Chapter 15

“No one ever listens to me…”

Jang-mi shouted from behind Kang-hyuk, but no one paid her any attention.

No—they couldn’t afford to.

Beep, beep.

The monitors attached to the transport bed started blaring urgently.

The kind of sound that made a person’s heart sink just by hearing it.

“H-His blood pressure…!”

The patient’s heart rate plummeted, skimming the floor.

At the same time, his blood pressure was no longer registering properly.

This was happening without any significant external bleeding.

That meant there was only one likely culprit—a dangerous increase in intracranial pressure.

“Shit. Knew one hole wouldn’t hold for long. Push two vials of [dexamethasone] (T/N: a corticosteroid used to reduce swelling) IV. And start flooding him with [mannitol] (T/N: an osmotic diuretic used to reduce brain swelling by drawing fluid out of the brain tissue).”

“A-Ah, okay!”

Whatever complaints Jang-mi had just moments ago were instantly forgotten as she snapped into action.

Even if this was an emergency operating room, it wasn’t frequently used—but at least it was fully stocked.

She quickly injected the ordered medications into the IV line already inserted into the patient’s arm.

Meanwhile, Kang-hyuk pressed two fingers against the right side of the patient’s neck.

He was trying to palpate the [jugular vein] (a major vein in the neck that carries blood from the brain back to the heart).

‘His blood pressure is too low… I can’t even feel his veins—hell, I can’t even get a pulse on his arteries.’

But standing still wasn’t an option.

If they hesitated, they’d lose the patient before he even made it onto the operating table.

So, Kang-hyuk relied on his deep anatomical knowledge, his years of experience, and his razor-sharp instincts as he reached for a [central venous catheter] (a long, thin, flexible tube inserted into a large vein to administer fluids, medication, or monitor pressure).

“Wait—Professor, are you really inserting it now? Shouldn’t we at least use an ultrasound…?”

“Anus, the patient will be dead before we even get the ultrasound ready. You see that, don’t you?”

“That’s… true.”

“Then watch closely and learn.”

With that, Kang-hyuk decisively stabbed the catheter into the right side of the patient’s neck.

“Ugh…”

Jaewon instinctively reached up, rubbing his own neck as if he had felt the needle himself.

‘This is insane…’

The [jugular vein] runs right alongside the [carotid artery] (the major artery supplying blood to the brain).

Attempting a central venous catheter insertion without ultrasound guidance in a patient with low blood pressure was, by all logic, a reckless gamble.

At least, according to everything Jaewon had learned in medical school.

But when dealing with critical trauma patients, textbook knowledge meant nothing—only real-time patient status mattered.

Failing to recognize that would turn a salvageable patient into a corpse.

That’s what separated Kang-hyuk from the rest of Hanguk University Hospital—and most of South Korea’s medical system.

‘Push it in slowly… You can differentiate between an artery and a vein by feeling the needle’s movement.’

If the blood vessel were too small, the needle wouldn’t penetrate easily—it would simply slip aside.

Blood vessels, by nature, contract away from foreign objects.

But the jugular vein was too large to avoid the needle.

This meant Kang-hyuk could take his time, inserting the catheter gradually with unwavering precision.

Several layers of tissue brushed against the needle tip before shifting aside.

‘This is muscle… this is fat… this is…’

For a split second, something unusual caught against the tip of the needle.

It was only a fleeting sensation—barely perceptible.

But Kang-hyuk knew immediately.

That was an artery.

‘Elastic recoil is strong. That means I was aiming almost dead center. If that’s the case…’

Without hesitation, Kang-hyuk swiftly angled the needle backward.

Then, with calculated precision, he continued inserting the catheter.

This time, when the needle tip caught onto something, he didn’t hesitate—he pushed through.

Swoosh.

Immediately, dark red blood pooled at the catheter tip.

A hasty or inexperienced doctor might have assumed it was venous blood based on color alone.

But Kang-hyuk knew better.

With the patient’s severely low blood pressure, oxygen saturation levels had plummeted.

That meant even arterial blood could appear darker than usual.

So, instead of rushing, Kang-hyuk waited.

If he had hit an artery, the catheter would pulsate with each heartbeat.

A second passed.

Nothing.

“Good. We’re in the vein. Connect the IV line, then flush it with saline.”

“Will the intracranial pressure be okay?”

“We’ll fix the brain swelling in surgery. But we can’t fix blood pressure that way. Push the fluids now, or we’re going to lose him.”

“Understood!”

Jaewon immediately connected a bag of [Hartmann’s solution], adjusting the drip rate to maximum flow. (T/N: an IV fluid used to treat blood loss and dehydration)

With the IV fluids and medications now circulating, the patient’s blood pressure began to recover—just barely.

Even so, it was still dangerously low at 50/30 mmHg.

But considering it had been undetectable earlier, this was progress.

“The patient’s condition is… really bad.”

At that moment, Park Gyeong-won arrived.

His ears were flushed red—probably from being pulled away from his studies.

Under normal circumstances, he might have been annoyed.

But instead, he rushed straight to the patient’s head, helping push the stretcher toward the operating table.

“What happened?”

He glanced at Kang-hyuk, asking about the mechanism of injury.

It might seem unnecessary—after all, he just needed to administer anesthesia.

But knowing the injury’s cause was crucial for managing the anesthesia safely.

And Kang-hyuk appreciated that.

