Bomb Drop (4)

Silence lasted for more than ten seconds.

Hundreds of doctors were mulling over, in their own minds, the ten minutes of information I had just poured out and my final provocative suggestion.

At last, Professor Kim Hyeokjae of Oseong Seoul Hospital broke the heavy silence.

“...Heh. Yes. I listened to your very... impressive presentation, Dr. Han Hyeonjae.”

Professor Kim's voice carried a complex emotion, and it was hard to tell whether it was admiration or bewilderment.

“Then, we'll begin the Q&A session now. If anyone has a question...”

Before the chair could even finish speaking, the resident who had snapped at me earlier raised his hand again.

He grabbed the microphone almost as if snatching it away.

“Thank you for the presentation.”

The resident's voice was much sharper and more aggressive than before.

“So your conclusion, Dr. Han Hyeonjae, is that nonsurgical fields like emergency medicine should actively promote surgery? Are you arguing that starting tomorrow, every emergency medicine doctor should pick up a scalpel?”

'Here we go?'

“No.”

He hesitated for a moment at my firm denial.

“What I'm trying to say is not that everyone should do it, but that systematic training for such last-resort situations and clear interdisciplinary discussion with surgery are necessary.”

“What exactly do you mean by that last-resort situation?”

He latched onto my words without letting go.

“What's the standard for that? If a trauma patient comes in and you botch damage control in an emergency room that isn't capable of handling it, do you know what could happen? That's not saving the patient; it's killing them.”

A murmur of agreement rose from all over the lecture hall.

But I wasn't flustered.

Because this was also a question I had perfectly anticipated.

“I deeply agree with your point, Doctor.”

I bowed my head first.

“First of all, if the hospital doesn't have the capacity to accept trauma patients, it should refuse admission.”

The murmuring died down a little.

“Or if a patient who has already arrived is judged to clearly exceed the hospital's capabilities, I believe the right thing is to attempt immediate stabilization while rapidly transferring them to a higher-level hospital—or another hospital—where definitive surgical treatment is possible.”

I took a brief breath.

“The last-resort situation I'm referring to is,”

I pointed at the screen.

“As you saw earlier, it refers to patients who walk in without prior contact with EMS and don't even have time to be transported...”

I pointed once again at the cover of the Japanese paper.

“It also refers to cases like the Japanese report, where geographical limitations leave no immediate backup options whatsoever. In the case of Sado Hospital in Japan at the time, even attempting helicopter transport to the nearest university hospital or main hospital would have made the patient's death all but certain.”

I adjusted my grip on the microphone.

“My presentation is not about a situation where there is no doctor who can do it, but about the moment when the doctor who must do it is not there.”

Breaking that brief silence, this time a hand went up from the middle rows over there.

“Thank you for the presentation. Could you go into a little more detail about the patient's ICU prognosis?”

Hm, why is he asking that.

This isn't even an intensive care medicine society.

The question was sharp.

“If such a major procedure was performed in the ER, I’d imagine the patient would have had a course that was clearly different from ordinary trauma patients in the TICU(* trauma intensive care unit), in terms of abdominal compartment syndrome, rebleeding, infection control, and so on. I'm curious about the data on that.”

I clicked my tongue inwardly.

But at the same time, I let out a sigh of relief.

'I'll answer first. This much isn't hard.'

“Thank you for the good question. The patient was transferred to the trauma ICU immediately after surgery, and we continuously monitored intra-abdominal pressure using intravesical pressure measurements for the first 24 hours.”

My tone sounded good too.

“As you said, the risk of ACS was high, so we intentionally maintained an Open Abdomen state with delayed abdominal closure for 24 hours while preparing a second-look operation. Fortunately, intra-abdominal pressure did not show any significant rise, and we successfully completed the second-look operation and final abdominal closure 48 hours after surgery. Without signs of infection, the total ICU stay was 14 days, and...”

While I recited my prepared answer like a parrot, the lecture hall was once again filled with murmurs.

'He really prepared a lot. He even knows the ICU records inside out.'

'Is that guy really EM?'

I finished my answer, deliberately ignoring the murmurs.

The doctor who had asked the question gave a slight nod with a satisfied expression.

'Phew. Got past it.'

I let out a sigh of relief and glanced toward Professor Cheon Eunjeong, who was standing at the very back of the audience near the entrance.

And I saw Professor Cheon in the distance staring at me with an expression of disbelief.

Through every gesture and expression, I could feel Professor Cheon's soul screaming at me.

'Hyeonjae! It was supposed to be a simple case presentation! Since when did I tell you to give that heretical presentation about the scope of emergency medicine treatment?! Tone it down and come down here! Can't you see the professors' faces?!'

Or at least, that's what it looked like she was saying.

'Hm.'

I hesitated for a moment.

Right, let's think of it positively.

'She's probably cheering me on, however low the probability may be.'

Professor Cheon must be shouting with her whole body right now, 'Go, Han Hyeonjae! Flatten the noses of those arrogant Seoul bastards! You're our hospital's pride!'

With that unwavering faith, I clenched my fist toward Professor Cheon.

