Dr. Harper met him outside the case conference room with a short nod.
“Wood. You’re on 3B today. One of our tougher patients came back up from the ER last night. They flagged her for diagnostic workup. Non-verbal, unstable vitals, no clear cause yet.”
“Non-verbal?” Edan asked. “Like neurologically impaired?”
“She can’t communicate verbally, but not aphasic. No family on-site yet. Nursing home transfer. Full code.”
Edan’s pulse kicked up. A complicated case—and without a history, every answer would have to come from signs, vitals, labs, and intuition.
“Got it. What’s her name?”
Dr. Harper passed him a thin folder. “Ms. Camilla Shore. 72 years old. Came in with weakness, mild fever, and hypotension. No focal signs. ER did a basic sepsis workup—chest X-ray clean, UA equivocal, lactate borderline. She's alert, but uncooperative.”
As Edan turned toward the room, the system chimed silently in the corner of his vision.
[Mission Start: Differential Dilemmas – Tier II Case]
Patient: Camilla Shore
Situation: Non-verbal patient with unstable vitals and unclear primary diagnosis.
Objective: Identify source of illness and initiate targeted management within 8 hours.
Bonus Objectives:
Correctly narrow differential using 3 clinical clues
Avoid unnecessary imaging or labs (Efficient Diagnostic Pathway)
Reward: +50 EXP, Unlock Pediatric Focus Side Path
Penalty: System Sync -5% if incorrect management initiated
Warning: Symptoms will evolve dynamically. Missed signs may lead to deterioration.
So I’m not just racing time—I’m racing the disease.
Room 310B
Ms. Camilla Shore lay in bed, thin and pale. Her eyes tracked Edan as he entered, but she didn’t speak. Not even a grunt. Her breathing was shallow but even, and her arms were folded tightly across her chest.
Above her floated a pulsing yellow HP bar:
HP: 61% – Status: At Risk
VitalSight Alert: Subclinical instability detected. Vitals may not reflect full severity.
“Ms. Shore?” Edan tried gently. “I’m Edan, a medical student working with the Internal Medicine team. I’m going to check you over, okay?”
No response.
Edan began the physical exam, methodical and calm.
Neuro: Pupils reactive. Strength slightly decreased in all limbs. Reflexes normal. No focal signs.
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Cardio: Regular rhythm, no murmurs.
Lungs: Clear bilaterally.
Abdomen: Soft, but when he pressed over the right lower quadrant, her eyes flared.
Not a sound. Not a word. But a definite expression of discomfort.
He pressed again—slightly to the side—and this time, she tensed her arms and turned away.
[Pattern Recognition Triggered]
Observation: Guarding present. Localized to RLQ. Suggestive of intra-abdominal pathology.
Differential Updated: Appendicitis (unlikely at age 72), Diverticulitis, Ischemic bowel, Gynecologic causes (rare at her age), or abscess.
But she didn’t have a fever anymore. And her WBCs were only mildly elevated.
Edan checked her skin next—and paused.
A faint mottling pattern ran along her left thigh. Subtle, but visible now that he rolled back the sheet.
[Clinical Awareness Activated]
Skin mottling inconsistent with systemic hypotension. Check for localized vascular compromise.
Suggestion: Consider Doppler or duplex ultrasound of the leg.
He pulled up the bedside chart.
Vitals: BP: 96/60 | HR: 105 | Temp: 99.1°F | RR: 18
Labs: WBC 13.4, Lactate 2.3, Creatinine trending up
Borderline sepsis labs. Vitals soft but not crashing. She’s brewing something—but what?
Edan ordered a duplex scan of the left leg and added a request for abdominal CT with contrast, then stepped out to find Dr. Harper for co-sign.
But just as he hit the hallway, another voice cut across the nurses' station.
“Already resorting to shotgun diagnostics, Wood?”
Edan turned.
A tall figure leaned against the counter, arms crossed. Sandy hair, sharp jawline, perfectly ironed white coat.
Colin Maddox.
Top of their med school class. Razor-sharp. Competitive. And never missed a chance to make sure people knew it.
“Good morning, Colin,” Edan said evenly.
Colin gave a dry smirk. “Heard you had a trauma moment yesterday. Bet it felt good finally getting something right.”
Joyce’s voice echoed in Edan’s mind: Drama magnet with a god complex.
“I’m working a case with no history,” Edan replied. “Every clue counts.”
“That so?” Colin stepped closer. “Vitals are stable. You already ordered a CT? Sounds like defensive medicine.”
Edan didn’t rise to it. “It’s not defensive if you’re looking for something specific.”
“I’ll take a look at her later,” Colin said with a dismissive shrug. “We’ll see what’s really going on.”
Edan turned away without responding. He had no time for ego when a real patient was on the line.
[Mission Update: Rival Observing Case]
If Colin identifies diagnosis first, reward reduced. System Sync may stall.
Priority: Complete three clinical clue confirmations before second evaluation.
The duplex result came back an hour later.
Left Femoral Vein Thrombosis Detected
Consistent with early deep vein thrombosis (DVT). Possible hypercoagulable state.
DVT—but no obvious signs of pulmonary embolism yet. Still… could this explain the systemic symptoms?
As Edan processed the result, the CT page buzzed.
CT Findings: Mild sigmoid diverticulitis. No abscess or perforation. No free air.
Diverticulitis could explain the RLQ pain, but not the leg mottling. Not the hypotension. Something’s missing…
He sat in the consult room and opened the system interface.
Differential Tree – Active Case: Camilla Shore
Confirmed: DVT
Suspected: Diverticulitis
Unconfirmed: Septic thrombophlebitis, Pelvic abscess, Occult malignancy
New Diagnostic Path Available: Hematologic Clue Chain
Trigger: Overlapping systemic inflammation and clotting abnormalities.
Bonus Synergy Detected: Internal + Emergency = Sepsis Mapping I
Apply Synergy Bonus?
Cost: 1 Skill Point
Edan blinked. This time it costs a point? So synergy bonuses aren’t always free...
He had 2 skill points remaining from recent missions.
Alright. Worth it.
He confirmed the activation.
Skill Point Used – Remaining: 1
Synergy Unlocked: Sepsis Mapping I
Effect: Highlights likely origins of infection and accelerates clue convergence from multiple systems.
Synergy Path Progress: 3/10 Active
On-screen, the interface shimmered—and three nodes lit up. One pulsed red: “Possible pelvic source with associated septic thrombosis.”
Edan stood up fast.
The infection isn’t just in her gut or blood. It’s localized… and spreading through clots.
He checked the vitals again. HR: 112. BP: 88/54.
The HP bar over Camilla’s bed was flickering now.
HP: 58% → 55%
Condition worsening. Intervention window narrowing.
Edan clenched his jaw. This wasn’t just a diagnosis. It was a race.
And he had hours—maybe less—to stop the wrong domino from falling.