Time Is Brain (2)
My voice was strangely calm. Perhaps all the crazy things I had experienced over the past few days had unconsciously forged my mental fortitude.
"Hello, ma'am. I'm an emergency medicine doctor, so please don't be startled. I just need to check a few things real quick. Is that okay?"
The elderly woman stared at me with anxious eyes and barely managed a nod. The other passengers in the bus began whispering and staring in our direction. I pulled my phone out of my pocket and turned on the flashlight. Since I didn't have a penlight, this would have to do.
"Ma'am, look at me. Can you open your eyes wide for me?" I gently lifted her eyelids and quickly shone the light into both pupils. Both pupils constricted symmetrically. However, her left eye was turned slightly outward. Deviation. An ominous sign that part of her cranial nerves had been compromised.
"Ma'am, can you squeeze both of my hands? As hard as you can." I placed my hands in hers. Her right hand squeezed with a surprisingly firm grip, even considering her age. But her left hand was different. There was absolutely no strength in it. It just slipped away limply. Clear left-sided hemiplegia. I was certain. This was, without a doubt, a stroke.
I realized there was no more time to waste. I sprang up from my seat, summoned every ounce of lung capacity I possessed, and shouted toward the front of the bus. "Driver!! Pull the bus over right now!! We have a stroke patient on board!!"
My desperate shout sent a wave of shock through the passengers. The bus driver glanced at me in the rearview mirror, immediately spun the steering wheel, and pulled the bus into the far-right lane. With a sharp, screeching sound, the bus ground to a halt. With trembling hands, I pulled out my phone and dialed 119. After two rings, a calm voice answered.
"This is the 119 Emergency Control Center."
"Ah, yes, hello. I'm a first-year emergency medicine resident."
"Yes, Doctor. What is the emergency?"
"I'm calling to report a suspected stroke patient on a bus. The patient is a female estimated to be in her 70s. Her mental status is alert, but she is unable to communicate properly. Onset is estimated to be around fifteen minutes ago. Physical examination shows positive signs for facial palsy, left-sided hemiplegia, and severe dysarthria. Her medical history is unknown, but acute cerebral infarction is highly suspected."
"Understood, a stroke. Could you tell us which bus number it is and your current location?"
I looked out the bus window. A familiar landscape. "It's bus number 1005. We've just passed Yeonsan Junction and pulled over in the far-right lane of the road heading toward the baseball stadium. The bus is stopped right now."
"Got it, Yeonsan Junction. Understood. The nearest paramedic unit has been dispatched. They should arrive within five minutes. Doctor, please make sure to answer any calls from unknown numbers, as it might be the responding paramedics."
"Yes, thank you." Hanging up, I crouched back down beside the elderly woman. Did I do everything I could? I called 119, identified myself, and conveyed the patient's condition as accurately as possible. Yes, I had finished the most important role I could play on-site. First, I needed to lay her down and make her comfortable.
I apologized to the lady in the adjacent seat and, with the help of the other passengers, carefully laid the elderly woman down. I took off my backpack to prop up her head and gently turned her head to the side to keep her airway clear. This was it. This was all I could do right now. I couldn't administer thrombolytics, get a CT scan, or manage her blood pressure. I was just a bare-handed doctor waiting for an ambulance to arrive.
Right then, a familiar temptation crept in. The gallery. The dilemma of whether to cross-check. My diagnosis was clear. Facial palsy, hemiplegia, dysarthria. This was page-one textbook stuff. Asking the gallery about something like this would be a sign of self-doubt, basically advertising to those crazy ghosts, 'I'm an idiot who can't even be sure of this.' ...No, let's not. I shook my head. This was a time to trust my own judgment.
But... wait. The mala xiang guo patient from last time who masqueraded as a myocardial infarction. The memory flashed vividly in my mind. Typical chest pain. Textbook symptoms. I had been completely baited by that 'typicality' and spent two hours barking up the wrong tree. If only I had doubted it even a little and asked the gallery for other possibilities back then. I might have avoided that massive farce. I suffered so much because I didn't use the gallery just because it seemed too typical. Overconfidence is a forbidden poison. Especially at this very moment, when a person's brain cells are dying in real-time.
Maybe just a quick cross-check? Right, this isn't doubting my own skills. This is a double-check. The safest choice for the patient. Rationalizing it to myself, I opened the blue window in my mind.
Pretending to take the elderly woman's pulse, I scanned the comments that materialized before my eyes.
