Chapter 181
“Have you finished all of them?”
Lee Jae-yoon asked.
“Yes. If there are any parts where the explanation is lacking or the answer is ambiguous, please let me know. I can provide more oral explanation.”
'I don't know, damn it. I don't know either.'
The die had already been cast.
I wrote the visible comments in order, and for some I only filled in the gaps with help from the ghosts based on my own knowledge, so I had no time to verify whether what I wrote was correct or not.
But I have no regrets.
If I back down here, I'm done for.
'If I make a good enough impression, I'll become a professor.'
Anyway, I'd already given up on local practice long ago.
I have no talent for cosmetic procedures whatsoever, and as for the salaried-doctor path, I'd already given that up long ago.
If I want to stay at a university hospital, I need to throw away that half-assed mindset.
I have to make an overwhelming impression, no matter what, to survive.
That's the path I chose.
“Hmm….”
Lee Jae-yoon collected the stack of answer sheets in front of me, then deftly sorted them by department and passed them around.
“Now then, could the professors in each department please grade the sections assigned to them?”
The answer sheets were handed over to the professors.
Lee Jae-yoon brought the remaining two stacks over to his own side.
“I'll handle the thoracic surgery section and the general surgery section.”
At that, Orthopedics Professor Chu Myung-seon asked in surprise.
“General surgery? But Director, you….”
That point seemed reasonable.
Because general surgery questions, especially those about abdominal trauma or multiple injuries, would be hard for thoracic surgery to judge.
“I'll have Trauma Surgery Center Director Kang Hyunjun look at them separately later and do a second round of grading. For now, I'll just do a preliminary check. I know the basics too.”
“Yes. Understood.”
Professor Chu, who had asked the question, soon shut his mouth and picked up a red pen.
The other department heads also picked up their own question papers.
Scratch.
Scratch.
Tap, tap.
Scratch.
Only the sounds of pages turning and pens scratching could be heard.
I rested my hands on my knees and listened to the sounds.
The sound of feedback being written.
The sound of tapping as questions were checked off.
And the sound of circles being drawn.
'Phew….'
So far, I still hadn't heard the telltale sounds of bad grading, like underlines or V marks.
Of course, it could also just mean my hearing had gone numb from the tension.
“Huh….”
Someone let out a dry laugh.
It was Neurology Chief Hwang Seong-jin.
“Seriously.”
This time it was Endocrinology Chief Shin Young-jun.
He shook his head repeatedly.
“Tsk….”
Orthopedics Professor Chu Myung-seon even twirled his pen while alternately looking at my face and the answer sheet.
Shallow sighs and groans burst out here and there.
I couldn't tell whether those were signs of approval or disapproval.
How much time had passed?
After about ten minutes that felt like a year.
“Director, we're done.”
Neurology Chief Hwang Seong-jin was the first to put down his pen.
“Already?”
Lee Jae-yoon looked up.
“Yes. Here you are.”
Swish.
Swish, swish.
The other professors also put down their pens one by one.
“I've finished grading as well.”
“Me too.”
One by one, the answer sheets that had been graded were gathered back into the director's hands.
Lee Jae-yoon started turning through the pages slowly from the first sheet.
He would occasionally pause to read the comments written in red pen, and sometimes a smile would appear at the corners of his mouth.
“Hrm-hmm… hrm, hm….”
Swish.
Rustle.
The sound of pages turning kept coming.
Whenever the director stopped and stared at some part of the paper, my heart would tense up for no reason.
'It's not like everything I wrote is wrong and only the ghosts' sections are right, is it?'
On top of that, a few professors were looking at me with very troubled expressions.
The stares were so suffocating that I forced my gaze to stay fixed on the window.
How much time had passed?
Lee Jae-yoon closed the last page.
Thunk!
“Dr. Han.”
“Yes, Director.”
I swallowed hard.
“There are a few parts where points were deducted for insufficient detail, but… well, that's only to be expected from a resident.”
Gulp.
“This is more surprising than I expected.”
“…Yes.”
Surprising? Was that good? Or bad?
“I don't know whether Dr. Han wrote the answers with a fully academic understanding of every pathophysiology and mechanism involved.”
Lee Jae-yoon tapped the stack of answer sheets with his hand.
“At any rate, these answers themselves….”
The answers themselves?
“They're all correct.”
“…?”
A silence fell instantly.
“?!”
The expressions on all the professors' faces changed to shock.
All correct?
“?!”
And my expression wasn't any different from theirs.
'Why?'
I doubted my ears.
There hadn't even been time for the ghosts to discuss it, and I'd just written down the topmost answer.
I had even filled in the trauma surgery and some other sections with my own knowledge.
Neurosurgery Professor Park Seung-woo cautiously asked while looking at the director.
“Director, could the answers have been leaked in advance? Or perhaps the questions were shown beforehand….”
“How would I possibly tell you the answers in advance? I got the questions from you this morning. Weren't you the ones who brought today's questions in the first place?”
“Then….”
“You just didn't write them in. Do I know neurology? Do I know cerebrovascular medicine? It wasn't even my own answer sheet, so what would there be to leak?”
Lee Jae-yoon shrugged.
It was impossible to refute logically.
The people who set the questions were the professors, and the people grading them were also the professors.
There was no opening for cheating to get in.
“That is true, I suppose….”
Professor Park Seung-woo was still rubbing his chin, looking unconvinced.
“Then, Director, may I ask you a few questions?”
“By all means. I'm curious too.”
Lee Jae-yoon readily gave permission and leaned back in his chair.
'I hate this.'
“Uh… Dr. Han. First of all, good work getting through it. The answer sheets are excellent. Very textbook. But the thing is….”
