Chapter 4 : The First Rounds Again (1)
Chapter 4 - The First Rounds Again (1)
Click.
The conference room door opened, and the senior residents burst in.
“Oh, is it the first-year doctors’ first day of work today? It brings back quite a feeling.”
Chief Resident Kim Min-hong, a 4th-year, said while looking at Cheon Si-hyeon and Hwang Jin-ho, who were sitting at the station.
“I will work hard!”
Hwang Jin-ho answered energetically and bowed at a 90-degree angle.
Sihyeon also bowed his head in the spur of the moment.
“Right. If there is anything you don't know while seeing patients, feel free to ask at any time—”
“Is working hard enough?”
Someone abruptly cut in, interrupting Kim Min-hong.
It was Kim Min-hong’s colleague, 4th-year resident Choi Ji-hoon.
Contrary to his seemingly generous impression, he was a character who poured out complaints whenever he opened his mouth.
Did I say something wrong?
Hwang Jin-ho looked at Choi Ji-hoon with a blank expression.
“Don’t just work hard; do a good job no matter what. Understand?”
“Yes! I’ll work hard... no, I’ll do a good job!”
‘That guy existed.’
Sihyeon frowned at his appearance.
“What I’m saying is, don’t make us clean up after you. Seok-yong, keep a good eye on them so these kids don’t cause any accidents.”
“I’ll take good care of them.”
It was like being treated as potential criminals. Even though they hadn’t done anything wrong, the atmosphere became grim.
‘Clean up after us, my foot. You’ve never even helped.’
A scoff almost burst out.
“Nothing happened in the ward overnight?”
“Yes, the patients in charge mostly slept well, and there are no complaints of drug side effects.”
Kim Seok-yong answered as if it were obvious.
Sihyeon knew Choi Ji-hoon’s style well.
While he piled on the work, he was extremely reluctant to take responsibility as a senior.
Whenever a problem arose, he often turned a blind eye. It wasn't like he was diligent about seeing his own patients, either.
He would come to work in the morning and ask the 1st and 2nd years about the status of the patients in his charge. That was the end of his preparation for rounds.
“Right. There probably wasn’t anything. Since I checked everything yesterday.”
Choi Ji-hoon spoke confidently.
He was obnoxious. Thinking of everything Sihyeon had suffered from him made his teeth grind.
“...One was missing, though?”
“Huh? What did you just say?”
He asked back as if he had heard something he shouldn't have.
“An order for a CBC (Complete Blood Count) for a patient in your charge was missing, so I added it this morning.”
As Sihyeon answered, the gazes of all the residents focused on him.
“CBC? Which patient are you talking about?”
“It’s the patient Jung Young-man. He’s the one who recently started clozapine administration.”
Clozapine, a treatment for schizophrenia.
While its effectiveness is known to be the best among all antipsychotics, it was a drug that rarely caused a fatal side effect called agranulocytosis.
Because of this, it was also a medication that required periodic blood tests.
“That patient already had a test this week, and you drew blood again? Do you want to cause an accident from your very first day as a first-year? Do you even know the testing guidelines before you start spouting off?”
Choi Ji-hoon's face was full of irritation.
“Don't you know I hate unnecessary tests? That's an imposition on the patient...”
“I added it because I considered it a necessary test,” Sihyeon answered in a calm tone.
“Really? Is that so? Then you, recite the blood test schedule for when starting clozapine.”
“To prevent agranulocytosis, it is recommended to check the CBC once a week for the first 18 weeks and at least once a month thereafter.”
At Sihyeon's words, the other residents, including Chief Kim Min-hong, widened their eyes.
‘He shouldn't have experience prescribing it yet.’
Since it was a drug basically administered on a limited basis to patients with treatment-resistant schizophrenia, even the residents didn't have much experience with it.
“Since you know so much! Then answer this. This patient already had this week's test, so why was another one ordered?”
“In the recent test, the WBC was 3,500, and the ANC began to drop below 2,000.”
“…….”
