Doctor X Episode 9 Recap: A Surgery No One Can Do Alone

On the day doctors vote on a strike and mass resignation, Sujeong asks her colleagues to help save an eight-year-old.

Spoiler warning: This post covers the main plot and final scene of Doctor X: Mafia in White Episode 9.

Eight-year-old Hyeona has three months to live, at most.

The surgery Gye Sujeong (Gye Su-jeong) proposes means taking six abdominal organs out of the body, cutting away the tumor, and putting them back in. It’s a surgery she has never done, and one no one can do alone. But it falls on the day doctors vote on a general strike and mass resignation. The hospital director asks twice: “Is there anyone who will join this surgery as an operating surgeon?” No one raises a hand.

Doctor X Episode 9 Recap: A Surgery That Began on the Day of the Resignation Vote

The Graduation Sujeong Missed

Cuba, the day of medical school graduation. Jang Heesook (Jang Hee-sook) and Eunggu (Eung-gu) come to celebrate, but Sujeong is asleep in her room. She stayed up late observing surgery and slept through her own graduation.

Director Jang places a graduation cap on the sleeping Sujeong and holds a modest ceremony right there. Episode 8 opened with doctors taking the Hippocratic Oath. In Episode 9, Sujeong isn’t even at the ceremony. She’s a doctor for whom the operating room came before the oath.

Two Meanings of the Name Doctor X

The present. Watching Gaeul’s surgery, Director Jang recalls a conversation with hospital director Bu Seunggwon (Bu Seung-gwon). When he asked whether Gye Sujeong was Doctor X, Jang said yes. If Doctor X means a true doctor who thinks only of the patient, then she is. Then she warned him that if he keeps digging into Sujeong’s past, she won’t sit back and watch. “You have glaucoma, don’t you? Why didn’t you operate on Yeo Jeongsun (Yeo Jeong-sun)? I looked into why the so-called hand of God ended up dipping that hand in muddy water.”

Bu Seunggwon answers differently. Gye Sujeong is indeed Doctor X, he says. A doctor who takes on dangerous surgeries no one has established, an arrogant hand of God who weighs a patient’s life against her own skill. A name that carries both respect and contempt.

The Weight of the Name X

The doctor placement agency. Now that the name Doctor X has surfaced again, Director Jang says they should wash their hands of this hospital. Sujeong hands over Hyeona’s file. Malignant myofibroblastic tumor. Extremely rare in children, and there’s no surgery for it. Director Jang tries to stop her, saying that operating would only make her look more like Doctor X. Then she hands Sujeong a letter from abroad. If you won’t reply, at least read it. Sujeong never manages to read it.

As Sujeong searches for a way in her room, Eunggu brings her a peeled apple. Everyone but Director Jang feels differently. They encourage Sujeong. This child’s life matters more, they say. You have to find a way.

A Book Stained with Nosebleeds

The walkout begins. Clearing out his things from the department office, resident Ma Seonggyu (Ma Seong-gyu) opens the book Taekyung returned to him. Inside are both of their nosebleed stains, along with a note from Taekyung saying Seonggyu will become a great doctor.

Seonggyu remembers. During COVID in 2020, he went to a restroom to wipe away a nosebleed that had run under his mask, and that’s where he first met surgery professor Bae Heunggon (Bae Heung-gon). Bae, too, had come to wipe off a nosebleed brought on by overwork. At heart, they were doctors who devoted themselves to their patients.

What arrives for Seonggyu now is a back-to-work order from the Ministry of Health and Welfare. He walks out of the hospital and faces the reporters waiting outside.

A Conference Room Where No One Raised a Hand

The director’s office. Sujeong walks into the room where Director Bu Seunggwon and Professor Do Yunsik (Do Yun-sik) are sitting. She presses Bu: didn’t he promise to apply her “surgeries she wants to perform” clause more broadly if she finished Gaeul’s surgery in six hours? Do Yunsik objects that Hyeona is a child they sent away because surgery had no chance of success, but Bu’s answer is short. Do it. But convince the other professors.

At the conference, Sujeong presents a multi-organ ex vivo tumor resection with autotransplantation. It means taking all six organs, the stomach, pancreas, spleen, liver, large intestine, and small intestine, out of the body, removing the tumor, and putting them back in. A huge number of blood vessels would have to be cut and reconnected. Bae Heunggon calls it insane. When asked if she has ever done it, Sujeong says no. Bae says it’s bound to fail.

