Chapter 17
Chapter 17
-----------------------------------------------------------------
Translator: crow
Chapter Title: Isn't It a Cold? (1)
-----------------------------------------------------------------
A few days had passed.
The gallery ghosts' forced study sessions were held without fail every one of my days off.
My holidays were no longer holidays.
But strangely, after enduring that hell, hospital life felt just a tiny bit easier.
Of course, it was still shit. That was an unchanging truth.
At least it wasn't like before, where I trembled in fear before every situation. Now, there was at least a faint framework in my head.
Of course, that framework didn't reduce the overall shittiness of my hospital life.
"No, doctor! I'm telling you my heart feels like it's going to explode! Forget that ECG or whatever—shouldn't you do a heart ultrasound right away? The neighbor's Kim kid had chest pain just like this, got an ultrasound, and they put in a stent or something immediately!"
Today's first villain was a man in his 50s.
He'd come to the ER complaining of heartburn after heavy drinking the night before.
Classic reflux esophagitis symptoms, and his ECG was clean.
But this guy was absolutely convinced he was an acute myocardial infarction patient on the verge of death.
"Patient, there's no sign of acute MI on the ECG. For now, get this IV, and we'll monitor..."
"Doctors these days don't even listen to patients! I looked it up online! Symptoms like mine have a high chance of being atypical MI!"
I pressed my temple hard.
Internet MD has arrived. These types always end up missing the real golden hour later, saying, "The internet said it was fine," and toughing it out without coming to the hospital.
After a long argument, I finally showed him the blood test results proving normal cardiac enzymes, and only then did he reluctantly take the IV. Thirty minutes later, he walked out burping contentedly, looking perfectly fine.
After vanquishing one troublemaker, it was time for an internal enemy to appear.
Nam Joo-hyun, second-year Emergency Medicine resident.
Joo-hyun was extra prickly today. He'd been ripping into an intern since morning like he wanted to eat them alive, and finally, the arrows turned to me.
"Han Hyun-jae."
"Yes, sir."
"Who ordered the CT for B-21?"
"Oh, I did. 80-year-old female patient, complaining of persistent headache and dizziness after a fall, so I ordered it to rule out possible intracranial hemorrhage..."
"By whose authority?"
"But earlier, you said for elderly patients in B ward, if they've fallen, lower the CT threshold even if symptoms are vague and shoot aggressively..."
"When did I say to order it on your own? You report to me first, discuss, then order under my name! Who are you to just shoot brain CTs? If they sue over radiation causing cancer, you taking responsibility?"
I was speechless.
'Fucking asshole told me to order it myself.'
My inner self spewed curses, but real-life me just bowed my head.
Falls get routine imaging anyway, fuck.
The guy just wanted to bite someone today. And I was the easy target. That's the law of this shitty hospital floor.
"I'm sorry. I'll report first next time."
"There won't be a next time."
Joo-hyun spat coldly and went on his way.
I flipped him the bird in the empty air, then returned to my spot.
Fuck. Today was extra shitty.
***
Not everything was shitty. The ER was hell, but also packed with the world's most fascinating spectacles.
A college kid wheeled in after dislocating his shoulder playing basketball. His right shoulder was slumped at an obviously grotesque angle. The Orthopedic Surgery second-year was called down.
"Ugh! It hurts! I feel like I'm dying!"
"Just hang in there a bit. Relax and breathe out, whoo~."
The OS second-year had the patient lie prone on the bed, then dangled his arm off the edge. He hung a 5kg weight from the wrist.
Waiting for the muscles to relax, using gravity for natural reduction.
I watched every move with keen interest from the side. That was technique.
About ten minutes later, the OS resident grabbed the arm, gently rotated it, and with a dull *clunk*, the shoulder popped back into place.
"Huh... huh? It doesn't hurt!"
The kid who'd been screaming in agony just moments ago lit up with relief.
I let out an involuntary sigh of admiration. How many shoulders do you have to fix to get that kind of hand skill?
***
1 PM.
The war-like morning finally ended, and lunchtime arrived.
Kim Ji-hoon tapped my shoulder.
"Hey, let's eat."
"Yeah, sure."
I rolled my stiff neck and stood up.
Before heading to the cafeteria, I habitually scrolled through the full patient list on the EMR screen from top to bottom.
Checking new arrivals, test results for my patients, any special notes—it had become reflexive.
The scroll wheel flew.
Colds, gastroenteritis, simple contusions, drunks... Peaceful list.
I scrolled past without a thought, turning away.
