The Trap of Convenience

As soon as the educational conference ended, I headed straight to the emergency room. I spent my time managing various mild cases. ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠There was a college student who had scraped his knee after drinking too much, a guy who came in for a tetanus shot after being scratched by a cat, and then... today's first nuisance made his grand entrance.

A perfectly normal-looking middle-aged man walked in with an incredibly grave expression, claiming that his back had been hurting since last night. He insisted that after Googling his symptoms, they perfectly matched terminal pancreatic cancer.

"From what I know, the five-year survival rate for pancreatic cancer is less than ten percent, right? Am I going to die? I need you to run a CT, an MRI, and that... what is it, a PET-CT? Run all of them. Do a tumor marker test, too."

I pressed my temples. Do you think this is a health screening center, mister? My inner demon roared, but on the outside, I maintained a gentle smile.

"Sir, let's start with basic blood work and an X-ray first. The most common cause of back pain is muscle soreness."

"Hey, doctor! You don't believe me? Do you have any idea how much research I did on the internet!"

Ultimately, after a thirty-minute tussle, the man finally got up to leave, but only after I showed him his perfectly normal blood test results. Even as he walked out, I could clearly hear him muttering, "The doctors here are so incompetent. I should go to another hospital."

I wished the best of luck to whichever poor soul was on duty at the next ER he visited.

Lunchtime. Huddled in a corner of the residents' office, I poured hot water into a cup of instant ramen. Kim Ji-hoon sat down next to me and let out a deep sigh.

"Hey, that's the first time I've ever seen the department chief smile at you. Are you really going to Internal Medicine?"

"I'm not."

"Bullshit!"

This bastard wasn't listening to a single word I said.

Colds, enteritis, headaches, dizziness. And the occasional nuisance squeezed in between.

By the time the sky outside grew dark, I was staring blankly at the EMR screen. The screen was still packed with a dense list of patient names.

Sigh, I'm tired to death. Where did my day off go? I was completely robbed of yesterday. But in exchange, I survived today's conference. Was that a fair trade? I had no idea.

The Human UpToDate. The new star of the ER. The crazy bastard preparing for a double board. All sorts of ridiculous titles were being plastered onto my name, but reality remained unchanged. I was still just a miserable first-year resident.

"Aaaargh! Doctor! My back! It feels like my back is breaking!"

Bed 15, Zone B. A man who looked to be in his mid-thirties was rolling around on the bed, screaming at the top of his lungs.

"Sir, pull yourself together. Where does it hurt, and how?"

"I don't know! It just... it just feels like my back is snapping! Argh! I think my old herniated disc ruptured! Please, give me a strong painkiller..."

The man was practically crying, looking ready to grab the hem of my pants at any second. I pressed on his back and legs to perform a neurological exam. There were no clear signs of motor weakness or sensory deficits. Yet, the man's expression was incredibly desperate.

"The one I used to get... Pethidine, I think? I felt better after getting that. Can't you just give me some of that? Please?"

I pinched the bridge of my nose. Eventually, I walked back to the station and sat in front of the computer. I opened the man's chart and pulled up the order window.

My finger hovered over the Enter key. Really? Is it okay to just give it to him like this? Something felt off. I couldn't shake a lingering sense of unease. Was it my instinct as a doctor, or just my survival sense as a slave?

Screw it, I don't know. Let's just ask. I summoned the blue interface in my pupils. Asking a senior about something like this felt awkward, so the gallery was the perfect place.

The comment section was quiet. The internal medicine ghosts didn't seem to care about a mere pain patient, and the other surgical ghosts were the same. Ah, screw it. Let's just give it to him. Just as I was about to bring my finger back to the Enter key—

DUR. Ah. Ah, shit. Swearing under my breath, I hurriedly pulled up the DUR. A new pop-up window filled the screen. And I couldn't believe my eyes.

