Assassin (5)

...Hm.

It was a little past 4 a.m.

Drip, drip.

Thump, thud-thump.

The sound of the rain outside striking the emergency room windows came through.

I stared blankly at the raindrops streaming down the window.

Suddenly, a bizarre thought flashed through my mind.

'The possession lasted 30 minutes, right?'

I remembered the number written on the shop page.

What if.

Just what if.

If that aortic dissection patient from earlier had been handed to me instead of cardiothoracic surgery?

If all the surgeons had gotten food poisoning, and the only one left to operate was the God of Scalpels….

'Would that guy... have been able to do it?'

Last year, in that sea of blood in the abdomen, he had found the spleen and torn into it in barely ten minutes.

That godlike hand speed.

A speed that seemed to ignore the laws of physics.

Besides, if you looked at his profile, he had double boards in GS and CS.

Meaning he'd even operated on hearts.

I was suddenly seized by pure curiosity.

It was more of a childish question on the level of 'who wins in a fight between a tiger and a lion?' than anything medically meaningful, but to a resident on duty at 4 a.m., it was excellent intellectual amusement.

I quietly opened the forum.

==================

[Dead Doctors Gallery]

@GodofScalpels@GodofScalpels@GodofScalpels

Posted by: HellJoseonSlave1

I need to ask something urgent

==================

It's dawn—did he go to sleep?

No way, there's no way ghosts sleep.

A reply came back in one second.

[Comments]

GodofScalpels : ?

ㄴ HellJoseonSlave1 : Can you do an aortic replacement within 30 minutes?

ㄴ GodofScalpels : Has this bastard gone crazy?

And then, in its wake, the gallery’s surgical ghosts started popping out as if someone had hit the seizure button.

OperatingRoomGhost3 : I hereby appoint you as an honorary internal medicine bastard.

LatteDays : Tsk tsk. Kids these days probably think surgery is some kind of game. Just click and it's over.

ㄴ HellJoseonSlave1 : Just asking in case, ㅇㅇ

ㄴ GodofScalpels : First you split open the center of the chest. Just cutting through that bone takes time. Then you open the pericardium. Let's say you can finish this in 5 minutes.

ㄴ GodofScalpels : To run the heart-lung machine, you need to insert cannulas into the aorta and right atrium. Then you have to stop the heart. That alone takes 10 minutes.

ㄴ GodofScalpels : Then you have 15 minutes left, right? In those 15 minutes, you have to cut out the torn aorta, size the artificial graft, and sew it up with that thin thread?

Hmm, now that I think about it, that's a pretty reasonable point.

ㄴ GodofScalpels : Let's say you did all that. Then what about restarting the heart, detaching the machine, stopping the bleeding, and closing the chest? Do your ancestors come down and do that for you? 30 minutes??? 30 minutes??? Thiiiiiirty minutes???

ㄴ OperatingRoomGhost3 : LMAOㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋㅋ Thiiiiiirty minutes ㅋㅋㅋㅋㅋㅋㅋㅋ

ㄴ OldTimerCardiothoracicSurgeon : The world record is probably around two hours? In 30 minutes, you'd barely have time to open the patient's chest, say "Nope, can't do this," and close up again.

ㄴ ㅇㅇ (210.94) : Are you thinking replacing an aorta is like stitching up a split forehead in the ER or what?

No, I really was.

That bastard's hands are on a crazy level, so I was genuinely, genuinely, seriously curious.

I know full well that it can't be done.

On top of that, he's double-boarded in GS and CS.

Supposedly a genius among geniuses.

I thought he'd say yes, since he was the kind of guy who could put in a REBOA blindfolded.

'Still, impossible is impossible.'

No matter how fast your hands are, there are procedures and physical limits.

Damage control—opening the abdomen and stuffing in gauze—and reconstructive surgery, where you carefully reconnect vessels, are problems on completely different levels of difficulty and time.

I closed the gallery window and clicked my tongue.

'Hmm, today's lesson.'

Conclusion.

Possession isn't all-powerful.

No matter how genius the ghost possessing your body is, the 30-minute time limit is absolute.

If you can't finish a surgery within 30 minutes, don't even try it in the first place.

The moment the possession wears off, all that'll be left is a patient with their chest wide open and heart stopped, and a second-year screw-up with a scalpel in his hand.

Just imagining it is a horrendous horror movie.

'...Right. Unless someday I end up in thoracic surgery sewing up an aorta.'

Not a chance.

I shook my head.

A second-year emergency medicine resident is already dying from this, and thoracic surgery?

I'd rather bite my tongue off and die.

I looked back outside.

The rain was still pouring down hard.

Up in the OR, Dr. Kang Minseong and the professor were probably still racing against time, working through that complicated process one step at a time.

A long battle of five or six hours, one you couldn't even hope to finish in 30 minutes.

"Please, hang in there…."

I raised my cup of instant coffee and toasted the air.

Know your place.

I'm just the gatekeeper guarding the ER.

***

Tap. Tap-tap.

I was forcing my heavy eyelids open and finishing the last line of the chart. The rain was still falling, and the ER air was damp.

Ugh, I hate this air.

Then I suddenly remembered one thing.

"Ah, right."

I turned and called to Baek Eun-seo, who seemed half asleep beside me while still glaring at the monitor.

