Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 108

#108 Serendipity by the Summer Sea (11)

The emergency room doors burst open.

Two large figures strode in.

They were two healthy, tall men in their twenties.

‘Are they athletes?’

That was the impression they gave.

Their skin, tanned and gleaming healthily under the sunlight, looked as if it had been forged from copper.

I approached them.

“What brings you here today?”

“Well… my friend here injured his chest during a sports match. He’s been in pain ever since.”

The man next to the patient answered.

But the patient waved his hand dismissively.

“Ah, it’s nothing serious enough for the emergency room. It’s just a little chest pain… What kind of man calls 119 [Korean emergency services number, similar to 911] and goes to the emergency room for something like this~?”

As he spoke, his breathing was slightly labored.

I guided the patient to a bed.

Then, I asked the friend.

“Could you explain how your friend injured his chest?”

“Well…”

The friend scratched his head, explaining the situation.

It was said to be a historically significant tournament passed down in Gokdam. [Jokgu is a Korean footvolley sport.]

Renowned Jokgu players from all over the country gathered at Gokdam Beach to compete all day long.

Today was that day.

“Our team made it all the way to the finals, but I got too excited at the last moment.”

The score was tied.

The final attack chance came.

Under the scorching sun, the ball bounced off the opponent’s foot and soared into the sky.

At that moment, the man thought.

‘This is my chance!’

The man jumped.

With the waves heading towards the beach as a backdrop, sunlight reflected off the tip of the jumping man’s foot.

And he executed a spectacular aerial spinning Sepak Takraw kick. [Sepak Takraw is a Southeast Asian sport similar to footvolley.]

But…

Thwack!

His foot struck his friend’s side.

In the end, the game concluded in defeat, leaving only the injury.

“You crazy bastard, you’re supposed to kick the ball, not me… I thought I’d been hit by a car.”

“Sorry.”

“Is ‘sorry’ enough?”

“But seriously, I mistook your nipple for the ball because of the sunlight.”

“Ah, you crazy… stop making me laugh. It hurts every time I laugh, you jerk.”

Heuk heuk….

The patient frowned, trying to suppress his laughter.

I couldn’t tell if he was laughing or suffering from pain.

Listening from the side, I was lost in thought.

‘He said it felt like a car accident? Just how hard did he hit him?’

Thinking that, I looked at the protector’s thighs, which were wearing shorts, and thought it must have hurt.

As expected of an athlete, his leg muscles were incredibly thick.

If he had been hit by a spinning kick from that leg, he probably would have received a tremendous impact.

“How long has the pain been going on? If you were to rate the pain from 0 to 10, what would you give it?”

I asked the patient again.

7 points if it’s hard to do daily life.

10 points for the most painful pain in my life.

Then, the patient scratched his head and explained his condition.

“Well, I think it’s about 6 points……”

His explanation continued.

Several hours ago.

He didn’t even realize it hurt right after the game ended.

He attended the runner-up trophy ceremony and even went to the after-party.

He was sharing soju [Korean distilled rice liquor] with his colleagues, lamenting the disappointment of losing today’s game.

But, gradually, he started to feel chest pain.

He quietly endured it, but his breathing gradually became more labored.

Eventually, his worried friend urged him to go to the emergency room, and that’s how he ended up here.

“Hey, explain it properly! You said it hurt more when you were talking to me earlier!”

In the end, the friend next to him stepped in to give me a more detailed explanation.

“He said his chest hurts even when he just laughs a lot. As you can see, he seems a little short of breath… He also said he feels a bit dizzy.”

Listening to the friend’s words, I was lost in thought.

‘Chest pain due to simple blunt trauma. He might have a cracked bone….’

It’s the start of another twenty questions.

A young patient in his twenties with no underlying diseases.

Currently, blood pressure, pulse, respiratory rate, and body temperature are all normal.

I have to diagnose the patient with a few conditions.

‘The chances of a young athlete developing heart disease are very slim. The most likely cause is pain from trauma… Let’s do all the basic tests for chest pain first.’

I quickly finished my thoughts and said.

“Let’s start by taking an X-ray.”

Chest X-ray.

This is the first test that should be performed in this situation.

The patient soon underwent the test, and the results appeared on the station’s monitor.

As I expected.

Rib fracture.

And there was also some bleeding that appeared to have occurred along with the fracture.

‘His patience is amazing. He endured for hours with a broken bone?’

But…

My eyes widened.

I had no choice but to stop the hand holding the mouse.

‘Wait. The broken bone isn’t the problem right now, is it?’

The more important thing is the lung.

The patient’s left lung was crushed to the size of a fist.

Pneumothorax!

A very large one at that.

In the meantime, my skills in reading chest X-rays had definitely been upgraded.

This was because the experience I had gained while working as a thoracic surgery intern under Dr. Song Yu-ju two months ago had steadily accumulated.

‘Moreover, this isn’t just a simple pneumothorax!’

I couldn’t take my eyes off the X-ray.

It’s more serious than expected.

The trachea, the path through which air travels when breathing, was pushed to the right.

Because air continued to leak from the left lung, the heart and trachea in the chest were pushed to the right.

Known as mediastinal shifting.

It was a typical chest imaging finding of tension pneumothorax.

Unlike general pneumothorax, tension pneumothorax can even be life-threatening.

‘It’s a much more dangerous situation than it appears.’

I rechecked the patient’s vitals.

Blood pressure 130/70.

