That's Enough
The main conference room in the main building, where the entire General Surgery department's case conference was held, carried a completely different weight in the air compared to the usual ward. This gathering, held every other Wednesday morning, was nothing less than an arena where the outcomes and errors of major surgical cases from each division were dissected in front of dozens of doctors.
For first-year residents who had only just been assigned to the ward, there was no right to speak. Their sole duty was to remain thoroughly hidden in the back row and observe their seniors' defensive battles.
Early that morning, as Oh Jae-hyeong organized the charts, the instruction he gave Baek Ijun was crystal clear.
"Attend today's conference and sit in the back. You probably won't need to open your mouth, but if any questions come flying about first-year treatment records, you'll defend them yourself."
The seating arrangement in the conference room was a visual diagram of the university hospital's brutal hierarchy. The plush chairs in the front row were reserved for the professors, followed by the fellows and chief residents, while the plastic folding chairs in the very back were packed tightly with the lower-year residents.
As Baek Ijun settled comfortably into the end seat of the back row, his classmates Kim Jinsu and Han Seungmin slid in close on either side of him.
"Hyung, Professor Kang Taesan is coming to today's conference," Jinsu whispered, his voice tight with tension.
Seungmin, seated on the opposite side, flipped through his tablet screen and added in his dry tone, "The moment that man walks into the conference room, the density of questions flying around here will change completely. Every senior resident presenting today is probably incredibly nervous."
No sooner had Seungmin finished speaking than the front door of the conference room opened. Professor Kang Taesan, with his solid build, walked in holding a single file folder. His steps weren't particularly fast or loud, yet each one carried undeniable weight.
The instant he took his designated seat in the center of the front row, the buzzing noise inside the conference room was cut off all at once, as if someone had flipped a master power switch.
Baek Ijun felt that strange shift in the atmosphere on his skin.
'It's not physical pressure. His very existence is controlling the variables of the space. That man is the absolute reference point of the system called General Surgery.'
At exactly eight o'clock in the morning, the conference opened under the chief resident's direction.
The presenter for the third case was third-year resident Oh Jae-hyeong. A CT image of a patient with an intra-abdominal abscess appeared on the large screen. Oh Jae-hyeong took the microphone and explained the patient's history, the abscess location, and the medical reasoning behind his choice of drainage tube insertion path.
It was a reasonably smooth briefing, covering the treatment course and final outcome.
Then, Kang Taesan, seated in the center of the front row, slowly switched on his microphone.
"That case you just presented. What was your specific criterion for choosing the right lateral drainage path?"
Oh Jae-hyeong's briefing halted abruptly. He adjusted his grip on the microphone and answered.
"On the CT image, it was the shortest distance to the abscess and the most accessible route that completely avoided damage to surrounding organs."
"What does 'short distance and easy access on the image' even mean as a criterion in actual operating room conditions?"
Kang Taesan's voice was low, but it cut sharply all the way to the back of the room.
"Look at the abscess location. How was the patient's position set during the procedure?"
A heavy silence descended over the conference room. Oh Jae-hyeong's lips parted around the microphone, but no sound emerged.
Baek Ijun instantly calculated the meaning of that silence.
'He either didn't personally confirm the patient's position or failed to record it in the chart. He relied solely on the 2D data from a static CT image and missed the 3D variables of the actual procedural environment.'
Kang Taesan pointed at the abscess location on the screen with a laser pointer and continued in a cool tone.
"A drainage path isn't simply the route a needle takes. You must calculate the direction gravity pulls along with it. No matter how short the path appears on imaging, when the patient's position changes, the organs shift and the drainage tube's tip position twists completely. Miss that, and less than half the abscess drains. It pools, and you end up needing reoperation."
Oh Jae-hyeong answered in a rigid voice, forcing the words out.
"It was my oversight. I'll review it again and document it properly."
Kang Taesan was about to set down his microphone and move on to the next case when a single hand rose quietly but clearly from the corner of the very back row. It was Baek Ijun's hand—a first-year resident without speaking rights.
