Blind Obstinacy
I was left completely speechless by that absurd demand. To be precise, I had plenty to say, but if I let any of it slip past my lips, my own head would probably roll first. Seoul? Ohsung Hospital?
"Sir, please listen to me carefully. Your current condition is a disease that absolutely requires immediate surgery. Your appendix has either ruptured already or is right on the verge of doing so. Even at this very moment, inflammation and pus could be spreading throughout your abdomen. This is called peritonitis, and if it progresses, it can lead to sepsis, which is life-threatening."
I tried to look as desperate and sincere as possible.
"Going all the way to Seoul? Even if we call an ambulance right now, it will take at least four hours to get there. No one can guarantee what will happen during that time. Our hospital's general surgery department is highly capable. Here..."
"What?!" the middle-aged man cut me off. "What do you know, you young punk!"
His voice suddenly boomed.
"Do you think I don't know what you're up to? You're just trying to hold onto patients in this backwater hospital to rip them off because you lack any real skill!"
He even pointed a finger at me, cornering me.
"Hey, punk! I go to the sauna with the director of Ohsung Hospital! Yeah! We do everything together! The chief of general surgery there is my friend! I'm going there to get my surgery, so who the hell do you think you are to stop me?!"
"Sir, it's not a matter of money. Right now, your life is..."
"Doctor? An ER doctor is barely a doctor! Kids like you just prescribe cold medicine and give shots in the butt! A surgeon who cuts open bellies! A real doctor is one who actually holds a scalpel! What do you know?!"
...
[System: Han Hyeon-jae has entered Deep Pissed-Off Mode]
"Sir, this is..."
"What? What are you going to do about it?" the man sneered back.
Right then, a figure who could either be a savior or a demon appeared.
"Hey, what's going on?"
It was Lee Min-jae. He must have been on his way back from seeing another patient, as he approached with a furrowed brow upon seeing the commotion.
It was Lee Min-jae. If it was this passionate lunatic, maybe something could be done. When dealing with a stubborn, unreasonable old man like this, that guy might actually be more effective than me.
I took a step back and briefed Lee Min-jae on the situation.
"Sir, based on the CT, we suspect perforated appendicitis accompanied by a peri-appendiceal abscess. One liter of Hartmann's solution has been administered, and emergency surgery is required. However, the patient is refusing surgery at our hospital and wants to transfer to Ohsung Hospital in Seoul, so he is currently insisting on AMA."
Lee Min-jae's expression stiffened instantly as he listened to my briefing. He quickly scanned the patient's chart and even checked the CT images. Then, with a sigh much deeper than mine, he turned toward the man.
His face practically screamed, 'Fuck. Tonight's night shift is going to be absolute hell.'
Lee Min-jae also began his persuasion.
"Sir, right now, the state of your abdomen is basically the equivalent of feces exploding inside you. To put it simply, it's a time bomb. One that could go off at any second."
"W-What? Feces?"
"Yes. If your appendix ruptures, the stool and bacteria inside it will spread throughout your entire abdominal cavity. That's called peritonitis. If we don't operate immediately to cut out the ruptured part and wash out your abdomen, those bacteria will travel through your bloodstream and spread to your entire body, leading to sepsis. Then you simply die."
Lee Min-jae put heavy emphasis on the word die.
"Seoul? Ohsung Hospital? Fine. It's the best hospital in South Korea. But, sir, if you go into shock or your heart stops inside that ambulance on the way to Seoul, you will just die on the road. You'll kick the bucket before you even cross the threshold of Ohsung Hospital's emergency room. No matter how skilled the doctors there are, they can't bring a dead man back to life."
Lee Min-jae took another step closer.
"Do I look like I'm lying to you right now? This is your life. You can get surgery here, survive, recover, and then go to Ohsung Hospital to get treated like a VIP later. Or, you can be stubborn right now and end up as an unidentified corpse on the road to Seoul. The choice is yours, sir."
Isn't this a violation of ethical guidelines? In any case, Lee Min-jae was practically threatening the man. It wasn't really something a doctor should say, but he must have realized that normal persuasion wouldn't work at all.
However, the man did not back down. Instead, he dug his heels in even harder.
"Shut up! What do you know! You're all in on this together! You're just trying to force me to get surgery here to rip me off!"
Watching this scene, a deep sense of helplessness washed over me. I desperately hoped that Lee Min-jae's aggressive persuasion would work on this stubborn man. But the man remained completely unyielding, repeating like a parrot that he knew his own body best and couldn't trust quacks like us.
Time was ticking away. The patient's life and our patience were running out together.
Right then, a new figure appeared like a savior.
"Ah, the general surgery doctor is here."
At Lee Min-jae's words, I turned my head to see a doctor in green scrubs walking briskly toward us.
It was the general surgery resident on duty, Jo Jaeshin, a third-year whom I had consulted beforehand via EMR. I hadn't expected him to come down so quickly. He must have realized the severity of the patient's condition and rushed over.
"What's going on? Looking at the chart, we need to send him straight to the OR. Why is he still here?"
Jo Jaeshin looked back and forth between us and the patient.
"Ah, you're the surgery doctor who came down after getting the call, right?" Lee Min-jae approached him first.
"Yes, yes. That's right. Shouldn't we send the patient up immediately? The professor has already left for the hospital and should arrive in about five minutes."
