Tutoring (2)
3:42 AM. The ambulance sirens, which had been wailing like mad from 7:00 PM until 2:00 AM, had finally quieted down. The frantic footsteps of nurses rushing around the station, along with the patients' shouting and groaning, had also entered a brief lull.
Of course, that didn't mean there were no patients at all. From behind the curtains of Zone B, the thunderous snoring of a heavily intoxicated middle-aged man hooked up to an IV echoed intermittently. Over in the pediatric ER of Zone C, the faint, whimpering cries of a child suffering from a fever of unknown origin drifted through the air. There weren't that many patients... and they were mostly mild cases.
I was practically melting into my chair at the station, mindlessly spinning a paper cup of lukewarm instant mix coffee. Ah, I want to go home. This dreadful fluorescent lighting. This pungent, nose-stinging smell of disinfectant. Lee Min-jae had been bragging up a storm about finally becoming a fellow, but in the end, he was still rolling around in the exact same hell as the rest of us. As for me, saddled with the awkward rank of a second-year resident, I was stuck playing the role of middle management in this purgatory.
Beside me, Baek Eunseo was still hitting the books. Does she ever sleep?
"Dr. Han."
"Yeah?"
"About that suspected case of Brugada syndrome earlier. In that case, does the patient—"
"Sorry, but I really need to rest my eyes for a second..."
"Ah, yes! I'm so sorry!"
She didn't need to be that sorry. I rolled my stiff neck, wishing only for this tedious shift to pass as quickly as possible.
Right then.
Ding.
Something popped up on the triage monitor hanging in the center of the station. A new patient. Ah, please. Let it be constipation, diarrhea, or just a common cold. Or even a split-open head from some drunkard tripping over his own feet. Please, just let it be something like that. My brain didn't have the bandwidth to process anything more complicated right now.
With eyes as dull as a dead fish, I scanned the text on the monitor.
Patient: Kim O-ji (F/19)
Admission Time: 03:41
Chief Complaint: Palpitations, Dyspnea
"..."
Nineteen years old? That made her barely twenty in Korean age. A total baby. But her chief complaints were nasty. Palpitations... and dyspnea... chest fluttering and difficulty breathing. If those two came as a package deal to drag someone to the ER at three in the morning, it was definitely not a case of malingering.
I clicked the mouse to check the initial triage note the nurse had just entered.
A sudden onset? In a perfectly healthy nineteen-year-old? What could it be? The wheels of differential diagnosis began to grind reluctantly in my head. Panic attack. That's the most common for young women. Drugs? Did she take something weird at a club? Pneumothorax? Pulmonary embolism? No, surely not. Or is it an actual cardiac issue?
I nudged Baek Eunseo, who still had her nose buried in the stack of EKGs.
"Eunseo."
"Yes, Dr. Han!"
"Pop quiz. Look at the monitor over there." I gestured toward the triage screen with my chin. "A nineteen-year-old female. No medical history, sudden onset of palpitations and dyspnea thirty minutes ago. What do you think it is?"
Without a second of hesitation, Eunseo stared at the monitor with that same academic fire in her eyes. Her lips parted slightly as she mumbled her own differential diagnosis. Young age, acute paroxysmal... no medical history... Then, she answered with absolute confidence.
"Um... let's see. Could it be PSVT? Since she's young."
PSVT. Paroxysmal Supraventricular Tachycardia. I let out a soft chuckle. That was indeed the textbook answer. The very first thing a first-year resident should think of. Young, healthy, sudden onset, heart racing like crazy—ninety-nine percent of the time, it's PSVT. It could sometimes be confused with a panic attack, but we'd get our answer once we ran an EKG.
"Hmm, let's go check on her together." I pushed myself up, my joints creaking. After all, the only doctors sitting at the station right now were Choi Sumin, our fourth-year chief resident, myself, and Eunseo.
Eunseo's eyes went wide as saucers at my suggestion.
"Is that really okay?"
"What is?"
"I mean... instead of you seeing her alone, I get to... I get to come with you?"
"The ER is dead quiet right now. Let's go." I waved my hand dismissively and led the way. Eunseo scurried right behind me, keeping pace.
