The Ten-Second Blank
The 2 a.m. hour in General Surgery Ward 4 was when the deepest darkness settled. The silence that made it feel as if even the air at the station had frozen solid was ripped apart by a call that bordered on a scream exploding from room 605.
Baek Ijun sprinted toward the room without even closing the chart window he had been writing in. The scene unfolding beyond the sliding door of room 605 was a gruesome bloodbath. A man in his fifties, hospitalized with end-stage cirrhosis, was vomiting massive amounts of dark, clotted blood onto the bed. Ruptured esophageal varices. The hardened liver had forced blood to reroute, swelling the delicate veins in the esophagus until they could no longer withstand the pressure and burst—a fatal error in the system.
Nurse Jeong Dain, who had arrived first, was securing the patient’s airway while urgently calling out.
“Doctor Baek, the patient just had massive hematemesis and his systolic blood pressure is plunging below seventy!”
The Archive, waiting beyond Ijun’s optic nerve, flared to life with ferocious light. Red three-dimensional visualization layers cascaded like a waterfall across the patient’s chest and abdomen. The exact location of the ruptured esophageal vein, the collapsing hemodynamic trajectory of the entire body, and the flawless treatment algorithm required to seize control of the situation all materialized cleanly in a holographic window.
Target: Hypovolemic shock due to ruptured esophageal varices.
Recommended Protocol: Immediate maximum-dose administration of visceral vasoconstrictor (Terlipressin) and large-volume fluid resuscitation required.
Ijun’s logical circuitry adopted the perfect answer the Archive presented without a shred of doubt.
“I’ll secure the airway with suction. Nurse Dain, immediately establish two large-bore central venous lines and push the maximum dose of the visceral vasoconstrictor Terlipressin.”
Ijun’s voice was clear and unshaken. The moment his order landed, Dain drew the medication from the cart and drove it forcefully into the patient’s vein. It was the textbook hemorrhage-control protocol the Archive had laid out. Once the drug took effect and fluids poured in, the visceral vessels would constrict, lowering the pressure on the ruptured esophageal vein and inducing hemostasis.
Ijun gripped the suction device, clearing the pooled blood from the patient’s mouth while waiting for the monitor values to return to a stable trajectory. But the patient’s vital signs monitor began to shriek an entirely different alarm. Instead of rebounding, the blood pressure continued its plunge as the ECG waveform twisted into a grotesque shape. The heart rate, which should have held steady, plummeted from 100 to 60, then to 40. The oxygen saturation alarm blared frantically, and the patient’s once-pale face turned a cold, ashen gray.
Cardiac output crashing. Myocardial ischemia in progress.
Ijun’s breathing stopped completely for a moment. The computational circuits in his brain—brilliant in the face of ordinary errors in the OR or ward—had slammed into catastrophic overload and frozen solid.
Why? The Archive’s protocol was perfect. We used a vasoconstrictor to control the bleeding—why is the heart stopping?
Buried beneath the flood of incoming data, Ijun could not calculate the next move. The Archive only warned of the result—that the heart was failing—but it offered no insight into the causal flaw in the treatment pathway he had chosen.
Ten seconds. For those ten seconds while the patient’s life teetered on the edge of the cliff, Ijun stood frozen in perfect silence, suction device still in hand. It was a hideous, terrifying void, as though the brain that had grown dependent on the machine’s flawless answers had forgotten how to think for itself.
Dain’s sharp gaze pierced Ijun’s rigid face. Her eyes no longer held their usual trust; instead they burned with deep suspicion and horror toward a doctor who had lost control.
“Doctor Baek, the patient is on the verge of cardiac arrest! Give the next order, quickly!”
The instant Dain’s desperate cry echoed through the room, someone shoved the door open and burst inside. It was Park Dong-hun, the Emergency Medicine chief resident, who had come up to the ward for a cross-department consult.
Park Dong-hun’s eyes scanned the patient’s distorted ECG waveform and the empty medication ampoules in a single second.
