Things Doctors Inadvertently Miss – Dr. Shin’s Notes

Outside the emergency room, the siren of an ambulance grew nearer. Through the frosted glass of the emergency room door, I could see the flashing lights of the ambulance as it came to a stop. Shortly after, the security guards at the reception desk swung open the entrance to the ER. Cold air from February rushed into the ER lobby through the open doors. Soon, a few paramedics entered, carrying a lady in her sixties on a stretcher. I approached the last paramedic in an orange uniform who was holding a file.

“What’s the situation with the patient?”

“A 62-year-old female with no significant medical history, started feeling dizzy and having difficulty breathing about 20 minutes ago. Her current blood pressure is 110/63, and her oxygen saturation is 97%.”

“Okay, understood. I’ll take it from here.”

I kept an eye on the lady’s condition as I led her to an available bed. Thankfully, she seemed able to converse without difficulty. She mentioned that her dizziness and breathing difficulties had slightly improved since leaving her home. After she settled on the bed, I asked her a few questions. She had been generally healthy, not taking any regular medications like blood pressure or diabetes pills, and had no history of lung disease or cardiac issues.

I recorded her statements on her chart and examined her overall condition for any anomalies. One thing caught my eye—around her knees, there were mottled red spots, resembling insect bites. I asked her about these marks. She claimed to be seeing them for the first time and didn’t know how they came about. However, her manner of speaking, avoiding my gaze as if hiding something, suggested otherwise. There was an old saying, “A strong denial is a confirmation.”

There was another suspicious element. During our conversation, I noticed a man, constantly near her, watching us from a distance. He was a middle-aged man in modernized Hanbok, with long graying hair tied back in a ponytail. He had been circling the area ever since the lady was brought in. I approached him to ask if he was her guardian. Taken aback by my unexpected question, he confirmed he was and cautiously inquired about her condition.

I explained that we were planning to conduct a chest X-ray to investigate the cause of her respiratory distress and urged him to share anything that might be a clue to her symptoms. I also asked if he knew why she had multiple bite-like marks on her knees. After a moment’s hesitation, touching his forefinger to his lip, he hesitantly revealed that he had been treating her at his research lab with bee venom acupuncture right before coming to the ER because she suddenly clutched her throat, struggling to breathe, and he had called for an ambulance just in case. He claimed to have been doing bee venom therapy for over a decade on numerous individuals, suggesting that this was a temporary reaction and not something to worry about.

Bee venom therapy involves injecting bee venom, a substance obtained from the stinger of a bee, into the skin for its supposed therapeutic effects. The issue is that many who perform these treatments are unqualified, and the unrefined bee venom they administer can provoke a deadly anaphylactic reaction.

Anaphylaxis is a severe, widespread allergic reaction. Exposure to an allergen like bee venom can rapidly trigger hives or angioedema on the skin or mucous membranes, accompanied by respiratory symptoms like difficulty breathing or circulatory symptoms like low blood pressure, which can confirm anaphylaxis. If treated promptly, recovery from anaphylaxis can occur without serious sequelae, but delays or inappropriate treatment can be fatal.

I immediately fetched an epinephrine injection from the prep room and administered it into the lady’s thigh muscle. Epinephrine helps alleviate breathing difficulties by expanding the airways and is the standard emergency treatment for suspected anaphylaxis. Even before confirming anaphylaxis, if the situation suggests it, using epinephrine is advisable.

Considering her stabilized condition, I decided to continue observing her progress with oxygen supply and IV fluids for a couple of hours. She also underwent an X-ray, which showed no significant issues. After the injection, her symptoms improved rapidly, confirming that it had been an acute respiratory issue caused by anaphylaxis.

About 30 minutes later, I revisited her to find her sitting up in bed, reassuring someone on the phone—likely a family member—that she was alright and they need not come.

“It’s nothing serious. Don’t bother coming, just a bit of rest and I’ll be fine.”

