Fifth Vital [EN]: Chapter 10

Vital Sign 5 – Episode 10

Episode 10. NRS Numeric Pain Scale

“Can you believe we’re all together after so long?”

“I know, it feels like it’s been three years since we all gathered like this.”

“Ui-jin should have made time sooner.”

“Sorry, my friends.”

Ui-jin was celebrating her birthday with her closest high school friends, thanks to the hospital’s temporary closure.

“So, the birthday girl is treating us to delicious food and expensive wine, right?”

“Oh my! It’s been ages since I had alcohol. Can we skip the snacks and just drink straight from the bottle? I even got permission from my husband to stay out all night.”

Seeing over ten bottles of wine, the friends couldn’t hide their delighted expressions.

“Is ‘Alcohol Queen’ Jeong-hee going to show off her skills from the old days?”

“Come on, with the legendary drinker Dr. Jeong Ui-jin here, how can we? Right, Ui-jin?”

“That was only in our twenties. If I drink like that now, I’ll die.”

“True, true. But Ui-jin, don’t you have a boyfriend?”

“I went to the same university as Ui-jin. She was really popular back in medical school.”

“Hold on. So, do you have a boyfriend or not?”

The friends were curious about Ui-jin’s love life, as she was the only one still unmarried.

“Guys, Ui-jin is a doctor. How can she have time to meet men when she’s always in the operating room?”

“What are you talking about? If that were the case, all doctors in the country would be single.”

“Whoa, whoa. Calm down, everyone. I do have someone I’m seeing. I haven’t seen them for a few days, but I see them every day.”

“Oh my gosh! I knew it! Who is it?”

“They greet me warmly every time I see them and listen to me more attentively than anyone else… my patients.”

“Ugh! That’s it. You’re getting a smack.”

“Are there no decent guys at the hospital?”

“Nope.”

“Guys, let’s stop this pointless talk and light the birthday cake.”

A fancy cake topped with strawberries had over thirty candles stuck in it.

“Guys, getting older is depressing enough. Who put all these candles? You’re cruel.”

“That’s why you need to find a good man before you get even older.”

“Right. We’ll be in our forties soon.”

“Ui-jin, you’re getting a call.”

The friend sitting across from her handed Ui-jin her vibrating phone. Ui-jin checked the caller ID and got up.

“Hello.”

– “Dr. Jeong, this is Lee Chan-hee.”

“Oh, Dr. Lee, what’s up at this hour?”

– “Are you busy right now?”

– “This is the hospital.”

Before Ui-jin could answer, an unfamiliar man’s voice came through.

– “I apologize for calling so late, but can you come to the hospital now?”

“Now?”

– “Yes, we have an emergency patient coming in, so I urgently contacted you.”

“Okay, I’ll be right there.”

Ui-jin didn’t ask any questions about the sudden call. She was a doctor known for her quick action.

“Guys, I’m sorry, but I have to go to the hospital.”

“Why? Is it urgent?”

“Yeah. Don’t worry about me and have fun.”

Click-

“She left without even blowing out the candles on her birthday.”

“Being a doctor is tough.”

“Wait, didn’t Ui-jin just leave in her pajamas?”

“It’s okay. She’ll probably change into scrubs anyway.”

The friends were dumbfounded, watching Ui-jin leave in her pajamas.

* * *

Lee Chan-hee, who had been chattering like an excited child just moments ago, was now as quiet as a clam.

“Um, Director, the patient coming in now doesn’t necessarily need surgery, right?”

He asked Tae-kyung, who was standing in front of the main entrance waiting for the ambulance.

“That depends on the patient’s condition, but if surgery is needed, we’ll have to do it, of course.”

“I see.”

Lee Chan-hee clicked the innocent pen in his gown repeatedly, lost in thought.

‘Epigastric pain.’

Acute gastritis, chronic gastritis, reflux esophagitis, gastric ulcer, duodenal ulcer, duodenitis, stomach cramps, functional dyspepsia. These were all possible conditions to consider with upper abdominal pain.

‘It could be a problem with the pancreas or gallbladder, or even require surgery… but it’s probably nothing serious.’

More people than he thought visited the emergency room for simple indigestion.

Lee Chan-hee clicked the pen even faster, hoping it wasn’t a surgical case.

“…Doctor?”

“Dr. Lee!”

“…Yes! Did you call me?”

“What are you so distracted by? The patient has arrived.”

“Patient?”

Tae-kyung opened the main entrance wide, watching the ambulance stop in front of the hospital.

“The patient has arrived.”

Tae-kyung quickly approached the patient.

‘The smell!’

As usual, the patient had a smell. The smell of pain.

‘It’s different! Different!’

But the smell was different. It was the smell of feces. A new smell had been added.

‘More toxic than ammonia but weaker than formalin.’

While moving the patient to the emergency room, Tae-kyung thought about the smell.

If he were to arrange the intensity of the smells he had encountered so far, it would be vinegar, ammonia, feces, and then formalin.

‘So, does that mean the urgency is lower than Kim Deok-soo’s case? Let’s examine the patient first.’

The paramedics reported the patient’s condition as they understood it, handed over the patient, and left the hospital.

“Patient?”

“Doctor, will my wife be okay?”

As Tae-kyung tried to examine the woman, her husband began to ask anxiously, his face full of worry.

“Does she have a serious illness? Does she?”

“Are you the guardian?”

“I’m her husband.”

“Don’t worry too much, and let’s start with the registration. I’ll help you.”

At Tae-kyung’s signal, Lee Chan-hee naturally calmed the guardian and headed to the registration desk with him.

“Can you tell me where it hurts and how it hurts?”

“It hurts… here.”

The middle-aged woman, who was curled up on the bed like a shrimp, pointed to the area near her solar plexus.

