Airway Management is Crucial (2)
My finger hovered over the call button. The moment I pressed this, not only my peaceful day off but my entire future hospital life could go down the drain. Just because I'd done a lot of stupid things before didn't mean it was okay to keep being stupid. Though I had forgotten that fact for a moment.
Anyway, under the ghosts' relentless badgering, whatever resembled reason in my head snapped. All the fatigue, resentment, and sheer misery that had accumulated exploded at once. I put down my phone and, channeling all my rage, began typing a post in the gallery.
Stop backseat driving, you bastards!!!!!!!!
Author: Hell Joseon Slave 1It's true I get a lot of help from you guys, and thanks to you, I don't kill patients, get scolded less by my seniors, and sometimes get treated like an ace, but there's a limit!!!!!!!!
Let me rest on my days off, you damn ghost bastards!!!!!!!!!!!!!!
I'm seriously going to die!!!!! Please let me rest, let me rest, let me rest!!!!!!!!!
The gallery fell silent for a moment at my madness-infused post. Soon, flustered comments began popping up one by one.
Uh... Slave... don't be like that... We only did it because we want you to succeed...
O living one, we have momentarily forgotten your toil. Pray, appease your wrath.
Kids these days lack grit... No, that's not it. Right. Sorry.
I'm seriously going to fucking quit this gallery, you dog-like ghosts.
Of course, I had no intention of actually quitting. Why would I throw away such a broken cheat key? This was purely for blackmail.
My threat was highly effective. The gallery instantly plunged into a state of panic.
Hey!!!! No!! Don't go!! I'll show you my entire bone marrow slide collection!!
Let's talk this out.
And finally, their declaration of surrender was posted.
Slave! We'll only push you half as hard!!!!! Let's just study for one or two hours a day, okay? How about that compromise!
Tsk.
The negotiation was a success.
Still, just in case, maybe I should try making a call. I needed to show those ghosts that 'at least I tried.'
And honestly, I was curious if an individual could even rent one.
First, I called the Education and Training Department. Then, I called the Chief.
Fortunately or unfortunately, neither the Education and Training Department nor the Chief picked up. The line rang, but nobody answered.
I hung up without any lingering regrets.
'Whew, saved.' I let out a sigh of relief.
But a corner of my mind felt uneasy. Wait, is this really a good thing? The Chief might be too busy to answer. But... you guys in the Education and Training Department should have picked up.
Does it make sense for the department responsible for managing the residency environment to not answer the phone for no good reason? What if it was a real emergency? I'm definitely filing a complaint later.
With those thoughts, I lay back down on the sofa.
At least the biggest crisis of the day had passed. The gallery was quiet. All it took was one threat of quitting.
Why on earth had I been stupidly taking their abuse until now? Am I an idiot?
Learning is good, but too much of it is poison. Yes, this was enough. The negotiation was a success, and I had protected my precious day off.
I picked up the remote and turned on the TV. Then, while enjoying some streaming shows, I opened a delivery app and ordered chicken. I could afford to splurge a bit today. After all, I had just won a victory against those ghost bastards.
However, even as the chicken arrived, the beer can was popped, and I was laughing at the TV, the uneasiness in the corner of my mind didn't disappear.
'We'll only push you half as hard!!!!!' The desperate cry of that anonymous user kept echoing in my head.
'...But still.' I paused, holding a chicken drumstick, lost in thought.
'The ghosts' lectures might be miserable and exhausting, but it's true they're helpful.'
Like that myocardial infarction patient... or the ciguatera patient. Saving those patients' lives was entirely thanks to the ghosts of this gallery.
I'm still just a green first-year resident who doesn't know much. My hands are still clumsy, and my knowledge is shallow.
Even though those ghosts have terrible personalities and treat me like a toy, they were experts who reached the pinnacle of their respective fields in life. Do I really have the right to reject their knowledge?
Anyway, sorry for flying off the handle... I sent a very faint apology in my heart. They wouldn't hear it, though.
And I made a decision.
Maybe I should study airway management again. Since things turned out this way, it's a winning deal to just use those ghosts as free private tutors to my heart's content.
Well, there's nothing bad about studying. If I get smarter, in the end, I survive, and my patients survive too.
I set the leftover chicken down on the table and opened the gallery again. Then, I uploaded a short post.
Guys, I'm back. I won't run away.
