The Numbers of the Field
The air in the corridor of General Surgery Ward 4 at three in the afternoon was thick with the restless clamor of post-operative groans and the rumble of carts rolling past. Baek Ijun stood at the station desk, his fingers sweeping rapidly across the EMR tablet screen. His afternoon rounds route—starting from Room 9 in the corner, passing through the treatment room, and looping back to the station—was already optimized in his head. The calculations that minimized wasted movement and streamlined treatment orders had clicked into place with clean precision.
“Baek Ijun.”
A low, heavy voice sliced through the corridor noise and struck him squarely. Baek Ijun stopped mid-step and turned at once. At the far end of the opposite hallway, silhouetted against the backlight, stood a massive figure. It was Kang Taesan, the chief of General Surgery. He carried neither chart nor smartphone—his hands were perfectly empty. There was no overt threat in his posture, no heavy footsteps. Yet as he approached, the loose atmosphere of the ward seemed to compress, tightening against the skin.
The nurses bustling around the station froze for a split second. Kang Taesan halted exactly three steps in front of Baek Ijun.
“Busy?”
“I was reviewing the afternoon rounds route and treatment orders, sir.”
“One question.”
It was an ambush without warning. Baek Ijun tightened his grip on the tablet and met the professor’s gaze.
“Yes, please go ahead.”
It wasn’t the overbearing stare of someone trying to intimidate. It was an ice-cold, precision-measuring look, as if calibrating something to the micron.
“A male patient in his sixties presents. His direct bilirubin is abnormally elevated, and ALP—his biliary enzyme—is more than three times the upper limit of normal. Yet the patient reports absolutely no abdominal pain. What diagnosis should you suspect first?”
Kang Taesan’s eyes flashed sharply. The moment the question ended, the Archive system vibrated faintly behind Baek Ijun’s retinas, ready to engage. But he consciously and completely shut it down. This wasn’t the domain of visual penetration used to catch monitor errors in the OR. This was a pure contest of knowledge—testing the trajectory of accumulated medical texts and clinical data inside a surgeon’s mind.
Elevated direct bilirubin meant biliary obstruction. Elevated ALP was a classic sign of biliary pathology. But no pain.
Painless jaundice.
Baek Ijun spoke in a calm, crystal-clear voice.
“I would prioritize suspecting pancreatic head cancer.”
“Reason?”
“Painless jaundice with skyrocketing ALP is clinical evidence that the bile duct is being slowly compressed and obstructed by an extrinsic tumor.”
The answer came without hesitation.
“Since it’s not a stone tumbling and jamming the duct, there’s no pain.”
“Method of confirmation?”
“After confirming Courvoisier’s sign on physical examination, I would immediately order a contrast-enhanced abdominal CT.”
Kang Taesan offered neither approval nor rejection before driving in the next variable.
“Probability of gallstones?”
“Cholelithiasis can also cause biliary obstruction, but it inevitably comes with severe colicky pain.”
Baek Ijun held his defensive line firm.
“If the patient has complete absence of pain, it is more reasonable to lean toward a mass rather than stones.”
“Would you rule out PSC—primary sclerosing cholangitis?”
A sharp thrust before he could even readjust his shield. Baek Ijun’s mental calculations stuttered for a brief 0.5 seconds. An autoimmune disease often associated with inflammatory bowel disease. A clever trap.
“It cannot be ruled out,” Baek Ijun replied, quickly patching the logical gap. “I would immediately check the patient’s history for inflammatory bowel disease.”
“Next?”
“A simple CT alone would make it difficult to differentiate whether inflammation is narrowing the bile ducts.”
“Therefore?”
“I would definitely add an MRCP—magnetic resonance cholangiopancreatography—using MRI.”
“Cholangiocarcinoma?”
The questions were growing shorter. Baek Ijun’s answers accelerated to match.
“Cancer arising inside the bile duct can also cause painless jaundice. Microscopic cholangiocarcinomas are likely to be invisible on CT due to resolution limits, so I would keep the pathway open for ERCP with endoscopy.”
