Chapter 102
Chapter 102
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Translator: crow
Chapter Title: Assassin (3)
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“Doctor, what’s…”
Baek Eun-seo grabbed me with a look of utter confusion.
“Quick. Orders in?”
“Yes, they’re placed. If we send to the CT room now…”
“Let’s just check the echo first.”
An echocardiogram was a crucial turning point for differential diagnosis in a patient like this.
We had to shave off every second—even the brief time heading down to the CT room, even the split second waiting for the elevator.
If it really was dissection, the patient could drop dead right there on the way to CT.
“Grab the portable. Hurry.”
“Oh, yes!”
Baek Eun-seo startled and shouted behind her. The intern grunted as he dragged the bulky portable ultrasound machine over to the bedside.
I squeezed a thick dollop of gel onto the patient’s xiphoid.
“I’ll just take a quick look at the ultrasound. Hold your breath.”
I pressed the probe against him.
A black-and-white heartbeat rippled across the screen.
My eyes darted around busily.
Pericardial effusion? Heart wall motion?
Baek Eun-seo swallowed hard as she peered at the monitor beside me.
“Doctor, the RV… looks mildly dilated?”
Confidence crept into Baek Eun-seo’s voice.
“Eun-seo, hold on.”
I gripped the probe tighter and cut her off.
Yeah, I saw it too.
The right ventricle swollen and gasping.
“What’s going on?”
A chilling voice came from behind me then.
It was Professor Cheon Eun-jeong.
Coffee in hand, she approached with a furrowed brow at the sudden commotion.
“Professor!”
Baek Eun-seo explained the situation in a flash, like she’d spotted her savior.
“Patient’s dyspneic, tachycardic, has S1Q3T3 findings, and echo shows RV dilatation—strong PE suspicion. But Dr. Han Hyun-jae wants aortic CT.”
Professor Cheon’s eyes turned to me.
If I had to read that gaze from my perspective…
It might be suspicion: *What are you scheming now?*
Or maybe expectation: *Something’s up again, huh?*
Her face was tough to read anyway.
“PE… not it? Hyun-jae, why push for…”
I swallowed dryly and laid out my hypothesis.
“What I’m seeing… looks like aortic dissection involving the RCA.”
“…What?”
Professor Cheon’s eyes widened.
“Dissection? Aortic?”
“Yes. Patient has suspected Marfanoid features. And this RV dysfunction… not PE. More likely RV infarction from the dissection flap covering the right coronary ostium.”
Silence.
Professor Cheon clamped her mouth shut and glanced back and forth—my face, the patient, the ultrasound screen.
Here’s the gist of my claim.
The torn aortic intima blocked the vessel feeding the heart.
The right ventricle starved of blood and quit.
That’s why it dilated.
Echo looked just like PE, but the cause was dead opposite.
Mistake it for PE and hit with anticoagulants or thrombolytics?
Blood gushes from the ripped aorta—patient dead on the spot.
Professor Cheon stepped up silently and stared at the monitor.
Her gaze sharpened.
*Phew, thank god.*
I let out a silent sigh of relief.
Good thing the professor showed.
My theory sounded slick, but honestly…
*Ultrasound’s too murky for my eyes to call it clear.*
Real dissection flap or just artifact?
RV akinetic from block or pressure?
My second-year chops couldn’t pin it 100%.
*Hah, spill this and the Cardiology Ghost’ll tear me a new one.*
Cardiology Ghost: *Hey, you lisinopril-eyed fuck! See that flap waving in the aorta? No?! Eyes just for show?*
The ghost’s comment flickered like a hallucination.
Truth was, even now my eyes saw a big RV with shitty motion—straight PE vibes.
Baek Eun-seo nailed it.
But my gut screamed no. The ghosts too.
I slipped a step behind Professor Cheon.
Shifting blame?
Nah.
Respect for the boss.
Obviously.
*Professor, save me.*
I stared desperately at her back.
Spot it, please.
That flapping vessel scrap.
“Root… uh… um…”
Professor Cheon leaned nose-to-screen and muttered.
Her pupils hunted desperately through the black-and-white image.
Then she whipped her head around.
“Hey. CTA. Straight to CT—push now.”
