All I wanted was to collapse into bed and sleep like a stone.
But before that, there was one thing left to do.
I staggered, threw myself onto the sofa, and opened that damned Medical Gallery again.
Title: Guys, give me goodnight cons, I'm off to bed now
Author: HellJoseonSlave1
Going to bed now, yeah yeah. Give me goodnight cons.
Good riddance to these exhausting ghosts, at last.
Please don't come looking for me until tomorrow morning.
The moment I closed my eyes, praying for peace, comment notifications began ringing relentlessly.
BackInMyDay: ??
HippocratesDescendant: ?? Living one, what nonsense is this?
HematomaIsHell: ?? You're going to sleep? Now?
The mood was strange.
BackInMyDay: You finished suturing, so now it's our turn.
EndocrineMaster: Where do you think you're going to sleep. Sit down.
CardiologyGhost: Shall we start with the ECG?
Fuck.
What the hell.
Had these bastards been lying in ambush together?
HellJoseonSlave1: No, I'm just really tired, but...
My explanatory comment was ruthlessly ignored.
Not long after my comment went up, the first question appeared.
CardiologyGhost: 68-year-old male. Complains of nausea and yellow vision for several days. This morning, altered mental status, presented to the ER. ECG shows atrioventricular block (*a type of arrhythmia). Labs: K+ 6.8 mEq/L. (*Serum potassium concentration; normal range is 3.5–5.0.) The drug overdose you should suspect first, and the drug you must never administer to this patient? You have one minute. Yeah.
My head spun.
Xanthopsia, bradycardia, hyperkalemia.
I'd seen this in a textbook. Cardiac glycosides.
I answered without hesitation.
HellJoseonSlave1: Digoxin (*a type of cardiotonic agent) poisoning. When accompanied by hyperkalemia, calcium gluconate administration is contraindicated. It can actually induce ventricular fibrillation.
As expected, it was correct. A classic case perfect for killing patients if you didn't know it.
CardiologyGhost: Correct.
HippocratesDescendant: The living one seems to have studied internal medicine quite well!
Immediately, the second question flew in.
NephrologyGeezer: 45-year-old female with alcoholism. Presented with altered consciousness after 3 days of heavy drinking. Labs: Na+ 108 mEq/L. (*Serum sodium concentration; normal range is 135–145.) Cause of altered consciousness determined to be hyponatremia. State your treatment plan. How, and how rapidly, will you correct it?
This one's easy too.
Altered consciousness due to hyponatremia. She's symptomatic, so we have to correct it quickly.
HellJoseonSlave1: Severe symptomatic hyponatremia, so IV infusion of 3% hypertonic saline. Rapid correction at a rate of 1–2 per hour to relieve symptoms.
The moment my reply went up, the gallery was engulfed in icy silence.
And soon, a barrage of replies began.
NephrologyGeezer: Hahahahaha this bastard's gonna kill someone.
BackInMyDay: I knew it, tsk tsk. Kids these days don't have the basics down. The rate is the problem, you quack.
HematomaIsHell: Trying to save the patient but paralyzing the brain instead. A very creative method of murder.
What, what's the problem?
Flustered, I racked my brain.
Rapid correction is the right answer, isn't it?
Or what...
Ah.
Fuck.
Central Pontine Myelinolysis. CPM. Central pontine myelinolysis.
If you correct sodium too quickly, the center of the brain melts away, and the patient can fall into a permanent vegetative state.
Something I'd memorized by rote.
For a moment, driven by the thought that I had to correct quickly, I'd almost done something insane.
InfectiousDiseaseGhost: Let's move to the next question. 50-year-old male, chronic alcoholic. After sobering up, not fully alert, keeps rambling, can't move his eyeballs properly. Gait is unsteady. What vitamin must be administered first before giving glucose via IV fluids? And why?
I can get this one. Thiamine. Vitamin B1.
HellJoseonSlave1: Thiamine. Alcoholics are highly likely to be thiamine deficient, and administering glucose first in this state can induce acute Wernicke's encephalopathy.
InfectiousDiseaseGhost: Correct. You got this one.
Thank god.
But there was no time to rest.
The fourth question came from an area I never expected.
RheumatologyHag: 35-year-old female of reproductive age. Presents with intermittent fever and polyarthralgia for the past month, plus a butterfly-shaped facial rash. Labs reveal pancytopenia, and urinalysis shows proteinuria and hematuria. The suspected disease, and the three specific blood antibody tests that must be performed first to diagnose this patient?
