What Exactly Went in There? (End)
I did my best to ignore Park Seongjeong's bright red face and the deep despair pooling in his pupils. That's right, Seongjeong. You have to grow up tough.
Giving Seongjeong's shoulder one last encouraging pat, I returned to the station and put in a few additional orders.
"The patient is in a lot of pain, so first give him an IM injection of one ampule of ketorolac. And to get that thing out, we need to relax his muscles a bit, so slowly administer 2mg of midazolam IV. It'll make him a bit drowsy and help him relax. That should make it much easier."
"Yes, senior..."
Leaving behind his soulless reply, I returned to my seat. Now, my role was truly finished. I had made the diagnosis, formulated a plan, and even designated the personnel to execute it. Could there be a more perfect delegation of duties? I took a sip of my coffee, feeling immensely satisfied.
But that peace didn't even last five minutes.
"Aaaaaaaaargh!!!!"
A desperate, agonizing shriek—hard to believe it could come from a human being—burst from the depths of Zone B. Everyone at the station reflexively whipped their heads in that direction.
...It seemed Seongjeong had failed. I pressed a hand to my forehead. A scream of that caliber meant he hadn't just failed; he had definitely poked something he shouldn't have.
Sure enough, a nurse came running out. "Dr. Han. The... patient in Bed B-8... I think you need to go over there. The intern was doing something, and then the patient suddenly..."
Damn it, is there no one else? I desperately scanned my surroundings. Another sacrificial lamb—no, another intern—to help me navigate this hellish situation. Right, there was definitely one more. We had two interns on duty today. Ah. Yes. My radar locked onto another pure soul diligently organizing ECG papers on the opposite side of the station.
"Minseong, let's go!"
Choi Minseong. Right, we had him. I sprang up from my seat and strode toward him like a man who had just found his savior. I grabbed him firmly by the shoulders.
"Yes? Senior? Where are we going?"
"There's an incredibly rare and educational case. It's a sight you might see only once in your entire medical career. As your senior, it's my duty to personally guide you and show you these things. Follow me."
Allowing no room for protest, I practically shoved Minseong by the back toward Zone B. Don't worry. Interns are a renewable resource. Probably.
Pushing the curtain aside, Bed B-8 was an absolute disaster zone. The patient was writhing and groaning on the bed, while Park Seongjeong stood there with a pale face, completely at a loss. The latex gloves in his hands made it easy to guess the full story of the catastrophe that had just unfolded.
I let out a deep sigh at the gruesome sight. Then, I slipped on the mask of an incredibly competent and composed senior physician.
"Seongjeong, what happened? Explain calmly."
"Se... Senior... I, well... after giving the injection, the patient seemed to relax, so... I had him lie on his side... and tried to pull it out... but then he suddenly screamed..."
I nodded, assessing the patient's condition. "Seongjeong, did you just tell the patient to relax without instructing him on abdominal breathing?"
"Huh? Abdominal breathing?"
"You should have guided him to take a deep breath into his abdomen and then exhale slowly, letting all the tension leave his body. The sphincter naturally relaxes when you exhale, so you had to aim for that exact timing."
"Ah..."
"And the positioning. You just have the patient lying on his side. You should have had him pull his knees as close to his chest as possible. That's how you secure enough space for the foreign body to come out. In an awkward posture like this, it gets caught inside and won't budge."
I began to logically analyze the cause of his failure step by step. If there was one thing I had studied with absolute devotion during my internship, it was this. Simply because I wanted to avoid witnessing a horrific scene at all costs...
"The most important thing is the direction. You tried to pull it straight out, didn't you?"
Seongjeong's eyes wavered. It seemed I had hit the nail on the head.
"Our colon is a curved structure that bends in an S-shape. Especially because of the sacral bone, there's a curve that bends backward. You can't just ignore that and pull."
At my flawless analysis, the way the two interns looked at me shifted. In truth, this was entirely thanks to me lurking on the forum earlier while drinking coffee, reading an informational post titled Removal of Rectal Foreign Bodies.txt.
"Both of you, come over here and watch closely. They say failure is the mother of success. Building upon Seongjeong's noble failure, we shall now march toward success!"
I declared solemnly as I snapped on a pair of latex gloves. "As of this moment, we begin the second attempt..."
And then, reality hit me. Before me was a patient still writhing in pain and shame, and on my hands were the clean latex gloves I had just put on. Meanwhile, the cold, hard truth echoed in my mind: You are a clumsy-handed fool who can't even insert an IV line properly.
Me? Do this? Personally?
