A Chaotic First Conference, Part 5
We dragged our heavy feet and walked into the waiting crowd. The sea of people parted for us like the Miracle of Moses. Fuck. This is way too much pressure. Every single eye in the room locked onto Kim Ji-hoon and me.
"They're here."
"Is that Dr. Han Hyeon-jae?"
"He's way younger than I expected."
"Of course he is. He's only a first-year resident."
Forcing a calm expression, I stood in front of the poster bearing my name. Beside me, Kim Ji-hoon took his place in front of his own poster, looking half-dead and utterly checked out.
"The patient's final diagnosis was a right coronary artery occlusion. Could you explain the correlation with the sore throat symptom in a bit more detail?"
"Certainly. The right coronary artery is a crucial vessel that supplies blood to the inferior wall of the heart and the right ventricle. Ischemic pain in this region often radiates to the neck, jaw, and back. This phenomenon occurs because the pathways of the vagus and sympathetic nerves, which innervate both the heart and the neck, partially overlap in the thoracic spinal ganglia..."
I fluently rattled off the contents of the paper I had memorized all night, pretending it was my own innate knowledge. It was a model answer I had prepared in advance, one that the ghosts had reviewed dozens of times. The doctor who asked the question nodded in satisfaction.
The initial atmosphere wasn't bad. The questions were well within my expected range, and I spat out the answers with absolute precision. If things kept going like this, I would get through this unscathed.
Right then, Professor Kim Hyuk-jae of Ohsung Seoul Hospital—the man who had been eyeing me closely in the seminar room earlier—raised his hand.
"Dr. Han, excellent presentation. It's a highly intriguing case. However, I do have one question."
Thump. What now?
"In a state of extreme physiological stress like myocardial infarction, it is rare but possible for ischemic damage to occur in other organs as well. Especially in patients with underlying vascular disease, did you consider the possibility that non-occlusive mesenteric ischemia, triggered by a drop in cardiac output, could present as atypical laryngopharyngeal discomfort? If both conditions had occurred simultaneously, what would be the key clinical clue to differentiate them in the ER?"
Silence fell over the crowd.
...Mesenteric... what?
My brain ground to a complete, screeching halt.
NOMI? Non-occlusive mesenteric ischemia? Sure, I'd read about it in textbooks. But I had never, not even once, imagined I would be asked to differentiate it in a myocardial infarction patient presenting with a sore throat.
Professor, this isn't a question a first-year resident can answer.
I couldn't utter a single word, my mouth merely hanging open like a fish. Cold sweat poured down my spine.
"Uh..." I barely managed to squeeze out a sound. "Could... could I have a moment to think before answering?"
Just like that, I declared surrender in the face of the worst crisis of my medical career.
The gallery. The forum. Please.
Murmurs began to ripple through the crowd.
"Where is he looking? The empty air?"
"What's wrong with him? Did he suddenly lag?"
"Well, they do say geniuses are always a bit eccentric. I guess it's true."
"Ah, yes. I will answer your question."
At my calm voice, the murmuring crowd fell silent once more.
"Thank you very much for your insightful question, Professor. In a state of extreme stress such as acute myocardial infarction, the possibility of concurrent non-occlusive mesenteric ischemia is indeed a crucial differential diagnosis to consider. This would be especially true if the patient were elderly or had underlying vascular disease."
Whew, calm down. My voice trembled slightly, but I pressed on.
"However, in the case of the patient I treated, the abdominal physical examination performed upon admission showed absolutely no signs of peritoneal irritation, such as abdominal distension, localized tenderness, or rebound tenderness. Furthermore, the initial blood tests showed no significant elevation in lactate levels that would suggest metabolic acidosis."
Now was the time for the conclusion.
"If both conditions had manifested simultaneously, it is highly probable that we would have seen a rapid rise in lactate levels due to intestinal ischemia alongside the elevated cardiac enzymes. Therefore, based on the patient's clinical presentation and laboratory results at the time, we tentatively ruled out NOMI as highly unlikely."
Once I finished speaking, silence fell over the room again. Then, Professor Kim Hyuk-jae burst into a hearty laugh, looking immensely satisfied with my response.
"Haha! This kid is the real deal! A first-year resident operating at this level? Our generation couldn't even compare!"
At his high praise, the other professors standing nearby nodded in agreement. I bowed awkwardly, offering a sheepish smile amidst the shower of compliments.
"Oh, you flatter me, Professor. Thank you."
"I'm not joking. If you ever find yourself interested in a critical care subspecialty or a fellowship later on, make sure to contact me. Ohsung is the absolute best in this field, haha!"
"Thank you, Professor."
