People who might once have been called the hands of god in their respective fields were now, after death, going wild over a minor diagnosis from a first-year resident.
Were they that starved for real patients and clinical practice?
These crazy workaholic ghosts.
In that moment, I recalled how I had sutured a child's forehead earlier.
The suturing had been a crooked, tangled mess.
What the other seniors would have finished in five minutes, I had struggled over for twenty minutes, barely managing to finish.
In the end, Senior Choi Sumin couldn't stand watching anymore and came to finish the job, even saying, "Hyeonjae, you need more practice with your technique."
I could borrow brains, but I couldn't borrow hands.
I impulsively started writing a post on the gallery.
Title: But guys, real talk
Author: HellJoseonSlave1
How do I get better at hand skills? Seriously, it takes forever just to suture a fall victim's forehead. Any tips?
Post.
The moment I posted, regret flooded in.
Ah, fuck.
Should I not have posted?
What if they mock me with, "A cripple with his hands should quit being a doctor"?
***
I closed the gallery window.
I was an idiot for expecting anything.
Anon (14:52): You'll get better with practice.
BackInMyDay: Buy pig skin and practice suturing at home every day. That's what everyone did in my day.
LurkingInTheORCorner: These days, suturing lectures are all over YouTube, so look those up. Don't just sit there like an idiot.
ScalpelGod: Hands are a matter of talent. Those who don't have it, don't have it. You should stick to using your head.
…Goddamn it. Fuck.
I laughed hollowly and rested my head against the wall. This damn gallery didn't let me download hand skills too.
Ha, maybe there was no point in even using possession.
Would the day ever come when I collected 5,000 LP and summoned Scalpel God into my body for thirty minutes?
It was while I was drowning in self-loathing like that—
—that the automatic doors at the ER entrance slid open, revealing a completely unexpected figure.
It was Professor Choi Yeongjun of Rheumatology, whom I had encountered a few days ago over a VEXAS syndrome patient.
My heart sank.
Why at this hour?
Why the ER, of all places?
Could he be here to chew me out because it wasn't VEXAS after all?
Professor Choi Yeongjun walked straight toward me without even glancing around.
"Dr. Han Hyeonjae."
"Yes, Professor! What brings you here!"
I reflexively sprang to my feet and bowed.
Professor Choi lightly acknowledged my greeting with a nod and thrust the tablet PC he was holding in front of my eyes.
"I was just passing by while reviewing a patient's progress, but today's bone marrow biopsy results were rather interesting. So I stopped by for a moment."
On the screen was a test result packed with English abbreviations and numbers.
Bone marrow biopsy result : Hypercellular marrow with prominent erythroid and myeloid dysplasia… prominent ring sideroblasts(18%)… UBA1 somatic mutation confirmed. (*Bone marrow biopsy result: Hypercellular marrow showing prominent erythroid and myeloid dysplasia. Prominent ring sideroblasts (18%) confirmed. UBA1 somatic mutation confirmed.)
"Dr. Han, does this result remind you of anything? You said you were very interested in rheumatologic diseases, didn't you?"
Since it was the VEXAS patient's result, it obviously had something to do with VEXAS.
But I had no fucking clue what these numbers and words specifically meant.
Fuck. Emergency.
My mind went blank. With the UBA1 mutation confirmed, the VEXAS diagnosis was solid.
But there was no way a first-year resident like me would know the clinical significance of the other findings. Besides, I was an emergency medicine doctor. Not an internist.
Anyway, to avoid shattering my image, I desperately needed to buy time.
I put on the most intellectual expression I could and pretended to stare at the tablet screen.
At the same time, the gallery window opened at the speed of light.
Title: Guys what is this urgent;;; VEXAS patient bone marrow results
Content: (scanned image) Hypercellular marrow, dysplasia, ring sideroblasts 18%. What does this mean?
The moment I posted, I opened my mouth and started spewing bullshit to buy time.
"Ah, Professor. Could you give me a moment? If we comprehensively consider these bone marrow findings and the genetic markers, there are aspects that are difficult to view purely as autoinflammatory disease findings…"
I strung words together and spouted empty nonsense into the air.
Professor Choi Yeongjun watched me with his arms crossed, eyes full of interest.
