Chapter 20 : ER (2)
Chapter 20 - ER (2)
“Dr. Chae Yi-jin, I have a ‘noti’. A 40-year-old male patient has visited with a chief complaint of squeezing chest pain that has persisted since an hour ago. The patient is...”
As soon as Chae Yi-jin sat down, an intern approached and began the ‘noti’.
Out of joy, Sihyeon almost pretended to know her for a moment, but unfortunately, the two of them had almost no acquaintance during this period.
‘When was the first time we met?’
Sihyeon retraced his old memories.
……
Four years ago.
[20xx New Resident Orientation]
While most were friends who had done their internship together at Sama University Hospital, Chae Yi-jin, who came from another hospital, stood out exceptionally.
— Who is she? It’s my first time seeing her.
— I heard she’s from Korea University. She did her internship there, too.
— If she’s from Korea University, is there a need for her to come to our hospital?
Several colleagues whispered.
And for good reason—Korea University’s College of Medicine was one of the best in the country, and Korea University Hospital was a mega-hospital competing for the first or second spot in terms of bed count.
— Why did she come here? I heard her grades were good there.
— Did she try to go for a minor (popular specialty) but get pushed out of the competition?
— What do you mean, minor? She’s an Internal Medicine resident.
Unless there was a special reason, there seemed to be no need to apply to Sama University Hospital.
However, Chae Yi-jin drew attention not just because of the school she came from.
“Sihyeon, look over there. Isn’t that doctor really pretty?”
It was Seo Hyeok-sang, Sihyeon’s internship colleague.
“Huh? You’re right...”
“It’s a visual that doesn’t exist at Sama University’s Medical School. I think she’s really my style. This time, I’m serious.”
Exactly the 21st time.
Ever since he had known him from being in the same lab group during General Biology in the first year of pre-med, Sihyeon had seen twenty female students who were ‘really his style.’
The problem was that there wasn't a single commonality among those many female students.
Seo Hyeok-sang was simply a born ‘fast-crusher.’
“This is no time to be sitting like this. Since we’ve now become colleagues in the same Internal Medicine department, I should at least go and say hello...”
The expression on Seo Hyeok-sang’s face as he stared blankly at Chae Yi-jin became quite serious.
‘Oho, this time something is...’
Anticipation flickered in Sihyeon’s eyes as he watched him.
“No, wait. It’s our first meeting, so she might feel uncomfortable if I suddenly act too friendly.”
Seo Hyeok-sang, who was about to stand up gallantly, sat back down.
‘Of course.’
Seo Hyeok-sang had extremely severe shyness.
Especially when talking to the opposite sex, his body heat would rise to the top of his head and his face would turn red, so he couldn't even strike up a conversation easily.
It was a symptom of so-called erythrophobia (fear of blushing) that social anxiety disorder patients often complain of, and it was so severe that Sihyeon had seriously considered recommending treatment.
Thanks to that, he remained a molo (born-solo) until right before the specialist exam.
“Hyeok-sang, don't be like that. Go with Jeong-seo and Eun-hyeong hyung and say hello. Hurry!”
Yeon Jeong-seo and Jeong Eun-hyeong were both new first-year Internal Medicine colleagues.
Only after joining the other Internal Medicine colleagues was Seo Hyeok-sang finally able to exchange names with Chae Yi-jin.
That was also the first time Sihyeon saw her.
……
‘This part is truly difficult.’
Having returned after experiencing the entire residency training period in advance, his medical knowledge was already at the level of a specialist.
However, knowing whether or not he knew something at a specific point in time was another matter entirely.
It’s the same logic as how anyone can answer that Washington is the capital of the United States, but answering exactly when they first learned that fact is quite difficult.
If the former is closer to semantic memory, the latter can be seen as a complex form where episodic memory is combined with metacognition.
‘I need to be more careful.’
Recalling the words Choi Se-young said a few days ago, Sihyeon walked toward the resident dormitory when he saw someone walking toward the Emergency Room while on the phone from the opposite side.
“What? Chest pain?”
That characteristic voice, thick with irritation.
It was Nam Hye-mi, a third-year Internal Medicine resident.
“What about the ST segment? Tell me properly! I might have to report this to the professor.”
The patient’s chief complaint was chest pain—specifically, severe chest pain with a squeezing sensation. It could potentially be an emergency situation such as a myocardial infarction or unstable angina.
Nam Hye-mi’s pace quickened.
