Despair (1)
The word "quiet" that slipped from Baek Eun-seo's mouth was more powerful and immediate than any ancient god's curse. Honestly, even if someone were to hurl double-barreled curses at God, Buddha, and Allah all at the same time, it would be hard to conjure a hex more potent than that. The fleeting peace of the emergency room shattered into a million pieces.
The moment a nurse picked up the receiver, a torrent of frantic, unintelligible shouting seemed to spill out from the other end. Her expression rapidly soured. "Yes, yes, what's the location? A truck versus a sedan... Yes... The patient's condition? Yes, one moment. I'll connect you to a doctor right away."
A truck versus a sedan? I needed to gather whatever information I could right now. Was it the truck driver coming in, or the sedan driver? Were there any passengers?
"Dr. Han! Take this call! It's a trauma call!"
With a racing heart, I pressed the receiver to my ear. "Yes, this is Dr. Han Hyeon-jae, Emergency Medicine."
"Yes, Doctor! This is the Dongrae Sajik paramedic team! We have a truck-versus-sedan TA at the entrance of Mandeok Tunnel!"
Over the line, the wail of sirens and a chaotic din of background noise blended together. It sounded like a massive accident. "What's the patient's age? How long did extrication take? Did they get him out immediately?"
"Male patient in his twenties, driver of the sedan! He was pinned inside the vehicle and was extricated after twenty minutes!"
Reflexively, I grabbed a pen and began scribbling everything down furiously on a blank sheet of A4 paper. "How is the patient? What are the vitals?"
"Patient's mental status is stupor, BP is seventy over forty, and heart rate is tachycardic at over one hundred and forty! Suspected open pelvic fracture with severe hemorrhaging! Field GCS is seven—E1, V2, M4! ETA is five minutes!"
GCS 7. Practically comatose. BP 70/40. Ugh, profound shock. And an open pelvic fracture. The absolute worst of the worst. Probability of damage to the aorta or vena cava? Extremely high. A hellish injury with a mortality rate easily exceeding fifty percent. This was bad. My hand flew across the paper.
- Open Pelvic Fx / GCS 7 / BP 70/40, HR 140+ / ETA 5 min
As I wrote those words, I saw the first-years staring at the paper with grim expressions. Yeah, welcome to the ER, babies. I tore off a corner of the paper and scribbled on it.
Page any attending, fast.
I silently shoved the scrap of paper into Park Seong-jeong's hand. He stared blankly for a second, but once my intention clicked, he bolted toward the residents' office like a madman. Keeping the receiver pressed to my ear, I began tapping away at the keyboard with my free hand. Let's see... ICU... ICU...
[Trauma Intensive Care Unit (TICU-01)] [19/20]
ICU... There's one TICU bed open. Okay. Operating rooms... No emergency surgeries currently in progress. I threw another question to the paramedic while simultaneously mapping out the worst-case scenario in my head. "Do you have lines established in both arms? How much fluid has been administered?"
"We secured one side with an 18-gauge, and we're running a one-liter fluid bolus wide open, but there's almost no blood pressure response!"
Right then, Lee Min-jae came sprinting into the station. Without a word, I slid the scribbled memo over to him. Lee Min-jae's face hardened. His eyes darted between me and the computer screen. I grabbed the pen and quickly wrote two words in the margin of the paper.
Accept patient?
Lee Min-jae didn't hesitate for even a second. He looked straight at me and gave a firm nod. I pressed the receiver back to my mouth. "Yes, we will accept the patient."
The moment I hung up, I looked at Lee Min-jae standing behind me. "Patient ETA is five minutes! We're forming a team right now. As for the lead... I'll take it. I'm the team leader, and I'm assigning roles starting now!" His finger began pointing at each of us with pinpoint accuracy.
"Han Jae-eon!"
"Yes, sir."
"You're the most senior resident here, so you're on Airway. Once the patient comes in, protect the C-spine, assess the airway status immediately, and if necessary, don't hesitate—prepare for intubation right away."
"Understood," Han Jae-eon replied curtly, immediately beginning to inspect the laryngoscopes and endotracheal tubes.
"Han Hyeon-jae!"
"Yes, sir."
"You're on Circulation. When the patient arrives, you and I will flank him on both sides to locate and control any visible bleeding points. While I perform the FAST scan, you'll apply pressure to the abdomen or pelvis to help maintain blood pressure. Keep your head in the game."
"Yes, sir!"
"Baek Eun-seo!"
"Yes, sir!"
Baek Eun-seo, who had only recently promoted to a second-year but was still green, had a face pale with extreme tension.
"You're on procedures. Prepare to secure 18-gauge IV lines in both arms, and get the ABGA kit and Foley catheter set ready beforehand. Execute whatever we order immediately. Got it?"
