Chapter 43
Chapter 43
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Translator: crow
Chapter Title: Migraine (2)
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It wasn't a severe bruise like you'd get from a major injury.
Just the faint kind you often see from bumping into furniture.
The sort of minor mark you'd usually brush off.
But for some reason today, that bruise was nagging at my nerves.
Without thinking, I stopped in my tracks and peeked behind the curtain.
"Patient."
At the sound of my voice, the nurse and patient both turned to look at me.
"There's a bit of bruising on your arm. Did you bump into something?"
At my question, the patient glanced down at her own arm, her expression as if she hadn't even realized it was there.
"Huh? Yeah, there is. When did that happen...?"
She furrowed her brow, trying to recall.
"Yesterday while rushing a deadline, maybe hit the desk...? Can't really remember...."
Her answer was vague.
Was it that she truly couldn't remember, or did she just not think it was a big deal?
Either way, that uncertainty left a tiny, nagging spark in my mind.
I couldn't explain why.
It just... felt off.
A young woman who'd pulled a few all-nighters, exhausted.
A throbbing migraine.
And a bruise she wasn't even aware of.
Taken separately, they were all too common symptoms and signs—nothing unusual.
'...Should I just let it slide?'
There was a 99% chance this was nothing.
But that remaining 1%.
An ER doctor's job is always betting their life on that 1% possibility.
I hesitated for a moment.
'...Something still feels off.'
In the end, I decided to trust that inexplicable unease inside me.
I turned to the nurse.
"Ma'am, sorry, but before the injection, let's draw some blood first. Add a CBC—complete blood count. And hold off on the ketorolac for now."
My sudden order made the nurse's eyes widen slightly, but she nodded right away.
The patient looked puzzled, like 'Blood tests too...?', but she obediently extended her arm.
Leaving them behind, I headed back to the station.
Yeah. It'll be fine.
I'm just being overly sensitive.
Aftermath of that crazy incident, probably.
I tried to reassure myself like that and dove back into my backlog of tasks.
Time passed, and my memory of that young designer patient faded into the noise of other ER cases.
About 40 minutes later.
An intern approached me clutching a stack of charts.
"Doctor, labs are back for that 28-year-old headache patient in Bay B, Bed 9 from earlier...."
Something was off in the intern's voice.
"Everything else is normal, but platelets... 38,000."
My typing fingers froze.
I slowly looked up.
"What did you say?"
"Platelet count is 38,000. Normal starts at 150,000.... Lab error? Bad sample, or machine glitch? Should we rerun it?"
The intern's reasoning made sense.
A number that absurdly low is usually a lab error.
...Suck in a breath?
I drew in a sharp breath.
Forcing myself to stay calm, I told the intern,
"Yeah, rerun it. Must be a bad sample. Draw a fresh tube and take it to the lab yourself by hand to confirm."
My voice came out eerily steady.
But a cold sweat was trickling down my spine.
Please.
Please be a lab error.
I stared blankly at the spot where the intern had vanished.
38,000.
The number loomed ominously in my head.
I shuffled to the corner of the station, leaned my head against the wall, and sank into solitary rumination.
Okay, stay calm first.
Patient: 28-year-old female.
Chief complaint: headache.
Migraine.
She said it herself.
I thought so too.
But platelets at 38,000.
Does migraine eat platelets?
Fuck, that's ridiculous.
So my initial diagnosis was wrong.
This headache isn't just a migraine.
Then what are the possibilities?
The differential diagnosis list I'd memorized inside out flashed through my mind like a slideshow.
Causes of thrombocytopenia.
Worst one first: leukemia or some blood cancer.
Cancer cells invading the bone marrow, preventing normal blood cell production.
But her other blood counts were normal.
WBC, RBC—all fine.
So cancer probability down a notch for now.
Next?
Drugs.
Certain meds can destroy platelets.
But she said no recent medications. Clean history.
Liver cirrhosis? Splenomegaly?
