Chapter 12
Chapter 12
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Translator: crow
Chapter Title: Respiratory Failure
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Lee Min-jae's rumor about the double board had spread like a contagious disease.
Not even a full day had passed before it reached the entire emergency medicine department.
I woke up from a short nap in the on-call room at dawn and was pulling a fresh gown from the supply closet when a voice came from behind me.
"Hyun-jae?"
It was fourth-year Yoo Seong-hoon. His face looked as chronically exhausted as always.
"You're really switching to internal medicine?"
"Huh?"
"It's the right timing, sure. Happens sometimes in the fall of first year—guys who test the waters and bail. So, giving up your residency? Or is it really double board like Min-jae said?"
I squeezed my eyes shut tight.
I replayed the past year in my head.
Days of getting chewed out and covered in blood.
I'm not giving up.
Who in their right mind would do this all over again?
The thought of enduring this hell for four whole years was terrifying enough, but switching departments and repeating the process for another three or four? Double board? That was inhuman.
I answered as firmly as I could.
"No. I have no plans to switch departments. I'm not giving up my residency."
"Then double board?"
"No, not doing that either."
"Hmm."
Fourth-year Yoo Seong-hoon gave me a look like he wasn't sure whether to believe me, stared for a moment, then shrugged and went on his way.
But this was just the beginning.
I was writing orders at the ER station when third-year Choi Soo-min approached with a worried face.
"Hyun-jae."
"Yes, senior?"
"You're really doing the double board? That's a brutal path. You could wreck your health."
I was on the verge of tears by now.
"I'm not doing it, senior. Who the hell started this ridiculous rumor...?"
"Oh? Good, then. Anyway, don't push yourself too hard."
She patted my shoulder reassuringly before leaving, but it didn't help at all.
I'm not switching, you bastards....
And then, it finally happened.
My classmate Jo Soo-yeon.
"Hyun-jae!!"
"Huh? What's up?"
"You traitor! I knew it all along! Ditching EM?! You even recruited me first and now you're bailing on EM?!"
I pressed my temples hard.
My head throbbed.
No.
I'm not going.
I'm not doing it.
I screamed it in my mind dozens of times, but no one believed me anymore.
Not going. Not doing it. Can't do it.
Just survive these four years here—that's my only goal.
Please believe me, you bastards.
***
Friday, 1 a.m.
The regional emergency medical center at our hospital—one of the busiest in Korea—was wide awake even then.
"Suction ready! BP keeps dropping! 80 over 50!"
"Heart rate 140! Doctor, we need central line access right now!"
In the resuscitation bay, a fierce battle raged to save a polytrauma patient from a car accident.
All the senior residents, fellows, and even the professors were glued to it.
I stayed quietly at my station, handling charts.
That wasn't my place yet. My best contribution was clearing the growing pile of charts for minor cases to ease the seniors' load a bit.
That's when it happened.
Beep-beep-beep-beep!
An alarm blared from a completely different direction.
Zone B. Where the more stable patients stayed.
I turned to see the station monitor flashing red for B-12's oxygen saturation.
85%
84%
83%...
"Shit."
I jumped from my chair and bolted toward the bed.
All the seniors were tied up with the trauma patient.
An elderly woman in her 70s lay there. She had a history of COPD and had come in yesterday afternoon with worsening shortness of breath.
Her sats had been low on arrival, so we'd started nasal cannula oxygen and were monitoring; she'd stabilized enough that discharge was on the table soon.
But now, she was totally different.
Her face was ashen, lips blue. She didn't look like she was breathing right. Consciousness was nearly obtunded.
"Min-jun! You were watching this patient, right? What happened?"
I yelled at first-year Choi Min-jun, who was pacing anxiously beside her.
"Sats dropped suddenly, so I cranked the oxygen first! She's on a non-rebreather mask at 10L now, but it's still dropping!"
Sure enough, she had the mask on, dialed to 10L.
But her condition was worsening. Consciousness fading more.
Choi Min-jun looked like he was about to cry as he shouted.
"What do we do? Max it to 15L? Or prep for intubation right away?"
Oxygen dropping. COPD patient. I'd seen this somewhere. Learned it, tested on it.
What was the exact mechanism?
How the hell did this guy pass the licensing exam?
Anyway, that wasn't important now.
My mind went blank for a second.
I knew this.
'Gallery!'
I pressed the stethoscope to her chest, pretending to listen, and summoned the blue interface in my vision.
Title: URGENT 70s COPD patient. Came in for dyspnea. On 10L O2, sudden LOC drop and sats crash. Why?
Author: HellJoseonSlave1
I posted and yelled at Choi Min-jun.
"Secure the airway—lift her jaw first!"
Buying time like that, I caught a glimpse of comments appearing in the corner of my vision.
RespiratoryGhost: Idiot, it's CO2 retention. Don't you know high-flow O2 in COPD suppresses the respiratory drive? Hypercapnia causing narcosis. Drop the O2 NOW and draw ABG to check pCO2. Prep BiPAP if needed.
Everything clicked.
I slung the stethoscope around my neck and bellowed at Choi Min-jun.
"Choi Min-jun! Drop the oxygen! 2L right now!"
"What? Drop it? Sats are under 80! She's gonna die, Hyun-jae!"
"This is a COPD patient! Forgot the history?! Didn't you take the boards?! More O2 here and her heart stops, you idiot!"
"...Ah!"
I shoved Choi Min-jun's shoulder aside and roughly dialed down the oxygen myself.
Then I shouted at the nearest nurse.
"Ma'am! ABG kit and heparinized 1cc syringe—hurry! Puncturing the radial artery!"
"Yes, doctor!"
"And Nurse Lee Soo-jin! Portable X-ray and BiPAP machine—now!"
The nurses moved like clockwork.
I smacked Choi Min-jun's back with a loving whack and shoved the Ambu bag into his hands.
Soon, the nurse brought the kit, and I drew arterial blood. Seeing the bright red fill the syringe let me breathe for a second.
"Stat to the lab! Tell them immediate!"
Right then, the nurse and respiratory therapist hauled in the bulky BiPAP machine.
"Doctor! BiPAP here!"
The therapist asked me.
"Doctor, initial settings? IPAP and EPAP?"
"..."
My mind blanked again.
Fuck.
Settings? How would I know?
I knew BiPAP was needed thanks to the gallery.
But specific numbers? No clue.
Just say 10 and 5?
What if I damage her lungs?
"Doctor?"
The therapist prompted me.
Choi Min-jun and the nurses all stared at me.
Sweating bullets, I desperately stalled.
"Hold on. Need to recheck consciousness and chest movement before deciding."
I bluffed that and pretended to approach the patient.
Flipping her eyelid to check pupils, I reopened the gallery window.
Title: [URGENT22] BiPAP initial settings plz!!
Author: HellJoseonSlave1
No sooner had I hit post than RespiratoryGhost jumped back in.
RespiratoryGhost: Start IPAP 12, EPAP 5. RR at 14. Redraw ABG in 30 min, adjust pressures based on CO2 drop. Served it on a platter and you can't even eat.
The insult stung, but not now.
"Initial: IPAP 12, EPAP 5, RR 14."
"Got it."
The therapist set it up smoothly.
Moments later, a nurse called out toward us.
"B-12 ABG results!"
My heart pounded.
"Doctor! pH 7.15, pCO2 92, bicarb 30!"
"...Yes!"
I clenched my fist without thinking.
"Okay, hold BiPAP settings. Follow-up ABG in 30. Check tolerance every 10 minutes!"
I'd done it.
Again.
Saved the patient with this insane gallery's help.