Chapter 88
“...Six cans?”
I thought I was hearing things.
This twenty-year-old had slammed down six cans of energy drink or coffee at this hour of the night, supposedly to study for a test?
Does he even have a liver left?
No, does his heart even have any left?
It's tachycardia, sure, but the cause is obvious.
Caffeine overdose.
I let out an inward sigh.
The worst miseries you run into in the ER usually happen when you can't tell the cause or can't do anything about it.
At least the cause was clear this time.
Right then, Baek Eun-seo ran up, panting.
An intern followed behind her, dragging the EKG machine.
“Doctor! The EKG is here!”
“Oh, okay. Good job.”
I gave Baek Eun-seo's shoulder a light tap.
“Eun-seo, let's move that patient to an A-zone bed... no, B-zone. An A-zone bed is too good for him. Put him down in the empty spot in B-zone.”
“Get a line and give him just one liter of fluid. Normal saline.”
“Ah, yes!”
Baek Eun-seo hurried off to guide the patient to the bed.
“Student.”
“Y-yes... yes... Am I going to die? Is my heart going to explode?”
“Right now, um... this seems to be because you drank way too much energy drink? If you pour in that much caffeine, it'd be weird if your heart didn't go crazy. Running at 160 is only natural.”
The patient's face shifted from fear to embarrassment and confusion in an instant.
“Oh... then... am I okay?”
“We'll have to see that now, won't we.”
I laid the patient down on the bed and returned to the station.
I grabbed the EKG printout the intern had taken.
Baek Eun-seo had somehow already stuck herself right next to me and was staring hard at the paper with me.
I tapped the paper with my pen.
“Now, take a look. What does it look like?”
“It's sinus tachycardia.”
“Right, sinus tachycardia.”
I yawned widely and set the paper on the desk.
I drew back the curtain in B-zone where the patient was lying and walked over to him.
“Well, first of all, there doesn't seem to be any major problem with your heart. It's not like a coronary artery suddenly got blocked or your heart muscle is necrosing or anything like that. Just understand it as your heart freaking out and having a fit.”
“Oh, is that so...”
Baek Eun-seo asked carefully, as if trying to confirm something she'd learned in a textbook.
“Doctor. But I have a question.”
“What is it.”
“If the heart is beating so fast that the P wave overlaps the T wave and is hard to see, so it's ambiguous whether it's sinus tachycardia or PSVT, how should we differentiate them? They're both narrow-QRS tachycardias...”
‘Oh. Good question.’
Even through my fatigue, I was mildly impressed.
“Once the heart rate starts climbing past 150 and 160, the P waves get buried in the T waves and you can't see them. Then you can't tell whether it's sinus tachycardia with buried P waves or PSVT with the P waves hidden somewhere weird to begin with.”
“Yes! Then what do you do...”
“Use adenosine.”
I pointed at the crash cart with my finger.
“Ah! Not for treatment!”
Baek Eun-seo's eyes lit up.
“That's right. For diagnostic purposes. You just shut down the AV node(* atrioventricular node) for a few seconds.”
I snapped my fingers.
“Now, say you give 6 mg of adenosine to that confusing tachycardia patient. If the tachycardia stops and the rhythm returns to normal? Then it's PSVT. The reentry circuit passing through the AV node got cut off by the adenosine. Diagnosis successful.”
“Wow...”
“Now the second case. You give adenosine. But then the sawtooth pattern pops right out. Those are called F waves. It's atrial flutter. Since only the AV node gets blocked, the atria going crazy shows itself clearly.”
“Scenario three: you give adenosine, and the heart rate slows for just a moment before speeding up again. But even during that slowdown, the P waves are still neatly sticking out in front of the QRS complexes. Then what is it? That's sinus tachycardia.”
“Oh... adenosine...”
“The cause here is obviously caffeine. The diagnosis is clearly sinus tachycardia too. For now, let's pump in fluids and watch the course.”
At that moment, the patient on the bed called to us in a trembling voice.
He seemed to have heard our entire conversation.
“Then, doctor... can I be discharged right away...?”
Baek Eun-seo and I both looked at the patient at the same time.
I stared blankly at the patient for a moment.
“...No?”
“What? But you said there wasn't any major problem with my heart. It was just... because of the energy drink.”
“Yes. But the energy drink is still in your bloodstream, so where are you going? Your heart is running a full marathon right now.”
I ran a hand over my face.
“Just go to sleep. I'll discharge you much, much later.”
“What? When?”
“When? That number on the monitor over there. When it's not 160 anymore and drops below 100. When your chest isn't pounding, when you're not short of breath, when you can walk around just fine. That time.”
I tapped Baek Eun-seo's shoulder.
“Follow up the EKG every 30 minutes. Once that liter of fluid is done, hang another one.”
“Yes! Understood!”
Baek Eun-seo answered brightly.
