Migraine (1)

The day after. I opened my eyes before my alarm even went off. Although the lingering effects of severe muscle aches still clung to my entire body, I felt strangely light as a feather. Was it the relief of survival? I took a shower and spent an extra five minutes drying my hair with more care than usual. Then, I picked out my cleanest clothes to wear. Today was a good day. It was the blessed first day of my extended medical career. My steps toward the emergency room were incredibly light. The automatic doors slid open, revealing the familiar landscape of hell, but today, even that scenery felt welcoming. Even the dead, fish-like eyes of my colleagues, wandering around like zombies from pulling all-nighters, somehow seemed to sparkle today.

Unable to contain the positive energy welling up inside me, I called out energetically toward the first thing that caught my eye, the nurse station. "Haha! Hello, nurses! Good morning!"

At my booming greeting, all movement at the station ground to a halt. The nurse catching up on overnight charting, the nurse ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠preparing medications, and the nurse getting ready for handovers—everyone stared at me with expressions that clearly said, Has this bastard finally lost his mind? I didn't care about their chilly stares.

I continued my march. Passing the laboratory, I smiled brightly and waved at the medical technicians who were transporting specimens with exhausted faces. "Haha! Good to see you, technicians! Let's do our best today!"

The technicians stared at me blankly, looking as if they might drop the specimen tubes they were holding. "Oh! Good to see the administration staff too! And to our security guards who reliably protect our ER, isn't the weather just beautiful today? Haha!"

I flashed them a thumbs-up. The administration clerk almost slapped the cheek of the patient they were registering in shock, and the security guard, who always stood with a blank face, let his mouth hang open slightly. "..." I leisurely vanished into the residents' office.

Only after the door to the residents' office closed and Han Hyeon-jae completely vanished did the frozen time in the emergency room begin to flow again. "...Hey," the head nurse whispered, being the first to break the silence. With an expression of utter disbelief, she stared down the hallway where Hyeon-jae had just disappeared and whispered to her colleague.

"What's wrong with Dr. Han? Did he eat something bad? Did he finally blow a fuse in his brain after staying up all night writing that Incident Report last time?"

"I know, right? Wasn't he walking around like a corpse just yesterday?"

"The Han Hyeon-jae I know is not ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠someone who smiles so brightly. Why is he so hyped up like a crazy person today?"

"Exactly. I've never seen anyone in such a good mood in the morning. Out of all the doctors... actually, out of all human beings."

Just then, a medical technician chimed into their conversation. "Oh, you didn't know?" "Know what?" "It came out."

The head nurse's eyes narrowed. "What? Oh, that? The disciplinary committee for cutting open that patient's abdomen?"

"Yes." The technician lowered his voice, looking around. "A rumor spread like wildfire through the Education and Training Department and the administration office this morning. A written reprimand and a one-month salary reduction. That's how it ended. He wasn't even referred to the formal disciplinary committee."

At those words, the young nurse's jaw dropped. "Oh my god, really? After causing such a massive scene, that's all he got?"

"Ah..." The head nurse let out a long sigh of comprehension. "No wonder he's so thrilled. I thought he was going to get fired, but since he got off with just a minor pay cut, it makes sense he's running around like a lunatic."

With that, the head nurse turned her gaze back to her monitor. "Leave him be. The guy hit the jackpot. With luck like that, he's fully excused for acting like a madman for at least today."

Thus, under the conclusion that Han Hyeon-jae isn't actually crazy, he's just in an incredibly good mood after dodging a bullet, the emergency room began to regain its usual hectic pace.

As soon as I entered the Residents' Office, I tossed my bag into the worn-out locker bearing my name. I tore open a packet of instant mix coffee, emptied it into a paper cup, and fell into deep contemplation about how I would survive the day. Right then—

Slam! The door to the residents' office burst open with enough force to shatter it. Standing there was the living disaster of the Emergency Medicine department and my ultimate nemesis, Chief Resident Lee Min-jae.

"Is what I heard... actually true, Han Hyeon-jae?!"

I put on my most innocent, 'I know absolutely nothing' face. "Excuse me? What are you talking about, senior?"

"What? Are you playing dumb with me right now?!" Min-jae strode over and ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠grabbed both of my shoulders in a vice grip.

"Did you! Seriously! Perform an emergency laparotomy! In the ER Resuscitation Room?! A guy who hasn't even undergone proper trauma resuscitation training yet!!! This is a miracle! A divine revelation! And this, right here, is the exact reason why you can never run away and must bury your bones in this Emergency Medicine department forever!!!!!!"

Argh, Senior, I get it!! Please stop burying my bones! I'll bury my own bones when the time comes! My head rattled from his passionate shaking, making me feel like I was about to get a concussion.

He finally let go of my shoulders, took a step back, and looked at me again. "Anyway..." he began. "Let's calm down and talk. Han Hyeon-jae. I sincerely commend you."

"I'm not just saying this because of the outcome. It's the process and your judgment. From what I heard, you didn't make a single mistake in that absolute chaos. And... you didn't hesitate at the most critical moment. That's not something a first-year resident can pull off. It was truly magnificent."

As I scratched the back of my head in embarrassment, Min-jae's eyes grew sharp again. "But." Min-jae stared straight into my eyes. "Aren't you notoriously clumsy-handed?"

He hit the nail right on the head. "I remember it clearly. Just a few months ago, you couldn't even find a vein, leaving patients' arms bruised black and blue. When you were suturing, your hands shook so badly that I had to step in and finish it for you more than once or twice."

His eyes were filled with suspicion. Breaking into a cold sweat, I dragged out the same absurd excuse I had used before the training committee.