“In this case, there is no need to discontinue medication, but it is recommended to test twice a week until the blood cell counts stabilize or increase.”
If following the guidelines, it was a situation where testing twice a week was required instead of once a week.
The other residents nodded repeatedly at his unhesitating answer.
It was only natural, as it was content he had memorized by heart in a hotel room until the night right before the exam.
“…….”
On the other hand, Choi Ji-hoon was completely rendered speechless.
‘T-this brat...’
“If you believe it is an unnecessary test, I will cancel it even now. I will also apologize to the patient.”
He had been humiliated from the very first day by a first-year—the very same first-year he had told to do a good job and not cause any accidents.
The atmosphere was very bad.
However, Sihyeon did not miss the expressions of the other residents who were secretly smiling beside him.
Click.
A moment later, the door opened, and someone hurriedly entered the conference room.
It was a middle-aged doctor with a sophisticated aura, looking well-dressed in a white shirt and a neat tie.
“Has the Department Head arrived?”
The residents all stood up at once to greet him.
“Oh, I'm sorry for being late. I had a minor fender bender on the way.”
Lee Gwang-seop, the Head of the Psychiatry Department and the Chair of the Department of Psychiatry, said while wiping sweat from his forehead.
“Are you all right?”
“It's just a scratch. Let's see the patients first and then have our discussion.”
“Yes, Professor!”
“Professor, here is the patient list.”
When Kim Min-hong gestured, the intern handed the chart board with the list to Lee Gwang-seop.
The professor in charge of rounds arriving late on the first day of work.
The back of the intern running off hurriedly.
Everything was the same as his previous memory.
Thus, the first rounds began.
……
Around the familiar corner, the first patient room.
Perhaps because it was early March, the particularly clumsy intern took the lead, throwing open the door to the room.
‘I can't tell if he's guiding us or blocking the way.’
For smooth rounds, the intern should be guiding the medical staff...
Because of the intern who kept blocking him, Lee Gwang-seop had been stopping and starting repeatedly for a while now.
Lasers began to shoot out from the residents' eyes, but the intern, whether he knew it or not, continued his awkward movement path.
‘Which department did that intern end up in?’
If he had stayed at the hospital as a resident, I would definitely remember him.
Seeing as I don't, in all likelihood, after completing his internship, he became a military doctor... no, there’s a high possibility he was dragged off to the army.
“You went home for an overnight stay this weekend, didn't you? How was it?”
“Yes, it was very good. My family liked it too. They say they're coming to process the discharge today. Thank you for everything.”
“Yes, I’ll see you at the outpatient clinic.”
His condition had improved a lot, so it seemed he was being discharged today.
Since he was a patient being discharged on my first day of work, I had no particular memory of him.
Lee Gwang-seop shared a few more words with the patient before heading to the next room.
“Doctor, I’ve really improved a lot. Can't I be discharged? My mood has become very calm. I don't feel annoyed at a~ll.”
A patient requesting discharge with a considerably excited face.
A few hours later during lunchtime, this patient would pick a fight with a sturdy male patient in the next room and end up getting pummeled in return.
‘I remember running to the ward because of this patient in the middle of eating.’
I still remember the two pieces of pork cutlet I couldn't finish eating back then.
“I see. I will discuss it later during the treatment team meeting.”
Lee Gwang-seop's ‘discussion’ was virtually close to a rejection.
He could have stated firmly that further inpatient treatment was necessary, but Lee Gwang-seop was the type to speak indirectly so as not to hurt the patient's feelings.
In the beginning of my first year, I didn't understand this context and almost accidentally discharged a patient.
A smile naturally formed as I thought of that time.
While doing rounds, I saw quite a few familiar patients.
This was because there were many patients who continued to receive outpatient treatment even after discharge.
There were patients who did well and mostly received repeat prescriptions, but I also saw patients whose symptoms frequently relapsed after discharge, causing trouble in the outpatient clinic.
A middle-aged male patient sitting on the bed by the window in room 903 was like that.
