Chapter 87
3:42 a.m.
The ambulance sirens that had been blaring like crazy from 7 p.m. until 2 a.m. had finally died down, and the sounds of nurses running around the station, as well as the patients' shouts and groans, had also entered a brief lull.
Of course, that didn't mean there were no patients at all.
Beyond the curtain in Area B, the loud snoring of a middle-aged man who'd come in dead drunk and was now getting IV fluids echoed intermittently, and from the pediatric ER in Area C, the faint cries of a child fussing over a fever of unknown cause could be heard.
There weren't that many patients, either...
And they were minor cases.
I was slumped halfway melted into the station chair, idly fiddling with a paper cup of ice-cold instant mix coffee.
'Ah, I want to go home.'
This damn fluorescent light.
The nose-stinging smell of disinfectant.
That Lee Min-jae guy was all excited, bragging that he'd become a fellow, but in the end he was still grinding away in the same hell.
And I, wearing the awkward badge of a second-year, was acting as the middle manager of that hell.
Beside me, Baek Eunseo was continuing to study.
Does she never sleep?
“Doctor.”
“What?”
“About that suspected Brugada syndrome finding from earlier. Then this patient”
“Sorry, but I’m trying to rest my eyes for a bit...”
“Ah, yes! Sorry!”
No need to apologize, though.
I rolled my stiff neck and just hoped this boring time would pass quickly.
Right then.
Ding.
Something popped up on the triage monitor hanging in the middle of the station.
New patient.
Ah, come on. Poop, diarrhea, or just a cold.
Or a split-open head from someone who got drunk and fell over.
Please let it be one of those.
My brain has no capacity left for anything more than that right now.
I scanned the text on the monitor with dead-fish eyes.
[Patient: Kim Oji (F/19)] [Arrival time: 03:41] [Chief complaint: Palpitations, Dyspnea]
“......”
Nineteen?
So she's twenty by Korean age.
She's just a baby.
But that chief complaint sucks.
Palpitation... and dyspnea...
Heart palpitations. Shortness of breath.
If those two are bad enough together to make someone run to the ER at 3 a.m., then it's definitely not fake.
I clicked the mouse and checked the initial triage note the nurse had just entered.
[Sudden onset of palpitations and dyspnea 30 minutes before arrival. No known past medical history. Alert.]
It started suddenly?
A perfectly healthy twenty-year-old?
What could it be?
The differential diagnosis list in my head started grinding reluctantly into motion.
Panic attack.
Since she's a young woman, that's the most common.
Drugs.
Did she maybe go to a club and snort something weird?
Pneumothorax?
Pulmonary embolism?
No way, right?
Or is it really a heart problem?
I lightly tapped Baek Eunseo, who was still buried in a pile of EKG printouts beside me.
“Eunseo.”
“Yes, Doctor!”
“Quiz time. Look at the monitor over there.”
I pointed at the triage monitor with a tilt of my chin.
“Nineteen-year-old woman. No prior history, and sudden palpitations and shortness of breath that began 30 minutes ago. What do you think it is?”
At my question, Baek Eunseo shot the monitor an intense, scholarly look without even a second's hesitation.
Baek Eunseo's mouth opened and closed for a moment as she muttered her own differential diagnosis.
'Young age, acute paroxysmal... no past history...'
Then she answered in a very confident voice.
“Uh... well. Maybe PSVT? She's young, after all.”
PSVT.
Paroxysmal supraventricular tachycardia.
Paroxysmal supraventricular tachycardia.
I let out an involuntary snort of laughter.
That's the right answer.
The answer every first-year should think of first, straight from page one of the textbook.
Young, healthy, sudden onset, and racing like crazy.
99% of the time, it's PSVT.
Sometimes it gets confused with a panic attack, but if we start with an EKG, we'll get the answer.
“Hm, let's go take a look together.”
I hauled myself up from the chair, my body creaking.
After all, the only doctors sitting at the station right now were fourth-year Choi Su-min, me, and first-year Baek Eunseo.
Baek Eunseo's eyes went as round as saucers at my words.
“Is that okay?”
“What's okay?”
“I mean... not you looking at it by yourself, but me too?”
“The ER isn't busy. Let's go.”
I waved my hand dismissively and led the way.
Baek Eunseo hurried after me with tiny, quick steps.
'You said I was your role model, punk. Then you should follow me around and learn.'
