Chapter 24
Chapter 24
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Translator: crow
Chapter Title: Not a Heart Condition? (2)
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I stared at the patient. His face was still pale with pain.
Malingering? That acting?
All that cold sweat, shallow rapid breathing, and the faintest tremor in his fingertips?
If that was acting, this guy needed to head straight to Chungmuro for auditions.
'No.'
A lingering spark in my mind whispered.
'Something's there.'
Yeah, fuck it.
If it doesn't show up once or twice, check three or four times.
Myocardial infarction is a dynamic disease.
He could be fine now and screaming in ten minutes.
I decided to keep follow-up ECGs every twenty minutes.
At the same time, I stared into space, opening the gallery window in my head.
Title: [HELP] Chest pain patient, all tests normal. But he keeps saying it hurts.
Author: Hell Joseon Slave 1
50s/M, classic ACS-suspect chest pain. But follow-up ECG every 20 mins, X-ray, basic labs, troponin—all normal. Patient's still rolling around sweating bullets. What am I missing? Or just discharge him?
I'd just posted my desperate question when Yoo Sung-hoon, passing by, glanced over my shoulder at the monitor and clicked his tongue.
"Still hanging on to that patient? Keeping ECG follow-ups? Hmm, yeah, it's iffy."
His voice was half pity, half mockery.
"But in my opinion..."
The moment Yoo Sung-hoon opened his mouth.
The first comment appeared on the blue interface in my vision.
Cardiology Ghost: You idiot. ACS with normal troponin? Unstable angina, dumbass. ECG can be normal.
And that voice overlapped perfectly with Yoo Sung-hoon's from behind me.
"...can't rule out unstable angina either. Not at emergency cath level right now, but..."
Fuck.
Chills ran down my spine.
Yoo Sung-hoon immediately started new orders.
"Follow-up troponin every three hours for now, start heparin infusion (*Heparin Infusion, continuous or intermittent IV administration of the anticoagulant heparin)... Nah. Just give sublingual nitroglycerin (*dissolved under the tongue) if chest pain persists and observe. Gotta keep watching."
I hurriedly entered the drug orders as instructed.
"But it might not be angina."
"Yes?"
Even ghosts say angina?
You think it's angina too?
Suddenly?
"Look at the timeline. Pain started an hour before arrival, two hours since. That severe unstable angina should've bumped troponin even a little or caused an MI (*myocardial infarction) by now. It's... weird."
I glanced at the station clock and let out an "ah..." groan.
Yoo Sung-hoon was right. Time. It explained everything and muddied everything.
***
Time passed, and our last hope vanished.
Troponin check: still perfect. Completely normal.
I couldn't leave without knowing what happened to this patient, sitting there like a madman past quitting time.
I logged back into the gallery. This time, pleading.
Title: Not angina either. What the hell is it now.
Author: Hell Joseon Slave 1
Cardiology Ghost, it's not that ㅠ 3-hour troponin follow-up normal too. Patient still says it hurts. What do I do now? Call psych for somatoform disorder?
The comment came from an unexpected place. A new nickname I'd never seen.
GI is Important: Thought about esophageal spasm? If not malingering, that's the top bet. Hit him with ketorolac, prescribe a GI cocktail (*gastrointestinal cocktail, mix of meds for indigestion relief). It'll improve dramatically.
I stared blankly at the comment. Esophageal spasm?
'GI cocktail? What's that, weeaboo...'
I searched the unfamiliar term on my phone.
Gastrointestinal cocktail...
No way, that's what American docs use, you fuck.
We don't give that combo here.
This is South Korea. Prescribe some baseless cocktail and the health insurance review board calls instantly.
But...
Esophageal spasm really can mimic heart disease symptoms perfectly.
And right in front of me lay a chest pain mystery with every cardiac test normal.
Nothing to lose.
Can't make the cocktail, but I can mimic the principle.
Meds to relax severe esophageal spasms.
Like grasping at the last straw, I entered a new order. Powerful antispasmodic. Tiropran injection.
Yeah. If not heart, let's fix the esophagus.
Please, just catch something.
Nearly self-abandoned, I asked the nurse to prep the injection.
Please, let this work. Make him just a nasty stomach cramp case.
I don't care if I look like an idiot for the last few hours of bullshit, just don't let him have something deadly.
The nurse hooked the syringe to the patient's IV and slowly pushed the drug. I watched anxiously.
Right then.
Far off, Cardiology Fellow Park Woo-young finished consulting another patient and was heading out of the ER.
On impulse, I grabbed him and explained the history.
Heart expert, maybe he'd have a hunch.
