Fifth Vital [EN]: Chapter 20

Fifth Vital Sign – Episode 20

Episode 20. Scarlet Hemorrhage

After the official holiday at the hospital, Tae-kyung was on his way to work by bus as usual.

-Beep

-Transfer.

-Transfer.

Despite the obvious empty seats, Tae-kyung stood behind the driver’s seat, watching the people boarding.

‘Pass, pass, sour, ammonia, sour…’

After gaining his ability, Tae-kyung developed a habit. He would check the smells emanating from people when using public transportation.

‘Five at stage 1, three at stage 2.’

The reason was simple. The stronger the smell, the more likely they were to have an illness or be classified as emergency patients, so he wanted to help them.

‘Thankfully, no one with stage 3 or 4 smells today.’

Tae-kyung, having arrived a little early, headed to a nearby snack bar to fill his empty stomach.

“Welcome! What can I get for you?”

“Hello. I’ll have kim… Sorry, just a moment.”

Tae-kyung, about to order kimbap [Korean seaweed rice rolls], rushed outside at the sound of a rapidly ringing phone.

“Hello…”

-Doctor!?

Before he could even finish saying ‘Hello,’ he heard Nurse Lim Jeong-suk’s agitated voice.

-Doctor, we have a big problem!

“A big problem? Did an emergency patient arrive?”

-No, it’s not that. People are flocking here because of the video.

“Video?”

-I mean, people are… Never mind. Where are you right now? Are you on your way to the hospital?

“I’m near the hospital. I was going to grab some kimbap before heading in.”

-Kimbap is not the issue right now! Just hurry up and get here. Run!

“I’ll be right there.”

He didn’t quite understand what she was saying, but he could sense the urgency in her voice, so Tae-kyung headed to the hospital.

“What’s going on?”

* * *

Tae-kyung arrived at the hospital and was passing through the automatic doors at the main entrance when…

“……!”

The smell of pain rushed in through the opening of the automatic doors.

“Ugh! What’s with this smell…”

The sour smell, the strong ammonia smell, and even a faint fecal odor assaulted his sense of smell.

“No!”

And the moment he reached the central reception desk, Tae-kyung’s eyes widened at the unbelievable sight.

“What on earth…”

It was packed with people.

“Excuse me? Are you not taking 접수 [jeopsu – registration]?”

“Is my 접수 [jeopsu – registration] confirmed?”

“What time does 진료 [jillyo – medical examination] start?”

“접수 [jeopsu – registration] is being done in order of arrival. Yes, your 접수 [jeopsu – registration] has been confirmed.”

The reception area was a complete madhouse, with people filling the waiting room chairs and even standing to wait.

“Doctor!?”

Nurse Lim Jeong-suk, spotting Tae-kyung staring blankly at the astonishing scene, hurried over to him.

“Why are you only coming now? How long have we been waiting?”

“What’s going on? Why are there so many people?”

“All those people over there are here to see a 진료 [jillyo – medical examination] at our hospital.”

“What?”

Until this morning, even on his way home from work, Tae-kyung had been worrying about how to save the hospital.

He was grateful for the people who had come to the hospital, but he couldn’t help but wonder what was happening all of a sudden.

“A video of you treating a patient was uploaded to the internet. All those people there came after seeing that video.”

“Video?”

Confused, Tae-kyung listened as Nurse Lim Jeong-suk explained the situation.

“How much time is left until the 진료 [jillyo – medical examination] starts?”

“We have some time.”

“Are all the staff here?”

“Yes.”

“Please call all the staff to my 진료실 [jillyosil – examination room], no, the 의국실 [uiguksil – doctors’ office].”

* * *

Doctors, nurses, kitchen staff, the general affairs team, even the janitorial staff.

All the hospital staff who had come to work today gathered in the 의국실 [uiguksil – doctors’ office] at Tae-kyung’s summons.

“First of all, I apologize for calling you all together so suddenly.”

“What are you talking about? Our hospital is being revived thanks to you, so the staff are in high spirits,” said Choi Byung-geun, the good-natured head of the general affairs team, with a hearty laugh.

“Now that everyone knows what’s going on, I’ll go over some precautions.”

Unlike the excited expressions of the staff, Tae-kyung’s expression was serious and not at all elated.

“As you know, when patients start flocking to the hospital, both doctors and patients become impatient.”

He wanted to prevent the confusion that could arise from the influx of patients, rather than just being happy about it.

“People who come to the hospital are often sick or in pain, so they can be sensitive to even small things. Keep that in mind.”