“He fell down a mountainside trail. About 5 meters.”

“Five meters…? Then his injuries might not be limited to just his head. Have any other scans been done?”

“You saw what happened. He’d die before we even finished a scan.”

“Then when we transfer him to the surgical table, I’ll keep his spinal board in place.”

“Good. I like that you’re sharp.”

With effortless strength, Kang-hyuk helped lift the patient onto the operating table—spinal board and all.

“BP’s still 50/30. Cause is intracranial pressure, right?”

“Yeah.”

“Alright. I’ll induce anesthesia using [remifentanil] (T/N: a short-acting opioid painkiller) and [ketamine] (T/N: a dissociative anesthetic that preserves blood pressure). If his BP drops too low, I’ll add a [vasopressor] (T/N: a medication that constricts blood vessels, increasing blood pressure, often used to treat severe low blood pressure). That okay?”

“Yeah. His heart looks stable.”

As Kang-hyuk spoke, he glanced at the ECG monitor.

All six cardiac leads showed a normal rhythm.

Of course, that didn’t guarantee survival—but it was better than nothing.

There were no visible injuries near the heart, so it was likely stable.

“Anesthesia is in place.”

At Gyeong-won’s words, Kang-hyuk nodded and extended his hand.

A nurse, who had been standing by for quite some time, immediately handed him the requested instrument.

“Good. Let’s start with the head first. We need to be fast. Stay sharp, everyone. Give me the [bovie electrocautery] (T/N: a surgical tool that uses electrical current to cut or stop bleeding).”

“Here.”

“Anus, move your hand when I tell you to.”

“Yes.”

“Now.”

“Yes, professor.”

As soon as Jaewon lifted his hand from the bleeding blood vessel, Kang-hyuk pressed the electrocautery tip against it.

Buzz.

Because the vein had been compressed for so long, very little blood was left to escape.

But even so, it had to be cauterized.

Even veins could continue bleeding once their cut surfaces were exposed.

In just a few seconds, Kang-hyuk finished cauterizing the vessel and extended his hand again.

“Scalpel.”

“Here.”

“Swap the blade. Use a #10 blade.”

“A-Ah, yes. Switching… Done.”

For cranial incisions, surgeons typically used a #15 blade, which had a finer tip for precision.

But Kang-hyuk didn’t have the luxury of precision—this surgery needed speed over perfection.

Given how much time had already passed since the accident, plus the uncertainty of prior treatments, speed was the only way to maximize survival chances.

“Anus, what are you waiting for? Pull!”

“A-Ah! Yes!”

At Kang-hyuk’s command, Jaewon grabbed the edges of the incision and pulled both sides apart.

Kang-hyuk then extended the incision with a swift stroke of the #10 blade.

The blade’s exceptional sharpness allowed him to move quickly and cleanly.

‘There’s barely any bleeding. That’s not because I’m skilled…’

It meant the patient’s condition was deteriorating.

Kang-hyuk’s hands moved even faster.

“Electrocautery.”

“Here.”

“What’s the power setting?”

“Fifteen.”

“Increase it to twenty.”

“Understood.”

As Jang-mi adjusted the power setting, Kang-hyuk had already inserted the electrocautery tip into the incision site, burning through the underlying tissue.

At the same time, Jaewon pulled back the scalp tissue, ensuring it didn’t get burned in the process.

Buzz—!

With the increased power, the underlying muscles sizzled violently as they split apart.

Under normal circumstances, Kang-hyuk would have clicked his tongue in disapproval at such a rough technique.

But right now, speed meant survival.

“Get the cranial drill ready. We’re about to expose the skull.”

“Yes!”

Without hesitation, Kang-hyuk peeled away the membrane covering the skull.

Unlike earlier in the helicopter, he now had a fully powered electrocautery unit, allowing him to work significantly faster.

Jaewon, watching up close, was shocked.

‘This is insane. How is he doing this so fast…?’

Anyone with experience in neurosurgery knew that separating the skull membrane was an incredibly tedious process.

But Kang-hyuk made it look like he was simply tidying up something that was already detached.

“Done. Give me the drill.”

“A-Ah, professor! The drill tip isn’t attached yet—”

“Didn’t you hear me say hurry up?!”

“S-Sorry! Here—!”

“Anus! Spray normal saline on the bone. The drill generates heat, you know this!”

“Y-Yes!”

Even as Kang-hyuk shouted, he had already brought the drill to the skull.

Vrrrrrrrr!

The horrifying screech of the drill cutting into bone echoed through the room.

Even though Jaewon had drilled cadaver skulls during his residency training, he still found himself wincing at the vibration.

‘The tremors must be intense… And what if he hits a blood vessel?’

But Kang-hyuk never once lifted the drill from the skull.

And somehow, there wasn’t a single drop of blood.

Jaewon would never understand why.

Because Kang-hyuk was seeing something others couldn’t.

‘The bone surface is red. There’s a blood vessel beneath it. I’ll reverse the drill direction here.’

The drill in his hands was a cutting drill.

If he reversed its rotation, it wouldn’t cut—it would crush.

Instead of slicing through, it would press down on the bone, clogging any smaller blood vessels with bone fragments, effectively sealing them off.

Screeech—!

Using this technique, Kang-hyuk controlled the bleeding as he continued drilling through the skull.

To the others, it simply looked like luck—like they had happened to avoid a major blood vessel.

“Alright, one hole done. Next!”