The patient—Jordan Miller, male, mid-twenties—sat hunched on the chair, looking like he hadn’t slept in days. Pale, slightly diaphoretic, and holding his chest with a vague grimace. But that wasn’t what set Edan’s nerves on edge.
It was the HP bar.
Bright yellow.
And dropping.
HP: 71% → 70%
Status: At Risk
VitalSight Alert: Deterioration detected. Unknown etiology. Immediate assessment advised.
It’s falling in real time? What the hell is going on here? Edan stepped forward carefully, schooling his face into a calm expression.
“Hi Jordan, I’m Edan Wood, a medical student working with the Internal Medicine team today. Mind if I ask you a few questions and check you out?”
Jordan nodded, rubbing his sternum. “Yeah… I guess. Just been feeling weird all day. Lightheaded, tired. Chest feels tight, but not sharp pain. I almost didn’t come in, but…” He trailed off, looking embarrassed. “I just don’t feel right, man.”
Good instinct, Edan thought. Something’s definitely not right.
“Alright, let’s start with some basic questions,” he said. “When did this start?”
“Maybe last night? I got up to pee and felt dizzy. Thought it was dehydration, but it didn’t go away.”
“No fever? No cough or sore throat?”
Jordan shook his head. “No. Just... this feeling like something’s off.”
Edan clicked his penlight and checked Jordan’s pupils. Equal, reactive. He moved quickly through the neuro check—no obvious deficits. Jordan’s pulse, however, felt slightly fast under his fingers.
“Do you have any medical history? Allergies? Meds?”
“Nothing major. I take Adderall sometimes for ADHD—prescribed. No smoking, no drugs.”
“Any recent illnesses? Travel?”
“Nope.”
Edan stepped back, trying not to show how tense he felt. The HP bar had dipped again.
HP: 69%
Rate of Decline: Moderate
Clinical Awareness Activated
Subtle jugular venous distension observed. Mild tachycardia present.
Consider cardiovascular origin.
Edan blinked. JVD? In a 24-year-old? He turned his attention to Jordan’s neck again and now noticed it—a barely perceptible fullness above the clavicle. Not prominent, but noticeable if you were looking for it.
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The system chimed softly.
New Mission: Unstable Foundations
Objective: Identify the primary cause of Jordan Miller’s deterioration and initiate appropriate workup.
Reward: +20 EXP, Early Intervention Bonus
Failure Penalty: Missed Diagnosis – System Sync Reduction (-2%)
Hint: “The most dangerous cases wear the most innocent masks.”
Edan took a breath. Okay. He’s not crashing, but he’s heading somewhere bad. Think. Lightheadedness, chest pressure, JVD…
“Jordan, has your heart ever raced or skipped before? Any history of fainting?”
“Not really. I mean—well, last month I blacked out for a second during a basketball game. But I thought it was just heat exhaustion.”
Syncope during exertion. Possible red flag for underlying structural heart issue. Edan’s thoughts raced as he opened the vitals chart on the wall tablet. BP: 102/68. HR: 110. SpO2: 98%. Temperature normal.
Low-normal BP. Tachycardia. Subtle signs of fluid backup. Could this be early heart failure? Or something more acute, like pericardial effusion?
Dr. Harper entered then, flipping through the intake form.
“You’ve seen him already?”
“Yes, sir,” Edan replied, eyes still on Jordan. “Vitals are okay for now, but something’s wrong. He’s got mild JVD and reports presyncope. I’d like to order an ECG and stat bedside echo if possible.”
Harper raised an eyebrow. “Bedside echo? For a stable 24-year-old?”
“I know it seems early, but the system—I mean—his symptoms and signs don’t line up with a benign cause. There’s progression.”
Harper eyed him. “You’re sure?”
Edan nodded, pulse thudding in his ears. Please trust me.
“Alright. Let’s see what the ECG shows first. You can put in the order and notify ultrasound if it’s abnormal.”
[Mini-Mission Update: Provisional Test Justified]
+5 EXP
Skill Usage Validated: Clinical Awareness
Jordan’s ECG came back 20 minutes later.
Sinus tachycardia… with low voltage QRS.
Harper narrowed his eyes. “Interesting.”
Edan leaned over. Low voltage? Why? Could be pericardial effusion… maybe tamponade if things get worse…
The system pulsed again.
Warning: Jordan Miller HP now at 65%
System suggests potential fluid accumulation affecting cardiac function.
Edan keyed the bedside ultrasound requisition and wheeled in the portable unit himself. Harper observed quietly, arms folded.
Jordan lay back on the gurney, trying to breathe steadily. “I’m not dying, right?”
Edan shook his head. “You came in early. That’s good.”
He placed the probe over the chest, nerves jangling as the fuzzy black-and-white image resolved.
Then he saw it.
A black crescent around the heart—pericardial effusion.
A decent-sized one.
He moved the probe for a subcostal view—more clear fluid. But there was still cardiac motion. No overt collapse yet. Not tamponade… but the pressure was building.
Harper leaned in. “You were right. Pericardial effusion. Possibly viral or autoimmune.”
Edan felt a flash of relief—and adrenaline.
[Mission Complete: Unstable Foundations]
+20 EXP
Bonus Achieved: Early Intervention
+1 Skill Point
System Sync: 16%
New Unlock: Passive Skill – Pattern Recognition II
Effect: Further enhances detection of atypical presentations. Reduces delay in forming uncommon diagnoses.
Jordan’s HP bar flickered… then stabilized at 65%.
They were in time.
An hour later, after cardiology was consulted and Jordan was admitted for further monitoring, Harper caught Edan outside the room.
“You pushed for an echo before anyone else would have,” he said. “Keep that up. Just don’t let it make you cocky.”
Edan nodded, still buzzing inside. “Yes, sir.”
As Harper walked off, the system opened once more.
Next Mission Available: Crossroads of Care
Objective: Handle a conflict in triage—two walk-in patients, both high-risk, but limited resources. Who gets prioritized?
Edan stared at the blinking icon, the question already tightening his chest.
Two lives. One path. And I have to choose?