Chapter 111
Chapter 111
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Translator: crow
Chapter Title: Psychosis? (1)
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The warm midday sunlight squeezed through the gap in the emergency room's automatic doors.
I was slouched in the station chair, prodding my colleague Kim Ji-hoon, who sat beside me with the same blank expression, staring at the monitor.
“Kim Ji-hoon.”
“What.”
Kim Ji-hoon answered without even turning his head.
“There’s a Chinese buffet that opened up in front of the hospital. Wanna go sometime?”
At my suggestion, Kim Ji-hoon’s pupils shifted ever so slightly.
Hospital food—convenience store lunches—delivery.
The word that tantalized the palate of a resident exhausted by this endless, nauseating triangle.
“Chinese?”
“Yeah. Jajangmyeon, jjampong, fried rice, sweet and sour pork. They even have chili shrimp. Sound good?”
“How much.”
The most important question.
For us, with bills eating up our paychecks, cost-performance was life itself.
“Nine thousand won.”
Kim Ji-hoon finally turned his head to look at me.
A spark of life flickered in his rotten pollack eyes.
“That’s dirt cheap. Let’s go.”
“When? After work today?”
“Cool.”
It was simple happiness.
To get this excited over a nine-thousand-won Chinese buffet.
It was proof of how wrecked our lives had become, but whatever.
Sweet and sour pork on unlimited refill.
The day had been physically tiring with all the minor cases, but no critical patients, so mentally it had been relatively easygoing—until then.
Just as we were about to dive into a deep debate on whether sweet and sour sauce should be poured over or dipped...
“Someone’s trying to kill me!!!! Help!!! Aaaah!!!! Waak!!! Wegh!! Wuugh!!!!!!!”
A scream sharp enough to shred eardrums pierced the air from the parking lot outside the ER.
“…What’s that noise?”
Kim Ji-hoon furrowed his brow.
The very next instant, as I instinctively stood up.
Bang!
A stretcher cart slammed through the doors faster than they could open.
“Doctor! Restraints for this patient! Can we get her on the stretcher?!”
The paramedic’s urgent shout.
Followed by two uniformed police officers.
They were drenched in sweat, wrestling to subdue a woman thrashing wildly on the stretcher.
“Let go!! Let me go!! Those people are trying to kill me!! Aaaah!!!”
She appeared to be a young woman in her early twenties.
Her hair was a tangled mess covering her face, her eyes rolling back in frenzy.
Foam bubbled at her mouth.
Like a demon-possessed soul, she twisted and bucked against three grown men holding her down.
“Argh! She bit me! Won’t let go?!”
“Ma’am! Calm down! You’re in a hospital! We’re here to help!”
“Shut up! You’re all in on it! I know! You’re after my organs! Aaaah!”
Persecutory delusions.
Aggressive behavior.
Risk of self-harm or harm to others.
The nearby nurses and EMTs sprang into action.
“Get the restraints! Hurry! Limb restraints!”
“Should I prep a sedative, Doctor?”
In an instant, the middle of the ER turned into chaos.
Other patients recoiled in horror, while a few whipped out their phones, flashes popping like they were at a spectacle.
I let out a deep sigh at the sight.
Shattering my sweet dreams of that Chinese buffet.
How could something this tragic happen.
“Fuck.”
The curse slipped out.
Patients past the talking stage were a real hassle.
The ultimate physical showdown: restraining with your body, jabbing IVs, tying them down.
“Psych ER case.”
Kim Ji-hoon shook his head with a look of dread.
With cops in tow, she must’ve been compulsorily transported after causing a scene in public.
For cases like this, history-taking or anything else was pointless until you calmed them down.
One wrong move, and you’d get punched or bitten.
“Let’s go.”
I stood up.
If only to save my lunch sweet and sour pork, I had to quell this madness fast.
Wait for me, dipped sweet and sour pork.
I pulled on gloves and headed toward the bed where the screams echoed.
“Let go! Let go of this! There’s a ghost over there! It’s come to gouge out my eyes!”
The patient clawed at the air, shrieking.
No grasp on people, place, or time.
Disorientation present.
Check.
Add in clear auditory and visual hallucinations, plus uncontrollable extreme agitation.
Classic acute psychosis presentation.
“Ativan! 4 mg! Right now!”
Kim Ji-hoon pinned her arm and shouted urgently.
The nurse cracked open the ampule with practiced ease.
“Ativan 4 mg IV push!”
Ativan.
Lorazepam, generic name.
A benzodiazepine sedative.
