Chapter 209
Episode 209 Observation (1)
Cho Kyeong-woon stood frozen with his arms crossed, staring intently at Han Hyeonjae. The deep furrow between his brows showed no signs of smoothing out, and his tiger-like gaze wavered with complex emotions. He was currently mired in a deep swamp of dilemma.
‘To think I’d encounter a young resident like this…’
In his mind, the rumors he had heard about this emergency medicine resident over the past few days clashed with the scene he had personally witnessed earlier dawn. The young resident’s eyes looked sharp. Even in front of a patient whose condition was completely unpredictable, he didn't panic or flee; his eyes saw exactly what needed to be done. His hands, judging by the medical records and the treatment just performed, also seemed exceptional. The sheer audacity and precision required to plunge an 18-gauge needle near the heart. His unflinching hand movement.
The resident’s diagnostic ability was so outstanding that it defied comparison, and his capacity to handle unexpected crises or improvise was superb. On top of that, his reputation within the hospital was stellar. Whether in a good way or a bad way, or by the nickname "crazy bastard," he was someone whose name frequently rolled off the professors' tongues.
Cho Kyeong-woon had to admit it.
‘If only I had met this fellow as a general surgery or thoracic surgery resident…’
If that were the case, Cho Kyeong-woon would have doted on him. No, more than just liking him, he might have done whatever it took to make him his top disciple and pass down everything he knew.
‘If only he were a surgical resident, that is.’
But unfortunately, the audacious young man before him belonged to Emergency Medicine. Cho Kyeong-woon was a doctor who prioritized the patient's life above all else. For that very reason, paradoxically, he was the type of person who loathed the reckless bravado of young doctors more than anyone and actively opposed it.
Holding a blade.
Cutting into a human body, touching organs, and manipulating life at one's fingertips was not a realm one could enter simply because they had good dexterity. It required a deep, vast understanding of pathophysiology underlying it all, along with anatomical expertise regarding each organ. One had to be prepared for the tens of thousands of variables that could arise during surgery. And above all, they needed an understanding of the prognosis and complications that would await the patient after the knife was laid. Without all of this backing it up, wielding a blade wasn't medicine—it was assault.
Cho Kyeong-woon judged that Emergency Medicine, which skims through every department broadly but shallowly, would find it difficult to cover such profound expertise. It wasn't that he dismissed Emergency Medicine as a whole, but he simply didn't like doctors from other fields grabbing a mes when it wasn't their specialty.
‘I thought he was just arrogant.’
He had assumed this fellow was just another bright resident with a promising future who possessed decent hand skills and a quick brain. That was why he needed to be corrected even more, and why he had to be taught the principles.
‘I thought I would show him exactly what a surgeon is.’
Because a blade is far too dangerous a weapon for both the patient and the doctor themselves when held by an unaccomplished physician.
But.
‘That explanation just now…’
Cho Kyeong-woon’s pupils trembled. From the anatomical variations occurring post-surgery to the pressure differences, and even the hemodynamic changes—he understood the causal relationships perfectly, as if a thoracic surgery fellow or a junior staff member had run a simulation in their head.
‘If that's the case…’
This resident had clearly stabbed knowing exactly what would happen. He acted with a complete understanding of what results his needle would bring, why he had to stab, and what was waiting beyond that.
‘Then, is my principle wrong?’
He could hear a crack forming in his ironclad belief, maintained for decades, that only specialists should hold the blade.
‘Is it acceptable to hand a blade to this fellow?’
Cho Kyeong-woon fell into deep thought.
‘No, a surgeon without experience is dangerous.’
…
…
It was then.
“…Chief? Chief?”
“….”
“Section Chief Cho Kyeong-woon?”
At the sound of someone calling him, Cho Kyeong-woon’s consciousness snapped back to reality.
“Oh, what is it?”
As Cho Kyeong-woon looked up with a start, Professor Han Ihyeon was looking down at him with an anxious expression.
“Are you feeling unwell? You suddenly went completely blank.”
“Ah, no. I was just… thinking for a moment.”
Cho Kyeong-woon cleared his throat and adjusted his posture in his seat. Han Ihyeon gave a bright smile and spoke.
