The Weird One (4)
People who might once have been called the hands of God in their own fields were now, in death, going wild over a single minor diagnosis from a first-year resident. Were they really that starved for actual patients and real clinical work?
These insane workaholic ghosts.
At that moment, the image of myself stitching up a child's forehead earlier flashed through my mind. The sutures had been crooked — a complete mess. What any other senior would have finished in five minutes, I had grunted and struggled through for a full twenty. In the end, Choi Soo-min had come over, unable to watch any longer, and finished it for me.
"Hyeon-jae, your technique still needs more work."
I could borrow a brain. I couldn't borrow a pair of hands.
On impulse, I started writing a post on the Gallery.
The second I posted it, regret came crashing in.
Ah, fuck. Should I not have put that up?
What if they laugh at me and tell me to quit being a doctor if my hands are this worthless?
I slammed the Gallery window shut.
I was an idiot for expecting anything.
…Fucking hell.
I let out a hollow laugh and tipped my head back against the wall. This goddamn Gallery wouldn't even go so far as to let me download hand skills.
Ha. Maybe I just wouldn't ever have to use Possession. Would the day even come when I'd scrape together 5,000 LP and summon God of the Scalpel into my body for thirty minutes?
I was drowning in self-loathing when it happened.
The automatic doors at the ER entrance slid open, and a completely unexpected figure stepped through. It was Professor Choi Youngjoon from Rheumatology — the one I'd run into a few days ago over the VEXAS syndrome patient.
My heart sank. Why at this hour? Why the ER, of all places? Don't tell me it wasn't VEXAS after all, and he'd come here to tear me a new one?
Professor Choi Youngjoon didn't so much as glance around. He walked straight toward me.
"Dr. Han Hyeon-jae."
"Yes, Professor! What brings you here?"
I shot to my feet on reflex and bowed at the waist. Professor Choi acknowledged the greeting with a slight nod, then thrust the tablet PC he was holding in front of my eyes.
"I happened to be passing by while checking on a patient's progress, and today's bone marrow biopsy results were rather interesting. Thought I'd drop in."
The screen was packed with English abbreviations and numbers.
FINDINGS: Hypercellular marrow with prominent erythroid and myeloid dysplasia. Prominent ring sideroblasts (18%).
GENETICS: UBA1 somatic mutation confirmed.
"Dr. Han, does anything come to mind looking at these results? You mentioned you had a strong interest in rheumatic diseases, didn't you?"
It was the VEXAS patient's results, so of course it was related to VEXAS. But I didn't have a fucking clue what any of these numbers and words actually meant.
Fuck. Emergency.
My mind went white. The UBA1 mutation was confirmed, so the VEXAS diagnosis was solid. But there was no way a first-year like me would know the clinical significance of the other findings. Besides, I was an emergency medicine doctor. Not an internist.
Either way, I had to stall — desperately — if I didn't want to shatter the image I'd built. I arranged my face into the most intellectual expression I could manage and pretended to study the tablet screen.
At the same time, the Gallery window was flying open at the speed of light.
The instant I posted, I opened my mouth and started running it to buy time.
"Ah, Professor. Could you give me a moment? In my assessment, when we comprehensively consider these bone marrow findings together with the genetic markers, there are aspects that make it difficult to view this as simply the presentation of an autoinflammatory disease…"
I assembled words at random and spat nonsense into the air. Professor Choi Youngjoon stood with his arms folded, watching me with interested eyes.
Please. Just one comment!
Whether my inner scream actually reached them or not, a small notification finally blinked in the corner of my vision.
Every last wisp of fog in my head cleared away.
"Professor, I'll get straight to the conclusion."
Professor Choi Youngjoon's eyes widened slightly.
"This patient is, with a very high probability, already progressing toward myelodysplastic syndrome — that is, a pre-leukemic state."
I pointed at the ring sideroblasts 18% on the tablet.
"In particular, the ring sideroblast count exceeds 15%, which is a high-risk finding. Left as is, the likelihood of transformation into acute myeloid leukemia within a few years is extremely high. We need to contact Hematology-Oncology immediately and establish a new treatment plan that considers chemotherapy as well as, in the long term, allogeneic hematopoietic stem cell transplantation."
When I finished speaking, a heavy silence settled over the ER station.
Professor Choi Youngjoon stared at me with his mouth slightly open, as if he couldn't believe what he'd just heard. At first it had seemed like intellectual curiosity — an oh, not bad kind of look. But as my explanation went on, his gaze shifted into outright shock. He stared at me blankly for a long time, mouth still hanging open. I felt like I was going to suffocate.
Did I overdo it? Was I showing off too much for a first-year? Had I come off as arrogant, trespassing on Hematology-Oncology's turf?
"Dr. Han."
"Yes, Professor."
…?
"…Excuse me?"
A vacant sound tumbled out of my mouth.
Double Board. One physician earning specialist certifications in two fields. And he was asking me that?
Seeing my vacant expression, Professor Choi Youngjoon seemed to realize even he found his own question absurd. He let out a short laugh and shook his head.
"Ah, never mind. Right. I suppose I got a bit carried away myself. Our hospital's Emergency Medicine department has gained a truly remarkable talent."
He tapped my shoulder lightly, genuine admiration in his voice.
"I learned a great deal today, thanks to you. I'll be sure to pass this along to the department chair."
With that, Professor Choi Youngjoon turned and left the ER looking thoroughly unburdened.
Wait. What? The department chair? Pass what along to the department chair? Hey — what the fuck?
I could feel the surrounding gazes shift against my skin. I stood there in that awkward silence, dazed, when a massive shadow fell over me from behind.
I turned around, very slowly.
Lee Min-jae, the Emergency Medicine chief resident, was staring at me with his mouth hanging open. I had no idea how long he'd been standing there. He'd heard every word of my conversation with Professor Choi Youngjoon from start to finish — that face left no doubt. The chief looked back and forth between me and the direction Professor Choi had vanished, his expression as vacant as someone who'd just seen a ghost.
"You crazy bastard!"
Lee Min-jae seized both of my shoulders.
Oh, come on. What now. Why was he coming after me this time.
"You… you little shit! You've been prepping for a Double Board behind my back?! I knew it! I knew something was off about you!"
I couldn't even collect myself under the chief's roar.
"Hey! So that's why you were so damn sharp on internal medicine cases? Huh? All those rare diseases you rattled off that none of us knew — that was groundwork for jumping ship to IM? Emergency medicine was just a stepping stone?! You were going to betray us — your comrades in this ER — and bolt to internal medicine, you traitor!"
The chief's wail had already crossed the river of misunderstanding and was sailing straight into the ocean of delusion. All I could do was stand there and sway. My head was starting to spin, but I kept my mouth shut anyway.
Explain? What the hell was I supposed to say. This guy probably wouldn't listen no matter what came out of my mouth.
Fucking hell, Chief. What Double Board is a first-year preparing for. I'm just a grunt whose only goal is to get through each day without getting chewed out and without killing a patient.
Double Board, my ass. Right now my only wish would be a double cheeseburger and some goddamn sleep.