It calms brain excitation, practically the emergency shutdown button for rampaging ER patients.
Usually, slamming a dose like that intravenously turns even the wildest bull-drunk into a docile lamb, out cold in five minutes.
“Ugh! What’s this! You’re poisoning me right now?! How dare you try to assassinate me!”
The patient convulsed as the needle pierced her.
Kim Ji-hoon and the paramedic pressed down with their full weight to hold her.
“It’s in! Checking vitals now!”
The nurse measured vitals, and the monitor lit up with numbers.
[BP: 160/95 / HR: 128 / RR: 24]
“Huh… BP’s a bit high. Pulse is racing too.”
“From the agitation, right?”
Kim Ji-hoon wiped sweat from his brow, brushing it off.
Fair point—even screaming and thrashing like that, normal blood pressure would be weirder.
Sympathetic nervous system in overdrive.
“Dunno. You hold her down for now. Watch till the meds kick in. I’ll go take a history from the guardian.”
I handed the patient off to Kim Ji-hoon and approached the middle-aged woman pacing anxiously at the ER entrance.
Looked like the patient’s mother.
“Hello. Are you the guardian?”
“Y-yes… Doctor, my girl… my girl right now… she’s…”
Her face ashen, she clutched my sleeve.
“Take a breath, ma’am. I need to ask a few things for an accurate diagnosis. I’ll need your help.”
I kept my voice as calm as possible.
“Has the patient ever had mental health struggles before? Depression meds? Or anything like hallucinations today, hearing odd things? Ever seen a psychiatrist?”
Top priority: check for schizophrenia or bipolar history.
If she’d been on psych meds and stopped, relapse was likely.
But the mother shook her head vigorously.
“Nooo… Nothing like that at all. She’s always been such a good, quiet girl. Great at school, great at work… But this morning, she just started screaming out of nowhere…”
“Does she drink often? Any diet pills or such?”
“She can’t even touch alcohol. No meds either.”
History-taking yielded nothing.
No past history.
No family history.
No meds.
Clean social history.
Nothing stands out.
“Hmm…”
I rubbed my chin.
First-episode psychosis?
Sure, schizophrenia often debuts in early twenties.
But the guardian’s account was too spotless.
No prodromal symptoms, and overnight plunge into this?
“Hmm… But patients hide psych visits or meds from family all the time…”
Can’t take the guardian’s word at 100%.
“Does she have a regular hospital? Ours or another nearby?”
The mother thought for a moment before answering.
“Oh, here… She comes here a lot. For colds or stomachaches, always this university hospital. We live right nearby.”
“Got it. Please wait in the lounge. We’ll check records and update you.”
I escorted her to the lounge, then strode straight to the triage desk.
If she’s a regular here, something would be in the EMR—electronic medical records.
Perks of the 21st-century info age.
No need to hunt around; just pull up the records.
If she’d come before for related symptoms, something would show: psych consults, sleep med scripts.
“Jung, pull up that patient’s EMR for me. Need to check history.”
“Sure, one sec. Registration number…”
Jung tapped away at the keyboard.
The patient’s visit timeline scrolled up on the monitor.
…
“…Huh?”
I squinted at the screen.
Spotless.
Too spotless.
Psychiatry?
No visits.
Neurology?
None.
Some ER visits, but…
[2023.05.10 - Acute Gastroenteritis (AGE)]
[2022.08.12 - Ankle Sprain]
…
All minor stuff.
No psychoactive med prescriptions.
Just a normal patient who comes when sick, like the guardian said.
And the most recent entry at the top…
Ah, there.
Three days ago.
[Chief Complaint: Fever, sore throat, cough]
[Diagnosis: Acute Pharyngotonsillitis]
[Prescription: Brufen tabs, Amoclan tabs (3 days)]
[Attending: Park Se-young]
“…”
Her latest visit? Just three days ago for a cold, right here in our ER.
Think, Han Hyun-jae.
Piece together the beatings from memories, the dogged crawling, the info.
..
Cold and pharyngotonsillitis.
Then three days later, acute delirium and hallucinations.
I alternated between the “fever” in the monitor and the 37.8°C from her earlier vitals.
Might not be your run-of-the-mill psychosis.
A perfectly fine person catches a cold, then suddenly goes berserk right after?
‘..This is off.’
What if it’s not just psych, but something wrong with the brain itself?
Organic cause.
Encephalitis.
A chill ran down my spine.
I turned back toward the ER.
Ah.
I’ve got a hunch.