Do Yunsik sneers. “‘I don’t fail.’ Why aren’t you saying that now?” Instead of answering, Sujeong says something else. She needs a team to rebuild the six organs once they’re out. She’s asking for help. The surgery will take 15 hours. And to give the child a better chance of survival, they have to keep to that time.

Bu brings up approval from the IRB, the hospital’s Institutional Review Board, but that would take a week. When someone asks if she means to shake up other people’s careers too, Sujeong answers: “I want to save an eight-year-old’s life. As her doctor, I’m prepared to take responsibility for that decision.”

Bu asks the room. Is there any professor who will join this surgery as an operating surgeon? No one answers. He asks again. Still, no one raises a hand.

Sujeong puts a photo of Hyeona on the screen, her neck and hands covered in bruises, and bows her head. “Please.” As the professors start to leave, anesthesiology professor Jo Wonjin (Jo Won-jin) stands up. The IRB, the rally, they’re all excuses, she says. You should be ashamed.

“I Might Not Wake Up”

The hospital garden. Wonjin tells Sujeong, “I’ll open an operating room for you even if no one else shows up. You may say you never fail, but I never give up.”

Sujeong goes over the steps again and again, looking for ways to save time so she can operate even without a team. Then Hyeona comes in with her mother. She thanks Sujeong for operating on Gaeul and on Pogeuni, and for agreeing to the surgery no one else would do. When told she can thank Sujeong after the surgery, Hyeona says, “I might not wake up.” “That won’t happen. Because I never fail,” Sujeong answers.

Non-Alcoholic Beer and Tasteless Snacks

On the way home, Bu Seunggwon and Do Yunsik drink non-alcoholic beer outside a convenience store. Bu’s vision is fading from the center outward.

He confesses. He thought he’d feel good when Gye Sujeong bowed her head to him. He really thought he would. Do Yunsik replies, “These snacks don’t taste like anything.”

That night, Director Jang says she’ll go to the hospital tomorrow to end the contract. If the surgery fails, Wonjin and Taekyung will be finished too. Instead of answering, Sujeong shows her the photo of Hyeona.

In her hospital room, Hyeona skips her snack, saying she might have surgery tomorrow. She and her mother play a game, taking turns naming foods they want to eat together, when a clump of Hyeona’s hair falls out. Her mother hides it from her.

The next day. Hyeona opens her eyes to find herself being rushed down the hall on a gurney. She sees her mother crying.

The Day of the Strike and Resignation Vote: The Operating Room

Sujeong’s resignation letter is wedged into the door of Director Jang’s office. When Jang said she’d end the contract with the hospital, Sujeong resigned from the agency instead.

Hyeona’s operating room. Sujeong announces the multi-organ ex vivo tumor resection with autotransplantation. Only Sujeong, Wonjin, and Taekyung are in the room. The goal is fifteen hours. When they open Hyeona up, a massive tumor appears. In the director’s office, Lee Seonae (Lee Seon-ae), head of the strategic planning team, explains that in an emergency, the surgery can be reported afterward. But it could clearly still become a problem.

Do Yunsik Walks Out of the Vote

The voting hall. With the Magnolia Society’s backing, Kim Changsu (Kim Chang-su), president of the Seonam City Medical Association, gives a speech. In it, there are no patients, only the rights of the white coat. A resignation requires more than 80 percent in favor.

Do Yunsik, who got a call before the meeting that the surgery had begun, can’t sit still. Finally, he can’t hold out any longer. He jumps to his feet and runs to the operating room. The Magnolia Society men watch with disapproval.

Stepping into the operating room, Do Yunsik says, “My career’s going to take a hit today too.” Director Jang rushes to the hospital as well. She reaches for a drink and gets scolded by Eunggu and Migyeong (Mi-gyeong), and when Eunggu puts acupuncture needles in her trembling hand, the tremor settles.

With Do Yunsik on board, the surgery continues. Organs are lifted out of Hyeona’s tiny body in a single mass. Perfusion begins on the removed organs. Now the real surgery starts.

Her blood pressure drops. Any lower, and she’ll suffer brain damage. Do Yunsik desperately shouts for someone, anyone, to be called in. The operating room door opens, and Director Jang walks in.

“Surgeon Jang Heesook.”

