Fifth Vital [EN]: Chapter 94

94. Lee Chan-hee! Report Again

“Thank you, doctor. You know what I mean, right? Please take good care of her. We’re both doctors.”

Lee Chan-hee didn’t respond, recalling Tae-kyung’s words as he approached the patient.

‘Always focus on what you need to do now and the patient in front of you.’

“Right, as Dr. Tae-kyung said, I just need to do my job well. Think about the patient in front of me.”

Clatter-

Lee Chan-hee briskly pulled back the curtain and faced the patient.

“Are you in a lot of pain?”

“Yes… I… I’m in so much pain.”

“Doctor, my mom had a colonoscopy and suddenly became like this. She’s been in pain all day since yesterday.”
The 80-year-old female patient and her daughter, the guardian, spoke simultaneously as soon as they saw Lee Chan-hee.

“My stomach hurts so much.”

“Doctor, my mom keeps saying her stomach hurts like this. I don’t know why she’s suddenly like this after the examination.”

Even at a glance, the patient appeared to be suffering from severe abdominal pain. She was about 160cm tall, with some abdominal obesity, and looked like a typical 80-year-old grandmother.

“Doctor, please do something about my mom’s pain.”

“Yes, I’ll give her a strong painkiller first. Does the patient have any past medical history?”

“Not really, but I’ve heard she has some kidney issues.”

“No diabetes or high blood pressure?”

“No. She didn’t have those diseases. But yesterday…”

“Aaaagh! Oh my!!”

Before the daughter, the guardian, could finish speaking, the patient cried out in extreme pain.

“Doctor, it hurts so much. It hurts so much.”

The pain was so severe that the patient writhed and groaned.

“Here, give her pethidine [a narcotic analgesic] first. I’ll write a prescription.”

“Yes, Doctor.”

“Mom? Are you okay? Mom!”

The guardian, with a worried face, stayed close to the patient and checked on her mother.

“Excuse me, guardian. I need to palpate [examine by touch] to accurately diagnose and treat her before the painkiller is administered. Could you please step aside for a moment?”

“Ah, yes. I’m sorry. Please take good care of my mom.”

“You’re in a lot of pain, aren’t you? Where does it hurt the most right now?”

“Oh, doctor, it all hurts. I feel like I’m dying.”

Usually, elderly people exaggerate a bit, but not now. This elderly patient was suffering so much that she kept saying she felt like she was dying.

“I’m going to check your abdomen.”

Lee Chan-hee first palpated the abdomen, continuing from the lower abdomen to the upper part near the stomach.

‘Huh!?’

But the palpation was strange.

Even though she was in so much pain, pressing firmly on her abdomen didn’t seem to worsen the pain.

Usually, patients with severe abdominal pain due to abdominal issues experience significant pain during palpation and immediately express their pain. But the pain didn’t seem to worsen significantly.

‘There’s not much difference between palpating and not palpating?’

It felt similar whether he pressed or didn’t press any area.

“Hmm…”

That wasn’t all.

Lee Chan-hee could tell that the patient’s abdominal muscle rigidity was generally unclear.

If inflammation spreads to the peritoneum [the membrane lining the abdominal cavity], rigidity naturally occurs. It is a very important indicator for emergency surgery.

But now it was ambiguous. It seemed like it wasn’t, and it seemed like it was.

‘Why isn’t there rigidity…’

With such a painful patient, there should have been tremendous rigidity. Lee Chan-hee was somewhat taken aback by the ambiguous palpation.

“Doctor, the pethidine is ready. Should we administer it now?”

“Yes, give it right away.”

No sooner had Lee Chan-hee finished speaking than he took out his stethoscope and placed it on the patient’s abdomen.

‘I can’t hear it?’

The bowel sounds that should have been heard through the stethoscope were not audible at all. A very faint sound was heard from afar, but it sounded hollow.

Lee Chan-hee thought he could get a sense of it through a physical examination. Because it was a bit obvious.

