A Hazardous Sport, Part 1
Looking at Baek Eunseo's earnest, sparkling eyes, I sensed the greatest crisis of my medical career. The moment of reckoning had arrived. She was undoubtedly about to ask me to teach her some ridiculous procedure far beyond my actual capabilities, or perhaps propose we do a case study on some rare disease together. How on earth was I supposed to live up to this massive illusion created in the wake of the REBOA procedure? I swallowed hard, preparing to take a step back as naturally as possible.
"With what? What do you want me to help you with?"
But... it turned out to be surprisingly simple. Eunseo adjusted her glasses and pointed toward a bed in Zone B.
"Oh, the patient who just arrived in Bed B-3 seems to have dislocated his finger. We took an X-ray, but since I'm still lacking in experience... I was hoping to get some tips on the reduction..."
...A reduction? A finger dislocation reduction?
"Ah, you wanted help with a reduction?" A sigh of relief escaped my lips before I could stop it. It wasn't a shoulder or an elbow dislocation—just a finger. This was such a basic procedure that it barely even registered as one, the kind of thing interns occasionally did.
"Yes, senior! I saw it done a few times during my internship."
This much is easy. All my anxiety melted away like snow. I could definitely handle this. Even if my hands were cursed with the ultimate clumsiness, popping a dislocated finger bone back into place was well within my reach. After all, how many posts like [Dislocation Reduction Pro-Tips.txt] had I scrolled through on the medical forums? The angle of traction, the anesthesia method, the post-reduction splinting—the perfect theory was already fully loaded in my brain. Granted, the number of patients I had actually performed this on myself was... well, not many. But still! This was a procedure highly doable even with my clumsy hands. It was incomparably safer and simpler than slicing open an abdomen or shoving a balloon catheter into an aorta. I had absolute confidence in this.
"Really? Alright, let's go. What's the patient's story?"
"Oh, here's the case." Eunseo unfolded a small piece of paper she was holding, as if she had been waiting for this exact moment, and began her briefing.
"He's a thirty-five-year-old male. He was playing basketball today and took a bad hit to his finger from the ball. Since then, he hasn't been able to bend his fourth finger. If you look at the X-ray..."
Eunseo pulled up the EMR screen to show me the freshly taken X-ray. In the image, the middle joint of the ring finger was completely displaced, with one bone clearly riding on top of the other. It's straight out of a textbook.
"I see it," I said, nodding.
"Anyway, I wasn't sure if we should page Orthopedics for this, or if we could just handle it ourselves..." Eunseo asked cautiously.
Hmm... could we call Orthopedics for this? Of course we could. The orthopedic residents—those elusive creatures scattered all over the hospital—would grumble about it, but they would eventually show up and resolve it. However, it was currently 7:30 PM. If we paged them now, they wouldn't arrive for at least thirty minutes, and the patient would be in pain the entire time. We can easily pop this back in ourselves. I made my decision. This was a problem I could easily handle.
"No, we can do this ourselves. No need to page Ortho. Let's go." I stood up. Eunseo quickly followed suit.
"Alright, Eunseo. Before we head over to the patient, let's double-check a few things."
"Yes, senior."
"Did you do a neurovascular check? Is the sensation at the fingertip okay, and did you confirm good perfusion?"
"Yep! Sensation is intact, and capillary refill time is normal at under two seconds!" Oh, not bad.
"Then what are the contraindications for a reduction?"
"Uh... open dislocations, meaning where the bone breaks through the skin, or if there's an associated fracture. Also, we shouldn't touch it if there's suspected nerve or vessel damage..."
"Okay, perfect." I nodded with a highly satisfied expression. She's got the theory down pat. Now we just need to see it in practice. "Alright, let's go."
We pulled back the curtain of Bed B-3. The patient was still staring down at his twisted finger with a pained expression. I walked over to the crash cart, doing my best to look like a skilled, relaxed veteran.
"Lidocaine, check... 10cc syringe and a 27-gauge needle... povidone sticks... sterile gauze..." I gathered the necessary supplies one by one, mentally reviewing the procedure. I would inject local anesthetic on both sides of the dislocated finger to ease the pain of the reduction. This was something even my clumsy hands had done dozens of times. Having finished the preparations, I approached the patient again.
"Sir."
"Yes..."
"I'm going to give you an anesthetic injection in your sore finger first, and then I'll pop the dislocated bone back into place."
But then I noticed Eunseo standing right next to me, her sparkling eyes tracking my every word and movement with intense focus. Ah, right. Teaching. I cleared my throat and added rather awkwardly:
"Since this is a university hospital, we also have an educational role to play. For the sake of training, this colleague of mine here..." I gestured toward Eunseo with my chin. Why are her eyes so damn sparkly? It's putting on the pressure. "Anyway, I'll be performing the procedure in front of her. Is that alright with you?"
