Chapter 181

Episode 181 Test (2)

“Are you saying you’ve solved them all?” Lee Jae-yoon asked.

“Yes, sir. If there are any parts where the explanation is insufficient or the answer is vague, please let me know. I will provide additional oral explanations.”

‘I don’t know, damn it. I don’t know either.’

The die was already cast.

I had simply written down the comments that caught my eye in order, and since I only supplemented some of them using the ghosts based on my own knowledge, I didn’t have time to verify whether the answers I wrote were correct or incorrect.

However, I had no regrets.

If I backed down now, all my efforts would go down the drain.

‘If I make a good impression, I’ll become a professor.’

After all, I had long since given up on working at a local clinic.

I had absolutely no talent for cosmetic procedures, and I had already abandoned the path of a fellow a long time ago.

To survive at a university hospital, the mindset of just aimlessly doing halfway well had to be thrown to the dogs.

I had to unconditionally and overwhelmingly leave a strong impression to survive.

That was the path I chose.

“Hmm….”

Lee Jae-yoon collected the stack of answer sheets placed in front of me, skillfully sorted them by department, and passed them along.

“Now, shall the professors of each department grade the sections they are responsible for?”

The answer sheets were handed over to the professors.

Lee Jae-yoon brought the remaining two stacks in front of himself.

“I’ll take charge of the Thoracic Surgery part and the General Surgery part.”

At that, Professor Choo Myung-sun of the Orthopedic Clinic asked, looking puzzled, “General surgery? But Director, you are…”

The criticism seemed reasonable.

It would be difficult for someone in Thoracic Surgery to know General Surgery questions, especially those regarding abdominal trauma or multiple injuries.

“I plan to show it to Kang Hyun-joon, the center chief of Trauma Surgery, separately later for a second grading. For now, I’ll just do a preliminary grading. I know what’s relevant too.”

“Yes, sir. Understood.”

Professor Choo, who had asked the question, quickly shut his mouth and pulled out a red pen.

The other section chiefs also picked up their respective question sheets.

Scribble.

Scribble.

Tap, tap.

Scribble.

Only the sound of turning paper and pens was heard.

I listened to that sound with my hands placed on my lap.

The sound of writing feedback.

The sound of tapping to check questions.

And the sound of drawing circles.

‘Phew….’

The distinct sounds of incorrect grading, like two-syllable or one-syllable slash marks or checkmarks, didn’t seem to be heard yet.

Of course, it could also be that my hearing was paralyzed due to the tension and I just couldn't hear it.

“Huh….”

Someone let out a dry laugh.

It was Section Chief Hwang Seong-jin of Internal Medicine.

“Good grief.”

This time it was Section Chief Shin Young-jun of Internal Medicine.

He shook his head from side to side.

“Tsk….”

Professor Choo Myung-sun of the Orthopedic Clinic even spun his pen, looking back and forth between my face and the answer sheet.

Shallow sighs and groans burst out from everywhere.

I couldn’t tell whether that was a positive sign or a negative sign.

How much time had passed?

After about ten minutes, which felt like a year, passed.

“Director, I'm done.”

Hwang Seong-jin of Internal Medicine was the first to put down his pen.

“Already?”

Lee Jae-yoon looked up.

“Yes. Here it is.”

Swish.

Scribble, scribble.

The other professors also put down their pens one by one.

“I’ve finished grading too.”

“Me too.”

That way, the answer sheets that finished grading one by one gathered back into the Director's hands.

Lee Jae-yoon began to slowly turn the pages from the very front.

Sometimes he would pause to read a comment written with a red pen, or a smile would appear on his lips.

“Mmhmm… Mmm, hm….”

Swish.

Rustle.

The sound of pages turning continued to be heard.

Whenever the Director stopped his hand and stared at a section of the paper, my heart tightened for no reason.

‘It’s not that the parts I wrote are all wrong and only the ghosts' parts are all correct, right?’

It was an added bonus that several professors stared at me with very troubled expressions.

