Chapter 84 – Future Plans of a General Hospital (1)

Emergency Center General Clinic, 6:50 a.m.

“Yejun, say ah~.”

Dowook shone a pen light through the open mouth of a four-year-old boy. After examining whether there was any wound on the surface of the esophagus or whether the larynx was swollen, he turned to the guardian standing next to him.

“He swallowed it straight down. His breathing looks good.”

The father, who seemed relieved, asked.

“Then what about the coin he swallowed?”

“If it went down his esophagus then it’ll come out of his stool. The location of the coin is…….”

Dowook looked at the X-ray he just took. The location of the coin was the upper esophagus. In this case, it was better to push it down with an esophageal dilator and wait for it to emerge on its own.

He was going to tell the father about this, but he heard the nurse’s voice.

“Dr. Dowook. The doctor on duty is here.”

When he turned his head, he saw an emergency medical resident approaching. It was Noh Myeong-deok, who firmly endured his first year of residency while being directly or indirectly educated by Seong Chang Soo.

“Thank you for your hard work, doctor. I’ll take over this patient.”

As a resident who had reached his second year, he was now a bit mature.

“Do you want to? It’s a pediatric case with a foreign object in the esophagus. The breathing is okay, but the patient finds it difficult to swallow.”

“Phew, kid. You should eat something delicious.”

Noh Myeong-deok patted the head of the boy sitting, with tears in his eyes and checked the X-ray.

“Sir, if you push the coin into the esophagus with the expander, you just need to check the stool for about four days.”

Noh Myeong-deok’s response was the same as his, so he thought he was liberated from the 12-hour long training session.

Dowook, who was slightly bowing and backing away, suddenly stopped walking in front of the child’s X-ray. The ratio was subtly different to call it a coin. Something that wasn’t the same size as a 100 or 500 won coin. Was it foreign currency?

Ji Hwi-gwan’s sense seemed to be exerting a strong warning, so Dowook immediately asked the child.

“Yejun, what you swallowed, was it a coin?”

“A round one.”

The child didn’t seem to be able to distinguish it well, so he took out his cell phone and searched for a picture of a 100 won coin and showed it to the child.

“Like this?”

The child shook his head. A 500 won coin got the same reaction.

Dowook turned to the child’s father and asked.

“What was Yejun doing before swallowing the coin?””

“He was playing with toys.”

Dowook searched for a picture of a button battery on his cell phone and showed it to the child.

“This one?”

He glanced and soon nodded. Dowook turned serious and immediately shouted at the nurse.

“Please prepare a catheter kit. The patient swallowed a button battery.”

At this, Noh Myeong-deok was also surprised and turned back towards the X-ray picture.

Dowook spoke quickly to the child’s father while preparing for the procedure.

“When a child swallows something that is not food, they often don’t know what it is. If it’s a coin waiting for it to come out is fine but this is a battery. It’s safer to take it out as soon as possible. If you agree, I’ll try to remove the foreign matter right away.”

Both the child’s father and mother nodded in surprise.

“Yejun, can you lie on your side?”

He stood next to Noh Myeong-deok who quickly assisted Dowook.

The mouth opener hung on the child’s mouth, and the airway was secured. A helping catheter was lifted to gauge the length of the esophagus.

“Do you want to do it?”

“I’ve never done an endoscopy on a pediatric patient…”

Dowook didn’t have any experience in responding to emergency pediatric patients either, but his hands naturally knew what to do since he had Chief Ji’s sense.

“I’ll do it then.”

Spray anesthetics were sprayed on the child’s neck.

Dowook slowly inserted the catheter into the child’s mouth after checking the balloon attached to it.

“Count up to 10 in your head, Yejun. Then everything will be over.”

Dowook felt that he had reached the place where the foreign substance was located because of the feeling at the end of the catheter. 3 ml of saline was inserted into the catheter.

As soon as the catheter was pulled out, the battery appeared through the child’s throat.

He used forceps to grab it, and put it on the cart’s plate.

Clatter.

“Phew.”

As expected, it was a battery.

“It ended well, sir.”

When the child burst into tears, his father quickly ran to hug him.

“Yeah, okay, okay. Our Yejun. You were really brave.”

Dowook smiled as he looked at the child who was crying loudly enough to wake everyone in the emergency room.

Noh Myeong-deok approached Dowook, who took off his sterile gloves after finishing his work.

“As expected of Dr. Park. If I had diagnosed it, I would have handled it as a coin. How did you know what it was by just looking at the X-ray?”

“That’s….”

Dowook couldn’t just say that he had a feeling so he was trying to think of an excuse when someone suddenly approached.

“Myeong-deok. As an emergency surgeon, don’t you do X-ray analysis training?”

It was Chief Ji Hwi-gwan who was on duty today.

Chief Ji touched the monitor on which the X-ray of Yoon Yejun was shown.

“Here. This circumference. It’s different from coins. Dr. Park figured it out at once. If you want to make the right clinical decision, make that effort.”