“I mentioned earlier that I’m scrubbing in for an emergency OP with Dr. Hong Seonho. I plan to bring along Dr. Han Hyeonjae, who is out here on rotation, to let him observe. I apologize for leaving early.”
“Ah, uh, right. You should. Go ahead.”
“Yes, sir. We will take our leave first, then.”
…
…
With that, we stepped out of the 7th-floor Thoracic Surgery doctor's office meeting room and walked down the long hallway. Professor Han Ihyeon led the way. Following behind him was the 4th-year Head of Doctor's Office, Hong Seonho. And bringing up the rear, warily reading the room, was me.
It was when we stood in front of the elevator hall. Professor Han Ihyeon glanced back slightly and spoke.
“Alright, Seonho, keep quiet for a second.”
“Yes?”
Hong Seonho blinked with a look that said he didn't know what was going on.
“It’s nothing major, I just want to ask Dr. Han something. It won't be any fun if you answer.”
“Ah… yes, sir. Understood.”
Hong Seonho shut his mouth and stepped back.
‘I have a bad feeling about this.’
A chill ran down my spine. What is this gentleman trying to ask now? He was clearly thrilled about me getting the cardiac tamponade pathophysiology right in the meeting room earlier and was fully intent on putting me to the test. Instantly reacting on instinct, I flicked my right hand and popped the blue window open.
Ding—
The elevator doors opened, and we stepped inside. During the brief time it took to descend to the 4th-floor operating room, the high-pressure interview inside the enclosed space started.
“Alright, so this patient is a re-do OP (*reoperation) case who had surgery yesterday and blew today. How should we approach it?”
Professor Han Ihyeon tossed the question out casually while looking at the floor indicator.
Air had filled the pericardium, and a pericardial window needed to be made. The most standard way to approach the heart is to split the bone right down the center of the chest.
“Ah, obviously a median sternotomy—”
The moment I was about to say it, I caught the extremely subtle twitch of Professor Han Ihyeon’s brow.
‘Look at his face.’
That was the expression for ‘wrong answer.’ It was a trap. This patient had lung surgery yesterday. If so, they would have opened the side of the chest to remove the right lower lobe. If the cause was an air leak from the lung, was there any need to go and cut the perfectly fine front chest bone again?
“….is not what we should do!”
I hastily twisted the end of my sentence. At that, the corners of Professor Han Ihyeon’s mouth tugged upward slightly. Satisfied. Wow, how transparent. I can see right through him.
Deliberately pretending to contemplate, I pressed my fingers between my brows to buy time.
“Hmm, let me think about this carefully.”
My gaze quickly swept across the Gallery window floating in the void.
Korean Slave 1: Kind ghosts, tell him the reoperation approach.
Thoracic Surgery Fossil: Didn't they slash his side yesterday? Shouldn't they go in through there?
Mes of the God: Posterolateral thoracotomy. You have to go in a way that gives good access to the lung.
Okay.
“I think we should reuse the right posterolateral thoracotomy.”
“Reuse?”
Professor Han Ihyeon asked back. He seemed to like the choice of words.
“Yes. I mean the incision site used during the primary surgery. Reopening the area that was opened yesterday for the right lower lobectomy will be less burdensome for the patient, and it will also make it easier to check the lung surface where the air leak is occurring.”
“Right, right. That makes sense.”
Professor Han Ihyeon nodded, looking pleased. Standing beside him, Hong Seonho also stared at me with an expression that said, ‘Not bad.’
However, the questions didn't end there.
“Then, just one more.”
Professor Han Ihyeon stared intently at me.
“What do you think the success of this surgery depends on?”
“….”
For a moment, I was at a loss for words.
‘What do you mean, what does it depend on?’
It depends on your hand skills, you gentleman. Isn't it entirely about how well the lead surgeon sutures and how well he finds the leak? But I couldn't exactly say, “Your fingers, sir, your fingers,” in front of a professor. Swallowing those words down, I gathered my mental focus once more and pulled up the window in the void.
“I suppose it would be the hands of the lead surgeon… but in terms of the technical aspects…”
I checked the window out of the corner of my eye.
