Chapter 98
Breaking the brief silence, this time a hand went up from the other side.
Damn it. What now?
From the podium, I spotted that face and screamed internally.
If I remembered right, that professor's name was Park Joo-seong or something like that.
That was the very professor from Seoul Catholic Sacred Heart Hospital who had blown my classmate Kim Ji-hoon to pieces last fall at the rhabdomyolysis poster presentation with a question like, “What’s the efficacy of urine alkalinization therapy?”
And... last year, when Professor Kim Hyuk-jae handed me his business card, that guy had been staring straight at me too.
The moderator pointed him out.
Professor Park Joo-seong took the microphone.
“I enjoyed your presentation. I’m Park Joo-seong from Catholic Sacred Heart Hospital. Dr. Han’s case is very interesting. However, a single case is just that—an interesting case. I’d say the evidentiary level is far too low to draw institutional or academic conclusions.”
‘...Here it comes. A textbook attack.’
I swallowed hard.
“As for the part in the latter half of your presentation where you raised institutional discussion and the education system, I hope you’ll consider that this may actually be the biggest leap in the presentation as well as its key point. Yes.”
He wasn't asking a question. He was just pointing it out.
'Your evidence is weak, so why are you acting so full of yourself?'
He had dressed that up in polished academic language and dumped it right in my face.
'...What is this? Is this a question or not?'
I stared blankly at Professor Park for a moment.
Was he telling me to answer or not?
The lecture hall started to murmur again.
“He’s right… We did go too far with just one case.”
“What system are you trying to discuss with a case report?”
I had no choice but to take the microphone.
At times like this, all I can do is back down.
The logic was similar to that resident's earlier argument, but the speaker was different.
Even a professor had stepped in and said it was hard to generalize from a single case, so going with the same “Can’t we just make it from now on!” line like before just wouldn’t do.
“Thank you deeply for your valuable opinion, Professor….”
“And one more thing.”
Professor Park cut me off.
'Ah, so it was a combo.'
“Sterility, lighting, instruments, and personnel. Performing a laparotomy in an ER resuscitation room where all of these are inadequate is an extremely dangerous procedure that exposes the patient to a huge infection risk and a high risk of the procedure itself failing. You were aware of that, correct?”
“...Yes, I understood. But the situation at the time was urgent….”
“Performing a procedure that isn’t included in a resident’s training on your own unilateral judgment.”
Professor Park's voice turned cold.
“You’re creating risks for the entire system. Just because the outcome was good doesn’t mean you can rationalize the judgment that led to it.”
The air in the lecture hall turned ice-cold.
He was beating me down in public.
I tried to salvage things by squeezing out the argument for necessity once again.
“Of course, Professor. But the patient’s chance of survival was less than 1%, and in that treatment gap where surgical support was unavailable…”
Every time I started making excuses, Professor Cheon Eun-jung, standing far off by the entrance, could be seen in the corner of my eye grabbing the back of her neck.
Professor Park listened quietly to my excuses and finally nodded.
“So, as a professor, the conclusion I’ve reached is….”
...Conclusion?
“That there’s value in trying despite those risks.”
"...Pardon?”
A dumb sound escaped my mouth.
The entire lecture hall buzzed.
'What the hell? He just beat him to a pulp and now the conclusion is weird?'
Professor Park looked at me and, for the first time, gave a faint smile.
“Scope of practice
(* Scope of practice)
Discussing it—that’s something professors do. But if you think of it as the fire of a young resident grinding it out directly on the front lines….”
He swept his gaze across the audience.
“Rather than crushing that fire, it means we should start a discussion so we can guide that energy in the right direction. It means that preparing some sort of education system for the worst-case scenario that could happen at any moment is something well worth discussing.”
He looked at me again.
“I enjoyed your presentation.”
“…Yes. Thank you.”
I stood there dazed and bowed automatically.
What is this?
It felt like I’d just been beaten like a dog.
When I came to my senses, he was already patching me up.
Is that the legendary make-you-sick-and-then-cure-you move?
The moderator finally took the microphone.
“Yes, due to time constraints, we’ll end the Q&A here. Once again, please give a big round of applause to Dr. Han Hyeonjae.”
Clap. Clap. Clapclapclapclap…
Applause far louder and more fervent than before filled the lecture hall.
I bowed blankly and came down from the podium almost as if fleeing.
My legs were shaking.
The hundreds of gazes that had just been pressing down on me were now following the back of my head with expressions mixed with awe, curiosity, and sympathy (?) for “that crazy bastard.”
I ignored those gazes as best I could and hurried toward my advisor, my only shield and the very person who had shoved me into this hell, who was still standing by the entrance with her hand on the back of her neck.
“Professor. About that presentation….”
As I stood before Professor Cheon and opened my mouth in a voice tiny as an ant's, Professor Cheon slowly lifted her head.