I felt a faint wave of relief washing over me as I read their comments. It felt as though my judgment had been validated by deceased experts. Well, it wasn't just a feeling—it was exactly what had happened. In any case.
I continued to monitor the elderly woman's level of consciousness, checking if she was breathing properly and if her pulse was regular. At the same time, however, a terrible sense of helplessness washed over me once again. There was absolutely nothing I could do. All the knowledge I possessed, all the drugs I had memorized, and all the procedures I had practiced were completely useless inside this bus. Am I just... a bystander? A sense of self-loathing crept in.
It was at that moment. Wee-woo, wee-woo— A faint siren began to wail in the distance. The sound drew closer and closer. No. Get a grip. I shook my head to dispel the defeatist thoughts. I wasn't just a bystander. Because of me, this bus had stopped, and because of me, that siren was rushing toward this very spot.
The siren wailed to a halt right in front of the bus. The doors flew open, and two paramedics in familiar orange uniforms rushed in, carrying emergency kits. "Where is the patient?!"
I stood up and gestured toward them. "Over here."
"Doctor, what's the situation?"
"Sudden onset of left-sided hemiplegia, facial palsy, and dysarthria. Her consciousness is still alert. Acute cerebral infarction is highly suspected."
While listening to my brief report, the paramedics wrapped a blood pressure cuff around the patient's arm and clipped an oxygen saturation monitor onto her finger. Their movements were fluid and natural. I continued to monitor her condition while the paramedics searched for a vein to secure an IV line. The paramedic who appeared to be the senior officer looked at me with an awkward expression.
"Doctor, since there's no guardian present and the patient's condition could fluctuate, would you mind riding with us until we hand her over at the hospital? Having a medical professional on board would be best for the patient."
Ah. In my head, I could hear the sound of all my post-work plans—the ones I had happily imagined while waiting at the bus stop—shattering into pieces. Taking a warm shower, drinking a cold can of beer from the fridge, and mindlessly scrolling through short-form videos before falling asleep... my simple happiness. And so, I ended up hitching a ride.
"Sure. I'll do that." An answer completely contrary to my true desires slipped out of my mouth.
The ambulance's rear doors slammed shut. The paramedics moved busily, securing an IV line in the patient's arm and connecting a normal saline bag. The portable monitor displayed her ECG, blood pressure, and oxygen saturation in real-time. I asked toward the driver's seat, "Which hospital are we heading to?"
"We're heading to the nearest regional cardiovascular and stroke center! Cheongjin!"
Oh. Oh, fuck. Cheongjin Medical Center. My workplace. The very hell I had just escaped. I was now voluntarily escorting myself back into that fiery pit. Resigning myself to my fate, I pulled out my phone. "Ah, that's my hospital. I'll call them ahead of time." I dialed the familiar number. The emergency medical center. Ring, ring—
"Yes, Emergency Medical Center." The person who answered was the most senior nurse in our ER, someone I could recognize instantly just by her voice.
"Ah, yes, hello. It's Han Hyeon-jae."
"Ah, oh? Yes? Yes, Doctor. What's the matter? Did you leave something behind..." Her voice was thick with the unspoken question: Why the hell is a guy who just clocked off calling me? and a clear sense of annoyance.
"No, it's not that... I'm actually in an ambulance on my way to the hospital right now."
"...Excuse me?"
"A stroke—well, anyway, I happened to hitch a ride in the ambulance, and I'm calling to give you a heads-up on the patient's condition." I adjusted my grip on the phone and began pouring out all the information I had organized in my head over the last thirty minutes.
"She's a female patient in her 70s. Onset is estimated to be about thirty minutes ago. Her mental status was alert but is now transitioning to stupor, with a GCS of around 11. Vitals are stable with BP 160/90, HR in the 60s, and SpO2 at 99%. Initially, I thought it was hemiplegia, but she shows clear left-sided facial palsy and left-sided hemiparesis, with a motor grade of about 2 to 3. Her dysarthria is also severe."
I took a breath and added the most crucial part. "Please contact the neurology resident on duty and radiology so they can prepare for an immediate CT scan. Our ETA is five minutes."
There was a long silence on the other end of the line. Only the urgent voice of the nurse calling out to another colleague and the rapid clacking of a keyboard could be heard. After a moment, the nurse asked back in disbelief.
"Understood, Doctor. We'll get everything ready. But... are you seriously in an ambulance right now?"
"...Yes." Hanging up, I stared out the window. The outline of a familiar building was beginning to appear in the distance. Our hospital's emergency medical center. Damn it. My clock-out.