Emergency Quest (2)

The department head's booming laugh still echoed through the station.

Only after that heavy hand had clapped my shoulder a few more times did he look satisfied enough to go. He left a parting remark as he walked off with the fellow.

"Yeah. Keep working that hard."

I didn't unbend from that ninety-degree bow until the two of them had vanished completely from sight.

Choi Soo-min was watching me with a complicated smile — shock, pity, and a sliver of respect all tangled together.

"Hyun-jae... you're actually really good at office politics...."

I could only offer a weak smile in return.

In the corner of my vision, the quest window was still blinking, screaming the time at me.

I'd just burned eight precious minutes on a social call with the department head.

I gathered what was left of my shredded nerves, dragged over an empty chair at the station, and sat down.

I have to find a patient.

Area A. The Resuscitation Room. The isolation rooms. Every critical-care zone in the ER was empty.

That left only one possibility: someone who'd been triaged as mild or moderate, but whose condition was actually crashing — a patient the doctors and nurses hadn't caught yet, left to deteriorate on their own.

I logged into the EMR. The familiar hospital logo loaded, and a list of every patient currently in the Emergency Medical Center filled the screen. I scrolled the mouse wheel and started opening charts one by one — the patients lying in Area B, the general beds.

First patient. Twenty-four-year-old woman. Chief complaint: abdominal pain. She'd come in because her lower belly had been aching since last night. Vital signs stable. Blood work entirely normal. The intern who'd seen her first had charted R/O simple gastroenteritis — suspected simple gastroenteritis.

That's just constipation or menstrual cramps. Pass.

Second patient. Thirty-eight-year-old man. Chief complaint: Common cold.

Cold? A cold?

Runny nose, cough, and a low-grade fever for two days. ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠When asked why he'd come, he said the hospital was near his office, so he'd dropped by after work.

This is a tertiary-care Emergency Medical Center. Does he have any idea how much his copay is going to be? He could have gone to a neighborhood ER. I would never come here. Not with my own money on the line.

I seethed internally and moved to the next chart.

Third patient. Forty-five-year-old man. Chief complaint: dead drunk. The police had found him collapsed in the street and brought him in. Blood alcohol concentration: 0.25%. Vitals stable. Just sleeping it off. Pass.

Fourth, fifth, sixth. Cold. Body aches. Headache. Indigestion. Dizziness. Cold. Cold. Cold.

"Ha... fuck."

The curse slipped out before I could stop it. The fingers scrolling the screen were going slack.

Something was wrong. Not a single one of these people was dying. Most of them could be discharged right now without the slightest problem.

I took my hand off the mouse and tipped my stiff neck back. The red quest window filling my vision looked even sharper.

Time was running, and instead of clues I only had a deepening suspicion.

Ugh... is the status window just messing with me?

Maybe this whole thing was an elaborate show playing out inside my head. The VEXAS syndrome diagnosis had been a lucky hit, and this emergency quest was a fake lure the system had thrown out to mock me. Wasn't that a reasonable suspicion?

But... but that reward — 1,000 LP and Unlock Hidden Trait — was far too tempting. And what if there really was a patient I'd overlooked?

Again. From the beginning.

I packed my doubts down tight and scrolled back to the top. Age, sex, underlying disease, current medications, allergies. I compared every lab value against the reference range, lined them up against prior results, tracked the trends. I reopened the X-ray and CT reads and stared until my eyes hurt, hunting for any tiny lesion radiology might have missed.

The result was identical.

Clean. Impossibly clean. A parade of textbook mild cases. Not a shadow of death anywhere among them.

I finally slumped back against the chair, deflated. Time had bled away without mercy. Less than thirty minutes left. The adrenaline was gone, and in its place sat a deep exhaustion and the taste of defeat.

Where the hell was this patient?

A patient left neglected in the hospital, dying.

The wording of the quest circled through my head. Was I missing something completely basic? Or was the patient not even in the ER to begin with?

I closed the EMR window. Letters and numbers on a screen weren't going to give me an answer.

I ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠stood up and started walking slowly through the department, scanning the Area B beds one by one. The quest had maybe twenty minutes left. Anxiety was tightening around my throat, but on the outside I played the part of a doctor making unhurried rounds.

I walked up to one bed and yanked the curtain open. A woman in her twenties, who'd been sleeping soundly, startled awake.

"What is it, doctor...?"

Her eyes were full of who is this lunatic wariness. I scanned her face and the vitals on the bedside monitor in a single second. Stable heart rate. Normal oxygen saturation. Nothing wrong.

"...Uh, nothing. I came to check that your blood pressure was holding. Just go back to sleep...."

I made an awkward excuse and hurriedly drew ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠the curtain shut again. The bewildered stare burning into my back made my face flush hot.

I repeated this insanity a few more times. I pinched the foot of a drunk sleeping man to check his response. I walked up to a headache patient and suddenly shone a light in his eyes to check pupillary reflexes. Patients' complaints and nurses' puzzled looks stabbed into my back like knives.

Wandering the ER like that, my feet stopped in front of Area B, Bed 17.

A middle-aged man who looked to be in his mid-fifties lay groaning on the bed. Cold sweat beaded on his forehead, and his face was pale — the classic picture of acute gastroenteritis. This was a patient I'd seen in the EMR earlier. He'd presented with vomiting and abdominal pain, was being treated as food poisoning, and was receiving IV fluids while they watched his course.

Hmm. Was there anything special about this one?

I pulled out my phone, opened the EMR again, and checked the chart.

Literally nothing. A textbook case. There was no way this patient was dying.

I was about to turn away in disappointment when the man called out to me, his voice strained.

"Hey... doctor."

"Yes, sir. Are you alright? Is your stomach really bothering you?"

"No, it's not that. I'm having a hard time getting up. Could you bring me a glass of water? My throat's burning..."

Well, the water cooler was right by the station. I could do that much. I nodded and headed over, filled a paper cup with cold water from the dispenser, and brought it back to him.

"Here you go. Drink it slowly."

The man dipped his head in thanks, took the cup, and had a sip. Then he said something very strange.

"......?"

I doubted my own ears.

Warm water?

Something was off. I had definitely pressed the blue cold-water button on the dispenser. I hadn't tasted it myself, but the condensation beading on the cup made it obvious this was cold water. And the patient had felt it as warm.

"Sir, does the water feel hot to you?"

"Hmm? No, it's not lava-hot or anything. Just lukewarm. I prefer it cold, that's all. Heh."

The man laughed as if it were nothing. I couldn't laugh. Warning lights started going off in my head.

I muddled through the moment.

"Understood. I'll bring it cold next time."

I went back to the station. My heart was pounding again. I went straight to Choi Soo-min and explained what had just happened.

"Sunbae, the B-17 patient. The gastroenteritis guy. I gave him cold water and he said it was lukewarm. I think there's something wrong with his temperature sensation."

Choi Soo-min's eyes lit up with interest. She opened the EMR and went through the chart again, carefully.

"Abnormal temperature sensation... that's a pretty unusual finding, but it's hard to act on just that one symptom. Severe dehydration or an electrolyte imbalance can cause temporary sensory changes... or, very rarely, it could be neurological."

She rested her chin on her hand, thought for a moment, then landed on the textbook answer.

"Let's redraw labs, and put in a ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠neurology consult. We'll ask the neuro on-call to take a look."

As expected. No real solution. The symptom was too vague, too nonspecific. There wasn't enough to hang a suspicion on and start digging.

"Yes, understood."

I said it, but my insides were burning up.

How long would it take to put in a neuro consult, have them see the patient, run tests, and find a cause? Would this patient — and my quest — still be intact by then?

I stood alone in the corner of the station, staring anxiously at Bed B-17.

Ah. I have a feeling it's that patient... what do I do...

Should I put up a post on the Dead Doctors Gallery in my head? But what would I even write?

Like that? There was no guarantee I'd get a clean answer the way I had with VEXAS.

...Ah, screw it.