Chapter 23
Chapter 23
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Translator: crow
Chapter Title: Heart Condition? (1)
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The emergency room was in chaos about two hours before shift change. Traces of all sorts of incidents and accidents that had erupted throughout the night.
My eyes were completely hollowed out, and the charts needing attention were piled up on the station like Mount Everest.
I was tapping away at the keyboard with lifeless eyes. My fingers moved mechanically, but my brain had stopped functioning long ago.
Anyone seeing me right now would probably think I was a robot.
*Beep bop. Current bot activated.*
It was right then.
"Doctor! Chest pain patient incoming! You need to see them right now!"
The triage nurse called out to me in a sharper voice than usual.
*Beep.*
My stalled brain forcibly rebooted.
I shot up from my chair and headed in the direction the nurse was pointing.
***
Right in front of the triage desk, a man sat in a wheelchair.
Usually, they'd be classified first before coming in. Was it that urgent?
The man, who looked to be in his mid-50s, had a face pale to the point of gray, with cold sweat glistening on his forehead and the bridge of his nose.
Looking at his body, he was clutching the center of his chest with his left hand, breathing raggedly.
His expression looked extremely grave too.
*Shit. This is bad. For real.*
I approached the man and asked in as calm a voice as possible.
" Sir, are you with us? When did it start, and where does it hurt, how bad?"
"About... an hour ago...."
He barely managed to continue.
"Suddenly... the center of my chest feels like... someone's squeezing it... like a heavy rock... pressing down...."
It matched the classic pattern of myocardial infarction pain.
"Does the pain radiate anywhere else?"
"Yeah... left shoulder... down the arm... tingling...."
Radiating pain. Nailed it.
I pulled up the chart and quickly checked the history.
Hypertension, diabetes, and over 15 years of smoking a pack a day.
He had every worst-case risk factor for heart failure.
The most deadly differentials flashed in my mind.
Acute coronary syndrome, aortic dissection, pulmonary embolism.
Miss any one of those, and this man would be a cold corpse in front of me within hours.
The silver lining: all the circumstantial evidence pointed to just one culprit.
*Miss this, and he dies. Not me—the patient.*
Cold sweat trickled down my spine.
Diagnosis took less than a minute.
But every minute and second from now would decide the rest of this patient's life.
"Nurse! Move this patient to A bay right now! Hook up the monitor, secure IV lines first! I'll place two 18-gauge in both arms! EKG here stat! We'll run it immediately! Aspirin 300 mg, have him chew it!"
Right now, the ECG was priority one.
I grabbed the nearest intern by the shoulder.
"Find a senior resident now—anyone! Check where they are and bring them stat! Strong suspicion for ACS! They need to come right away! Hurry!"
Last MI, things were so hectic I handled it solo like a one-man show. But with this, having a senior around eased my mind.
I considered logging into the Gallery, but nah. This was textbook of textbooks. Protocols would cover the tests anyway.
Plus, I didn't want the patient thinking I was some weirdo staring into thin air.
The nurses sprang into action. The intern dashed down the hall on his phone, hunting senior locations. Someone wheeled in the EKG machine.
I stuck close to the patient, monitoring his vitals.
BP 145/90, pulse 95.
He was holding on.
But he could crash any second.
I took his hand. It was clammy and cold with sweat.
"You're okay, sir. We'll do everything we can from here. Just hang in there a bit longer."
My voice was shaking.
That's when the EKG machine rumbled to a stop beside the bed.
"EKG's here!"
The nurse's shout coincided with the wheels halting behind me.
The nurse lifted the patient's shirt and started attaching chest leads.
That brief wait for the strip felt eternal.
My mind was flooded with horrific waveforms screaming myocardial infarction.
*Whirrr—zzzt zzzt—*
The machine finally spat out the long paper inscribed with the heart's language.
I snatched the strip before it fully printed, ripping it free.
And.
"......"
What the hell.
I looked at the strip again, this time much slower, more meticulously.
Sinus rhythm. 95 bpm.
Intervals regular, P waves, QRS, T waves—all textbook normal.
No ST elevation or depression anywhere I'd desperately hunted for.
Just... a perfectly normal ECG.
Clean enough for a textbook illustration.
"What is this?"
The cry slipped out from deep inside.
"Leads placed right, nurse?"
My voice came out snappier than intended.
*Oh god, sorry.*
"Yeah? Of course. Checked multiple times."
The nurse sounded baffled.
Just then, fourth-year resident Yoo Sung-hoon strode into A bay.
"Noisy in here. This the patient?"
I silently handed him the ECG strip.
Yoo Sung-hoon took it, glancing between the sweating, groaning patient and the pristine ECG.
Patient once.
ECG once.
Patient again.
ECG again.
Ceiling once.
My eyes once.
*Why look at me?*
His brow furrowed slightly.
"ECG's clean... but patient's a classic textbook case."
His mutter brought faint relief.
Yeah, I wasn't the only one thinking it was weird.
"Stabilize for now. Portable chest X-ray, then ECGs every 20 minutes."
***
Ten minutes later.
Portable X-ray done. Image sent straight to PACS. Yoo Sung-hoon and I stood at the station monitor, reviewing the chest X-ray.
What we sought was obvious.
Fluid or air in lungs, enlarged heart, or worst-case, widened mediastinum from aortic tear.
But the patient's chest on screen was serene.
Lungs clear and expanded bilaterally, heart size and shape normal.
Aortic outline smooth. No clues why he hurt like he was dying.
Yoo Sung-hoon's face hardened colder.
"This just musculoskeletal? Rib fracture maybe. Or malingering."
"But the pain pattern's too classic. Pressure with radiation..."
"I know. But tests say no."
Skepticism laced his voice. My head spun too.
Had I jumped the gun? Overreacted? Fallen for the patient's act with my textbook knowledge?
***
Forty minutes later.
Patient still yelling in pain; we waited indefinitely.
ECGs every 20: still normal.
ER ramped up again. Yoo Sung-hoon and I saw other patients but fixated on lab results.
Finally, EMR pinged.
[Blood test results arrived]
Sweat slicked my mouse hand as I clicked. Yoo Sung-hoon peered over my shoulder.
CBC: normal.
Chemistry: normal.
CRP: normal.
D-dimer: normal.
Everything, every number—obnoxiously normal.
No inflammation, no electrolytes off, no clots hinting PE.
Yoo Sung-hoon sighed deeply.
"See? Just a tweak somewhere. Ibuprofen one tab, if still hurting, refer to neuro or ortho clinic and discharge."
No.
Not over yet.
"Doc, hold on. One last test... can we wait for that before discharge?"
"...Right. Check all results first."
So we waited more.
***
One hour 25 minutes post-arrival.
Last bastion.
Final verdict when everything's normal: heart involvement or not.
Cardiac enzymes.
Troponin especially—most sensitive and specific. Must rise if even microscopic heart muscle damage.
Call from rapid labs. I picked up the receiver with trembling hand.
"Yes, Emergency Medicine, Han Hyun-jae."
"A-2 patient's troponin resulted."
My heart sank.
"Wh-what's the result?"
The lab tech recited flatly.
"Troponin I, less than 0.04. Normal."
*Click.*
I hung up.
ECG normal, X-ray normal, labs normal, even final cardiac enzymes perfect.
All evidence screamed my diagnosis was wrong.
Yoo Sung-hoon patted my shoulder once, face saying *Told you so*, and went to another patient.
Left alone.
*Fuck. What the hell.*
So why's he in pain? Was the whole hour-long circus my delusion?
What is this?
Am I crazy?
What the fuck!!
Think of next steps.
...Gallery.