Chapter 44
Chapter 44
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Translator: crow
Chapter Title: Migraine (3)
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I finished explaining the admission to the patient and returned to the station with a heavy heart.
‘ITP. Idiopathic thrombocytopenic purpura.’
A disease where the immune system temporarily loses its mind and destroys its own platelets.
Of course, it’s a serious condition, but among blood disorders, it’s relatively common and one of the milder ones to treat, starting with steroids.
Yeah, that’s gotta be it.
If it’s not a lab error, ITP is the most likely.
Especially since it’s common in young women.
All the signs point to it.
I tried to reassure myself like that.
But the vague unease lodged in a corner of my heart wouldn’t go away.
In the end, I couldn’t overcome that anxiety and summoned the all-purpose tutors in my head.
Just one more check to confirm.
If even those crazy ghosts say it’s ITP, then I can hand the patient off to hematology-oncology with a clear conscience.
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Title: 28/F, headache, bruising, platelets 38k. ITP?
Posted by: HellJoseonSlave1
Re-check came back like this. Can I just call it ITP and start steroids? Anything else to consider?
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It was an utterly ordinary question.
But the moment it went up, the gallery turned into a hellish battlefield.
HematologyIsHell: You crazy bastard, are you seriously trying to get yourself killed!!!!!!!!!!!!
…Huh?
For a moment, I doubted my own eyes. Did I ask something wrong?
HematologyIsHell: ITP? ITP my ass, you quack! Why did the patient come in? Huh? Headache! She came in with a headache! And her platelets are trashed! Can’t your pea brain figure out what that means!
That was the start. Ghosts from every department piled on and tore into me.
LatteIsJustWords: Tsk tsk. These kids these days have no basics. Headache, low platelets, bruising. Just these three should set off alarms in your head! And you’re spouting ITP?
CardiologyGhost: Hey, did you check LDH (*lactate dehydrogenase) and bilirubin when you sent the labs? No signs of hemolytic anemia? Kidney function? Are her renal numbers fine?
HematologyIsHell: No peripheral blood smear? Ruling out TTP?? While you’re prescribing steroids and twiddling your thumbs, the patient’s clotting like it’s party time and heads straight to the afterlife! You maniac!!
TTP.
Thrombotic thrombocytopenic purpura.
A disease where blood clots form like mad in every microvasculature for no reason.
Platelets get consumed making those clots, so counts bottom out, and red blood cells forced through the narrowed vessels get shredded, causing microangiopathic hemolytic anemia.
And those clots block vessels to the brain, heart, kidneys—the body’s vital organs—rotting them away bit by bit.
If diagnosis is even slightly delayed, it’s the worst emergency in hematology, with a mortality rate nearing 90%.
Its symptoms.
Thrombocytopenia. Microangiopathic hemolytic anemia. Neurologic symptoms. Renal failure. And fever.
My patient…
…Headache. …Low platelets. …Bruising.
I felt the blood drain from my body as I slumped into the station chair.
While I was reassuring myself it was something benign, clots might have been forming in her brain vessels.
HematologyIsHell: Get a peripheral blood smear slide stat and check for schistocytes first, you idiot! If it’s TTP, you’re fucked, kid!!!!!! Run!!!!!
That last comment snapped me out of it.
No time to sit here blaming myself.
I shot up from my seat and snatched the intercom like I was screaming.
Extension 7111.
Beep.
Beep.
Beep.
Beep.
“Hello, central lab…”
“Lab, right? The re-draw from ER B-9, 28-year-old female! Chart number 1397131—make a peripheral blood smear slide from that sample right now and look under the microscope! Don’t need anything else, just tell me ASAP if there are schistocytes! Urgent! STAT! STAT!”
“Huh?”
“Chart 1397131—peripheral blood smear, stat! Urgent!”
“Y… yes.”
My voice was trembling with terror.
I set down the receiver and covered my face with shaking hands.
