Chapter 56
Chapter 56
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Translator: crow
Chapter Title: Chaotic First Conference (5)
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We dragged our heavy footsteps into the crowd waiting for us.
Like Moses' miracle, the people parted to make way.
Fuck. This is overwhelming.
All eyes were fixed on me and Kim Ji-hoon.
"He's here."
"Is that the one, Dr. Han Hyeon-jae?"
"He's way younger than I thought."
"Of course, he's only in his first year."
I forced a calm demeanor as I stood in front of the poster with my name on it.
Kim Ji-hoon, practically out of his mind, took his place in front of his own poster.
"The patient's final diagnosis was occlusion of the right coronary artery. Could you explain in more detail the connection to the sore throat symptoms?"
"Yes, the right coronary artery is a vital vessel supplying blood to the inferior wall of the heart and the right ventricle. Ischemic pain in this area often radiates to the neck, jaw, and back. This occurs because the pathways of the vagus and sympathetic nerves innervating the heart and neck partially overlap at the thoracic sympathetic chain ganglia..."
I recited the paper I'd memorized all night as if it were my own knowledge, fluently.
It was the model answer I'd prepared in advance, reviewed dozens of times by the ghosts.
The doctor who asked nodded in satisfaction.
The early vibe wasn't bad.
The questions were within my expected range, and I nailed the answers.
If it kept going like this, I'd make it through unscathed.
Right then, Professor Kim Hyuk-jae from Ohsung Seoul Hospital—the one who'd been eyeing me in the seminar room earlier—raised his hand.
"Dr. Han, great presentation. Very intriguing case. But I have one question."
Thump. What the hell?
"In a case like yours, with the extreme physical stress of a myocardial infarction, other organs can rarely suffer ischemic damage too. Especially in patients with underlying vascular disease, non-occlusive mesenteric ischemia from reduced cardiac output could manifest as atypical discomfort in the laryngopharynx. Did you consider that possibility? If both had occurred simultaneously, what would be the key clinical clue to differentiate them in the ER?"
Silence fell.
...Mesenteric... what?
My brain froze completely.
NOMI?
Non-occlusive mesenteric ischemia?
Sure, I'd seen it in books.
But I'd never imagined a question like differentiating that in a myocardial infarction patient presenting with sore throat.
This isn't a question for a first-year resident, Professor.
I just stood there, mouth agape, unable to speak.
Cold sweat trickled down my back.
"Uh..."
I barely squeezed out a voice.
"Could... could I have a moment to think before answering?"
With those words, I declared surrender in the worst crisis of my medical career.
Gallery, Gallery. Please.
Murmurs rose around us.
"What is he looking at? Into thin air?"
"Why's he acting like that? Did he lag out?"
"Hmm, they do say geniuses are a bit off, and it looks like it's true."
Hell Joseon Slave 1: Dude!! That Ohsung prof is asking some weird shit right now!! Patient's got MI but he's going on about mesenteric ischemia possibly coming along with it—what bullshit is this!!! Quick, differential points!!!!! 10 seconds!!!! If you don't tell me, I'm declaring suicide and bailing right here!!!!!
At my desperate threat, the gallery sprang into frantic action.
Latte is Just Talk: Calm your crazy ass! NOMI! That shit's a total bitch!
God's Scalpel: Differential is abdominal exam and lactate levels!
Cardiology Ghost: Mesenteric ischemia pain isn't just tummy ache—it's agonizing! Abdominal distension, rebound tenderness on palpation, or metabolic acidosis from gut necrosis spiking lactate like crazy! Your patient had a fine belly and normal lactate on labs! Say that!
"Ah, yes. Let me answer."
My calm voice quieted the murmuring crowd again.
"I'm deeply grateful for the professor's question. In extreme stress like acute myocardial infarction, non-occlusive mesenteric ischemia is definitely a key differential to consider. Especially in elderly patients or those with underlying vascular disease."
Phew, stay cool.
My voice trembled slightly.
"But in my patient, the initial abdominal exam showed no distension, no tenderness, no rebound—zero peritoneal signs. And labs had no significant lactate elevation suggesting metabolic acidosis."
Now for the conclusion.
"If both had presented together, we'd expect a sharp lactate rise from bowel ischemia alongside rising cardiac enzymes. So, based on the clinical picture and labs at the time, I provisionally ruled out NOMI as low probability."
