My Cultivation System Runs on Karma

The cursor blinked on the cracked monitor, tapping out a steady, mocking rhythm in the dim light of the intern breakroom. 

I sat in the stiff plastic chair, my spine curved, feeling the ache settle deep into my lumbar spine. The harsh, artificial glare of the screen illuminated the dusty keyboard, but all I could focus on was the reflection of my own face in the dark margins. I looked like a corpse. The skin under my eyes was bruised a sickly purple, and my black hair was a greasy, tangled mess sticking to my forehead. 

I tasted old, burnt vending machine coffee at the back of my throat, mixed with the faint, ever-present hospital tang of industrial bleach, rubbing alcohol, and latex. 

My fingers hovered over the keyboard. They were trembling. 

Letter of Resignation.

To the Administration of Hanseong Central University Hospital:

Effective immediately, I, Ryeong Bin, Medical Intern…

I couldn't type the rest. The shaking in my hands wasn't from fear or hesitation. It was the physical manifestation of a body pushed entirely past its breaking point. Seventy-two hours. I had been awake and on my feet for seventy-two straight hours, running on nothing but stale crackers, lukewarm tap water, and a bitter, hollow sense of spite. 

Hanseong Central wasn’t a place of healing. I had learned that within my first month. It was a meat grinder dressed up in pristine white tiles and million-dollar MRI machines. Interns like me were just the cheap grease that kept the gears turning. We were the ones blamed when an arrogant senior resident butchered a routine procedure, and we were entirely invisible when someone actually survived. 

I had entered medicine because I wanted to save lives. It was a naive, stupid dream. For the past eight months, my reality consisted of fetching iced Americanos for department chiefs, forging hours on duty logs, and watching patients die in the hallways because the higher-ups were too busy fighting over funding to approve emergency scans.

I pressed the backspace key. I held it down until the letters vanished, swallowed by the blank white document. 

"I'm done," I whispered to the empty room. My voice sounded like crushed gravel. "I'm just… done."

I reached for the mouse to close the window. My gym bag was already packed by the door. I was going to walk out the automatic sliding doors into the freezing Seoul night, let the winter air hit my face, and never, ever look back. Medicine could rot for all I cared.

BEEP. BEEP. BEEP.

The pager clipped to my waistband vibrated so violently it felt like a shock against my hip. The shrill, piercing sound cut through the dead quiet of the breakroom like a physical blow. 

Code Blue. Emergency Room. Bay 4. Mass Trauma.

I squeezed my eyes shut. I let out a long, ragged breath, feeling the air shudder in my chest. I could just leave. My resignation was practically written. I wasn't even supposed to be on call right now; I was covering for a third-year resident who had sneaked out two hours ago to meet his girlfriend at a bar in Gangnam. 

But the pager kept screaming against my hip. 

I shoved the chair back. The metal legs screeched loudly against the cheap linoleum floor. I didn't grab my white coat. I just walked out the door, my worn-out sneakers squeaking against the polished tiles of the hallway. Every step felt like walking through waist-deep water, but the adrenaline was already beginning to hijack my exhausted nervous system, forcing my heart to pump faster.

The ER doors burst open before I even reached them. 

The smell hit me first—the sharp, unmistakable metallic stench of fresh blood, immediately overpowered by the acrid odor of vomit, motor oil, and street dirt. The noise was a physical wall. Nurses were shouting conflicting orders, monitors were blaring high-pitched alarms, and the wheels of gurneys clattered wildly against the uneven floorboards. 

"Car accident! Drunk driver ran a red light into a crosswalk!" a paramedic yelled, jogging alongside a stretcher, his boots slipping slightly on the slick floor. He was completely out of breath, his bright uniform stained a sickening dark red. "Pedestrian hit! Eight-year-old male!"

Following closely behind the stretcher was a woman. Her clothes were torn, her face smeared with soot and blood, and she was sobbing with a frantic, guttural sound that made the hairs on my arms stand up. "My baby! Please, God, someone help my baby!" 

"Ma'am, you need to stay back! You can't go in there!" a security guard shouted, wrestling the frantic woman backward. I caught a glimpse of the ID badge dangling from her torn purse—Seol Mee.

