Chapter 84
I was speechless in the face of that absurd demand.
More precisely, I had plenty to say, but if I let any of it out, it felt like my neck would be the first thing to get cut off.
Seoul?
Oseong Hospital?
“Sir, listen to me carefully. Your condition is precisely the kind that requires surgery as soon as possible. Your appendix has already ruptured or is just about to. Even at this very moment, inflammation and pus could be spreading through your abdomen. That’s called peritonitis, and if it progresses, it can lead to sepsis and put your life in danger.”
I put on the most desperate, earnest expression I could manage.
“Going all the way to Seoul? Even if we call an ambulance from here right now, it’ll take at least four hours. No one can guarantee what might happen during that time. Our hospital’s surgical department is more than capable too. Here…”
“Huh?!”
The man cut me off.
“What the hell do you know, you young punk!”
The man’s voice suddenly grew louder.
“You think I don’t know you’re scheming to keep me trapped in some incompetent backwater hospital like this so you can squeeze money out of me!”
The man even pointed his finger at me as he badgered me.
“I’m close with the director of Oseong Hospital, you hear me! We even go to the sauna together! I do all that with him! The chief of Surgery is my friend! I’m saying I’m going there for surgery, so who the hell are you to stop me!”
“Sir, this isn’t about money. Right now, your life…”
“Doctor! What kind of doctor is an emergency-room doctor? Guys like you just prescribe cold medicine and give butt shots! A doctor who cuts open bellies! A real surgeon who handles a knife—that’s a real doctor! What the hell do you know!”
…
[system : Han Hyun-jae has entered Deeply Pissed-Off Mode]
“Sir, this is…”
“What? What are you going to do?”
The man asked back with a mocking laugh.
Just then, someone appeared who might have been a savior—or a demon.
“Hey, what’s going on?”
It was Lee Min-jae.
Perhaps he was returning from seeing another patient; when he spotted the commotion, he frowned and walked over.
It’s Lee Min-jae. If it’s this hot-blooded nutjob, maybe he can somehow handle this.
Someone like that stubborn old man might respond better to him than to me.
I stepped back and briefed Lee Min-jae on the situation.
“Doc, CT shows a peri-appendiceal abscess
(*abscess around the appendix)
accompanied by suspected perforated appendicitis
(*perforated appendicitis)
He’s received one liter of Hartmann’s
(*IV fluid)
, and he needs emergency surgery, but he’s refusing surgery at our hospital and wants to be transferred to Oseong Hospital in Seoul, so he’s currently insisting on AMA
(*Against Medical Advice, refusal of medical advice)
.”
Lee Min-jae’s expression hardened instantly as he listened to my briefing.
He quickly skimmed the patient’s chart and checked the CT images too.
Then, with a sigh far deeper than mine, he turned toward the man.
His face practically said, ‘Fuck. This night shift fucking sucks.’
Lee Min-jae started trying to persuade him too.
“Sir, your abdomen is basically in a state where shit has burst inside it. To put it simply, it’s a ticking time bomb. We don’t know when it’ll go off.”
“W-what? Shit?”
“Yes. When your appendix bursts, the feces and bacteria inside it spread throughout your abdomen. That’s called peritonitis. If we don’t operate right now, cut out the ruptured part, and wash out your abdomen, those bacteria will spread through your bloodstream to your entire body and cause sepsis. Then you’ll simply die.”
Lee Min-jae put particular emphasis on the word ‘die.’
“Seoul? Oseong Hospital? Fine. It’s the best hospital in Korea. But, sir, if you go into shock or your heart stops inside that ambulance on the way to Seoul, you’ll just die on the roadside. You won’t even make it over the threshold of Oseong Hospital’s ER before heading to the afterlife. No matter how skilled their doctors are, they can’t bring back someone who’s already dead.”
Lee Min-jae took another step toward him.
“Do I sound like I’m lying to you? This is your life. You can have surgery here, leave alive, recover, and then go to Oseong Hospital later to be treated like a VIP. Or you can keep being stubborn right now and become an anonymous corpse on the road to Seoul. The choice is yours, sir.”
Isn’t that a violation of medical ethics?
Anyway, Lee Min-jae practically threatened the man.