And I gave a very short, powerful nod.

'Fighting!'

Professor Cheon grabbed the back of her neck.

Professor Cheon's body seemed to sway, but that was clearly because she had been moved by my support.

'Heh heh.'

I turned back toward the audience.

“Dr. Han. That was a truly moving lecture on philosophy.”

'Philosophy, huh.'

“However, your argument right now is based on a single case. No, if we include the Japanese paper from earlier, that would make two cases.”

He let out a sneer.

“Are you saying you want to expand the entire department's scope based on simple case reports like these? This isn't an academic presentation; isn't this just incitement?”

That was a fact.

The attack that there wasn't enough data.

It was a fundamental attack stronger than any logic I had prepared.

All the gazes in the lecture hall turned back to me.

Back there, I could see Professor Cheon frantically waving her hands as if to say, 'Please surrender!'

I adjusted my grip on the microphone.

What would the God of Scalpels have said in a situation like this?

'Who cares? The patient survived, didn't they?'

Right.

That’s the spirit.

“Yes, unfortunately, as you know, there have been almost no retrospective studies or multicenter studies on emergency-room-led laparotomy, so it was hard to cite any.”

I took the attack head-on.

At that moment, Professor Cheon grabbed the back of her neck.

Is Professor Cheon's neck acting up again?

“In that sense, if any of you have taken something away from this presentation,”

I took a brief breath.

“If you use this procedure in those last-resort situations, as I said today, to save a patient.”

I met the eyes of that third-year resident who had been glaring at me.

“I also think we could gather more cases and carry out that valuable multicenter study you want so badly.”

Silence.

The murmuring grew louder.

“Isn't he crazy?”

“Wow, is that really a second-year?”

“He just assigned homework to all the professors?”

“That bastard is the real deal....”

I looked toward the back.

Professor Cheon... had grabbed the back of her neck again.

Well then, I'd at least have to get her an appointment at the joint clinic.

**

Meanwhile, Park Juseong of Seoul Catholic Sacred Heart Hospital had one thought.

With an expression heavier than any professor in the room.

'...That bastard is dangerous.'

The look he gave second-year Han Hyeonjae on the podium was not one of awe or admiration.

It was caution, as if he were looking at a clearly unpredictable natural disaster or an uncontrollable beast.

'Yeah, in cases like that, emergency medicine can perform the procedure.'

Park Juseong ran a simulation in his head.

As a last resort, if you truly accept every risk, during that one minute while the patient is about to stop right in front of you.

That could happen.

But if he saw an emergency medicine doctor do something like that, Park Juseong would say he was crazy.

'So I have to tell that young resident up there that he's a lunatic.'

He thought, resting his chin on his hand.

'And a case that says that openly at a conference presentation is even crazier.'

That isn't an incident report.

That second-year brat is now dressing up that case as a proud achievement and the presentation of a new paradigm.

And anyone who uses that to talk about expanding the scope of the entire department must be out of their mind.

He even brought a Japanese paper to make the claim that 'emergency medicine doctors should stitch up bellies and hearts too.'

And it's not even a professor saying it—it's just a second-year resident.

'You should stay far away from a lunatic like that.'

Park Juseong shook his head.

If you bring in someone like that by mistake, the entire hospital system will shake from the roots up.

Rules and procedures were written in blood.

One aberration like that could ruin it all.

'That should definitely be the case, but...'

A realistic, strategic calculation completely opposite to his rational judgment began to creep up in his mind.

'For Catholic Sacred Heart Hospital, which was preparing to be designated as the trauma center for the Seoul region, the only region without a regional trauma center...'

Professor Park's expression became subtly complex.

Trauma centers in Korea, especially those outside university hospitals with separate buildings, such as Ajou University Hospital and Pusan National University Hospital, had clear structural limitations.

Even if patients came through the trauma center entrance, the workflow often partially overlapped with the existing ER, or initial treatment was performed in collaboration with emergency medicine.

'From Catholic Sacred Heart Hospital's perspective, since there are no particular plans to build a separate building just for the trauma center...'

Even if a trauma surgeon is on duty 24 hours a day, the person most likely to see the patient first and make the initial judgment is ultimately an emergency medicine doctor.

Then what's needed isn't an ordinary emergency medicine doctor who, when every second counts, says, 'This isn't my job, so let's wait until the surgeon gets here.'

'...Which means that lunatic is worth taking a shot at.'

The guts to ignore the rules entirely.

That nerve to grab the knife first, saying he'll save the patient regardless of seniors, professors, or anything else.

And... above all, that inexplicable skill with his hands that actually made it work.

Having one guy like that embedded in the ER could become a far more powerful weapon than any cutting-edge equipment in the integrated trauma center model Catholic Sacred Heart Hospital was envisioning.

Park Juseong even regretted that, at last fall's Spring Academic Conference, he had only stood there with his arms crossed and watched Oseong Seoul Hospital's Kim Hyeokjae shove a business card at Han Hyeonjae and try to rope him into a meal, thinking, 'That old geezer's at it again, trying to sweet-talk a young kid.'

'Ah, damn. I should've given him my business card too back then.'