Chapter 45
Chapter 45
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Translator: crow
Chapter Title: Migraine (4)
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It was right then.
“Han Hyun-jae!”
A frantic voice called out to me from behind.
It was Choi Soo-min.
She must have sensed something had gone terribly wrong when she saw me clutching the station phone, my face drained of color, standing there in a daze.
“What happened? Why do you look like that? Who are you talking to?”
Choi Soo-min approached me with a worried expression.
Still holding the receiver, I silently raised one hand.
‘Just a moment.’
I mouthed the three letters clearly, pouring every ounce of terror and urgency from my entire life into them without a sound.
T. T. P.
I watched her eyes shift from confusion to sheer horror in an instant.
Of course, she fully grasped the hellish weight those three letters carried.
Just then, a loud whirring noise came from the fax machine in the corner of the station, spitting out a single sheet of paper.
It was the lab results.
Still gripping the phone, I snatched the paper from the machine and held it up right in front of Choi Soo-min’s face.
At the bottom of the results, the lab tech’s scrawled red-ink note stood out clearly.
[Schistocytes: 3+ observed, suggest TMA rule out, esp. TTP] (Fragmented red blood cells 3+ observed. Suspected TMA, especially consider TTP.)
Choi Soo-min didn’t ask another question.
“Jeong! B-9 patient—move to a bed in A-zone right now! Hook up vital sign monitoring again, check blood pressure every 15 minutes—no, every 5 minutes! Keep assessing consciousness level, insert a Foley catheter and start tracking hourly urine output!”
The entire station sprang into action at her orders.
Nurses rushed around, preparing to transfer the patient.
In the midst of the chaos, Choi Soo-min grabbed another phone.
“MICU? This is Choi Soo-min, third-year EM resident. We’ve got a suspected TTP patient in the ER—can you free up an ICU bed right away?”
“Yes, TTP. Thrombotic thrombocytopenic purpura. We need to start plasma exchange immediately. To save this patient, we have to move her now. Please, as fast as possible.”
With that battle raging behind me, I focused on the crisis in front of me.
Jin Se-hee on the other end of the line was already barking orders at me.
[…Start high-dose steroid IV therapy right now, and contact the blood bank to secure at least 20 units of fresh frozen plasma for plasma exchange ahead of time. Call nephrology too, tell them to prep the plasma exchange machine and staff. I’m heading down immediately.]
“Yes, doctor. Got it.”
The call ended.
I set down the receiver and looked at Choi Soo-min, who had just finished her call with the ICU.
“The fellow’s on her way down.”
“I know. I heard.”
The war had begun.
“Load 1 gram of Solu-Medrol and call the blood bank again for emergency release of at least 20 units FFP, up to 30 if possible. Call nephrology again too—tell them to prep plasma pheresis! Hurry! Hurry!”
The station was pure pandemonium.
Nurses dashed back and forth, phones ringing off the hook nonstop.
That complacent assumption of ITP.
My ignorance in thinking we could just give steroids and watch.
If it hadn’t been for the gallery’s mad ghosts, I’d be writing that patient’s death certificate by now.
“Han Hyun-jae! Snap out of it!”
Choi Soo-min’s shout jolted me back to reality.
Now wasn’t the time for self-recrimination.
I had to make up for my mistake.
“Go explain to the patient right now. How serious this is. Has the guardian arrived?”
“No, not yet.”
“Then call them immediately—tell them to come now. And tell the patient we’re moving her to the MICU from here on out. That we’re going to do everything we can. Go relay that.”
I dragged my heavy feet toward the patient’s bed, which had just been moved to A-zone.
The patient lay staring anxiously at the ceiling, her face even paler than before.
She must have sensed something from the sudden bustle around her.
“Ma’am.”
I paused to wipe my face.
“The situation… it’s much more serious than we first thought.”
My voice came out stiff and rigid.
No time for detailed explanations or reassurance.
“It looks like a far more urgent and dangerous condition than we initially believed. It’s not just a matter of blood not clotting…. Right now, even as we speak, countless tiny blood clots are forming in the smallest vessels throughout your body. And those clots are attacking vital organs like your brain and kidneys.”
The patient’s eyes widened.
“Please contact your guardian right away and have them come. We’re transferring you to the medical ICU immediately. To save you, we need to start a treatment called plasma exchange there, which replaces all the blood in your body. From now on, it’s truly a race against time.”
I couldn’t say more and met the patient’s trembling gaze.
Guilt and remorse crashed over me like waves.
On my way back to the station after delivering what was essentially a death sentence to the patient—
I stopped for a moment.
In all this chaos, was I overlooking something?
Logically, the to-dos were sorted, but deep down, anxiety still swirled.
In the end, I opened that forbidden window once more.
HellJoseonSlave1: Pumping steroids now and prepping plasma exchange. Platelets at 30k—should we prep platelet transfusion too just in case?
My question seemed perfectly reasonable.
Platelets are low, so give platelets, right?
But the moment it posted, the gallery erupted in flames of fury once again.
BloodCancerIsHell: This lunatic is really hell-bent on killing the patient to the bitter end!!!
LatteIsJustWords: How did an idiot like this even become a doctor? Every professor who let him graduate needs to do some soul-searching. Doesn’t know the basic pathophysiology of TTP.
CardiologyGhost: Hey!!!!!!!!!!! Giving platelets to a TTP patient is like pouring gasoline on a burning house, you madman!!!!!!!!!!
BloodCancerIsHell: You trying to add more fuel to the blood clot factory? Platelets are already clumping like crazy in her body making clots—add fresh ones and what do you think happens?
BloodCancerIsHell: Bigger, more numerous, stronger clots will form and completely block her brain vessels! Absolutely! Never give platelet transfusions unless she’s hemorrhaging to death!
BloodCancerIsHell: (Mantou spontaneously combusting emoticon)
Ah…
It was right then.
“We’re from hematology-oncology!”
A sharp voice rang out from the ER entrance.
It was the blood cancer fellow, Jin Se-hee.
“Where’s the patient?”
“A-zone. We just moved her there.”
“Lead the way.”
Jin Se-hee gave me no moment to breathe.
Overwhelmed by her presence, I mechanically started the briefing.
“28-year-old female, strong suspicion of TTP. Chief complaint on arrival was headache. Platelets 35k, schistocytes 3+ on PBS. Elevated LDH and bilirubin, renal function still normal. High-dose steroids infusing now, 20 units FFP and plasma exchange prepping. Patient conscious and vitals stable.”
She nodded silently as I reported.
“Good job.”
She said curtly.
“For an EM first-year, that’s an excellent initial response. Calling me right after passing the second-year? Spot-on decision.”
Her praise left me dumbfounded.
I’d braced for a dressing-down.
“I’ll take it from here.”
With that, she headed to the patient.
Her back as she walked away looked insanely reliable—like an elite special forces operative parachuting into a warzone where the rest of the unit was already wiped out.
Damn, so this is what an internal medicine doc is like.
Cool as hell.
Whoops, even thinking that is taboo.
If I let it slip out loud, I’d never hear the end of it from Lee Min-jae.
Jin Se-hee personally checked the patient and began issuing orders like a storm.
“Prep for a central line right away. For plasma exchange, we need a dual-lumen catheter in the femoral vein—get the kit. Keep monitoring BP, prep norepinephrine drip if it drops.”
All the responsibility shifted from my shoulders to hers.
Only then could I finally let out a long sigh.