"Yes! Understood!"
"Lastly, Park Seong-jeong!"
"Y-yes, sir!"
Park Seong-jeong looked like he was on the verge of tears. *Suck it up. If you want a good work-life balance, you have to endure a little hell while you're on the clock.*
"You're on recording duty. Stand in front of that whiteboard. From now on, record every single intervention we perform, the patient's vitals, the names and dosages of the medications we use, and the exact time down to the second. Got it?"
"Yes, sir!"
Just like that, our ragtag group transformed into a cohesive unit in an instant. Our roles were set. I rushed to the resuscitation room corridor and slipped on a heavy, uncomfortable lead apron. Over it, I donned a plastic gown, pulled on gloves, and finally strapped on a face shield.
Amidst the frantic scramble, Lee Min-jae's thunderous voice roared out. "Hey, hey! Park Seong-jeong! Face shield!"
"Ah, yes, sir! I'm sorry!"
Park Seong-jeong was so nervous he had forgotten the most basic protective gear. He scrambled to find a face shield and shoved it onto his head.
"Are you going to march onto the battlefield without a rifle? Get your head straight!"
Before Lee Min-jae could finish his scolding, Baek Eun-seo slammed down a receiver at the station and shouted, "Doctors! I just paged the on-call trauma surgery and orthopedic residents! They said they'll head down as soon as they finish what they're doing!"
"Good!"
The nurses sprinted to their respective positions. One wheeled over the crash cart, while another prepared the IV fluids and blood transfusion sets. Park Seong-jeong stood before the whiteboard, his face completely bloodless, his hands trembling so violently he could barely pop the cap off the marker. *With nerves like that, how is he ever going to survive as an Emergency Medicine physician?*
All preparations were complete. As if by unspoken agreement, we took our places around Resuscitation Bed 1. Silence fell. Not a single sound could be heard. Only the faint, distant wail of an approaching ambulance siren grew louder, tightening like a vice around our chests.
Weeee-woooo-weeee-woooo—
The siren now blared right outside the emergency room, loud enough to rupture eardrums. *Whoosh—* The automatic doors slid open. *Screeech—bam!* The stretcher cart was wheeled into the resuscitation room with such force it nearly took the door off its hinges.
"Male patient in his twenties! Truck TA! Extrication took twenty minutes, and his level of consciousness dropped further during transport!" the paramedic barked out a frantic briefing. The screech of the stretcher's wheels scraped against the floor. From the patient's mouth came a series of agonizing, intermittent groans.
"Ugh... ah... ugh..."
The sharp, mechanical beeps of the monitors hooking up joined the cacophony, instantly transforming the resuscitation room into a noisy hell. "One, two, three!" We transferred the patient to the bed.
"I'm going to suction right away! Pass me a suction tip!" Han Jae-eon yelled from the head of the bed, laryngoscope already in hand.
"Breath sounds are diminished on the left! Get a portable chest X-ray! Fast!" Lee Min-jae roared, his stethoscope pressed firmly to the patient's chest.
"His pulse is incredibly thready, and I can't feel any peripheral pulses at all! His blood pressure is still plummeting!" Baek Eun-seo cried out, her hand on the patient's wrist, on the verge of tears.
"Hey, get another line! Stick a femoral line if you have to! Run the fluids wide open!"
Together with an intern, I began using trauma shears to shred the patient's clothes, which were caked in blood and dirt. *My God. What is this?* Beneath the shredded trousers, the patient's pelvis was a disaster—shattered bone had pierced through the skin. The surrounding area was already drenched in dark, venous blood. And then there was his abdomen. It was covered in deep purple bruising. While it didn't look severely distended yet, it felt incredibly rigid to the touch.
"Fuck... An open pelvic fracture and a massive hemoperitoneum..." A low curse escaped Lee Min-jae's lips. "MTP! Activate the Massive Transfusion Protocol! Call the blood bank and tell them to send up four packs of O-negative blood right now, and have ten more packs on standby! Hurry!"
In his panic, Park Seong-jeong stammered, "D-doctor, we haven't even run a type and screen yet—"
"Forget cross-matching, just tell them to send it up! It's an MTP! What good is finding his blood type after he's dead?!"
Everything was spiraling toward the worst-case scenario. Despite the fluids pouring in, the patient's blood pressure continued to slide. One of the hard-won IV lines clotted off as the pressure dropped too low, causing blood to back up into the tubing. The portable X-ray machine hadn't even arrived yet because it was tied up with another emergency patient.
"This is a total shitshow! Nothing is going right!" Lee Min-jae yelled, grabbing his head with his gloved hands. *Uh, Senior... you just contaminated those... your gloves...*