Because that gaze was too burdensome, I forced my eyes to stay fixed outside the window.

How much time had passed?

Lee Jae-yoon closed the last page.

Thump!

“Teacher Han.”

“Yes, Director.”

I swallowed hard.

“There are a few partial deductions due to insufficient detailed explanations… but well, that’s natural since you’re a resident.”

Gulp.

“This is more surprising than I thought.”

“…Yes.”

Surprising? Is it positive? Is it negative?

“I don’t know if Teacher Han wrote the answers with a perfect academic understanding of all the pathophysiology and mechanisms themselves.”

Lee Jae-yoon tapped the stack of answer sheets with his hand.

“For now, this answer itself…”

The answer itself?

“Is all correct.”

“…?”

A silence flowed for a moment.

“?!”

The expressions of all the faculty members changed to astonishment.

All correct?

“?!”

And my expression was no different from theirs.

‘Why?’

I doubted my ears.

The ghosts didn’t even have time to discuss, and I had just written down the answer that appeared at the very top.

Even the questions on traumatology or some fields, I had just filled them in with my own knowledge.

Professor Park Seung-woo of Neurosurgery looked at the Director and asked cautiously, “Director, could it be that the answers were leaked in advance? Or did he see the questions beforehand…?”

“How on earth could I tell him the answers in advance? I received the questions from you guys just this morning. In the first place, weren’t you the ones who brought today’s questions?”

“If so…”

“I didn't write them down for him. Do I know neurology? Do I know cerebral blood vessels? It's not even an answer sheet I wrote, so what is there to leak?”

Lee Jae-yoon shrugged his shoulders.

It was logically impossible to refute.

The question creators were the professors, and the graders were also the professors.

There was no room for cheating to intervene.

“That’s true, but…”

Professor Park Seung-woo stroked his jaw with an expression that still showed he couldn't accept it.

“Then Director, may I ask a few questions?”

“Go right ahead. I’m curious too.”

Lee Jae-yoon readily gave permission and leaned his body against the backrest.

‘I hate this.’

“Uh… Teacher Han. First of all, you worked hard to solve it. The answer sheet is excellent. It’s very textbook-like. By the way.”

He pointed to a page of the answer sheet with his finger.

“This. This question. Number 12.”

“Yes.”

“It was a complex case accompanied by dissection in cerebral infarction. You wrote here that you would perform neurosurgical decompressive craniectomy first, and then enter thoracic surgery.”

“That is correct.”

“To operate on the heart, you have to run a cardiopulmonary bypass machine and use heparin. It puts the whole body in an anticoagulated state.”

“Yes.”

“Then wouldn't blood gush out from the brain? It’s a situation where the intracranial pressure instantly spikes, brain edema occurs, and there is a risk of brain herniation. Your answer only stated surgery after hemostasis, but that’s not as easy as it sounds.”

As Park Seung-woo pushed hard, Section Chief Hwang Seong-jin of Internal Medicine, who was next to him, cut in.

“Professor Park, aren't you going too deep? Emergency Medicine is a department that just does initial treatment and sets the direction, so asking about detailed processes during surgery like this is a bit…”

“No. This guy needs to know. If he wrote this level of an answer, we should check if he wrote it knowing what follows.”

Park Seung-woo did not back down.

‘Okay, now is the time.’

I cheered inwardly and brought up the gallery post in the void.

[Comments]

Korean Slave 1 (Male): When opening the brain and using heparin, how should brain herniation be handled? I feel like they’re going to ask about closing it.

ㄴ HeadTUTU: If you just cover the skin, the brain expands and gets pressed. You have to do a duraplasty. Securing space using an artificial dura mater is the lifeline.

ㄴ ThoracicSurgeryFossil: That’s also important, but from a thoracic surgery perspective, venous return is more important. If it’s that case, they’ll probably do extracorporeal circulation…

Okay.

“No. It’s fine. Section Chief Hwang, don’t stop him. Keep asking.”

When the Director restrained him, Hwang Seong-jin had no choice but to shut his mouth again.

