Chapter 4 – Time in the Operating Room
The moment the operating room doors closed, time outside stopped.
Inside, another clock began to move.
Time was no longer measured in seconds, but in breathing, heartbeats, and the sound of suction.
Elias Lee was washing his hands.
The stream of water rose to his elbows and struck his skin.
He did not feel the temperature.
Only one structure existed in his mind.
The lateral tibial plateau.
Depression.
Split.
“Time-out.”
The anesthesiologist’s voice filled the room.
“Patient identity.”
“Male, forty-two.”
“Surgical site?”
“Right knee.”
Elias nodded.
Verification was not awareness—it was an obligation.
In the operating room, mistakes had no excuses.
The drapes were placed.
Only the knee remained exposed.
The swelling was still present.
The skin was tense.
The joint line was blurred.
“Fluoroscopy ready.”
The C-arm moved.
The outline of bone appeared on the screen—
colder, more honest than reality itself.
Elias took the scalpel.
The first incision was always short.
Not habit—conviction.
Unnecessary damage always demanded payment later.
Lateral approach.
Soft tissues were carefully retracted.
Less bleeding than expected.
“I see it.”
The depressed articular surface emerged.
It was different from CT.
What had been numbers on imaging was now texture.
“Elevator.”
The instrument was handed to him.
Elias lifted the depressed fragment gently—
micrometers at a time.
Too much force, and the opposite joint surface would fracture.
In that moment, he stopped breathing.
Now.
Reduction.
The joint surface returned to position.
Not perfect—
but as flat as possible.
“Looks good.”
The assisting fellow spoke.
Elias did not respond.
It was not over.
The split line remained.
Thin, not long—
But if ignored, the entire structure could fail.
“Plate.”
A locking plate was placed.
Positioned.
Screws inserted one by one.
The first screw was the reference point.
If the angle was wrong, everything would be wrong.
“Angle is good.”
Fluoroscopy confirmed the screw did not violate the joint surface.
Second screw.
Third screw.
His wrist began to ache slightly.
He slowed down deliberately.
A fast surgery is not a good surgery.
“One more check.”
Fluoroscopy again.
The joint surface held.
Only then did he exhale.
Midway through the operation, silence filled the room.
Inside that silence, Elias saw a face from seven years ago.
A patient.
A case.
Back then, he had not created this scene.
Not created it—by choice.
This time is different.
Final sutures.
Nearly four hours had passed.
“We’re closing.”
Elias removed his gloves.
His hands trembled faintly.
As always, only after surgery did the tension return to his body.
The patient was transferred to recovery.
A face not yet fully awake from anesthesia.
Elias stood still for a moment.
Under the OR lights, the plate and screws replayed in his mind.
A choice I can explain.
The question he had asked himself before surgery.
On the way back to the doctor’s office, he saw his reflection in the window.
He looked older.
But it was fine.
A doctor, he thought, must age this way.
He opened his notebook and wrote one line:
— In the operating room, it is not time that flows, but choices.
He set down the pen.
Now, only the outcome remained.
Chapter 5 – The Weight of a Single Screw
The end of surgery is not the end of everything.
In fact, that is when another kind of time begins.
The time of waiting.
And the time of doubt.
Elias Lee arrived at the hospital early the next morning.
By habit, he opened PACS first.
Postoperative X-rays and CT scans were aligned.
He opened them slowly.
AP.
Lateral.
Oblique.
The plate was where it should be.
Screw lengths were appropriate.
No joint surface violation.
“Looks okay.”
Minjae said carefully.
Elias nodded—but did not close the screen.
“On the surface.”
He zoomed into the CT again.
A tiny step-off of the articular surface.
About one millimeter.
Numerically insignificant.
But he knew the time that number could create.
“Isn’t that within acceptable limits?”
Minjae asked.
“Acceptable is a standard,” Elias said quietly.
“Not an outcome.”
He pointed at the screen.
“This screw.”
The most lateral subchondral screw.
“This one carries the load.”
The memory of his wrist in the operating room returned.
The moment he paused to adjust the angle.
That choice was now here.
Rounds began.
The patient was awake.
Pain present, but expression stable.
“Doctor.”
“Yes?”
“Did the surgery go well?”
Elias hesitated.
Then said,
“It went according to plan.”
He did not use the word perfect.
Instead, he showed the X-ray.
“This is the plate. These screws support the bone.”
The patient nodded.
Understanding was uncertain—
but explanation itself was part of trust.
“When can I walk?”
“No weight-bearing for now.”
The patient frowned slightly.
“It will take time.”
Again, the word he had used most in this case.
Time.
Outside the room, the fellow Junho approached.
“You saw the step-off on CT.”
“I did.”
“I don’t think it warrants reoperation.”
Elias stayed silent.
He knew reoperation now would likely cause greater damage.
“But still…”
Junho continued.
“What bothers me is—
even if we didn’t make a mistake,
The result remains.”
Elias repeated the sentence in his mind.
That afternoon, labs came back.
No major issues.
Edema was controlled.
Yet one question circled endlessly in his head:
Was it enough?
That evening, he went to the hospital rooftop again.
The wind was cold.
Hands in his pockets,
he remembered the tremor in the operating room.
A doctor always carries two scales.
One is science.
One is conscience.
He took out his notebook and wrote:
— The weight of a single screw is not metal, but time.
Below, the lights of an ambulance passed.
Another case was coming.
Elias Lee walked back down the stairs.
The story was not finished yet.
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