Chapter 180
Rain kept falling.
The sound of rain beating against the windows echoed through the medical center director's office, and the chief of endocrinology, Shin Young-jun, who had been called in early that morning, opened the door and stepped inside with a sullen expression.
In his hands was a thick envelope of papers.
“Why did you call me in so urgently this morning, Director? Is something urgent….”
“Ah, Professor Shin, you’re here?”
Lee Jae-yoon, who had been reading a newspaper on the sofa, took off his glasses and greeted Shin Young-jun warmly.
With an odd look of anticipation in his eyes.
“Come in. Want a cup of tea?”
“It’s fine. Here, this is what you asked me to bring, Director.”
Shin Young-jun dropped the envelope onto the table.
“As I said, I wrung the fellows in each internal medicine subspecialty dry and had them come up with problems, but… the kids were crying bloody murder. Just what sort of difficulty were you after, that you keep telling us to make them harder than before?”
Shin Young-jun clicked his tongue.
“Well, as you can see, this was compiled not only from endocrinology but also from gastroenterology, pulmonology, cardiology, nephrology, and the rest, gathered from each department’s professors. Quality is guaranteed.”
“You’ve worked hard. Let’s see.”
Lee Jae-yoon opened the envelope and took out its contents.
Flap.
Rustle-rustle.
Cases written in dense detail, complex lab values, and questions demanding tricky differential diagnoses.
They were high-level questions that didn’t just ask for simple differential knowledge, but could only be solved with clinical judgment and experience.
“Excellent. Is this because our internal medicine department is so strong?”
“Don’t try to brush it off with praise.”
Shin Young-jun asked with suspicious eyes.
“What exactly are you planning to use all these questions for? I told everyone the pretext was that they’d be used for education at the university, that they were needed for an advanced course… but to me, these aren’t at the level of medical students.”
“I said they’re for education. Why are you like this, Professor Shin? Hoho.”
Lee Jae-yoon replied with a gentle smile.
“It’s just that the target isn’t students.”
“Then who is it? Is this some kind of new professor hiring exam?”
“Test.”
Lee Jae-yoon spat out the word briefly.
“A test, you say?”
“Yes, tes…”
Creak—
Then, as the heavy wooden door opened, new visitors entered and bowed.
“Director, you called for us?”
It was Hwang Seong-jin, the chief of neurology.
Behind him followed Park Seung-woo, an associate professor of neurosurgery with a sharp expression.
“Ah, yes, yes. Come in, come in. Sit, sit.”
Lee Jae-yoon gestured.
The two gave Shin Young-jun a light nod and sat down.
They too were carrying thick binders.
“These are the cases you requested on neurological examinations, differential diagnosis of neurologic disease, indications for emergency craniotomy, and other neurological emergencies.”
Professor Park Seung-woo handed over the file and added,
“To be honest, I don’t know how many students at our university would be able to solve this.”
“You worked hard. This is very good.”
Bang.
At that moment, the door burst open without even a knock.
A sturdy man who looked as if he’d just finished an urgent surgery came in, wearing only a lab coat over his scrubs.
He was Choo Myeong-seon, an orthopedic surgery assistant professor.
“Director! I’m sorry I’m late! A fracture patient suddenly…”
“It’s fine, it’s fine. Welcome, Professor Choo.”
“Where’s my seat… Ah, I’ll sit here.”
Choo Myeong-seon wiped the sweat from his face and took a spot at the edge of the sofa.
He, too, took out a crumpled bundle of papers from inside his coat and set it on the table.
“I focused on multi-trauma and pelvic fractures. I filled it only with field-style questions.”
It seemed things were more or less organized now.
Internal medicine, neurology, neurosurgery, orthopedics.
The heads of the hospital’s busiest and most important departments had gathered in the medical center director’s office.
It looked like a multidisciplinary conference, but the atmosphere was quite different.
“Director, but why are the professors here….”
Choo Myeong-seon looked around and asked in confusion.
Internal medicine, neurology, and surgery all gathered in one place to make exam questions?
It had never happened before.
Lee Jae-yoon slowly looked over them.
“You’ve all finished the complex cases I asked for, right?”
“Yes…”
“We did bring them, but.”
Everyone took out several bundles of papers.
The stack of documents on the table became quite high.
“What exactly is the purpose of this…”
Hwang Seong-jin adjusted his glasses and asked seriously.
“At first, I thought this was a resident selection exam. But judging by the difficulty, that’s not it. Are you perhaps holding some kind of quiz competition?”
Everyone’s gaze turned to Lee Jae-yoon.
Why exactly had he made these busy professors create such high-level questions?
Lee Jae-yoon tapped the pile of problem sheets with his hand.
“They’re question sheets for a test.”
“A test?”
“What kind of test is it? Are you maybe selecting professors this time….”
