Chapter 114
Chapter 114
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Translator: crow
Chapter Title: Not Psychosis (2)
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Clap!
The sound of the applause was louder than expected.
The nurses prepping IV fluids, the interns organizing charts, even the patient's guardian passing by in the hallway.
Every gaze within a 10-meter radius of the station locked onto me at once.
I slowly lowered my hands, frozen in mid-air, and cleared my throat as if nothing had happened.
“Nothing to see here. Get back to work, everyone. Haha.”
Embarrassment is fleeting; the diagnosis is forever.
I quickly turned back toward Kim Ji-hoon.
Kim Ji-hoon still couldn’t tear his eyes away from the bizarre teratoma mass on the monitor.
“Ji-hoon.”
“Huh? Yeah?”
“Call neurology again.”
“Call neurology again?”
Kim Ji-hoon recoiled in horror.
He clearly didn’t want to dial that rude second-year resident, Hwang Joo-hyuk, a second time.
We’d been totally dismissed earlier with a “don’t call unless you have data.”
But things were different now.
“Yeah. With this, even that prickly guy can’t back out.”
I tapped the monitor.
“Encephalitis symptoms plus a lump this size in her abdomen? If he still insists on psych first after seeing this, he’s not a doctor—he’s a quack. He’ll come down for sure.”
“That’s true.”
“And wait… no. OB-GYN… actually… screw it, call both.”
I hesitated for a moment, then waved it off.
OB-GYN handles cause removal; neurology manages encephalitis treatment and seizure control.
They’d both need to huddle up anyway.
No point in deciding who to call first.
We’re emergency medicine.
We set the table, but we can’t cut it out ourselves.
“Huh? Uh… got it.”
Kim Ji-hoon picked up the receiver with a determined look.
Beep. Beep.
Once I confirmed he was dialing irritably, I headed toward the door leading out of the ER.
Now for the most important task.
‘Oh right. I need to call her.’
I pulled out my phone from my pocket as I walked down the hallway.
The person who’d been brainstorming with me just moments ago.
[NP Joo Jeong-hyun]
I hit call.
He picked up after a couple of rings.
[Yes, this is Psychiatry’s Joo Jeong-hyun.]
“Doctor, this is Emergency Medicine’s Han Hyun-jae.”
[Oh, yes! Dr. Han. Results back?]
Tension laced his voice.
If nothing turned up, the patient would bounce back to psych.
“Yes. We found it. No need for you to come down again.”
[…What? You found it?]
“Abdominal CT shows an 8cm giant teratoma on the right ovary. Clinically, it all fits NMDA encephalitis.”
[Whoa….]
An exclamation burst through the receiver.
“We just called neurology and OB-GYN for consults. With the organic cause confirmed, we’ll handle admission on their end. Thanks for your help while you’re so busy.”
[Wow… okay, got it. Good work.]
I hung up and pocketed my phone.
My steps felt lighter.
I’d even lightened the psych doctor’s load.
I took a deep breath and opened the door to the family waiting room.
Creak.
The air in the waiting room was heavy and cold.
Amid the droning TV noise, I spotted the patient’s mother in the corner, talking on the phone.
She clutched a tissue tightly, her shoulders shaking.
“…No, honey, that’s what I’m saying—Hye-ji suddenly started screaming like a lunatic… I couldn’t even recognize her….”
Her tear-choked voice filled the room.
“What are we gonna do, honey… If this is schizophrenia, what happens to our girl… What if she has to live on meds and locked in hospitals forever….”
The despair of a mother crumbling under the shock of her perfectly fine daughter going mad overnight.
I approached carefully and tapped her shoulder.
“Ma’am.”
She jumped and turned.
“Oh, uh. Honey, the doctor’s here. I’ll call you back.”
The patient’s mother ended the call.
“Yes, Doctor.”
I stepped closer and spoke as calmly as possible.
“Guardian. For now, you can breathe a little easier.”
“Yes…?”
“The test results are in, and it doesn’t look like the psychiatric issue we initially feared.”
Her eyes widened.
“Not a mental illness? Then? Why is my girl acting like that? She’s not faking it….”
“Yes. It’s not faking. And it’s not a mental illness.”
I steadied my breath and launched into my prepared explanation.