"Well, you see... Senior... I'm still clumsy with basic things like IV lines or simple sutures, so I can't do them well. But in a special situation like this... um... for surgical procedures that I've simulated countless times in my head... I guess I managed to tap into an immense level of concentration in the heat of the moment..."

Min-jae listened to my pathetic excuse in silence. "Hmm... Is that so?" His gaze remained doubtful. He clearly didn't buy my excuse. Just as he was about to press further—

Creak. The door to the residents' office opened slightly, and an intern poked his head in. "Ah, Dr. Lee Min-jae. You need to take over the pediatric ER shift, and there's a baby patient who isn't doing too well right now..."

"Ah, is it that time already?" Min-jae stood up, giving me a meaningful look. "I'll head out then. Let's finish this conversation later."

Min-jae squeezed my shoulder firmly. "You must! You absolutely must stay in EM! Got it?!" With those final words, he left the residents' office without looking back.

Let's never see each other again... Please... Stop scheduling our shifts together... Talking to that man drained more energy than performing CPR on a cardiac arrest patient.

After the commotion in the residents' office, I returned to the station with a hollow soul. I mechanically moved my fingers as I processed the charting. Patient admissions, discharges, transfers. This tedious and draining labor actually brought me peace of mind. At least there were no unpredictable variables here.

About an hour passed like that. The nurse at the triage desk called me over the intercom. "Dr. Han, could you take a look at a headache patient in Zone B?"

"Sure, I'll be right there." It had finally come. A headache. Along with colds and abdominal pain, it was one of the top three non-emergency complaints that frequently plagued the ER. Well, it's not like the ER only gets patients with sliced-open bellies or blood geysering from their throats. Feeling rather relieved, I stood up.

Heading toward the triage desk, I ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠glanced at the chart the nurse had just finished entering.

A 28-year-old female. Chief complaints were headache and nausea. Her vital signs were stable. The patient was sitting on a chair in front of the triage desk, pressing her temples firmly. She was a young woman, dressed in a comfortable hoodie and sweatpants. Her face was pale, and dark circles hung heavily under her eyes, looking as though she hadn't slept in days. At a single glance, she had the exact look of a typical, overworked modern Korean office worker.

She said her job was a web designer. Hearing that she had pulled several all-nighters to meet a deadline, I even felt a sense of kinship. Upon seeing me, she spoke with a nearly resigned expression.

"Doctor... I think it's just a really bad migraine. I get them occasionally. I didn't even have time to come to the hospital, so I tried to endure it, but today it was just too much... Can't I just get a painkiller shot and go?"

"Ma'am, could you please lie down on that bed over there for a moment? I'll come over, check a few things, and then get you a shot."

I guided the patient to an empty bed in Zone B. Once she lay down, I drew the curtains and began a basic medical history and physical examination.

"When did the headache start? Does your whole head hurt, or is it just on one side?"

"Since yesterday afternoon. It's a throbbing pain right around my right temple. I also feel a bit dazed."

"Do you feel extra sensitive to light or sound?"

"Yes. Even now, the fluorescent lights are making me feel a bit dizzy."

"Have you recently hit your head, had a fever, or experienced any neck stiffness?"

"No, not at all."

Every single answer aligned perfectly with the textbook symptoms of a classic migraine. Finally, I performed a neurological examination. I checked her pupillary light reflex with a penlight, tested the motor strength in her limbs, and examined her facial sensation for any abnormalities. Everything seemed fine. Her pupils were symmetrical, and there was no sign of weakness or sensory loss. There wasn't a single red flag to suggest dreadful conditions like a stroke or meningitis.

The diagnosis was practically certain: an acute migraine exacerbated by overwork and stress. I returned to the station and sat in front of the computer. All that was left was the prescription. First, what IV fluid should I give? I could just give her an intramuscular injection of painkiller in the buttocks and discharge her immediately, just as she wanted. It was the fastest and most efficient way. However, that felt a bit too cold for a patient who had been pulling all-nighters. She was probably dehydrated too. Let's set her up with a bag of IV fluids. I opened the order window. One liter of normal saline as the base fluid. Now, what should I mix into it? The painkiller Ketorolac and Macperan to reduce her nausea were absolute essentials.

...Vitamins? The so-called nutritional IV fluid. A yellow-tinted fluid mixed with various minerals like vitamin B complex, vitamin C, and magnesium. I clicked on the vitamin B complex and added it to the IV order. There, a special cocktail for the overworked Korean office worker. Chuckling to myself, I pressed the enter key to finalize the prescription. Now, this patient would take a sweet one-hour nap while receiving the yellow fluid and be discharged with a refreshed face. It was a perfectly peaceful, ordinary, and flawless scenario.

After hitting the enter key, I leaned back in my chair. Whew. Finally, a breather. Just as I was enjoying this peaceful moment and thinking about brewing a cup of instant mix coffee, a familiar voice echoed from the nurse station.

"For B-09, the 28-year-old patient, it's 1 liter of normal saline with Ketorolac, Macperan, and a vitamin mix, right?"

"Yes, that's correct." It was the order I had just placed. The nurse headed toward Zone B, carrying a tray with the IV bag and medications. As it happened, my path to the restroom overlapped with the nurse's route. Consequently, when the nurse drew the patient's curtain, I reflexively glanced inside. It was a mundane scene: wrapping a tourniquet around the patient's arm and wiping the injection site with an alcohol swab to find a vein. The patient, seemingly afraid of needles, was deliberately looking away. I was about to walk past. But right at that moment, a faint, dark blue mark on the inner side of the patient's right forearm, which the nurse had just wiped, caught my eye. Wait... is that a bruise on her arm?