HP: 55% → 54%

  VitalSight Alert: Ongoing deterioration detected.

  Intervention threshold approaching. Complications imminent.

  Edan moved fast.

  The system’s Sepsis Mapping synergy had illuminated the path, but he still needed human backup. A diagnosis this rare — septic pelvic thrombophlebitis — would never stick without buy-in from the team. And standing between him and that buy-in was one unavoidable obstacle:

  Colin Maddox.

  Sure enough, Colin was already outside Room 310B, speaking low to Dr. Harper and flipping through the chart with his signature performative calm.

  “I still think we’re overcomplicating this,” Colin said. “She’s an elderly woman from a nursing facility with diverticulitis and a borderline WBC count. Weakness and mild hypotension? Probably simple sepsis from a gut bug. Fluids and broad-spectrum antibiotics should stabilize her. No need to chase zebras.”

  Dr. Harper glanced up as Edan approached. “You’ve got a counter-opinion, Wood?”

  Edan met Colin’s stare. “Yes, sir. I think we’re looking at septic pelvic thrombophlebitis — and it’s evolving fast.”

  Colin scoffed. “Seriously?”

  Edan didn’t blink. “Her duplex ultrasound showed a left femoral DVT. Her vitals are deteriorating. CT confirmed diverticulitis, but no abscess or perforation. Meanwhile, she’s developing skin mottling, rising heart rate, and signs of systemic inflammation out of proportion to imaging. The infection source isn’t just local — it’s in the venous system.”

  “Interesting theory,” Colin said coolly. “But speculative. That’s not something you treat without firm imaging or blood cultures.”

  

  [Mission Update: Presenting Working Diagnosis – High Risk]

  System warning: Senior attending will weigh your clinical judgment. System Sync may increase or decrease significantly based on outcome.

  Bonus Goal Active: Reputation Shift – Impress supervising physician with rare diagnosis and initiative.

  “I agree we need data,” Edan said. “So I called ID and Hematology for input. They’re reviewing the labs now.”

  Colin’s smirk twitched.

  Dr. Harper raised an eyebrow. “You called two consults before presenting to me?”

  “Yes, sir. I didn’t want to waste time. The window for early intervention is closing.”

  Stolen from its rightful place, this narrative is not meant to be on Amazon; report any sightings.

  There was a pause.

  Then, Dr. Harper leaned slightly forward.

  “Walk me through it.”

  Edan took a deep breath and began.

  “Septic pelvic thrombophlebitis is a rare complication of intra-abdominal or pelvic infections — most commonly postpartum, but also in elderly patients with inflammatory bowel issues. It occurs when infection spreads from the pelvis into the venous system, creating a septic thrombus that can propagate and embolize. It won’t show up clearly on standard abdominal CT, and early signs are subtle — persistent bacteremia, rising lactate, DVT without clear cause.”

  “Labs?” Harper asked.

  “Lactate is rising. WBC is 13.4. Creatinine’s creeping up. Mild thrombocytopenia too — which could point to early DIC.”

  Colin shook his head. “You’re treating a textbook ghost. No one in this hospital has seen a pelvic septic thrombophlebitis in years.”

  “And that’s why most of them get missed,” Edan shot back.

  

  [Clinical Confidence Check Passed]

  Impact on Team Perception: Rising

  +10 EXP

  Reputation Trait Updated: “Decisive Under Fire” now visible to senior staff.

  Just then, a knock came at the open doorway. A tall woman in navy scrubs and a badge labeled Dr. Naomi Decker – Infectious Diseases stepped inside, followed by a younger hematology fellow scrolling on her phone.

  “Got your page, Edan,” Dr. Decker said. “Interesting case. We ran a coag panel and some extended inflammatory markers. Fibrinogen’s dropping. D-dimer’s sky-high. ESR and CRP elevated out of proportion. That, combined with DVT, nonverbal status, and diverticulitis history… I agree it’s possible.”

  The hematology fellow chimed in. “We also noticed subtle prolongation in her PT. She’s heading toward coagulopathy. If this is septic thrombophlebitis, we need to start therapeutic anticoagulation and broad-spectrum IV antibiotics now.”

  Dr. Harper looked between them, then back at Edan.

  “I’ll cosign the order set,” he said quietly. “Nice work.”

  Colin’s jaw tightened slightly.

  

  [Mission Complete: Differential Dilemmas – Tier II Case]

  +50 EXP

  +1 Skill Point

  +Reputation Shift: Team Standing Improved

  Unlock: Pediatric Focus – Side Branch (Available)

  System Sync: 35%

  Bonus Achievements:

  

  
• 
  
    Rare Diagnosis Confirmed
  
    


  
• 
  
    Multi-Specialty Coordination
  
    


  
• 
  
    Diagnostic Stand Under Pressure
  
    


  

  

  Team Reputation: “Harper Rotation – Trusted”

  Effect: You may now independently propose diagnostic plans under Harper's supervision. Increased trust in high-acuity settings.

  As the consult team left, Colin remained by the chart, silent.

  Dr. Harper didn’t gloat — he never did. But he met Edan’s eyes and nodded once.

  “You’ve got instincts. And the guts to stand by them. That’s worth more than a hundred academic top scores.”

  Edan’s chest tightened with a quiet kind of pride.

  He didn’t need applause. He didn’t need to outtalk Colin.

  He just needed to be right — when it mattered.

  Later that afternoon, Edan sat in the physician lounge, replaying the day.

  

  [System Menu – Update Available]

  

  
• 
  
    Skill Points: 2
  
    


  
• 
  
    New Branch: Pediatric Focus (Optional)
  
    


  
• 
  
    Reputation Tracker Unlocked
  
    


  
• 
  
    Synergy Pathway Expansion Available:
  
    


  

  ? Internal Medicine + Emergency Medicine

  ? Status: 3 Synergies Active

  ? Next Unlock: Adaptive Responder I (Cost: 2 Skill Points)

  Effect: Enhances decision-making in cases with evolving symptom profiles. Increases clue generation and lowers delay in ambiguous presentations.

  Adaptive Responder, Edan thought, leaning back with a slow breath. That’s what I’m becoming.

  And for the first time since this system appeared in his life — he didn’t feel overwhelmed.

  He felt ready.