I sat on my officetel sofa, repeatedly slicing open and stitching up an imaginary neck dozens of times.

Little by little, this lesson started to get interesting.

[Anon (211.36): Alright! Focus up! Next question!]

A new anatomy image was uploaded.

The epiglottis.
A small lid that opens and closes the airway.

An epiglottis that should normally be thin and pink was now swollen and bright red.

The bloated epiglottis looked ready to burst at any moment and was almost completely blocking the already narrow airway.

[Anon (211.36): Alright! This is a patient with a severely swollen throat due to acute epiglottitis. They’re barely breathing right now, but it wouldn’t be strange if the airway became completely obstructed at any moment. You need to intubate immediately. In this situation, what tube size do you use, and how do you proceed!]

Damn it.

This was a trap.

If you recklessly shove in a laryngoscope, you could irritate that hypersensitive, swollen epiglottis and trigger complete airway obstruction.

Breaking out in a cold sweat, I desperately wrote out the answer in my head.

[HellJoseonSlave1: You should use a smaller tube than usual. About one to two sizes smaller.]

[Anon (211.36): Reason?]

[HellJoseonSlave1: The entire airway will be swollen. There’s a high chance the usual size won’t pass.]

[Anon (211.36): Correct. Then what else do you need to be careful about. What do you prepare, and what must you avoid. Explain in detail.]

I squeezed my brain dry.
First, stimulation had to be minimized.

[HellJoseonSlave1: Don’t recklessly depress the tongue or stimulate with a laryngoscope. Keep the patient as calm as possible. Especially in pediatric patients, preventing crying or struggling through sedation is the top priority.]

Right on cue, the pediatrics ghost appeared like clockwork.

[PediatricsGhost77: Hey! Now you’re finally saying something like a real doctor! You should never shove tongue depressors at kids! The moment they panic and cry, the airway can close and they’ll turn blue instantly! Keep them calm in their mother’s arms and gently give oxygen!]

[AnesthesiologyPain: And this isn’t a procedure to do in some corner treatment room of the ER. The principle is to perform it with the most experienced doctor present, with ENT and anesthesia standing by. If intubation fails, ENT has to immediately cut the neck and perform a tracheostomy on the spot.]

[ScalpelGod: If you touch that with your trash hands, it’s a 100% airway obstruction. Just stand to the side and watch, and if things go bad, cut the neck like I taught you.]

I carved their instructions into my memory.

And before I could even catch my breath, the next image was uploaded.

[Anon (211.36): Alright, next is a patient bleeding heavily from the throat!]

In front of my eyes appeared the throat of a patient who had undergone a tonsillectomy.

Whether a vessel at the surgical site had ruptured, bright red blood was gushing up from deep in the throat like a spring.

[Anon (211.36): The cause is probably secondary bleeding after tonsil removal. What do you do in this case. The blood is about to block the airway. What’s the top priority right now. The patient can’t breathe and the saturation keeps dropping.]

Ah, wait, what was it again?

Shouldn’t you suction the blood first?

[HellJoseonSlave1: Suction?]

[Anon (211.36): Suction is the bare minimum, idiot!]

[AnesthesiologyPain: Suction is basic. After that, airway securing. Use the largest laryngoscope blade to sweep the tongue and blood clots away in one motion, then insert the tube as fast as possible and inflate the cuff so blood doesn’t flow into the lungs!]

Airway securing.
And airway protection.

I see now.

Note it down.
Note it down.

And so, sitting on my officetel sofa, I repeatedly killed and saved imaginary patients dozens of times.

The alarm rang.

The same time.
The same sound.

A signal that it was time to return to hell.

Dragging my body to pieces from the study session, I mechanically got ready for work.

What choice did I have.

The morning in the emergency room passed faster than expected.

There wasn’t much work, and most patients were mild cases, so it wasn’t too burdensome.

The afternoon in the ER, as always, was a marketplace.

I was stuck in a corner of the station, charting a simple laceration patient who had just come in.
A middle-aged man who had gotten drunk, staggered, and smashed his head into asphalt.

“Man, you really should drink in moderation.”

I muttered to myself and continued charting.

The boring, draining daily routine of the ER.

After dealing with about ten patients like this a day, my soul feels as worn out as gauze soaked in disinfectant.

That was when it happened.

“Dr. Han!”

The voice of the senior veteran nurse at the triage desk rang out.

“Could you come over here for a moment. This patient just arrived, and I think they need to be seen right away.”

That single sentence from a veteran nurse always sends a chill down my spine.

Shiver.

I saved my charting and stood up.

At the triage desk sat a young man who looked to be in his early twenties, his face full of fear.

I approached him and pulled over a chair to sit down.

“Alright, sir. What brings you in today?”

At my question, the man looked at me anxiously and answered.

“Well… I had my tonsils removed last week, and it feels like there’s a bloody smell and something stuck there….”

Ah.
Wait.
Tonsil surgery?

A bloody smell?

“You had tonsil surgery a week ago. You’re noticing a metallic smell and a foreign body sensation in your throat. Could you explain in a bit more detail?”

