Is It Not a Cold? (1)

A few days passed. The forced study sessions with the forum ghosts took place without fail every single time I had a day off. My days off were no longer days off.

Yet, strangely enough, surviving that hell made hospital life a tiny bit easier. Of course, it still sucked. That was an immutable truth. But at the very least, I no longer felt like I was trembling in fear before every single situation. A basic framework, however faint, had finally begun to take shape in my mind. Not that this framework did anything to reduce the sheer volume of misery in my daily hospital life.

"Hey, Doc! I'm telling you, my heart feels like it's about to explode! Forget this EKG thing or whatever, shouldn't you be doing an echocardiogram right now? The son of the Kim family next door said his chest hurt like this, and they did an echo and immediately put in a stent or something!"

Today's first villain was a man in his fifties. He had come to the emergency room complaining of heartburn after drinking heavily the night before. It was a textbook case of gastroesophageal reflux disease, and his EKG was perfectly clean. Yet, this man was utterly convinced that he was an acute myocardial infarction patient on the verge of death.

"Sir, your EKG doesn't show any signs pointing to an acute myocardial infarction. For now, let's get you an injection and monitor your progress..."

"They say doctors nowadays don't listen to a word their patients say, and they're right! I looked it all up online! There's a high chance a symptom like mine is an atypical myocardial infarction!"

I massaged my temples. Behold, the internet MD. People like him are always the ones who, when they actually get sick later on, stay home saying, "The internet said it was fine," missing their golden hour entirely.

After a lengthy argument, I finally showed him his blood test results confirming his cardiac enzyme levels were normal. Only then did he reluctantly agree to the injection. Thirty minutes later, he walked out with a perfectly fine face, letting out loud, satisfied burps as if nothing had ever been wrong.

Once that nuisance was dealt with, an enemy from within made his appearance. Second-year Emergency Medicine resident Nam Juhyeon. Nam Juhyeon was exceptionally on edge today. He had been tearing into an intern since morning as if he wanted to eat him alive, and now, his sights were finally set on me.

"Han Hyeon-jae."

"Yes, senior."

"Who put in the CT order for the patient in B-21?"

"Ah, I did. She's an eighty-year-old female patient who has been complaining of persistent headaches and dizziness after a fall. I wanted to rule out a potential intracranial hemorrhage..."

"Who gave you permission?"

"Well, earlier you said that for elderly patients in Zone B who have suffered a fall, we should lower our threshold and aggressively order CT scans even if their symptoms are ambiguous..."

"When did I ever tell you to just order it on your own whim? You're supposed to report to me, discuss it, and then put in the order under my name! Who do you think you are, just ordering brain CTs left and right? If they sue us later claiming they got cancer from the radiation, are you going ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠to take responsibility?"

I was left speechless. You literally told me to put in the order, you son of a bitch. My inner self screamed profanities, but in reality, I could only bow my head. Besides, we always order them as a routine for fall patients anyway, fuck. The guy just wanted someone to bite today, and I happened to be the easiest target. That was just how things worked in this godforsaken hospital.

"I'm sorry. I will make sure to report to you first next time."

"There won't be a ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠next time," Nam Juhyeon snapped coldly before walking away. I flipped off his retreating back in the air and returned to my desk. Fuck. Today is exceptionally shitty.

It wasn't all bad news, though. While the emergency room was a living hell, it was also a place filled with some of the most fascinating spectacles in the world. A college student was brought in, having dislocated his shoulder while playing basketball. Even at a glance, his right shoulder was slumped at a bizarre, unnatural angle. A second-year Orthopedic Surgery resident was called down.

"Argh! It hurts! I feel like I'm going to die!"

"Just bear with it for a moment. Relax your muscles, and take a deep breath out. Whew~ like this."

The Orthopedic Surgery resident had the patient lie face down on the bed, letting his arm dangle off the side. ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠Then, he attached a five-kilogram weight to the patient's wrist. It was a method of waiting for the muscles to relax so that gravity could naturally reduce the dislocation. I watched every single movement from the side with keen interest. So that's what a real clinical procedure looks like.

About ten minutes later, the ortho resident grabbed the patient's arm and rotated it gently. With a dull *clunk*, the shoulder popped right back into place.

"Oh... oh? It doesn't hurt!" Color returned to the face of the patient who had been screaming in agony just moments ago. A soft exclamation of awe escaped my lips. How many shoulders did one have to pop back into place to acquire that kind of manual dexterity?

1:00 PM. The war-like morning finally drew to a close, and lunchtime arrived. Kim Ji-hoon tapped my shoulder. "Hey, let's go grab some food."

"Yeah, sure." I rolled my stiff neck and stood up. Before heading to the cafeteria, I habitually scanned the entire patient list on the EMR screen from top to bottom. It was an almost reflexive routine by now—checking who the new arrivals were, whether the test results of the patients I had seen were out, and if there were any anomalies. The scroll wheel spun rapidly. Cold, gastroenteritis, simple contusion, intoxication... a peaceful list. I was about to turn away, casually scrolling past the screen. It was at that exact moment. My eyes froze on a single line on the monitor. Huh? Wait a minute.