That's when it happened.
My eyes locked on one line on the monitor.
Huh?
Wait.
Kim Ji-hoon urged me.
"What? Coming or not?"
I stopped scrolling, moved the mouse, and hovered over that patient's chart.
"Hey, Han Hyun-jae!"
"You go ahead. Gotta check something. I'll catch up."
Every sense in my body was screaming.
That patient.
Something.
Something was very wrong.
I swallowed dryly and clicked open the chart.
[Patient: Park Jin-su (M/54)] [Arrival: 12:10] [KTAS: Level 5] [Chief Complaint: Sore Throat]
Nothing wrong so far.
54-year-old male. Sore throat. KTAS Level 5.
Common ER case. These roll in like a conveyor belt, dozens a day.
I scrolled to the initial note. Written by my classmate Jo Soo-yeon.
[Initial Note]
Sore throat started 3 days ago, took OTC cold meds but no improvement. Pain worsened this morning, now hard to speak or swallow.
Vitals: BP 130/80, HR 88, RR 20, BT 36.8°C, SpO2 99%
Pharynx & Larynx: no erythema, no swelling, no exudate. Tonsils symmetric, not enlarged. Uvula midline.
[Assessment & Plan]
R/O: Acute pharyngitis, Common cold
Plan: IV fluids & symptomatic treatment
From my first-year perspective, Soo-yeon's charting was perfect.
Textbook, no flaws.
Full physical exam matching the chief complaint, leading to the most reasonable differential.
And starting the most basic treatment.
By-the-book play for a suspected simple acute pharyngitis KTAS Level 5.
But.
Fuck, but.
Warning alarms blared wildly in my head.
Larynx clean?
Not that the charting was wrong. Soo-yeon probably wrote what she saw.
Medically, the patient's throat was pristine. No redness, swelling, pus. All clean.
But complaining of severe throat pain?
That's the illogical point.
Not just a scratchy cold throat. Pain so bad speaking or swallowing is tough.
That level should show fiery red swelling, huge tonsil abscess, or at least white pus.
But nothing. Zero.
Huge gap between objective findings and subjective symptoms.
I scanned the chart up and down again. Vitals stable. No fever even.
Viral or bacterial pharyngitis usually comes with at least a low-grade fever.
A cold... maybe not?
Then where's this vicious pain from? If not the throat itself?
...Referred pain?
My heart sank.
Referred pain.
Pain felt in a different area from the source.
The nervous system is tangled complex; brain often mislocates pain.
And the scariest, most lethal cause of referred pain to the throat that any ER doc should leap out of bed for...
Ha, fuck.
Wait.
Puzzle pieces clicked in my head.
54-year-old male. Middle-aged. Age where CV risk skyrockets.
Cold meds no help. Of course.
Cause isn't a cold.
Throat pain. Atypical referred pain from MI radiating to jaw, shoulder, back.
Right?
I licked my dry lips unconsciously. Soo-yeon did nothing wrong. Anyone looking at symptoms and KTAS would think the same. Hidden trap.
Right?
If I'm right, that patient's lying in an ER corner bed, getting IV fluids while his heart muscle necrotizes slowly.
Not KTAS Level 5, but Level 1 needing immediate monitoring and cath lab.
I jumped up. Need EKG now.
Cardiac enzymes too.
But first, confirm. If wrong, I'm the idiot panicking over a healthy cold patient.
I headed to the patient, already typing.
Post to gallery first, then order tests.
Title: [Urgent] Sore throat patient— is this right?
Poster: Hell Joseon Slave 1
50s/M. Chief complaint: severe sore throat, no improvement on cold meds. Exam shows clean pharynx/larynx. No fever. Should I read this as atypical ACS? Feels like it to me.
Hitting post in my head, I arrived at B-28.
Patient was breaking a cold sweat, moaning faintly at the ceiling.
He struggled to open his eyes as I approached.
"Doctor, my throat feels like it's burning..."
Burning pain.
Classic MI chest pain pattern. Manifesting in the throat now.
I steeled myself.
"Patient, hold on. Need to do an important test."
I rushed to the nearest computer.
My fingers trembled faintly logging into EMR.
"Everyone! B-28 Park Jin-su— EKG stat! Bring portable machine here now, and labs including cardiac enzymes and full cardiac panel ASAP!"
My urgent shout froze the drowsy pre-lunch station air.
"Pardon? B-28? That cold patient...?"
The nurse looked at me puzzled.
"May not be a cold. Hurry."