Restoring Breath
The patient in Room 7 had end-stage chronic obstructive pulmonary disease (COPD). When I rushed over at the intern's call, his oxygen saturation was at 82%. Normal is above 95%. At 82%, his lips were already starting to turn blue. Even with the oxygen mask already in place, it wasn't climbing.
"How long has he been like this?"
"It dropped suddenly about 10 minutes ago."
I pressed my stethoscope to his chest. Almost no breath sounds on the left lung. The right was rough too. Pneumothorax flashed into my mind first. Sudden drop in oxygen saturation, absent breath sounds on one side. Spontaneous pneumothorax is a common complication in COPD patients.
"Get a chest X-ray right away. Portable. And EKG at the same time."
The intern dashed off. I looked at the patient's face. Early 70s male. Conscious, but his eyes were anxious. Every breath pulled at his neck muscles. Things were deteriorating fast.
"Grandpa, breathing's tough right now, isn't it? I'll help you."
He nodded. The X-ray came back. The left lung had collapsed. Pneumothorax confirmed. More than 20% compression.
"Prep for chest tube insertion."
The nurse brought the tray. I gloved up, running the sequence in my head. 4th or 5th intercostal space, mid-axillary line. Local anesthetic, incision, insertion, secure. A sequence I'd never fumbled.
"Grandpa, anesthetic shot first. It'll sting."
The procedure took 12 minutes. Air started hissing out through the tube. I checked the monitor. 84%, 87%, 88%, 90%. I let out a breath.
The nurse said quietly, "Doctor, that was fast."
I peeled off my gloves and double-checked the monitor. Oxygen sat at 90%. Color returning to his face. Neck muscles easing a bit.
"Keep watching him closely. Call me if the sats drop."
Back in the procedure room, I sank into a chair. My mind replayed it: suspect pneumothorax, confirm with X-ray, insert tube, sats recover. Textbook. Nothing special. And thankfully, it went well.
About 30 minutes later, the nurse opened the door. "Doctor, Room 7's up to 94%. Patient says to thank you."
I nodded. Alone again, I sat there. 94% is near normal. Just an hour ago, 82%. There wasn't some grand reason I'd chosen pulmonology. It just happened. But this moment felt different. Seeing breath return. Confirming the lungs working again. For a second, that seemed like the whole job.
Was it because of the Gatong with King Munjong? My sense of calling as a doctor felt a little stronger.
Then my phone buzzed. Gatong.
I smiled at the screen. Jeon Sun-ui was reading it the same way I was. Vegetable vital energy. Vitamin A. Strengthens respiratory mucosal immunity. He'd interpreted it in terms of qi and blood.
Jeon Sun-ui had suggested keeping radish greens in the soups too. I opened King Munjong's clinical record file.
Green-yellow vegetable diet implemented. Confirmed with Jeon Sun-ui.
Saved. Afternoon break. Time to check on sleep, like I'd thought about this morning.
Night sweats decreasing, sleep improving. Good sign. But more could be done. For TB patients, sleep matters deeply. Severe night sweats shallow sleep. Shallow sleep weakens immunity. Weak immunity reactivates bacteria. Vicious cycle. Good sleep speeds immune recovery. Growth hormone releases, immune cells rebuild during sleep. Sleep is treatment.
I added to the clinical record.
Night sweats decreasing, sleep improving. Recommend pre-bed ventilation. Recommend small amount of eobyeong soup before bed.
Next, Jeon Sun-ui's prescription issue. Current: Ophiopogon, Platycodon, Astragalus, Licorice, Atractylodes. Platycodon bothered me. Expectorant, promotes drainage. Thins phlegm to expel it. For acute phase. Munjong now in recovery, phlegm decreasing. High Platycodon could irritate airways unnecessarily. Shift to Astragalus for vitality better.
Directly altering Jeon Sun-ui's prescription risks imbalance. We'd handled diet, exercises outside meds. Ratios different.
Solution: Have Munjong tell Jeon Sun-ui phlegm much reduced. He'd adjust himself. He'd know it's right.
Next day, Gatong.
Jeon Sun-ui reached same conclusion himself. Not me meddling; his judgment. Proper way.
I added to record.
Jeon Sun-ui prescription adjustment: Reduce Platycodon, increase Astragalus. From next month. Per Jeon Sun-ui's judgment.
End of shift, home. Sofa, laptop open, reread clinical file from start.
Ventilation. Bosinsijok. Eobyeong. Sunbathing. Radish greens. Sleep environment. Jeon Sun-ui adjustment. Seven items.
Anti-TB meds absent. Modern TB: four-drug combo six months plus. Isoniazid, Rifampin, Ethambutol, Pyrazinamide. Kill bacteria directly. None in Joseon.
Know supportive care alone insufficient. Still, my role: make environment hostile to growth. Set conditions for immunity to hold. Not kill directly, but aid killing.
Munjong responding. Early modern TB: sanatoriums. Rest, fresh air, nutrition. Munjong can't stop state affairs. Healthier, more vigorous like crown prince days.
Fresh air via ventilation, sunbathing. Joseon air fresher than modern.
Nutrition: more focus per records. Vitamin E, zinc, probiotics come to mind. But careful—no big butterfly effects like bosinsijok or eobyeong.
This morning's Room 7 replayed. 82% sats. Pneumothorax. Tube in 12 min. 90%. Another lung patient. Tools different, era different, methods different. But same: restore breath.
Room 7, Munjong: lungs that must endure.
Recalled first Gatong. Yi Hyang. Joseon shock. History buff kicked in, kept talking. Led here. No intent, no plan. Symptoms, causes, actions.
Regret over late history-taking faded. Direction confirmed, filling gaps. That's doctoring.
Became doctor for stable high income. True. But now, seeing this file, Room 7 at 97%, Munjong's Gatong on morning eobyeong hotpot. Something inside shifted. Always there unnoticed? Born here? Doesn't matter.
Lungs that must endure. Room 7. Munjong. I'm beside those lungs.
Room 7 shares my time, doctor-patient in ward. Munjong Yi Hyang: 600 years apart, linked by Gatong. But work same. Duty same. Restore breath.
Reread Munjong's file, yesterday and today, start to end. Tomorrow busy too. More patients' breaths to restore. Steeled myself, eyed filename one last time, closed laptop.
Clinical Record: Yi Hyang (1451.12.)