Special Tutoring (3)
Fuck. Do these bastards not even sleep?
No — they're dead. Of course they don't sleep.
Damn it.
That's right. Today was a holiday handed down by God himself. I was off.
Apparently the gallery ghosts could not have cared less about my sacred day of rest.
I was speechless. These insane workaholic ghosts had no concept of rest whatsoever.
"Fine. Let's do it. Bring it on, you sons of bitches."
And just like that, my sacred day off was hijacked into a mandatory study group run by the greatest physicians of the afterlife.
How much time had passed, I couldn't have said.
Dozens of ECG waveforms tore through my skull. Cardiology Spectre hurled every bizarre, atypical tracing he could find at me and drove me into the ground with them.
"Yes, yes! I see it! I can see it!"
No sooner had my scream died than Nephrology Old Geezer snatched the baton.
"It's hypophosphatemia from insulin dragging glucose and phosphate into the cells together! Treatment is phosphate replacement, oral or IV!"
I typed the answer like I was practically wailing.
Whenever I managed to come back to myself, RheumatologyGranny was already barking at me to recite the antibody profiles of rare autoimmune diseases, and before I could even catch my breath, Pulmonology Ghost was dumping dozens of arterial blood gas reports on me and demanding I interpret every last one.
In the gaps between, God of the Scalpel ordered me to fetch the pig skin.
I staggered over to the kitchen table and picked up the needle again.
My hands were, very slightly, better than yesterday.
How much longer it went on, I had no idea. Right as my soul was about to peel itself out of my body—
God of the Scalpel said it like he was doing me a favor.
I managed, barely, to tap out a reply.
Hah... finally. I can rest.
It was over. At last. The relief hit me like a wave.
I hauled my tattered body upright. Outside the window, the dark had already settled in thick and heavy. In a daze, I picked up my phone.
What time is it?
And the instant I saw the number on the screen, my brain stopped.
Afternoon?
Seven o'clock?
I threw my head back and roared loud enough to shake the studio apartment off its foundations.
A shrieking alarm dragged my eyes open.
Ding-ding-ding. Good morning. Ba-ba-ba-ba-ba, ba-ba-ba-ba.
"Fuck..."
The word came out in a ruined croak.
Yesterday's day off had not been a day off. It had been torture. It had been livestock training. It had been a study group from hell, and nothing else.
I got up like a zombie and staggered to the bathroom. In the mirror stood a first-year slave whose face was worse than yesterday, if that was even possible — not a single thing improved. I raised my middle finger at those hollow eyes.
Flip off.
You bastards... give me my day off back.
I changed clothes and boarded the bus to the hospital with a look of pure rot on my face.
I'd thought this was a cheat code. I hadn't expected it to become one of the things actively fucking my life over. These lunatics were dead serious about education, too.
I considered opening the shop for a second — maybe grab a fatigue recovery tonic — but Possession was still the first priority, so I shut the window again just as fast.
Eight in the morning. The Emergency Medicine Conference Room.
I had wedged myself into the farthest, most invisible corner I could find, trying very hard not to exist.
"Alright, let's begin. This is a case from last week."
The presenter was the chief resident, fourth-year Lee Min-jae.
"Forty-eight-year-old female. Presented with a week of high fever over 39°C, myalgia, and arthralgia. Initial workup showed elevated white cells and liver enzymes but was otherwise unremarkable, and neither blood cultures nor imaging identified a clear source of infection. A classic FUO — fever of unknown origin."
The screen was packed with the patient's labyrinthine lab results and chart notes. The chief walked through the differential one diagnosis at a time, never once losing the thread, laying the logic out clean. The presentation itself was tight — not an ounce of fat on it. The guy was an ECG freak with a personality from the fourth dimension, sure, but when it came to skill, he was the real deal among the residents.
"...So ultimately, combining the lab finding of a ferritin level that had skyrocketed past 20,000 with the characteristic clinical picture, we diagnosed the patient with AOSD — Adult-Onset Still's Disease — and started high-dose steroid therapy. She's currently showing dramatic improvement and is stable on the rheumatology ward."
When the presentation ended, Department Head Park Woong, who had been sitting in the front row with his arms folded, listening in silence, spoke in a low voice.
"Good presentation. It's a solid case. Ferritin was the key clue in diagnosing AOSD."
He nodded, looking satisfied — then suddenly turned his head and swept his gaze across us juniors.
My heart dropped like a stone.
I knew that look. It was the omen of an ambush question.
Please. Anyone but me. Please.
"It's well known that ferritin rises abnormally in AOSD. But in an ER setting, when you see extreme hyperferritinemia like this — over 20,000 — there are a few other lethal diseases you have to differentiate. This is something every emergency physician needs to know."
The Department Head's eyes drifted through the air and landed, with surgical precision, on mine.
"Dr. Han Hyeon-jae."
Ah, fuck.
"Why don't you take a shot. What else is there?"
Every gaze in the conference room swung toward me.
My mind went blank. Ferritin? Hyperferritinemia? I'd heard of it, sure. Recite several diseases besides Still's, right now? My mouth went bone-dry. Cold sweat slid down my back.
A flicker of pity crossed the chief's face as he watched me panic.
...Wait.
Hold on.
Ferritin... hyperferritinemia...
Hadn't one of those ghost bastards ripped into me about this yesterday?
The hematology-oncology ghost, maybe? The one who'd shoved cancer cases in my face and hammered on about how important the ferritin number was.
Yesterday's memory started to surface, faint but there. I opened my mouth, fumbling.
"Ah... well, first, you have to consider a systemic inflammatory response associated with sepsis."
The Department Head's eyebrows lifted a fraction.
"And... um... ferritin can also spike dramatically in MAS — macrophage activation syndrome. Especially in patients with underlying rheumatic disease..."
The fragments of memory were clicking into place, one after another. The knowledge those ghosts had jammed into my skull yesterday was, of all things, saving me in conference.
"Malignancies like lymphoma or leukemia can also dump massive amounts of ferritin from tumor cells, and in something like fulminant hepatic failure, the ferritin stored in the liver can flood into the bloodstream."
When I finished, silence filled the room. I held my breath and waited for the Department Head's reaction.
Please let that be right. Just let me live.
He stared at me for a moment, then nodded, a satisfied smile spreading across his face.
"That's correct. Excellent. Mentioning MAS in particular is worth praising."
Hah.
Every ounce of strength drained out of my body at once. The chief was staring at me with his mouth slightly open, and the looks from the other seniors and my classmates were packed with the same stunned surprise.
It felt like yesterday's hell of a day had just paid me back.
Of course, the godawful side effect was that those people would now be fully convinced I was that lunatic prepping for an Internal Medicine Double Board.