VEXAS Syndrome, Part 1
Hell. If hell existed in this world, it would undoubtedly be this godforsaken emergency room.
My name is Han Hyeon-jae, a first-year resident in Emergency Medicine.
Slurp—
"Eat a little quieter, will you? You're loud as hell."
My co-resident, Kim Ji-hoon, flipped me off, his face drenched in sweat. Slumped like corpses in the corner of the duty room, scraping by on cold convenience store bento boxes and cup ramen—this was our daily life. Just as I was lamenting our existence, the hallway outside suddenly grew noisy.
Oh, please. No. Don't let it be.
Clack—
"Traffic accident patient! ETA is eight minutes!"
Shit.
"Ah, seriously," Kim Ji-hoon spat out a curse, leaving his noodles half-chewed as he bolted from his seat.
I stood up as well, my movements semi-mechanical. My body, which had felt like lead just a second ago, reacted to the sound like Pavlov's dog. I suppose you could call it my only talent, forged through endless grinding.
"Patient is a fifty-eight-year-old male pedestrian! Eleven minutes since initial discovery, BP and pulse are undetectable!"
"Give me one milligram of epi!"
"Starting compressions!"
"Nurse Yoon, get the Lucas!"
"Yes!"
Everything moved in perfect, chaotic order. Someone climbed onto the patient's chest, compressing it hard enough to crush ribs, while someone else squeezed the Ambu bag, forcing oxygen into the lungs. I stared blankly at the scene for a moment.
A man with his hand on the doorknob of the underworld. Would all this frantic effort of ours actually pull him back to this side?
Skepticism. Yes, skepticism. What on earth was I doing this for?
That was when it happened. Right in the air before my eyes, a faint, rainbow-colored static seemed to flicker and rise.
...Am I seeing things because I'm tired?
I rubbed my eyes. But it didn't disappear. The static soon began to take on a clear shape, resembling a translucent system window straight out of a sci-fi movie.
Congratulations! You have met the qualifications for Savior.
A special skill has been granted. The skill you have received is: [Gallery Ticket]!
What kind of bullshit is this?
I thought I had finally lost my mind. Overwork and stress had undoubtedly melted a specific part of my brain. Was I the only one who could see that? I almost asked the nurse securing an IV line next to me. 'Excuse me, but do you happen to see blue letters over there?' If I did that, I'd be fast-tracked straight to the locked psychiatric ward.
"Checking rhythm!"
The compressions paused briefly.
"It's V-fib!"
Fortunately or unfortunately, the ridiculous system window vanished without a trace in a single second, as if it had never been there to begin with.
Right, it's just a hallucination.
When I snapped out of it, the defibrillator paddles were already in my hands.
"Step back! Charging, 200 Joules!"
"Clear!"
"Shock!"
Thud!
The patient's body jolted upward. The ECG graph on the monitor was still a mess. It showed no intention of returning to normal. Another thirty minutes passed like that. In the end, with the declaration of the end of CPR, everything was over.
Sweat and effort evaporated uselessly into the air. Rest in peace.
I headed back to the duty room. The moment I threw my body onto the bed, the message I had seen earlier flashed in my mind again. Gallery Ticket?
"What am I supposed to do with that?"
Was this like those web novels trending these days? Status windows? Skills? Hunters? Was a gate going to open here or something? Just in case, feeling incredibly pathetic, I tried shouting it in my head. 'Gallery!'
Nothing happened.
I let out a dry chuckle. Right, as if I'm some kind of protagonist. It's just my exhausted brain playing tricks on me. I closed my eyes and tried to force myself to sleep, but my mind was a tangled mess. Gallery... Gallery... The word 'gallery' had several meanings. The photo app on a smartphone was a gallery, and the art museums we commonly knew were galleries too... Ticket? Could it be that 'gallery' refers to that kind of gallery?
At that moment, a translucent window popped up before my eyes once more. This time, it was different. It wasn't just a simple message box like before.
"...What is this screen?"
What unfolded before my eyes was an interface identical to a website I had visited at least once or twice. A dull blue color. A clunky UI. And the name of the gallery stamped in the top-left corner of the screen: [Deceased Medical Scientists Gallery].
"Pfft!"
I burst out laughing without realizing it. Deceased Medical Scientists? Ah, so that's the concept? My brain had truly gone off the deep end. For a delusion conjured up by the overworked mind of a lowly doctor, it had a pretty decent B-movie aesthetic.
Sure, my brain is throwing a whole tantrum. Then why don't you try solving this?
I suddenly recalled a patient that an Internal Medicine friend of mine had been agonizing over for a while. After texting him to get the patient's chart number, I decided to try writing a post in the gallery. How do I write? Do I just imagine typing on a keyboard?
The moment I mimicked typing in my head, characters miraculously began appearing in the gallery's post creation window. *Oh. This actually works. Maybe my imagination is higher quality than I thought.*
There. That should be enough. I posted it by simply thinking of the submit button. Who on earth would reply in this crazy delusion? That thought was shattered in less than a second.
Seeing even the IP address show up made it feel like a highly detailed delusion. 118.235 was a Korean IP, wasn't it? But VEXAS?
"What the fuck is VEXAS?"
It was a disease name I had never heard in my life. My brain was truly remarkable for making up something like this. I let out a dumbfounded laugh, but my fingers were already moving on their own, picking up my phone to access UpToDate—the ultimate bible for doctors. I typed 'VEXAS' into the search bar. And the moment the search results appeared on the screen, I felt my heart drop straight to the floor.
Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic syndrome
An adult-onset autoinflammatory disease caused by somatic mutations in the UBA1 gene. Key symptoms include recurrent high fevers, hematologic abnormalities such as anemia, skin rashes, chondritis, and vasculitis...
I stopped breathing. The words on the screen and the details of the patient's chart I had carelessly skimmed through earlier began to swirl in my head like a tempest.
'The patient has an erythematous rash on his face.'
'CBC results showed everything else was normal, but the red blood cell count was subtly low. Mild anemia.'
'He complained of red, swollen ear cartilage.'
'Holy shit.'
No other words could form in my head except curses. The letters spelling out VEXAS Syndrome on my phone screen were so vivid they felt like they were burning into my retinas. And the thing that had told me this was the crazy delusion in my head called the [Deceased Medical Scientists Gallery].
I immediately picked up my phone.
Beep— Ring... Ring... Ring... Ring... Click—
"Hello?"
"Hey, what's up? Hyeon-jae, did something happen?"
"You know that patient you were so frustrated about last time?"
"Which patient? Dude, do you know how many patients like that I have? The patients I have to see..."
"The one you suspected of Sweet syndrome plus vasculitis! You said recently you were suspecting relapsing polychondritis."
"Ah... Oh, that patient. Why? Did... did something happen? He's not the type of patient who'd end up in the ER, though."
"No, it's just..."
Ah, shit. How was I supposed to make an excuse? I think I know the definitive diagnosis for the patient admitted to your department, but actually, something resembling a delusion in my head told me. I obviously couldn't say that.
"I stumbled upon it while looking through some papers. It really seems to match your patient's presentation."
"What is it? What kind of disease?"
"VEXAS syndrome."