He pointed at one page of the answer sheet with his finger.
“This one. Question 12.”
“Yes.”
“It was a complex case involving cerebral infarction and a dissection. You wrote that you would first perform a neurosurgical decompressive craniectomy, then proceed with the thoracic surgery.”
“Yes.”
“To operate on the heart, you have to run cardiopulmonary bypass and use heparin. That puts the whole body into an anticoagulated state.”
“Yes.”
“Then blood would surge to the brain, wouldn't it? The intracranial pressure would spike instantly, causing cerebral edema and creating a risk of herniation. You only wrote 'surgery after hemostasis' in your answer, but that's not as easy as it sounds.”
As Park Seung-woo pressed him, Neurology Chief Hwang Seong-jin beside him jumped in.
“Professor Park, aren't you going a bit too deep? Emergency medicine is still a department that handles initial treatment and sets the direction; asking about detailed intraoperative procedures like this is a bit….”
“No. He needs to know. If he's written answers at this level, then I need to check whether he knew the rest as well.”
Park Seung-woo refused to back down.
'Okay, this is it.'
I cheered inwardly and brought up the comment thread in midair.
[Comments]
HellJoseonSlave1 : If you open the skull and use heparin, how do you handle herniation? I feel like they'll ask about closing it too.
ㄴ SkullCracker : If you just cover the skin, the brain expands and gets compressed, right? You need a duraplasty. Using artificial dura to secure space is life or death.
ㄴ ThoracicSurgeryVet : That's important too, but from thoracic surgery's perspective, venous return is even more important. In a case like that, they'd probably use cardiopulmonary bypass…
Okay.
“No, it's fine. Chief Hwang, don't stop him. Keep asking.”
When the director intervened, Hwang Seong-jin had no choice but to close his mouth again.
Park Seung-woo opened his mouth again.
“Ahem. Let's continue. How would you physically close it at that point? You can't put the bone back in, and if the brain is swelling, you can't just force the scalp closed.”
I steadied my breathing and started repeating the ghosts' advice.
“First, I would leave the bone flap out and perform a duraplasty using plenty of artificial dura to make room for the brain to swell. I'd carry out a wide expansion closure, leaving enough room for the brain to expand.”
“Hmm….”
“But the key point, even more important than the surgical technique, is venous return.”
“Venous return?”
“Yes. During cardiopulmonary bypass in heart surgery, if the cannula inserted into the right atrium or superior vena cava even slightly obstructs the outflow of cerebral venous blood, venous pressure in the brain rises and the brain swells rapidly.”
I glanced toward the director and continued.
“So in this case, I'd coordinate with anesthesiology to keep the patient's head elevated at 30 degrees, ask the thoracic surgery team to keep checking the SVC cannula position, and force cerebral venous pressure below 10 mmHg. Drainage has to be smooth to prevent cerebral edema.”
Professor Park Seung-woo's mouth fell slightly open.
I had pointed out the key points of a multidisciplinary surgery that went beyond the scope of a simple neurosurgeon.
A non-surgical specialty, at that.
“Huh….”
Before Park Seung-woo could even recover from his surprise, Lee Jae-yoon cut in.
“The brain aside, then. That was excellent.”
Lee Jae-yoon turned the page.
“But when you do aortic surgery, don't you drop the body temperature all the way to deep hypothermia? Then platelet function is paralyzed and a coagulopathy that makes bleeding hard to stop is inevitable; reducing heparin won't solve that.”
The director's eyes flashed.
“If there's oozing at the surgical site, especially on the brain side of the surgical field, how would you control it? If blood pools in the brain when you rewarm after surgery, it's all for nothing. Cauterizing it with a Bovie has its limits.”
Ah.
I didn't even need to ask the Gallery about this.
I knew this one myself.
It was one of those bits of trivia I'd picked up while studying on my own and shooting the breeze with the Gallery users.
'I remember.'
I answered in a confident voice.
“So I think antifibrinolytics like aprotinin or tranexamic acid should be administered in high doses before the pump is even started.”
“With medication?”
“Yes. And the rewarming period is the most dangerous. Bleeding breaks out when the constricted blood vessels rapidly dilate as the temperature rises. So we'd keep the rewarming rate very slow, at just 0.5 degrees per hour….”
I swallowed hard.
“I think it might be best to have the neurosurgery team perform a second hemostasis through the reopened scalp flap. You know, checking it one more time before closing… r..ri..right?”
After saying it, I wondered if I sounded too cocky, so I trailed off at the end.
“….”
Lee Jae-yoon stared at me with his eyes wide.
And then, a moment later.
“Ha! Hahaha, ha! Come on….”
Lee Jae-yoon threw his head back and burst out laughing.
It was a laugh that sounded triumphant, or perhaps like he was so dumbfounded he couldn't speak.
“Did you hear that, Professor Park? Professor Shin? Did you hear it?”
Lee Jae-yoon pointed at me with a finger while looking around at the other professors.
“He knows this?”
The other professors' expressions were strange as well.
“So… Director. Could the reason we all gathered today be….”
Endocrinology Chief Shin Young-jun asked cautiously.
Then Lee Jae-yoon stopped laughing and returned to a serious expression.
“Ah, right. Just wait a moment.”
Lee Jae-yoon returned to his seat and handed out one envelope each to the five professors, including me.
It was heavy.
A red [Confidential] stamp was printed on the outside of the envelope.
“Here.”
Lee Jae-yoon sat down and clasped his hands together.
“Dr. Han's skill has been verified, and I've confirmed the enthusiasm of the professors here as well.”
He pointed at my envelope.
“Now it's time to talk about the real reason we gathered today. Open it.”