I pushed through the crowd of gaping onlookers and panicked junior staff, using my shoulders to carve a path. I reached Trauma Bay 4 just as the paramedics transferred the boy from the transport stretcher onto the hospital bed with a heavy thud. 

The kid was tiny. His chest was covered in angry, swelling purple bruises from the direct impact of the bumper. But what made my stomach drop was his face. His lips were a terrifying, dusky shade of blue. He wasn't breathing. His chest was making short, violent, uneven jerks, like a fish flopping on dry concrete. 

Nurse Jo Hyun-Jung was already at the head of the bed. Her hair was pulled back into its usual severe, tight bun, not a strand out of place despite the chaos. She moved with ruthless, practiced speed, strapping the blood pressure cuff to his tiny arm and slapping the sticky ECG leads onto his bruised chest. 

"Heart rate is one-forty and climbing! SpO2 is dropping fast! Eighty-five percent!" Nurse Jo shouted over the din, her eyes darting between the monitor and the boy. "Where the hell is the attending? We need a doctor right now!"

Dr. Rim Du-Ho shoved past me, nearly knocking me into a tray of instruments. He was a senior attending known more for his golf swing and his temper than his diagnostic skills. He looked annoyed, hastily throwing a yellow isolation gown over his wrinkled dress shirt. 

"Alright, alright, calm down, I'm here," Rim muttered, clicking a penlight and shining it roughly into the boy's unreactive pupils. "Probably a severe concussion, massive head trauma causing respiratory failure. Maybe some internal bleeding. Let's get him intubated immediately. Hand me the Mac 3 blade."

I stood at the foot of the bed, my hands gripping the plastic rail. I watched the boy's chest. Something was fundamentally wrong. The left side of the boy's chest was rising with those violent jerks, but the right side remained entirely flat, perfectly still. I let my eyes trail up to his neck. The trachea—the windpipe—was visibly pushed off-center, jutting to the left side of his throat. 

I opened my mouth to speak, but before the words could leave my throat, a sharp, blinding pain split my skull. 

I staggered back, ripping my hands away from the bed to grip the sides of my head. It felt like a white-hot, electrified needle had been driven directly behind my eyeballs. I squeezed my eyes shut, gasping in a breath, but the light didn't go away. It exploded outward, growing brighter until it filled my entire vision. 

A high-pitched, digital ringing drowned out the screams of the mother and the alarms of the ER. 

Then, a translucent blue screen materialized out of thin air, floating perfectly in front of my face. 

I blinked. I rubbed my eyes so hard I saw stars. But when I opened them, the screen stayed. It hovered directly above the dying boy's chest, glowing with a soft, unnatural, highly-rendered light.

[System Initialization Complete.]

[Host: Ryeong Bin. Status: Severely Exhausted. Motivation: Critical Low.]

What the hell? I thought, my heart hammering furiously against my ribs. Am I hallucinating? Did my brain finally snap from the sleep deprivation?

The text on the floating blue screen shifted. The old words deleted themselves, and new ones typed out with terrifying, rapid precision, accompanied by a soft clicking sound only I could hear. 

[Critical Patient Detected]

[Male, 8 years old]

[Death Probability: 98% within 3 minutes]

My breath caught in my throat. Ninety-eight percent. It was a death sentence written in glowing blue text. 

The screen flashed violently, the borders turning a dangerous, urgent shade of crimson. 

[Cause: Severe Tension Pneumothorax leading to imminent Cardiac Arrest]

[Warning: Attending Physician is misdiagnosing. Intubation under positive pressure will cause immediate respiratory collapse and death.]

[Mission Generated: Prevent Patient Death]

I stared at the floating words, my medical training slamming into my brain, bypassing the exhaustion. Tension pneumothorax. Air was escaping from a tear in his right lung and getting trapped in the chest cavity. The pressure was building with every ragged gasp, physically crushing his working lung and pushing his heart to the side so it couldn't pump blood. The boy didn't just need an airway tube. Pushing air into his lungs with a bag-valve mask would be like blowing up a balloon inside a locked metal box. It would crush his heart instantly. He needed the pressure released. Now.