Endocrinology chief Shin Young-jun asked.
“Hoho. I think it would be more accurate to call it a very special test than that.”
Lee Jae-yoon shook his head and smiled.
“We can think of it as a test for just one person.”
“……Pardon?”
The professors’ mouths dropped open.
Just one person?
They had put together internal medicine, surgery, and neurology chiefs to make questions just to evaluate one person?
Who was it?
A presidential doctor?
Or the next hospital director candidate?
“Th-that person, who is it?”
Neurosurgery’s Park Seung-woo asked, dumbfounded.
“A fellow? Or a professor from another hospital?”
Instead of answering, Lee Jae-yoon checked his watch.
It was exactly the agreed-upon time.
Tap.
Tap.
Tap.
At the sound of knocking, a deep smile spread across Lee Jae-yoon’s lips.
“Looks like the person in question has just arrived.”
Rising from his seat, he said toward the door,
“Tell them to come in.”
The professors’ eyes all turned to the door at once.
Just what sort of big shot was it, that the medical center director himself had set the stage and waited?
The doorknob turned, and the heavy door slowly opened.
Creak—
In that moment, everyone held their breath.
Through the gap in the door, an unexpected person appeared.
Neat scrubs.
A cleanly pressed lab coat.
“Good afternoon.”
Han Hyeonjae stood there with a calm expression.
At Han Hyeonjae’s appearance, the professors gathered there shook as if an earthquake had struck.
‘…A resident?’
…
‘Fuck. What the hell is this?’
The moment I stepped into the medical center director’s office, I sensed the biggest crisis of my life: “big-time screwed.”
I had clearly been told it was a meeting with the director.
So I expected a friendly little gathering where we’d have tea and exchange some warm words.
But what was this murderous lineup?
Those people filling the sofa.
One department chief, another department chief.
One associate professor, one assistant professor.
Every single one of them was the kind of professor whose name alone could make trainees piss themselves.
Why the hell are all the professors in here?
‘Okay, poker face. Don’t get scared.’
I swallowed dryly and forced up the corners of my mouth.
I put on the sort of expression a resident should have—alert, but not stupid or cocky—and bowed.
“Good afternoon. I’m Han Hyeonjae, a resident in emergency medicine.”
“Sit here.”
Director Lee Jae-yoon pointed to the seat across from him.
“Ah, yes. Excuse me.”
I sat down with only half my weight on the seat.
I could feel the professors’ gazes piercing the side of my head.
‘What’s this punk doing, getting called in directly by the director?’
‘We’re busy as hell, and we got dragged here because of him?’
That kind of look.
Lee Jae-yoon gathered the thick stack of papers on the table and pushed them toward me.
Then he looked around at the professors seated nearby and asked,
“Everyone here doesn’t have morning outpatient clinics or surgeries scheduled today, correct?”
The professors replied with reluctant expressions.
“Ah, yes. We’ve finished all rounds.”
“That’s true, but.”
“Yes, Director.”
“We do not have any, but if an emergency call comes in, we have to go out. Especially….”
As Professor Choo Myeong-seon shifted uncomfortably and shot him a look, Lee Jae-yoon smiled kindly and waved him off.
“It’s fine, it’s fine. Of course you should go immediately if an emergency call comes in. The patient comes first. But until a call comes in, let’s just be this guy’s audience for a little while.”
Audience?
The director calmed the professors and then looked back at me.
“I called you, Han, because I wanted to put you through a test.”
“A test, sir?”
“That’s right. A tes…”
“Director, I think this is a bit much.”
Neurology chief Hwang Seong-jin, unable to hold it in any longer, cut in.
“If you want to evaluate a resident’s competence, you can leave that to the training department. Bringing all the department chiefs together to create a scene like this is too harsh on Mr. Han, and our time as well….”
So true…
Professor, you’re right.
Please let me go home.
Chief Hwang, fighting!
But Lee Jae-yoon was firm.
He raised a finger and cut off Hwang Seong-jin’s words.
“This is not an evaluation from the training department. There’s something I personally want to confirm. And harsh? This is an opportunity.”
Lee Jae-yoon pointed at the question sheets.
“You have all day. You can take your time. The professors here will grade them, so solve them at your leisure.”
At your leisure?
You want me to solve this comfortably with four grim reapers sitting here?
I looked down at the stack of papers in front of me.
“Ah… then would it be all right if I took a quick look at the questions?”
“Go ahead.”
I turned the first page with trembling hands.
Rustle. Rustle-rustle.
With every page I turned, it felt like my eyes were shaking with the force of a magnitude 7.0 earthquake.
[Q1. 56-year-old male, brought in with sudden loss of consciousness. Initial blood test shows Na 115…]
[…Describe the expected complications and the preventive measures for them.]