Silence fell once more when I finished.
Professor Kim Hyuk-jae burst into hearty laughter, clearly delighted.
"Haha! This guy's the real deal, the real deal! A first-year pulling this off? Nothing like our day!"
His high praise drew nods of agreement from the other professors nearby.
Amid the shower of compliments, I bowed awkwardly with a smile.
"Oh, you're too kind. Thank you."
"No joke—if you're ever interested in critical care fellowship or something, give me a call. Ohsung's the best in this field, haha!"
"Thank you."
With my answer done, the attention on me faded.
A few residents tossed light questions, but nothing major.
I parroted my prepped model answers like a mynah bird.
Once questions for me wrapped, one of the interrogating professors—Professor Park Joo-sung from Seoul Catholic Sacred Heart Hospital—shifted his gaze next door.
"Who's this? Poster P-116... Kim Ji-hoon? Cheongjin Medical Center. Oh, a classmate?"
Professor Park scanned Kim Ji-hoon's poster with keen interest.
The topic: "Rhabdomyolysis Case from Excessive CrossFit."
A common, educational ER case these days.
'Oh man, Ji-hoon. Sorry.'
My flashy(?) debut had jacked up the judges' expectations sky-high.
They might now think every first-year from Cheongjin Medical Center is some freak like me.
But Ji-hoon was just your average, diligent first-year.
Sure enough, Professor Park spoke up.
"Dr. Kim Ji-hoon. Good presentation. The patient's CK—creatine kinase—over 100,000 was impressive. In severe rhabdomyolysis like this, the big worry is acute kidney injury."
What are you gonna ask?
"Question here. To prevent myoglobin from clogging renal tubules in urine, we often do fluid therapy plus urine alkalinization. What's your take on the debate over whether urine alkalinization actually improves outcomes?"
Fuck.
I swore inwardly.
That's not a question for an emergency medicine first-year.
Go ask a nephrologist, you old coot.
Why dump it on Ji-hoon?
Kim Ji-hoon's face went pale.
Sweat beading on his forehead, he racked his brain desperately.
"Ah... yes... um... Professor..."
Ji-hoon started fumbling.
"For rhabdomyolysis patients, uh, first off, aggressive fluids... to ensure urine output... that's key."
Textbook page one stuff.
"And... uh... urine alkalinization... can... help prevent kidney damage..."
His voice trailed off weaker and weaker, eyes darting anxiously to the floor.
Professor Park asked no more.
He just gave a faint, brief nod and moved on to another poster.
***
With all the attention gone, only Kim Ji-hoon and I remained at our posters.
Poor guy...
Kim Ji-hoon called to me.
"Hyeon-jae."
"Yeah."
"Am... am I an idiot?"
I couldn't answer right away.
"Uh..."
What should I say?
'No, you're not an idiot'—would that comfort him?
'Yeah, you are'—that'd make me an asshole.
"You could've... you could've answered that, right? What the prof asked."
"...Nah?"
I shrugged as casually as possible, feigning total ignorance.
"No clue, man."
His eyes went wide at my reply.
Boing.
"Huh? You don't know? For real?"
"Nope."
I clapped him on the shoulder.
"I hammered just my topic—that sore throat MI case. Predicted questions, model answers, memorized it all. But rhabdomyolysis? Urine alkalinization efficacy? How the hell would I know? Not my wheelhouse."
My shameless act slowly lifted the shadow from his face.
"Wow... you mad bastard."
Awe laced his curse.
"How hard did you prep to spit answers like that without blinking in front of those profs? I thought my heart was gonna explode. You're insane."
"Argh."
I smacked his back hard.
"Shoulda prepped better all along, buddy."
He had no comeback.
Just stared at me like, 'This guy's one tough son of a bitch.'
Sorry, Ji-hoon.
This is the only way we both survive.
Can't exactly say my head's haunted by community ghosts.
That's when an awkward but warm camaraderie started budding between us.
"Hey, you guys did good? There was a huge crowd earlier!"
Professor Cheon Eun-jeong approached, waving, back from checking other presentations.
"I got wrecked, Professor."
And loyally, Kim Ji-hoon credited it all to me.
"Hyeon-jae carried the whole thing solo."
"Oh, really?"
Professor Cheon looked at me with a satisfied 'I knew it' expression.
I just scratched the back of my head with an awkward smile.