Migraine, Part 4
It was at that exact moment.
"Han Hyeon-jae!"
An urgent voice called out from behind me. It was Choi Sumin. Seeing me standing at the station, clutching the receiver with a pale, shell-shocked face, she must have sensed that something had gone terribly wrong.
"What's wrong? Why are you so pale? Who are you on the phone with?" Choi Sumin approached me, her face etched with worry.
Still holding the receiver, I silently raised a hand. Just a moment. Then, mouthing the words with all the terror and urgency I had ever felt in my life, I clearly formed three letters.
T. T. P.
I watched as Choi Sumin's eyes widened—first in confusion, then in sheer horror. Naturally, she understood the crushing weight of the living hell those three letters represented.
Right then, the fax machine in the corner of the station whirred loudly, spitting out a single sheet of paper. It was the lab results. Still clutching the phone, I snatched the paper from the tray and thrust it in front of Choi Sumin's face. At the bottom of the page, the lab technician's red-inked handwriting was stark and clear.
[Schistocytes: 3+ observed, suggest TMA rule out, esp. TTP]
(* Schistocytes 3+ observed, suspect TMA, rule out TTP as primary consideration.)
Choi Sumin didn't ask another question.
"Nurse Jung! Move the patient in B-9 to Zone A right now! Reattach the vital monitors, and check her blood pressure every fifteen minutes—no, make it every five minutes! Keep monitoring her mental status, and insert a Foley catheter to track her hourly urine output!"
At her command, the entire station erupted into a flurry of activity. Nurses rushed off to prepare the patient for transfer. In the center of the chaos, Choi Sumin grabbed another phone.
"Is this the MICU? This is Choi Sumin, third-year Emergency Medicine resident. We have a suspected TTP patient in the ER right now. Can we secure an ICU bed immediately?"
"Yes, TTP. Thrombotic Thrombocytopenic Purpura. We need to initiate plasmapheresis immediately. We have to transfer her right now if we want to save her. Please, as fast as possible."
Leaving the frantic scramble behind me, I focused on the crisis at hand. On the other end of the line, Jin Se-hee was already barking out a barrage of orders.
"...Start high-dose IV steroid therapy immediately. Contact the blood bank and tell them to secure at least twenty units of Fresh Frozen Plasma for plasmapheresis. Call Nephrology ahead of time to have them prepare the plasmapheresis machine and staff. I'm heading down right now."
"Yes, Doctor. Understood."
The line went dead. I hung up the receiver and looked at Choi Sumin, who had just finished her call with the ICU.
"The fellow is on her way down."
"I know. I heard."
The war had begun.
"Load one gram of Solu-Medrol, and contact the blood bank again to request an emergency release of at least twenty to thirty units of FFP immediately. Call Nephrology again and tell them to prep for plasmapheresis! Hurry! Move, move!"
The station was absolute pandemonium. Nurses were sprinting, and the phones were ringing off the hook. My complacent assumption of ITP. My ignorance in wanting to just give her steroids and monitor her. If it hadn't been for the crazy ghosts in the gallery, I would probably be writing that patient's death certificate right now.
"Han Hyeon-jae! Snap out of it!"
Choi Sumin's shout jolted me back to reality. Now was not the time for self-pity. I had to make up for my mistake.
"Go to the patient right now and explain the situation. Tell her how serious this is. Are her guardians here?"
"No, not yet."
"Then call them and tell them to get here immediately. Tell the patient she's being moved to the ICU, and that we're going to do everything we can. Go!"
With heavy steps, I walked over to the patient's bed, which had just been moved to Zone A. Her face was even paler than before as she stared anxiously at the ceiling. She must have guessed why everything around her had suddenly turned so chaotic.
"Excuse me," I said, rubbing my face for a brief second. "The situation... is much more serious than we initially thought."
My voice was stiff. There was no time for detailed explanations, nor did I have the luxury of trying to comfort her.
"It appears to be a much more critical and dangerous condition than we first suspected. It's not just a simple issue of your blood not clotting... At this very moment, countless tiny blood clots are forming inside the microvessels of your body. And those clots are attacking vital organs like your brain and kidneys."
The patient's eyes widened in terror.
"Please contact your guardians and tell them to come immediately. We are going to transfer you to the Medical Intensive Care Unit right away. To save your life, we must begin a treatment called plasmapheresis, which essentially filters and replaces all the plasma in your blood. From this moment on, it is a race against time."
I couldn't bring myself to say anything more as I met her trembling gaze. Waves of guilt and apology washed over me.
After delivering what felt like a death sentence, I walked back toward the station, pausing for a moment. Was there anything I was missing in all this chaos? Logically, I had organized everything that needed to be done, but deep down, anxiety still swirled like a vortex. Ultimately, I opened that forbidden window once again.
My question seemed perfectly logical. If her platelets were low, shouldn't we just give her more platelets? But the moment that post went up, the gallery erupted in flames of fury once again.
Ah...
It was at that exact moment.
"Hematology-Oncology is here!"
A sharp, clear voice rang out from the entrance of the ER. It was the Hematology-Oncology fellow, Jin Se-hee.
"Where is the patient?"
"Ah, we moved her over to Zone A."
"Lead the way."
Jin Se-hee didn't give me a single second to breathe. Overwhelmed by her commanding presence, I began my briefing almost mechanically.
"Twenty-eight-year-old female patient, highly suspected of TTP. Her chief complaint upon arrival was a headache. Lab results show a platelet count of 35,000, and a peripheral blood smear confirmed Schistocytes Grade 3+. Elevated LDH and bilirubin levels were observed, while renal function is still within normal limits. We have initiated high-dose IV steroids, and we are currently preparing twenty units of FFP and setting up for plasmapheresis. The patient's consciousness is still clear, and her vitals are stable."
Jin Se-hee nodded silently as she listened to my report.
"Good job," she said briefly. "For a first-year EM resident, this is an exceptionally well-handled initial response. Bypassing the second-year to call me directly was also an excellent decision."
I stood there, utterly dumbfounded by the praise. I had fully expected to get chewed out.
"I'll take over from here."
With those final words, she headed toward the patient. Watching her walk away, she looked incredibly reassuring and dependable—like an elite special forces operative who had just parachuted into a desperate battlefield where the entire squad was on the brink of annihilation.
Damn, so this is an internist. She's so cool.
Ah, wait. Even thinking things like that is strictly forbidden. If I ever let a thought like that slip out loud, I'd never hear the end of it from Lee Min-jae.
Jin Se-hee personally assessed the patient's condition and began barking out orders like a hurricane.
"Prepare to insert a C-line immediately. We need to place a dual-lumen catheter in the femoral vein for plasmapheresis, so bring the kit. Keep checking her blood pressure, and be ready to start norepinephrine the moment it shows any sign of dropping."
The crushing weight of responsibility had finally shifted from my shoulders to Jin Se-hee's. Only then was I able to let out a long, deep sigh of relief.