Chapter 25

“Blood pressure dropping! Administering [vasopressors]!”
(T/N: Vasopressors are medications that tighten blood vessels and raise blood pressure, used to treat severe low blood pressure (shock))

Jin-yong’s voice cracked with urgency as he called out the patient’s deteriorating status.

But even if he hadn’t screamed, everyone in the OR already knew things were bad.

Beep, beep.

The monitors had been shrieking nonstop for the past few minutes.

“Do it! Whatever works!”

Kang-hyuk barked back, his hands still deep in the patient’s abdomen, using the suction to clear the pooling blood.

To Jaewon and Jang-mi, it almost looked pointless—

Suctioning out blood, only for more to pour in.

A hopeless cycle.

Pouring water into a broken jar.

‘This isn’t good…’

Jaewon turned his head briefly.

Empty blood bags were strewn across the floor, like discarded snake skins.

‘We’re on the seventh pack already…’

They weren’t out of blood.

The patient was A-type, and this was a fourth-tier medical facility with a directly managed blood bank.

But blindly pumping in blood wasn’t a solution either.

If they weren’t careful, the patient could develop [disseminated intravascular coagulation]—a fatal condition where the body’s clotting mechanisms shut down.
(T/N: DIC is a condition in which excessive clotting depletes platelets and clotting factors, leading to uncontrolled bleeding.)

At that point, no one would be able to save him.

“Professor, switching blood bags.”

Jang-mi announced as she saw the assisting nurse swapping out the transfusion pack.

Eighth unit.

But instead of responding, Kang-hyuk abruptly shoved his left hand deep into the blood-filled abdominal cavity.

Then, he turned to Jang-mi.

“Found it. Suture.”

“…Huh? Found what?”

“The bleeding site. Give me the damn suture. My hands are slipping.”

“A-Ah! Yes, sir!”

Jang-mi had been holding a prepared suture all along, praying for this moment.

Praying that Kang-hyuk would find the bleeding source and stitch it shut.

Snap.

Kang-hyuk took the suture from her palm, his eyes still locked on where his hand had vanished.

Jaewon, on the other hand, couldn’t see a thing.

All he could make out was a mass of blood, obscuring everything.

But one thing was certain—

The insane hemorrhaging had finally begun to slow.

“Suction.”

“Y-Yes!”

“Stay sharp. I’m not the only one performing this surgery.”

“Understood!”

Jaewon maneuvered the suction carefully around Kang-hyuk’s hand.

For the first time, the relentless blood flow eased, revealing what Kang-hyuk had been gripping—

The [superior mesenteric artery], branching off from the abdominal aorta. Nearly severed in half.
(T/N: The superior mesenteric artery supplies blood to a significant portion of the intestines. Severe injury can cause massive hemorrhage.)

“So that’s what it was…”

Jaewon nodded grimly.

A tear like this could absolutely explain the near-fatal level of bleeding.

Kang-hyuk didn’t waste time marveling—he had already predicted this.

Pop.

With one swift motion, he began suturing along the ruptured artery.

There was no time for a slow, meticulous stitch.

Instead, he used a [continuous suture technique], stitching rapidly along the cut in one uninterrupted motion.
(T/N: Continuous sutures are faster but require precision to avoid leakage or further tearing.)

‘Fast… He’s unbelievably fast.’

Even though it was a continuous suture, Kang-hyuk’s hands moved so quickly it almost looked like a sewing machine stitching fabric together.

“That should do it.”

The moment he completed the final stitch, Kang-hyuk pulled his hand away.

The difference was immediate.

The once endless hemorrhaging had almost completely stopped.

Of course, small amounts of blood still leaked here and there.

But Jaewon could handle those minor bleeds on his own.

“Set the Omni retractor. Anus, cauterize every visible bleeder.”

“Yes, sir.”

Unlike other retractors, the Omni retractor didn’t require a person to hold it in place—it was self-retaining.

In North America, it was commonly used to cut down on labor costs.

Here, in trauma surgery, it was simply because they didn’t have enough staff.

The team was so used to working short-handed that they handled the equipment instinctively.

Jaewon positioned the Omni retractor to provide the clearest surgical view, then picked up the electrocautery.

“Alright…”

Meanwhile, Kang-hyuk took a warmed saline solution from Jang-mi and poured it into the abdominal cavity.

As the warm fluid filled the space, tiny, hidden injuries began to reveal themselves—blood oozed slowly from sites that had gone unnoticed before.

This was one of the best ways to identify subtle internal bleeding.

Buzz.

Jaewon pressed the electrocautery to each newly exposed bleed, burning the tissues shut.

Kang-hyuk always emphasized, “When stopping a hemorrhage, assume that every single red blood cell counts.”

So Jaewon, being his disciple, cauterized with extreme precision.

Soon, the surgical field looked much cleaner.

That didn’t mean the patient’s condition had improved—but at least they had stabilized the bleeding.

“Professor… What do we do about this part? I can’t cauterize it all…”

Jaewon hesitated, pointing at a specific area.

Kang-hyuk followed his gaze and frowned.

The organ still actively bleeding—

Was the liver.

“Hm. This is…”

Jaewon had only been looking at the bleeding sites.

Kang-hyuk, however, was looking at the entire organ.

And his expression was even darker.