"...This still heart-related, doc? Did I miss something?"
Park Woo-young answered without a second's hesitation.
"Just indigestion, right?"
He patted my shoulder, said "Good work," and walked off.
Indigestion.
...Is it?
I turned back to the patient.
***
Two or three minutes after the injection finished.
A miracle happened.
The patient's furrowed brow slowly relaxed.
His ragged breathing steadied.
He loosened his grip on his chest and stared blankly into space.
"Huh...?"
He took a deep, incredulous breath.
"Doc... It doesn't hurt."
Chest pain resolved.
...
I couldn't speak for a moment.
That brutal chest pain vanished like a lie with one shot.
Not cardiac.
I pulled up a chair beside him with a hollow laugh.
"Anything special for dinner last night, sir?"
At my question, he scratched his head like he'd come to his senses.
"Last night... I ate big."
"Yeah, what?"
"Uh... That trendy mala xiang guo... And with friends, a lot of gaoliang liquor. Like three bottles...."
Mala xiang guo. Gaoliang.
A fantasy combo from the start.
Surely not three bottles solo.
"Then before bed, stomach burned a bit... So I chased with a bulgogi burger set from the fridge."
I pressed my temple.
Oily mala xiang guo, harsh gaoliang, cold cola and burger.
This'd clog a sewer drain, not just an esophagus.
"Any workout yesterday?"
"Oh! Hit the gym!"
His face lit up.
"No wonder my chest felt stiff! Did bench press heavier than usual!"
Confirmed.
Puzzle pieces fit.
Muscle pain from chest workout...
Reflux esophagitis and esophageal spasm from greasy spicy food and booze.
Thoracic muscle strain from overdoing bench.
Perfect synergy mimicking acute MI.
I scheduled GI and ortho clinics, wrote prescriptions.
Observed another hour, pain fully gone, then discharged.
"Doc, you saved my life! Big hospital's different!" He bowed and left. I gave an awkward smile.
...
Back at the station with a hollow laugh, I opened the gallery to report the ridiculous end.
Title: Yo, that chest pain dude was just indigestion lol
Author: Hell Joseon Slave 1
Mala xiang guo and gaoliang bender, burger hangover cure, then wrecked bench press uncle. One Tiropran shot and he walked out fine. No biggie lol Gonna suspect GI first for atypicals from now on. Cardiology Ghost wrong this time lol
I hit post, thinking, 'That'll deflate those ghosts.'
But the gallery reaction was ice cold.
Cardiology Ghost: What'd you just say?
First comment ominous.
Latte is Just Words: This one's minor lol But what? Suspect what first from now on?
Cardiology Ghost: You year-one shitstain. Know how scary unstable angina is? "No biggie lol"? Lucky esophageal spasm guess. If it was real angina, he'd swallow your gut meds and drop dead on the way home. Suspect GI first now?
I was speechless at the screen rage.
What'd I do wrong? It wasn't. Tests clean.
Before my grievance faded, more from Cardiology Ghost.
Cardiology Ghost: Gonna school your ignorance. Case: 45M smoker. Wakes at dawn next day after drinking with chilly chest feeling, gone in 30 mins, back to sleep. Fine morning, goes to work, same pain afternoon, comes to ER. Pain free on arrival. ECG normal, troponin normal. What do you do? Answer.
...What?
I frowned. No pain, tests normal?
> Hell Joseon Slave 1: No symptoms, tests normal? Reassure, book cardio clinic for detailed tests, discharge?
My reply posted, gallery exploded again.
Cardiology Ghost: LMAOOOOO Handing out murder licenses!
God's Scalpel: (What even)
Cardiology Ghost: Variant angina (*rare type, tough to diagnose), you quack! Coronary spasm, know it? Admit NOW, 24h monitoring, provocation test (*induce spasm for diagnosis) or straight CAG (*coronary angiography) to confirm and start calcium channel blockers! Send him home? He'll infarct in his sleep next dawn!
My mind went blank.
Ah.
> Hell Joseon Slave 1: Fuck how am I supposed to know that. Am I a cardiologist?
Latte is Just Words: Shoulda asked if you didn't know lol
OR Ghost 3: That's why we're here.
Pulm Ghost: Confused? Iffy? Fucked? Ask us always.
Cardiology Ghost: (Frog clenching fist emoticon)
No reply from me.
> Hell Joseon Slave 1: Fiiiine, got it
I barely managed one line.
Closing the gallery, exhaustion hit hard.
...
Staring at the empty A bay bed, I muttered.
Still a fuckton to learn.
...But relief.
Not heart disease.