Chapter 1
Chapter 1
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Translator: crow
Chapter Title: VEXAS Syndrome (1)
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Hell.
That's what people called our hospital's emergency medical center.
And me, Han Hyun-jae, was one of its denizens—a first-year resident in emergency medicine.
"Slurp—"
"Fuckin' eat it quietly, that shit looks disgusting."
"Hey, isn't it a miracle this crap's even going down my throat? Huh? I just did 30 minutes of CPR on a fresh MI patient. Be grateful it tastes like instant noodle soup."
My classmate Kim Ji-hoon said it with sweat dripping off his face.
We were sprawled out like corpses in the corner of the on-call room, scraping by on cold convenience store bentos and cup ramen to fill our stomachs somehow.
Things started getting noisy outside.
Oh, please no. Not again.
"Docs! Arrest in the resuscitation bay!"
Fuck.
"Fuck, for real."
Kim Ji-hoon spat out his curse mid-slurp of noodles and shot up from his seat.
I dragged myself up half-mechanically too. My body, which had felt like a thousand pounds just moments ago, reacted to that alarm like Pavlov's cursed dog.
The one skill I'd picked up from all the rolling with the punches.
The moment I kicked open the resuscitation room door, a wave of blood stench, antiseptic, and human desperation slammed into my nose.
"Patient, 58-year-old male! Found unconscious! Eleven minutes since discovery, no palpable BP pulse!"
"Giving epi and starting compressions right away!"
"Compressions starting! One, two, three, four..."
Everything moved with clockwork precision—and utter chaos at the same time.
Someone climbed on the patient's chest, pounding down hard enough to crush ribs. Someone else squeezed the Ambu bag, forcing oxygen into lungs. I stared blankly at the scene for a moment.
Some old guy clutching the grim reaper's doorknob. Could all our frantic bullshit actually drag him back?
Doubt. Yeah, doubt. What the hell was I even doing this for?
That's when it happened.
Right in front of my eyes, in empty air, a flicker of rainbow static crackled up for a split second.
'...Hallucinating from exhaustion.'
I rubbed my eyes.
But it didn't vanish. The noise sharpened into a clear shape, like a translucent system window from some sci-fi flick.
『Congratulations! You have achieved the qualifications of a Savior.』
『A special skill has been granted. The skill you have received is [Gallery Pass]!』
What the fuck is this bullshit?
I figured I'd finally lost it.
Overwork and stress must've melted some part of my brain. Was this just in my head?
I nearly asked the nurse securing the IV line next to me. 'Excuse me, you see any blue text floating there?'
Yeah, that'd land me straight in psych ward lockdown.
"Checking rhythm! It's VF!"
Luckily or not, that lame-ass system window vanished without a trace in one second. Like it had never been there.
'Yeah, just seeing shit.'
I snapped back to reality and realized I was holding the defibrillator paddles.
"Everyone clear! Charge, 200 joules!"
"Clear!"
"Shock!"
Thwack! The patient's body arched up like a bow. The monitor's EKG was still a mess. No sign of him coming back. Another 30 minutes dragged by like that.
In the end, with the attending professor's call to stop CPR, it was all over.
***
Sweat and effort scattered pointlessly into the air.
Rest in peace.
I headed back to the on-call room.
The second I flopped onto the bed, that message from before popped into my head again.
Gallery Pass?
"What the hell am I supposed to do with this."
Was this some trendy webnovel shit? Status window? Skills? Hunter crap?
On a whim—feeling like a total idiot—I tried yelling it in my head.
'Gallery!'
Nothing happened.
Pfft.
I let out a hollow laugh. Yeah, right, like I'd be the protagonist. Just my fatigued brain playing tricks.
I shut my eyes and tried forcing sleep, but my mind was racing. Gallery... gallery... Wait, did "gallery" mean that gallery?
Right then, a translucent window popped up in front of my eyes like a dialog box.
This time it was different. Not just a simple message.
"...What the hell is this screen."
What spread out before me was an interface identical to a site I'd browsed at least once. Dingy blue tones. Clunky UI. And smack in the upper left corner, the gallery name.
[Burned-Out Docs Gallery]
"Pffft!"
I burst out laughing without meaning to.
