NOVEL WEB Chapter 5
Chapter 5
Intern Shin Seonhan (4)
Thud!
I burst out into the hallway.
Other interns are also springing out like jack-in-the-boxes.
The internal medicine department is divided into nine subspecialties, with 18 interns assigned, and half of them, nine, are on night duty.
Some are stationed in the main building, and some are in the cancer center dormitory, where I am.
“Wait, let’s go together!”
I see Yeonseo running from the women’s dormitory, her messy hair tied up in a hurry.
Wow…
I thought it was a scene from a commercial.
Even in this chaotic situation, the male interns are staring at Yeonseo with wide eyes.
She can pull off that look even when she’s just woken up.
No, that’s not important right now.
Thump, thump, thump!
I ask as I run,
“Yeonseo, did they say 17th floor, west wing?”
“Yes.”
“You said the patients were stable earlier.”
“I don’t know who’s having the CPR either. When I went to do the dressings, the ward was completely silent…”
Yeonseo’s face is pale.
It’s understandable since a Code Blue occurred in the ward she’s in charge of.
“This will be the fastest.”
Thump, thump!
As soon as we arrive at the elevators, Geun-uk presses all six elevator buttons.
When we reach the 17th floor, a harsh voice greets us as if waiting.
“Looks like interns have it easy these days?”
Damn, it’s a face I don’t want to see.
Kim Beomsu, the 3rd-year internal medicine resident, also known as “Kim Snake.”
His irritable personality is especially prominent during on-call duty.
“The patient’s life is on the line, and you’re only arriving now? Already slacking off in your first month as an intern?”
Kim Snake’s ferocious voice continues.
Of course, it’s unfair to us, considering we sprinted all the way here.
Even at our fastest speed, it takes at least five minutes to get from the intern dormitory in the cancer center building to the main building.
Unless we’re Usain Bolt, there’s no way we could have arrived any sooner.
But excuses don’t work here.
“We’re sorry.”
We lower our heads.
A university hospital.
A place where you can never let your guard down.
Here, interns are no different from low-ranking soldiers. We have to come when called and run when ordered.
Fortunately, due to the urgency of the situation, Kim Snake’s scolding doesn’t last long.
“One person takes over the ambu bag here, the rest line up and do compressions.”
“Yes!”
Perhaps it’s fortunate, in a way.
The interns who arrived earlier are already taking turns performing chest compressions.
For a patient whose heart has stopped, chest compressions must be continued for at least 30 minutes unless ROSC (Return of Spontaneous Circulation)[mfn]is the resumption of a sustained heart rhythm after cardiac arrest. It’s a positive sign and the goal of CPR, but it doesn’t necessarily predict the patient’s long-term outcome.[/mfn] is achieved.
Usually, we take turns every two minutes, but when you’re actually pressing on the chest, it’s not a short time at all. Most people are drenched in sweat after two minutes.
I check the patient’s face while waiting for my turn.
‘Gasp!’
It’s a familiar face.
Patient Kim Jeongsu.
As I feared, it’s the very same patient.
The content of my dream is actually coming true.
What in the world is going on?
“200 joules charge!”
“Everyone step back! Shock!”
“Rhythm back to normal!”
Fortunately, right before my turn, the electrocardiogram returns to a normal rhythm after defibrillation.
Emergency situation over!
I breathe a sigh of relief.
But with Kim Snake’s personality, there’s no way he’d let us go quietly.
“Interns, listen carefully.”
“Yes.”
“When you’re late, the time we have to save the patient decreases. Do you understand what I’m saying?”
“Yes, we understand.”
“Now, then, in a CPR situation like this, when the patient is intubated, can anyone tell me how often to squeeze the ambu bag according to the guidelines?”
Kim Snake asks in a sharp voice.
My neck stiffens, and tension fills the air.
This is a test.
My fellow interns look flustered.
Of course, if we think calmly, it’s not difficult content, but we’re bound to stutter when faced with a surprise question.
“Can’t answer right away? Is this the level of Yeonguk University Hospital interns?”
Kim Snake’s voice becomes harsher.
It’s not going to end well if we drag this on any longer. Knowing his personality, there’s no telling what kind of verbal abuse might erupt.
In the end, I step forward.
“When the airway is secured, we should ventilate once every six seconds.”
“What about the diastolic pressure during compressions?”
“The intra-arterial blood pressure should be above 20 mmHg during diastole.”
Kim Snake’s expression softens slightly.
He stares directly at me and throws another question.
“What’s the dosage of Amiodarone for a shockable rhythm?”
“Initially, 300mg bolus, then 150mg.”
“Correct.”
Kim Snake nods.
“It’s a relief that there’s at least one intern who’s paying attention.”
…Well, I’ve been thinking about this all day.
The scene from my dream this morning was so vivid that I’ve been replaying the CPR scenario in my head all day.
If it weren’t for that, I might not have been able to answer so quickly.
In any case, Kim Snake’s tone becomes somewhat gentler.
“The rest of you interns, reflect on yourselves. Especially those from Yeonguk University.”
“Yes.”
“What are you waiting for? Get out of here.”
The interns bow and leave the ward.
Before leaving, I glance at the clock on the wall.
02:40—
Time is passing into the early morning.
***
“What was that? It ended so quickly without us doing much.”
“I know, right?”
“I’ve been working out lately, so I was ready to give some intense compressions. What a shame. Haha.”
On the way back to the dormitory, Geun-uk flexes his arm muscles and jokes around.
His joke eases the tension among the interns.
“By the way, why did Kim Snake let us go so early?”
“It’s thanks to Seonhan. I don’t even want to imagine how much we would have been scolded if he hadn’t been able to answer those questions.”
“Seriously, why is that guy such a jerk?”
“I’m never going into internal medicine. I can’t stand Kim Snake.”