Please, just one comment!
As if my inner scream had been heard, a small notification finally blinked in the corner of my vision.
HemOncIsHell: Aside from the UBA1 mutation, the MDS (*Myelodysplastic Syndrome) findings are clear. If ring sideroblasts are above 15%, it's high-risk. It means the VEXAS is progressing to MDS. Yeah. It means the prognosis is fucking terrible, and from now on you need to contact hematology-oncology and set up chemotherapy or a hematopoietic stem cell transplant. Otherwise it'll progress to leukemia within a few years.
All the fog in my head lifted.
"Professor, allow me to give you the conclusion first."
Professor Choi Yeongjun's eyes widened slightly.
"This patient is, with very high probability, already progressing to myelodysplastic syndrome—that is, the pre-stage of blood cancer."
I pointed to the "ring sideroblasts 18%" section on the tablet.
"In particular, showing high-risk findings with ring sideroblasts exceeding 15%, if left as is, the likelihood of progression to acute myeloid leukemia within several years is very high. We must contact hematology-oncology immediately and establish a new treatment plan that includes chemotherapy and, in the long term, allogeneic hematopoietic stem cell transplantation."
When I finished speaking, heavy silence fell over the ER station.
Professor Choi Yeongjun was looking at me with his mouth slightly open, eyes filled with disbelief.
At first, it seemed to be intellectual curiosity.
An expression that seemed to say, "Oh, impressive?"
But as my explanation continued, Professor Choi's gaze turned to shock.
Professor Choi stared at me blankly with his mouth open for a long while. During that time, I felt like I was suffocating.
Had I gone too far? Had I pretended to know too much for a first-year? Did I look arrogant for overstepping into hematology-oncology territory?
"Dr. Han."
"Yes, Professor."
"Are you perhaps preparing for an internal medicine double board?"
"…?"
"…What?"
A stupid sound tumbled out of my mouth.
Double board.
When one doctor obtained two specialist certifications.
And he was asking me that?
Seeing my blank expression, Professor Choi Yeongjun soon seemed to realize his own question was absurd, let out a short laugh, and shook his head.
"Ah, never mind. I suppose I let my imagination run wild too. Our hospital's emergency medicine department has truly gained a great talent."
Professor Choi Yeongjun marveled genuinely and lightly patted my shoulder.
"I learned a lot from you today. I'll be sure to relay this to the Chief."
With that, Professor Choi Yeongjun turned around with a light expression and left the emergency room.
Wait, what?
The Chief? What exactly was he going to relay to the Chief?
Excuse me, fuck?
I could physically feel the gazes around me change.
As I stood there blankly in that awkward silence, a huge shadow fell over me from behind.
I turned around very slowly.
Senior Lee Minjae, Chief Resident of the Emergency Medicine Department, had been standing there for who knows how long, looking at me with his mouth hanging open.
He had definitely heard the entire conversation between Professor Choi Yeongjun and me from beginning to end. That expression said it all.
The Chief looked back and forth between the direction where Professor Choi had disappeared and me with a soulless expression, as if he had seen a ghost.
"You crazy bastard!"
Bam!
Senior Lee Minjae grabbed me by both shoulders.
No, why this time too. Why are you trying to torment me again?
"Y-you… you bastard! You've been preparing for a double board without telling me?! No wonder! No wonder you've seemed so off!"
I couldn't come to my senses at the Chief's roar.
"Hey! So that's why you were so sharp on internal medicine cases? Huh? Knowing all those rare diseases we didn't recognize was all groundwork to switch to internal medicine?! Was emergency medicine just a stepping stone?! Us! Were you planning to betray your comrades in this ER and jump to internal medicine, you traitor?!"
The Chief's screams had already crossed the river of misunderstanding and were sailing into the ocean of delusion.
All I could do was stand still and waver. My head was starting to spin, but even so, I kept my mouth shut.
An explanation?
What could I possibly say?
That guy probably wouldn't care what I said anyway.
Fuck, Senior, what first-year prepares for a double board?
I'm just a newbie whose only goal is to survive each day without getting my ass chewed out and without killing a patient.
Double board my ass. Right now, I'd have no other wish than to eat a double cheeseburger and get some sleep, fuck.