Senior Lee Minjae’s prophecy became a curse and came true with perfect accuracy.
After that day, my status in the Emergency Medical Center changed completely.
Of course, I should say it wasn’t status in a positive sense.
No, maybe depending on how you looked at it, it was status in a positive sense.
The one thing that was certain was that, for me, the situation was not particularly positive.
Of course, it was a good thing for my classmates and juniors. They were the reason my status had risen in the first place.
But the seniors shouldn’t be happy about this, should they? I mean, I get that it might be annoying when people come ask you questions, but come on, you people.
No matter what, a first-year is getting worked to the bone here. Shouldn’t you at least keep an eye on things?
In any case, I had become someone who was no longer treated like a first-year newbie, but burdened with embarrassing titles like “God of Diagnosis,” “Walking UpToDate,” and “Savior of the Juniors.”
And the price was horrific.
“Dr. Han Hyeonjae! Just a moment!”
At three in the morning, right around the time my mind was going hazy from dealing with the flood of patients, an intern came running toward me with a pale face. In his hand was an EKG printout he had just taken.
“There’s a seventy-eight-year-old grandmother over there who keeps saying she has pain around her pit of the stomach and feels nauseous. I thought it was probably just simple indigestion, but I took an EKG just in case, and it looks a little ambiguous….”
The intern’s voice was shrinking into itself.
I sighed inwardly and took the EKG.
At a glance, it didn’t look much different from a normal electrocardiogram. But as the intern said, the ST segments from V1 to V3 were very subtly depressed by about 0.5 millimeters. It was a finding that someone in the early part of their first year might easily brush off as “within the margin of error” or a “nonspecific change.”
Holding the EKG, I stared for a moment at a point in empty space.
‘Access the Gallery.’
Title: 78/F, epigastric pain, nausea. Subtle ST depression in V1–V3 on EKG. Differential?
Author: HellJoseonSlave1
Not even 0.5 seconds after I posted, that 118.235 IP appeared again.
ㅇㅇ (118.235): Suspect posterior MI (*Posterior Myocardial Infarction, infarction of the posterior wall). Run leads V7–V9, dumbass.
After checking the answer sheet, I turned my gaze back to the intern.
“Considering the patient’s age and symptoms, you can’t rule out an atypical myocardial infarction. Especially since this could be a posterior wall infarction, attach additional leads V7 through V9 on the patient’s back and take another EKG. And send labs including troponin (*Troponin, a protein found in cardiac muscle) and cardiac enzyme levels right away. Notify me as soon as the results come out.”
“Huh? A posterior wall infarction? Ah! Understood!”
A short while later, the additional EKG the intern brought back showed clear ST-segment elevation in leads V8 and V9.
A textbook finding of posterior wall myocardial infarction. I immediately called the cardiology doctor on duty, and the patient was taken for an emergency procedure.
I had saved yet another patient who had nearly been left alone as an indigestion case while her heart muscle rotted away.
Proud.
***
Things like this repeated several times a day.
“Hyeonjae, take a look at that patient. Twenty-five-year-old male, X-ray is completely normal, but he’s had a dry cough and fever for a week. Something feels off.”
My classmate Kim Jihun scratched his head as he asked me.
‘Access the Gallery. [25/M, dry cough, fever. Chest PA normal. R/O?]’
ㅇㅇ (14.52): It’s Mycoplasma pneumoniae (*Mycoplasma pneumonia, a type of atypical pneumonia). Atypical pneumonia often doesn’t show up well on X-ray. Put him on Azithromycin (*a type of antibiotic).
“…Hmm, even if the X-ray is clean, it could be atypical pneumonia. Considering a Mycoplasma infection, I think it’d be best to try empirical treatment with the antibiotic azithromycin first.”
“Ah, right! Atypical pneumonia! I almost sent him home with just cold medicine.”
Kim Jihun was genuinely impressed as he smacked my shoulder.
‘The guy who, when asked something, suddenly stares off into empty space and thinks deeply, then gives an incredible answer a moment later.’
That was my new title.