It wasn’t exactly something a doctor should say, but he must have decided that ordinary persuasion simply wasn’t going to work.
But the man didn’t back down.
If anything, he dug in even harder.
“Shut up! What the hell do you know! You’re all in on it together! You’re trying to make me have surgery here no matter what so you can squeeze money out of me!”
Watching the scene, I sank into a deep sense of helplessness.
I desperately hoped Lee Min-jae’s rough persuasion would work on that stubborn old man.
The man remained utterly immovable, repeating like a parrot that he knew his own body and couldn’t trust quacks like us.
Time passed.
Both the patient’s life and our patience were running out.
Just then, another figure appeared like a savior.
“Ah, the general surgeon is here.”
I turned at Lee Min-jae’s words and saw a doctor in green scrubs approaching at a brisk pace.
It was the third-year Surgery resident on call, Cho Jae-shin, whom I had already consulted through the EMR.
I hadn’t expected him to come down this quickly.
He must have recognized the seriousness of the patient’s condition and rushed over immediately.
“What’s going on? Looking at the chart, it seems like he should go straight to the OR
(*operating room)
so why are you still here?”
Cho Jae-shin looked back and forth between us and the patient.
“Ah, you’re the surgeon who came down after getting the call earlier, right?”
Lee Min-jae approached him first.
“Yes, yes, that’s right. Shouldn’t we take the patient up immediately? The professor has already left for the hospital and says he’ll arrive in about five minutes.”
Cho Jae-shin must have naturally assumed the patient would already be ready for surgery.
But reality was the exact opposite.
With a deep sigh, Lee Min-jae tried to deliver the shocking truth to Cho Jae-shin.
“Who the hell are you?! What gives you the right to butt in here!”
The moment the man saw Cho Jae-shin, he shouted as if he had found a new target for his anger.
Cho Jae-shin looked at me with an expression that said he had no idea what was going on.
“Uh… well… the patient is insisting on DAMA
(*Discharge Against Medical Advice, refusal of medical advice)
right now.”
“What? DAMA? In this condition? Why?”
Cho Jae-shin’s voice rose with disbelief.
“He… well… he says he wants to go to a hospital in Seoul instead of ours. Oseong Hospital.”
“Seoul? In the condition his abdomen is in right now?”
“Yes… well… you should hear it from him yourself.”
Lee Min-jae gave a slight nod, passing the baton to Cho Jae-shin.
And so, with the Surgery resident joining in, the desperate battle to persuade one impossibly stubborn patient began anew, with three doctors on one side.
From a surgeon’s perspective, Cho Jae-shin calmly explained how terrifying the peritonitis caused by a ruptured appendix could be and how deadly the consequences could become if surgery were delayed.
But the man had already shut his ears.
He only repeated that we were all in it together and that we were trying to scare him into giving us his money.
Watching the scene, I opened the blue window along with my deep sense of helplessness.
Maybe there was some brilliant solution that could get us out of this insane situation.
[The Gallery of Dead Physicians]
=======================
[FUCKING URGENT EMERGENCY] How do I save this guy, guys? Seriously fucking urgent, please;;
Author : Hell Joseon Slave 1
Currently trying to stop a perforated appy patient from going AMA
Any way?
Patient is stubborn as fuck. Insisting on going to Oseong Hospital in Seoul.
If I send him off like this, it’s basically a free pass to the afterlife.
Any way to get him admitted?
=======================
My desperate question sent the gallery in an unexpected direction.
[Comments]
Yeah (210.94) : How can a doctor stop a DAMA? The patient’s made up his mind. Just get him to sign a form saying the doctor isn’t responsible if something goes wrong later, and you’re done.
ㄴ Back in My Day : It’s bitter, but he’s right. Doctors aren’t gods. We don’t have a duty to save someone who’s struggling to kill himself.
Descendant of Hippocrates : No! A doctor has to persuade the patient to the very end! We have to find a way to save that stubborn soul!
Yeah (118.235) : But I heard he caused some trouble at the conference? Didn’t anyone exchange business cards with him?
Ah.
That’s right. Professor Kim Hyuk-jae.
ㄴ Hell Joseon Slave 1 : I do have his number, but if I call him at this hour and say something stupid, won’t he block me?
