Chapter 183
Episode 183 Test (End)
“Tell me. Where exactly is it impossible, and where is it ambiguous?”
Lee Jae-yoon stared at me, maintaining his relaxed smile. It was as if he was fully prepared to enjoy whatever counterargument came out of my mouth.
However, the expressions of the professors sitting around him were different. A gaze mixed with anxiety and anticipation? I swallowed hard and began to pour out the logic I had organized in my head.
“First is the concern over patient safety and continuity of care.” I held up a single finger. “The center's purpose is good—one-stop diagnosis and surgery. But surgery is not the end; it is just the beginning. Post-operative management determines the prognosis.”
I looked toward Professor Park Seung-woo of Neurosurgery and continued.
“Managing intracranial pressure in neurosurgery patients. Hemodynamic monitoring for cardiac surgery patients. These are the domains of ICU specialists and professors who have received professional training. No matter how well I perform the diagnoses and procedures, it is impossible for me alone, or a small team, to handle all the follow-up care after they leave the operating room.”
At my words, Professor Park Seung-woo of Neurosurgery and Section Chief Shin Young-jun of Endocrinology nodded simultaneously. My statement probably represented their inner thoughts: 'If you just perform the surgery and dump them, who is going to clean up the mess?'
“Hm, you have a point. Keep going.” Director Lee Jae-yoon nodded, jotting something down on a notepad.
“Second is the issue of expertise.”
“Expertise?”
“Yes. Let’s assume the Acute Care Center operates 24 hours a day. But what if a neurosurgery professor is on duty in the hospital, or a thoracic surgery doctor is on standby?”
The director looked up.
“It’s hard to justify the Acute Care team taking over a surgery when a specialist is perfectly available in the hospital. Distrust will inevitably arise among fellow doctors, as well as from the patients and their guardians.” I continued, “If it's strictly about filling a blank space during an emergency, that's one thing. But taking a patient under the jurisdiction of the Acute Care Department when an expert is available could result in failing to provide the best treatment due to a gap in competence. There's also the issue of territorial infringement.”
At my remarks, the professors' expressions softened noticeably.
Yes, professors. I told you I didn't plan this with the director.
“So that’s what you think, Dr. Han.”
“Yes. And this is the most realistic problem.” I let out a sigh and opened my mouth. “It’s a staffing issue.”
“Staffing?”
“Yes. For this team to run 24 hours a day, we need at least five dedicated specialists. And they have to be genius doctors who can handle both surgery and critical care. Where do you find that kind of manpower?”
For reference, five was a number tailored to the staffing of emergency medicine specialists at a fairly large local emergency room. In other words, even more might be needed.
“There isn't a single doctor in South Korea who can handle the killer workload and burnout risk of this team. No matter how good my stamina is, I can't stay on duty throughout the entire week.”
The logic was flawless. Safety, expertise, and reality. They were all common-sense criticisms that were hard to refute. The other professors listened quietly to my words, their expressions turning to relief.
“Ha, haha! Hahaha!” Director Lee Jae-yoon suddenly burst into laughter. “Good, good. Very sharp. This is exactly what I wanted.”
…?
“Staffing issues? Don’t worry about that. I plan to recruit as much as possible, enough to overflowing.”
“?”
“If money is the problem, we can solve it with money. If people are the problem, I'll personally go the extra mile to bring them in.”
‘What on earth is he talking about?’
What did he mean just now? Enough staffing? Solving it with money? At a time when university hospitals are reeling from deficits and scrambling to cut labor costs?
The calculator in my head spun rapidly. ‘Then our hospital...’
We already have a Regional Emergency Medical Center running 24 hours a day. Well, that's federally funded and essential, so pass. There is also the 24-hour aortic surgery team that Director Lee Jae-yoon set up. On top of that, the lights never go out at our hospital's Regional Trauma Center. Just maintaining these must cost an astronomical amount in labor and upkeep, yet he wants to build another 24-hour Acute Care Center? And with a fully stacked staff at that?