Turning my head, I saw the man with the ponytail, who had accompanied her, fiddling with his smartphone. Noticing my approach, he gestured for me to come aside, turned to wave at the lady with a smile, then cupped his hand around his mouth and coughed to clear his throat before speaking to me.

“I think I can leave now. There doesn’t seem to be a reason for me to stay any longer.”

I responded,

“Even if you’re her guardian, shouldn’t you stay until the patient is discharged?”

He replied,

“Well, I’d like to, but I left the lab open, and other clients are waiting.”

I didn’t respond further. Clearly, he didn’t need my consent to leave; he had already grabbed his bag and was heading towards the exit. I turned back to the lady, who now sat alone, looking our way.

I resolved to clear up some pending tasks before returning to her. It seemed a good opportunity to chat and keep her company until the next call. During our conversation, she mentioned working at a nearby restaurant, a typical family-style diner commonly found in Seoul’s alleys. She wasn’t the cook but helped with dishwashing and clearing tables. Working 14-hour shifts from 8 AM to 10 PM, Monday through Saturday, she earned 1.2 million won a month (about $945, based on current exchange rates).

She mentioned her knees had started to ache in recent months, growing worse until standing for more than an hour became unbearable. Planning to visit an orthopedist, she was advised against it by a co-worker who insisted that such visits always lead to surgery. Instead, she was directed to try bee venom therapy, which she received just before ending up in the ER.

I asked her why she hadn’t disclosed the bee sting therapy initially. She explained that with the man watching, she felt too embarrassed to speak the truth. Looking into her eyes, I reassured her that she had no reason to feel embarrassed towards him—rather, it was the other way around. Holding her hand firmly, I advised,

“Please, don’t go through such risky procedures like bee venom therapy carelessly again.”

She understood and agreed. As I was about to leave, a call for an intern echoed from the station. It was time to get back to work. I told her to rest a little longer and that she would likely be discharged without any complications.

An hour later, after finishing some blood draws and heading to drop off the samples, I glanced towards her bed. She was packing up, likely preparing to go home, and shortly after, she walked out of the very door she had been wheeled through hours earlier.

While she disappeared from view, I remained stationary. Observing everyday hardships, it becomes clear how the vulnerable are more susceptible to deceptive practices, wasting precious time and money on false treatments when timely and appropriate medical care would suffice. At the heart of these ironies are charlatans like the ponytailed man, unhesitatingly exploiting the unverified, taking advantage of those in desperate situations.

Reflecting on this, I faced an uncomfortable truth—I was not fundamentally different from them. At the moment I injected the epinephrine, I was acting mechanically, not fully understanding the situation, just following what I had been taught. This revealed a broader issue with medical education: it is often rigid, unyielding, and excessively reliant on rote learning.

Many doctors follow their training without critical engagement, perpetuating knowledge as if it were scripture. This approach is problematic not only because it fosters rigidity but also because it masks the vast amount of medical knowledge no single doctor can master, evidenced by the continuous publication of medical research that occurs faster than it can be absorbed.

Regrettably, many doctors are reluctant to admit their ignorance in front of their patients, perceiving it as a personal affront or a challenge to their life’s work. This mindset turns medical errors into existential crises, stiffening their approach as they age and gain experience.

Perhaps the lady chose the illegal clinic over a standard medical consultation because of the inflexibility she perceived in the medical profession. If more doctors could admit that their knowledge might be incomplete and listen more attentively to their patients, perhaps fewer would turn to such risky alternatives.

Acknowledging one’s mistakes and admitting ignorance are crucial distinctions between true healers and charlatans. Genuine doctors should embrace the philosophy that their knowledge might not always be correct. This mindset, more than any accumulated knowledge or experience, is what should be fostered during medical training.

NextUpcoming Posts, ‘May They Too Enjoy This Blessing’, ‘That night at the trauma center’, ‘Going My Own Way’ via email.

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