“It doesn’t really hurt badly… but it keeps feeling like there’s a bloody smell in my throat… and every time I swallow saliva, it feels like something surges up. It’s been bothering me a lot…”

I reassured the patient and picked up a penlight.

“Alright, could you open your mouth wide for me. I’m going to take a look at the back of your throat.”

The man opened his mouth.

I shined the penlight deep into his throat, examining the tonsillectomy site.

At first glance, it didn’t look like anything was wrong.

But the moment I gently pressed the tongue down with a tongue depressor to secure my view.

I saw it.

From a tiny gap between the scabs at the surgical site, a bright red droplet of blood was seeping out.

It was slow, but it was definitely active bleeding.

My mind went blank.

Right now it was just oozing, but at any moment, with a spike in blood pressure or a single bad cough, the vessel could rupture completely.
A ticking time bomb.

‘F*ck.’

I hid my expression and asked the patient, forcing myself to stay calm.

I desperately hoped my voice wasn’t shaking.

“Did you have the surgery at our hospital, by any chance?”

“Yes. A week ago, with Professor Kim Jaeyoung from ENT…”

The moment I heard his answer, the ghosts’ hellish training flashed through my mind like a panorama.

‘Alright! A patient bleeding heavily from the throat!’
‘This is airway securing. Airway securing is the top priority, you idiot!’
‘Use the largest laryngoscope blade to sweep away the tongue and blood clots, then insert the tube as fast as possible and inflate the cuff so blood doesn’t go into the lungs!’

…Damn, is this why those ghosts drilled airway practice into me?
Are they shamans or what.

Ah, right.
They’re ghosts.
Some kind of ghostly intuition, maybe?

“Sir, please listen carefully to what I’m about to say. There is some bleeding at the surgical site. It doesn’t automatically mean it’s a serious problem, but just in case, in the unlikely event of something happening, we’re going to start a few precautionary measures.”

I turned away from the patient and called out to the nurse behind me.

“Clear one bed in Zone A immediately! We’re starting monitoring right away! This is post-op bleeding!”

At my urgent shout, the previously calm ER atmosphere froze instantly.

“And secure two IV lines right now! Send CBC and coagulation studies STAT, and prepare cross-matching for four units of PRBC immediately!”

My mouth didn’t get a second of rest.

“Call the on-call ENT right now! Tell them there’s active bleeding after tonsillectomy and that they need to come down immediately!”

I took a breath and gave my final order.

“And… prepare the largest size laryngoscope blade, a size 7.5 tube, and suction equipment, and bring them to the bedside. Right now.”

The nurses began moving in perfect coordination.

One secured the IV lines.
Another labeled the blood sample tubes.

For now, it wasn’t bleeding heavily, which was a relief.

For now.

But this kind of bleeding can become explosive at any time.

Until ENT and anesthesia arrived, there was only one thing I needed to do.

Keep the current situation as stable as possible.

“Nurse, could you get me an ampule of Bosmin, a long Kelly clamp, and packing gauze?”

I requested the necessary items.

A moment later, the supplies arrived on a stainless steel tray.

I carefully soaked the gauze in Bosmin solution and firmly grasped it with the long forceps.

“Sir, I’m going to press on the bleeding area for a bit to stop the bleeding. It may be uncomfortable. Please open your mouth wide.”

Explaining as I went, I carefully advanced the forceps deep into the throat.

Found it.

I located the tonsillectomy site.

Then I began firmly pressing the bleeding area with the long forceps.

The patient grimaced.
I reassured him and maintained steady pressure with my hand.

At that moment, a calm voice came from behind me.

“What’s going on?”

I didn’t need to turn around to know who it was.
Han Jae-eon, a third-year emergency medicine resident.

Han Jae-eon had already walked up beside me and was looking down at the scene with her hands in her pockets.

Holding the forceps, I slightly turned my head and began briefing.

“Twenty-two-year-old male. Had a tonsillectomy at our hospital’s ENT department a week ago. Showing signs of post-op bleeding, so we’re currently packing with Bosmin-soaked gauze. The active bleeding isn’t severe, more like oozing. Vitals are stable for now, and ENT and anesthesia have been notified.”

Listening to my briefing, Han Jae-eon leaned in and glanced at the patient’s throat.

“Mm. It’s oozing. Not arterial. Just keep pressing like that until ENT arrives.”

With that, she went back to the station.

What, you’re not going to help?

The thought had barely crossed my mind when Han Jae-eon started gathering something and heading back.

Ah, so she didn’t just ditch me.

I refocused on the patient.

I could feel the pulse through the forceps.

Fortunately, I no longer felt blood seeping from the compression site.

The pressure seemed to be working.

Whew, at least the bleeding isn’t severe.

At this level, they’ll probably just cauterize it and be done.

A sigh of relief escaped me.

Looks like I won’t need to use that hellish airway securing technique the ghosts taught me today.

Reality isn’t always that dramatic.

Not every patient spirals into the worst-case scenario.

Watching the patient’s stable vital signs on the monitor, I waited for this tedious compression time to end as soon as possible.

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