Chapter 27 - A Suspicious Patient and an Even More Suspicious Guardian (5)
“Ha... ha...”
Upon entering Room 903, a patient who had turned ghostly pale greeted them.
“What’s the saturation?”
“94%... no, it’s 93%!”
Even as Lee Seon-ji checked the oxygen saturation levels, the patient's condition was gradually deteriorating.
“Call Dr. Hwang Jin-ho. He should be in the hospital.”
The person who knew the patient's condition best was the physician in charge, Hwang Jin-ho.
‘What’s the cause of the recurring dyspnea?’
But he couldn't just sit idly by and wait until he arrived. Sihyeon recalled what Hwang Jin-ho had reported during rounds.
— Patient Jeong Gi-cheol in Room 903 had unstable vitals and findings of pericarditis (inflammation of the mbrane surrounding the heart).
However, the patient had returned to the psychiatric ward after his condition stabilized over the past few days.
‘Print out the consult history from the other departnts.’
[SORA: Outputting the consult records for patient Jeong Gi-cheol from Thoracic Surgery and Cardiology.]
‘The pericarditis has clearly worsened again.’
This was not a condition that could be managed in a psychiatric ward. Checking the records, Sihyeon imdiately opened his phone.
[Thoracic Surgery, Han Jun-sik]
Ring— Ring—
Whether it was just his imagination or not, Han Jun-sik's ringtone seed to drag on endlessly. anwhile, the patient's breathing grew slightly more labored.
‘Jun-sik, pick up. Fast...’
His right hand, gripping the phone, trembled slightly.
—This is Dr. Han Jun-sik’s phone.
Soone barely managed to answer just before it went to voicemail. It was a woman’s voice he hadn't heard before.
“This is Cheon Sihyeon from Psychiatry. Is Dr. Han Jun-sik unavailable to talk?”
—Yes, he’s currently assisting in an ergency surgery with a third-year resident. Do you have a ssage?
It seed like an OR nurse.
“There’s a patient in Ward 9 who had a pericardiocentesis for pericarditis, and his condition is very poor. Is there much left of the surgery?”
—It seems to be almost over. I’ll tell him to contact you imdiately.
“Yes, please.”
It was a difficult situation with the Thoracic Surgery resident on duty being in the operating room. Sihyeon opened his phone again. Chae Yi-jin’s na was on the Internal dicine duty roster.
[Internal dicine, Chae Yi-jin]
Ring— Ring—
This ti, the call was connected almost imdiately.
—Th-This is Chae Yi-jin from Internal dicine. Huff, puff.
The sound of Chae Yi-jin’s breathing on the other end was unusual.
“This is Cheon Sihyeon from Psychiatry. We have soone in our ward who had consults from Thoracic Surgery and Cardiology for pericarditis...”
—Doctor, I’m sorry. I have a patient undergoing CPR (cardiopulmonary resuscitation) in the ER right now. I’ll head there as soon as we finish up here.
“Ah, I understand.”
If there was a CPR in progress, Chae Yi-jin’s back-duty resident was also likely tied up in the ER. Neither departnt had anyone who could co imdiately.
‘This is bad.’
Clack.
Just then, the ward door opened, and Hwang Jin-ho rushed into the room, out of breath.
“What happened?” Hwang Jin-ho asked, wiping the sweat from his forehead.
“Oxygen saturation is dropping and blood pressure is low.”
“I don't think we can handle this. We need to call Internal dicine right away...”
“They say Internal dicine is doing CPR in the ER right now. CS (Thoracic Surgery) is in the middle of ergency surgery.”
“Then what should we...”
Hwang Jinho wore a look of utter despair.
‘I have to buy ti.’
Sensing that the patient's condition was unusual, the other patients in Room 903 began to murmur in commotion.
“First, let's move the patient to the stabilization room,” Sihyeon said.
Hwang Jinho nodded at Sihyeon's words.
……
“Give him maximum oxygen.”
“Yes, Doctor!”
“Please prepare an IV set and 1,000cc of NS (Normal Saline).”
While Lee Seonji prepared the oxygen tank and nasal prongs, Sihyeon secured an IV line in the patient's left arm.
“We're doing an ABGA (Arterial Blood Gas Analysis), and the labs will include Troponin and CK-MB. Please send the samples to the lab imdiately!”
“I'll take them down right away!”
While Sihyeon was drawing blood, Hwang Jinho brought the ECG machine and began attaching electrodes to the patient's limbs and chest wall.
It was rare to see a patient with unstable vitals in a psychiatric ward, but the three of them were surprisingly well-coordinated.