“I’m sorry, chief.”

“Go to the DB, analyze and write a report about 100 charts of patients who’ve swallowed foreign substances. And, did you leave the procedure to a doctor from another department because you lacked endoscopic experience?”

“I’m sorry about that, too.”

“There are numerous patients receiving gastroscopy at the general examination center, go apply for it and come back after performing it 100 times.”

It was a brutal follow-up.

Dowook had no choice but to cheer for Noh Myeong-deok, who was dealing with Chief Ji.

It had been 2 years since he first started. However, the responsibility as a doctor required of a second year was not light. Dowook hoped this year Myeong-deok could continue to endure.

Chief Ji turned to Dowook, who was about to leave the emergency surgery clinic.

“Dr. Park Dowook.”

“Yes, chief.”

“I think I see you often when I’m on duty these days.”

“I applied on purpose because I wanted to observe your emergency response method.”

Dowook quickly thought of an excuse although it was also the truth.

“By any chance, are you…”

Chief Ji’s eyes became intense as if looking at Dowook’s inner thoughts. Dowook became nervous under the intense gaze.

‘Professor Choi’s style is so different.’

To put it in movie terms, Commander Ji was a righteous hero, and Last Choi was more of an egocentric hero.

Even if they were both heroes, Chief Ji was the type who you couldn’t talk to and would only proceed his own way.

“…Are you planning to apply for the position of a professor once the regional trauma center is decided?”

“What?”

“I don’t think it’s a bad idea because there will be an opening for a professor in neurosurgery. Same goes for Seodaemun Fire Station. Seeing this silent enthusiasm, I like how you’re taking the initiative and helping us at the emergency center. I look forward to your kind cooperation.”

Misunderstandings were intertwined and unexpected words came out.

He said good-bye to Chief Ji, and tilted his head while walking in the hallway of the emergency room.

“He just said he would support me if I applied for the professor position in the regional trauma center, right?”

He wasn’t sure at first, but the meaning behind those words were as he thought.

The metropolitan trauma center was not decided, and the name Professor Park Dowook was a very attractive call.

“Anyway, it means he knows I follow him around whenever I’m on duty but he doesn’t mind. Let’s just focus on learning quickly.”

Seong Chang Soo yawned and walked out of the medical office when he encountered Dowook.

“Huh? Dowook, why are you coming from that direction? Were you on duty again?”

“You’re supposed to be in at 7 PM and you decide to crawl out at 7 PM?”

“I’m a staff member from this year. A regular shift is an option.”

“Oh, option. That’s why Chief Ji was happily waiting for you to be on duty. He was taking care of the staff options.”

Seong Chang Soo flinched at this.

“You’re so playful today. Chief Ji wasn’t on duty yesterday.”

“Can’t you see this face without a smile? You didn’t even check the changed work card…….”

He didn’t finish his sentence as Seong Chang Soo had already started running like lightning toward the emergency room.

-Hey! Get out of my way!

After getting on the elevator and getting off the seventh floor, Dowook went straight to the shower room used before surgery.

Shhhhhh!

After relieving the fatigue accumulated over 12 hours with a hot shower, he was planning to collapse and prepare for the afternoon surgery. Dowook, who was opening the door to the night shift room, recalled that there was a briefing session at 9 o’clock.

He picked up his cell phone and found information in the text piled up.

[1st quarter outpatient briefing – 6th floor auditorium]

This was an indispensable meeting because he had to work in the outpatient clinic starting next week.

The auditorium that could seat 300 was about half full.

Dowook sat leaning against the outer seat.

“Dr. Park?”

When he turned to the familiar voice, Professor Lee Won Seok caught his eye. Jeong Woo-seok, a pianist, who was under the charge of the Neurology clinic was the reason they knew each other. He was also one of the professors whose sense Dowook had borrowed.

“Hello, Professor Lee.”

“It’s been quite hard to see your face these days. Happy New Year.”

Professor Lee waved to the other professors in the department he entered with and sat next to Dowook.

“Is this the first time you’re taking on outpatient cases in your name?”

“Yes.”

In fact, there had not been so many outpatients. For surgeons, the ward treatment that they had while following professors was priority and daily life.

“I’m not worried much because it’s you, but to tell you one thing. You must build friendships with the doctors in the internal medicine department. When you diagnose, you’ll have a lot of patients that you’ll have to hand over to that side.”

“It’s… I’ve already had an argument with Chief Won Dong-gil. Because of Tom Brand.”

“That’s why I’m saying this. Chief Won complained openly at a company dinner at the beginning of the year. It had a lot of jealousy in it.”

Those on the board of directors’ side and those on the dean’s side.

The integrated internal chief was the former, and the last time Dowook talked to him, he had been forced to take the dean’s side.

“Maybe because the dean and vice-dean are all former surgeons, the internal medicine department is generally dissatisfied with how the hospital is being run. If anything uncomfortable happens in the process, let me know. I’ll try to mediate as much as I can.”

“Thank you for your consideration.”