You said I was your role model, kid. You've got to follow me around to learn. I chuckled inwardly. Of course, my true motive was half wanting to tease a first-year to break up the monotony of this boring dawn, and half wanting to test if she could actually apply the EKG lesson I'd just given her in a real-world scenario.
I headed toward the triage area, where the patient was just entering after finishing her registration.
"So, what seems to be the trouble..." Before I could even finish my sentence, I froze in my tracks.
The patient looked nothing like the fresh, lively twenty-year-old college student I had pictured. Her face was pasty, almost gray, her bangs were damp with cold sweat, and she was gasping for air, her expression consumed by sheer terror. Her lips even looked slightly blue. She was clutching her chest as if trying to tear it open.
Okay, this was definitely not a case of faking it. Thank goodness for that. Or maybe not. My body reacted before my brain did.
"Miss, stay with me." I gently shook her shoulder. "Have you ever been told you have a heart condition? Like an arrhythmia or a heart valve issue?"
"N-no..." she managed to gasp out between ragged breaths. "Never... my breathing... I've never felt like this before..."
No medical history. Sudden onset. The likelihood of PSVT grew even stronger. However, the severity of her dyspnea was highly alarming. I whipped my head around and barked at Eunseo, who was standing frozen behind me.
"Eunseo."
"Yes, Dr. Han!"
"Go grab the EKG machine. Right now. Get an intern to do it or do it yourself, just have whoever's faster bring it here. Hurry!"
"Yes, sir!" Eunseo practically tripped over her own feet as she bolted back toward the station.
The EKG will tell us what it is, but before that... I turned my attention back to the patient and began the standard ER intake questions.
"Do you drink or smoke? Are you taking any other medications? Cold medicine, diet pills, or even herbal medicine? Anything at all."
"I don't drink or smoke, and I don't take any medicine. Really..." The patient looked on the verge of tears.
No alcohol or drugs? My thoughts tangled. If it wasn't a panic attack, a congenital heart defect, or drugs, then what on earth was making this twenty-year-old's heart race at 160 beats per minute? Was it really PSVT after all?
"When did this start? What were you doing when it happened? Were you exercising intensely? Did you get into a fight with your boyfriend? Did you experience any major emotional stress, or did something bad happen to someone close to you?" I desperately tried to dig up some kind of stress trigger. But her answer threw me off yet again.
"Ah, I was... studying..."
"...Studying?" A dumbfounded sound escaped my lips. Studying?
"Yes, I've been studying non-stop since yesterday... But then my heart suddenly started pounding, and now I feel really weird, Doctor. I didn't eat anything strange either... There really wasn't anything else..."
I instinctively glanced at the clock on the station wall. 3:43 AM.
"So you were studying right up until you came to the hospital?"
"Yes... once my heart started racing, I came straight here..."
...Studying? At this hour? A twenty-year-old studying so hard that her heart was about to burst and she could barely breathe?
...Wait. In my head, pieces of a puzzle that had seemed completely unrelated began to click into place. A situation requiring someone to stay up all night studying. Something that would make the heart beat like crazy. Young age. No medical history. No drug use.
I looked straight into the patient's eyes. Though she was terrified, her pupils were slightly dilated, and the fingertips clutching her chest were trembling ever so slightly.
...Is she... no way. I swallowed hard and decided to interrogate the prime suspect that had just surfaced in my mind.
"Student." My voice dropped an octave. "By any chance, did you drink any energy drinks or coffee?"
The moment the question left my mouth, her eyes shook violently, as if hit by an earthquake. She looked exactly like someone who had just been caught red-handed. Is this what it felt like to be a detective? The culprit is you, caffeine!
"Ah..." The patient cleared her throat, avoiding my gaze. "Ah... yes."
Bingo. I cheered inwardly. But this was only the beginning. It wasn't just about whether she drank them; it was about how much.
"Exactly how much did you drink? It would also help if you could tell me what kind of drinks they were."
The patient immediately hung her head. "Well..." Her voice was barely a whisper.
"I can't hear you. It's okay. You won't get in trouble for telling me."
At my reassurance, she finally confessed. "Um... about six cans of energy drinks?"
"..."
Six cans. I was momentarily struck speechless. You crazy kid. Did you really think you'd be fine after chugging that much?