Please.
Please, no.
Please, no schistocytes.
***
I hunkered down in the corner of the station, mindlessly refreshing the EMR window.
I saw other patients, did some charting, even dozed off nodding, but every nerve was fixed on that one call from the lab.
Minutes felt like hours in this hellish wait. My head filled with every worst-case scenario.
‘Those bruises and headache were too suspicious. If it really is TTP…’
Right then.
Rrrrrrring!
The station phone shrilled piercingly.
It drowned out every noise in the ER.
I grabbed the receiver on reflex.
My heart pounded wildly. Please. Please say no.
“Yes, emergency medicine.”
My voice shook without me realizing.
“There!! ER B-9 patient! 28-year-old female peripheral blood smear results are back!!!!”
I swallowed hard at the frantic shout.
“Multiple schistocytes on the slide, looks like Grade 3+! Severe thrombocytopenia with giant platelets clear as day, and polychromasia too! Perfect fit for thrombotic microangiopathy like TTP or HUS (*hemolytic uremic syndrome)! You need to check this now…!”
Fucked.
My worst fear.
No, the gallery ghosts’ prophecy had come true.
Multiple fragmented red cells. Grade 3+. Blood full of RBC corpses.
Bone marrow’s churning out undertrained platelets and reds on a crash course since so many are dying.
Doesn’t matter if it’s TTP or HUS.
Both are shit thrombotic microangiopathies where no treatment means the patient dies.
TTP fits better anyway.
I hung up before they finished.
No time for panic.
From now on, every minute, every second ties to the patient’s life.
“Internal! Internal fuck!”
I vaulted from the chair and bolted to the whiteboard in the center of the station.
Nurses stared in shock, but I saw nothing.
Only the densely packed names and numbers.
Hematology-oncology.
Heme-onc.
Who’s on for heme-onc.
My trembling fingers traced down the board.
[Internal Medicine (Heme-Onc) On Call]
- Primary: IM R2 Kim Ji-eun
- Secondary: Heme-Onc Fellow Jin Se-hee
Two names.
Kim Ji-eun. Jin Se-hee.
Wait. Call primary first, then secondary?
Reason clashed with instinct in my head.
Protocol says call the R2 Kim Ji-eun first.
A first-year intern bypassing a second-year to call the fellow direct? Hospital suicide.
Kim Ji-eun would be pissed, and Fellow Jin Se-hee might shred me: ‘Some random intern calling me direct?’
But…
This isn’t the time for hierarchy.
How much does an R2 like Kim Ji-eun even know about TTP?
She’d see the patient, freak, and call her fellow anyway.
My hunch, sure.
But that wastes at least 10 minutes.
And in those 10, clots choke the brain, heart, kidneys, destroying organs.
“Still, heme-onc needs to see this.”
I decided. Fuck my hospital life—save the patient first.
It’s already fucked anyway.
No fear.
“Secondary!”
I pulled out my phone, punched in Heme-Onc Fellow Jin Se-hee’s number from the board like mad. Right before hitting call, I caught my breath.
Hoo… ha… fuck… fuck…
My fingertips were ice-cold.
Every word from here decides one life.
Rrring.
Rrring.
Two rings, then connected.
A woman’s voice, slightly weary, came through.
[Yes, this is Heme-Onc Fellow Jin Se-hee.]
“Hello, Dr. Jin Se-hee. This is first-year EM resident Han Hyun-jae. Calling urgently about an ER patient.”
I steadied my breath to keep my voice from shaking.
“28-year-old female. Chief complaint headache, but platelets 35k on labs. And just now on peripheral smear… schistocytes Grade 3+, multiple observed. Strong suspicion for TTP, so bypassing the R2 to call you direct. Sorry.”
Silence for one second after my report.
[…Wait. What? Schistocytes 3+ with platelets 35k? TTP?]
Her voice snapped to full alert in an instant.