"Eun-seo."

"Yes, doctor?"

Baek Eun-seo straightened up reflexively and answered.

"That dissection patient from earlier. The one who got 20 mg of labetalol."

"Yes, doctor. It went in."

"When did you order that? I was too busy talking on the phone while looking at the ultrasound, so I missed the timing."

In all that chaos, the order had already gone in before the professor even shouted for a beta-blocker.

Baek Eun-seo answered as if it were nothing.

"Ah, well... as soon as the professor saw the echo and said there was a flap, I ordered it right away."

"...."

"I felt weird doing it on my own, so after placing the order, I got confirmation from the CS on-duty resident on the way to CT. The blood pressure wasn't dropping below the 150s...."

'...Huh.'

I let out a dry chuckle.

Situational awareness.

Timing.

And the sense to get confirmation from another department resident so a first-year wouldn't get chewed out for using a drug on his own.

No, wait. Maybe "sense" isn't the right word?

Anyway.

'...He's pretty damn sharp.'

This wasn't just mildly sharp.

If a first-year in spring is this sharp, this kid's prospects are golden.

I felt a strange sense of crisis.

'My position is under threat.'

At this rate, give it another year and he'll be coming at me with, "Dr. Han Hyeonjae, I think that's the wrong call."

If I want to keep my role-model authority, I guess I need to work even harder.

"Good job. Nice instinct."

"Thank you."

Baek Eun-seo smiled bashfully at my praise.

Then he pulled his chair in and asked a question.

"But, doctor."

"Yeah?"

"How did you know that for real?"

"Know what."

"The aortic dissection."

Baek Eun-seo's voice rose slightly.

It was a tone mixed half and half with resentment and admiration.

"I mean, no matter how you look at it, it only looked like PE. Honestly, not just me—anyone would have thought it was PE."

Baek Eun-seo began passionately counting off points on his fingers, looking frustrated.

"Think about it, doctor. The patient had been on a plane. That's a textbook risk factor for DVT

(* deep vein thrombosis)

—right?"

"Right."

"And the symptoms were dyspnea

(* shortness of breath)

and chest discomfort

(* chest discomfort)

and the vitals showed tachycardia

(* rapid heartbeat)

and tachypnea

(* rapid breathing)

So up to there, everything fit.

Baek Eun-seo pointed at the EKG of that earlier patient displayed on the monitor, looking deeply aggrieved.

"But the EKG was dead obvious! The exact pattern we all memorized as PE showed up right there! On top of that, when we looked at the echo, the right ventricle was enlarged, and even the septum looked a little shifted...."

Not a single thing in Baek Eun-seo's words was wrong.

From a medical algorithm standpoint, Baek Eun-seo's judgment was correct.

"Every clue was shouting, 'I'm a pulmonary embolism!' and then you suddenly said no. When you told me to get a CTA, I seriously thought you'd lost your mind, doctor. But then it really was torn open after the scan... wow...."

Baek Eun-seo shook his head.

"What exactly did you see, really...."

I took a sip of coffee and paused for effect.

Should I tell the truth?

That I knew because the heart ghost in my head kept yelling, 'Isn't it Marfan?'

If I did, psychiatry would probably be consulted on the spot.

I set down the paper cup and put on an arrogant, profound expression.

"Because I saw something that didn't fit."

"Something that didn't fit?"

"Yeah. You saw it too. The patient's fingers."

"His fingers?"

"The fingers were long like spider legs. The patient was tall and thin too. A textbook Marfan syndrome build. And he had uncontrolled hypertension. He also wasn't taking his medication regularly."

Baek Eun-seo's eyes sparkled.

You're making this hard on me, kid.

"And, most importantly, a maternal family history. That meant there was a genetic predisposition. On top of that, leg swelling that had been going on for two or three months doesn't fit acute DVT. It's chronic."

Baek Eun-seo's jaw dropped.

"I heard about the leg swelling and just figured there must be a DVT causing the leg to swell, so I brushed it off. I didn't think about the duration."

"History-taking is important."

I dropped a line worthy of a second-year senior resident.

Of course, I'd gotten help from the gallery.

If I hadn't asked, I might have just followed the PE protocol and started heparin.

But.

I looked down at my hands.

It was me who had closely examined the patient's fingers.

It was me who had probed the family history in detail.

It was me who felt that subtle mismatch and asked the ghosts about it.

And most importantly, it was me who, after hearing the ghosts' advice, decided to get a CTA and actually carried it out.

'In the end, I was the one who did the doubting.'

The ghosts only provide knowledge and direction; in the end, the one making the call on the scene is me, the living doctor.

If I had been thinking about nothing, no matter how much the ghosts blabbered, I wouldn't have heard a thing.

'Guess after getting beaten down for over a year, my eye for detail leveled up too.'

I snorted.

The suffering paid off.

I feel like I'm actually doing a decent job as a doctor.

Baek Eun-seo solemnly nodded while jotting down my words in his notebook.

This kid's going places.

He might become a monster, really.

"Yeah. Sunrise is almost here. Let's hold out a little longer."

"Yes, sir!"

The sky outside was brightening.

The stormy night had passed.

The patient was sent up to the OR, and we had survived another day.

And so the dawn in the emergency room passed.