A Toxic Sport (2)

"...Excuse me?"

I doubted my own ears. What did he just say? The Giants?

"Let's move him to the treatment room over there first. We'll start with an EKG and basic labs."

People are brought into the emergency room for literally every imaginable reason. Swallowing a dry laugh, I followed the stretcher carrying the elderly man to the treatment room.

I carefully transferred him to the treatment bed. While the EKG electrodes were being attached and the blood pressure cuff was wrapped around his arm, the old man kept his eyes closed, letting out nothing but a faint groan. "Ugh..." His vitals were still stable. Why on earth did he collapse?

"Sir, can you hear me? Do you know where you are?" I started with the basic mental status questions.

The old man slowly opened his eyes. His gaze was slightly unfocused, but he seemed to recognize me. "Is... is this... the hospital...?"

"Yes, that's right. You're in the hospital emergency room. Do you happen to remember today's date or about what time it is?"

"Don't know the date, but... it should be about time for the baseball game to end..."

"What is your name and age?" His basic orientation was intact.

"I heard you suddenly collapsed at home. Before you fell, did you feel any chest pain, shortness of breath, or sudden dizziness?"

"Nothing like that... just... just..." The old man's face contorted in pain again. He couldn't finish his sentence, as if recalling something utterly horrific. I couldn't help but wonder if this reaction was connected to his earlier outburst about "those Giants bastards."

"Sir, about the baseball game..." As I cautiously broached the subject, the old man's eyes trembled.

"What happened to the Giants today?" At my direct question, the old man's face turned pale.

"A... a... ugh... Doctor... those words... I can't bring myself to say those words with my own mouth..."

I looked at the nurse setting up the IV line next to me. "Nurse Jung."

"Yes, Doctor?"

"Do you happen to know how the baseball game turned out today?"

"Ah, Doctor, today..." She let out a deep sigh. "It was an away game at Jamsil. They were winning 4 to 1 up until the top of the ninth." Up to this point, it sounded hopeful.

"Then, in the bottom of the ninth, with two outs and bases loaded, they gave up a walk-off grand slam and lost 5 to 4..."

...Aaargh! I screamed internally. Oh my god. Now I knew exactly why this old man had collapsed. I stared at the patient lying on the bed with a mixture of awe and profound pity.

"My head... oh... oh, my aching head..." The old man clutched his forehead, in genuine agony. I patted his shoulder with a bitter smile. Right now, what this patient needed wasn't an EKG or blood tests, but warm comfort—and perhaps the vain hope that the Giants might actually win the championship next year.

"My poor heart..."

"It's just an exhibition game, sir. Just an exhibition. The regular season hasn't even started yet. It's basically a practice match. Today's loss means nothing. The real games haven't even begun!"

Indeed, it was only just past March, so the exhibition games were only beginning. At my words, the old man's groaning paused for a moment.

"Aigoo... but still, Opening Day is at the end of this month..."

"Don't get too worked up. If you do this now, you'll be in real trouble when the regular season actually starts."

The old man still held his head, but his groans had grown significantly quieter. Good, the immediate fire was put out. Now it was time to do my job as a real doctor.

"Sir, have you ever suddenly lost consciousness or collapsed like this before?" I began the formal history-taking. The causes of syncope are incredibly diverse. It could be a cardiac issue, a neurological issue, or simply a temporary drop in blood pressure or vasovagal episode. Even though there was clear circumstantial evidence that he collapsed because of baseball, taking that at face value could lead to missing a truly fatal condition.

"Never... this is the first time in my entire life..."

"Do you have a history of high blood pressure, diabetes, or have you ever been told you have a bad heart?"

"I've been taking blood pressure meds for about ten ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠years. No diabetes. As for my heart... it feels a bit tight sometimes, but the hospital never said there was anything wrong with it."

History of hypertension. That's one risk factor checked. I marked it off on my mental checklist and asked the next question.

"Right before you collapsed, did you feel any sudden chest pain, tightness, or palpitations? Or did you feel dizzy, like the world was spinning or going black?" I asked meticulously to rule out prodromal symptoms of cardiac or neurological issues.

"Just... I was just watching the game, and when I saw that play... my vision just went white, and... I blacked out instantly..." The old man made a pained face, as if reliving that awful memory once more. It was a textbook trigger and presentation for vasovagal syncope. But it was still too early to let my guard down.

"Did you regain consciousness immediately after falling? Do you know how long you were out?"

"When I opened my eyes, my son and daughter-in-law were slapping my cheeks... Must've been about a minute..."

