Discharge Procedures (2)
“This patient suffers from severe delusions, you see.”
Professor Kim Seok-tae began explaining the patient restrained to the bed.
“He was admitted for AKI — acute kidney injury, that is — and now he insists he's fully recovered and wants to check himself out.”
Apparently the man had thrown a fit in front of the administration office, demanding his discharge, and had been dragged down to psychiatry after displaying excessive violence.
The one mercy, compared to the soldier, was that his aggressiveness was milder — and because his kidney function was so poor, his surgery had been marked pending.
As Professor Kim looked down at the man strapped to the bed, worry poured freely from his eyes.
“And yet, the patient still isn't mentally ‘healthy’ enough to be discharged, is he?”
At those words, the catchphrase of [Happy Relieved Hospital] surfaced in my mind.
Every person imagines the role of a hospital a little differently.
Some see the hospital as a place to cure disease; others see it as a place to be healthy.
Happy Relieved Hospital was built around the latter view.
Mental health.
That was the only value they pursued.
"What does it mean to be mentally healthy?"
Professor Kim Seok-tae asked.
"No generalized anxiety about the future. No trauma-related intrusions about the past. No affective dysregulation in the present."
What is perfect mental health, really?
"To define mental health as happiness — well, reality is far too difficult a place to be healthy in."
His voice was soft, but utterly certain.
Yet the patient gown of the man listening from the bed was soaked through with sweat.
“Ugh! Ughhh!”
“You see? Aggression, and now anxiety on top of it. This is a man who needs a frontal lobotomy.”
Rattle, rattle!
The wrists bound in the restraints had swollen red, and his bloodshot eyes darted rapidly in every direction as if warding off unseen threats.
Professor Kim gazed down at the patient, his eyes brimming with concern.
"But don't worry. We won't give up on you. We will make you healthy — happy — without fail."
His heart toward the patient was, without question, utterly sincere.
“So, Professor Lee — do you think this patient is operable?”
“Uhhh!! Ughh!”
“…”
The patient strained against his restraints, screaming for his life.
I leafed through his test records and spoke with careful weight.
“For one thing, his kidney function is significantly reduced, and look at this pulse and blood pressure. The EKG is… a little off, too. Operating right now would make me uneasy.”
My mouth was naturally reeling off every reason this patient should not be operated on.
“His T waves are abnormal, aren't they? It's not a myocardial infarction, but still.”
Of course it wasn't.
Those were normal T waves.
Their shape wasn't pretty — slightly inverted, admittedly — but under this much tension, that pattern could easily appear. And if it wasn't tension, it might be hyperventilation syndrome, or perhaps excess catecholamines from an adrenaline surge.
The causes were many, but at least one thing was certain: none of them usually warranted postponing surgery.
And yet I lied.
“We should run an echocardiogram first.”
I was no humanitarian so devoted that I genuinely wanted to save this man —
“Honestly, it's pre-testing, so I can't say for sure, but given his history of kidney problems, there's a real possibility of cardiac involvement. He could even be borderline hyperkalemic.”
— but I wanted to stop my beloved mentor from becoming a monster any further.
As a soldier, there had been nothing to be done. But I refused to watch Professor Kim sacrifice more patients.
Because when he came back to himself as a human being, I knew he would grieve.
“Hmm…”
At my assessment, Professor Kim fixed me with a long, searching stare.
The suspicion in his eyes toward me would not fade.
My own heart was pounding, too.
'Please…'
Frankly, this was a gamble.
Professor Kim wasn't a cardiologist — but he was no layman when it came to the heart, either.
Anyone who's eaten university hospital rice long enough picks things up over a colleague's shoulder, and psychiatry in particular deals with cardiology constantly, thanks to antidepressant overdose suicide attempts.
There was every chance a man like him wouldn't buy my line.
“…Professor Lee?”
Gulp.
I swallowed dryly.
“Understood. Once his kidneys and heart are corrected, we'll reschedule the surgery.”
Whew.
For now, it seemed he still trusted me.
Then Professor Kim called me by name.
“By the way, Jeong-uk?”
“Yes, Professor!”
“Diligence is admirable, but don't let your vision narrow. The most common mistake specialists make is assuming their own field is the most serious one.”
“Haha…”
An awkward laugh slipped out.
That was a warning.
I'd back down a step out of respect for cardiology's standing, he meant — but only a step, and only so far.
As a doctor, it was perfectly reasonable advice. But hearing it as one Entity to another made my heart sink.
'A yellow card, then.'
Not a misdiagnosis, not overtreatment.
He seemed to have read the situation as two physicians squabbling over a gravely ill patient until one department won — that kind of thing.
“Thank you, Professor.”
“I'm only letting you have this one because I know how hard you've been working.”
Professor Kim was smiling warmly.
The smile was so gentle it nearly made me forget, for a moment, that this man had resonated.
…Until I spotted the curette — a scraping instrument, surgical steel — poking out of his pocket with a sliver of human flesh still stuck to it, at which point my sanity promptly returned.
“Then we'll transfer this patient to our ward and run blood work and the ultrasound.”
“All right. Good work.”
With Professor Kim's blessing, I wheeled the restrained patient out of the closed ward.
Once I'd moved him to the cardiology ward, I undid his restraints.
I gave him one instruction.
“We need the ultrasound on record first, so wait here.”
Only then would my pretext for taking him from Professor Kim hold any weight.
The patient nodded without a word.
Good. How lovely it is, having a quiet patient.
I left him in his room, and Shiho and I stepped out briefly to fetch the ultrasound machine.
