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Chapter 3

VEXAS Syndrome (End)

7 min read1,593 words

An awkward silence hung over the ward after Professor Choi Yeongjun left.

Just moments ago, the nurses had been stealing glances at me with gleeful eyes, as if thinking, *That bastard's about to get torn apart like a dog,* but now they were looking at me with gazes mixed with awe and astonishment.

What are you looking at, you people.

I saw all of you betting on how badly I'd get ripped apart.

I'm a human being with at least some tact, damn it!

I could almost hear the whispering of the nurses and a few medical technicians all the way from over there.

"Is he crazy? Not even Internal Medicine—how would a first-year EM resident know about a rare rheumatologic disease?"

"He called the professor directly and instead of getting chewed out, he got praised?"

Shut up, all of you.

And I can hear everything, okay? I'm literally dying of embarrassment right now, so please, just be quiet.

I blankly stared down the end of the hallway.

My body, drained of adrenaline, felt as heavy as though it weighed thousands of pounds, but my brain was running clearer than ever.

Something hot that had been welling up from a corner of my chest now felt like it was heating the blood throughout my entire body.

Flicker, flicker.

Is this passion?

'Good job.'

What was so special about those words.

Throughout my shitty resident life, the only things I'd heard were

"You don't even know this?"

"Get a grip."

"If you're going to do it like that, just quit."

Nothing but words like these.

Of course, there was the occasional praise, but given that I was a clueless first-year resident, it was only natural which type of words I'd hear more often.

But today, I'd heard sincere praise from a professor's mouth.

Together with a heavy sense of achievement that I might have saved a patient's life.

And the beginning of all of this was…

probably this crazy delusion that had appeared in my head.

[Dead Doctors Gallery]

I avoided the surrounding gazes, hurriedly said goodbye to Gang Taejin, and quickly scrambled into a corner of the hallway.

The moment I threw myself into a chair, I closed my eyes and recalled that damned gallery again.

'Gallery.'

With a *ping—* a familiar yet gloomy blue interface unfolded across my vision.

First, I needed to focus more on this so-called gallery.

What was its true nature?

I stared holes into the screen.

Hmm, so there are users doing their thing.

And what was this interface, anyway?

It had a crude design that looked like something from the early 2000s, yet it bore an uncanny resemblance to a certain site I knew.

First off, the interface was very intuitive.

At the top of the screen, various gallery lists were lined up.

[Dead Doctors Gallery]

[Dead Internists Gallery]

[Dead Surgeons Gallery]

[Dead Pediatricians Gallery]

[Dead Psychiatrists Gallery]

They'd divided them up quite neatly by department.

I had selected [Dead Doctors Gallery] among them. It seemed to be a kind of general board.

"Ha...."

A hollow laugh escaped me.

Could this really be a delusion inside my brain?

A sophisticated hallucination created by my subconscious after stress surpassed its critical point?

Lately, I'd been sleeping poorly and eating irregularly. It could be a psychotic symptom manifesting as part of burnout syndrome.

'Should I get a consultation with Psychiatry?'

It was absurd to give myself such a diagnosis.

What would I even say? 'Doctor, I see a community website where dead doctors are gathered.'? I'd obviously get a shot of sedatives and be sent straight to a locked ward.

But... if this really was a delusion, how could I explain VEXAS syndrome?

It hadn't existed in any small corner of my knowledge, not even at the very end of my forgetting curve.

Only after searching on UpToDate did I learn that it was a rare disease defined just a few years ago.

The chances that I had recalled this on my own converged on zero.

Then was this... a real gallery?

Did it have a physical form?

Grabbing my confused head, I started lurking through other posts. I scrolled through the list of latest posts.

Title: What do they look at besides N-myc for Neuroblastoma, a type of pediatric cancer, these days?

Author: PediatricsGhost77

In my time, all we could do was pump in chemo and pray. Are there no ALK mutations or other targets? Any new drugs that have passed Phase 3 clinical trials?

Comments

Anon (1.234): Talk about "back in my day" lol. You've been dead for over 20 years, it seems. These days they use Lorlatinib, a third-generation anticancer drug targeting ALK. But resistance develops quickly with that too, which is a headache.

Anon (211.36): CAR-T (Chimeric Antigen Receptor T-cell therapy, an immunotherapy) is the answer. It's just a matter of money. The clinical results for GD2-targeting CAR-T were good, but isn't it unavailable in Korea yet?