Park Seung-woo opened his mouth again.

“Ahem. Let's continue. At that time, how are you going to physically close the brain? You won't be able to put the bone back in, and the brain is swelling up, so you shouldn't forcibly suture the scalp.”

I took a breath and began to speak the advice of the ghosts.

“First, while leaving the bone removed, I will perform a duraplasty using an ample amount of artificial dura mater to secure space for the brain to swell. I will expand and suture widely as if creating space to provide room for the brain to expand.”

“Hmm….”

“However, the core key that is more important than the surgical technique is venous return.”

“Venous return?”

“Yes. When running extracorporeal circulation during heart surgery, if the cannula inserted into the right atrium or superior vena cava slightly obstructs the drainage of cerebral venous blood, cerebral venous pressure rises and the brain swells rapidly.”

I continued speaking while slightly looking toward the Director.

“So in this case, in consultation with the anesthesia department, we will maintain the patient's head position elevated by 30 degrees, and request the thoracic surgery team to frequently check the SVC cannula position to force the cerebral venous pressure below 10 mmHg. The drainage must be smooth to prevent brain edema.”

Professor Park Seung-woo’s mouth opened slightly.

It pointed out the focus of multidisciplinary surgery that went beyond the domain of a simple neurosurgeon.

By a non-surgical department resident.

“Huh….”

Before Park Seung-woo could even be surprised, this time Lee Jae-yoon jumped in.

“Let's leave the brain aside. It's very excellent.”

Lee Jae-yoon turned the page.

“But when performing aorta surgery, don’t they drop the body temperature to deep hypothermia? Then platelet function will be paralyzed and a coagulation disorder where blood doesn't stop will inevitably come, but in this case, reducing heparin won't solve it.”

The Director's eyes flashed.

“If there is oozing in the surgical site, especially on the brain side, how will you catch it? If blood pools inside the brain when raising the body temperature after surgery, it's all for nothing. Singing with a bovie also has its limits.”

Ah.

There was no need to ask the gallery for this.

This was something I knew.

One of the miscellaneous pieces of knowledge I picked up while studying alone and chatting with the gallerists.

‘I remember.’

I answered with a confident voice.

“Therefore, I think antifibrinolytics like aprotinin or tranexamic acid should be administered in high doses even before the pump starts.”

“With medication?”

“Yes. And the rewarming period is the most dangerous. Hemorrhage bursts when the blood vessels that had constricted as the temperature rises rapidly expand. Therefore, while keeping the rewarming speed very slow at 0.5 degrees per hour…”

I swallowed hard.

“I think it would be good to have the neurosurgery team perform a second hemostasis through the scalp that was left open once again. Checking it one more time before closing… right?”

After saying it, I thought it sounded too arrogant, so I blurred the end of my sentence.

“….”

Lee Jae-yoon stared at me with wide eyes.

And soon after.

“Ha! Haha, ha! Good grief….”

Lee Jae-yoon threw his head back and burst into a loud laugh.

It was a laugh as if he felt refreshed, or as if he was so dumbfounded that words wouldn't come out.

“Did you hear that? Professor Park, Professor Shin? Did you hear it?”

Lee Jae-yoon looked around at the surrounding professors and pointed at me with his finger.

“He knows this?”

The expressions of the other professors were also unusual.

“That… Director. Is this perhaps the reason why we gathered today…?”

Section Chief Shin Young-jun of Internal Medicine asked cautiously.

Then Lee Jae-yoon stopped laughing and returned to a serious expression.

“Ah, that’s right. Wait a moment, everyone.”

Lee Jae-yoon returned to his seat and handed out an envelope to each of the five professors, including me.

It was heavy.

On the outside of the envelope, a red stamp reading [Confidential] was pressed.

“Now.”

Lee Jae-yoon sat down and clasped his hands together.

“Since Teacher Han’s skills have been verified, and the passion of the professors here has also been confirmed.”

He pointed to my envelope.

“Now we should talk about the real reason we gathered today. Open it.”