“Of course.”

“Don’t worry.”

“Today will be a long day. Let’s all do our best without getting exhausted.”

The staff understood exactly what Tae-kyung was trying to say.

“We can’t keep the patients waiting any longer, so we’ll start the 진료 [jillyo – medical examination] in 10 minutes.”

* * *

The hospital was literally overflowing with people.

Tae-kyung meticulously examined patients while rushing between the outpatient clinic and the emergency room.

“I’ll prescribe some medication, so don’t forget to take it.”

“Yes, thank you.”

“Please pay and pick up your prescription.”

“Thank you for your hard work.”

As each patient’s 진료 [jillyo – medical examination] ended, Tae-kyung made sure to record which diseases caused which smells.

“Time really flies.”

Looking at the clock on his desk, he saw that it was past 11 PM.

“I know, right? It’s about time for the emergency room to get busy.”

Nurse Lim Jeong-suk also checked the time.

“We had some patients admitted today, right?”

“Yes, and we have a patient being transferred here tomorrow.”

“Check their underlying conditions thoroughly and hand over the EMR (electronic medical record) as soon as it’s ready.”

“By the way, Doctor, you haven’t had a meal yet, have you?”

Nurse Lim Jeong-suk was concerned about Tae-kyung, who was the only one who hadn’t eaten.

She had repeatedly offered him food, but Tae-kyung had said he was fine and prioritized the incoming patients.

“You’re right. I’m starting to get hungry.”

“Of course. Even cars need gas to run, and people need food to function.”

“That’s true.”

“The outpatient 진료 [jillyo – medical examination] is closed, so go eat quickly before the emergency room gets busier.”

“Should I? Then I’ll go eat quickly. Call me immediately if there’s an emergency.”

He was starting to get hungry anyway.

“Yes, Doctor Chan-hee. Doctor, are you here?”

Just as Tae-kyung was about to leave the 진료실 [jillyosil – examination room], Nurse Lim Jeong-suk answered the phone.

“Bloody stool?”

The moment he heard the words ‘bloody stool,’ Tae-kyung burst out of the 진료실 [jillyosil – examination room].

“Doctor Chan-hee, Doctor Kim went right away.”

-Okay, I understand.

“Looks like you won’t be eating today.”

* * *

“Where’s the patient?”

“They’re in the 베드 [bed] now.”

“Bloody stool?”

Tae-kyung asked again as soon as he saw Lee Chan-hee.

“Yes, Doctor. A 57-year-old man came in with bloody stool.”

Bloody stool can lead to massive bleeding depending on the location of the hemorrhage, so a thorough and prompt examination is necessary.

In particular, if the bleeding site is in the digestive system, the patient’s life can depend on whether an emergency endoscopy is possible.

Therefore, quick decisions and responses are necessary.

“Is the gastroenterologist here today?”

“I already called, but they said their child is sick and they can’t come in today.”

Tae-kyung’s pace quickened upon hearing that.

In this case, the patient must be assessed and transferred quickly if necessary.

And in the case of massive bleeding, he must be responsible for holding out until they arrive, so that no emergency situation arises during the transfer.

Shwaaa-

The smell of ammonia wafted in like a greeting as soon as he opened the 베드 [bed] curtain where the patient was.

‘Stage 2.’

It was a relatively light stage 2 according to the smell index, but Tae-kyung was not relieved.

He knew that the smell could change in an instant depending on the patient’s condition.

The most accurate thing to do is to check the patient’s condition.

“Hello, patient.”

The man lying on the 베드 [bed] sat up, looking a little weak.

“I heard you had bloody stool?”

“Yes, Doctor.”

“Have you ever had bloody stool before?”

“No. I’ve never had this much bloody stool before.”

“Did you feel dizzy or lightheaded while having the bloody stool?”

“No, I didn’t.”

“Do you have any underlying conditions?”

“No.”

“Then I’ll take a look at your anus first. Please lie on your side and lower your pants.”

Putting on gloves, he looked at the anus and saw blood pooling on one side, with the flesh slightly sunken in.

It looked like a laceration, but the edges were too clean to be a laceration.

This was clearly a surgical scar.

“Have you had any anal surgery?”

“Oh, yes… I had hemorrhoid surgery two weeks ago.”

Tae-kyung’s prediction was correct.

“But I haven’t had bloody stool since then.”

“Have you had any difficulty or pain passing stool recently?”

“The first time I had bloody stool was this morning. It was a bit large since it had been a while since I had a bowel movement.”