And a few minutes later, when we returned to his room —
“Ah… damn it.”
“Jeong-uk. You should never trust black-haired beasts. Just saying.”
The patient had fled his bed.
Heh… hah…
The patient's ragged breathing rang through the hospital corridor.
'They were both in on it!'
Park Gangjae. A man admitted for acute kidney injury, dragged off to a closed psychiatric ward, and — moments ago — escaped from the cardiology ward.
'That Lee Jeong-uk bastard has resonated too, I'm sure of it!'
What else could explain it? No healthy cardiologist would insist on an echocardiogram for a perfectly fine man like him, and no sane doctor would chat so cozily with that monster.
'What's cardiology planning to harvest, the heart?'
So he ran.
The moment that horrifying professor and that unidentified woman left the room, Park Gangjae fled the ward.
His once-in-a-lifetime escape show was a triumph. From then on, he moved toward a single purpose.
When a nurse approached from the far end of the corridor, he quickly arranged his expression and walked on, natural as anything.
“Are you all right, sir? You look unwell.”
“Yes, just stepping out to the restroom.”
Whenever they threw a question his way, he played his part.
Nurses were easy to fool, after all.
Inside the hospital, nurses were humans who knew nothing — so even if they'd resonated, they couldn't be all that different. That was Park Gangjae's thinking.
The only thing he feared was a white coat appearing around every corner.
Fortunately, on his way down to the underground parking lot, he encountered not a single white coat.
Only upon reaching the underground parking lot did he finally review his plan.
'I don't know what that fog is, but why on earth should I wait around for a transfer order?'
What mattered, as he saw it, was not a transfer.
A resonant psychiatrist had refused his discharge on nonsense grounds — so discharge itself was no longer an escape condition.
'An ambulance! That's the answer!'
Park Gangjae let out a sigh of relief, and the corners of his mouth climbed upward.
Was this how a patient felt, stumbling by chance upon the miracle anticancer drug that money-mad doctors had failed to notice?
So thinking, Park Gangjae began hunting through the underground parking lot for an ambulance.
As it happened, one was sitting there, preparing to leave.
'That's the one. I'll take that.'
“I say there!”
Park Gangjae hailed the paramedic in the driver's seat.
“Name's Park Gangjae. If that passenger seat's going empty, might you see fit to give a man a ride?”
At his words, the paramedic turned his head toward him.
The paramedic was wearing a ski mask and sunglasses.
“…Get in.”
“Much obliged. Once we're out, I'll see you're properly compensated, I assure you.”
Park Gangjae climbed into the passenger seat.
With escape at his fingertips, his grin spread of its own accord.
'Right. Trusting those doctor bastards is what makes a fool. It's the information age — no need to take only their word for anything. It's all in the books and on the internet.'
The world was something you survived alone.
Men who lived off other people's words were simply living at their mercy.
'I'm getting out, you idiots.'
Sinking into the plush passenger seat, drowsiness stole over him naturally.
Now and then came the clank of metal equipment bumping together in the rear compartment, but he paid it no mind.
The driver, noticing Park Gangjae nodding off, spoke up.
“Plenty of room back there. Recline the seat and lie back.”
Park Gangjae accepted the kindness and tilted the seat down.
Warm heater air wrapped around his face. It was so, so cozy.
The moment the tension of escape drained away, fatigue crashed over his whole body.
From the back came sounds of something being prepared, but Park Gangjae paid them no mind.
It was an ambulance, after all — surely preparations for some other patient being taken to another hospital.
As his consciousness drifted farther and farther away, Park Gangjae heard the paramedic in the rear compartment speaking to the driver.
“Hyung-nim. This bastard's smiling?”
“No idea. Probably having a nice dream, that's all.”
“Son of a—”
The morning after that insolent patient escaped.
I clocked in and checked the hospital network to find a consultation request waiting under my account.
[From: Transplant Surgery. To: Cardiology.]
At that point, nothing in particular crossed my mind.
[Post-Operative Consultation: Orthotopic Heart Transplantation]
Even reading that title, I felt nothing special.
[Donor: Park Gangjae / Recipient: Lee Hyo-sang]
Only when I saw that did my heart turn to ice.
As I scrolled down through the consultation request, cold sweat beaded out along my hand.
Orthotopic heart transplantation was performed from donor Park Gangjae to recipient Lee Hyo-sang.
Cardiac allograft transplantation was completed via the bicaval technique (1* anastomosis of both vena cavae). CPB time (2* cardiopulmonary bypass time): 185 minutes. Ischemic time (3* time the donor heart was deprived of blood supply): 240 minutes.
Spontaneous sinus rhythm recovered following termination of cardiopulmonary bypass, and intraoperative TEE (4* transesophageal echocardiography) confirmed no abnormality in biventricular function (5* function of both cardiac ventricles).
The patient is currently maintaining a stable state in the CICU (6* cardiovascular intensive care unit), and a triple immunosuppressive regimen (7* three-drug immune suppression therapy) has been initiated.
We respectfully request your expert care regarding post-operative management and monitoring for acute rejection.
Reading the consultation request, Shiho and I let out a sigh at exactly the same time — no need to decide who went first.
Shiho patted me on the back and spoke.
“Jeong-uk. Rulebooks are written in blood. There you have it.”
“…Right. For now, I'll report this to the Transplant Surgery department — and file a notice about ‘the ambulance in the underground parking lot’ as well.”
Listening to myself say it, one thought settled in my mind.
No matter how I turned it over, Entity were terrifying things —
but patients who wouldn't listen were somehow even more frightening.