“…He has [liver cirrhosis].”
(**T/N: Liver cirrhosis is severe liver scarring caused by long-term damage, which can lead to liver failure.**)

“What?”

The one most shocked by that statement wasn’t Jaewon—

It was Jin-yong.

Cirrhosis?

That meant the patient’s liver function was already severely impaired.

Which, in turn, meant Jin-yong needed to radically reduce the dosage of certain anesthetic drugs.

“Pull up his test results. They should be out by now.”

Instead of responding to Jin-yong, Kang-hyuk turned to the assisting nurse next to Jang-mi.

Unlike the rest of the surgical team, the assistant wasn’t in sterile gear, meaning they were free to handle the computer.

“Yes, Professor. Checking now… Patient is still listed as ‘Unidentified Male.’”

Either the patient’s identity hadn’t been verified yet, or the administrative office hadn’t processed it.

Regardless of whether the patient was truly unidentified or just awaiting administrative processing, one thing was certain—

His next of kin hadn’t been contacted yet.

“Well, that’s something we can deal with after saving him. For now, pull up the test results.”

“Yes, sir. The tests are being processed in 30-minute intervals. The latest results we have are from an hour ago.”

“Fine, let’s see them.”

In cases of major surgeries like this, continuous testing was essential.

A patient’s condition could shift drastically during an operation.

Fortunately, Hanguk University Hospital was meticulous about these protocols.

Thanks to that, Kang-hyuk had no reason to complain as he scanned the data.

“Platelet count is low, but… still within normal range. When was this sample taken in terms of transfusion volume?”

“At two units.”

That’s practically nothing.

It meant the test results only reflected the patient’s baseline condition before massive transfusions began.

In other words, it wasn’t enough to determine if [disseminated intravascular coagulation] had set in yet.

That said, if DIC had already started, they would be seeing catastrophic bleeding from everywhere by now.

Still, Kang-hyuk wasn’t taking any chances.

“We’ll have to keep watching. Now, liver function tests… Hm.”

“The values are technically within normal limits.”

“The [viral marker] test was included, right?”
(T/N: Viral marker tests check for infectious diseases like hepatitis, which could affect liver function.)

“Yes, but that won’t be ready until the standard processing time.”

“What’s the point of running an emergency department overnight if the lab still works business hours?”

Kang-hyuk grumbled but didn’t push further.

Instead, he refocused on the patient.

A normal liver function test in a patient with cirrhosis was not a good sign.

It didn’t mean the liver was fine—

It meant the liver was so damaged that no more functioning cells were left to even produce abnormal results.

In other words, this patient’s liver was barely functioning.

“Let’s check the injury again.”

“Yes, Professor.”

“Wipe it down with gauze. No suction—be gentle and slow.”

“Understood.”

At Kang-hyuk’s direction, Jaewon carefully dabbed at the liver with damp gauze, wiping away the blood.

The impact had likely been concentrated on the upper right abdomen.

The entire liver was swollen, and the lacerations were extensive.

A ruptured liver.

It was hard to imagine how much force had been involved.

‘The backseat passengers died instantly…’

If the front-seat occupants had suffered this much trauma, it made sense.

Kang-hyuk’s expression darkened as he continued inspecting the damage.

No matter how he looked at it, less than a quarter of the liver was salvageable.

“Professor, I think we need to resect at least 80% of the liver.”

Jaewon’s voice was grim.

He pointed to the liver, which looked shredded beyond repair.

Normally, Kang-hyuk would have chewed him out for suggesting such a drastic measure so quickly—

But this time, he agreed.

“80%. Yeah… That’s the only way to stop the bleeding. The damaged tissue is unsalvageable anyway.”

“But… can he survive after that?”

Jaewon asked, hoping—praying—for Kang-hyuk’s usual confidence.

But Kang-hyuk couldn’t lie.

He wasn’t the type to give false reassurances.

“No. The chances are slim.”

“Then… shouldn’t we just close him up?”

Jaewon had always been pragmatic.

If the patient was going to die, then it was better to leave his body intact so his family could see him in a dignified state.

“No. Medicine is always a numbers game. There’s no such thing as a 100% fatal case.”

“But—”

Kang-hyuk cut him off.

“The transplant coordinator who clocked in earlier—he was handling an organ donation case, right?”

“Ah, yes. But by now, the allocation must be complete.”

Jaewon glanced at the clock.

It had been an hour and a half since the coordinator arrived.

If everything had proceeded smoothly, the donor’s liver might already be in another operating room being transplanted.

“You never know. This is life-and-death—we have to ask.”

“Understood.”

Once Kang-hyuk made up his mind, there was no arguing.

Jaewon gestured to the assisting nurse to make the call.

Fortunately, the coordinator hadn’t left the hospital yet and picked up immediately.

“Yes, this is Kang Chang-soo from the Transplant Surgery Department.”

“Ah… Doctor Kang, it’s been a while. This is Yang Jaewon from Trauma Surgery.”

“Ah, Doctor Yang! It has been a while. What can I do for you?”

“We have a patient in urgent need of a liver transplant. Would it be possible to allocate an organ for them? There was a brain-dead donor earlier, right?”

“Yes, but…”

The coordinator hesitated.

Then, after about a minute of silence, he spoke again.

“The donor’s next of kin said they would come in to give consent… but they still haven’t arrived. And now we can’t reach them.”