↳ PediatricsGhost77: What the hell is CAR-T... fuck me. All sorts of things popped up after I died. Drop the paper coordinates.

Title: Who the fuck is the bastard who prescribed Fentanyl to my patient

Author: AnesthesiologyAndPainMedicine

Can't you see they're an end-stage renal failure patient? I got info from some newbie working at the same hospital that they prescribed Fentanyl. Even a med student knows that Fentanyl's metabolite, Norfentanyl, accumulates and causes respiratory depression. You should have used Hydromorphone, you fucking quack bastard. The patient ended up in the ICU because of you.

Comments

Anon (101.11): I died working under a bastard like that too, so I know it well. They just don't think.

Anon (58.235): We're all dead anyway, so why get so angry? Just rest easy in the afterlife.

↳ AnesthesiologyAndPainMedicine: Fuck, how could I not be angry? That was a patient I spent years nurturing.

...What the fuck.

I was lost for words as I looked at the screen.

The tone was that of a cheap forum flooded with curses and profanity, yet the level of conversation going on inside rivaled conferences held by active professors.

All manner of cutting-edge knowledge and in-depth medical discussions were taking place.

Hmm....

I rested my chin on my hand and fell into deep thought.

First of all, was I the only living person here?

Judging by the nuance of the posts and comments, everyone was using expressions like "back when I died," or "when I was alive."

...At least, that's what the posts seemed to suggest.

Wait, if that was the case?

It felt like my heart dropped with a thud.

With trembling hands—no, trembling thoughts—I returned to the post I'd written. I scrolled down to check the comment section.

Below the comment "Looks like VEXAS, send tests," which I'd seen last, new comments had been added.

Anon (182.21): But this bastard's post seems weird, doesn't it? "The patient is—please take a look" means he's seeing them right now.

Anon (39.7): Right? "The patient keeps having a fever and is weak, but I don't know the cause"—that's present continuous.

ORGhost3: What? You're seeing that patient? Are you a living doctor?

HippocratesDescendant: ?? How are you seeing a patient? How are you putting in orders? It's not like you're possessing someone.

BoneOtaku88: You're seeing a patient? Are there patients in the afterworld? Is there an ER in the underworld too?

Ah, fuck.

I'm screwed.

It felt like all the blood in my body was turning cold.

Cold sweat ran down my spine. I'd unconsciously written from a living person's perspective.

Among these dead souls, I had used present-continuous language all alone.

I'd been found out. My identity was exposed.

The fact that a living human existed in this crazy community of dead bastards had been completely revealed.

What would happen now? Would I be forcibly kicked out? Or would this delusion disappear without a trace?

The moment all sorts of anxious thoughts flashed through my mind, the atmosphere in the comment section began to shift in a strange direction.

Anon (118.235): ...Wait. Is that bastard really alive?

HeoJunsTraditionalMedicineThought: OMG.

Anon (210.94): Wow, fuck. Really? "HellJoseonSlave1"—that gentleman is a living, practicing doctor?

AnesthesiologyAndPainMedicine: ?? Wow, fuck, being able to see a patient in real-time—it's been so fucking long (dead for 3 years).

PediatricsGhost77: Crazy fuck, are you really alive? Are you alive, fuck. Answer me, quickly, before I beat your ass—are you really alive?

BoneOtaku88: Hey, then can you livestream this VEXAS patient? You're going to do a bone marrow biopsy, right? Can't you show me the bone marrow slides? I'm fucking good at reading bone marrow, so seriously just give me a chance, real talk. I'll give you an amazing interpretation.

HippocratesDescendant: Wow, then does that mean we don't have to leech new medical knowledge from freshly dead gallery users anymore?? We can just ask a practicing doctor directly? Crazy;;

ORGhost3: This is insane, fuck. So this is the medicine of the living. Hey poster, hurry up and spill what laparoscopic machines your hospital uses. Did you get the latest da Vinci version? I'm asking you to share the surgical field with us, yeah.

"...."

I couldn't believe the sight unfolding before my eyes.

Wariness and suspicion had changed in an instant into frenzied excitement and cheering.

Like people discovering an oasis in a barren desert, these dead doctors were going wild at the appearance of a living doctor.

They weren't rejecting me.

On the contrary, they were craving me.

Alone in the empty on-call room, I looked into the empty air and muttered.

"Isn't this the jackpot?"

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