Just Another Peaceful Day in the ER
After sending off the myocardial infarction patient, a brief peace settled over the emergency room. I sat in an empty chair, staring blankly into space with a look of utter existential fatigue on my face.
I had received double the praise from both Cardiology and Thoracic Surgery. Hehehe. Oh, right. I think I got some more shop points earlier. I wonder how much I received this time?
Just as I was about to check—
But the peace was shattered in an instant.
"Male patient in his thirties, continuous vomiting!"
Along with the paramedic's loud shout, the ER's automatic doors slid open once more. The wheels of the stretcher screeched noisily as it raced down the hallway. Lying on his side on top of it was a man who looked to be in his thirties, groaning as he clutched his stomach.
I instinctively stood up and rushed to the side of the stretcher.
"Are you conscious? Where does it hurt?"
The patient didn't even seem to have the energy to answer. He glanced at me once, then immediately buried his face back into a plastic bag and began to retch violently.
"Bleeegh!"
The paramedic standing beside him answered on his behalf with an embarrassed look.
"According to the patient, this evening... well, he ate an entire bag of dried seaweed."
My brain short-circuited.
"..."
Did I hear that right? Dried seaweed? The stuff you rehydrate in water to make soup?
Doubting my own ears, I asked again.
"He ate dried seaweed?"
"Yes... bleegh..."
The paramedic added pityingly, "Well, he said it was so crispy that he just ended up eating the whole bag."
It was the most bizarre chief complaint I had ever heard in my life. A dried seaweed feast. Was this guy actually insane?
"What are his vitals?"
"At the scene, his blood pressure was 140/90, heart rate 110, respiratory rate 24. He's fully alert. It took us fifteen minutes to arrive at the scene, and he vomited continuously during transport. It's been about twenty-five minutes now since we arrived at the hospital."
His blood pressure was slightly elevated, and his pulse and respiration were fast. If you considered it a typical reaction to pain and dehydration, it was normal. He wasn't in immediate danger of dying, but it was an awkward situation where we couldn't just leave him alone either.
"Sssip... Let's put him in Zone A for now."
Continuous vomiting of that intensity could cause severe dehydration and electrolyte imbalance. So, I decided to place him on a bed in Zone A.
As soon as he was transferred to the bed in Zone A, the patient curled up like a shrimp and continued to vomit. I snapped on my latex gloves and palpated his abdomen. His stomach was completely bloated and distended, and he grimaced every time I pressed down.
Could this be a bowel obstruction?
The worst-case scenario flashed through my mind. Dried seaweed expands dozens of times its size when it absorbs water. There was a high probability that the massive amount of seaweed had passed through his stomach and completely blocked his narrow small intestine. If so, this wasn't just a funny anecdote—it was a surgical emergency that might require immediate operation.
"Nurse! Let's get two IV lines on this patient and order some fluids. Also, order abdominal X-rays, both supine and erect! And get a basic lab panel drawn right away!"
A moment later, the X-ray results popped up on the monitor. I widened my eyes and scanned the screen, looking for any characteristic signs of a bowel obstruction.
"There's nothing?"
The X-ray was clean. Or rather, to be precise, other than his stomach being severely distended, there were absolutely no findings suggesting a bowel obstruction. His blood test results were also within normal limits, except for some mild dehydration. The radiologist's reading, which arrived shortly after, confirmed the same: No signs of bowel obstruction.
Ah. It wasn't an obstruction. It was just... the seaweed had expanded like crazy inside his stomach. It wasn't blocked in the small intestine; it had already reached maximum saturation right in the stomach. The seaweed, bloated to dozens of times its original size, was pressing against the stomach walls, and his brain was ordering his body to vomit to expel the foreign substance.
I stared blankly at the patient, who was still clutching the plastic bag and dry-heaving. Good grief. Bowel obstruction, my foot. But actually, this was a relief. If it had been an obstruction, I would have had to call General Surgery and cause a massive scene, and the patient would have suffered that much more.
"Doctor... am I... going to die...?" the patient wheezed between gasps.
I looked at him with pity as he asked so desperately. Die? Why would you die? You just have a seaweed party going on in your stomach.
The problem was how to end this party. The first thing that came to mind was a Levin tube. A primitive but surefire method: shove a thick tube down his nose into his stomach, connect it to a suction machine, and suck out the contents.
Is that even possible?
I imagined the scene of shoving a Levin tube into the patient's nostril with my own hands. The tube reaches the stomach wall, and suction begins. But what gets sucked through the tube wouldn't be clear gastric juice. It would undoubtedly be a slimy, slippery, unrecognizable green mass of bloated seaweed. The moment that seaweed clump clogged the tip of the tube, the suction machine would scream and grind to a halt. It might tear the gastric mucosa, or worse, cause gastrointestinal bleeding.
