Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 42

#42 The Marine in the ICU (2)

“Yes, this patient clearly has delirium. Judging from the nonsensical rambling, their judgment is impaired…”

“Ah…”

I nodded at Nurse Cha Yuri’s words.

Delirium.

Acute consciousness disorder.

A phenomenon that mainly occurs in elderly patients after major surgery.

Patients in delirium suddenly experience hallucinations or delusions and start talking nonsense.

“When you work in the ICU, you just get a feel for it. You can tell right away if a patient is likely to develop delirium or not.”

Cha Yuri’s voice showed no signs of panic.

Indeed, delirium is a surprisingly common symptom.

There are statistics that show two out of three ICU patients experience delirium.

‘Come to think of it, this is the first time I’ve actually seen a patient with delirium.’

Of course, I had vaguely heard that there were many delirium patients in the ICU.

I approached the grandfather and cautiously asked.

“Sir, do you know what year it is right now?”

I asked the most basic question.

To determine if the patient correctly recognizes TPP (Time, Place, Person).

This is also referred to as ‘orientation.’

Soon, the grandfather’s mouth opened.

“Nineteen hundred… seventy…”

1970?

Oh, my goodness.

That’s a whole 50 years ago.

It seems the patient’s orientation is significantly impaired.

“It’s delirium, right?”

“Yes, it is.”

I exchanged a silent glance with Nurse Cha Yuri and nodded.

The patient’s condition may seem similar to dementia in some ways.

However, dementia and delirium are distinctly different.

Unlike dementia, where symptoms appear gradually, delirium manifests intensely and suddenly one day.

And then, the symptoms may suddenly disappear one day.

“Even before, he was talking to himself as if he were on a battlefield, which was quite unsettling.”

“Oh dear… We’ll have to be on high alert tonight.”

“Tonight?”

“These patients usually get worse at night.”

Delirium usually occurs more often at night.

Even doctors don’t know the exact reason why.

Because of this, guardians sometimes describe delirium patients as being ‘possessed by a ghost.’

Think that’s an exaggeration?

Absolutely not!

If you actually see the symptoms with your own eyes, you’ll realize that such expressions are not an exaggeration at all.

“If you go to Phu Cat… be careful in the forest… there might be booby traps…”

Mutter, mutter….

The grandfather continued to ramble incoherently to himself.

Right now, he is just making nonsensical statements with impaired cognitive function, but in severe cases, behavioral disorders can also occur.

And especially at night, they often get worse and are unable to sleep.

If he starts acting out (explosively expressing antisocial emotions), the ICU will be quite noisy.

‘So many different things happen in the ICU….’

As I was thinking that.

Nurse Cha Yuri skillfully called the on-duty thoracic surgery resident.

“Doctor, this is C03S. The patient who was attacked is disoriented and saying strange things. I think you need to come and take a look!”

Soon, Nurse Cha Yuri hung up the phone and prepared an IV.

She took out a fist-sized, greenish-yellow 20% albumin bottle and tried to insert it into the IV line.

Then, she accidentally slipped and dropped the bottle.

“Oops!”

Clang, clatter―

The glass bottle hit the bed frame and rolled to the patient’s feet.

But then.

Suddenly, the grandfather who was attacked jumped up like a flying squirrel!

“Grenade in the foxhole!!”

“Oh my, you scared me!”

Startled!

Cha Yuri was so surprised that she took a step back.

The patient suddenly thrashed around, causing a commotion.

“Patient, you mustn’t move!”

The nurses all rushed over in horror.

Because the grandfather had not only a chest tube in his chest but also several lines in his arm.

It would be a disaster if the lines came out while he was struggling!

But the grandfather was shouting with the most solemn expression in the world.

“It’s a grenade! Everyone, get out of the way!!”

No, what is this….

This isn’t a war movie.

We looked at each other, speechless.

Even in the midst of all this, the grandfather’s struggle to avoid the grenade did not stop.

“Patient, it’s not a grenade, it’s a medicine bottle!”

I tried to calm the patient down by showing him the medicine bottle.

Nevertheless, the patient muttered grenade, grenade for a while before finally calming down.

“……Hoo.”

Once the situation was under control, we all breathed a sigh of relief.

Wiping away the cold sweat, I returned to the station, and Doctor Byun chuckled as he looked at me.

“Were you flustered?”

“Yes. It’s my first time seeing a delirium patient.”

“Hehe… But that grandfather is quite unique. In all my years, it’s the first time I’ve seen someone mistake the ICU for a battlefield.”

Doctor Byun chuckled and then became engrossed in his phone game again.

Then Nurse Cha Yuri approached and said.

“Oh my, that was almost a disaster.”

“Are you okay?”

“Yes. I looked at the nursing information record earlier, and it turns out he actually participated in the Vietnam War.”

“Ah… So that’s why he was using military terms during the delirium episode.”

“Was he?”

“He called me a medic and told me to bypass the right trench and advance.”

“Puh-ha, he’s a cute grandfather.”

Cha Yuri smiled at my words.

I took advantage of a break in my work to open the chart.

Soon, I was able to confirm the information about the grandfather who was attacked.