The interns’ chatter turns into gossip.
Cursing the resident we can’t stand is one of the few comforts of intern life.
But I can’t focus on the conversation at all.
What is this feeling?
It’s as if I’m missing something important…
.
The events from my dream have already come true.
If the dream unfolds in reality once again…
In about 40 minutes,
I stop in my tracks.
The other interns look back at me, wondering what’s wrong.
“Hold on a second. Something’s bothering me.”
“What?”
“You guys go ahead.”
“What? Hey, where are you going!”
Thump, thump, thump!
I turn back towards the west wing.
Of course, I know it’s a pointless delusion.
But…
‘It can’t hurt to check.’
If I go back to the dormitory like this, I don’t think I’ll be able to shake off this uneasy feeling.
As I run, I hear a voice behind me.
“Wait, I’m coming with you!”
I turn around to see Yeonseo hurrying after me.
“Why are you following me?”
“Where are you going?”
“To check on a patient again.”
“Why are you worried about patient Kim Jeongsu? He was originally my patient. If anyone should be concerned, it should be me.”
Is that so?
Come to think of it, she’s right.
“Then let’s go together.”
Anyway, two is better than one.
With my mind in turmoil, I don’t think I can think objectively right now.
***
Patient Kim Jeongsu is sleeping peacefully with a ventilator attached.
The attending physician, Kim Snake, is nowhere to be seen; he must have gone to the bathroom or something.
Yeonseo and I examine the patient’s condition.
Beep, beep…
The rhythmic beeping of the patient’s heart monitor echoes monotonously.
I nudge Yeonseo with my elbow and ask,
“What do you think?”
“About what?”
“About the patient’s condition.”
“Eh, can we even tell just by looking? We’re only one month into our internship.”
“That’s true.”
Even as I say that, I can’t take my eyes off the patient.
Maybe, even with our inexperienced eyes, we might be able to pick up on something.
“Do you know anything about this patient?”
“Well… I passed by him when he was being wheeled to the Cath Room for the PCI procedure. And I smelled cigarette smoke.”
“Cigarette smoke?”
My eyes widen.
It goes without saying that smoking is discouraged during hospitalization.
Especially for a patient about to undergo a heart procedure.
“I wondered if it was coming from the patient, but I went to do other tasks.”
“Hmm…”
Of course, smoking once might not be immediately fatal.
But if he couldn’t resist smoking even before a heart procedure, how much did he usually smoke?
I check the patient’s EMR (Electronic Medical Record) on the monitor next to him.
———————–
[Kim Jeongsu]
63/M
HTN/DM/Dyslipidemia (+/+/+)
Smoking Hx (+) 80 pack-years
Ejection fraction 35%
PCI d/t unstable angin
———————–
“That’s serious.”
I frown.
The record shows a history of smoking at least two packs a day for 40 years.
And that’s not all.
Hypertension, diabetes, dyslipidemia…
He has all the signs of poor vascular health.
And his ejection fraction is only 35 percent. In other words, his heart’s pumping function is significantly low.
Yeonseo also looks at the chart with a shocked expression.
“Wow… Now that I see it, it’s no wonder he might have problems after the PCI procedure.”
“You think so too, right?”
“Yes.”
Yeonseo nods in agreement.
PCI.
Percutaneous Coronary Intervention.
It sounds complicated because it’s a medical term, but the concept itself isn’t that complex.
Our body has blood vessels called “coronary arteries” that supply blood to the heart.
But when these coronary arteries narrow, the heart muscle doesn’t receive enough blood.
PCI is a procedure to artificially widen this passage.
It involves inserting a small metal tube called a “stent” into the blood vessel to create a sturdy pathway.
However, since it involves inserting an artificial device into the body, problems can arise.
‘So, how will this patient die? He clearly recovered earlier…’
I try to recall the textbook I saw in the intern dormitory.
Damn it…
I can’t remember even though I just read it.
I never forget the names of fish sold at Garak Market once I hear them, but medical knowledge seems to vanish from my mind instantly.
It takes several repetitions for it to finally stick.
That’s why they say studying medicine is like pouring water into a bottomless jar, isn’t it?
As a medical student, I was a jar with a huge hole, the type who just kept pouring water in diligently.
Anyway, that’s not important. The question is, how will this patient die? Remember something, anything!
Just then, a word flashes through my mind.
“Refractory V-fib.”
I mutter under my breath.
Refractory Ventricular Fibrillation (Refractory V-fib).
It refers to a malignant, recurring ventricular fibrillation that doesn’t respond to repeated shocks or medication.
If that happens, the patient has a very high chance of dying!
I stare intently at patient Kim Jeongsu’s electrocardiogram.
“Doesn’t something seem off?”
“What do you mean?”
“Look at the ECG rhythm. Look at the APCs and VPCs passing through.”
Indeed, the graph is changing little by little from normal.
Strange waveforms appear like noise between the regular rhythms.
“I don’t really see it… But now that you mention it, I guess it does look like that.”
“We need to report this quickly.”
“About what?”
“That the patient is in danger.”
“Are you serious?”
Yeonseo asks, startled.
Frankly, I’m surprised at myself for even suggesting it.
A one-month intern voicing their opinion to the attending physician?
It’s unheard of.
It’s like a newly hired trainee giving advice to their superiors.
Especially in a hierarchical society like Korea, it’s even more unacceptable.
“Are you really going to say something? Knowing Kim Beomsu’s personality, he’s not going to take it well…”
Yeonseo says with a worried look.
…Actually, she’s right.
Who am I to say anything?
Let’s just pretend we didn’t notice anything.
There’s no benefit in sticking my neck out.
What if I get labeled as arrogant from the first month of my internship?
My head says one thing, but my feet move on their own.
—————–
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