Something Went in There (1)
After sending the TTP patient up to the ICU, I sank deep into my chair at the station. As the tension drained from my body, a wave of exhaustion washed over me, accompanied by a strange surge of confidence coursing through my veins. Yes, I did it again! Although the help of the forum ghosts had been absolute, in the end, I was the one who made the call, shouted the orders, and took action.
Performing an open laparotomy, getting dragged to a disciplinary committee, and diagnosing a TTP patient. In just a few days, I had experienced a lifetime's worth of events that other first-year residents might only encounter once throughout their entire training. Haha! I'm a madman! A hospital-certified lunatic!
I wore a highly satisfied smile as I waited for the next patient. Right then, the triage nurse called me over the intercom. Her voice carried a subtle, unusual hint of embarrassment.
"Dr. Han, in Zone B... um... a somewhat... serious patient has arrived. I think you need to take a look."
A serious patient? I tensed up reflexively. What happened now? Yet, the nurse's voice didn't sound particularly urgent. Besides, if it was so serious, why did she assign the patient to Zone B in the first place?
I got up from my chair and headed toward Zone B. As I approached the curtained bed, I heard a man groaning in pain from inside. Taking a deep breath, I pulled back the curtain.
On the bed, a man in his thirties was curled up on his side. His face was flushed beet-red with agony.
"What brings you in today? Where does it hurt?"
At my question, the man couldn't bring himself to meet my eyes. Clutching the blanket tightly, he mumbled.
"Um... Doctor... I, by mistake... in my butt... something went in there."
...Excuse me? I doubted my own ears. What did he just say? His butt?
"Can you... do something about it? It really just slipped in by accident," the man pleaded, on the verge of tears.
I froze for a solid second. The extensive list of differential diagnoses for every fatal disease I had mentally rehearsed over the past few days vanished like a puff of white smoke. It felt as if my brain had been completely hard-reset.
Ah. It's that.
The legendary case that only whispered down through ER folklore. My newfound confidence and medical insights were utterly useless in the face of this primal problem. Why the hell would you put something like that in there?
I forced the corners of my mouth upward, offering the patient the gentlest smile I could muster.
"Ah, yes... Just a moment, sir. We'll take care of it right away. Please wait just a bit."
I pulled the curtain shut and stepped outside. Fuck. Oh my god. Please. I began scanning the ER with sharp, predatory eyes. Hmm. Let's see. Aha! Found you!
My radar locked onto a fresh, energetic intern diligently charting in the corner of the station. His name was... right, Park Seong-jeong.
"...Hmm, where's the intern? Where did our intern go?" I muttered slyly to myself as I crept up directly behind him. Then, I gave Park Seong-jeong's shoulder a highly friendly pat.
"Seong-jeong."
"Yes? Dr. Han?" Park Seong-jeong spun around, startled. His eyes were filled with the pure, untainted passion of someone who had yet to taste the bitter realities of the world. Yes, that look. With eyes like that, I can entrust this to him.
I wore the smile of an incredibly benevolent senior and rested my hand on his shoulder.
"Seong-jeong, a patient just arrived at Bed 8 in Zone B, and the case is highly educational. It's a rare case that you might never see again in your entire life if you miss it during your internship. Do you want to take charge of it? Of course, I'll be right by your side to guide you."
"Really? What kind of case is it?" Seong-jeong's eyes sparkled with curiosity.
"A... rectal foreign body."
"...Excuse me?" The pure passion instantly drained from Seong-jeong's face, replaced by an expression of one hundred percent pure despair.
"I'm counting on you." I gave Seong-jeong's shoulder another firm squeeze. Yes, work hard, Seong-jeong. You've got this.
"What? Dr. Han? No, wait, just a second!"
Leaving Seong-jeong's panicked cries behind, I threw back a hearty word of encouragement.
"That's it, Seong-jeong! You can do it! Fight on!" *Scamper.* I made my escape at the fastest walking pace of my life. A desperate cry, bordering on a sob, echoed from behind me.
"Dr-Dr. Han!"
I'm sorry, Seong-jeong. But it can't be helped. That is the destiny of an intern. I'm a first-year resident now, so I have to look at the bigger picture. Rationalizing it to myself like that, I leisurely strolled back to the station.