“Give them aspirin and Plavix, and tell them to get the labs out fast!”
‘If it’s the ST segment...’
It was a part of the waveforms that make up an EKG, and one of the parts considered particularly important in angina or myocardial infarction.
Add to that the medications that inhibit thrombus formation—it seemed like an emergency.
‘Is Nam Hye-mi the third-year on duty today?’
Since patients that a first-year cannot handle alone often come to the ER, a second-year or higher senior resident would stand duty alongside the first-year.
It’s called ‘back-duty’ because they watch the first-year’s back.
‘Is it that patient from earlier?’
The chief complaint of the patient Sihyeon had heard just before leaving the ER was definitely chest pain. Watching Nam Hye-mi’s receding back, a bitter smile escaped him.
To think that Nam Hye-mi, famous for keeping the lower-years under her thumb, was the back-duty. Chae Yi-jin’s weekend duty didn't look like it would be smooth sailing.
As soon as Sihyeon returned to the dormitory, he brought up the ER patient list.
‘Wait. Chae Yi-jin and Nam Hye-mi... and chest pain?’
An ominous premonition flashed through his mind.
‘Ms. Lee Jeong-mi has been discharged.’
His own patient had already left the ER, but the patient Chae Yi-jin and Nam Hye-mi were seeing together weighed on his mind.
When he opened the chart to check the details, Sihyeon’s eyes widened.
‘It’s that patient.’
It looked like getting even a wink of sleep during today’s duty wouldn't be easy.
……
[3:03 AM Resident Dormitory]
Bzzzzzt.
As expected, the phone rang before long.
“Psychiatry R1 Cheon Si-hyeon speaking.”
—Internal Medicine R1 Chae Yi-jin speaking.
A brief silence. He could vividly picture Chae Yi-jin on the other end of the line, likely wearing a troubled expression.
—I’m sorry for calling at this late hour, but could I request a consultation for a patient?
In fact, he already knew her next line.
“You’re calling because of patient Jeong Seong-hwan in the ER, right?”
—Pardon? Yes... yes.
“I’ll come down and hear the details. Just a moment.”
To think he’d say he’d come down immediately at this hour. Chae Yi-jin was dumbfounded by the unexpected answer.
[3:06 AM Emergency Room]
“I’m sorry it’s so late. My senior resident told me to get all the consults from other departments done before admitting the patient to the ward...”
Chae Yi-jin’s voice trailed off.
“They said the patient had some mood swings and enjoyed drinking. I’d appreciate it if you could leave a brief comment on that.”
As expected, it was the same development as before.
Sihyeon brought up the patient's chart on the ER computer.
[Jeong Seong-hwan M/41 Intern Noh Min-hye / Internal Medicine Chae Yi-jin]
“Since the ST segment and Troponin levels are stable, it doesn't look like an immediate PCI (Percutaneous Coronary Intervention) situation?”
“Pardon? Ah... yes, that's right. He's a patient who will be moving up to the ward for now.”
“So you’re not seeing it as NSTEMI (Non-ST Elevation Myocardial Infarction), but rather as UA (Unstable Angina) for the time being?”
Sihyeon asked after scanning the test results.
Chae Yi-jin looked slightly surprised.
It was because a resident from another department already understood her patient's condition before she even explained it.
‘He’s definitely not a patient in urgent need of psychiatric care.’
Nevertheless, the reason Chae Yi-jin was calling a resident from another department to see him at this ungodly hour was because Nam Hye-mi was hounding her.
— Could it be that his symptoms worsened because his heart rate went up and the load increased due to an anxiety disorder? And what if alcohol withdrawal kicks in during hospitalization?
It was as clear as day that her logic went something like that.
In reality, it was likely because once she became the physician in charge after admission, she’d have to put in the consults herself, so she was trying to get the junior to handle it in the ER first.
Actually, Chae Yi-jin herself knew best that the patient didn't need urgent psychiatric care.
That's why calling Sihyeon at this hour was more than a little embarrassing.
“I'll interview the patient briefly and leave a note.”
“Yes, thank you.”
However, contrary to her concerns, Sihyeon headed toward the bed where the patient lay without any particular complaints.
……
“Mr. Jeong Seong-hwan, I am Cheon Si-hyeon, the psychiatry resident on duty.”
“Psychiatry? I'm here because my heart hurts?”
As expected.
This is usually the reaction of patients referred by Nam Hye-mi.
