Two Trajectories

General Surgery Ward 4's station clock pointed to four in the afternoon. After the morning's storm-like treatment orders had swept through, the ward had settled into an eerie calm, as though it had entered the eye of the storm. Baek Ijun stood at one side of the desk, updating the patients' afternoon vital signs into the EMR. Just then, the sound of heavy footsteps announced Oh Jae-hyeong's arrival. He was still in his blue surgical scrubs, his face etched with irritation and fatigue.

Oh Jae-hyeong slammed a thick chart file onto the desk with a loud thud. "Baek Ijun."

Ijun looked up from the monitor, maintaining his usual calm tone. "Yes, sir. What is it?"

"I just got called down to the ER for a multiple-trauma patient. No idea when it'll end. 504, Song Gi-cheol. Go check on him and decide the initial management plan."

Ijun's gaze shifted to the chart tossed onto the desk. Decide. It was rare for a first-year resident to be entrusted with determining the direction of care rather than simply carrying out procedures or orders. Especially from a third-year like Oh Jae-hyeong, who valued hierarchy and control above all.

"Are you sure it's all right for me to decide the direction on my own?"

Oh Jae-hyeong fixed him with a cold stare. "The guy who bypassed the ER and overrode my orders without hesitation is suddenly acting modest? Assess the patient's condition and decide whether to go conservative or call the professor to ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠open the OR. If you're wrong, it's on you."

It was a test wrapped in rebuke—a poisoned chalice offered to the first-year who had slipped his control, daring him to shoulder the weight of responsibility himself. Ijun read the intent perfectly but neither dodged nor made excuses.

"Understood. I'll assess the patient's condition accurately and set the direction."

Oh Jae-hyeong left the station without another word. Ijun picked up the chart and quickly filed the patient's basic data in his mind. Song Gi-cheol, sixty-five-year-old male. Four days post-hernia repair and recovering. He had begun complaining of sudden abdominal pain the previous evening. His WBC count was only slightly above normal, lactate was stable, and vital signs showed no major fluctuations. On paper, the trajectory matched textbook postoperative paralytic ileus exactly.

Ijun opened the door to Room 504. The scene inside, however, diverged sharply from the chart's dry numbers. The patient lay curled on the bed, drenched in cold sweat.

"Sir, I'm the on-call surgical resident. Is your stomach hurting badly?"

The patient groaned in agony and clutched at Ijun's gown. "Doctor, my stomach… it feels like it's being torn apart. Do something for the pain. I can't breathe."

This was far beyond the discomfort a simple ileus patient would describe. Ijun immediately lifted the patient's gown and began abdominal palpation. Strangely, despite the patient's apparent agony, the abdomen remained soft. There was no board-like rigidity from peritoneal irritation, nor any rebound tenderness. The patient's subjective suffering and the objective physical findings were completely at odds.

At that moment, a cool light seeped across Ijun's retinas and a translucent holographic interface unfolded. The Archive had activated. But this time the pattern was different. Two tabs hovered in the air, each emitting its own distinct glow.

The patient's subjective agony far exceeded what any textbook ileus would produce. Ijun's breathing grew heavy. The system had presented him with its first cruel binary choice: trust the textbook, or trust the Archive's intuition.

Following the Encyclopedia's guidance—inserting an NG tube and observing—would leave even Oh Jae-hyeong with no grounds for objection. It was the perfect standard of care. Yet the patient's bowel would necrose within hours. Conversely, trusting the Warning meant ordering an urgent abdominal CTA and preparing thrombolytics. If the Archive was wrong, the unnecessary expensive test and disruption of hierarchy would get him permanently banned from the operating room.

The moment of decision was brief. Ijun looked at the patient's pain-twisted face. Hiding behind textbook probabilities and ignoring a patient's screams would betray the very trajectory that had led him to abandon engineering for medicine.

"Sir, there's a high chance a vessel to your bowel is blocked. This isn't simple gas. We'll do an emergency CT right away and prepare for vascular intervention. Please hold on a little longer."

Ijun left the room at once. Back at the station, he logged into the EMR, placed the fastest possible emergency CTA order, and began maximum-rate fluid resuscitation.

Time raced by. Two hours later, the emergency CT report uploaded to the system.

The occlusion was not complete. Mesenteric ischemia was progressing, just as the Archive had warned, yet the finding was so subtle that even the radiologist could not confirm it. Ijun discarded conservative management without hesitation and called vascular surgery for an anticoagulation protocol.

At eight in the evening, Oh Jae-hyeong returned from the ER, still blood-spattered from trauma surgery. He checked the monitor immediately. The treatment record for Song Gi-cheol. His eyes locked onto the CTA order and anticoagulation entry logged under his own name. The air in the station froze.

Oh Jae-hyeong turned to face Ijun directly. "Baek Ijun."

The call was low and cold. Ijun approached with measured steps. "Yes, sir."

"I told you to set the direction for 504. Why is a CTA and anticoagulation running under my name? All his labs were normal. Textbook management would have been NG tube and ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠serial X-rays. What's your justification for ordering a million-won scan and a dangerous drug?"

The interrogation was precise and flawless. Ijun did not search for excuses. There was no way to translate the Archive's colliding tabs into the language of reality.

"The objective numbers and physical findings pointed to ileus," he answered calmly. "But the patient's pain far exceeded those numbers. Pain grossly disproportionate to physical findings—that is the only and most lethal sign of early mesenteric ischemia."

Oh Jae-hyeong gave a short, incredulous laugh. "So you ran the ischemia protocol based solely on the 'feeling' that the patient was writhing in pain, even though labs were normal and the CT was equivocal?"

"Yes. That is correct."

There was not a single gram of hesitation in Ijun's reply. "It wasn't merely a feeling. I calculated that the weight of pain the patient was enduring exceeded the variables of ileus. It was simply what I saw."

What I saw. It was neither arrogance nor rebellion—only a firm declaration of the responsibility he had chosen to carry.

Oh Jae-hyeong's lips pressed into a hard line. He studied Ijun's calm, resolute face. Under normal circumstances he would have slammed the chart down and banned the first-year from the OR. Yet his gaze returned to the monitor. After anticoagulation, the patient's pain score had dropped dramatically from 9 to 3. The ambiguous CT finding now stood as proof that Ijun's impossible intuition had struck true.

The outcome had overwhelmed the process. Oh Jae-hyeong asked nothing more. He roughly closed the EMR window for Room 504 and spoke in his usual dry tone.

"Re-check 504's labs before morning rounds. Notify me immediately if anything looks off."

That was all. No praise, no anger, no further rebuke. Only a heavy, peculiar silence that absorbed Ijun's decision into the system itself.

Ijun answered briefly and stepped away. The fingertips tucked into his gown pocket felt faintly warm. Between the textbook system and the unknown variable called Archive, he had drawn his own trajectory for the first time.

The station alarms resumed their regular rhythm. Ijun regained his composed expression and walked silently toward the next patient's treatment cart. The heavy night of the ward deepened without a sound.