Throughout the suffocating exchange, not a single flicker of emotion crossed Kang Taesan’s face. He lightly stepped over Baek Ijun’s logical defenses and advanced to the next stage.
“Assume we performed the abdominal CT based on your judgment.” Kang Taesan took one step closer. “A two-centimeter mass is clearly identified in the pancreatic head.”
“……”
“Next step?”
“I would order tumor marker blood tests including CA 19-9.”
Baek Ijun stared straight into Kang Taesan’s eyes without wavering.
“At the same time, I would confirm the pathology with endoscopic ultrasound-guided fine-needle aspiration—FNA.”
“Treatment direction?”
“After adding a chest CT to screen for distant metastasis, I would evaluate the feasibility of surgical resection.”
“What are the specific criteria for determining resectability?”
This was the most brutal and structural limitation a field surgeon could face. Baek Ijun chose his words with extreme care.
“The tumor must not invade the major surrounding vessels for surgical resection to be possible.”
“More specifically.”
“Especially if it encases the superior mesenteric artery—SMA—or the celiac artery by more than 180 degrees, it crosses into the unresectable category.”
“Why exactly 180 degrees for vascular involvement?”
A raw, foundational pressure question. Those who had merely memorized textbook print would bottom out here. Baek Ijun visualized an engineering cross-section of a vessel in his mind.
“Because the cross-section of a blood vessel is circular.”
“Continue.”
“Involvement beyond 180 degrees physically means that more than half of the vessel’s circumference is already in contact with cancer cells.”
“Therefore?”
“If you try to forcibly peel the tumor away in that state, the outer wall of the vessel will inevitably tear, or you won’t be able to secure a safe resection margin.”
“Then what about resecting the vessel segment itself and reconstructing it with an artificial graft?”
A lethal leading question. Baek Ijun slowed his answer slightly.
“Some centers do attempt resection on the premise of reconstruction.”
“However?”
“The operative time becomes extremely prolonged, and risks such as anastomotic bleeding skyrocket.”
Baek Ijun took a breath and delivered his conclusion.
“Therefore, it is difficult to view that as the trajectory of a universal standard treatment.”
Kang Taesan’s gaze deepened. A taut tension, like walking on thin ice, pressed down on the entire station.
“Good.”
Kang Taesan placed the final variable on the table.
“Now assume this patient is a frail seventy-five-year-old with diabetes as a comorbidity.”
“……”
“Would you still drag him into the operating room?”
The Whipple’s operation—pancreaticoduodenectomy—ranked among the highest-difficulty procedures in general surgery. In an elderly patient with diabetes, the odds of dying on the table from surgical shock were overwhelmingly high. But abandoning surgery left only the slow trajectory of wasting away.
Baek Ijun finished his brutal mental weighing and spoke with resolve.
“We cannot declare an absolute contraindication to surgery based solely on age and diabetic history.”
“Reason?”
“If comprehensive evaluation of cardiopulmonary function and anesthesia tolerance shows the patient can withstand surgery, it must be considered without exception.”
“Evidence?”
“If the lesion is resectable, surgery is the only physical opportunity that offers any hope of cure.”
A solid strength entered Baek Ijun’s voice.
“The trajectory of giving up is one hundred percent mortality.”
“And if your evaluation concludes that cardiac function is so poor that surgery is simply not tolerable?”
“I would immediately pivot to palliative care.”
“How?”
“I would insert an endoscopic stent to relieve the obstructed bile duct and drain the jaundice, then consult with Internal Medicine to explore tolerable levels of chemotherapy.”
At last, the relentless barrage from Kang Taesan’s lips ceased. A long silence followed. Before the overwhelming authority, Baek Ijun did not retreat a single inch, meeting that icy gaze head-on.
Finally, Kang Taesan spoke slowly.
“The vascular reconstruction question.”
“Yes.”
“You were wrong on that one.”
Baek Ijun’s heart sank coldly. He rapidly replayed the chain of logic he had believed was flawless, searching for the broken link.