‘What is this? Is he running a charity?’
Or did the director secretly hear a rumor from the Health Insurance Review and Assessment Service or the Ministry of Welfare about an upcoming hike in vital care fees? Unless he received some absolute guarantee like 'We will increase vital care fees by 500% in the future,' there is no way he would engage in such crazy management. But then again, the hospital is back in the black for the first time in a while.
As if reading my expression, Lee Jae-yoon leisurely lifted his teacup. “Any other concerns? Tell me everything.”
Ah. Right.
“It’s a concern over legal issues.”
The air in the director's office turned cold again.
“You must know the current situation, Director. Legally, almost any medical act is permissible as long as you have a doctor's license, but reality is different.”
“Hm...”
“Medical staff from the Acute Care Department—who are non-surgical specialists without a general surgery board certification, let alone a subspecialty—performing surgery? It's fine if the outcome is good, but what if something goes wrong with the patient?”
“Go on.”
“In court, they will challenge the operator's qualifications. There is no logic to defend against the question of why someone who isn't a specialist held the scalpel. It won't just shake the individual doctor; the entire hospital could be compromised.”
Even if I perform a perfect surgery through possession, legally, I'm just a quack.
“A lawsuit issue, I see,” Lee Jae-yoon muttered to himself. “Yes, that’s the scariest part. I understand why you're being cautious.”
“Yes.”
“That’s why I told you earlier, didn't I? A year and a half.”
“Pardon?”
“Until the day you earn your specialist license. During that year and a half of preparation, I will do my utmost to overhaul the institutional framework and lay the groundwork. Both internally within the hospital and externally.”
“An institutional framework, sir?”
“We will rewrite the hospital regulations to explicitly grant surgical authority to your team. If necessary, I'll find a loophole through whatever means possible. The hospital will take ultimate responsibility for any action you perform to save a patient. I'll throw the entire legal team on the line to block it. So, you...” Lee Jae-yoon clenched his fist tightly. “Only focus on the patient. That is the sole condition I expect from you.”
“....”
I was lost for words. The professors sitting next to me gaped as well. This crazy gentleman really intends to do it. He is staking his remaining tenure, his influence, and the fate of the hospital on this.
‘But why?’
The reason was unknown, but he was determined to push through.
“Thank you for the words,” I bowed my head. ‘The director is truly locked in.’
“Would you like me to tell you why I ousted Park Kwang-suk?” Lee Jae-yoon asked out of nowhere.
Well, there was no reason to refuse. “Yes. I would like to hear it.” I adjusted my posture.
Was it because he tormented me? Or because he interfered with the director's surgery?
“Park Kwang-suk's criticism was reasonable.”
“Pardon?” It was an unexpected answer.
“In that situation, it was legally risky for an emergency medicine resident to assist in thoracic surgery, and strictly speaking, it was normal to stop it. His judgment wasn't wrong.”
“Then why...”
“But Park Kwang-suk offered no alternative for the patient.”
“An alternative?”
“If you don't operate in that situation, the patient dies. Yet, Professor Park only threw codebooks and regulations around. Without a single alternative. Not even the common phrase that he would look into a transfer.” Lee Jae-yoon's gaze locked onto me. “But Dr. Han, while you argued against the plan, your underlying motive was entirely filled with worry for the patient.”
“Ah...”
“Review what you just said. Every single word came from worrying about the harm the patient might suffer, not about your own safety. While your reasons for this plan being unrealistic make sense, your thoughts for the patient came first.” Lee Jae-yoon smiled broadly.
‘Actually, I was a bit worried about myself too...’
“That is why I like you, Dr. Han.”
I knew it was a compliment, but it felt incredibly burdensome. “Thank you.” I bowed my head awkwardly.
“Let’s wrap up the touching moment there. Tell me more. Do you have any other grievances?”
I snapped out of it and moved on to the next point. This was a truly realistic issue.