After the endoscopy, severe abdominal pain was most often caused by perforation [a hole in an organ]. He had that in mind when he did the examination, but he couldn’t be sure anymore.

“We’re going to take a CT scan first. Since I heard that the patient’s kidneys aren’t good, I’ll take a blood test and check the kidney levels before taking the scan.”

The patient went to get a CT scan with her guardian, and the internal medicine doctor was still restless, pacing around with an uneasy expression.

Lee Chan-hee headed to the station while waiting for the CT scan.

‘Is it not a stomach perforation? Then what is it?’

Lee Chan-hee, who was constantly thinking about the cause of the patient’s abdominal pain, got up from his seat and looked at the nurse.

“Is the CT scan delayed? Is something wrong?”

The images that should have been up by now had been silent for 30 minutes.

“Doctor, they said they’re taking the emergency room patients in order. Should I ask them to take it faster than other patients if it’s an emergency?”

“Yes, please ask them to do it quickly.”

“Doctor, the lab results are out.”

In the meantime, the nurse informed him that the blood test results were out.

Click-

Lee Chan-hee quickly clicked the mouse and shifted his gaze to the screen.

Fortunately, the numbers indicating kidney function were not bad. However, the numbers for WBC [white blood cell count], CRP [C-reactive protein], etc., which indicate the degree of inflammation or infection, were not as high as expected.

“Is that all?”

If it were a perforation, it wouldn’t be strange for the numbers to be two or three times higher, but it was only about 20% higher than the normal range.

‘Ha! What’s the cause? Is it not a perforation?’

There must be a reason why the patient is in so much pain, but he was frustrated.

“Excuse me, Doctor…?”

The internal medicine doctor who performed the endoscopy approached Lee Chan-hee again.

“Yes?”

“What do you think about the patient? Is it a stomach perforation?”

“It’s not certain yet, but based on the current test results and physical examination, it may not be.”

“Really? And could you please talk to the guardians nicely?”

He said it could be, but he didn’t definitively rule it out. However, the internal medicine doctor, who had been fidgeting, now seemed to subtly shift his expression.

“Yes? What do you mean by asking me to talk nicely?”

“You know what I mean. I was hoping you could, you know, gently suggest that this kind of thing *can* happen during an endoscopy, or something along those lines.”

“…….”

Lee Chan-hee was so dumbfounded by those words that he stared intently at the internal medicine doctor for a moment, his eyes wide.

“Actually, it’s like this. It’s not like *I* tore the stomach wall; I just did what’s normally done. So, there’s a possibility that the patient’s stomach wall was already in very bad condition, right?”

The internal medicine doctor was rapidly spouting out excuses with a forced smile. His demeanor was truly unpleasant and unsettling.

Nevertheless, Lee Chan-hee maintained his politeness because the other doctor was his senior.

If it were someone he knew, he might have told them to get a grip. But since he didn’t know this person well and considered it a basic courtesy to a senior colleague, he held back.

“I’ll wait for the test results.”

In the end, Lee Chan-hee closed his eyes slightly and replied.

“Yes, thank you. I feel relieved that you seem to understand what I’m saying.”

“……!”

Lee Chan-hee forcibly suppressed his rising anger.

‘How can he be like that?’

He was dumbfounded and now furious. But he didn’t want to argue. Actually, he especially didn’t want to argue with *someone like that*.

He was disturbed by the realization that things that seemed so obvious to him might not be to others.

Thump, thump, thump-

“Doctor! Doctor?”

A nurse who had run over urgently called out.

“The patient who had the endoscopy, their blood pressure is dropping.”

Lee Chan-hee and the nurse jumped up and ran to the patient.

“Mom! Mom, wake up! Doctor, what’s wrong with my mom?”

“How long has the patient been like this?”

“Just now. I told you right away.”

“First, give a normal saline bolus [a rapid infusion of saline] without adjusting the rate. What’s the oxygen saturation?”

“It’s continuously dropping.”