Despite his pain, the patient nodded as if he had no choice. And just like that, I concluded my very first, incredibly absurd, and sudden lecture as a senior colleague. Did I even do a reduction during my internship? My memory was hazy. I couldn't recall.
"Alright, you'll feel a slight pinch." The needle pierced the skin. After about five minutes, the patient's expression eased slightly.
"How does it feel now? It doesn't hurt as much when I touch it, right?"
"Just a bit numb..."
"Great. I'm going to pop it back in now. Watch closely." I glanced at Eunseo, then took hold of the patient's finger. The tips I had read on the forum flashed through my mind. With that, I smoothly began the reduction.
"Relax, sir. Take a deep breath out..." Applying traction to the finger, I pressed down firmly with my thumb on the protruding, displaced bone. At the same time, I gently guided the entire finger into a slight flexion.
Thump. Success. I carefully bent and straightened the patient's finger. Unlike before, it moved smoothly.
"How is it? You can move it now, right?"
"Yes! Wow, that's amazing!" A smile of mixed relief and wonder spread across the patient's face.
"We'll take another X-ray to make sure the bone is perfectly back in place, and then we'll apply a splint." After sending the patient to Radiology, I returned to the station.
"Senior, that was incredibly fast!"
"Haha, it's nothing. You'll get a feel for it once you do it a few times." Yeah, thanks, you bone geek. I'll make sure to show you a bone marrow slide sometime soon. I promise.
A moment later, the X-ray popped up on the EMR screen. Ah. The finger bone on the screen was perfectly back in its proper place, as if nothing had ever happened. Flawless. Wearing a satisfied smile, I scheduled an outpatient follow-up with Orthopedics and prescribed discharge medications.
"Make sure to visit the Orthopedics clinic. Don't take off this splint until then, and avoid putting any strain on your finger." The patient nodded repeatedly. He bowed politely and left the emergency room.
Yes, sometimes medicine needs to taste like this. I couldn't spend every single day looking at blood and listening to people groaning on the verge of death. The clean success of the finger reduction planted a dangerous illusion in my mind for a brief moment: Maybe I'm actually a decent doctor. See? It worked when I just followed the textbook and principles. Maybe I was finally escaping my clumsy-handed curse?
But that brief moment of self-indulgence was instantly shattered by a barrage of questions from my junior. As if I were a walking medical encyclopedia, Eunseo constantly sought me out to ask about all sorts of basic concepts.
"Senior! Earlier in Zone A, when Dr. Lee Min-jae was placing a C-line, he did it under ultrasound guidance. But in textbooks, we learn the landmark technique first. Do people actually use ultrasound almost all the time in practice? And do you have any pro-tips for distinguishing between an artery and a vein on ultrasound...?"
"You just press down gently with the probe. The one that collapses is the vein, and the one that stays round and pulsates is the artery."
The questions were endless. From reading EKGs, to the criteria for choosing antibiotics, to the indications for different types of IV fluids, and even useless questions like, "What did you have for lunch, senior?" Half-dazed, I satisfied her curiosity by blending my shallow knowledge with all kinds of trivia I had picked up from the forum ghosts.
In this manner, I managed to survive the onslaught of questions by combining empty advice with forum-sourced knowledge. I answered what I knew, and for what I didn't, I either glossed over it plausibly or deflected: "You'll only improve if you look that up yourself." Yep, I really am an excellent senior.
Before I knew it, the clock was ticking toward 8:20 PM. Watching the numbers in the bottom right corner of the monitor change to 20:20, I let out a deep sigh. It had only been an hour and twenty minutes since I clocked in, so why did I already feel like my soul had left my body?
For a brief moment, a miraculous peace settled over the station. The evening rush of patients had been somewhat cleared out, leaving a short lull before the next wave hit. I sat in an empty chair and closed my eyes. I wanted to pass out like this for just ten minutes... no, even five minutes would do.
Right then.
"Incoming patient!"
An urgent shout from a paramedic echoed from the automatic doors of the ER. The 119 rescue squad wheeled a patient in. The stretcher cart rattled loudly as it rushed toward the station. Lying motionless on it with his eyes closed was an elderly man who looked to be in his sixties. Reflexively, I stood up and hurried to the side of the stretcher.
"What's the situation?"
"Yes, the family found him after he suddenly collapsed in his living room and called it in! He was conscious when we arrived on scene. His current vitals are BP 110/70, heart rate 70, respiratory rate 18, and SpO2 98%. His GCS is a clear 15. We transported him while administering 2 liters of oxygen via nasal cannula. No other signs of trauma."
The paramedic's briefing was quick and concise. Listening to him, I rapidly assessed the patient on the stretcher. I lifted his eyelids to check his pupillary reflex and checked the movement of his limbs. There didn't seem to be any signs of paralysis.
What is it? Did he just lose consciousness for a moment? Vasovagal syncope? Or an arrhythmia? While I was running through differential diagnoses in my head, the patient faintly opened his eyes and muttered something in a hoarse voice.
"Those... Giants... those... those... sons of bitches..."