Heart rate 90,

Respiration rate 18.

All normal.

Is it because he’s a young patient?

Compared to the events unfolding inside his body, his body seemed to be holding up well.

But I can’t be relieved.

‘I can’t just stand by and watch while his vitals are normal! I have to take action immediately.’

Thud.

I jumped up from my seat.

Time is of the essence.

I approached Chief Kim Gi-hoon, who was writing another patient’s chart.

“Chief, would you please take a look at Sung Sang-hyun’s X-ray?”

“Why? What’s wrong?”

“It looks like a tension pneumo [short for pneumothorax].”

“What? Tension?”

The chief was startled.

Then, he checked the X-ray and his eyes widened.

He seemed to grasp the seriousness of the situation at a glance.

“What is this? This patient has a hemo-pneumothorax [presence of both air and blood in the pleural cavity]? It’s quite severe. How are his vitals?”

“Yes, they’re still normal. He’s only complaining of pain.”

At my words, the chief’s face lit up and he let out a sigh of relief.

“Whew, that’s good. He’s a thoracic surgery patient, right? Since his vitals are still okay, send him to Gokdam General Hospital quickly!”

Quick transfer.

That was his judgment.

It’s 30 minutes to Gokdam General Hospital.

However, I felt uneasy.

Tension pneumothorax can progress to an emergency situation that requires immediate attention at any time.

Worried, I cautiously said to Chief Kim Gi-hoon.

“Sir, the amount of pneumothorax is large, and there’s a high possibility that his vitals will deteriorate during the transfer. Shouldn’t we insert a chest tube before sending him?”

“What? A chest tube?”

As soon as he heard my words, the chief looked at me with a dumbfounded expression.

“No, who’s going to insert a chest tube here? Don’t you know we don’t have thoracic surgery at our hospital?”

His words were true.

There is no thoracic surgery department at Gokdam First Hospital.

That’s why patients with thoracic surgery conditions are not brought here in the first place.

However, in this case, the 119 brought him here because they didn’t know the exact cause of the chest pain.

“From the beginning, this wasn’t a patient we could treat at our hospital. Send him to another hospital quickly while his vitals are still okay!”

“But 30 minutes is not a short time. We don’t know when it will get worse……”

“Haa, Dr. Shin.”

Wag wag. [gesture of dismissal]

The chief gestured to me.

Then, he said in a voice low enough that the patient and guardian couldn’t hear.

“Just transfer him.”

“But the patient’s condition is……”

“Does anyone not know that right now? Do you not know the patient’s condition is bad?”

Kim Gi-hoon.

He was what you would call a safety-first person.

Unlike Dr. Jang Pung, who was confident and had a unique personality, he usually quietly blended into the hospital.

He gently persuaded me.

“Originally, these difficult cases should be handled by a thoracic surgery specialist. What if something goes wrong while we’re doing it?”

“……”

“You’re leaving for Seoul in a month, but the people who stay here will take the blame. Do you want to see the emergency room fail?”

The emergency room fails.

The weight of that expression was enormous.

Didn’t I just hear the story of the emergency room in the next town failing last month?

The chief’s chilling voice continued.

“It’s not wrong to transfer a patient who needs thoracic surgery skills to a place 30 minutes away according to our protocol, right? And his vitals are still fine.”

“……”

“Even if the patient gets worse during the transfer, it’s not our responsibility. We did it according to the rules. Do you know what I mean? Don’t go stirring up trouble.”

Thump, thump.

He patted me on the shoulder.

And before disappearing, he added one last word.

“Well, if you’re confident that you can take all the responsibility, go ahead and insert a tube or whatever. I clearly told you to send him for transfer quickly while his vitals are still okay.”

Kim Gi-hoon said that and disappeared into the treatment room.

And after a while.

I was left alone, hesitating.

‘What should I do?’

I am once again at a crossroads.

The easy way.

The difficult way.

Of course, choosing the easy way might be the right answer.

Besides, the chief’s words make sense.

Sending the patient to another hospital for transfer right now is not a particularly unethical act.

But……

If I choose the easy way, the patient’s risk increases that much more.

It could even be life-threatening!

At that time, Geun-wook came to me and whispered.

“Hey, you’re thinking something crazy again, aren’t you?”

“Huh?”

“Your eyes are exactly like they were back at Gangnam Station.”

Geun-wook grabbed my arm as if to stop me and said.

“Hey, if it’s an urgent patient like you said, you have to send a transfer quickly. What are you trying to do? You’ve only inserted a chest tube once, haven’t you? This is Gokdam! You can’t do something here that you can’t take responsibility for!”

Right.

Even a few seconds of hesitation is a waste.

I made a decision.

‘Okay. Right now, a quick transfer is the answer. Instead, let’s ask him to let me ride in the ambulance during the transfer. The chief will at least allow that much.’

I approached the patient and said.

“Patient, please prepare to be transferred to another hospital right away.”

“Another hospital?”

“Yes.”

Then, the friend next to him widened his eyes.

“No, can’t I just get treatment here? This is also a pretty big hospital in Gokdam.”

“We don’t have a thoracic surgeon……”

I was about to answer the friend’s question.

But then, the patient said.

“Um, doctor. I feel like I haven’t been able to breathe properly since a little while ago…, huh, huh.”

At that moment.

Ding— Ding—

The alarm went off.

Suddenly, the patient’s heart rate began to increase rapidly and his breathing became labored.