Lesson

As soon as the conference ended, I headed to the ER.

I spent the time handling one minor patient after another.

There was a college student who'd tripped while drunk and scraped his knee, another gentleman who'd been scratched by a cat and came in for a tetanus shot, and then...

Today's first nuisance showed up.

A perfectly healthy-looking middle-aged man wore a grave expression and claimed that since his back had started hurting a little last night, he'd searched Google and found that every symptom matched terminal pancreatic cancer.

"As far as I know, pancreatic cancer’s five-year survival rate is under ten percent, right? Am I going to die now? Please give me a CT, an MRI, and that... what's it called, some P-whatever CT too. And a cancer marker test as well."

I pressed my temples hard.

This isn't some middle-aged guy's health checkup center.

The demon inside me roared, but I kept a gentle smile on my face.

"Sir, let's start with a basic blood test and an X-ray first, then I'll talk to you. The most common cause of back pain is muscle pain."

"No, doctor! You don't believe me? Do you know how much I searched online!"

In the end, after thirty minutes of back-and-forth, the man only got up reluctantly after I showed him that his bloodwork came back normal.

As he left, I could clearly hear him muttering, "These doctors aren't any good. I’ll have to try another hospital."

I wish the on-call doctor in some other hospital's ER good luck.

***

Lunchtime.

In a corner of the residents' room, I poured hot water into a cup of noodles. Kim Jihoon sat down beside me and let out a deep sigh.

"Hey, it's the first time I've ever seen the chief smile at you. Are you really going to internal medicine?"

"I'm not."

"Liar!"

This bastard wasn't listening to a single word I said.

***

Colds, gastroenteritis, headaches, dizziness.

And the nuisances wedged in between them.

By the time the sky outside turned dark, I stared blankly at the EMR screen for a moment.

The screen was still crammed full of countless patient names.

Damn, I'm exhausted to death.

Where did my day off go?

I had an entire day stolen from me yesterday.

But in return, I survived today's conference.

Was that actually a profitable trade?

I don't know.

Human Up-to-date. The ER's new star. The lunatic preparing for double board certification.

All sorts of fucked-up labels had been plastered in front of my name, but reality didn't change. I was still just a first-year rookie.

"Aaaagh! Doctor! My back! My back feels like it's being torn in half!"

B area, bed 15.

A man who looked to be in his mid-thirties rolled around on the bed, screaming his lungs out.

"Sir, calm down. Where exactly does it hurt, and how?"

"I don't know! Just! My back feels like it's being ripped apart! Aah! I think the disc I hurt before has burst! Please, give me something stronger for the pain...."

The man looked almost ready to grab onto my pant leg and cry.

I pressed on the patient's lower back and legs and performed a neurological exam.

There were no clear findings like muscle weakness or sensory loss.

But the man's expression was far too desperate.

"The thing I used to get... that Pethidine

(*Pethidine, a type of narcotic painkiller)

stuff? Could you give me that? Please? I'm begging you."

I pressed my temples hard.

In the end, I went back to the station and sat down in front of the computer. I opened the man's chart and brought up the order window.

[Pethidine 50mg IV]

My finger hesitated above the Enter key.

Really?

Is it really okay to just give this?

Something felt off. It didn't sit right.

Was it my doctor's instinct, or my survival instinct as a slave?

Screw it, I don't know. Let's ask.

I brought up a blue interface before my eyes.

For something like this, asking a senior felt awkward, so I figured the gallery was perfect.

Title : 30/M severe low back pain. Claims a history of disc disease. Asking for pethidine. Can I just give it?

Author : HellJoseonSlave1

The comment box was quiet.

The internal medicine ghosts seemed uninterested in a pain patient like this, and the other surgical ghosts were the same.

Ah, fuck.

Just give it.

The very moment I was about to move my finger back to the Enter key.

God of the Scalpel : DUR

(*Drug Utilization Review, a medication safety service)

Did you check it?

DUR.

Ah.

Ah, fuck.

I swallowed my curse and hurriedly checked DUR. A new pop-up window filled the screen.

And I couldn't believe my eyes.

[Prescribed drug name : Pethidine injection | Date prescribed : 3 days ago]

[Prescribed drug name : Fentanyl patch | Date prescribed : 4 days ago]

[Prescribed drug name : Oxycodone extended-release tablets | Date prescribed : 1 week ago]

[Prescribed drug name : Targin extended-release tablets | Date prescribed : 8 days ago]

A list of narcotic painkillers that filled the entire screen.

This bastard had been touring hospitals over the past ten days, sweeping up narcotic painkillers everywhere he went.