A list of narcotic painkillers filled the screen. This bastard had been touring multiple hospitals over the past ten days, sweeping up narcotic painkillers. This was textbook doctor shopping.

I leaned back in my chair, feeling the strength drain from my entire body. How could those other doctors just hand out narcotics without checking... No, it probably meant his acting was just that good.

Meanwhile, new comments were starting to pile up under my post.

Cold sweat broke out on my forehead as I read the ghosts' banter. What if I hadn't checked the DUR and pressed Enter? I would have added the name 'Sucker Doctor Han Hyeon-jae' to that junkie's shopping list.

I snapped out of it. I moved my mouse to close the DUR window and delete the order. "Phew..." Right at that moment, a massive shadow loomed over my back.

"What are you doing?"

Standing there with his arms crossed, looking down at me, was Lee Min-jae, the fourth-year chief resident of Emergency Medicine. I had no idea how long he'd been there. His gaze was locked onto the computer screen where I had almost placed the order. I was screwed.

"You were going to give him Pethidine?"

"Just like that? Without checking the DUR, without properly evaluating the patient's condition, you're just going to hand it over because he asked for it? This is exactly why first-years shouldn't be given ordering privileges..."

I couldn't say a word. No, that's why I checked! I asked the gallery, checked the DUR, realized he was a junkie, and was just about to delete the order! The scream inside my head couldn't make it past my throat.

To the chief, I must have looked like a thoughtless first-year rookie who got fooled by a junkie's acting and was caught right before prescribing narcotics. And that was half-true. If it weren't for the gallery, I really would have pressed Enter.

The chief's scolding was long and harsh.

"The ER is not a marketplace. We aren't a vending machine that spits out whatever drug a patient asks for. Get your head in the game!"

"I'm sorry."

"Every single order you write must have a reason, evidence, and responsibility behind it. If you feel even slightly uneasy, check and check again. Ask a senior. If you still don't know, look it up in a textbook."

"..."

"Checking the DUR doesn't even take thirty seconds."

After a storm of nagging that felt like it lasted forever, the chief let out a deep sigh and turned around. "Don't let this happen again. Understood?"

"Yes, sir. I'll keep that in mind."

Even after the chief's back disappeared from view, I stood there as if nailed to the spot for a long time. I felt humiliated and wronged. But in one corner of my mind, a realization began to dawn.

Until now, I had been using the gallery like an all-powerful cheat key. Whenever I got stuck, I just posted a question. When an answer came, I parroted it. In doing so, I was skipping the most crucial step of being a doctor: thinking. The process of doubting, contemplating, finding evidence, and verifying.

"Ah. I need to stop living without thinking."

I muttered quietly to myself at the empty station.

After that day, a subtle change occurred in my ER life. Of course, it was still just as exhausting and miserable, but I decided to stop relying entirely on the gallery. I resolved to trust my own head, my own hands, and my own eyes first. Naturally, that process was far from smooth.

A child sitting on an ER bed was crying. A two-centimeter laceration gaped open on the child's forehead. Assuring the mother, I irrigated the wound and administered local anesthesia with lidocaine. Then, under a senior's watchful eye, I picked up the suture ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠kit. My heart fluttered slightly. It's fine. I practiced all night.

Stitch by stitch, just as the God of Scalpel had taught me. Slowly, but meticulously. The thread didn't tangle, and my fingers didn't get tied in knots like before. Of course, I was still clumsy. Yoo Sung-hoon, a fourth-year resident, watched my hands, clicked his tongue, and chimed in.

"Hey, you're tying the knots too tight. If you do that, it'll leave a nasty scar when they're removed. Tie them just enough so the edges barely touch."

"Ah, yes! Understood!"

I adjusted the tension as advised. After fifteen minutes, I finished the suturing entirely on my own. Yoo Sung-hoon patted my shoulder as he walked past.

"Well, that's ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠actually half-decent."

At that casual remark, a smile crept onto my face despite myself.