ㄴ Yeah (118.235) : Nothing to lose, right? If that chief says a word directly to the patient, maybe it’ll actually work.
ㄴ Descendant of Hippocrates : Ooh! What a brilliant idea! Communicate directly with the chief and solve the problem!
ㄴ Hell Joseon Slave 1 : Calling a department chief at another hospital in the middle of the night is a bit much;
ㄴ God of the Scalpel : What are you hesitating for? Your fucked-up social skills exist for times like this. Just think of it as me having wrecked your social skills in advance for this exact situation. Go for it.
This fucking bastard.
But somehow, it actually convinced me.
This might really work.
Meanwhile, things over there were still noisy.
“septic condition
(*septic condition)
causing delirium
(*delirium)
and either get the guardian’s consent and take him straight to the OR, or just get DAMA and let him disappear.”
“Ah, doctor. Please calm down and try to persuade him a little longer. Something really bad could happen to him on the road at this rate…”
“Haa…“
Lee Min-jae let out a deep sigh.
“Yeah. ER shaman Hyun-jae, put in a little more effort and try persuading him. If it works, great; if not, just get him to sign the DAMA form and send him off.”
Lee Min-jae returned to the station.
I should too… Hmm, if I’m going to make the call, I’d better go to a corner of the station.
On the way back to the station, Lee Min-jae asked me,
“Did you start the antibiotics? If perforation
(*perforation)
is suspected, you obviously have to start broad-spectrum antibiotics first.”
“Ah, not yet. I’ll put in the order right now…”
“Do it now. Ceftriaxone 2 g and metronidazole 500 mg. The basic set. Hurry.”
I sat down in front of the computer and hurriedly entered the antibiotic orders.
Meanwhile, inside the treatment room, Cho Jae-shin from Surgery was still struggling desperately to hold on to the patient.
His voice was growing more and more exhausted.
Cho Jae-shin brought over the nearby gauze bin, drew an appendix on it with a pen, and even mimed it bursting as he explained with all his might.
“If this bursts right here with a bang, the bacteria inside will spread throughout your abdomen and…”
But the man wasn’t even willing to listen.
I pulled out Professor Kim Hyuk-jae’s crumpled business card from my pocket.
The cell phone number written beneath his name.
Calling the chief of Emergency Medicine at the best hospital in Korea at this hour.
It was insane.
Even knowing it was truly insane, I couldn’t think of any other way.
The phone began to ring.
Please pick up.
No, don’t pick up.
No, pick up…
On the fourth ring, the call connected with a click.
A sleepy, irritated middle-aged man’s voice came through the receiver.
[…Yeah… yeah… hello?]
“Ah…”
For a moment, I was speechless.
He actually picked up.
“Professor Kim Hyuk-jae, hello. I’m sorry to bother you at such a late hour.”
[Who… who is this?]
“I’m Han Hyun-jae, a second-year resident in Emergency Medicine at Busan Cheongjindae Hospital. We met at the conference last time…”
[Ah… who? Who did you say? The conference? The Busan kid? But why are you calling at this hour?]
Fortunately.
Even if he didn’t remember my name exactly, he seemed to remember roughly what kind of person I was.
I began briefing him on the situation as concisely as possible.
“Professor, I’m terribly sorry to bother you, but we have a patient with a ruptured appendix in our ER…”
I rapidly poured out the patient’s condition, the CT findings, and the fact that he would be in danger unless he underwent surgery immediately.
Then, at last, I got to the point of this insane phone call.
“But the patient is refusing surgery at our hospital and says he wants to be transferred to Oseong Hospital right now. Professor, would you perhaps…”
Before I could finish, a disbelieving chuckle came from the other end of the line.
[…So let me get this straight. You’re calling me because a patient at your hospital whose appendix has burst is throwing a fit about coming to our hospital without getting surgery, and you want me to talk him out of it? Right now? At this hour?]
His voice was thick with disbelief.
“Yes. I’m sorry.”
I wanted to crawl into a mouse hole and hide.
[…].
A deep silence flowed through the receiver.
[…This guy’s out of his mind.]
He muttered quietly.
[…Hah. Put him on.]