a good look at it.”
I nodded.
“Anyway, with this, should we call OS
(* Orthopedics)
or handle it ourselves, I wasn't sure…”
Baek Eun-seo asked cautiously.
Hmm… should we really call OS for this?
Of course we could.
Orthopedics, those fairy-like doctors scattered throughout the hospital, would grumble about this kind of thing and still come fix it in the end.
But it was 7:30 in the evening.
If we called now, they'd take at least thirty minutes to get here.
And the patient would keep being in pain in the meantime.
We can just handle this ourselves.
I made my decision.
This was a problem I could handle easily enough.
“No. We can handle this. No need to call OS. Let's go.”
I stood up.
Baek Eun-seo hurriedly stood up too.
“All right, Eun-seo. Let's check a few things before we go to the patient.”
“Yes, doctor.”
“Did you check the nerves and blood vessels? The fingertip sensation is okay, and you confirmed the blood flow is good?”
“Yep! No sensory abnormality, and capillary refill time was within two seconds, so it's normal!”
Oh, not bad.
“Then what are the cases where you shouldn't do a reduction, that is, the contraindications?”
“Um… open dislocations, meaning cases where the bone has come through the skin, cases with an accompanying fracture, and cases where nerve or vascular injury is suspected—you shouldn't touch those carelessly…”
“Okay. Perfect.”
I nodded with a very satisfied expression.
The theory was solid.
Now we just had to see the practical part.
“All right. Let's go.”
We drew back the curtain at bed B-3.
The patient was still staring at his twisted finger with a pained expression.
I headed to the emergency cart, trying to look as skilled and relaxed as a veteran.
“Lidocaine okay... 10cc syringe and 27-gauge needle... povidone swab... sterile gauze...”
I gathered the needed supplies one by one while reviewing the procedure in my head again.
The idea was to inject local anesthetic on both sides of the dislocated finger to ease the pain of the procedure.
I'd done this dozens of times even with my clumsy hands.
After finishing the prep, I approached the patient again.
“Sir.”
“Yes….”
“I'm going to give you an anesthetic injection into the painful finger first, then put the dislocated bone back in place.”
But then I saw Baek Eun-seo's sparkling eyes right beside me, watching every word and action in minute detail.
Ah, right.
Training.
I cleared my throat once and added awkwardly,
“But since we're at a university hospital, there's also an educational purpose here. So, from a learning standpoint, the person standing next to me is…
I gestured at Baek Eun-seo with my chin.
'Why are their eyes so sparkling? That's so pressure-inducing.'
“Anyway, I'll proceed in front of this person here. Is that okay?”
Even in pain, the patient nodded as if he had no choice.
Just like that, I finished the most absurd, out-of-the-blue first lecture as a senior in the world.
'Did I ever do a reduction when I was an intern too?'
My memory was hazy.
I can't remember.
“All right, this will sting a little.”
The needle pierced the skin.
After about five minutes, the patient's expression relaxed a little.
“How is it now? It doesn't hurt like before when I touch it, right?”
“Just a bit numb and tingly….”
“Good. Then I'll set it now. Watch closely.”
I gave Baek Eun-seo a glance and took hold of the patient's finger. The tips I'd seen on the gallery earlier flashed through my mind.
And so I smoothly began the reduction.
“Relax, sir. Exhale slowly and….”
While pulling on the finger, I pressed gently with my thumb on the protruding, misaligned bone.
At the same time, I moved the entire finger slightly in the direction of bending.
Pop.
Success.
I carefully bent and straightened the patient's finger.
It moved smoothly, unlike before.
“How is it? You can move it now, right?”
“Yes! That's amazing!”
A smile mixed with relief and surprise spread across the patient's face.
“We'll take another X-ray now to make sure the bone is properly back in place, then I'll put on a splint.”
After sending the patient to radiology, I returned to the station.
“Doctor, you were really fast!”
