Chapter 14
Chapter 14
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Translator: crow
Chapter Title: Special Tutoring (2)
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I just wanted to collapse into bed and sleep like a rock.
But before that, there was one last thing I had to do.
Stumbling over, I threw myself onto the sofa and reopened the Doctors' Gallery.
**Title:** Guys, give me a goodnight con, I'm off to bed
**Author:** Hell Joseon Slave 1
Heading to bed ㅇㅇ give me a goodnight con
Now I could finally say goodbye to these damn ghosts.
Please don't come looking for me until tomorrow morning.
With that prayer for peace, I was about to close my eyes when the comment notifications started blaring relentlessly.
**Latte is Just Talk:** ??
**Hippocrates' Heir:** ?? O living one, what do you mean by that?
**Hematoma is Hell:** ?? Sleep? Right now?
The vibe was off.
**Latte is Just Talk:** You sutured it up, so now it's our turn.
**Endocrinology Master:** Where do you think you're going to sleep. Sit down.
**Cardiology Ghost:** Shall we start with an ECG?
Fuck.
What the hell.
Were these bastards lying in wait as a group?
**Hell Joseon Slave 1:** No, I'm really just tired...
My explanation got completely ignored.
Not long after I posted it, the first question dropped.
**Cardiology Ghost:** 68-year-old male, nausea and yellow vision for a few days. Came to ER this morning with altered mental status. ECG shows atrioventricular block (*a type of arrhythmia). Blood work: K+ 6.8 mEq/L (*serum potassium level, normal 3.5~5.0). What's the drug overdose to suspect first, and the drug you absolutely must not give this patient? Giving you 1 minute ㅇㅇ.
My head throbbed.
Yellow vision, bradycardia, hyperkalemia.
I'd seen this in the textbook. Cardiac glycoside.
Without hesitating, I replied.
> **Hell Joseon Slave 1:** Digoxin (*a cardiac glycoside) overdose. Calcium gluconate is contraindicated with hyperkalemia. It could even trigger ventricular fibrillation.
As expected, correct answer. Classic case that'll kill a patient if you don't know it.
> **Cardiology Ghost:** Correct.
> **Hippocrates' Heir:** The living one seems to have studied internal medicine quite a bit!
The second question came right away.
**Nephrology Geezer:** 45-year-old female with alcohol dependence. Admitted after 3 days of binge drinking with altered mental status. Blood work: Na+ 108 mEq/L (*serum sodium level. Normal 135~145). AMS due to hyponatremia. What's the treatment plan? How, and how fast to correct it?
This one's easy.
Hyponatremia causing AMS. Symptomatic, so correct quickly.
> **Hell Joseon Slave 1:** Severe symptomatic hyponatremia, so 3% hypertonic saline IV. Correct rapidly at 1~2 mEq/L per hour to improve symptoms.
The moment my reply went up, the gallery fell into icy silence.
Then the reply bombs started exploding.
> **Nephrology Geezer:** ㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋ This fucker's gonna kill someone.
> **Latte is Just Talk:** Knew it ㅉㅉ. Kids these days don't know the basics. It's the speed, you quack.
> **Hematoma is Hell:** Trying to save the patient and paralyze the brain instead. Very creative murder method.
What? What's wrong?
Panicking, I racked my brain.
Fast correction is right, isn't it?
Or what...
Ah.
Fuck.
Central Pontine Myelinolysis. CPM. Osmotic demyelination syndrome.
Correct sodium too fast, and the middle of the brain melts, leaving the patient in a permanent vegetative state.
I'd memorized it cold.
For a second there, I almost did something insane just thinking "correct quickly."
**Infectious Disease Ghost:** Next question. 50-year-old male chronic alcoholic. Clear-headed after sobering up? No, rambling incoherently, can't move eyes properly. Ataxic gait. What vitamin must you give before glucose fluids? Why?
This I can get. Thiamine. Vitamin B1.
> **Hell Joseon Slave 1:** Thiamine. Alcoholics are often thiamine deficient, and giving glucose first can precipitate acute Wernicke's encephalopathy.