Korean Slave 1: Kind ghost, catch the killer point for him.
Mes of the God: You have to look for blood vessel damage. If it blew while dissecting adhesions yesterday, the pulmonary vein side might be tattered. If it is, you need to apply a technique like SCAT to secure the vessel first.
Bone Nerd 88: You thoracic surgery bastards really suffer like crazy, lol.
Pediatric Ghost: Hit like if you're just watching while sucking your fingers, lol.
Thoracic Surgery Fossil: I think we need to focus heavily around the interlobar fissure. If the RLL was cut out, the air leaks from the space between them more often than not. Checking the staple line is a must.
I rapidly combined those pieces of information in my brain and forged them into my own sentences.
“First of all, I think the immediate priority will be finding any microscopic blood vessel damage that might have occurred during the dissection of adhesions from a surgery 15 years ago. In particular, we'll need to check for bleeding or damage near the inferior pulmonary vein.”
Professor Han Ihyeon’s eyes widened slightly.
“And while finding the air leak point is the key, I think we should focus our search around the interlobar fissure or the staple line near the resected area.”
When my answer finished, a brief silence flowed inside the elevator. Professor Han Ihyeon crossed his arms and scanned me from head to toe.
“Hmm, I see.”
Ding—
With a cheerful chime, the doors opened.
[4th floor.]
Inhaling the overwhelming smell of disinfectant, we stepped into the operating room hallway.
[Main Surgical Center]
Beep.
[The door is opening.]
…
…
In front of the scrub station.
Professor Han Ihyeon and Hong Seonho familiarly grabbed brushes and began scrubbing their hands vigorously. I also turned on the water at the adjacent sink and picked up a brush. However, my hand movements were noticeably slower compared to theirs.
Finishing his hand wash, Professor Han Ihyeon shook off the water and looked at me.
“Dr. Han Hyeonjae?”
“Ah… yes, Professor!”
“Your hand washing… is quite slow. Being meticulous is good, but we're in a bit of a hurry.”
“…I'm sorry.”
“No, it's fine. It's good that you're cautious. Come on in.”
With that, we walked into Operating Room 5.
Drrrk.
Inside the operating room, the setup was already complete. The anesthesia professor and nurses were moving busily, and the patient was already anesthetized and covered in drapes.
Professor Han Ihyeon gestured while donning his sterile gown.
“Observe from over there.”
The place he pointed to was a spot right next to the patient’s chest, offering a clear view straight into the surgical field.
“Yes, sir.”
Hong Seonho tilted his head, practically wearing a question mark.
“Professor. But that spot isn't an observation spot; it's a spot where a third assist would normally st—”
Conventionally, a resident from another department out on rotation would watch from atop a stepping stool way in the back or from a corner near anesthesia.
“Uh-huh.”
Professor Han Ihyeon cut Hong Seonho off cleanly.
“Just let him stand there. He can see well.”
“Ah… yes, sir.”
Hong Seonho still looked puzzled, but he didn't argue further. I stood right near the operating table, feeling a bit awkward.
Right then, the man who had been sitting behind the anesthesia monitor stood up. It was Professor Son Myeong-jin from the Department of Anesthesiology and Pain Medicine.
“We will do a timeout.”
All the noise in the operating room ceased. The nurses, lead surgeon, assistants, and anesthesia team all stopped what they were doing and looked toward Professor Son.
“Patient Hae-woon Jeong, chart number 29371134. Male, age 54.”
Professor Son Myeong-jin’s dry voice filled the operating room.
“Procedure name: Exploratory thoracotomy and pericardial window formation. Surgical site is the right chest. Antibiotic administration complete, and imaging data has been verified.”
He looked across the monitor at Professor Han Ihyeon.
“Lead surgeon is Han Ihyeon from Thoracic Surgery, correct?”
Professor Han Ihyeon answered clearly through his mask.
“Correct.”
“Yes. Patient's vitals are stable, setup is ready.”
Timeout concluded.
Professor Han Ihyeon verified that the sterile drapes covered the existing incision site on the patient's right side, and then extended his right hand.
“I will start the surgery.”
His hand stopped right in midair.
“Blade.”