This is doctor shopping.

I felt the strength drain from my entire body and leaned back against the chair.

What, these people just hand out narcotic painkillers without checking anything...? No, wait, that means that bastard's acting was that good.

Before I knew it, new comments had started appearing under my post.

Anesthesiology/Pain Medicine : Hahahahahahaha, he got caught. Classic junkie tactic. Those bastards go around hospital to hospital memorizing the names of doctors who prescribe them well. If they think they've found a sucker, they become regulars.

Psychiatry Ghost : That's beyond dependence; that's addiction. He needs psychiatry.

Truck-Hit Guy : Wow, that bastard gets fentanyl prescribed by faking an illness. I got my whole body crushed by a truck for real and they gave me Tylenol. What a fucked-up world, seriously.

ㄴ ㅇㅇ(223.39) : For real? You got Tylenol?

ㄴ Anesthesiology/Pain Medicine : Yeah right, that's bullshit lol

Reading the ghosts' stories, I broke out in a cold sweat.

What if I had, hypothetically, not checked DUR and just hit Enter?

I would’ve almost added the name "Han Hyunjae, the gullible doctor" to that junkie's shopping list.

My mind snapped awake. I moved the mouse, closed the DUR window, and tried to delete the order.

"Phew...."

At that very moment.

A huge shadow fell over my back.

"What are you doing?"

I didn't know how long he'd been standing there, but Lee Minjae, the fourth-year emergency medicine chief resident, was standing with his arms crossed and looking down at me. His gaze was fixed on the computer screen where I'd just been about to place the order.

I was screwed.

"Were you about to give him pethidine?"

"This easily? Without even checking DUR, without giving enough thought to the patient's condition—just handing it over that easily because he asked? This is why first-years shouldn't be given authority...."

I couldn't say a word.

No, I checked it, damn it. I asked the gallery, checked DUR, found out he was a junkie, and was just about to delete the order!

The scream in my heart couldn't get past my throat.

In the chief's eyes, I must have looked like a thoughtless first-year rookie who'd been fooled by a junkie's act and was about to prescribe narcotics before getting caught at the last second.

And that was only half true. If it hadn't been for the gallery, I really would have hit Enter.

The chief's scolding was long and brutal.

"The ER isn't a marketplace. We're not a vending machine that hands out whatever drugs the patient asks for. Are you out of your mind?"

"I'm sorry."

"Every order you place has to come with a reason, evidence, and responsibility. If there's even a little doubt, check, then check again, ask a senior, and if you still don't know, look it up in a textbook."

"...."

"Checking DUR takes less than thirty seconds."

After a long storm of nagging, the chief let out a deep sigh and turned away.

"Don't ever repeat what happened today. Got it?"

"Yes. I'll keep it in mind."

Even after the chief's back disappeared from sight, I stood there for a long time as if nailed to the spot.

I felt humiliated and wronged.

But at the same time, another thought began to take shape.

Up until now, I'd been using the gallery like a universal cheat key.

Whenever I got stuck, I'd just post a question. When an answer came back, I'd recite it like a parrot.

In the process, I'd been skipping the most important step as a doctor: thinking for myself.

Doubting, considering, finding evidence, checking.

"Ah. I need to stop living without thinking."

I muttered under my breath in the empty station.

***

After that day, a subtle change came over my ER life.

Of course, it was still as fucked up and exhausting as ever, but I decided I wouldn't rely on the gallery for everything anymore. I was going to trust my own head, my own hands, and my own eyes first.

Of course, the process wasn't smooth.

A child sitting on an ER bed was crying. There was a roughly 2-centimeter laceration across the child's forehead.

I reassured the child's mother, cleaned the wound, and performed local anesthesia with lidocaine.

Then, with a senior watching, I picked up the suture set. My heart was trembling a little.

"It's okay. I practiced all night."

I stitched one stitch at a time, just as the God of the Scalpel had taught me. Slow, but careful.

Unlike before, the thread didn't tangle and my fingers didn't get twisted.

Of course, I was still clumsy. The fourth-year Yoo Seonghun clicked his tongue when he looked at my hands and added a remark.

"Hey, you're tying the knots way too tight. If you do that, it'll leave a bad scar when you take them out later. Tie it so the thread is just barely holding."

"Ah, yes! Understood!"

I adjusted the tension as advised.

And that was how I finished the suturing on my own in fifteen minutes.

Fourth-year Yoo Seonghun patted my shoulder as he passed by and said,

"Still, it's decent enough."

At that offhand remark, I found myself smiling.