Jinsu and Seungmin, seated on either side, stared at him in horror. The fellows in the front row all turned at once. Kang Taesan's sharp gaze cut through the crowd and locked onto Ijun in the back.
"What is it? Speak."
Ijun rose from his seat, his characteristic round, relaxed expression unchanged. Though he had no microphone, his voice rang out calm and clear across the space.
"Professor, in the drainage case just presented, I believe there is one more variable that must be considered besides position and gravity. The patient's respiratory cycle."
The air in the conference room grew even tighter than before. The unexpected action from a first-year resident triggered silent murmurs throughout the hall.
"When a patient takes deep abdominal breaths, the diaphragm is pushed significantly downward during inhalation. Even a path that appears safe on imaging can cause the drainage tube to deviate or stimulate unwanted areas if organ positions fluctuate according to the respiratory cycle. Static image data alone cannot capture that variable."
Kang Taesan leaned back against his chair and studied Ijun.
"Your evidence?"
"Anatomically, the diaphragm's range of movement shows considerable variation depending on breathing depth. If the patient's abscess is positioned tightly against the inferior liver border, the drainage tube tip would fall completely within the diaphragm's expansion range during inhalation."
Kang Taesan's eyes narrowed slightly.
"So. Did you personally confirm that patient's actual breathing pattern and diaphragm movement range?"
Ijun answered in an unwavering voice.
"No, sir. Since it was not my case, I did not confirm the patient's actual breathing pattern. What I described is an assumption based on the anatomical variables that could occur when draining an abscess in that location."
"An assumption? If that's the case, you should have clearly stated it was an assumption before opening your mouth."
Kang Taesan's criticism was as precise as a surgical blade.
Ijun did not retreat. He responded gently.
"You are correct, Professor. Failing to preface my statement as an assumption was clearly my mistake. However, I believe my clinical reasoning for including the respiratory cycle as a key variable when establishing a drainage path is sufficiently valid."
Kang Taesan simply looked at Ijun. Ijun remained standing, fully receiving that heavy gaze. Several seconds of standoff passed.
"That's enough."
Kang Taesan set down his microphone and uttered the words briefly.
That was the end. There was no further interrogation, no additional rebuke.
As Ijun quietly sat down, the facilitator hurriedly advanced to the next case's slides. Most faces in the conference room seemed to say, What the hell is that guy?
Jinsu nudged Ijun's arm and whispered in a creeping voice.
"Hyung, are you insane? What was that situation just now?"
Ijun, eyes fixed on the screen ahead, answered calmly.
"A situation where I made a mistake."
"At least you know it!"
Jinsu looked at him with an expression that clearly asked what he planned to do now.
"No matter how correct the logic, you can't package an assumption as fact when you deliver it."
Seungmin leaned in from the other side, speaking softly.
"Hyung, but I've never seen Professor Kang Taesan say 'that's enough' and let it go like that before."
Ijun turned to look at Seungmin.
"Really? You know his usual pattern well?"
"Yeah. Last year when I was an intern auditing these conferences, I pulled all the data on the professor's question patterns. If the facts are wrong, he digs in three or four times straight until the person is completely destroyed. But today he only probed you twice and stopped. In my opinion, it means he acknowledged your logic."
"Whew~~ Please let that be true..."
Jinsu let out the long breath he'd been holding while listening to Seungmin.
Ijun quietly ran the data through his mental calculations.
'It ended at two. Evidence that my analysis aligned with the system's criteria.'
The hallway immediately after the conference ended was crowded with doctors pouring out at once.
As Ijun, Jinsu, and Seungmin walked back toward Ward 4, Shin Seoyun came striding directly toward them from the opposite side of the corridor.
When her eyes met Ijun's, she didn't slow her pace. Instead, she naturally slipped into step beside him, walking shoulder to shoulder.
"Doctor Ijun, your comment during the conference earlier—"
Ijun looked at her with a relaxed smile.