In this case, it was highly likely that the surgically repaired area had been torn again.

This condition also had the potential for massive bleeding, but Tae-kyung was relieved because it was a visible treatment rather than an internal digestive issue.

“I’m going to do a digital rectal exam to check the inside. It might be a little uncomfortable, but it will be over soon.”

“What? You mean putting your finger in there?”

The patient looked horrified at the mention of a digital rectal exam.

“Yes, that’s right,” Lee Chan-hee, who was standing next to him, replied instead. In fact, most people with anal diseases do not welcome digital rectal exams.

“It might be a little uncomfortable, but it will be over quickly.”

“Doctor, have you ever had a sore butt?”

“Excuse me?”

“Don’t talk so easily just because it’s not your butt.”

Lee Chan-hee’s words, added to ease the tension, failed to resonate with the patient.

“I’ll insert it as slowly as possible. Anyway, since there’s bleeding, I have to do a digital rectal exam.”

The best thing to do in this situation is to soothe the patient.

“Okay.”

“Okay, relax as much as possible and say ‘ahhh’.”

“Ahhh!”

Tae-kyung slowly inserted his finger into the patient’s anus.

“Ugh!”

As he inserted his finger into the rectum and dilated it, bright red blood gushed out.

‘There must be more inside.’

There was still a lot of blood in the rectum. At the same time, blood was leaking from the area that appeared to be the surgical site.

No further examination was necessary.

Originally, gastric lavage is performed to determine whether there is bleeding in the upper gastrointestinal tract. However, it was clear that the cause of the bleeding was an anal disease.

“Okay, that’s it. Was it uncomfortable?”

“It was okay. What’s wrong with me?”

“You said you had anal surgery recently.”

“Yes.”

“This can happen after surgery. Did you contact the hospital where you had the surgery?”

“No, not yet. This is the first time this has happened since the surgery, so I didn’t think that was the cause. Does that mean the surgery was done wrong?”

“That’s not it. It can happen as a complication of surgery. I know you’re probably very embarrassed and worried, but these things happen.”

“So, the fact that I’m bleeding doesn’t mean I’m seriously ill or anything like that?”

“Of course not.”

Tae-kyung calmed the patient and explained, as he had often seen this at the university hospital where he used to work.

“Doctor Lee, I don’t think we need any more tests for this patient.”

“Yes, Doctor.”

Tae-kyung moved away from the patient’s 베드 [bed] and gave orders to Lee Chan-hee.

“And get the phone number of the hospital where they had the surgery from the guardian and ask what to do.”

“Yes, I understand.”

“Excuse me…”

The patient’s guardian called out to the two men, who were in the middle of a conversation, with a troubled expression.

“Yes, guardian.”

“My child says they need to have a bowel movement… What should I do?”

“No.”

Tae-kyung replied firmly.

“You have to hold in your bowel movement right now.”

Tae-kyung’s heart was not at ease telling the patient to hold in the stool that was trying to come out, but he had no choice.

“Are you in a lot of pain?”

“No, it’s bearable.”

“I’ve blocked your anus with gauze because there’s still bleeding. If you have a bowel movement now, the wound could get worse.”

Tae-kyung calmed the patient down without agitating them as much as possible. But then the patient put on their pants and started to sit up.

“You can’t do that.”

“Patient.”

Tae-kyung and Lee Chan-hee stopped the patient at the same time.

“Patient, first…”

“Urine! Urine! I can’t pee here.”

“Oh, yes. You can pee. Just be careful not to let the gauze fall out.”

The patient, who had become slightly sensitive from holding in their bowel movement, raised their voice.

“Why are you yelling?”

“Because I need to pee. I’ve been holding it in since earlier because of the 진료 [jillyo – medical examination].”

“Ugh. Lower your voice.”

“I can pee, right?”

“Yes. Just hold in your bowel movement.”

Tae-kyung, having emphasized the bowel movement once again, headed to the emergency room station with Lee Chan-hee.

“Is the inpatient chart ready?”

“Here it is. Should I give it to you now?”

“No. Doctor Lee, don’t give it to him now,” said Nurse Lim Jeong-suk, who was working, taking the tablet PC from Lee Chan-hee’s hand.

“Go eat first.”

“I’ll look at the chart while I eat. Is that okay?”

“You have to go straight to the cafeteria.”

“Of course.”

Just as the tablet PC that Nurse Lim Jeong-suk handed over was about to land in Tae-kyung’s hands…

Bang!

Suddenly, a loud noise and a nurse’s shouting voice were heard.

“Someone help this patient!”