> **Infectious Disease Ghost:** Correct. Got this one.
Phew.
But no time to rest.
The fourth question came out of left field.
**Rheumatology Granny:** 35-year-old woman of childbearing age. Intermittent high fever, polyarthralgia, malar rash for the past month. Pancytopenia on blood work, proteinuria and hematuria on UA. Suspected disease? And the three specific antibody blood tests to run first for diagnosis?
Malar rash? Pancytopenia? Proteinuria?
Fuck, what is this?
Lupus? SLE?
Seems like it...
Three specific antibodies?
Anti-dsDNA? Anti-Sm?
And what else?
My mind went blank. This isn't my field. How's a first-year EM doc supposed to know this?
'No, I'm not an internist. I don't need to know this...'
I couldn't post anything.
> **Rheumatology Granny:** Time up. SLE (*Systemic Lupus Erythematosus). Tests: anti-dsDNA, anti-Sm, C3/C4 complements. Isn't this basic? Patient's falling apart and you'd just stand there?
Basic, she says.
Basic for that damn hag, sure.
I just closed my eyes.
Then the fifth question.
**Cardiology Ghost:** Alright, last one. 55-year-old male with chest pain. ECG: deep symmetric T-wave inversion in V2, V3. Troponins normal. Pain-free now. What's this called, and treatment plan?
T-wave inversion... Myocardial ischemia?
But troponins normal and no pain now?
Observe then?
> **Hell Joseon Slave 1:** T-wave inversion suggests ischemia, but asymptomatic now with normal troponins, so observe and follow up with serial tests.
The gallery erupted in the biggest mockery fest yet.
> **Cardiology Ghost:** This retarded fuck really tried to kill a patient on purpose!!!!!!
> **Latte is Just Talk:** Observe that? That's like saying you'll watch a time bomb tick!
> **Cardiology Ghost:** It's Wellens' syndrome (*Wellens' syndrome, ECG finding in unstable angina), you psycho!!! Time bomb! Even if asymptomatic, cath lab and stent ASAP when you see that ECG!
Crash.
That day, I got two right, three wrong. Two were fatally wrong.
**Hell Joseon Slave 1:** No fuck you assholes, questions too advanced, I'm EM not internal medicine
Yeah, I'm emergency medicine.
ECG's one thing, but I don't have to know every deep internal medicine detail. This is too much.
> **Nephrology Geezer:** ㅇㅇ We know. So what? EM sees it first, right? Gotta know more. Do patients walk in saying 'I'm nephro'? Collapse saying 'cardio'? Every random case hits you first. You triage and treat first. Shouldn't you know internist-level? If not, quit.
What?
...
Silence.
I realized that ghost's logic was airtight.
The ER is the front line for every disease.
Can't pick and choose patients. So you need broader, deeper knowledge than anyone.
Ah.
Tired.
So damn...
I collapsed right there.
Leaving the trashed table, mangled pork rind, pathetic test results behind.
***
My head felt like it was splitting.
“Ugh...”
Groaning, I propped up my upper body.
Shoulders, back, wrists, every joint creaked. Aftermath of last night's suturing practice and sleeping on the floor.
Fuck, my life.
Absolute shit.
With hollow eyes, I stared at the table. Butchered pork rind, empty cans, scattered instruments in chaos.
'...Still.'
Yesterday's defeat was gone.
In its place, some inexplicable fire burned in my chest.
Might as well squeeze every drop out of those psycho ghosts.
Staggering up, I splashed cold water on my face. Mirror showed a dark-circled hospital slave.
I grinned at the pathetic sight.
Alright. Let's play again today.
Sitting on the sofa, like punching in at work, I opened the Doctors' Gallery.
Then, as brightly and cheerfully as possible, like forgetting yesterday's disaster, I posted.
**Title:** Galrumies, good to see you! Strong and mighty morning!
**Author:** Hell Joseon Slave 1
Light greeting.
But my hopes shattered with the first reply.
**Latte is Just Talk:** What's good about it. Sit.
Yeah, that's more like you guys.