"Did you hit your head or injure yourself anywhere when you fell?" I asked, scanning his body once more. ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠Fortunately, there were no visible signs of trauma.

"I fell toward the sofa, so..."

Even while taking his history, I listened to his heart sounds with my stethoscope and checked his pupillary reflex with a penlight. Everything was within normal limits. The EKG was also clean. Sinus rhythm, normal heart rate, and absolutely no evidence of arrhythmia. Now, only the blood test results remained. However, all the evidence so far pointed strongly to a single diagnosis.

What a ridiculously long diagnosis. Still, just to be safe, I had to wait for the blood test results before discharging him. Tonight was turning out to be quite spectacular.

"Sir, about your collapse earlier," I began, explaining in the gentlest, most accessible terms possible. "Medically speaking, it's highly likely to be a condition called vasovagal syncope."

"Vaso... what?"

"To put it simply, when a person gets too shocked, experiences extreme stress, or sees something like blood, our autonomic nervous system—the system that automatically regulates our body without us thinking about it—momentarily malfunctions."

I gestured with my hands as I continued. "Your heart suddenly slows down, your blood vessels dilate, and your blood pressure drops rapidly. This temporarily reduces the blood flow to your brain, causing you to lose consciousness and collapse. Fortunately, this usually resolves on its own within a few minutes and isn't a particularly dangerous condition. Even young people sometimes pass out while donating blood or just from watching someone get a shot."

The old man nodded at my explanation, but his expression remained skeptical. "But I've never had anything like this happen in my life..."

"Yes, that's true. Usually, people experience it when they're young, or only when there's a specific trigger. In your case, sir, today's trigger was just exceptionally powerful."

Ahem. "Sir, once we review all the test results and confirm everything is fine, you won't need to be admitted. You can be discharged right away. But in the future... well, even if you watch baseball, it might be best to be a bit careful. Especially in situations like today, where they throw away a lead at the last second."

The moment the words left my mouth, the old man's eyes flared. "What? What did you say?! Are you telling me not to watch baseball?!"

"No, sir, please calm down. That's not what I meant..."

"That's my only joy in life! An old man having a glass of soju while watching baseball is my one and only pleasure, and you're telling me to stop? Doctor, that's just too cruel!"

"No, I love the Giants too! I'm a die-hard fan! ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠A die-hard!" I hurriedly dragged out my inner Busan DNA and added a slight lie. To be precise, I wasn't a die-hard fan. More like a fifth-year casual fan.

"So, what I'm saying isn't that you should stop watching entirely. It's just that in certain situations, for the sake of your health, it would be wise to turn off the TV for a moment or take some deep breaths."

I grabbed a notepad and a pen nearby. With an incredibly solemn expression, I began to write down a "Baseball Viewing Guideline." "I'll write you a prescription." I carefully penned down each and every word.

"Now, sir. In the future, if you're watching a game and you see any of these situations coming, turn off the TV immediately and go to sleep, or just change the channel to a soap opera. Understood?"

I handed the note to the patient. The old man took it and read it over for a long moment. Then, he let out a sudden chuckle. "Haha, you're a clever one, Doctor. How do you know my heart so well?"

Just like that, we formed a bizarre bond over the shared denominator of baseball. Right on cue, the blood test results came back. As expected, every single value was within the normal range. His cardiac enzymes were clean, and there was no sign of electrolyte imbalance or anemia. He was a perfectly healthy (?) old man.

I called in his guardian and explained the patient's condition, the test results, and vasovagal syncope in detail once more. I advised them not to panic if a similar situation occurred in the future, explaining that laying him down comfortably and elevating his legs would lead to a quick recovery. And most importantly:

"Since your father tends to watch baseball with a bit too much passion, the family will need to... keep a close eye on him." I made sure to add this roundabout warning.

After finishing the patient education, the old man walked out of the emergency room supported by his son, his face looking much more relaxed than when he had arrived. I pray you have a peaceful season.

I tidied up the treatment room and returned to the station. As I sat down to write my final chart notes in the EMR, curiosity suddenly got the better of me. "By the way, did everyone watch today's game?"

At my question, the nurses and a few doctors at the station all looked up at me in unison, as if on cue. Then, without a word, they simply smiled. Of course. This was Busan. We were all comrades sharing the exact same pain.

Right then, a new nurse who had been quietly organizing medications in the corner chimed in with a bright, innocent face. "Oh, I watched it! I'm from Seoul, so I'm actually a Bears fan—"

Before she could even finish her sentence, the hand of Nurse Jung, the veteran charge nurse standing right next to her, shot out at the speed of light and muffled her mouth. *Mph, mph!*