Savoring the sweet aroma of freshly brewed instant mix coffee, I was admiring my own brilliant judgment. Yes, this is strictly for educational purposes. One must personally experience such primal cases to grow into a true physician. As a first-year, I am a wonderful senior who has provided a junior colleague with a precious learning opportunity. Feeling quite proud of myself, I took a sip of my coffee.
However, that peace did not last long.
"Dr. Han!" A moment later, Intern Park Seong-jeong returned from Zone B, calling out to me with a flushed, agitated face. Hmm, did something happen? I greeted him with my most benevolent and generous senior smile.
"Ah, yes, Seong-jeong. How was it? Was it a highly informative and rewarding experience? How is the patient doing?"
At my question, Seong-jeong's lips trembled.
"Doctor..."
"Yeah?"
"I went over there... and literally nothing has been done except for the history taking..." His voice was thick with resentment.
"Even on the chart, there's just one line..."
DIAGNOSIS:R/O Rectal foreign body
"...The patient keeps saying it hurts, but there isn't a single order placed... I didn't know what to do..."
I listened to the intern's protest without so much as blinking an eye.
"Oh, really? I must have forgotten because I was so distracted earlier. Haha. My bad, Seong-jeong. It could have been bad if you hadn't come and told me. I knew you were smart."
I patted Seong-jeong on the back and naturally guided him over to the computer at the station.
"Alright, Seong-jeong. Take a seat. From now on, I'll teach you one by one what basic orders we need to place for patients like this."
Keeping him standing right next to me, I opened the order window.
"First, NPO. This is the absolute basic of basics. Why? Because we don't know yet if we can extract it manually, or if we'll need an endoscopy or surgery. Since a situation requiring anesthesia might arise, we must keep them fasting."
I clicked the NPO order.
"Next, the IV line. Why do we give IV fluids? Because they can't eat. And we need to secure a route for medications in advance just in case of an emergency." I placed the fluid order.
"And the most important part: the tests." I opened the radiology order window.
"Now, Seong-jeong. Do you know what the most critical thing to look out for in a patient like this is? Perforation. Whether the bowel is torn or not."
Seong-jeong shot me a look that said, Do you really think I'm an intern who doesn't even know that? but I deliberately ignored it.
"If the foreign body punctures the intestinal wall and fecal matter leaks into the abdominal cavity, it can immediately lead to peritonitis, septic shock, and death. That's why we take abdominal X-rays. One flat, and one upright. Do you know why the upright view is absolutely essential?"
"To... check the distribution of bowel gas...?"
"Ding-dong-dang! Exactly. To be precise, we're looking for free air under the diaphragm. If there's a perforation, a crescent shape of air will appear right beneath the diaphragm. The moment you see that, you think, Oh, we're fucked! and immediately call general surgery and run to the OR."
Seong-jeong once again gave me a look that said, Do you really think I don't know this? Whatever.
"Yes..." I entered the X-ray orders with a highly satisfied smile.
A short while later, the X-ray results popped up on the screen. I tapped Seong-jeong on the shoulder and said,
"Alright, come take a look." We stood side-by-side, staring intently at the monitor. Fortunately, no free air was visible beneath the diaphragm. That meant no perforation. Breathing a sigh of relief, I scrolled down and zoomed in on the pelvis. And there it was. A very clear, vivid silhouette inside the rectum.
All sorts of medical knowledge and internet rumors began to jumble together in my head.
Hmm, it's not radiopaque. It's not metal or glass. Looking at the density...
This was... that... that thing. Ah, fuck. What on earth do you have to do for a device like that to "accidentally" slip in? I couldn't hide my sheer astonishment.
"Doctor... what is... that?" Seong-jeong asked beside me in an innocent voice. It seemed the intern had not yet recognized the true nature of this sacred object.
I hesitated to answer for a moment. How was I supposed to explain this here? Just then, two female nurses walked past us, chatting. I flinched instinctively. It was... somehow embarrassing. It was just my patient, not me, but I felt a strange urge to protect his dignity.
I grabbed Seong-jeong's shoulder and pulled him close. Then, I whispered the highly precise medical term into his ear.
"..."
The moment I finished whispering, Seong-jeong froze solid. The intern's pupils dilated wider than any I had ever seen in my life. He slowly turned his head to look back at the X-ray screen, then turned back to look at me. Yes, welcome to the ER.