The Spreading Contagion
The delusion of a Double Board spread by Senior Lee Min-jae raged through the department like an infectious disease. Before even a single day had passed, the rumor had swept through the entire Emergency Medicine department. When I woke up from a brief nap in the Duty Room at dawn and was pulling on a fresh gown in the supply closet, a voice called out from behind me.
"Hyun-jae?"
It was Yoo Sung-hoon, a fourth-year resident. His face, as always, was completely ravaged by chronic fatigue.
"Are you really transferring to Internal Medicine?"
"Excuse me?"
"Well, now is the right time. There are always a few guys who cut a deal and transfer around autumn of their first year. So, are you quitting your residency? Or is it really a Double Board like Min-jae says?"
I squeezed my eyes shut. My mind flashed back to my life over the past year—the endless days of getting screamed at and being drenched in blood.
I'm not quitting. Why on earth would I do this all over again? Just the thought of having to endure this hell for four years is agonizing enough, and you want me to go to another department and repeat this whole process for another three or four years? A Double Board? That's not something a human being does.
I answered in the most resolute voice I could muster.
"No, sir. I have no intention of changing departments. I am not quitting my residency."
"Then the Double Board?"
"No, I'm saying I'm not doing a Double Board either."
"Hmm."
Yoo Sung-hoon stared at me for a moment with an expression that made it impossible to tell if he believed me or not, then simply shrugged and went on his way.
But that was only the beginning. While I was entering orders at the ER station, Choi Sumin, a third-year resident, approached me with a worried look on her face.
"Hyun-jae."
"Yes, senior?"
"Are you really going for a Double Board? That is an incredibly brutal path. You'll ruin your health."
I felt like crying at this point.
"I'm not doing it, senior. Who on earth is spreading such ridiculous rumors...?"
"Really? Well, that's a relief then. Anyway, don't push yourself too hard."
She patted my shoulder and walked away, but it offered absolutely no comfort.
I'm not changing departments, you bastards...
And finally, the inevitable arrived. My co-resident, Jo Suyeon.
"Hyun-jae!!"
"Huh? What is it now?"
"You backstabbing bastard! I knew it! How dare you abandon EM?! You were the one who practically dragged me into this, and now you're running away?!"
I pressed my temples firmly. My head throbbed with a dull ache.
I'm not. I'm not going. I'm not doing it. I screamed it in my head dozens of times, but already, not a single soul believed me.
I'm not going. I'm not doing it. I can't do it. My only goal is to just survive my four years here and get out. Please just believe me, you bastards.
Friday, 1:00 AM. Even at this hour, our hospital's Regional Emergency Medical Center—one of the busiest emergency rooms in South Korea—never slept.
"Prepare suction! BP is still dropping! It's eighty over fifty!"
"Heart rate is one hundred forty! Doctor, I think we need to insert a C-line immediately!"
Inside the Resuscitation Room, a war was raging to save a multiple trauma patient brought in from a car accident. Every senior resident, staff member, and even the attending professor had thrown themselves into the struggle.
I was quietly typing up charts at my desk. That wasn't a battlefield I could join yet. The best I could do was clear the charts of the milder patients piling up at the station, easing the burden on my seniors even by a fraction.
It was then.
Beep— Beep— Beep— Beep—!
An alarm blared from a completely different direction. Zone B. It was the area where relatively stable patients were monitored.
When I turned my head, the oxygen saturation level for the patient in bed B-12 was flashing red on the station monitor.
85%... 84%... 83%...
"Shit."
I bolted from my chair and ran toward the bed. All the seniors were tied up with the trauma patient.
A grandmother in her seventies lay on the bed. She had a history of chronic obstructive pulmonary disease (COPD) and had been admitted yesterday afternoon due to severe dyspnea.
Because her oxygen saturation had been low upon admission, she had been placed on a nasal cannula to administer oxygen while we monitored her progress. Her condition had stabilized, and we were actually considering discharging her shortly.
But now, the patient's condition was entirely different. Her face was pale, and her lips had turned a deep shade of blue. She didn't look like she was breathing properly at all. Her consciousness was rapidly fading.
"Min-jun! You were monitoring this patient, right? What happened?"