Butterfly rash? Pancytopenia? Proteinuria?
Fuck, what is this.
Lupus? Systemic lupus erythematosus?
It seems like it, but...
Three specific antibody tests?
anti-dsDNA? anti-Sm?
And what was the other one?
My mind went blank. This isn't my field. How is a first-year emergency medicine resident supposed to know this?
'No, I'm not an internal medicine doctor. I don't need to know this stuff...'
In the end, I couldn't answer at all.
RheumatologyHag: Time's up. The answer is SLE (*Systemic Lupus Erythematosus). The tests are anti-dsDNA, anti-Sm, and C3/C4 complement. Isn't this common knowledge? Were you just going to stand there spacing out while the patient's entire body falls apart?
Common knowledge, she says.
It might be common knowledge for that damned hag.
I just closed my eyes.
And a moment later, the fifth question appeared.
CardiologyGhost: Alright, last one. 55-year-old male with chest pain. ECG shows deep, symmetric T-wave inversions in leads V2 and V3. Cardiac enzyme levels are normal. The patient says he has no pain right now. What is the name of this finding, and what is the treatment plan going forward?
T-wave inversion... Myocardial ischemia?
But the enzymes are normal and he says he doesn't hurt now?
Then do we just observe?
HellJoseonSlave1: T-wave inversion suggests myocardial ischemia, but since the patient is currently asymptomatic and cardiac enzyme levels are normal, we will observe the course and schedule follow-up tests for now.
The moment my answer went up, the greatest festival of mockery opened in the gallery.
CardiologyGhost: This crazy bastard has really decided to kill the patient!!!!!!
BackInMyDay: You see that and say observe? That's the same as looking at a time bomb and saying you'll watch!
CardiologyGhost: It's Wellens' syndrome (*an ECG finding seen in patients with unstable angina), you crazy bastard!!! A time bomb! The moment you see that ECG, even if asymptomatic, you have to get a cath lab ready and slap in a stent!
Everything came crashing down.
And so that day, I got two right and three wrong. Two of them were fatal errors.
HellJoseonSlave1: No, you crazy bastards, the questions are too hard. I'm EM, not internal medicine.
That's right. I'm emergency medicine.
Even if I should know EKGs, there's no obligation for me to know all this deep, detailed internal medicine crap. This is too much.
NephrologyGeezer: Yeah, so what? You're EM, don't you see them first? Then you should know more. Do patients walk in saying 'I'm a nephrology patient'? Do they collapse saying 'I'm a cardiology patient'? All sorts of random cases come to you first. Then you have to differentiate and treat them first. It's natural for you to know as much as an internal medicine specialist. If you can't, quit.
What?
...
Silence.
I realized that the ghost's words fit together with perfect logic.
The ER is the front line of every disease.
You can't choose your patients. That's why you have to know more broadly and deeply than anyone else.
Ah.
I'm tired.
So tired...
I collapsed just like that.
Leaving behind the ruined table, the ragged pig skin, and my miserable test results.
***
My head felt like it was going to split open.
"Ugh..."
Groaning, I raised my upper body.
My shoulders, waist, wrists, every joint in my body creaked. The aftermath of last night's suturing practice and the price of sleeping on the floor in snatches.
Fuck my life.
It's a piece of shit.
I looked at the table with sunken eyes. Pig skin ruthlessly mangled, empty drink cans, and surgical instruments strewn about chaotically.
'...Still.'
Yesterday's sense of defeat was nowhere to be found.
Instead, a strange, inexplicable fighting spirit was burning in a corner of my chest.
A bitter determination to milk those crazy ghost bastards for all they were worth, since it had come to this anyway.
I staggered up and washed my face with cold water. In the mirror stood nothing but a hospital slave with dark bags under his eyes.
I flashed a twisted grin at that pathetic face.
'Alright. Let's have some fun today too.'
I sat on the sofa and, like an office worker casually clocking in, familiarly opened that damned Medical Gallery.
And as brightly and energetically as possible, as if yesterday's disaster had never happened, I posted a new thread.
Title: Hey gallerians, nice to meet you! A strong and powerful morning!
Author: HellJoseonSlave1
A light greeting.
But my expectations were ruthlessly shattered by the very first comment.
BackInMyDay: What's so nice about it. Sit down.
Yeah, that's my guys.