Chapter 83
Chapter 83
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Translator: crow
Chapter Title: Stubbornness (1)
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11 PM.
Phone bells rang from all directions, and monitor alarms screamed nonstop.
Nurses dashed around at a brisk trot, while interns paced restlessly.
I was already half out of my mind, wrestling with a mounting pile of charts.
My fingers hammered the keyboard mechanically, but my brain had switched to power-saving mode ages ago.
That was when it happened.
A triage note popped up with a ding.
"Uh... what kind of patient is this...?"
Before I could even grasp the situation, an EMT wheeled in a stretcher cart.
Lying on it was a man who looked to be in his mid-50s, clutching his abdomen.
His suit was rumpled but still screamed money, and a gold watch gleamed from his sleeve.
I stood up from my seat.
"How can I help you, sir?"
I asked in my most professional tone, sticking close to the stretcher.
"Doc! My gut! It feels like my stomach's twisting up and killing me!"
The man groaned—whether exaggerated or genuine, I couldn't tell—as he pointed to his lower right abdomen.
"Started feeling like it wouldn't digest last night, then this morning it was poking sharp, and now it's like a knife stabbing! Threw up a few times too!"
I ran through my differential diagnosis list in my head as he spoke.
Right lower quadrant pain, tenderness, vomiting, low-grade fever...
This was textbook stuff.
Classic appendicitis symptoms.
I slipped on latex gloves and began palpating his abdomen.
"This is the spot that's hurting, right? Let me press here."
I gently pressed McBurney's point—the expected location of the appendix between the navel and right iliac crest—with my fingers.
"Ow!"
The man yelped.
Tenderness positive.
"Now I'm letting go."
I released my fingers quickly.
"Aaagh! It hurts more when you let go!"
Rebound tenderness positive too.
I ran a few more tests.
Rovsing's sign: pain in the right lower quadrant when pressing the left.
Psoas sign and obturator sign: pain triggered by lifting or internally rotating the right leg.
All positive.
Everything pointed straight to appendicitis, just like in the textbook.
Diagnosis was about 90% locked in.
All that was left was bloodwork to check inflammation markers and imaging—CT or ultrasound—to confirm the swollen appendix.
I was about to order routine labs and an abdominal CT.
That's when the man smacked my hand away.
"Hey, Doc! Quit dawdling!"
He jabbed at his belly, his voice thick with irritation.
"Can't you tell just by looking? Get the CT done first!"
I stared at him, dumbfounded.
"Sir, first we need to draw some blood..."
"Bloodwork? Screw the bloodwork!"
He cut me off. With a smug, scholarly expression, he started lecturing me on medicine.
"You know how much medical info I dug up last night without sleeping? I plugged in my symptoms, and it says this might not even be appendicitis!"
He launched into his "research findings" with dead seriousness.
"I looked it up—this could be diverticulitis, or maybe early Crohn's disease, which young folks get a lot. Pain in the right lower belly isn't always appendicitis! You docs need to hit the books more!"
I was speechless.
Diverticulitis usually hurts on the left side, and Crohn's main symptoms are chronic diarrhea and weight loss.
I had to admire his perfect self-misdiagnosis.
"So no time for blood draws and crap! CT first, Doc! That's how we find the real cause!"
I pressed my temple hard.
I swallowed a deep sigh.
Ah, here we go.
Coping strategy step one.
Acknowledge the patient's knowledge and start the conversation there.
"Sir, you've clearly done your homework overnight. Right lower quadrant pain isn't always appendicitis. Diverticulitis or Crohn's are possibilities worth considering. Good point."
At my soulless praise, a smug "I know my stuff" smile spread across his face.
Step one: success.
Now for the main pitch.
"Sir, there are a few things we absolutely need to check before the CT."
I tried to keep my tone as friendly and logical as possible.
"Blood draw takes way less time than rolling you to CT. Results in 30 minutes. CT has a backlog of emergencies right now, so you'd be waiting."
Time pressure. One of the ER's best tactics.
"And bloodwork gives us hard numbers: how bad the inflammation is, how high the white count. That tells us how urgent this is and what to look for on CT—helps us nail the diagnosis."
