Not a Heart Condition?
I stared at the patient. His face was still pale with pain. Could he be faking it? Was this an act? The cold sweat, the shallow and rapid breathing, even the slight trembling of his fingertips—all of it? If this was acting, the man needed to head to Chungmuro for an audition right this second.
'No,' whispered a spark that hadn't yet died out in my mind. 'There's something here.'
Fine, damn it. If once or twice isn't enough, I'll just run it three or four times. Myocardial infarction is a dynamic disease. Even if he's fine right now, his heart could start screaming ten minutes later. So, I decided to keep running follow-up EKGs every twenty minutes.
At the same time, I stared into space and opened the gallery window in my mind.
It was right as I posted my desperate question. Yoo Sung-hoon, who happened to be walking by, glanced at my monitor over my shoulder and clicked his tongue.
"Are you still holding onto that patient? You're going to keep following up on his EKGs? Well, it is a bit unsettling."
His voice was a mix of half-sympathy and half-mockery.
"But in my opinion..."
The exact moment Yoo Sung-hoon opened his mouth, the first comment flashed across the blue interface in my field of vision.
And that voice overlapped perfectly with Yoo Sung-hoon's voice coming from behind my back.
"...We can't rule out the possibility of unstable angina. Though it's not severe enough to call Cardiology for an emergency procedure right this second..."
Damn. Goosebumps broke out all over my skin.
Yoo Sung-hoon immediately began issuing new orders.
"First, follow up on troponin every three hours, and start a heparin infusion... Ah, wait, no. If the chest pain persists, let's just administer sublingual nitroglycerin and monitor his progress. We'll have to keep a close eye on him."
I hurriedly entered the medication orders according to his instructions.
"But then again, it might not be angina."
"Pardon?"
Even the ghosts said it was angina, and you just said so yourself! Why the sudden change of heart?
"Look at how much time has passed. The patient had chest pain for an hour before coming to the hospital, and it's been almost two hours since he arrived. If it were unstable angina severe enough to cause this much pain for that long, his troponin levels should have ticked up at least a tiny bit, or he should have had a full-blown MI by now. It's... a bit strange."
I looked at the clock hanging on the station wall and let out a low groan.
Yoo Sung-hoon was right. Time. A variable that explained everything, yet simultaneously plunged everything into a deeper mystery.
As time ticked away, even our last shred of hope vanished.
The rechecked troponin levels were still perfectly fine. Absolutely normal.
I couldn't even go home because I had to see how this patient turned out. I sat there like a madman, glued to my seat.
In the end, I logged back into the gallery. This time, I was practically begging.
The reply came from an unexpected place. It was a new username I had never seen before.
I stared blankly at the comment. Esophageal spasm?
'What the hell is a GI cocktail, you nerd...' I searched the term on my phone, having never heard it before in my life.
Gastrointestinal cocktail... Wait, this is something American doctors use, damn it. We don't prescribe medications in this kind of combination. This is South Korea. If I prescribed some ungrounded cocktail like that, the Health Insurance Review and Assessment Service would call me immediately.
But... esophageal spasms could actually trigger symptoms almost identical to heart disease.
And right in front of me lay a patient with mysterious chest pain whose cardiac tests were all completely normal.
Nothing to lose. I couldn't mix that cocktail, but I could use the same principle.
A drug to relieve severe esophageal spasms. Clutching at straws, I entered a new order.
A powerful antispasmodic for stomach cramps: a Tyropa injection.
Right. If it's not the heart, let's target the esophagus. Please, let just one thing work.
In a state of near-despair, I asked the nurse to prepare the injection.
Please, let this medicine work. Please let this patient just be suffering from a terrible stomach cramp. I don't care if I look like an idiot who put on a massive, useless show for the past few hours—just please don't let him have a fatal illness.
The nurse connected the syringe to the patient's IV line and began slowly infusing the medication. I watched anxiously.
Right then, I spotted Park Wooyoung, the Cardiology fellow, about to leave the ER after finishing a consult for another patient.
On impulse, I grabbed him and began explaining the patient's history. Since he was a heart specialist, surely he would have some insight.
"...This couldn't still be a heart condition, right, Doctor? Am I missing something?"
Park Wooyoung answered without a single second of hesitation.
"Isn't it just indigestion?"
He patted my shoulder and walked past, leaving me with a brief, "Keep up the good work."
Indigestion. ...Is that it? I turned my gaze back to the patient.
About two or three minutes after the injection finished, a miracle happened.
The patient's furrowed brow slowly began to relax. His ragged breathing gradually stabilized.
He slowly released his grip on his chest and stared blankly into the air.
"Huh...?" The patient took a deep breath, as if unable to believe it.
"Doctor. ...It doesn't hurt anymore."
Resolution of chest pain. ...I couldn't say anything for a moment.
That agonizing chest pain had vanished like a lie with a single injection. It wasn't a heart problem.
Letting out a hollow laugh, I pulled up a chair and sat next to the patient.
"Sir, what did you eat yesterday, by any chance?"
At my question, the man scratched his head, finally seeming to have come to his senses.
"Yesterday... I had a pretty heavy meal."
"Yes, what did you eat?"
"Well... that mala xiangguo that's popular lately... I had that, and drank quite a bit of kaoliang liquor with a friend. About three bottles..."
Mala xiangguo and kaoliang liquor. A fantastic combination right off the bat. Surely he didn't drink those three bottles all by himself.
"And when I got home, my stomach felt a bit sour before bed... so I had a bulgogi burger combo from the fridge to sober up before sleeping."
I pressed my temples.
Greasy mala xiangguo, strong kaoliang liquor, followed by cold cola and a hamburger. Even if you poured that down a sewer drain instead of an esophagus, it would clog.
"Did you happen to do any exercise yesterday?"
"Ah! I did go to the gym yesterday!" The man's face lit up. "No wonder my chest felt a bit stiff! I did bench presses a bit heavier than usual!"
Confirmed. Every piece of the puzzle fell into place.
So, muscle soreness plus stomach cramps... reflux esophagitis and esophageal spasms caused by greasy, spicy food and alcohol, combined with chest muscle soreness from overexertion.
These two had created a fantastic synergy, producing symptoms that perfectly mimicked an acute myocardial infarction.
I scheduled outpatient appointments for him in Gastroenterology and Orthopedics, and wrote him a prescription. After observing him for another hour to confirm the pain was completely gone, I finally discharged him.
The patient bowed deeply as he left, saying, "You saved my life, Doctor! A big hospital really is different!"
I gave him an awkward smile.
I returned to the station with a hollow laugh. As soon as I sat down, I opened the gallery window to share the conclusion of this ridiculous incident.
Clicking the submit button, I thought, 'This should leave those ghosts feeling a bit deflated.' But contrary to my expectations, the gallery's reaction was freezing cold.
I was left speechless by the sheer rage filling the screen. No, what did I do that was so wrong? It wasn't heart disease in the end. The test results were perfectly fine, too.
Before my sense of injustice could even fade, CardiologyGhost's next comment popped up.
...What is this? I furrowed my brow. No pain, and all tests are normal?
The moment my reply went up, the gallery exploded once again.
My mind went completely blank. Ah.
I couldn't say a word in response.
I barely managed to type out that single line. As soon as I closed the gallery window, a wave of intense exhaustion washed over me.
I stared at the empty bed in Zone A and muttered to myself.
"I still have a hell of a lot to learn."
...But I'm still glad. Glad it wasn't a heart condition.