She was still massaging the back of her neck with one hand, looking at me with an expression on the verge of enlightenment.
“Oh, my neck…”
“Pardon?”
“Hyeonjae.”
“Yes, Professor.”
“I’m sure the abstract you got me to approve….
Professor Cheon pressed a hand to her forehead in disbelief.
“Didn’t you write just one small line in the conclusion part about scope of practice—something like ‘further discussion may be needed’?”
The last paragraph of the file I had submitted last time came vividly back to me.
“Uh… I did, right? [Interdisciplinary discussion appears to be necessary.] I think it was exactly that much.”
“But you.”
Professor Cheon raised a hand and pointed at the podium where I had just been standing.
“You practically read out the Emergency Medicine Declaration of Independence up there.”
Professor Cheon grabbed the back of her neck again.
Looking into her eyes, I started to worry in earnest.
At this rate, she’d blow out her C6-C7 disc.
“Uh, Professor. Are you all right? Should I get you an appointment at the joint clinic? They specialize in discs…”
“...Hah, forget it.”
Professor Cheon waved off my pathetic joke with a sigh.
“Forget it. What’s done is done. Let’s go.”
And so we roamed around the conference hall under all kinds of stares.
Every time we passed through the hallway, I could feel the people from that lecture hall recognizing me, stopping short, and whispering.
“Hey…
“That second-year just now…
“The guy who cut open a belly in Busan.”
The murmuring followed me around.
I stuck close behind Professor Cheon, walking like a rookie hiding behind a giant shield.
***
Professor Cheon kept quietly warning me the whole time about how I should conduct myself from here on out.
We picked one of the afternoon sessions and went in.
“Oh, it’s Lee Min-jae.”
I spotted a familiar name on the speaker list posted at the session room entrance.
That meant we were there to hear Lee Min-jae’s presentation.
We took seats toward the back.
Lee Min-jae’s first conference presentation since becoming a fellow.
I wondered how exaggerated his gestures would be this time.
After a while, Lee Min-jae stepped up onto the podium.
Unlike when he was a fourth-year, he was pretending to be a very calm, intellectual fellow… but his tie was slightly crooked and his hair was a bird's nest.
Still, unlike last spring’s conference, he seemed a lot more at ease, as if he’d gained some experience.
“Good afternoon. I’m Lee Min-jae, a clinical instructor in the Department of Emergency Medicine at Busan Cheongjin University Medical Center.”
Oh, listen to that voice he’s putting on.
I exchanged a glance with Professor Cheon beside me and snickered.
Professor Cheon shook her head as well.
“The topic I’ll be presenting today is…”
A huge title appeared on the screen.
[Retrospective Analysis of the Predictive Utility of Serum Lactate Levels for Short-Term Mortality in Elderly Patients Visiting the Emergency Department With Nonspecific Symptoms]
Oh.
I found myself admiring it.
'So that guy can do stuff like that too.'
I’d just thought he was a loud, overly enthusiastic lunatic, but this was a surprisingly solid research topic.
Elderly patients with nonspecific symptoms are the hardest kind of case for emergency physicians.
‘They come in saying they’re “just tired” or “have no appetite,” and die the next day.’
It was a truly important topic.
“In elderly patients, severe illnesses such as myocardial infarction or sepsis often present without typical symptoms like chest pain or high fever, and instead manifest only as simple altered consciousness or low energy…”
Lee Min-jae, surprisingly, went on with his presentation in a very logical, well-organized way, walking through the data.
Had I really been underestimating Lee Min-jae that much?
“In this study, we confirmed that among elderly patients aged 65 and over who presented with such nonspecific symptoms, an initial serum lactate level of 2.5 mmol/L or higher was associated with a significant increase in 72-hour short-term mortality…”
I stared blankly at the presentation.
“Therefore, emergency medicine physicians must never overlook nonspecific symptoms in elderly patients, and by checking the initial lactate level they should actively…”
…That’s pretty cool.
Before I knew it, I had opened the gallery window.
HellJoseonSlave1 : Our fellow’s presentation is pretty sick, yeah. He says he’s predicting elderly mortality with lactate levels.
BackInMyDay : A high lactate level already means the cells are getting wrecked, so if that isn’t related to mortality, what would be?
ㄴ CardiologyGhost : That’s what scholars are for—proving it with data.
I closed the gallery window and looked at Lee Min-jae’s back, seated in the front row.
After safely finishing the Q&A session as well, Lee Min-jae came down from the podium.
He spotted us, wiped the sweat from his brow, and came over.
“Saw that? I was pretty awesome, right?”
The intellectual fellow from just moments ago was nowhere to be seen; back came that flippant lunatic's voice and face.
“Yes, sir. That was absolutely splendid.”
I applauded sincerely.
Our ER might not be so bad after all.