“Instead of thanks, would it be alright if we cooperate on other cases at the clinic over patients who can be operated like last time?”

“I’d like that, too.”

During the conversation, the director of the outpatient affairs department of the secretariat, who hosted the briefing session on the podium, was appointed.

-Ah, since it is 9 o’clock, I’ll start. First of all, there will be a change in the number of outpatients from this quarter, so please check your email. If you don’t check and consider that your allowance has decreased, our people in charge will be in a very difficult situation. Key notifications for Q1 are…….

For about 20 minutes, suggestions requested by the nursing department continued on the news of interior construction in the outpatient public waiting area.

Dowook yawned out of exhaustion and covered his mouth.

‘I think you can just check your email for this. Why are there so many experienced professors here?’

He couldn’t ask Lee Won Seok about this part. Because it would be obvious that he was bored with this briefing session.

-……Then, from now on, the vice dean has something to say.

“Huh?”

Dowook had no choice but to focus and sit properly. Now that he was sitting up, he realized that the vice dean was in the front seat.

The vice dean got on the podium and began to talk.

-You are the faces of our hospital where you receive an appointment under your name and treat patients. Therefore, I think you will understand what I am suggesting is for the future of the hospital.

The vice dean continued to talk, slowly examining the 150 doctors.

-A 50-year-old man came to the hospital emergency room with a fever and severe headache. The examination confirmed a heart aortic abnormality. Which department should the patient go to first? Neurology? Cardio? Or, suspecting the virus. Infectious medicine? In the process, the hospital’s image is bound to fall as time is delayed, the patient is exhausted, and even the doctor is confused.

In line with the vice dean’s remarks, the phrase “first stage of the new year’s business plan” arrived on the rear screen of the auditorium.

-Our hospital has been treating patients centered on doctors so far. And they gained their own reputation in their respective departments. But what’s the result? Despite the size of the medical staff belonging to the Big 5, we have never ranked first in the evaluation of general hospitals. No, in the last 10 years, we have never even been in third place.

When the introduction phrase “integrated outpatient operation” appeared on the screen, most of those watching could not take their eyes off the screen.

It was because the participation reward written on it was so unconventional.

-It’s time for us to start patient-centered diagnosis and treatment. In line with that, we plan to open the first integrated outpatient room. It’s the second quarter. The number of members is only the most suitable from each department. As you can see, the reward is like this.

A doctor in the front raised his hand.

-Sir, is it possible to actually get an additional salary? A few months ago we were in the red.

-The budget has already been secured by an external consultant.

-How do you choose the right person?

-We will watch all of your outpatient courses in the first quarter and evaluate them. The main evaluation factor is not the amount of patients or the benefits brought to the hospital, but the cooperation with other departments. An impressive case will be widely disclosed to the public by the newly established content marketing team.

There was a sound of murmur everywhere. Dowook also turned to Professor Lee.

“Did you know that the vice dean would announce such a plan?”

“Just roughly. I only talked about you because you visited the clinic and found a case of integrated treatment. Oh, I can see it over there.”

The screen moved on to the next slide. The article was about Jeong Woo-seok. The vice dean looked at the screen once and said.

-I’m sure you all know this case. Earlier this year, I received a report that the number of patients booked for Neurology doubled compared to last year.

“Wow. Twice as much?”

“At the end of last year, it was three times more.”

“That’s why Jae-geol cursed me at the end of the year.”

“Ha. Did Dr. Son do that? It’s understandable. We’ve been busy.”

-The time when hospitals competed on the basis of only being good at treatment is over. If it is a hospital that can listen to the patient’s condition and present an accurate diagnosis and vision after treatment. I think we can be reborn as the best general hospital in the world beyond the best in Korea.

-Vice dean, is Tom Brand’s case going to be included in the selected score?

The vice dean’s gaze moved toward the integrated internal chief who asked.

-The surgery was over in the first quarter, so we can include it if you want.

-Well, I was only of little help at the time of the consultation, but it is what it is. You know that professors from the top 5 hospitals in the U.S. visited recently, right? I was amazed by the fact that I caught this esoteric tumor in the beginning and returned.

The chief’s intention was to take the lead in the evaluation and take a position, so other doctors’ eyes became sharp. Even professors in the same department viewed the integrated internal medicine’s chief with an undesirable view.

‘This means that I’ll be reflected in the evaluation too.….’

Profit even if you just stayed still. However, Dowook shook his head and raised his hand.

“Sir! You don’t have to include Tom Brand’s case. The diagnosis was last year, and he was not an outpatient.”

The chief of the integrated internal affairs department in the front seat turned his head in anger at the cry.

-Who are you to decide on…?!

The head of the integrated internal medicine department’s embarrassed gaze was focused on Dowook, who played the biggest role in the collaboration.

-Why is Dr. Park here…….

“From this year on, I’m also participating in outpatient activities.”

The head of the integrated internal medicine department, who was coughing in embarrassment as if he had a respiratory infection, turned towards the podium.