[…Patient with rib fractures and pelvic fracture. In a hemodynamically unstable state, discuss whether to apply REBOA and determine the timing of orthopedic DCS (* damage control surgery)…]
[…In a patient who developed intracerebral hemorrhage after tPA administration. Write the criteria for neurosurgical intervention and the medication adjustment protocol.]
‘…Fuck. They’re all essay questions?!’
There isn’t a single multiple-choice question.
They’re all “describe,” “discuss,” “write.”
Some of them even seemed to go beyond the level of emergency medicine.
‘You want me to solve this right here, right now?’
Is this some silent pressure telling me to know my place?
Did I get too cocky?
I glanced up at Lee Jae-yoon.
He was leisurely sipping tea.
I didn’t know what they wanted from me, but one thing was certain.
My life motto of just coasting in the middle had long since been sunk in the waters off Geoje.
‘Prove it.’
Right.
‘You said you’d stay at the university, Han Hyeonjae.’
Not the local hospital—the university.
The goal of staying at the university is to become a professor.
Right, then let’s solve this.
I took a deep breath.
And turned to the screen floating in the air.
[Dead Medic Gallery]
And so I picked up my pen.
…
Scratch-scratch.
The first question.
[…mixed with diabetic ketoacidosis…]
I stared blankly into space.
The professors probably thought I was deep in thought, but in fact I was reading the screen.
Rheumatism Granny: If you run the DKA protocol, the patient’ll end up dead from cerebral edema. The sodium correction rate is the key, child.
ㄴ Hell-Joseon Slave 1: Grandma, how should I write this? Calculate the effective osmolality first and then normal saline?
ㄴ Rheumatism Granny: For this one, you calculate the effective osmolality first, and fluids must come before insulin. The point at which you use 0.45% saline here is… hoho, they wrote this question in a very sly way.
I copied down the grandmother’s advice exactly as it was.
Even the numbers were perfect.
…
God of the Scalpel: They’re even throwing in a dissection?
ㄴ Hell-Joseon Slave 1: This blood pressure is seriously a pain in the ass, what do we do?
ㄴ God of the Scalpel: Is there a hybrid OR? If there is, put in an ICP monitor, set the lower blood pressure limit while maintaining CPP at 60… the brain involvement is unclear. Shouldn’t we use heparin?
ㄴ Skull-Opener: If we have to use heparin, do we crack the skull open first and go into a thoracotomy?
ㄴ God of the Scalpel: That would be better.
…
Back in my day: In this case, the ventilator settings should follow the ARDSnet protocol. Lower the tidal volume to 6 cc/kg and raise the PEEP, but the important thing here is to keep plateau pressure at 30 or below.
ㄴ Hell-Joseon Slave 1: TL;DR, please.
ㄴ Back in my day: You little shit (grabbing the back of his neck)
‘Sorry, I just tried to make a joke.’
…
Anon(39.7): Of course, neurologically this case suggests a brainstem lesion. You can tell just from the exam and the weakness pattern. This is a case where you absolutely must not use anticoagulants before the MRI.
ㄴ Hell-Joseon Slave 1: (photo) What about this question?
ㄴ Anon(39.7): You know it, don’t you?
ㄴ Hell-Joseon Slave 1: Differentiate anti-NMDA receptor encephalitis?
ㄴ Anon(39.7): That’s right~
…
Hell-Joseon Slave 1: (photo) Wouldn’t it be polite to send this patient somewhere?
ㄴ Back in my day: Send him where, you punk.
ㄴ Back in my day: Ignore the central venous pressure and, watching the echo, give 200 cc boluses at a time. Start vasopressin before norepi. As soon as the blood pressure goes over 80, start CRRT at the lowest pump speed.
…
Scratch.
Scratch.
Scratch.
My hand did not stop.
The knowledge of the ghosts was vast, and their advice was useful.
Both the textbook-obvious answers and the answers forged from decades of clinical experience poured out from the tip of my pen.
At first, the professors who had been sitting there with their arms crossed and cocky postures began to change little by little.
Professor Park Seung-woo leaned forward, and Chief Hwang Seong-jin took off his glasses to wipe them.
Chief Shin Young-jun coughed dryly and took a sip of water.
‘He’s not getting stuck?’
Wordless shock began to fill the room.
But I didn’t stop.
The last page.
Orthopedics.
Bone Nerd 88: No Foley, no no no, RGU
(* retrograde urethrography)
Do that first, and the pelvic binder goes at the greater trochanter. Got it?
And so I wrote until the very last letter, then put a period.
Tap.
As I set the pen down, my wrist felt stiff.
My head felt like it was steaming.
But it felt exhilarating.
I lifted my head and said to the professors staring at me blankly,
“I’m done.”
At those words, all the professors turned to look at me at the same time, as if by design.
Director Lee Jae-yoon slowly checked his watch.
“….”
Elapsed time.
1 hour and 39 minutes.