A Rare Diagnosis
At this rate, in seven minutes, I would lose 1,000 LP and a hidden trait right before my eyes. This wouldn't do. I had to grasp at straws. In the end, I decided to reach for my last resort. You just can't beat collective intelligence. Once again, I conjured the Deceased Doctors Gallery in the air.
R/O Acute gastroenteritis patient. Chief complaint: N/V/D, abd pain. Vitals stable, labs unremarkable. But showing cold-hot reversal. Feels cold water is warm. What should I rule out first? No time.
The moment I hit the submit button, comment notifications began to flood in like crazy.
Just as I thought. These ghost bastards didn't care about my question at all; they were only obsessing over me. Right then, that familiar IP address appeared again.
Huh...? Fish...? Out of nowhere?
I narrowed my eyes. Southeast Asian travel? Fish? What on earth did those have to do with gastroenteritis symptoms and temperature paresthesia? Even after racking my brain and mobilizing all my medical knowledge, I couldn't find a connection. The suggestion of a stroke from 'Descendant of Hippocrates' sounded far more plausible.
I doubted the gallery—or rather, that anonymous user, 118.235. But I had no other options right now. Four minutes remaining. It was worth a shot anyway. I headed back to Bed B-17.
The patient, groaning with a face even paler than before, forced his eyes open as he saw me.
"Doctor... what is it now...?"
"Sir, I just need to ask you a few more questions. It's very important. By any chance, have you recently traveled to Southeast Asia?"
The patient shook his head.
"Southeast Asia? The only place I've ever been in my life is Jeju Island. What Southeast Asia?"
The first clue missed.
"Then, did you eat raw fish or some unusual fish dish yesterday or today? Something you don't normally eat."
At my question, the patient's eyes flickered faintly.
"Ah, fish!"
"Yesterday for lunch, my company president came back from the Philippines and made some braised fish... What was the name of it? Lapu... Lapu-something, he called it. About three or four hours after eating that, my stomach turned upside down, and this whole mess started."
A fish from the Philippines, Lapu-lapu.
I shouted to the patient, "Understood, please wait just a moment!" and ran like mad back to the station. Then, I immediately posted a second thread on the gallery.
Okay, I got the answer, but why did you tell me to ask? The patient recently ate a fish from the Philippines (Lapu-lapu). No travel history, said an acquaintance brought it back. What is this?
Not even a second after my post went up, the gallery exploded.
Are these crazy ghosts out of their minds? Just then, amidst the flood of mockery, the answer I wanted finally appeared.
Ciguatera. Ciguatoxin. Right, there was such a thing. That rare toxin I had only casually underlined in my textbooks, thinking I would never encounter it in Korea in my entire life. In the end, I had found the answer again with the help of these crazy ghosts. Of course, I was treated like a total quack in the process.
There was no time now.
"Dr. Choi!"
I shouted toward my senior, who was sitting at the station.
"The patient in Bed B-17 has ciguatera fish poisoning!"
Every sound at the nursing station instantly died. The rustling of charts, the ringing of phones, the idle chatter—everything stopped. My senior's eyes were filled with utter bewilderment, as if asking, What kind of bullshit is he spouting now?
"Hyeon-jae, wait. Ciguatera? That tropical fish toxin?"
Her reaction was perfectly normal. Ciguatera. At best, it was a disease that occasionally popped up in case reports from the southernmost regions like Jeju Island. A textbook illness that a clinician working in Korea might encounter once in a lifetime, if ever. And a first-year resident had diagnosed such a rare disease in a gastroenteritis patient? If I were in her shoes, I wouldn't believe it either.
Catching my breath, I quickly continued.
"The patient said he ate a dish made from a fish called Lapu-lapu yesterday, which an acquaintance caught directly in the Philippines. His gastrointestinal symptoms started a few hours later, and now he's even showing signs of cold-hot reversal."
As soon as I finished speaking, my senior's eyes widened.
"...Ah, wait! You're right!"
With a short exclamation, she spun around without hesitation and placed her hands on the keyboard.
Clack-clack-clack-clack!
She began entering orders into the EMR at a furious pace.
"Start another IV line, and load 20% mannitol calculated at 1 gram per kilogram over 30 minutes! Right now!"
"Keep the EKG monitoring going, and check his blood pressure hourly! Watch closely for bradycardia or hypotension!"
"Administer 300 milligrams of gabapentin immediately, and if the pain isn't controlled, give more on schedule!"
"We need to monitor his urine output, so insert a Foley catheter right away!"
Wow, holy shit. I stared blankly at the scene, utterly amazed. A third-year resident wasn't a third-year for nothing. Her speed was on a completely different level. I had merely thrown out the diagnosis of ciguatera, and without even needing time to think, she was pouring out a storm of orders. Was this the power of experience? If it had been me, I would have had to look up books, ask seniors, and agonize for ages just to write those orders one by one. But she had wrapped up the entire process in a matter of tens of seconds. I felt a genuine surge of respect for her. She was the savior who had saved my life—or rather, my LP.
Just before the quest timer ran out, Dr. Choi Sumin finally slammed the enter key, confirming the final order.
Phew. I did it. I let out a sigh of relief. Although I hadn't done anything other than provide the diagnosis, the quest was still a success. 1,000 LP and a hidden trait. I wondered what the hidden trait would be. I was practically drooling with anticipation. Hehehe.
At that exact moment—
Ding!
With a quiet, cold chime, a new system window popped up in my field of vision.
[You have delegated the treatment to another doctor!]
[Acquired LP is reduced by 50%!]
[Final Reward: 500 LP, Hidden Trait Unlocked (Locked)]
"..."
My brain ground to a halt.
What? Acquired LP reduced by 50%? 1,000 points instantly became 500. To make matters worse, there was a goddamn set of parentheses next to the hidden trait unlock: (Locked).
No, I was the one who asked the gallery and reported it! I was the one who found it! Just because my senior wrote the orders, the reward was cut in half? How incredibly irrational and absurd!
I heard something snap inside me. Fatigue, tension, and anger at the injustice blended together, paralyzing my brain. Before I knew it, my inner thoughts slipped past my filter and out of my mouth.
"Son of a fucking bitch!"
It was too loud to be a mutter, yet too quiet to be a shout.
The rapid clacking of my senior's keyboard abruptly stopped.
The entire atmosphere of the ER froze solid.
Dr. Choi Sumin slowly turned her gaze away from the EMR screen and looked at me. Her face was an unreadable mask of shock and bewilderment. Parting her lips, she asked me quietly,
"...Hyeon-jae, what did you just say?"
...Uh? Did I just curse out loud? Seriously? Did it actually come out? A swear word? Right in front of my senior? Am I completely insane?
Yes. Han Hyeon-jae, a first-year Emergency Medicine resident. A total bottom-of-the-barrel rookie. I had just become the lunatic who swore directly to the face of a third-year senior—the one known as the Angel of the ER—right after she wrote her orders.