As everyone stares in shock, Sujeong says, “She’s my mentor.” Jang looks at Sujeong. She seems angry, but there’s something else in her expression that’s harder to read.

What Does “Doctor X” Actually Mean?

“Doctor X” comes from the Japanese original, Doctor-X: Surgeon Michiko Daimon. In the original, Doctor X wasn’t the name of a single person. It was what people called surgeons who threw themselves into dangerous operations whose methods hadn’t even been established. The name carried both respect and irony: “Doctor X” was what people called these “devil surgeons” who put patients’ lives on the line. That is exactly the Doctor X Bu Seunggwon describes in Episode 9, and the Doctor X Director Jang describes is the respect within that name.

The final scene follows the original as well. Just as Akira, the head of the placement agency in the original, turned out to be a surgeon once called Doctor X and Michiko’s mentor, Director Jang was a surgeon and Sujeong’s mentor. I covered the differences from the original in *Doctor X Korean vs. Japanese*.

Until now, the words that defined Sujeong were “I don’t fail.” In Episode 9, an equally important line is “Please.” I believe Episode 9 is less about who got the meaning of Doctor X right and more about who answers that plea.

What Is Hyeona’s Malignant Myofibroblastic Tumor?

Myofibroblasts are cells that multiply as wounds heal, with traits of both fiber-producing cells and muscle cells. One example of a tumor that arises from them is the inflammatory myofibroblastic tumor. It’s found mostly in children and young adults, often in the lungs or abdomen. It rarely spreads to distant parts of the body, but it tends to invade nearby tissue and come back, so it’s classified as an intermediate tumor, somewhere between benign and malignant.

The standard treatment is surgery to remove the tumor completely. The problem comes when, as with Hyeona, the tumor is wrapped around abdominal organs and major blood vessels. Removing it inside the body would mean cutting the very vessels that keep those organs alive. That’s why the other doctors said there was no way to operate. The ex vivo surgery Sujeong proposes is a way past that wall.

What Is a Multi-Organ Ex Vivo Tumor Resection with Autotransplantation?

When a tumor is wrapped around several abdominal organs and major blood vessels, removing it inside the body can mean cutting off the blood supply to those organs. In that case, surgeons can take the organs out of the body, preserve them while removing the tumor, and put back the ones that can be saved. That’s ex vivo resection with autotransplantation. “Auto” means the patient’s own organs are transplanted back in.

The team has to decide which organs can be saved and reconnect the blood vessels one by one so blood flows through the reinserted organs. While the organs are being handled outside the body, surgery continues inside the body too. Being good with a scalpel is one thing. Doing alone what several people need to do at the same time is another. That’s why Sujeong said from the start that she needed a team.

Has Surgery Like This Ever Been Done in Real Life?

Yes. In 2009, at NewYork-Presbyterian Morgan Stanley Children’s Hospital, a team led by Dr. Tomoaki Kato performed a similar surgery on seven-year-old Heather McNamara. She had an inflammatory myofibroblastic tumor, a disease whose name closely resembles Hyeona’s. The clinicians worked in three surgical teams, and the operation took 23 hours.

The surgery succeeded, and Heather went home four weeks later. But while her liver, small intestine, and large intestine were put back, her stomach, pancreas, and spleen couldn’t be saved. The surgeons made a pouch from intestinal tissue to take the place of her stomach, and having lost her pancreas, Heather will need insulin for the rest of her life.

There’s no confirmation that this case was the model for Episode 9. But knowing it took three surgical teams 23 hours, you realize how reckless a plan it is for just three people, Sujeong, Wonjin, and Taekyung, to finish in fifteen hours, and how heavy the silence in that conference room really was.

Can Lifesaving Surgery Be Done Before IRB Approval?

An IRB, or Institutional Review Board, reviews research involving human subjects in advance. In Korea, the Bioethics and Safety Act requires prior review for research involving human subjects. Surgery to treat a single patient isn’t automatically research, but if it is research that requires review, being an emergency doesn’t mean you can do it first and get approval later. The exception in Korea’s Emergency Medical Service Act covers procedures for explaining treatment and obtaining consent. It doesn’t exempt research from review.

What stayed with me longer wasn’t whether the procedure could be skipped. It was whether, when a dangerous surgery is needed, there’s someone beside you to share that risk. Do Yunsik, who walked out of the vote, and Jang Heesook, who opened the operating room door, answer that question.