The outcome would be utterly disastrous. The patient would be in agony, and I would be standing there in despair, holding a tube covered in seaweed. This was beyond my level. But just in case, to gain some confidence in my judgment, I stared into the air for a moment.
My suspicion that the Levin tube would clog was now a certainty. At the same time, a wave of existential dread washed over me as I realized I was eavesdropping on a pathetic debate between deceased doctors.
...Sssip. Should I call Gastroenterology?
Yes. This was the domain of GI specialists. Gastroenterologists had endoscopes. They could go in directly with that camera, assess the state of the seaweed field, and pull it all out with all sorts of bizarre tools.
But for a lowly first-year resident to call the GI on-call fellow without even trying a Levin tube, just because "the patient ate dried seaweed like chips and is throwing up"? I'd be lucky if they didn't curse me out over the phone.
In the end, I decided to choose the most traditional and safest method.
Senior SOS.
I stepped out of Zone A and scanned the station. Just then, Yoo Sung-hoon, a fourth-year resident, was rolling his stiff neck while charting. Equipping my most pitiful, serious, and urgent expression, I approached him.
"Senior."
"What is it?"
Yoo Sung-hoon replied in his usual chronically fatigued voice.
"A male patient in his thirties came into Bed A-3 with nausea and vomiting, but the case is a bit unusual, so I'm reporting it to you."
"How unusual can it be? Is it another drunk who blacked out and is causing a scene?"
"No, it's not that... According to the patient, he ate a whole bag of dried seaweed like it was chips."
"..."
Yoo Sung-hoon froze. Then, very slowly, he turned his head to look at me. A faint look of What on earth did I just hear? seemed to flicker in his eyes.
"What did you say?"
"Dried seaweed. Dehydrated seaweed. Ever since he ate a whole bag of it, he's been vomiting continuously and complaining of abdominal distension. I initially suspected a bowel obstruction and took an X-ray, but there were no specific findings."
I reported as calmly and medically as possible.
When I finished, Yoo Sung-hoon said nothing for a moment. Then, letting out a short, disbelieving chuckle, he stood up.
"Let's go see him."
Yoo Sung-hoon headed to Zone A, saying he would examine the patient himself. I followed close behind my senior.
Yoo Sung-hoon pressed on the abdomen of the patient, who was still dry-heaving into the plastic bag, listened with his stethoscope, and then turned to me with a resigned expression.
"What about a Levin tube?"
"I figured it would just clog up, so I held off."
"Good call."
Leaving me with that brief word of praise, he returned to the station and picked up the phone. He was calling the Gastroenterology on-call. I held my breath and eavesdropped on the conversation.
"Hello, Doctor. This is Yoo Sung-hoon, a fourth-year Emergency Medicine resident. Is this the Gastroenterology fellow on call?"
"..."
"Ah, yes, Doctor. The reason I'm calling is that we have a patient in the ER right now, and the case is a bit absurd, so I think you might need to take a look."
"..."
When the fellow on the other end asked something, Yoo Sung-hoon hesitated for a moment before confessing.
"The patient apparently ate a whole bag of raw, dried seaweed."
"..."
"Yes, Doctor. Not rehydrated. He ate it raw, like chips. The entire bag."
Yoo Sung-hoon's brow furrowed slightly.
"Yes, I know, Doctor. I know it makes no sense. But he really came in like this and is vomiting continuously. The X-ray doesn't show an obstruction, but his stomach seems completely blocked. I'm calling to ask if this can be resolved via endoscopy."
After a lengthy conversation, Yoo Sung-hoon hung up, saying, "Yes, I understand, Doctor. We'll be waiting." Hanging up the receiver, he turned to me.
"Sigh... What a bizarre fellow. The GI doctor is coming down. When they do the endoscopy later, go in with them and watch. It's a sight you'll probably never see again in your life."
Of course, he didn't literally mean for me to go watch the gastroenterologist perform the endoscopy. It was just his way of expressing how utterly ridiculous the situation was.
A moment later, a thoroughly annoyed Gastroenterology fellow came down. He glanced at the patient, and with the same resigned look I had seen on Yoo Sung-hoon's face earlier, he said,
"Let's prepare for an endoscopy. Gastric lavage won't do a damn thing. I guess we'll have to go in and pull it all out."
In the end, under the unprecedented tentative diagnosis of 'suspected upper gastrointestinal obstruction due to acute dried seaweed ingestion,' the patient was wheeled off to the endoscopy room.
I stared blankly at his departing figure and thought: The ER really does attract all kinds of people.