Drip, drip, drip.
Watching the IV fluid fall drop by drop, Sihyeon waited for the ECG results to print.
Whirrr.
Dizzying black solid lines began to print out on the red grid paper.
“This is...”
Sihyeon's expression darkened significantly after checking the ECG results. Tachycardia, low voltage, and electrical alternans. It was a typical ECG that looked like it ca straight out of a dical school textbook.
‘It's cardiac tamponade.’
Cardiac Tamponade.
A condition where the pericardium surrounding the heart is filled with fluid, putting pressure back on the heart. It was as if soone were gripping the heart from the outside, preventing it from beating. It was a true ultra-ergency where failure to drain the fluid in ti could lead to shock and death.
“Doctor, the patient's BP is dropping! It's 70/50!”
The patient's blood pressure fell lower than before. Sihyeon reflexively set the IV to full drop. But that alone was not enough to raise the patient's blood pressure.
“Is the surgery still not over? The ER too? Why are they so late?” Lee Seonji stomped her feet in anxiety.
“He's going to have an arrest at this rate! I'm calling a Code Blue!!”
Hwang Jinho imdiately picked up the receiver. A Code Blue ant announcing over the hospital broadcast that a patient had gone into cardiac arrest.
—Code Blue. Code Blue. Main Building, Ward 9.
—Code Blue. Code Blue. Main Building, Ward 9.
Before long, an urgent voice announcing the Code Blue flowed from the speakers across all wards.
“Doctor, I can't get a blood pressure! There's no pulse!” Lee Seonji shouted urgently as she pulled the stethoscope head from the blood pressure cuff.
“Mr. Jeong Gicheol! Can you hear ?”
“......”
The patient had already lost consciousness and could not answer her.
“Damn it!!!”
Hwang Jinho imdiately rolled up his sleeves. He looked ready to start chest compressions right away.
‘I can't let it end like this.’
Sihyeon closed both eyes.
The cause of the patient’s cardiac arrest was cardiac tamponade. It was a state where the heart was essentially floating in water. No matter how hard the chest wall was pressed from the outside, effective CPR was impossible.
‘I only have one chance.’
Sihyeon opened his eyes.
[Owned Resources: 1,000P]
‘Potion of IPPA, hurry.’
[SORA: Purchasing and imdiately using the Potion of IPPA.]
Flash.
Once again, a brilliant light began to swirl in Sihyeon’s eyes.
Lubb-dupp— Lubb-dupp—
Fortunately, the patient’s heart was still beating, however weakly. But the heart sounds were gradually fading.
‘So this is what it ans when they say the heart is "swimming."’
In the water filling the pericardium, the patient’s heart was quite literally on the verge of drowning.
“Compressions from the outside are aningless.”
Sihyeon stopped Hwang Jinho, who was about to start chest compressions.
“Then what? Are you saying we should just give up? We have to do sothing...”
“Right. We have to try ‘sothing’.”
Sihyeon turned his gaze to Nurse Lee Seon-ji.
“Nurse, do we have a central venous catheter (CVC) set in the ward?”
“Pardon? There should be one in the ergency cart. But why would you...”
“Prepare it imdiately. Along with a few epinephrine syringes.”
“Yes!!”
At Sihyeon’s request, Lee Seon-ji imdiately began rummaging through the ergency cart.
“What are you trying to do? He's about to arrest—what good is a central line right now?” Hwang Jinho asked Sihyeon with a look of total confusion.
“I’m obviously not trying to insert a central line. This is the only thing we need right now.”
Sihyeon pulled a single syringe from the central line kit and gripped it. A needle as long as a finger was attached to the end of the syringe.
“You... no way...” Hwang Jinho shook his head.
“You're not, right? You’re going to pierce the pericardium right here? Without a sono guide (ultrasound)?”
Pericardiocentesis is the treatnt for cardiac tamponade. Normally, using ultrasound to find the exact puncture site is the safe thod, as accidentally piercing a blood vessel or the lungs can lead to fatal complications. However, now was not the ti to be picky.
“That’s insane! I called a Code Blue, so let’s just wait a mont...”
“It takes forever just to bring the ultrasound machine. The patient is already unconscious. We have no choice but to do it blind!”
While he explained this to Hwang Jinho, the patient’s heartbeat grew even weaker.
“D-Doctor! The patient’s condition!!”
Jeong Gi-cheol’s lips were turning blue with cyanosis. Sihyeon hurriedly wiped the patient’s epigastric area with Betadine. Then, he reached out with his left hand and felt the patient’s xiphoid process (the protruding part at the bottom of the sternum).