‘It’s true. 50 years ago, he served in the war….’

The patient was dispatched to the Vietnam War in 1970 and served on the battlefield for two years.

He currently has lung cancer, underwent surgery, and is hospitalized.

‘He was a war veteran.’

The Vietnam War…….

I never thought I would see a patient I had only encountered in newspaper articles in person.

Perhaps the trauma of the war was too great.

How else could he not forget what happened 50 years ago and still be suffering from it?

“But shouldn’t that patient be in the thoracic surgery department since he had lung cancer surgery?”

“Their ICU is full, so he came here.”

Doctor Byun answered my question.

Sometimes this happens.

When one ICU is full, they use the beds in another ICU.

It doesn’t make much difference to me, no matter which side he’s on.

But Doctor Byun, who belongs to the surgery department, seems annoyed.

“Ugh. Why does such a noisy patient have to come to our side, so troublesome.”

Doctor Byun grumbled.

He leaned back in his chair with the most lazy, sloth-like expression in the world and said.

“Tsk. I don’t know. I’m not the primary doctor anyway, so what~ If anything happens, you take care of notifying the thoracic surgery department.”

He yawned as he said that.

Of course, I understand.

From Doctor Byun’s perspective, there’s no reason to care about a patient who isn’t his responsibility.

But it sounds lazy and irresponsible.

If it were me, I would at least pay a little attention to a patient in the area I’m in charge of…….

As I was thinking that.

“Oh oh, I think he’s starting again……?”

Nurse Cha Yuri said urgently.

Following her gaze, the delirium of the grandfather who was attacked was starting again.

He seemed to be starting up with eyes as sharp as an eagle.

Then, he suddenly raised his upper body.

“The pride of thirty million, the Korean Marine Corps~” [The population of South Korea in the 1970s]

Suddenly, he started singing a military song loudly.

Then, even the other critically ill patients who had barely fallen asleep began to stir and wake up one by one.

“Camouflage flashing, going through the jungle~”

“Grandfather, please calm down!”

We tried to stop the patient, but the delirium continued for quite some time after that.

In the end, we had to administer a sedative to the patient after an hour of arguing.

70-year-old patient, Attacked.

He, whose name was unusual from the start, was one of the most unique patients I had ever met.

* * *

The next morning.

I did my rounds with a haggard look.

It was because I was busy taking care of the delirium patient and handling other calls during my night shift last night, so I didn’t get enough sleep.

On the other hand, around sunrise.

The grandfather who was attacked’s mind became perfectly clear as if by a lie.

It was as if nothing had happened last night.

He even greeted me with a gentle tone.

“Oh my, hello. Doctors. Thank you for your hard work from early in the morning.”

It’s like Jekyll and Hyde [a reference to the novella *Strange Case of Dr. Jekyll and Mr. Hyde*, about a man with two distinct personalities]…….

It’s like he has two personalities.

How can he be like that?

I disinfected the patient and asked cautiously.

“Patient, did you have a comfortable night?”

“Oh, of course.”

“Do you remember anything?”

“Haha. I only remember sleeping comfortably. I guess it’s thanks to the doctors taking good care of me.”

Well, you slept comfortably because you were given sleeping pills……?

“But somehow my voice doesn’t come out well, and my throat seems a little hoarse, hahaha.”

Well, that’s because you were screaming all night……?

There were many things I wanted to say, but I swallowed them inside.

Compared to his appearance yesterday, when he seemed possessed by a ghost, he looks so normal today.

Just in case, I asked one more time.

“Do you know what day it is today?”

“Let’s see. I had surgery yesterday, so is today May 17th?”

He even knows the exact date.

At this point, he is almost completely normal.

It’s absurd, but I feel relieved anyway.

‘Maybe delirium was just a temporary phenomenon.’

Come to think of it, yesterday was my first day in the ICU.

The patient’s psychology must have been unstable because he couldn’t adapt to the unfamiliar environment.

Won’t he be okay from today?

“Patient, then rest. If you have any discomfort, please tell me.”

“Oh, thank you, doctor.”

Fortunately, no special events occurred during the day.

Soon, it was 6 p.m., my work was over, and I switched with another intern colleague.

My intern colleague, Yoon-sung, burst into laughter after hearing about what happened last night.

“Puhaha, a grenade?”

“Hey, don’t laugh. The patient will hear you.”

“Hehehe…… That’s really funny. Even if it’s delirium, how can he say such nonsense?”

“Anyway, he was fine during the day, but I don’t know what will happen during the night.”

My intern colleague replied as if it were no big deal.

“Hey, don’t worry. How much trouble can an elderly patient lying motionless in an ICU bed cause? If necessary, we can subdue him with force.”

I tried to say something more but stopped.

Maybe I’m just worrying for no reason.

With that, I dragged my tired body to the dormitory.

* * *

The next day.

I hurried to work.

Of course, what I was most curious about was the condition of the grandfather who was attacked.

‘I hope nothing happened last night?’

Thinking that, I entered the ICU.

After exchanging brief greetings with the nurses, I approached the grandfather’s bed.

Then I stopped.

There were several red stains on the patient’s sheet.

‘What is that… Could it be bloodstains?’