"The part about the respiratory cycle variable. I think what you said is correct."
Seoyun continued walking forward, her voice steady.
"When I was watching the slides from the back, the diaphragm position caught my eye immediately. It was obvious the drainage tube would shift during insertion."
Ijun asked with open curiosity.
"Doctor Seoyun, if you saw the error, why did you stay silent? With your usual personality, I would have expected you to raise your hand and point it out right away."
"A first-year challenging a senior resident's case in conference has terrible efficiency. No need to create unnecessary trouble. I'm already busy enough controlling variables for the patients I'm responsible for."
At Seoyun's thoroughly pragmatic answer, Ijun let out a light laugh.
She continued.
"But the fact that Professor Kang Taesan said 'that's enough' and moved on—isn't that proof you didn't say something ridiculous but actually hit the right point?"
Before turning the corner, Seoyun added one more thing.
"Still, next time, make sure to state it's an assumption first."
With those words, she walked ahead toward the ward.
Watching her retreating figure, Ijun felt a pleasant sense of fulfillment.
'Seoyun approached me first not for casual greetings but for pure medical advice. A person who doesn't circle around the point but accurately identifies the flaw in my delivery method. She's truly an efficient partner, without a single unnecessary element.'
After Seoyun disappeared, Jinsu grabbed Ijun's arm with a bewildered look.
"Hey, did the ice princess Shin Seoyun just speak to you first? Personally! What's going on with her... She almost never interferes in other people's business."
Ijun answered lightly as he continued toward the ward.
"It wasn't interference. It was perfect feedback."
"Hyung, is your mentality really made of steel? You got called out by the professor and chewed out by your classmate, yet your face looks this bright."
"How fortunate it is to exist inside a system that tells you when something is wrong."
Eight o'clock in the evening. The atmosphere at the Ward 4 station had settled into a much calmer state.
While Ijun sat at the desk organizing charts for the next day's discharge patients, third-year Oh Jae-hyeong, fresh from evening rounds, approached and stood beside him.
Oh Jae-hyeong pulled up the patient list on the EMR monitor and spoke in a level voice.
"That respiratory cycle variable you mentioned in the conference this morning."
Ijun stopped his work and looked at him.
"I overstepped my place. I'm sorry."
"No. Getting torn apart was my burden, so there's no need for a late apology."
Oh Jae-hyeong set the chart down and continued dryly.
"After the conference, I went through the patient's underlying disease records again. There was a COPD entry buried in the internal medicine chart."
Ijun's eyes grew serious.
"If it's chronic obstructive pulmonary disease, the patient would overuse accessory respiratory muscles, resulting in deeper abdominal breathing. The diaphragm's vertical excursion range would inevitably be much greater than in a normal patient."
"Yeah. Your assumption was completely correct. I admit I missed that variable. Next week when we take the follow-up imaging, I'll check the drainage tube tip position with more precision. If it's shifted, we'll have to reinsert it."
Oh Jae-hyeong offered no further excuses. Acknowledging his error and adjusting the next treatment plan was the most responsible attitude a surgeon could display.
As Oh Jae-hyeong left the desk, he tossed out one last remark without stopping.
"Hey. But... from now on, when you take the microphone, always state first that it's an assumption. That way you won't get hurt."
Ijun quietly watched Oh Jae-hyeong's retreating back. The words Shin Seoyun had offered in the hallway and the advice from his direct senior Oh Jae-hyeong matched perfectly.
'No matter how sophisticated the internal calculations or how perfect the derived logic, if the delivery format to others is flawed, its value is cut in half. The method of information transmission is ultimately an important part of the system I must control.'
Assumptions must always be stated upfront as premises. Thoroughly separate the trajectories of facts and hypotheses.
He tore the written Post-it from the pad and firmly attached it to the most visible spot on the EMR monitor frame. By tomorrow morning the note would be completely imprinted in his mind and discarded without regret, but simply visualizing the system principle he had learned today was meaningful enough.