Trauma Center : Golden Hour - Chapter 3

“Get out of the way!”

Kang-hyuk shouted at Jaewon, who was standing awkwardly in front of him.

Startled, Jaewon quickly stepped aside, looking flustered. Kang-hyuk shook his head as he glanced at him.

“You’re too slow. Look carefully. How does someone claiming to be in trauma surgery not know how to perform pericardiocentesis?”
“W-well… I specialize in proctology….” (T/N: Proctology is a medical specialty focused on diagnosing and treating disorders of the [rectum], [anus], and lower [digestive tract].)

Jaewon replied, his tone filled with a sense of injustice. It wasn’t a lie.

In today’s world, who in their right mind would choose trauma surgery as a subspecialty? Most hospitals with trauma teams had already downsized or disbanded them. Even if you were lucky enough to find a position, you’d be left pretending to handle trauma cases while dealing with endless administrative headaches.

In comparison, proctology, while not glamorous in name, had a bright future. Hemorrhoids were practically a modern-day epidemic.

“Proctology? Then why are you in the ER?”
“I’m on call for the team. General surgery, neurosurgery, and thoracic surgery rotate one doctor at a time.”
“Rotating duty, huh? What nonsense.”

Kang-hyuk clicked his tongue in disbelief.

Even as he continued grumbling, his left hand expertly held the ultrasound probe, pinpointing the pericardium. As he predicted, it was filled with dark blood, compressing the heart, which was struggling to beat.

“Hey, Anus.”
“It’s Yang Jaewon. Yang Jaewon.”
“I only call capable people by their names. So, you’re ‘Anus.’ Got it?”
“Uh…”

Calling someone “Anus” was beyond insulting, and Jaewon started questioning his career choice for the first time.

“Anus, since you’re already here, watch closely.”
“Y-yes…”
“Not that someone specializing in Anus would understand, but…”
“Don’t dismiss my specialty, please.”
“I am dismissing it.”
“Oh.”

Jaewon realized continuing this conversation would only ruin his mood further. He decided to stay quiet and just observe.

But he couldn’t stop himself from gasping when Kang-hyuk, holding the ultrasound probe with his left hand, smoothly inserted a large needle with his right.

“Ah.”

The precision and speed were remarkable, triggering memories of pericardiocentesis procedures Jaewon had read about while studying for his board exams.

Before Jaewon could say another word, Kang-hyuk had already inserted the needle into the pericardium and began speaking.

“When inserting the needle into the pericardium, never hold it vertically like you were doing earlier. Sure, you’d pierce the pericardium, but you’d also puncture the heart nine times out of ten. Unless you’re as skilled as me, of course… which you’re not, judging by how much you’re trembling.”

Kang-hyuk pointed to the angle he had used.

“Forty-five degrees to the left of the xiphoid process (the bony tip of the sternum). Like this, Anus.”

He could have taught this more kindly, but he chose to make every statement a provocation. Yet Jaewon was too mesmerized to feel offended.

Blood began filling the syringe Kang-hyuk was holding. As the dark blood drained from the pericardium, relieving the pressure, the heart began to beat properly again.

“Blood pressure is stabilizing…”

The resident who had been manually ventilating the patient checked the vitals, letting out a relieved sigh. Even the tone of his voice brought a sense of calm to the room.

Kang-hyuk, however, remained expressionless. It was as if this result was the bare minimum of what was expected.

“Hey, Anus.”

Instead of celebrating, Kang-hyuk turned to Jaewon. Jaewon hesitated, unsure whether to respond to the nickname or not.

But he couldn’t ponder for long. Kang-hyuk’s icy gaze made it clear that ignoring him wasn’t an option.

“Y-yes.”
“You’re quick to adapt. That’s good. Now, what’s next?”
“Next… next…”

Jaewon stammered like a student being questioned by a professor. Despite meeting Kang-hyuk for the first time, his imposing presence was enough to unsettle anyone.

Even earlier, when Kang-hyuk barged in and took over, none of the nurses or interns dared to say a word. There was a reason for that.

“Will you kill the patient by wasting more time?”

Kang-hyuk didn’t even wait ten seconds before following up. His sharp gaze stayed fixed on the vitals, clearly ready to take action if necessary.

“C-CT scan! Now that the breathing and blood pressure have stabilized… we should scan to assess the extent of the left upper abdominal injury!”
“Hmm…”
“That’s correct, right? That’s why you’re making that face, isn’t it?”
“No, I’m just doubting whether you’re really a licensed specialist.”
“D-doubting me? I scored the highest on my board exam.”
“That just makes me doubt you more.”

Kang-hyuk shook his head, turning his attention to the resident.

The resident gasped.

Kang-hyuk hadn’t even said anything yet, but his intense stare alone was enough to rattle him.

“What’s the blood pressure now?”
“Uh… 65 over 40. Huh?”
“It’s dropping again, isn’t it?”
“Y-yes… but why…”
“Don’t use vasopressors. Start a blood transfusion. The blood type should be ready by now.” (T/N: Vasopressors are medications that constrict blood vessels, increasing [blood pressure] and improving blood flow to vital organs during critical conditions like shock.)
“Y-yes.”

The resident rushed to the emergency blood storage, retrieving blood matching the patient’s type and beginning the transfusion.