No, I can do this. I just need to follow the theory I literally just explained. Position him, guide his breathing, match the angle...
A perfect simulation ran in my head. However, my body and my hands seemed to have absolutely no intention of cooperating with that simulation. My fingertips trembled slightly. The memory of intern Park Seongjeong's failure and the patient's horrific scream flashed through my mind.
What if... what if I fail too?
What if I, who just spouted that grand theory like some legendary expert and solemnly declared a second attempt, fail in the exact same way?
The nickname "Han Hyeon-jae, the All-Talk-No-Action Keyboard Warrior" will start circulating among the interns.
Besides, this isn't something that absolutely has to be done right this second, nor is the patient's life in immediate danger, right?
I froze. Then, I adopted an incredibly grave and cautious expression. The two interns held their breath, waiting for my next move.
"Actually, no."
"Yes?"
"...We can't do this."
I peeled off the latex gloves I had worn for less than a minute and tossed them into the medical waste bin. "Not right now."
"What... do you mean we can't, senior?" Seongjeong asked.
"Manual extraction. We shouldn't attempt it right now."
I began to explain, putting on my best impression of a doctor making a profound clinical judgment. "Listen closely, guys. Seongjeong made the first attempt earlier. Although it failed, it was an attempt of immense diagnostic value."
Question marks practically popped up over the two interns' heads.
"Through that attempt, we learned one crucial fact: the patient's sphincter tone is incredibly high, far beyond what we anticipated. Furthermore, due to the pain and anxiety caused by the failed first attempt, the probability of success for a second attempt right now is extremely low. If we force it, we risk injuring the rectal mucosa, which could lead to much more severe complications like hemorrhage or perforation."
Adjusting my white coat, I concluded like a wise, seasoned mentor. "In times like this, a true professional doesn't let pride dictate their actions. Choosing the safest and most definitive method is what makes a real doctor. For the patient's sake."
I declared with solemn finality, "Let's call Gastroenterology!"
The two interns stood dazed for a moment at my declaration, but soon nodded, looking deeply impressed. Yes, this is entirely a decision made for the patient's well-being. Absolutely.
Leaving the two interns behind, I sauntered out of Bed B-8 with a perfectly natural stride. Cleaning up was the interns' job. Feeling as though a massive weight had been lifted from my shoulders, I leisurely made my way back to the station.
I sat down in front of the computer and logged into the EMR. I clicked the 'Consult Request' tab and selected 'Gastroenterology'.
Requesting Dept: Emergency Medicine
Receiving Dept: Gastroenterology
Primary Diagnosis: R/O) Rectal Foreign Body
Clinical History & Reason for Consult:
Patient presented to the ER today with a chief complaint of a rectal foreign body. Following a failed initial manual extraction attempt, the patient is experiencing severe pain and sphincter spasms. Continued manual extraction is deemed to carry a high risk of rectal injury.
We request a consultation for endoscopic removal. The patient's vitals are currently stable, and abdominal X-rays show no signs of perforation. We would appreciate a prompt response.
The moment I pressed the enter key, I was liberated from all responsibility and duty. Mwahaha. Now, this headache of a problem belonged to the Gastroenterology resident on duty. I leaned deep into the backrest of my chair.
About twenty minutes after I sent the consult, a man with a face practically dripping with exhaustion approached the ER station. It was the Gastroenterology resident on duty.
"Dr. Han Hyeon-jae from Emergency Medicine?"
"Ah, yes! I'm Han Hyeon-jae." I sprang up from my seat.
"Rectal foreign body... failed first manual extraction. What's the status now?"
"We've administered sedatives and analgesics, and we're currently monitoring him. Vitals are stable, and there are no signs of perforation."
"Hmm..." He stroked his chin, staring intently at the X-ray. Even seeing the vivid silhouette on the screen, his expression barely flickered. Then again, a guy like him probably saw this kind of thing all the time. He scrolled down to check my charting, tilted his head, and asked:
"The chart just says 'foreign body.' So, what exactly went in there?"
The moment of truth had arrived. I quickly scanned our surroundings. Nurses and other doctors were bustling about the station. Lowering my voice as much as possible, I leaned in close and whispered the truth.
"Well, it's..."
"Yes?"
"An adult... yes..."
"..."
The Gastroenterology resident froze.
"Ah... I see..."
He tried his best to maintain a straight face, but he couldn't stop the corners of his mouth from twitching. "Haha... I see..."
Without asking another question, he said, "Let's go see the patient first," and headed toward Zone B. Following closely behind him, I couldn't help but think: This is, without a doubt, the most awkward consult in human history.