Jo Jaeshin had naturally assumed the patient was ready for surgery. But the reality was the exact opposite.
Lee Min-jae let out a deep sigh, about to deliver the shocking truth to Jo Jaeshin.
"Who the hell are you now?! Why are you sticking your nose in here?!"
The moment the man saw Jo Jaeshin, he screamed as if he had found a new target for his rage.
Jo Jaeshin looked at me with a bewildered expression.
"Uh... well... the patient is currently refusing medical advice and insisting on DAMA."
"What? DAMA? In this state? Why?" Jo Jaeshin's voice rose in sheer disbelief.
"He... says he wants to go to a hospital in Seoul instead of ours. Ohsung Hospital."
"Seoul? With his abdomen in that state?"
"Yes... why don't you hear it from him yourself."
Lee Min-jae tilted his head slightly, passing the baton to Jo Jaeshin.
And so, with the general surgery resident joining the fray, the desperate struggle of three doctors trying to persuade one incredibly stubborn patient began anew.
Jo Jaeshin calmly explained from a surgeon's perspective the terrors of peritonitis that could occur when the appendix ruptures, and the fatal consequences of delayed surgery.
But the man had already closed his ears. He only repeated, "You're all in cahoots," and "You're just trying to scare me to rip me off."
Watching this scene, a deep sense of helplessness washed over me, and I opened the blue window. Perhaps there was some clever trick to break through this crazy situation.
Currently trying to stop a perforated appy patient from AMA. Is there any way? The patient is stubborn as hell. He's holding out to go to Ohsung Hospital in Seoul. If I let him go like this, it's literally a one-way ticket to the afterlife. Is there any way to force an admission?
This motherfucker. But surprisingly, I found myself convinced. This might actually work.
Meanwhile, things were still noisy over there.
"Either declare it delirium due to a septic condition, get the guardian's consent, and send him straight to the OR, or just get the DAMA signature and let him disappear."
"Ah, Doctor. Please calm down and let's try to persuade him just a little more. If he leaves like that, something really terrible could happen on the road..."
"Sigh..."
Lee Min-jae let out a deep sigh.
"Fine. Hyeon-jae, the shaman of the ER. You go through the trouble of trying to persuade him a bit more. If it works, great. If not, just get his signature on the DAMA form and send him packing."
With that, Lee Min-jae headed back to the station.
I also... well, if I was going to make a call, I had to go to a quiet corner of the station.
On the way back to the station, Lee Min-jae asked:
"Have the antibiotics been administered? If perforation is suspected, you should obviously start broad-spectrum antibiotics first."
"Ah, not yet. I'll put the order in right away..."
"Put it in right now. Ceftriaxone 2g and Metronidazole 500mg. The basic set. Hurry."
I sat in front of the computer and hurriedly entered the antibiotic orders.
Meanwhile, inside the treatment room, Jo Jaeshin of General Surgery was still struggling with the patient. His voice was growing increasingly exhausted.
Jo Jaeshin even brought over a gauze container, drew the shape of an appendix on it with a pen, and made a popping motion to desperately explain.
"If this goes bang! and ruptures right here, the bacteria inside will spread all over your abdomen..."
But the man didn't have the slightest intention of listening.
I pulled out Professor Kim Hyukjae's crumpled business card from my pocket.
The cell phone number written under his name.
Calling the head of emergency medicine at the best hospital in South Korea at this hour.
It was madness. Even though I knew it was truly insane, I couldn't think of any other way.
The phone rang.
Please pick up. No, don't pick up. No, pick up...
At the end of the fourth ring, the call suddenly connected.
From the other end of the receiver, a middle-aged man's voice, thick with sleep and irritation, came through.
"...Yes... Yes... Hello?"
"Ah..." I was momentarily lost for words. He actually picked up.
"Professor Kim Hyukjae. Hello. I am very sorry to call you at such a late hour."
"Who... Who is this?"
"My name is Han Hyeon-jae, a second-year resident in Emergency Medicine at Busan Cheongjin University Hospital. At the last conference..."
"Ah... Who? Who did you say? The conference? That kid from Busan? But why are you calling at this hour?"
Thank goodness. Even if he didn't remember my name exactly, he seemed to vaguely recall what kind of person I was.
I began to brief him on the situation as concisely as possible.
"Professor, I am incredibly sorry to bring this up, but we currently have a patient with a ruptured appendix in our ER..."
I poured out the patient's condition, the CT findings, and the fact that it would be dangerous if he didn't get surgery immediately, barely pausing to breathe.
And finally, I brought up the main point of this crazy phone call.
"But the patient is refusing surgery at our hospital and is insisting on transferring to Ohsung Hospital right now. Could you perhaps..."
Before I could even finish my sentence, a dumbfounded chuckle erupted from the other end of the line.
"...So, the reason you're calling me right now is because a patient with a ruptured appendix at your hospital is throwing a tantrum about coming to our hospital instead of getting surgery there, and you want me to talk him out of it? Now? At this hour?"
I could feel the sheer absurdity in his voice.
"Yes. I am sorry."
I wanted to crawl into a hole and die.
"..."
A heavy silence flowed through the receiver.
"...You're a crazy bastard, aren't you?"
He muttered softly.
"...Sigh. Put him on."