“We did a brain CT and abdominal CT. We found a mass in her abdomen—specifically, on the ovary. It’s called a teratoma.”
“A mass?”
“Yes. This mass contains tissues similar to brain cells mixed in. Her immune system kicked in to attack it but mistakenly hit the brain too. That caused inflammation in the brain.”
I pointed to my head.
“So the brain glitched temporarily—hallucinations, screaming, emotional dysregulation.”
As I spoke, the mother’s expression shifted constantly.
The tangle of emotions twisted her face.
“So… my girl’s mind isn’t broken? It’s that mass’s fault? She’s physically sick?”
“Yes, exactly. It’s a clear physical disease.”
Her legs gave out, and she sank into the chair, covering her face.
“Oh God… Thank you, Lord… I thought my girl’s life was over….”
The patient’s mother sobbed for a while, then suddenly looked up at me through tears.
Realizing the most crucial question remained.
“Will… will she get better? If we remove the mass, can she go back to normal?”
“I can’t promise exactly when she’ll be cured or wake up in a few days. Treatment won’t be easy. She’ll need surgery to remove the mass and possibly long-term immunotherapy.”
I paused, then continued.
“This disease is often diagnosed late. Patients spend months in psych wards before it’s found. But your daughter came in soon after symptoms started. She’s very lucky.”
Now the key part.
“If it’s not too late, most cases are fully curable. Even if it recurs—which we now know the cause of—we can cure it again. Starting treatment before brain damage sets in means a very high chance of full recovery.”
“Ah….”
A long sigh escaped her lips.
She grabbed my hand and bowed repeatedly.
Her tears fell onto the back of my hand.
Thanks to those noisy ghosts and the lucky clues.
But in this moment, I was glad to be her doctor delivering this hope.
“OB-GYN and neurology will be here soon. They’ll explain in more detail.”
I patted her shoulder one last time and left the waiting room.
From behind, I heard her calling her husband with a hopeful voice. My nose tingled.
‘Yeah. Now hand her off to neurology….’
My footsteps echoed loudly in the ER hallway.
A heavy yet refreshing weight settled in my chest.
That’s when I was trudging back to the station with my weary body.
Familiar voices drifted from afar.
“No, ER doctor. Hear me out.”
Irritated tone.
Neurology’s Hwang Joo-hyuk.
Facing him was my colleague Kim Ji-hoon, face flushed red and blue.
“Even if it seems clinically plausible, teratomas are pretty common in young women. Pathophysiologically, having a teratoma doesn’t automatically mean anti-NMDA receptor encephalitis. It could be incidental.”
Hwang Joo-hyuk crossed his arms and snapped rigidly.
“So let’s observe a bit more. Evidence isn’t strong enough for neuro admission right now.”
“No. Doctor.”
Kim Ji-hoon pounded his chest in frustration.
“Then where do we admit her…? Psych bailed saying it’s organic. OB-GYN will operate but won’t handle encephalitis care.”
Kim Ji-hoon’s voice rose.
“Neurology has to take her. Even if OB-GYN admits, you need to consult—steroids or IVIG at least. We should start empirical treatment now.”
“No, CSF results are needed for confirmation. Antibody tests take forever— what if we blast steroids and it’s not it?”
Hwang Joo-hyuk sighed and added.
“And MRI’s normal, right? Radiology read said no abnormalities.”
“Doctor.”
Kim Ji-hoon let out a disbelieving chuckle.
“You know MRI can’t confirm this. As a neurologist, you know better. Normal MRI doesn’t rule it out.”
Facts.
I proudly watched Kim Ji-hoon embody emergency medicine’s first virtue: fighting other departments.
But Hwang Joo-hyuk wouldn’t budge.
He was slyly muddying the waters, dragging it out…
‘Ah, classic hot potato.’
His shift was ending soon.
If admitted now, he’d have to write orders, initial management, charts—delaying his exit.
He was nitpicking to pass it to night shift and bolt.
That bastard.
Rage boiled inside me.
“Ha….”
Should I step in?
Charge at him?
‘Listen, you quack piece of shit.’ Grab his collar?
I clenched my fist and took a step forward.
“What’s the problem?”
A voice came from somewhere.
It was Lee Min-jae.