The delusion called “double board” that senior Lee Minjae had spread went around like an epidemic.
Before even a day had passed, the rumor had spread through the entire Department of Emergency Medicine.
At dawn, after waking from a brief nap in the on-call room, I was taking a fresh gown out of the supply room when a voice came from behind me.
“Hyeonjae?”
It was fourth-year Yu Seonghun. As always, his face was soaked in chronic fatigue.
“Are you really going to internal medicine?”
“What?”
“Now would be the right time, I guess. There are guys who strike a deal and transfer around the fall of first year. So are you giving up residency? Or are you really doing a double board like Minjae said?”
I squeezed my eyes shut.
In my head, I recalled what I’d been like over the past year.
The days of getting cursed out and covered in blood.
I’m not giving up.
As if I’m crazy enough to do this all over again.
It was horrifying enough that I had to endure this hell for four years, but to go to another department and repeat this process for another three or four years? Double board? That wasn’t something a human being should do.
I answered in as firm a voice as I could manage.
“No. I have no intention of changing departments. I’m not giving up residency.”
“Then double board?”
“No, I’m not doing a double board either.”
“Hmm.”
Fourth-year Yu Seonghun stared at me for a moment with an expression that made it impossible to tell whether he believed me or not, then shrugged and went on his way.
But this was only the beginning.
I was putting in orders at the ER station when third-year Choi Sumin approached with a worried face.
“Hyeonjae.”
“Yes, doctor.”
“Are you really doing a double board? That’s a really difficult path. You’ll ruin your body like that.”
By now, I almost felt like crying.
“I said I’m not, doctor. Who on earth spread such a ridiculous rumor…?”
“Really? Then that’s a relief. Anyway, don’t push yourself too hard.”
She patted me on the shoulder and left, but it didn’t comfort me at all.
I said I’m not changing departments, you bastards….
And finally, what had to come came.
My fellow resident, Jo Suyeon.
“Hyeonjae!!”
“Huh? What is it now?”
“You traitorous bastard! I knew it from the start! How dare you abandon EM?! You were the one who suggested it first, and now you’re running away from EM?!”
I pressed hard against my temple.
My head was throbbing.
I said no.
I’m not going.
I’m not doing it.
I shouted it dozens of times in my heart, but by then, no one believed a word I said.
I’m not going. I’m not doing it. I can’t do it.
My only goal is to finish four years here and get out.
Please just believe me, you sons of bitches.
***
Friday, 1 a.m.
Our hospital’s Regional Emergency Medical Center, one of the busiest emergency rooms in South Korea, could not sleep even at that hour.
“Prepare suction! BP keeps dropping! 80 over 50!”
“Heart rate 140! Doctor, I think we need to get a C-line right now!”
In the resuscitation room, a war was raging to save a multiple-trauma patient brought in after a traffic accident.
All the senior residents, staff physicians, and even the professors had joined in, fighting desperately.
I was quietly charting at my seat.
That still wasn’t a place for me to get involved. The best I could do was process the charts for the milder patients piling up at the station and lighten my seniors’ burden even a little.
That was when it happened.
Beep—beep—beep—beep—!
An alarm erupted from a completely different direction.
Area B. It was where relatively stable patients stayed.
When I turned my head, the oxygen saturation for the B-12 patient was blinking red on the station monitor.
85%
84%
83%…
“Fuck.”
I got up from my chair and ran toward the bed.
All the seniors were tied up with the trauma patient.
Lying in the bed was a woman in her seventies. She had a history of chronic obstructive pulmonary disease and had come in yesterday afternoon because her dyspnea had worsened.
At the time of arrival, her oxygen saturation had been low, so we had been observing her while supplying oxygen through a nasal cannula (*a nasal oxygen tube), and since her condition had stabilized, she had been a patient we were considering discharging soon.
But now the patient’s condition was completely different.
Her face was pale, and her lips were blue. It didn’t feel like she was breathing properly. Her consciousness was nearly clouded as well.
“Minjun! You were watching this patient, weren’t you? What happened?”
I shouted at first-year Choi Minjun, who was fidgeting beside the patient.
“Her sat (*saturation, oxygen saturation) suddenly started dropping, so I raised the oxygen first! She’s on 10 L through a face mask right now, but it keeps dropping!”
Just as he said, an oxygen mask was over the patient’s nose, and the oxygen flow was set at 10 L.
But the patient’s condition was getting worse and worse. Her consciousness was fading.
Choi Minjun shouted, looking almost ready to cry.
“What do we do? Should we raise the oxygen to the max, 15 L? Or should we prepare intubation (*endotracheal intubation) right away?”
Oxygen is dropping. COPD patient. I’ve seen this somewhere. I definitely learned it, and it was on exams too.