Kim Ji-hoon urged me. "What are you doing? Aren't you coming?"

I stopped scrolling and hovered the cursor over the patient's chart. "Hey, Han Hyeon-jae!" "Go on ahead. I have something to check. I'll catch up later." Every nerve in my body was screaming. That patient. Something... something is terribly wrong. Swallowing hard, I clicked to open the patient's chart.

Up to this point, there was absolutely nothing out of the ordinary. A fifty-four-year-old male. Came in with a sore throat. KTAS Level 5. It was a common case in the emergency room. Dozens of patients like this rolled in every single day like items on a conveyor belt. I scrolled down to check the initial examination record. The author was my peer, Jo Suyeon.

From my perspective as a resident, Jo Suyeon's charting was flawless. It was textbook, completely irreproachable. She had performed all the necessary physical examinations based on the patient's chief complaint, arrived at the most logical presumptive diagnosis, and initiated the most basic treatment accordingly. It was the most standard, by-the-book play for a KTAS Level 5 patient suspected of simple acute pharyngitis.

But. Fuck, but... the warning lights in my head were screaming like crazy. The larynx is clean? I wasn't saying her charting was wrong. Jo Suyeon had undoubtedly recorded exactly what she saw. Medically, there was absolutely nothing wrong with the patient's throat. No redness, no swelling, no pus. Everything was perfectly clean. Yet, he was complaining of severe throat pain? That was the part that made absolutely no sense.

This wasn't just a mild, scratchy throat from a common cold. It was pain severe enough to make speaking or swallowing saliva difficult. With pain of this intensity, it would be normal for the throat to be bright red and swollen, for a massive abscess to be sitting on the tonsils, or at the very least, for white pus to be coating the area. But there was nothing. Absolutely nothing. There was a massive discrepancy between the objective findings and the subjective symptoms the patient was complaining of.

I scanned the chart up and down once more. His vital signs were stable. He didn't even have a fever. If it were pharyngitis caused by a viral or bacterial infection, it would usually be accompanied by at least a mild fever. Is it... not a cold? If so, where was this excruciating pain coming from? If it wasn't a problem with the throat itself... Could this be referred pain? My heart sank.

Referred pain. Pain felt in a part of the body other than its actual source. The human nervous system is so intricately intertwined that the brain often confuses the origin of pain. And ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠the most terrifying, most fatal condition presenting with referred pain radiating to the throat—one that any emergency room doctor should be able to rule out even if shaken awake from a deep sleep—was... Oh, fuck. Hold on. The puzzle pieces in my head began to fall into place.

A fifty-four-year-old male. Middle-aged. An age where the risk of cardiovascular disease spikes dramatically. He took cold medicine, but there was no improvement. Of course there wasn't. Because a cold wasn't the cause. His throat hurt. An atypical referred pain of a myocardial infarction radiating to the jaw, shoulder, or back. That has to be it, right? I unconsciously licked my dry lips.

Jo Suyeon wasn't to blame. Anyone looking only at the patient's symptoms and KTAS level would have thought the same. This was a hidden trap. Right? If my suspicion was correct, this patient was currently lying on a bed in the corner of the ER, receiving IV fluids while his heart muscle was slowly rotting away. He wasn't a KTAS Level 5 patient; he was a KTAS Level 1 patient who needed immediate monitoring and a procedure to clear his blood vessels.

I bolted upright from my seat. I needed to get an EKG right this second. I also had to check his cardiac enzyme levels. But before that, I needed confirmation. If my guess turned out to be wrong, I would look like an absolute idiot making a fuss over a patient with a simple cold. I began drafting a post as I walked toward the patient. I'll post on the forum first, then put in the lab orders.

The moment I mentally hit the submit button, I arrived in front of Bed B-28, where the patient was lying. He had begun to break out in a cold sweat, groaning faintly as he stared at the ceiling. As I approached, he laboriously opened his eyes.

"Doctor, my throat... it feels like it's burning..."

A burning pain. It was one of the classic chest pain patterns of a myocardial infarction. And right now, it was manifesting in his throat. My resolve hardened. "Sir, please wait just a moment. We need to run an important test."

I rushed to the nearest computer. My fingers trembled slightly as I logged into the EMR. "Nurse! We're doing an immediate EKG for Park Jinsu in Bed B-28! Please bring the portable machine over right away, and let's draw labs for cardiac markers, including cardiac enzymes, immediately!"

At my urgent shout, the sluggish atmosphere of the station, which had been winding down for lunch, instantly froze. "Pardon? The patient in B-28? The one with the cold...?" The nurse stared at me with a puzzled expression. "It might not be a cold. Hurry, please."