The patient has no complaints, and one wonders if the consult is even medically necessary, but it's the kind of consult that's "good to have" to avoid responsibility if something goes wrong.
Even though he had fully expected it, it wasn't a very pleasant feeling.
But this patient was different.
Unlike Nam Hye-mi's intentions, Sihyeon clearly had a role to play here.
[Jeong Seong-hwan M/41 Intern Noh Min-hye / Internal Medicine Chae Yi-jin]
[Treatment Progress 18/100 | Until Discharge: 4 days 8 hours 20 minutes 19 seconds]
‘The treatment progress is low.’
Considering he was a patient who had just entered the ER, the low progress was at a plausible level. The part that was actually concerning was something else.
[Survival Probability 13%]
A new item that hadn't been visible for other patients.
It meant that if left as is, the patient would die in nine cases out of ten.
In fact, even before the regression, patient Jeong Seong-hwan had died a few days after admission.
— Doctor, the patient you saw in the ER a few days ago has expired (died).
— It seems it wasn't a heart issue, but there was bleeding from trauma. I should have looked more closely...
The words Chae Yi-jin had said began to surface in his mind.
‘Trauma for someone who came to the hospital for a heart problem?’
Sihyeon furrowed his brow. He couldn't tell which part of the body the trauma was in.
Back then, he was busy just seeing psychiatric patients and didn't have the leisure to listen carefully to stories about patients from other departments.
From now on, there was no choice but to seek the answer from the patient in front of him.
“Mr. Jeong Seong-hwan, does anywhere else happen to hurt besides your heart?”
“Anywhere else? Well... my chest hurts so much right now that I can’t tell if anywhere else is aching...”
“I’m going to examine you for a moment.”
Sihyeon began searching the patient from head to toe, looking for any possible injuries.
The patient looked a bit flustered.
It was understandable, considering a guy calling himself a psychiatrist had shown up, and instead of conducting an interview, he was poking and prodding various parts of his body.
‘I don’t see any particularly injured spots.’
Just in case, he checked the chest and abdomen and even performed auscultation, but there were no significant findings.
‘Should I just suggest we take a CT (computed tomography) scan of the head, chest, and abdomen?’
Currently, that was the fastest way to identify a trauma site. However, from the perspective of someone who had come for a psychiatric consultation, it was certain that he’d be looked at strangely if he suddenly insisted on additional CT scans.
‘Is a physical exam the only thing I can trust?’
Yet, Sihyeon’s clinical examination skills were mediocre at best.
For the past few years, his job had consisted entirely of sitting at a table and interviewing patients. He hadn't had many opportunities to perform this kind of physical exam.
‘What more should I try...’
Suddenly, the words Choi Se-young said a few days ago flashed through his mind.
— Be careful from now on. There might be eyes watching.
It was still a mystery who exactly was watching, but it certainly wasn't normal for a resident from a different department to show up in the middle of the night and drop a hint about a hidden injury that wasn't even visible.
‘Since he’s a patient with no immediate psychiatric discomfort, maybe I should just leave it at this...’
Sihyeon paused his search for the patient's lesion.
“Have you been feeling depressed lately, or perhaps suffering from severe insomnia?”
“Pardon? No, nothing like that specifically.”
“I see. Understood.”
It was an option to simply conduct a brief psychiatric interview and leave the ER, just as he had done in the past. It was a shame he couldn't help the patient, but at the very least, he wouldn't be making the current situation any worse.
“By the way, it’s Jeong-uk’s birthday next week. Did you buy a gift?”
Ulkuk.
At the words the patient spoke to the guardian, Sihyeon stopped in his tracks as he was heading toward the station.
“Is it that time already? I would have forgotten if you hadn't mentioned it.”
To think they were talking about a son’s birthday when they might be holding a funeral by next week.
‘This isn't the time to be talking about that.’
The words almost escaped his mouth.
‘I have to tell Yi-jin that I suspect trauma and that we need to find the lesion.’
Requesting additional tests without any evidence would surely look strange, but he couldn't just stand by and watch.
‘Even if I have to scan his entire body...’
His steps were still directed toward the station, but they carried a completely different weight than a moment ago. Sihyeon flung open the bedside curtain.
In the next moment, a familiar notification sound rang in Sihyeon’s ears.
Ding-dong!
‘Why all of a sudden?’
[System: There is a recommended item.]
[Would you like to use the Potion of IPPA (Grade D)? Y/N]
What entered his field of vision was not the scenery of the Emergency Room, but a new notification window.