What was the exact mechanism again?
No, but how the hell did this bastard pass the national licensing exam?
Anyway, that wasn’t what mattered right now.
For a moment, my mind was going blank.
I definitely knew this, didn’t I?
‘Gallery!’
Pretending to place my stethoscope on the patient’s chest and listen to her breath sounds, I brought up the blue interface in my pupils.
Title: Urgent. COPD (*Chronic Obstructive Pulmonary Disease) patient in her 70s. Came in with dyspnea (*difficulty breathing). Giving O2 10 L, but sudden decreased consciousness and sat dropping. Why is this happening?
Author: HellJoseonSlave1
After posting it, I shouted at Choi Minjun.
“First, lift the patient’s chin and secure the airway!”
As I bought time that way, I saw a comment appear in the corner of my vision.
RespiratoryGhost: You idiot, it’s CO2 retention (*carbon dioxide retention). Don’t you know that if you blast a COPD patient with high-concentration O2, it suppresses the respiratory center and they stop breathing? She’s gone into narcosis (*coma) from hypercapnia (*excessive carbon dioxide concentration). Lower the O2 immediately and do an ABGA (*Arterial Blood Gas Analysis) to check pCO2. If needed, get ready to put on BiPAP (*Bi-level Positive Airway Pressure, a type of ventilator).
All the puzzle pieces fell into place.
I hung the stethoscope around my neck and shouted at Choi Minjun.
“Choi Minjun! Lower the oxygen! Lower it to 2 L right now!”
“What? Lower it? Her sat isn’t even hitting 80 right now. The patient will die, Hyeonjae!”
“This patient has COPD! Did you forget her history?! Didn’t you take the national exam?! If you give her more oxygen here, her heart’s just going to stop, you bastard!”
“…Ah!”
I shoved Choi Minjun’s shoulder aside and roughly turned the oxygen dial myself.
Then I shouted to the nearest nurse.
“Nurse! ABGA kit and a heparinized 1 cc syringe here, quickly! I’m going to draw from the radial artery right away!”
“Yes, doctor!”
“And Dr. Lee Sujin! Please bring the portable X-ray and the BiPAP machine right now!”
The nurses moved in perfect order.
Then I gave the panicking Choi Minjun a loving smack on the back and handed him an Ambu bag.
Soon after, I drew arterial blood with the kit the nurse brought. Only after confirming bright red blood entering the syringe could I briefly catch my breath.
“Send this straight to the lab! Please ask them to run it STAT (*statim, immediately)!”
At that moment, a nurse and a respiratory therapist came running over, dragging the heavy BiPAP machine.
“Doctor! We brought the BiPAP!”
The respiratory therapist asked me,
“Doctor, how should we do the initial settings? Please give me the IPAP (*inspiratory pressure) and EPAP (*expiratory pressure).”
“…”
My mind went blank once again.
Fuck.
Settings? How would I know that?
Thanks to the Gallery, I knew BiPAP was needed.
But I had no idea whatsoever how to set the specific numbers.
Should I just say 10 and 5?
What if that damaged the patient’s lungs?
“Doctor?”
The respiratory therapist urged me.
Choi Minjun and all the nurses’ gazes were fixed on my mouth.
Breaking out in a cold sweat, I desperately racked my brain to buy time.
“One moment. I think I should check the patient’s level of consciousness and chest wall movement one more time before deciding.”
I made that excuse and pretended to approach the patient.
Then, while pretending to lift the patient’s eyelid and check her pupillary reflex, I opened the Gallery window again.
Title: [Urgent22] Need initial BiPAP settings!!
Author: HellJoseonSlave1
No sooner had I hit post than the same RespiratoryGhost from earlier instantly reappeared.
RespiratoryGhost: Start with IPAP 12, EPAP 5. Set RR (*Respiratory Rate, breaths per minute) to about 14. After 30 minutes, do another ABGA and see how much CO2 is coming down, then adjust the pressure. I set the whole table for you, and you still can’t even use the spoon.
The insult cut deep, but that wasn’t what mattered right now.
“We’ll start the initial settings at IPAP 12, EPAP 5, and a respiratory rate of 14 per minute.”
“Yes, understood.”
The respiratory therapist operated the machine with practiced ease.
A moment later, a nurse shouted toward us.
“The ABGA results are out for patient B-12!”
My heart pounded.
“Doctor! pH is 7.15, pCO2 is 92, bicarbonate is 30!”
“…Good!”
Without realizing it, I clenched my fist.
“Okay, maintain the BiPAP settings as they are, and we’ll run a follow-up (*continued observation) ABGA again in 30 minutes! Please keep checking every 10 minutes to see if the patient’s mental status crashes!”
I did it.
Again.
With the help of this insane Gallery, I had saved a patient.