Given that the heart had been compressed by blood earlier, indiscriminately using vasopressors could have caused another pericardial tamponade. Fortunately, the resident had enough experience to avoid such a mistake.

Just as the blood pressure was about to drop below 55, it stabilized.

Kang-hyuk turned to Jaewon with a slightly more relaxed expression.

“Still insisting on a CT?”
“N-no, sir.”
“Then what’s next?”
“Ah…”

Jaewon was on the verge of losing his mind. According to everything he had learned, a CT scan was essential. You needed precise information about the patient’s condition to plan treatment and perform surgery.

But every time he suggested a CT, Kang-hyuk dismissed it, and Jaewon couldn’t help but feel Kang-hyuk’s judgment was correct.

‘Surely… now it has to be CT.’

The pericardial tamponade had been resolved, blood was being transfused, and the patient was somewhat stabilized. Now they needed to assess the extent of the abdominal injury and move to the operating room.

“Let’s proceed with a CT scan.”
“Hey, Anus.”
“Yes?”
“Have you ever died because you couldn’t get a CT scan? Why are you so desperate to do it?”
“It’s standard protocol before surgery.”
“Standard? Who decided that?”
“Well… it’s common sense, isn’t it?”

Jaewon replied, looking as if he were the victim of a grave injustice. The other doctors in the room shared his sentiment.

If they were in a poorly equipped hospital or on the street, the situation would be different. But this was Hanguk University Hospital. It seemed absurd not to use the resources readily available.

Unfortunately, Kang-hyuk wasn’t satisfied with that answer either.

“Anus, take a look at the wound.”
“Huh? Oh, yes.”

Jaewon removed the blood-soaked gauze, revealing the stab wound from the sashimi knife.

“Anything strange about it?”
“Um…”

Jaewon stared at the wound with a confused expression. It looked the same as before—about 5 cm long, depth unknown.

“I don’t… I don’t see anything unusual.”
“Oh, dear. Our Anus…”

Clicking his tongue, Kang-hyuk gently ran his gloved fingers over the wound.

“Anything on my glove?”
“N-no.”
“You touched a knife wound, and nothing came off. What does that mean?”
“Oh, oh!”

Jaewon finally grasped the gravity of the situation.

“Hypovolemic shock!”
“Exactly. The pericardial tamponade was more urgent, but the hypovolemic shock didn’t just disappear. Think about it. This patient’s been stabbed for who knows how long—they’ve probably lost a lot of blood, right?”
“Y-yes! Then… we need to… ah, the blood’s already going in.”
“And yet, this is the situation. Soon… see, the bleeding’s starting again.”

Kang-hyuk pointed to the wound, which had been dry just moments ago but was now gushing blood.

Jaewon was horrified by the sight of blood flowing out with far more intensity than he had anticipated.

“This… this is bad.”
“The spleen isn’t just scratched—it’s been damaged internally as well.”
“Then what should we do?”
“You’re on call, aren’t you? What’s your plan? Still thinking about that CT?”

Jaewon couldn’t answer. Taking the patient for a CT scan now would surely result in their death. But heading straight to the operating room without scanning was equally nerve-wracking. Knowing the extent of the injury beforehand made a world of difference.

“Hey Anus, losing your nerve?”

Kang-hyuk patted Jaewon’s shoulder, his tone suddenly serious and composed, as if he were a different person.

“We’re going in for emergency surgery. Stab wound to the left upper abdomen, partial or total splenectomy. Notify the emergency OR team.”
“Y-yes!”

The resident dashed to the station and made a call. He remembered that today had a lighter-than-usual schedule of planned surgeries, meaning the anesthesiology team should have some availability.

“Hello?”

As expected, the anesthesiologist answered in a tired voice, likely annoyed at being bothered during what was usually a low-pressure shift.

“This is for the trauma team….”
“Yeah, yeah. You want to operate? Just transfer the patient to another hospital. Isn’t there a place nearby—Serin Hospital? They’re dying to take patients like this.”
“This patient’s too critical to transfer.”
“Goddammit… so we’re operating? Look, I was on call last night, and I’m supposed to be off this afternoon. I’m almost out the door.”
“Then could another doctor… we need to move immediately.”
“Are you kidding me? What other doctor?!”

The anesthesiologist vented his frustration, ranting as if he had no other outlet to express the injustice of being dragged into an emergency surgery.

“Is he dating someone or what?”

Kang-hyuk, watching the resident fumble with the call, walked over briskly and snatched the phone.

“Hey.”

The anesthesiologist, thinking the resident was still on the line, continued his tirade.

“You should’ve called earlier to give us a heads-up. What kind of fourth-year resident doesn’t have any sense? When are you going to grow up?”
“You’ve got a lot to say, don’t you?”
“Huh?”
“Didn’t you hear him? This is an emergency surgery. If you don’t get down here right now, the patient’s going to die.”

Kang-hyuk’s sudden, commanding tone caused the anesthesiologist’s voice to falter.

“Wh-who are you…?”
“Does it matter who I am? Who are ‘you’ to be lounging around on call?!”
“I-I was on call last night…”
“Save your excuses and get down here. If I take the patient to the OR and you’re not there, you’re dead.”