“Haha, it's nothing. You get a feel for it after doing it a few times.”
Yeah, thanks, you bone nerd.
“Soon I'll definitely show you a bone marrow slide.”
You have my word.
A little later, the X-ray image appeared on the EMR screen.
Nice.
The finger bones on the screen were perfectly back in place, as if nothing had ever happened.
Perfect.
With a satisfied smile, I set up an orthopedic outpatient appointment and prescribed discharge medication.
“Please be sure to go to the orthopedic outpatient clinic. Until then, don't remove this splint, and don't overuse the finger.”
The patient kept nodding.
The patient gave a little bow and left the emergency room.
Yeah, every now and then, this kind of thing is nice.
I couldn't spend every day staring at blood and listening to people groan like they were dying.
The clean success of the finger-dislocation reduction gave me, for a very brief moment, the dangerous illusion that I might actually be a pretty decent doctor.
See? When I followed what I'd learned and did it by the book, it worked, right?
Maybe I was finally escaping the clumsy-hands label?
But that brief self-satisfaction was shattered by the barrage of questions that followed from the juniors.
As if I were some kind of walking medical encyclopedia, Baek Eun-seo kept coming to me and asking all sorts of basic things.
“Doctor! Earlier in Zone A, when Dr. Lee Min-jae placed the C-line
(* central venous catheter)
under ultrasound guidance, right? But in books,
(* anatomical structures)
they teach you to place it by landmark from the start. But in practice, do people mostly use ultrasound? And when using ultrasound, any tips for telling arteries and veins apart…?”
“Just press lightly with the probe—the one that collapses is the vein, and the one that stays round and pulses is the artery.”
The questions were endless.
From EKG interpretation to antibiotic selection criteria and indications for each type of IV fluid, even useless questions like, 'Doctor, what did you have for lunch?'
I was nearly half out of my mind as I mixed my shallow knowledge with all the odds and ends I'd picked up from the gallery ghosts to satisfy Baek Eun-seo's curiosity.
And so, by combining hollow advice with gallery-born knowledge, I somehow endured the barrage of questions.
I answered what I knew, and what I didn't know I glossed over convincingly or shoved back with, 'Your skills only improve if you look that up yourself.'
As expected, I really am an excellent senior.
Before I knew it, the time was already heading toward 8:20 p.m.
Seeing the numbers in the lower right of the monitor change to 20:20, I let out a deep sigh.
I'd only been on duty for an hour and twenty minutes, so why did it already feel like my soul had run away?
For a moment, the station was miraculously peaceful.
A brief lull after the evening patients had been mostly sorted out and before the next wave came in.
I sat in the empty chair and closed my eyes for a moment.
I wanted to pass out like this for ten minutes... no, even five.
Right then.
“Incoming patient!”
An EMT's urgent shout came from the emergency room's automatic doors.
The 119 ambulance crew brought the patient in.
The stretcher cart rumbled loudly as it rushed toward the station.
On top of it lay an elderly man who looked to be in his sixties, motionless with his eyes closed.
I reflexively stood up and moved to the side of the stretcher.
“What happened?”
“Yes, the family found him collapsed suddenly in the living room at home and called it in! He was conscious when we arrived on scene. Current vitals are BP 110/70, pulse 70, respiratory rate 18, SpO2 98%. GCS is 15, fully alert. We transported him with 2L oxygen via nasal cannula. No other trauma findings.”
The EMT's briefing was quick and concise. Listening to him, I rapidly assessed the condition of the patient lying on the stretcher.
I lifted the patient's eyelids to check the pupillary reflex and also checked movement in both arms and legs.
There were no signs of paralysis.
'What is this? Did he just lose consciousness briefly? Vasovagal syncope
(* vasovagal syncope)
? Or an arrhythmia?'
I was running differential diagnoses through my head when
the patient slowly opened his eyes and muttered something in a hoarse voice.
“Giants... th-those... bastards....”