“Stop the Terlipressin immediately and start a nitroglycerin drip to prevent further myocardial ischemia!”
Park Dong-hun’s heavy voice shattered the frozen air of the room. He pushed past Ijun to secure the patient’s side and roughly clamped off the remaining infusion line.
“Switch to somatostatin for bleeding control—it places less burden on the heart—and administer it right away.”
The moment Park Dong-hun issued the new orders, Dain moved. As the new drug entered the bloodstream and the vasodilatory treatment took effect, the wildly crashing heart rate finally hit bottom and began a faint rebound. The bleeding, too, gradually came under control under somatostatin’s influence. The patient’s vitals stabilized at the precarious minimum required for transfer to the ICU.
The patient was urgently moved by transport staff to the endoscopy suite and ICU area. Inside room 605, still thick with the metallic stench of blood, only Baek Ijun and Park Dong-hun remained.
Park Dong-hun’s cool gaze turned toward Ijun.
“Your initial airway management and massive fluid resuscitation to delay the shock were excellent.”
Park Dong-hun’s first sentence was a dry statement of fact. Ijun felt no relief in the assessment; he already sensed the weight of the question that would follow.
“But why on earth would you push maximum-dose Terlipressin on a patient with two prior coronary stent procedures for angina!”
Ijun’s vision warped strangely. Angina. History of coronary stent placement. The Archive had focused solely on the most overwhelming pathologic error exploding before their eyes—esophageal variceal bleeding—and had failed to raise the critical underlying condition buried deep in the patient’s past medical record as a top-priority warning.
Terlipressin constricted visceral vessels to aid hemostasis, but it also powerfully squeezed the systemic vasculature and coronary arteries. Pouring the maximum dose into a heart that was already damaged was practically a death sentence.
The answer the Archive had provided was perfect for treating the disease, yet it was the worst possible mistake for saving the patient.
Ijun could not find a single word in his defense. Blindly trusting only the Archive’s text while failing to integrate the patient’s disease history and overall trajectory into a comprehensive calculation was an undeniable, complete failure of his own competence.
“I became fixated on controlling the single largest variable—the massive hemorrhage before my eyes—and committed a grave error by failing to include the patient’s critical underlying condition in my calculations.”
At Ijun’s answer, Park Dong-hun let out a light sigh.
“If you’re only going to cure the disease and kill the patient, that isn’t treatment—it’s just a failed experiment.”
Leaving behind that cold single sentence, Park Dong-hun walked out of the room.
Ijun stared silently at the patient’s bloodstains scattered across the floor. The Archive’s layers were quietly fading from his vision of their own accord. He had believed he held a perfect weapon, yet the moment he blindly trusted the conclusions it delivered, his ability to function as a physician had been completely paralyzed. Tonight had proven that truth in the most brutal way possible.
5 a.m. The on-call room. The blue darkness before dawn slipped through the window and settled on Ijun’s shoulders. He took an old notebook from the inner pocket of his coat and placed it on the desk. It was the same notebook he had left blank last time, unsure what to write amid the hospital system’s terrible irrationality.
Ijun took out his pen. The Archive beyond his retina was asleep, and his brain was colder and clearer than ever, organizing its own logic.
A machine could show cross-sections of the human body and detect pathologic errors, but it was impossible for it to combine the tens of thousands of histories and conditions a patient possessed to reach a final conclusion. The Archive was merely an auxiliary computational device. The one who must make the diagnosis was, without exception, the physician Baek Ijun.
The pen tip drove into the empty white page without hesitation, spilling ink.
First Principle
The machine sees the error of disease, but the physician must see the patient’s entire trajectory.
Second Principle
The Archive’s calculations can be wrong. The final judgment and the weight of the life that follows belong entirely to me.
When Ijun closed the notebook, his eyes sank deep within the cold dawn air. The true algorithm of physician Baek Ijun—abandoning dependence and completely mastering the system—had finally inscribed its first proposition on the blank page.