“Huh.”
Baek Eun-seo froze, slack-jawed.
PE lock just seconds ago, now aorta switch.
Brain-dead stun, no doubt.
“Uh… yes?”
“You blind? Here. Faint flutter line inside ascending aorta. And curling into the RCA ostium.”
“…”
Honestly? Still fuzzy to me.
Illusion. Noise.
But Cardiology Ghost called it. Professor too.
Good enough.
“…Ah, yeah—now it’s clear.”
I stared gravely at the monitor and piled on.
“Crystal! Flap pushing to the valve.”
*(See jack shit.)*
My eyes fried? Hers x-ray?
Unseen disease doesn’t vanish, though.
Professor Cheon drove it home.
“And key: septum. RV’s not squishing LV, right? You skimmed?”
“Ah.”
Finally, I nodded.
True that?
Massive PE hypoxia-level? PA pressure explodes—RV balloons massive, D-signs LV.
Screen RV big, sure—but no LV crush.
Just feebly heaving.
Not pressure.
Ischemia.
No flow, no power.
“PE odds drop then. Dissection clamping RCA fits.”
Professor Cheon’s call sealed.
“CT room. Vitals holding—fast scan, then OR.”
“Yes, doctor. I’ll push—”
I grabbed the bed rail. She smacked my hand.
“Nope. Eun-seo pushes.”
Eyes on me.
“You—call Thoracic Surgery.”
“…Yes.”
“Thoracic on-call who? Tell ’em: suspect aortic dissection, prep emergent surgery. CT then straight up.”
Her gaze hardened.
“Time bomb patient—you know? Call done, ping guardian—surgery needed. Get ’em here stat. Consent pre-OR.”
Time bomb.
Aortic dissection.
ER apocalypse—rupture any second, lights out.
I grabbed the receiver solemnly as Baek wheeled the bed out.
“Yes, got it. Calling now.”
My hand shook faintly lifting the phone.
*Please—just hold through CT.*
Praying inside, I punched Thoracic on-call.
Riiiing.
Riiiing.
Click.
Harsh breath—someone snatched it.
[Thoracic Surgery third-year Kang Min-seong.]
Dry swallow. I machine-gunned my spiel.
“ER second-year Han Hyun-jae. Urgent heads-up: fifties male inbound. Strong suspect aortic dissection—Type A.”
[Type A?]
Voice strung tight instant.
Type A: ascending rip. No OR? Mortality ticks 1% per hour—Thoracic hell-emergent.
“Yes. Chest pain, dyspnea post-flight. Marfanoid build.”
[Vitals?]
“BP 150/90, HR 110. Hanging on but…”
Breath, then differentials.
“Initial EKG: S1Q3T3, V1-V4 T inversion—PE first thought. So now…”
[Hold up, ER?]
Kang cut in.
“Yes!”
[EKG S1Q3T3. Flight. Dyspnea. Classic PE, no?]
Called it.
I’d react same.
Thoracic view: ER hawking dissection on PE case? *CT first, call when sure—quit bullshitting early.*
“No—so echo…”
Rushed on.
“Thought PE, ran echo. RV dilated, sure—but no crisp LV D-sign. Septum shift lacks pressure overload push. More global RV wall hypokinesis—ischemic vibe.”
[…Ischemic?]
“Key: aortic root intimal flap shadow. RCA flow down. Dissection occludes RCA ostium—RV infarct, dilation cause.”
No-breath flood.
“Prof Cheon EM confirmed—CTA en route. RCA-block Type A? Could code mid-scan—prep now!”
Silence flowed.
Kang piecing my dump.
S1Q3T3, not PE.
RV big, not pressure.
Aorta shredded, choked coronaries.
Verdict?
[…Fuck.]
Tiny curse.
Situation clocked.
Yeah, sorry—PE’s a joke next to this nightmare surgery.
[Got it. Understood.]
Tone flipped.
[Paging prof now. Team to ER. Post-CT fly-up. Anesthesia, OR synced for instant wheels-up.]
“Thanks!”
[Stabilize BP. Labs, blood set?]
“Yes!”
[On way.]
Click.
Receiver down. Long exhale.