‘What is it? Is it an infection? Sepsis [a life-threatening complication of an infection]? Or is it really a perforation [a hole in the stomach wall]?’

Lee Chan-hee’s mind raced.

Whether it was a perforation or something else, he wondered if sepsis could have occurred even though the WBC [white blood cell count] and CRP [C-reactive protein, an indicator of inflammation] weren’t that high. Moreover, he couldn’t figure out why the blood pressure kept dropping despite the lack of any prior medical history.

“Doctor, the patient’s blood pressure keeps dropping!”

“Are you administering fluids?”

“Yes, it’s going in, but it’s not working.”

“Prepare ephedrine (a vasoconstrictor [a medication that constricts blood vessels, raising blood pressure] that can be tried first when blood pressure drops).”

“The patient’s sat [oxygen saturation] keeps dropping.”

I don’t know. What is it?

Lee Chan-hee was on the verge of panic.

‘What on earth is the problem?’

Without any discernible reason, the patient’s condition was rapidly deteriorating.

It was also unusual for a patient’s condition to decline so quickly.

‘Calm down! Let’s calm down.’

As he mentally urged himself and tried to recall the medical knowledge stored in his head,

“Director!!”

Lee Chan-hee’s every cell reacted to the nurse’s shout, and he whirled around.

Tae-kyung, who had finished emergency surgery, was walking towards them.

‘He’s finally here.’

Lee Chan-hee wore an expression of profound relief, as if he had met a savior. In fact, he had never missed Tae-kyung more. There was no one more welcome on this planet at that moment.

When he felt helpless about a patient, it was incredibly reassuring to have someone of higher rank than him arrive. Moreover, that person was Tae-kyung.

No more words were needed.

“Doctor!”

Lee Chan-hee quickly ran to Tae-kyung.

“I knew you were in surgery, so I couldn’t contact you in advance. An 80-year-old patient after an endoscopy…”

Lee Chan-hee, standing right next to Tae-kyung, quickly began his explanation. But Tae-kyung’s behavior was strange.

He seemed to be only half-listening to the important briefing, and suddenly went into the treatment room next to them, the one equipped for emergency surgeries and procedures.

“D, Doctor?”

After about a minute, Tae-kyung emerged again.

“The patient’s blood pressure suddenly dropped, and the oxygen saturation at the same time…?”

Lee Chan-hee paused his briefing and asked, looking at Tae-kyung’s hand.

“Doctor, isn’t that a needle used for paracentesis [a procedure to remove fluid from the abdomen]? What are you going to use it for?”

The needle used for paracentesis is about 10cm long.

It is also thicker than other needles, so to a non-medical person, it looks almost like a weapon.

Step, step-

Kim Tae-kyung walked towards the patient with the needle. After connecting the large needle to a syringe taken from supplies for other patients, he hesitated for a moment, then opened a bottle of povidone [an antiseptic solution] next to him and poured it on the patient’s abdomen.

“Uh…?”

“!”

‘Why suddenly povidone…’

With this action, the guardian, the nurse, and Lee Chan-hee, who were nearby, stopped in unison, bewildered.

Tae-kyung, unconcerned, immediately took a stance. Without hesitation, he quickly plunged the large needle into the abdomen of the patient whose blood pressure was plummeting.

“Oh my! What is Dr. Lee doing now?”

“Guardian, please come this way for a moment.”

The nurse drew the curtains and guided the guardian away from the bed as the guardian loudly protested in surprise.

Meanwhile, Tae-kyung pulled out the needle with a calm expression.

-Pshooooo

At the same time as the needle was removed, the sound of air escaping was heard, and the patient’s abdominal distension immediately decreased noticeably. Simultaneously, the patient’s vital signs, which had been dangerously unstable, began to return to a stable range.

“Oh! It got smaller.”

Although she was generally obese, the patient’s abdomen had been unusually distended.

Tae-kyung pressed the patient’s abdomen up and down with light force, helping to release the trapped gas, and then turned his head slightly to the side.

“Lee Chan-hee! Report again.”