I gazed at him with wide, earnest eyes.
"Whether it's appendicitis, diverticulitis, Crohn's, or whatever inflammatory issue, bloodwork will show abnormalities. That's the right order. Trust me on this? Please?"
He shut his mouth, seemingly at a loss for words.
He still looked grumpy, but with blood draw being faster and the solid medical rationale for inflammation markers, he couldn't muster more resistance.
"Ahem...!"
He cleared his throat needlessly, then grudgingly stuck out his arm.
"Fine! But make it quick! No dawdling!"
I let out a silent sigh of relief.
Whew, at least he listens to reason.
"Nurse Jung!"
The nurse looked up.
"B-10 patient here—routine labs and CRP! Can you handle the draw?"
"Oh, sure!"
Nurse Jung wheeled over the phlebotomy cart like a pro and headed to the procedure room.
I tossed in one last reassuring line to ease his final worries.
"Based on your symptoms, I already suspect something, so we'll line up the abdominal CT right after blood results. No need to stress."
His face finally softened a bit.
I slipped quietly back to my station.
***
It took a while for the internet sleuth's blood results and CT to come back.
In the meantime, the ER doors kept swinging open and shut without mercy.
"Ughhh... b-blood... blooo..."
Fresh from some drunken college brawl, a student with a 10cm gash on his forehead stumbled in, propped up by friends.
Deep wound, heavy bleeding.
With drunk rambling as my soundtrack, I numbed it with lidocaine, irrigated the mess, and stitched it neatly with nylon suture.
His desperate plea for minimal scarring was already slurred into oblivion by anesthesia and booze.
Sorry, buddy—this ain't plastics.
"My whole body's itching... swollen up huge... can't breathe..."
A beekeeper stung all over, his body erupting in hives, burst in on the verge of anaphylactic shock.
I secured his airway first, jabbed epinephrine IM, and flooded him with steroids and antihistamines.
Only after his wheezing steadied did I catch my breath.
I'd handled three or four more patients in that blur, and suddenly dozens of minutes had flown by.
The man had faded from my mind.
That's when a small alert popped up in the bottom right of my EMR screen.
Finally—the internet sleuth's CT images and labs.
I clicked to open them.
Abdominal CT.
Appendicitis, as expected.
But...
Way worse than I'd thought.
A normal appendix should be finger-thin, but this guy's was swollen to thumb size—over 1.5cm.
Walls thickened, surrounding fat tissue dirty with inflammation.
Fat stranding... check.
Even a small appendicolith like a pebble lodged at the tip.
And the kicker.
Part of the appendix wall looked hazy and discontinuous, with suspicious tiny air bubbles and murky fluid nearby.
'...Perforation suspected.'
I swallowed hard.
Time bomb.
Now the bloodwork.
WBC over 18,000.
CRP over 15.
Inflammation markers through the roof.
All signs screamed: operate NOW or you're screwed.
I stood up.
I pulled back the curtain; he was still moaning on the bed.
"Sir, results are in."
I wheeled over a portable monitor and pulled up the CT right in front of him.
"This is a cross-section of your abdomen. See here in the right lower quadrant? That's your appendix—the worm-like bit at the end of your colon, what folks call the appendix."
I pointed to the inflamed, swollen appendix.
"It's more than twice normal size, surrounded by severe inflammation. Look at the tip—it's partially ruptured, with pus and air leaking out."
He grimaced, glancing between my face and the screen.
"Your condition's way worse than we thought. If you don't get emergency surgery ASAP, the infection could spread through your abdomen, leading to sepsis. Life-threatening. We need to operate right now."
"Surgery...?"
He echoed in disbelief.
Then anger and distrust flashed across his face.
He bolted upright and yelled.
"Surgery? Here? What the hell!"
He glared at me like I was a con artist.
"If I need surgery, send me to Seoul! Now! You know Oseong Hospital? I'm a VIP there! Take me to Oseong!"
He jabbed at his belly.
"Not getting cut open in some Podunk Busan hospital! Call the ambulance! I'm going to Seoul!"