Somehow that enthusiasm felt unfamiliar to me, and I smirked as I drew the curtain and was about to head back to the station.
Right then, the patient lying on the bed called out to me in a hurry.
“Doctor! Um... doctor.”
“Yes. Student. What is it.”
“Um... if you use some kind of medicine, won't it get better right away?”
The patient still seemed unable to let go of the idea.
I stopped and stared straight at the patient.
Even now, his determination to get out quickly and go do something felt impressive.
“Oh, a med student? A pharmacy student? Or a nursing student?”
Otherwise, there was no way he'd specifically bring up drug treatment in this situation.
“Ah... no. Nothing like that, I just... did a little searching...”
Ah, the internet.
I let out a deep sigh and walked back over to the bed.
“Searched? What did you search? 'Heart palpitations ER' or something like that?”
“Yeah... something like... treatments that help when your heart is racing...”
“Hmm...”
I folded my arms.
“Then what would you do if I discharged you, student?”
“Huh?”
“If I sent you home right this second, what would you do?”
The patient couldn't figure out the intent behind my abrupt question and glanced at the bag at the foot of the bed.
A corner of a thick exam prep book was visible between the zipper teeth.
“...Uh, studying...?”
I couldn't help letting out a snort at that answer.
What an incredible human being.
I turned to Baek Eun-seo, who was standing behind me with the exact same dumbfounded expression.
“Hey, Eun-seo.”
“Yes, doctor.”
“That wouldn't work, right?”
Baek Eun-seo immediately caught my meaning and shook her head vigorously.
“No. Absolutely not, doctor.”
I turned back to the patient.
“You see? Even the first-year doctor says no.”
“No, why... if you just give me medicine...”
“Student. What you found sounds like PSVT, but this is sinus tachycardia. They're different conditions.”
“What? How is that different...”
“Your heart wants to beat normally, but that caffeine has come down from your brain and is whipping it into running nonstop. That's sinus tachycardia.”
“Ah...”
“So, that magical shot you mentioned probably wouldn't do much. Probably.”
“Ah... okay...”
The patient's face flushed bright red with embarrassment.
I pulled over the chair beside the bed and sat down.
“This is usually case by case. Person by person.”
“Case by case...?”
“Some people are just naturally built different, or their bodies are made of steel, and they can drink ten cans of that stuff and still be fine, just going, 'I'm a little sleepy.' I've seen people like that too.”
“But then there are people like you. Some folks drink just two cans and go down hard, ending up carted into the ER. Their heart throws a fit like, 'Master, have you lost your mind?' You're just unlucky and built like the latter.”
The patient's face darkened.
“Anyway, we need to get that caffeine out of your body. This fluid is going in now so your kidneys can filter it, meaning you need to pee it all out.”
I motioned toward the IV line in the patient's arm.
“So this isn't something that gets cured with one magic shot. We need to watch it for a while until all that toxin leaves your body. You should rest too, right?”
I glanced at the patient's monitor.
158.
Still fast.
“Ah... okay...”
The patient finally lowered his head as if he understood.
That dejected look reminded me of my own from a year ago.
I asked absentmindedly.
“It's early March. Classes only just started, so what's so urgent that you're up like this at this hour? At twenty, you should be busy having fun.”
“Ah, I... I'm a repeat examinee...”
‘Ah.’
Silence fell for a moment.
‘I touched a nerve I shouldn't have.’
A repeat examinee.
Without meaning to, my voice softened a little.
“Studying is a marathon. It's not a 100-meter dash. If you keep pushing yourself by drinking six cans at a time, your body will give out before you even take the June mock exam. You have to take care of your condition as you go. Stuffing your head full without sleeping doesn't mean it all goes in.”
“Yes, doctor...”
“Anyway, get some rest. I'll check on you again once the fluid's all in. You see the nurse call button over there, right? If your chest hurts more or you get more short of breath, press it right away. Okay?”
“Yes, thank you...”
I gave Baek Eun-seo a look and drew the curtain.
When I went back to the station, Baek Eun-seo suddenly gave me that same role-model look again.
Ah, this is burdensome.
Maybe I should change the subject.
“Have you ever done that? Back in high school, during exam season, I'd mix energy drinks with coffee and chug them at dawn. When you drank that stuff, your heart would pound right next to your ears. Thinking back on it now, it was crazy...”
I looked at Baek Eun-seo, expecting some sympathy.
But Baek Eun-seo looked at me like she had no idea what I was talking about.
“Ah, I always went to sleep right when it hit 10 o'clock!”
“...”
I stared blankly at her for a moment.
“...Until when?”
“Until I graduated from med school!”
Baek Eun-seo answered brightly, puffing out her chest as if it were something to be proud of.
“...”
‘...I think I picked the wrong junior.’
Is she even human?
She went to bed at 10?
Is that even possible?
Even in clinical years? Even while taking the licensing exam?
Is she an AI or what.