He asked calmly, “May I ask which part of the logic was flawed?”
“Dismissing reconstruction itself as non-standard simply because complication risks are high lacks sufficient clinical evidence.”
“……”
“Your point that the surgical team’s proficiency is a variable is correct.”
Kang Taesan’s eyes flashed fiercely.
“But for that to become a valid argument, the phrase ‘our hospital—Korea University Hospital’s current vascular reconstruction success rate data’ should have come out of your mouth first as the baseline.”
A lightning bolt of realization flashed through Baek Ijun’s mind. He had hidden behind safe, general textbook principles and completely omitted the actual metrics of the reality he stood upon.
Baek Ijun bowed his head deeply and cleanly admitted the error.
“My thinking was shallow.”
“……”
“I should have first grasped this hospital’s cumulative vascular reconstruction case data and the team’s real-world capability, then built my hypothesis from that baseline.”
Kang Taesan looked down at him quietly.
“Anyone can memorize the letters in a textbook.”
Without further explanation, he turned his massive frame and began walking toward the end of the corridor. From behind his broad, receding back came one heavy sentence.
Use the numbers of the field as your baseline.
Kang Taesan rounded the corner and vanished from sight completely.
Baek Ijun stood motionless in the middle of the now-empty corridor. It was a cold rule: even a wrong answer was acceptable if the evidence was clear, but a correct answer without evidence would not be tolerated.
He turned the tablet screen back on. The fierce Q&A had ended, but countless variables still remained in the ward under his control.
Seven o’clock in the evening. After finishing the night-duty orders, Baek Ijun leaned his exhausted body against the station desk. A black ballpoint pen was in his hand. As if possessed, he pressed the pen firmly against the blank white label on the back of the EMR tablet and wrote.
Not textbook generalities—calculate based on the actual data of this very field.
“Doctor, are you really writing on hospital property with a ballpoint pen?”
Jeong Dain, who had been preparing to leave, rushed over in alarm.
“Ah.” Baek Ijun stopped the pen with an awkward expression. “I learned an important principle while walking the corridor—one I absolutely cannot forget.”
“Even so, if Chief Oh Jae-hyeong catches you when he does rounds, you’ll be up all night cleaning that tablet.”
Jeong Dain clicked her tongue, then opened her personal cabinet inside the station. She pulled out a small, palm-sized notebook with a deep blue cover and thrust it toward him.
“Here. I received it when I first started, but I never used it. It’s been rolling around in the drawer.”
Baek Ijun accepted the notebook with a faint smile.
“Thank you. I’ll use it with care.”
He quickly pulled an alcohol swab and vigorously erased the writing on the back of the tablet. As Jeong Dain buttoned her coat, she glanced at his disheveled hair.
“Doctor, did Professor Kang Taesan throw a case question at you today?”
Baek Ijun paused mid-wipe and widened his eyes.
“How did you know?”
Jeong Dain smiled playfully.
“It’s written all over your face!”
“What does my face look like?”
“It’s exactly the expression people have after being called in by Professor Kang and getting grilled in a brutal Q&A. Their souls are half torn out, but their minds are packed tight, desperately trying to organize everything they just learned. That exact look.”
With light steps, Jeong Dain left the station. Alone now, Baek Ijun carefully opened the first page of the blue notebook she had given him. He transcribed the sentence he had written on the tablet, pressing each character carefully into the paper with ink.
Use the numbers of the field as your baseline.
It was not merely a fragment of knowledge. It was the most essential survival rule for living as a surgeon within the ecosystem of this university hospital.
Baek Ijun closed the notebook and slipped it deep into the left breast pocket of his white coat—the place closest to his heart. The small notebook radiated a heavy presence there.
He didn’t need some overwhelming miracle or a perfect system right now. Baek Ijun was committing errors, breaking, revising, and forging his own solid trajectory. He thrust his hand deep into his pocket and walked silently toward the patient rooms where the quiet of night had settled.