With my reply, the intense focus on me began to die down. A few other residents lobbed a couple of minor questions my way, but they weren't a problem. I parroted my pre-prepared model answers like a well-trained machine.
Once the questioning for me wrapped up, Professor Park Ju-sung of Seoul Catholic Sacred Heart Hospital—one of the professors who had been interrogating me—shifted his gaze to the side.
"Who is this? Poster number P-116... Kim Ji-hoon? Cheongjin Medical Center. Oh, you two are co-residents?"
Professor Park scanned Kim Ji-hoon's poster with an intrigued look. The topic was 'A Case of Rhabdomyolysis Induced by Excessive CrossFit.' It was a standard, educational case commonly seen in the ER these days.
Oh, Ji-hoon. I'm so sorry.
Because of my flashy debut, the judges' expectations had skyrocketed to an absurd degree. The professors probably expected every single first-year resident from Cheongjin Medical Center to be a freak of nature like me. In reality, Kim Ji-hoon was just a normal, hardworking first-year.
Sure enough, Professor Park opened his mouth.
"Dr. Kim Ji-hoon. Excellent presentation. The patient's CK level being over 100,000 was highly impressive. Of course, the most concerning complication in such severe rhabdomyolysis is acute kidney injury."
What on earth was he going to ask?
"Here is my question. To prevent the myoglobin excreted in the patient's urine from obstructing the renal tubules, fluid resuscitation is commonly paired with urine alkalinization therapy. Could you give me your perspective on the ongoing controversy regarding whether this urine alkalinization therapy actually improves patient outcomes?"
Fuck. I cursed inwardly.
That was not a question you threw at a first-year Emergency Medicine resident. Go ask a nephrologist, you old bastard. Why the hell are you asking Ji-hoon this?
Kim Ji-hoon's face drained of all color. Cold sweat beaded on his forehead as he desperately racked his brain.
"Ah... yes... well... Professor..." Ji-hoon began to stammer.
"For rhabdomyolysis patients, um, uh, the primary focus is to aggressively administer... a sufficient volume of fluids to, um, secure adequate urine output. That is the most important step."
It was a textbook answer straight from page one.
"And... um... urine... alkalinization can also... uh, help prevent kidney damage..."
Ji-hoon's voice trailed off into a whisper, his eyes darting anxiously to the floor.
Professor Park didn't press any further. He merely gave a faint, brief nod and moved on to the next poster.
Once the crowd dispersed and the attention faded, only Kim Ji-hoon and I were left standing in front of our posters. My poor, unfortunate co-resident... Ji-hoon called out to me.
"Hyeon-jae."
"Yeah?"
"Am I... am I just an idiot?"
I couldn't bring myself to answer right away. "Uh..."
What was I supposed to say? Would telling him, No, you're not an idiot, actually comfort him? And telling him, Yeah, you're an idiot, would just make me a total asshole.
"If it were you... you would've been able to answer that, right? What that professor asked."
"...No?" I shrugged as high as I could, putting on a completely clueless expression. "I didn't know either."
Kim Ji-hoon's eyes went wide. "Huh? You didn't know either? Seriously?"
"Of course not, you dummy."
I nudged his shoulder. "I only dug insanely deep into my own paper's topic—the myocardial infarction presenting as a sore throat. I organized and memorized every single potential question and expected answer for that specific case. But rhabdomyolysis? The efficacy of urine alkalinization? How the hell would I know that? It's not my specialty."
Thanks to my shameless acting, the dark shadow hanging over Ji-hoon's face slowly began to lift.
"Wow... you crazy bastard." A curse filled with pure awe escaped his lips. "Just how hard did you prepare to be able to spit out answers like a machine without even blinking in front of those professors? My heart felt like it was going to explode. You're an absolute lunatic."
"Tsk." I smacked him hard on the back. "That's why you should've prepared properly beforehand, my friend."
Kim Ji-hoon couldn't find a single word to argue back. He just stared at me with a look that said, This guy is seriously relentless.
Sorry, Ji-hoon. This is the only way we both survive. I couldn't exactly tell him that the online community I frequented was populated by ghosts.
Just as a slightly awkward but warm sense of camaraderie was blossoming between us...
"Oh, how did it go? There was a huge crowd over here earlier!"
Professor Cheon Eun-jung, who had been checking out other presentations, waved and walked over to us.
"I got absolutely destroyed, Professor," Ji-hoon said. Then, loyal to the end, he gave me all the credit. "Hyeon-jae carried the entire team by himself."
"Oh, really?" Professor Cheon looked at me with an immensely satisfied expression, as if she had expected nothing less. I could only scratch the back of my neck and offer an awkward laugh.