I snickered to myself.
Of course, half of my real intent was just the fun of teasing a first-year in this boring early morning, and the other half was to test whether Baek Eunseo could actually use what I'd just taught her about EKGs in practice.
I headed toward the triage area, where the patient had just finished registering and was coming in.
“So what exactly is bothering you...”
Before I could even finish, I saw the patient and froze in place.
The patient was very different from the fresh-faced young woman I'd imagined.
A face so pale it had gone gray, bangs drenched with cold sweat, and breaths coming in ragged, terrified gasps.
Her lips even looked slightly blue.
She was clutching at her chest as if tearing at it.
Good, at least this definitely isn't malingering.
Thank goodness.
Or not.
My body reacted first.
“Miss, stay with me.”
I gently shook the patient's shoulder.
“Have you ever been told your heart wasn't in good shape? Like an arrhythmia or a problem with a heart valve?”
“Ah... no.”
The patient barely managed to answer between gasping breaths.
“Never... breathing... it never happened before...”
No past history.
Sudden onset.
PSVT became even more likely.
But that degree of shortness of breath was not normal.
I turned my head and snapped at Baek Eunseo, who was frozen behind me.
“Eunseo.”
“Yes, Doctor!”
“Run and get an EKG. Right now. Send an intern or run yourself, whichever is faster. Bring me the fastest one. Hurry.”
“Yes! Got it!”
Baek Eunseo ran toward the station with steps so hurried she was almost tripping over her own feet.
'If we get an EKG, we'll know what it is. But before that...'
I turned my gaze back to the patient and started the basic ER physician's history taking.
“Alcohol? Cigarettes? Are you taking any other medication? Cold medicine, diet pills, even herbal medicine. Anything.”
“I don't drink or smoke, and I don't take any medicine. Really...”
The patient looked on the verge of tears.
'Not alcohol or drugs either?'
My thoughts began to tangle.
If it wasn't a panic attack, a heart defect, or drugs.
Then what on earth was making this twenty-year-old woman's heart race at 160 beats per minute?
Was it PSVT after all?
“When did this start? What were you doing when it happened? Did you exercise vigorously? Or did you fight with your boyfriend or something? Was there anything that caused you major emotional stress? Or something bad happen to someone around you?”
I tried hard to find a stress trigger.
But the patient's answer once again missed my expectations.
“Ah, I... while I was studying...”
“......Studying?”
A dumbfounded sound escaped my mouth.
Studying?
“Yes, I'd been studying continuously since yesterday... but then all of a sudden my heart started pounding, and now I feel kind of weird. Doctor. Other than that, I didn't eat or take anything strange... really, nothing...”
Without meaning to, I glanced at the clock on the station wall.
3:43 a.m.
“So you were studying right up until just before coming here?”
“Yes... when my heart started racing, I just came straight to the hospital...”
...Studying?
At this hour?
A twenty-year-old studying so hard her heart feels like it's going to burst and she's out of breath?
'...If that's the case.'
The puzzle pieces that had seemed completely unrelated up until now began falling into place one by one in my head.
A situation where she'd had to stay up studying until this early morning.
Something that made her heart pound like crazy.
Young age.
No past medical history.
No medication use.
I looked the patient straight in the eyes.
Though terrified, her pupils were slightly dilated, and the fingertips clutching her chest were trembling faintly.
'...Could it be...?'
I swallowed hard and decided to confirm the most likely suspect that had come to mind.
“Student.”
My voice dropped a notch lower than before.
“Did you drink anything like an energy drink or coffee?”
The moment my question ended, the patient's eyes shook violently as if an earthquake had struck.
Like someone whose weak spot had just been hit.
Is this what it feels like to be a detective?
The culprit was you all along, caffeine?
“Ah...”
The patient looked away and coughed awkwardly.
“Ah... yes.”
'Bingo.'
I cheered inwardly.
But this was only the beginning.
It wasn't whether she had drunk it that mattered, but how much.
“How much did you drink? It'd also help if you could tell me exactly what drink it was.”
The patient soon hung her head.
“I...”
The patient's voice sank to an ant's whisper.
“I can't hear you. It's okay. It's not like saying it will cause some huge problem.”
At my words, the student finally spilled everything.
“Uh... about six cans of energy drink?”
“......”
Six cans.
For a moment, I was speechless.
You crazy student.
Did you really think you'd be fine after drinking that all at once?”