A Physician’s Clinical Diary, Episode 45— Between Numbers and People —Surgery and Treatment of a Motorcycle Accident Patient(3)

Surgery and Treatment of a Motorcycle Accident Patient

Chapter 3: The Night Before Surgery


At night, the hospital reveals a different face.

When the daytime bustle drains away, only unresolved questions remain. This was the hour when Elias Lee thought the most—and wavered the most.

On the night before surgery, he opened PACS once again. He had already reviewed the images dozens of times, yet his hand moved the mouse by habit. Coronal, sagittal, axial. Zoom in, zoom out. As he repeated the motions, he questioned himself.

Is this really the right extent?

Additional MRI images had been uploaded. Soft-tissue injury. Signal changes in the lateral meniscus. Structures that could not be seen were always more talkative than the fracture itself.

Elias leaned back in his chair. The glow of the monitor covered half his face. Fifteen years into practice, the tension of the night before surgery had still not become familiar. In some ways, that unfamiliarity was what sustained him.

The door to the doctors’ office opened, and Minjae stepped in cautiously.

“You’re still here, sir.”

“Yeah.”

“Tomorrow’s case… is it weighing on you?”

Elias didn’t smile.

“There’s no such thing as a surgery that doesn’t.”

He pointed at the screen.

“Especially when it’s a joint.”

Minjae nodded. Silence lingered between them.

“Sir.”

“Yes?”

“What if… the classification is wrong?”

The question was simple—but dangerous. Elias did not answer for a long moment. Instead, he turned off the monitor and dimmed one of the office lights.

“The classification could be wrong,” he said frankly.
“Doctors aren’t gods.”

Minjae’s eyes widened slightly.

“Even so, you still have to choose,” Elias continued.
“And you have to take responsibility for that choice to the very end.”

With those words, a door in his memory opened.

Seven years ago.

It had been night then as well. He was much younger, much more certain. Lateral tibial plateau. Mild depression. He had judged it Type III.

Conservative treatment should be sufficient.

That was what he said. He avoided surgery. The patient thanked him.

Two years later, the same patient returned—this time with a limp.

The CT showed a clear collapse of the articular surface. It was already too late.

After that day, Elias understood something: delaying a decision is itself a decision.

Back in the present, he clenched his hand. A fine sheen of sweat formed on his palm.

“So tomorrow…” Minjae began.

“We’re going all the way to plating,” Elias said firmly.
“We’ll preserve the articular surface as much as possible.”

Minjae lowered his head.

As the night deepened, the ward grew even quieter. Elias made one more round of the patient rooms. The patient was asleep. His breathing was steady. Elias looked at the knee once more.

Will this knee be able to withstand time again?

He rehearsed in his mind the explanation he would give the family—risks, complications, rehabilitation. Yet after all those words, only one sentence ever remained.

— I will do my best.

Doctors pass through the night on those words.

Back in the office, Elias took out his notebook and wrote slowly.

— The night before surgery. The most dangerous thing is not fear, but certainty.

He set down the pen and looked out the window. Between the darkened wards, only the lights of the emergency room were still alive.

Tomorrow, he would have to choose again.
And that choice would once more change someone’s time.

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To be continued

https://medicalhumanstory.blogspot.com/2026/01/a-physicians-clinical-diary-episode-45_28.html

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