Author: Hell Joseon Slave 1Fine. I get it. It's not like I was destined to rest anyway, so let's finish what we were doing earlier. Airway management.
At my post, the quiet gallery instantly regained its vitality. The ghosts pounced as if they had been waiting.
Ohhh! You're back, Slave! I knew you were destined for greatness!
Tsk tsk, you should have done that from the start. Wasting energy for nothing.
You want me to actually leave the gallery?
Ignore him, he's just an idiot!!!!! Please don't go!!!!!!!!
A wise decision, O living one! The path of learning is indeed endless!
Hmph. If there's no physical mannequin to practice airway management, we have no choice.
At those words, my heart sank, fearing that the hellish mission of 'calling the professor' would be given to me again. But the next comment completely defied my expectations.
We can just use drawings.
Drawings? Drawings?? Why drawings all of a sudden?
Exactly! I happen to have some excellent materials. I was so bored after I died that I spent about thirty years pestering a medical illustrator ghost in the underworld to create an anatomical chart series. I pride myself on it being more accurate than any existing anatomy book.
Good grief, so I wasn't the only living doctor being driven crazy by their relentless pestering out of boredom. I decided to pray for the soul of that unknown medical illustrator.
Anyway, starting with those words, an unbelievable sight began to unfold before my eyes.
What appeared in the gallery before me wasn't just a simple anatomical drawing, but an image of such exquisite quality that it looked as if they had literally brought a living person over.
So they made someone draw this by pestering them for thirty years? That person—no, that ghost—must be a saint.
Now, let the oral exam begin.
And the exam began. In the new post uploaded to the gallery, a perfectly normal adult airway cross-section appeared.
Question 1. The most basic airway management. Which hand do you use to hold the laryngoscope? Which side of the tongue do you insert the blade?
I searched my memory for a moment and typed out the answer in my head.
Hold it with the left hand, insert it to the right of the tongue, and push it to the left.
Correct. Then, where should the tip of the blade be positioned so that the epiglottis is lifted and the vocal cords are visible? What is the name of that structure?
Vallecula. (*Epiglottic vallecula)
This much was a piece of cake. Easy peasy!
After a brief pause with no other comments, a new post was uploaded. This time, the image changed. It was the airway of a patient who had been in some kind of accident. It was a chaotic mess of broken teeth and blood.
Scenario initiated. Trauma patient. Visualization is blocked by oral bleeding and vomitus. What is the very first thing you must do?
Ugh, if it's trauma, obviously you should call an ambulance.
Call 119?
No, you dumbass, in the hospital!!!!!!! Why would you call 119 again!!!!! Are you going to ask the EMTs to secure the airway for you!!!!!!
Ah, for a moment, I was so focused on the trauma patient and the trauma situation that I forgot what kind of test I was taking. I snapped out of it and decided to leave a proper comment.
Suction.
Obviously. Then, while suctioning the vomitus with a large suction tip, you accidentally stimulated the larynx. The patient suddenly developed a laryngospasm. The vocal cords are tightly closed, and the tube won't go in. What do you do now? You have 30 seconds.
I panicked. My mind went completely blank. Should I put the patient to sleep first? Or...
Inject a small dose of muscle relaxant to relieve the spasm.
Too late. The patient has already suffered cardiac arrest due to hypoxia. The patient has passed away. You idiot. In this situation, you should attempt positive pressure ventilation with an Ambu bag while simultaneously preparing for a surgical airway!
Damn it. I killed the patient in the virtual scenario right from the start.
This time, the external structure of the neck appeared before my eyes. The thyroid cartilage, the cricoid cartilage, and the thin membrane between them.
Alright, intubation is impossible, and Ambu bagging is impossible. The patient's oxygen saturation is plummeting into the 70s. You have an No. 11 blade (*scalpel) in your hand. Where do you cut? Draw the exact line where you would make the incision on the image using your thoughts.
Sweating profusely, I located the cricothyroid membrane in my mind and drew a line over it. Wow, this gallery has a lot of features—it even has a MS Paint function. Then, I uploaded the image as it was.
Not there, you moron! If you cut there, you'll pierce the thyroid gland! Are you trying to kill the patient from excessive bleeding?! Again!
I drew the line again and uploaded it.
Too high! That's the thyroid cartilage! Are you planning to slice through bone?!
And so, sitting on the sofa in my officetel, I repeatedly sliced and stitched up an imaginary neck dozens of times. It was the most bizarre airway management practice session in the world.