I shouted at Choi Min-jun, the first-year resident who was standing by the bedside, fidgeting in a panic.
"Her saturation suddenly plummeted, so I increased the oxygen first! She's on ten liters through a face mask right now, but it's still dropping!"
Just as he said, an oxygen mask was strapped over the patient's face, and the flow meter was set to 10L. Yet, the patient's condition was only deteriorating. Her consciousness was slipping away.
Choi Min-jun cried out, on the verge of tears.
"What do I do? Should I crank the oxygen up to the maximum of fifteen liters? Or should we prepare for immediate intubation?"
Oxygen saturation dropping. A COPD patient. Where have I seen this before? I had definitely learned this, and I had even taken exams on it. What was the exact mechanism?
Wait, how on earth did this guy even pass the licensing exam? Regardless, that wasn't what mattered right now. My mind was suddenly going blank. I knew I had learned this, but what was it?
The gallery!
Pretending to listen to her breathing by pressing a stethoscope to her chest, I conjured the blue interface before my eyes.
After posting, I shouted at Choi Min-jun.
"First, lift her chin and secure the airway!"
As I bought us some time, I saw a comment pop up in the corner of my vision.
Every piece of the puzzle fell into place. I slung my stethoscope around my neck and roared at Choi Min-jun.
"Choi Min-jun! Lower the oxygen! Turn it down to two liters right now!"
"What? Lower it? Her saturation isn't even hitting eighty right now! She's going to die, Hyun-jae!"
"This patient has COPD! Did you forget her history?! Did you not take the licensing exam?! If you give her any more oxygen, her heart is going to stop, you bastard!"
"...Ah!"
I shoved Choi Min-jun aside and violently twisted the oxygen dial down myself. Then, I shouted to the nearest nurse.
"Nurse! I need an ABGA kit and a heparinized one-cc syringe, fast! I'm going to puncture the radial artery right away!"
"Yes, Doctor!"
"And Nurse Lee Su-jin! Please bring the portable X-ray and the BiPAP machine right now!"
The nurses moved in perfect unison. I gave the panicked Choi Min-jun a sharp smack on the back to snap him out of his daze and shoved an Ambu bag into his hands.
Shortly after, I performed the arterial blood draw using the kit the nurse brought. Only after confirming the bright red blood filling the syringe could I catch my breath.
"Send this to the lab immediately! Tell them to run it STAT!"
At that moment, a nurse and a respiratory therapist came rushing over, wheeling the heavy BiPAP machine.
"Doctor! We brought the BiPAP!"
The respiratory therapist asked me.
"Doctor, what are the initial settings? Please give us the IPAP and EPAP."
"..."
My mind went blank once again. Damn it. Settings? How am I supposed to know that?
I only knew she needed a BiPAP thanks to the gallery. I had absolutely no idea what specific values to set.
Should I just guess and say ten and five? What if that damages the patient's lungs?
"Doctor?"
The respiratory therapist urged me. The eyes of Choi Min-jun and all the nurses locked onto my mouth.
Cold sweat breaking out, I desperately racked my brain to buy some time.
"Just a moment. I need to re-evaluate the patient's level of consciousness and chest wall movement before deciding."
I made up an excuse and pretended to approach the patient. Then, feigning to check her pupillary reflex by peeling back her eyelids, I opened the gallery window again.
The moment I hit submit, the same Pulmonology Ghost from earlier immediately reappeared.
The insult stung, but that wasn't what mattered right now.
"We'll start with an initial setting of IPAP twelve, EPAP five, and a respiratory rate of fourteen."
"Yes, Doctor."
The respiratory therapist skillfully operated the machine. A moment later, a nurse called out in our direction.
"ABGA results are back for the patient in B-12!"
My heart hammered against my ribs.
"Doctor! pH is seven point one five, pCO2 is ninety-two, and bicarbonate is thirty!"
"...Yes!"
I clenched my fist without even realizing it.
"Okay, keep the BiPAP settings as they are. We'll do a follow-up ABGA in thirty minutes! Please check the patient's mental status every ten minutes to see if she's waking up!"
I had done it. Again. With the help of this crazy gallery, I had saved another life.