“Yes. I will connect this to the topic of sustainability.” I counted on my fingers as I explained. “According to the current proposal, a single center handles too many acute fields, including the brain, heart, and abdomen. They are expected to handle the primary surgery, or in some cases, final treatment...”
I shook my head.
“To be completely honest, even if you praise me as a genius, it's physically impossible. The doctors in the Acute Care Department will inevitably have their expertise diluted in each field. Even if expanded from Emergency Medicine, it will ultimately result in knowing broad but shallow...”
“Ah, right. Expertise.” Lee Jae-yoon nodded as if he had anticipated this. Then, he pulled out another piece of paper from his briefcase. “I was planning to show you this anyway.”
Thud.
I picked up the paper with a puzzled look.
[Notice of Emergency Medicine Resident Dispatch Schedule to Other Departments]
“Director, isn't this the schedule for our rotation to other departments during our 1st year? With this...”
Emergency medicine residents usually do brief rotations in other departments during their first year to learn. It was a process I had already completed.
“That’s not it,” Lee Jae-yoon replied shortly.
“?”
“?”
“?”
The professors from the other departments also had question marks popping up over their heads. I looked back down at the paper.
‘The 1st-year schedule is as planned...’
Below that, I spotted my name.
[3rd Year Resident Han Hyeonjae]
[Period: Mid-August – Mid-December (4 Months)]
[Dispatch Department]
General Surgery (Trauma/Vascular) / Thoracic Surgery / Neurosurgery (Brain) / Neurology / Orthopedic Clinic
“...What is this?”
“A plan to expand expertise,” Lee Jae-yoon said casually. “A special training regimen to deepen the shallow knowledge you're worried about.”
“....”
The expressions of the professors sitting next to me split down the middle between annoyance and intrigue. Professor Park Seung-woo of Neurosurgery looked like he was already smacking his lips in anticipation.
“Director, but...” I swallowed hard. It was an opportunity, sure. “Even if that's the case, the issue of sustainability still remains. Even if I return as a genius equipped with surgical skills, there's no guarantee that more doctors capable of covering the entire scope will emerge in the Acute Care Department.” I appealed to him. “I can't do it alone. I can't stay on duty 24 hours a day, 365 days a year. No successors will join. Who would willingly subject themselves to such a crazy curriculum?”
This was the biggest problem. An organization that relies on individual talent rather than a system cannot last long.
“Would you look at the appendix of the TF proposal?” Lee Jae-yoon motioned with his chin.
“The appendix, sir?”
I flipped to the very back page of the thick proposal from earlier. The supplementary materials.
Rustle.
[Appendix 1. Acute Care Center Staff Recruitment and Organizational Structure Plan (Draft)]
[Expanding the concept of acute care surgery currently piloted in other domestic hospitals to include internal medicine and other fields, structured as a multidisciplinary specialist team.]
And the specific headcount written below it.
[Center Chief: 1 Emergency Medicine Specialist | Team Members: 4 General Surgery Specialists, 3 Thoracic Surgery Specialists, 3 Internal Medicine Specialists (In charge of critical care/procedures), Neurosur...
...Total Count: 14 Specialists, 20 Dedicated Nurses, around 10 Dispatched Residents]
“...Ah?”
This... was not the picture I had envisioned. According to this plan, they were essentially setting up a small general hospital inside the emergency room. And it was solely for acute patients.
‘If it’s this...’ My eyes shook.
A patient arrives. A primary diagnosis is made. Immediately, a general surgery specialist and a thoracic surgery specialist pop out. There is no need to call other departments and beg. The ICU management is exclusively handled by internal medicine specialists.
“If it's like this... it works.”
It was possible. No, it was perfect. As long as the manpower could be secured.
“Director, but the manpower...”
“Do you think I can't recruit dozens of crazy bastards who are resting across the country? I am not asking you to carry the burden alone.” Lee Jae-yoon looked at me with a smile. “Do you find it trustworthy now?”
“...Yes.”