Bad liver or enlarged spleen can trap and destroy platelets.
But in a young woman?
With zero other symptoms?
Unlikely.
That leaves...
'Autoimmune disease.'
A faint possibility surfaced in my mind.
The immune system mistakenly identifies our own platelets as enemies and attacks them relentlessly.
A disease where only platelet count plummets solo.
Idiopathic thrombocytopenic purpura. ITP.
It all clicked into place.
Yeah, right now, this is the most reasonable suspicion.
I couldn't keep agonizing alone anymore.
I glanced around.
Third-year Choi Soo-min had just finished charting another patient—perfect timing.
I approached Choi Soo-min and reported in as calm a voice as I could muster.
"Dr. Choi Soo-min. Reporting on the 28-year-old female headache patient in Bay B, Bed 9."
"Oh, that migraine case? She still says it hurts even after the meds?"
"No, it's not that... I spotted some bruising on her arm, so I ran a CBC just in case. Platelets came back at 38,000. Rerun's in progress."
At my words, Choi Soo-min's face hardened instantly.
She grabbed the mouse and pulled up the patient's chart.
"38,000? Other values?"
"WBC and hemoglobin all normal."
"Hmm...."
Choi Soo-min rested her chin on her hand, staring at the monitor. The same differential list was probably running through her head.
"Doctor, I think with no other findings, ITP is the top suspect."
At my cautious opinion, Choi Soo-min nodded.
"I think so too. Too textbook for anything else. Let's wait for the rerun. If it confirms...."
Not long after, the intern came sprinting back, face pale as if on the verge of tears.
He clutched a freshly printed result sheet.
"Doctor, rerun results... 35,000."
It had come.
Not a lab error.
Choi Soo-min took the sheet and let out a deep sigh.
"Ha... As expected. You go explain to the patient yourself. She needs admission."
"Me?"
"Yeah. You caught it. Be calm, make it easy to understand. Explain well and come back."
I swallowed hard. I had to tell this patient—who'd just wanted a painkiller shot and to go home—that she had a serious suspected autoimmune disease requiring admission for further tests.
With heavy steps, I made my way back to her bed.
I pulled back the curtain; she was on her IV, scrolling her smartphone. I dragged a chair over and sat by the bedside.
"Patient, I need to talk to you for a minute. It might be shocking, so please stay calm and listen."
I began explaining slowly, choosing the simplest words possible.
"Have you ever heard of platelets?"
"Platelets?"
"They're cells that rush to wounds when you get hurt and bleed, plugging them up to stop the bleeding. Think of them as your body's repair crew."
I paused to catch my breath.
"A normal person has 150,000 to 400,000 platelets in their blood. But we just tested yours, and it's at 38,000."
Her eyes widened.
"What? Is that low?"
"Yes. Very low. Even minor impacts can rupture blood vessels easily, and without enough platelets to plug them, you get bruises like that."
"Why me..."
"The condition we're most strongly suspecting right now is idiopathic thrombocytopenic purpura—ITP for short."
I used an analogy to help her understand.
"It's a tough name, but simply put: Our immune system is supposed to attack only invading bad bacteria or viruses. But sometimes it glitches and attacks our own healthy cells by mistake. That's an autoimmune disease. In your case, it looks like your immune system is mistaking your own platelets for enemies and destroying them nonstop."
The longer my explanation went on, the paler her face grew.
"It's not immediately life-threatening. Don't worry too much. But with platelets this low, dangerous situations can arise. For example, if even a small vessel in your brain bursts, it could lead to a brain hemorrhage. And we can't completely rule out that your headache might be a warning sign of that."
Her pupils trembled with fear.
"So you can't go home today."
I stated firmly.
"You need to be admitted right now. Here at our hospital, for more precise tests to confirm if it's truly ITP or something else. And at the same time, start treatment to calm your immune system and stop it from destroying more platelets."
My explanation was complete.
The patient stared blankly into space, saying nothing.