Slipping Through the Cracks
The Department Head's boisterous laughter echoed through the ward. Only after his heavy hand gave my shoulder a few more hearty pats did he finally look satisfied. "Right, keep up the good work," he said, before turning to leave with the fellow.
I remained bent at a ninety-degree angle, not straightening up until they had completely vanished from sight. When I finally stood, my senior, Choi Sumin, was staring at me with a complex expression—a mix of sheer disbelief, pity, and a strange touch of respect. "Hyeonjae... your survival skills in the workplace are truly next-level."
I could only offer a weak, hollow laugh.
I had just wasted eight precious minutes playing the dutiful junior to the Department Head. Forcing my frayed sanity back into order, I dragged over an empty chair at the nurse's station and sat down.
I had to find the patient. Zone A, the Resuscitation Room, the isolation rooms—every critical care area in the emergency department was currently empty. That left only one possibility: a patient triaged as mild or moderate whose actual condition was rapidly deteriorating. Someone slipping through the cracks, neglected because the doctors and nurses had failed to notice.
I logged into the EMR system. The familiar hospital logo flashed on the screen, followed by a list of every patient currently admitted to the ER. Scrolling down, I began opening the charts of the patients in Zone B's general observation beds, one by one.
First patient. A twenty-four-year-old female. Chief complaint: abdominal pain. She had presented with mild, dull pain in her lower abdomen starting the previous evening. Vitals were stable. Lab results were completely normal. The charting by the examining doctor read: R/O simple gastroenteritis. This is probably just constipation or menstrual cramps. Pass.
Second patient. A thirty-eight-year-old male. Chief complaint: common cold. A cold? He had a runny nose, a cough, and a mild fever starting two days ago. When asked why he came to the ER, he said he just dropped by after work because the hospital was near his office. This is a tertiary university hospital emergency center. Did he have any idea how much his out-of-pocket copay was going to be? He could have easily gone to a local clinic. I wouldn't dream of coming here for a cold, if only to save my own money. Suppressing my rising irritation, I clicked on the next chart.
Third patient. A forty-five-year-old male. Chief complaint: severe intoxication. The police had brought him in after finding him passed out on the street. Blood alcohol concentration: 0.25%. Vitals were stable. He was just sleeping it off. Pass.
Fourth, fifth, sixth... Cold, body aches, headache, indigestion, dizziness, cold, cold, cold.
"Ah... damn it." A curse slipped out before I could stop it. My finger on the scroll wheel grew heavy. Something was wrong. Not a single one of these patients was anywhere near death. In fact, the vast majority of them could be discharged right this second without a single issue.
I let go of the mouse and leaned back, stretching my stiff neck. The crimson quest window hovering in my field of vision seemed to glow even brighter.
Time was slipping away, but instead of finding clues, my skepticism was only deepening. Ugh... Is this system window pulling my leg? Maybe this whole thing was just an elaborate hallucination playing out in my own head. Maybe diagnosing VEXAS syndrome had been nothing more than a fluke, and this urgent quest was just a red herring thrown by the system to mock me. It was a perfectly rational suspicion, wasn't it?
But... those rewards—1,000 LP and Unlock Hidden Trait—were far too tempting to ignore. And what if there really was a patient I had overlooked? Again. From the beginning. I forced my doubts down and dragged the scroll bar back to the very top.
Age, gender, underlying conditions, current medications, allergies... I cross-referenced every single lab value against the normal ranges, comparing them with historical data to spot any subtle trends. I pulled up the X-rays and CT scans again, squinting at the images to see if the radiologists had missed some microscopic lesion.
But the results were identical. Clean. Impeccably clean. It was a parade of textbook mild cases. Not a single shadow of death loomed anywhere. I finally slumped back against my chair, utterly defeated. Time was marching on mercilessly; now, less than thirty minutes remained. My adrenaline had completely bottomed out, leaving nothing but bone-deep exhaustion and a crushing sense of failure.
Where on earth could they be? A patient dying neglected within the hospital. The phrasing of the quest echoed in my mind. Was I missing something incredibly basic? Or was the patient not even in the emergency room to begin with? In the end, I slammed the EMR window shut. The letters and numbers on the screen weren't going to give me the answer.
I stood up and began to pace the ER floor. I scanned the beds in Zone B one by one, looking around. The quest's timer was down to barely twenty minutes. Anxiety clawed at my throat, but I did my best to maintain a facade of calm, playing the part of a relaxed doctor doing his rounds.