To an intern who said a patient had sprained an ankle but there was an ambiguous little bone fragment on the X-ray, I told him, “That’s an accessory bone (*an additional bone fragment attached to a normal bone), so just leave it alone.” To a classmate who said a child kept touching his ear and fussing, I advised, “If there’s no redness on the eardrum, something like an insect might have gotten into the ear canal, so take a look with an otoscope.”
Thanks to this Gallery, I was forced to spew out knowledge far beyond my year at all hours of the day.
Most of them were apparently things that would be easy enough to distinguish and think of once you had accumulated a little experience.
Of course, as a newbie bastard, I couldn’t properly recall most of those cases on my own.
Before I knew it, it was past five in the morning.
Worn ragged by the endless barrage of questions, I hid in a corner of the supply room, avoiding everyone’s eyes.
When I leaned my head against the cold wall, my eyes slowly closed.
Please, even one minute would be fine, just don’t let anyone look for me.
Fuck. Please just ask the senior residents.
Don’t come to me. Go ask the third- and fourth-years sitting over there, you sons of bitches.
I don’t know either.
I’m just a first-year like the rest of you.
***
With my head leaning against the cold supply room wall, I opened the system window to check the compensation for my labor.
For the past several hours, I had moved, thought, and provided answers without rest.
I had become the savior of the interns and my classmates, preventing their mistakes. What reward had I been given in return?
I tapped the LP acquisition history. A list of small entries appeared on the screen.
[Assisted diagnosis of posterior wall infarction: +10 LP]
[Assisted diagnosis of atypical pneumonia: +5 LP]
[Assisted differential diagnosis of accessory bone: +2 LP]
[Assisted differential diagnosis of foreign body in ear canal: +2 LP]
[Assisted diagnosis of urinary tract infection: +3 LP]
…
That’s it, fuck?
All of it added together was 22 LP. My total LP had become 622 points. I let out a hollow laugh.
Fuck, they’re all minor cases, and since none of the cases I confirmed count as ones I personally treated, the LP barely accumulates.
The system was cold. Diagnostic assistance was only assistance, and it did not grant a full reward.
It was structured so that proper points only came in when I personally took the patient’s history, made the diagnosis under my own responsibility, and began treatment with my own orders.
At this rate, playing the role of a human consultant cleaning up after other people, it would easily take months just to collect 1,000 LP, let alone 5,000.
I irritably closed the LP window and moved to the main page of the [Dead Medical Scholars Gallery].
I wanted to see what kind of nonsense those ghost bastards were spouting now.
And then I couldn’t believe my eyes.
The entire popular posts list on the Gallery was plastered with stories about me.
Title: HellSlave1 fucking nailed a Posterior MI diagnosis lmao
Author: AnesthesiologyPainMedicine
That was pretty decent, how HellSlave1 came to ask the Gallery about what the intern kid almost dismissed as simple indigestion and caught a posterior wall infarction. Come ask often from now on, punk.
Title: For today’s atypical pneumonia case from HellSlave1, would Doxycycline (*Doxycycline, a type of antibiotic) have been okay instead of Azithromycin?
Author: BackInMyDay
Azithromycin was a good choice too, but if it were me, I think I would have used Doxycycline. What do you all think? Let’s have a discussion on this topic.
Title: Thanks to Lord HellSlave1, the Gallery’s been fun these days
Author: BoneNerd88
Thanks to this guy, even after dying, I get to see the latest cases, and it feels like I’m seeing patients in real time, so it’s fucking great. How should I put it? It feels really fresh or something. Hard to explain, but there’s something like that.
Dumbfounded, I stared blankly at the screen.
These ghost bastards had been watching my suffering in real time on the Gallery and even holding discussions about it.
To these crazy Gallery bastards, I was no longer an ordinary living doctor, but something like a streamer on a twenty-four-hour livestream channel that relieved the boredom of these insane ghosts.
I entered one post and checked the comments.
ㅇㅇ (14.52): They’re all small-fry cases, but doesn’t it feel good because it’s like seeing real patients?
ㄴ PediatricsGhost77: For real lol. Plus, when he makes diagnoses while referencing our posts and then comes back to report on it, it feels like we’re participating in the treatment process, you know?
DescendantOfHippocrates: Primitive fools. To take such delight in such trivial cases. However, it is true that it is somewhat enjoyable.
These lunatics are treating my patients like a hobby.