A faint light shimred at Sihyeon’s fingertips.
‘Right here!’
Deep beneath the ribs. He felt a sensation as if a massive water balloon were gently rippling. The dying heartbeat was transmitted directly to his fingertips.
‘From here, toward the left shoulder...’
Thrust.
The needle in Sihyeon’s hand pierced the patient’s swollen pericardium without a single mont of hesitation.
“It’s coming out! It’s coming out!”
Hwang Jin-ho shouted in excitent as clear pericardial effusion began to fill the syringe.
“One ampule of epinephrine, IV imdiately!”
“Right, it’s going in now!”
Hwang Jin-ho injected the epinephrine into the line secured in the patient’s left arm, then lifted the arm and squeezed the IV bag tightly.
He was trying to deliver the dication as quickly as possible since the heart was not yet functioning properly.
Thump.
After draining about 200cc of fluid from the pericardium and adding the epinephrine, the patient’s heart sounds began to be heard again.
“Doctor, the blood pressure is being caught again. It’s 90/70!”
Lee Seon-ji looked as though she was about to burst into tears.
‘We’ve crossed the hump.’
The strength left his legs. Both Sihyeon and Hwang Jin-ho slumped down onto the floor of the stabilization room.
……
A short while later.
“There was cardiac tamponade... and you perford a pericardiocentesis with this syringe?”
Chae Yi-jin, who arrived late, asked with eyes wide as a rabbit’s.
‘How could he even think of sticking a needle in blindly in this situation...’
It might be possible in theory, but when faced with that actual situation, it was a decision no one could easily make.
“Phew. That was a close call. What exactly happened here?”
[Thoracic Surgery R3 Sim Il-dong]
The Thoracic Surgery resident, who had rushed to Ward 9 imdiately after finishing his ergency surgery, was equally surprised.
The other residents who had run over after hearing the Code Blue had already returned, looking like villagers tricked by the Boy Who Cried Wolf after seeing the patient’s heart beating normally.
However, Sim Il-dong thought differently.
‘This was a truly dangerous situation. And a first-year did this...’
It wasn't even a Thoracic Surgery first-year. It was a Psychiatry first-year.
“Did you say your na is Cheon Sihyeon? I think you rotated through Thoracic Surgery last year?”
“Yes, I rotated in July of last year.”
“I see. Back then, you weren't quite to this extent...”
“Pardon?”
When Sihyeon questioned him, Sim Il-dong wore a troubled expression.
‘We missed out on an intern like this?’
A bitter smile flashed across his face.
“Ah, no. I think you were an A-turn (Grade A intern) even back then, but you still seem excellent. Haha.”
[System: Sim Il-dong is lying. (99.9%)]
“Th... thank you,” Sihyeon said, laughing awkwardly.
“This patient will need to be transferred to Thoracic Surgery to re-evaluate the pericardial effusion. Anyway, you both worked hard.”
Sim Il-dong left the ward imdiately after receiving a few reports from Hwang Jin-ho regarding the patient’s psychiatric status.
……
‘Now it’s really over.’
It had been an exceptionally long day. It was a ti when almost all the patients were asleep.
As Sihyeon was about to head back to the dormitory, Lee In-im, who was still on the phone at the end of the hallway, caught his eye.
‘That’s a long phone call.’
She had been on the phone since before he went to see patient Jeong Gi-cheol, so it must have been at least 30 minutes.
—Don’t worry. Everything will be fine.
‘A man’s voice?’
It was a familiar voice heard from sowhere. Sihyeon looked around.
‘Who is it?’
No matter how hard he looked, there was no one in the dark ward except for Lee In-im.
—I’ll only trust you.
Then ca the woman’s voice. Although it was strange that a voice from so far away sounded so vivid, it was unmistakably Lee In-im’s.
[Potion of IPPA - Remaining Ti 00:01:54]
Only after checking the notification window did Sihyeon understand the situation.
‘The potion’s effect hasn’t ended yet.’
Feeling relieved that what he heard wasn’t a hallucination, he was about to leave the ward when Lee In-im’s voice was heard once again.
—Will we... be okay like this?
‘We? Who is she talking to?’
Sihyeon’s attention turned toward the person on the other end of Lee In-im’s call.
A mont of silence.
And then, the conversation continued.
—Everything will be fine. There's nothing to worry about. Let’s et tomorrow and talk more. ...I love you.
‘Just now, that voice... Ah!’
Sihyeon barely managed to swallow the gasp that nearly escaped his lips.
An impressive, baritone male voice was flowing from the other side of Lee In-im’s receiver.
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