[Jung Sam-tae M/53 Attending R2 Kim Seok-yong / Prof. Lee Gwang-seop]
‘This person was Dr. Kim Seok-yong's patient.’
Hollow eyes from not being able to sleep properly.
An anxious gaze that frequently looked around.
Sihyeon fiddled with his gown pocket while looking at the patient.
While other patients had finished their meals and were sitting on their beds, Jung Sam-tae was still eating, clattering his spoon and chopsticks.
“Patient, could you finish your meal after rounds are over?”
“Are you telling me not to eat right now?”
The patient responded irritably to the intern’s words as he tried to tidy up the bed before rounds.
“Mr. Jung Sam-tae, how are you feeling today?”
“Professor, you ought to manage your staff better.”
“What do you mean by that?”
Lee Gwang-seop wore a troubled expression.
“That young lady over there has been swearing at me continuously since a while ago, didn't you hear her?”
The patient spoke while pointing out a nurse among the medical staff doing rounds.
“I didn't hear it, but what did she say?”
“That damn bastard said I'm hospitalized again and told me to go die.”
The patient's main symptoms were auditory hallucinations and persecutory delusions.
“Oh dear. So that's what you heard. We'll look into it more after rounds.”
Lee Gwang-seop listened to the patient's words calmly without affirming or denying them.
Fortunately, the patient seemed somewhat stabilized, and Professor Lee Gwang-seop headed toward the next patient's bed.
Clatter!
It was then that the patient hurled his tray onto the floor.
“That bitch is still swearing at me!”
The patient kicked off from the bed in an instant and grabbed the nurse's neck.
“Die!”
Before the startled nurse could even look back, the patient brought down the chopsticks in his hand toward the nurse’s shoulder.
No, he almost did.
If Sihyeon hadn't snatched the patient's wrist from behind.
“Let go of this, you bas—”
Without giving the patient even a moment to look back, Sihyeon immediately extended his leg and pressed down on the back of his knee.
Thud.
In an instant, the patient collapsed helplessly in front of the nurse he had tried to stab.
“Orderly! Intern!”
Kim Seok-yong, the patient's attending doctor, shouted.
In an instant, the intern and ward orderlies swarmed the patient.
“Let go! I said let go!”
The patient resisted while hurling curses, but was soon led into the stabilization room by the hands of four grown men.
“Give him one ampoule of Peridol!”
“Here it is.”
As if he had been waiting, Sihyeon pulled a syringe out of his pocket and handed it to Kim Seok-yong.
‘Why is that coming out of there?’
Peridol was a medication injected intramuscularly for the purpose of sedating patients during acute phases.
He wondered when the guy, who had been holding down the patient with him until just now, had managed to pop the ampoule and fill the syringe, but Kim Seok-yong took the syringe for now since it was an emergency.
Thrust.
Not long after Kim Seok-yong administered the intramuscular injection, the patient calmed down and began to snore.
……
“Doctor, thank you,” the nurse, whose neck had been grabbed by the patient in the room, said to Sihyeon.
“Don't mention it. Are you alright?”
“Yes, except for being startled.”
“That's a relief. Especially since you're not alone...”
“Oh, did you know? Is it already that obvious?”
The nurse asked while touching her lower abdomen.
‘Ah.’
Looking at her stomach alone, it was a stage where she didn't look like a pregnant woman yet.
“No. Not at all. I think I heard someone mention it earlier.”
He had definitely heard it from someone.
— I'm pregnant, so I'm worried about taking antibiotics.
Specifically, from the nurse herself before the regression.
She had suffered for a long time from inflammation because she couldn't use medication properly even after being stabbed by the contaminated chopsticks.
“Did the Head Nurse mention it?”
The nurse tilted her head but didn't seem to care much.
In the sight of the nurse smiling brightly and talking to the patient, the previous image of her grimacing while clutching her shoulder gradually faded away.
‘I guess this is actually quite alright.’
– The right to not see unwanted scenes (+)
Sihyeon took out his notebook and added a line to his strengths.