Burned-Out Docs? Oh, so that's the gimmick? My brain's really gone off the deep end this time.
Pretty solid B-movie vibe for a delusion cooked up by some overworked doctor's fried neurons.
'Alright, my brain's throwing a full tantrum. Fine, let's see you solve this one.'
A patient who'd just rolled into the ER came to mind.
Some guy who'd been suffering unexplained fevers for days, bounced around other hospitals. The stack of charts from the previous hospital that the nurse just handed me was plastered with test results—all saying "no remarkable findings" or some useless crap.
I'd skimmed it myself and thought, 'Eh, nothing weird.'
'How do I write a post? Imagine typing on a keyboard?'
I pretended to tap out keys in my head, and like magic, text started appearing in the gallery's compose window. Oh, fuck. This is real.
Title: FUO patient, take a look
Author: HellKoreaSlave1
68yo male. Persistent fever over 38.5C for 2 weeks. Has rash.
Copied records from previous hospital: CBC, LFT, CRP, Chest PA, Abdomen CT, blood cultures—all normal. RF negative.
Patient's still burning up and wasting away, but no clue on cause. Anything else to check?
Good enough. I thought "post," and up it went. Who'd reply in this insane hallucination anyway.
That thought shattered in less than a second.
[New comment posted.]
Anonymous (118.235): Dumbass? Looks like VEXAS, send out tests
I was impressed by the instant fuck-you greeting. Even showing the IP—talk about detail. 118.235 was a Korean IP, right.
But VEXAS?
"VEXAS? What the fuck is that."
Never heard of it in my life.
My brain's a genius at making up bullshit diseases.
I snorted in disbelief, but my fingers were already pulling out my phone, opening UpToDate—the doctors' bible.
I typed "VEXAS" into the search bar.
And the instant the results loaded...
My heart plummeted with a thud.
[VEXAS syndrome]
Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic syndrome
Adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene.
Key symptoms: recurrent fevers, hematologic abnormalities like anemia, skin rash, chondritis, vasculitis...
I stopped breathing. The text on screen swirled in my head with the patient's chart I'd glossed over.
'Patient had erythematous rash on his face.'
'CBC was normal except for slightly low RBC—mild anemia.'
'He complained of redness and swelling around the ear cartilage.'
Fuck.
Fuck.
FUCK!
No other words came to mind but curses. The "VEXAS Syndrome" on my phone screen burned into my retinas.
And it came from this lunatic hallucination called [Burned-Out Docs Gallery] in my head.
I grabbed the intercom right away. The attending wouldn't be me from emergency medicine—it'd be internal medicine once he was admitted. Rare cases like this needed IM consult, obviously.
Protocol was clear: IM on-call integration, R3 Nam Seung-hyun.
Guy was notoriously prickly and asshole-ish even on normal days.
Riiiing—
Riiiing—
A pissy voice tore through the receiver.
"Who is it."
"Uh, sir! Hello! This is Han Hyun-jae, first-year EM resident!"
I pitched my voice low and polite, like a private talking to the division commander.
"EM? Why at this hour. Make it quick."
"It's about a FUO patient who just came into the ER. Calling for a consult. 68-year-old male, and combining the records from the other hospital with our initial findings..."
I swallowed hard and spat it out.
"VEXAS syndrome is strongly suspected."
"..."
Silence flowed over the line.
One second, two, three.
That brief span felt eternal. Finally, Nam Seung-hyun scoffed.
"What? Say that again."
"VEXAS syndrome... that's what I said."
"Hey, Han Hyun-jae. You messing with me right now?"
His voice turned ice-cold.
"Some psycho who scarfed down weird case reports and decided to call. Ha, fuck. Unbelievable."
"But sir, the symptoms match the textbook perfectly. Recurrent fevers, skin rash, mild anemia findings, cartilage..."
"Hey!"
Nam Seung-hyun cut me off. His tone dripped with open contempt.
"You assholes are the worst problem. Basics not even down, picking up rare disease names and writing fanfic on patients. Just try spouting that shit to the family. Rule out basic infections first. Run viral markers and autoantibodies again, then call when results are in. Actually, don't call. Just note it in the handoff sheet. Hanging up."
"But sir, looking at the previous hospital chart..."
Click.
The line went dead unilaterally.
"...Fuck."