“When did it start hurting?”

“Well, it suddenly started hurting like it was being squeezed while I was watching a drama this evening.”

“Please listen carefully.”

Tae-kyung knelt down to make sure the woman, who was bent over in pain, could hear him clearly.

“I’m going to ask you about the pain. If 0 is no pain at all and 10 is the worst pain imaginable, what number would you rate your pain right now?”

Tae-kyung asked about the NRS.

NRS (Numeric Rating Scale) is a numeric pain scale used to assess the degree of a patient’s pain.

“About… 7 or 8, I think.”

The closer to 10, the more significant the pain the patient is experiencing. Therefore, the woman was experiencing considerable pain.

“Doctor? What’s wrong with my wife?”

“The doctor is examining her, so please calm down for a moment.”

Lee Chan-hee calmed the husband, who was worried about his wife, after he finished the registration and returned.

“Dr. Lee, please help check the patient’s V/S [vital signs] and run some tests. Dr. Lee?”

“Ah… yes, Doctor. I understand. Please come this way.”

Lee Chan-hee supported the patient with the guardian and performed basic tests.

“Oh my, Doctor, what’s going on?”

Nurse Lim Jeong-sook, who had just finished administering an enema to an inpatient, approached urgently.

“We have an emergency patient.”

“An emergency patient?”

Nurse Lim Jeong-sook listened to Tae-kyung’s explanation and nodded.

“Since the emergency rooms at the surrounding large hospitals are full, we often get emergencies at our hospital.”

“They said it would take three hours to get to another hospital from here, so they were told to come to our hospital.”

“You did well. I’ll go into the lab and help Dr. Lee.”

Shortly after-

“Doctor, the results for patient Jo Mal-rye are in.”

“Her temperature is high.”

“Yes, it’s 38 degrees [100.4 degrees Fahrenheit].”

The tests confirmed the patient’s abnormal signs. Her temperature had risen to 38 degrees, and blood tests showed an increased white blood cell count.

“I’m going to examine you. Please lie down and bend your knees.”

Still leaning forward on the bed, she struggled to adjust her position instead of answering. And then, when Tae-kyung pressed on her upper right abdomen.

“Ah! Ouch, it hurts!”

The patient cried out in pain as if she were about to faint.

“Honey, are you okay? Doctor, what’s wrong with her?”

“Has she been on a severe diet recently?”

“How did you know? That’s right. She’s in a diet club with the women in the neighborhood.”

The husband, amazed by Tae-kyung’s question, answered instead of his wife.

“They decided to give 1 million won [approximately $750 USD] to the winner, so she’s been going crazy with hiking, swimming, and skipping meals to lose weight.”

“Has she had a health checkup?”

“Come to think of it, I always nagged the kids and me to get them, but she’s never had one.”

Tae-kyung listened to the husband’s story and thought.

‘Diet, fever, white blood cells, and tenderness pain.’

The patient had been on an extreme diet and hadn’t had a health checkup in years.

‘Plus, fever, white blood cells, and severe right upper quadrant pain.’

Based on the basic tests and the patient’s condition, there was a suspected diagnosis.

Tae-kyung quickly proceeded with a CT scan of the patient for an accurate diagnosis.

“Doctor, the CT scan is ready.”

“Patient Jo Mal-rye has cholecystitis, right?”

“Yes, that’s correct.”

Tae-kyung said before Lee Chan-hee could even hand over the CT results.

‘As expected, it was cholecystitis.’

The CT scan revealed typical cholecystitis (inflammation of the gallbladder) caused by gallstones in the gallbladder.

The gallbladder, also known as the gallbladder, is an organ that stores bile, a digestive fluid produced by the liver. The majority of causes of cholecystitis are gallstones.

Gallstones can occur when you eat too many fatty foods, but they can also occur if you don’t consume enough fat.

That’s why obese people and women on diets often get cholecystitis.

Moreover, this patient had acute cholecystitis and needed surgery urgently.

“The results of the patient’s tests are in.”

“Really? What is it?”

“It’s cholecystitis. It’s also commonly called gallstones.”

“Gallstones… are you talking about stones?”

“That’s right. Extreme dieting is often the cause of gallstones.”

“So, do you have to remove the stones in my wife’s gallbladder?”

“We need to perform surgery to remove those stones.”

“Yes! Surgery?”

The patient, who had been listening quietly to the conversation because of the pain, opened her mouth in surprise at the word surgery.

“Stones in my body… Doctor, is there no other way?”

“The patient’s current condition requires surgery.”

Not everyone with gallstones in their gallbladder needs surgery. Some people live without pain.

However, if the pain caused by gallstones persists, as in the case of this patient, surgery to remove the gallbladder is necessary.

“Doctor, I’ll have the surgery.”

The patient, after hesitating, finally decided to have the surgery. She didn’t want to experience this pain again, which was different from the simple heartburn or stomach cramps she had thought it was.

“We will remove patient Jo Mal-rye’s gallbladder through single-port laparoscopic surgery.”

“Um, Doctor, I’m sorry, but I’m supposed to take a body profile after my diet is over, so please make sure there are no scars.”

“Damn it! This woman is talking nonsense before surgery! Huh!?”

“You can’t shout here.”

“If you say one more word about that diet, I’m going to…”

“I don’t think this is going to work. Let’s go outside for a moment.”

The husband, who was agitated by his wife’s diet talk, eventually left the emergency room with Nurse Lim Jeong-sook.

“Since we’ll be performing a single-port laparoscopy, you don’t have to worry about scars.”

“Really? Thank you.”

“Dr. Lee, prepare for surgery.”

“Yes, Doctor. I will prepare.”

Unlike his quick reply, Lee Chan-hee’s pupils were subtly shaking.