Approaching one bed, I yanked the curtain aside. A woman in her twenties, who had been sleeping soundly, jolted awake. "What is it, Doctor...?" her eyes practically screamed, Who is this psycho? I spent a single second scanning her face and the vital signs on the monitor beside her bed. Stable heart rate, normal oxygen saturation. Nothing wrong here.
"...Ah, sorry. Just making sure your blood pressure is holding steady. Please, go back to sleep..." I stammered an awkward excuse and hastily pulled the curtain shut. My face burned under the weight of her utterly bewildered glare.
I repeated this madness a few more times. I lightly pinched the foot of a sleeping drunk to check his responsiveness, and flashed a penlight into the eyes of a patient complaining of a headache to check their pupillary reflex. The patients' grumbles and the nurses' highly suspicious stares stabbed into my back like daggers.
Wandering aimlessly, my feet finally came to a halt in front of Bed 17 in Zone B. A middle-aged man in his mid-fifties lay there, groaning in discomfort. Beads of cold sweat dotted his forehead, and his face was pale. He was the picture of a classic acute gastroenteritis patient—the same one I had seen on the EMR earlier. He had presented with vomiting and abdominal pain, and was currently being monitored on IV fluids under the assumption of food poisoning.
Hmm, was there anything unusual about him? I pulled my phone from my pocket and opened the EMR app to check his chart again. A fifty-four-year-old male. Chief complaint: vomiting, diarrhea, and abdominal pain. R/O acute gastroenteritis. His vitals were stable, and his labs showed nothing out of the ordinary except for mild dehydration. It was literally nothing. A textbook case. There was absolutely no way a patient like this was on the verge of death.
Just as I was about to turn away in disappointment, the man weakly called out to me. "Excuse me... Doctor."
"Yes, sir. Are you alright? Is your stomach still bothering you?"
"No, it's not that. It's just... I'm having a hard time sitting up. Could you bring me a cup of water? My throat is absolutely parched..."
Well, the water dispenser was right by the nurse's station, so I could easily do that much. I nodded and walked over, filling a paper cup to the brim with ice-cold water. I brought it back and handed it to him.
"Here you go. Drink slowly." The man gave a grateful nod, took the cup, and took a sip. Then, he said something incredibly bizarre.
"...Oh! Doctor, you didn't have to go through the trouble of getting me warm water. Cold water would have been fine, haha. But thank you anyway."
"..." I stared at him, doubting my ears. Warm water? Something was wrong. I had definitely pressed the blue button for cold water. Even without tasting it myself, the condensation forming on the surface of the paper cup made it glaringly obvious that this water was ice-cold. Yet, the patient perceived it as warm.
"Sir, does the water feel warm to you?"
"Huh? Oh, not boiling hot like lava or anything. Just lukewarm. I just prefer cold water, that's all. Haha."
The man chuckled as if it were nothing, but I couldn't bring myself to smile. Alarm bells were screaming in my head. I quickly glossed over the situation. "I see. I'll make sure it's cold next time," I said, before retreating to the nurse's station. My heart was hammering against my ribs.
I marched straight up to Choi Sumin and explained what had just transpired. "Senior, the patient in B-17. He's here for gastroenteritis, but when I gave him ice-cold water, he complained that it was warm. I think he has a temperature sensation anomaly."
Choi Sumin's eyes sparked with interest. She pulled up the EMR and thoroughly reviewed the patient's chart once more. "A temperature sensation anomaly... That is a highly unusual symptom, but it's a bit too vague to act on by itself. Severe dehydration or electrolyte imbalances can cause temporary sensory disturbances... or, in very rare cases, it could be a neurological issue."
Resting her chin in her hand, she pondered for a moment before arriving at a standard, textbook conclusion. "Let's run a repeat lab first, and maybe put in a consult to neurology? We can ask the neurology resident on duty to take a look at him."
As expected, there was no immediate breakthrough. The symptom was simply too vague and non-specific; we lacked any solid ground to suspect a particular diagnosis and dig deeper. "Understood," I replied, though my insides were twisting with anxiety.
How long would it take to submit the neurology consult, wait for the resident to come down, examine the patient, run the tests, and finally pinpoint the cause? Would this patient—and my quest—even survive that long?
Standing alone in the corner of the nurse's station, I stared anxiously at Bed B-17. I'm almost certain it's him... What do I do? Should I post a thread on the Deceased Doctors Gallery floating in my mind? But what would I even write? '54M, presenting with gastroenteritis symptoms and a temperature sensation anomaly. What could this be?' Like that? There was no guarantee I'd get a clear, definitive answer like I did with the VEXAS case.
...Screw it, I have to try.