Trauma Center : Golden Hour - Chapter 4

“Wow.”

The resident gave a discreet thumbs-up.

After all, wasn’t the anesthesiology department considered the most powerful in the hospital hierarchy? Outsiders might think that operating rooms magically opened when needed, but that was far from reality.

‘Hey, the anesthesiology team is going on a retreat soon. Get them a bottle of liquor. Oh, I spent a fortune on this one… couldn’t even take a whiff myself.’

It was practically tradition for every surgical department to offer a bottle of premium alcohol to the anesthesiology team whenever they had a gathering.

And yet here was a trauma surgery professor, from arguably the lowest rung of the surgical ladder, mercilessly berating an anesthesiology clinical instructor.

‘Is he insane?’

The resident was thinking this when Kang-hyuk locked eyes with him. He let out a small groan.

Kang-hyuk’s face had already been intimidating before, but after his outburst, he looked like the devil incarnate.

“What are you staring at? Are you crazy? Get ready for the operating room!”
“Y-yes, sir.”
“And where are you running off to? Tell them to prepare the surgical instruments. Open-heart procedure.”
“Y-yes, doctor!”

After tearing into the resident, Kang-hyuk headed back to the treatment room.

Blood was now being transfused through the central venous catheter, but the wound continued to bleed heavily.

Anus (Jaewon) was firmly pressing down on the wound with a wide, thick gauze pad.

“Hmm.”

Kang-hyuk inspected the area, looking a bit concerned. Many so-called specialists couldn’t even manage something as basic as applying proper pressure to a wound.

But Anus was different.

‘Not bad, Anus. You’re actually doing this effectively.’

There were generally two ways to control bleeding from a wound. If blood was simply oozing from the cut surface, you pressed directly on the cut. But if the source was a visible blood vessel, compressing the vessel itself was far more effective.

Anus was currently pressing on the vessel from inside the abdomen, while keeping pressure on the wound surface. Thanks to his efforts, the bleeding wasn’t as severe.

“Anus, keep pressing just like that. You’re doing well.”
“Ah, th-thank you.”

Anus nodded, wondering whether that was a compliment or an insult. Being called “Anus” made it sound like he was being praised for holding in bowel movements or something equally ridiculous.

“Hey! Resident! Did you call the operating room?”

Kang-hyuk turned away from Anus to look outside. The resident nodded enthusiastically.

“Yes, sir! You can head there now.”
“What do you mean, ‘you can head there now’? You’re coming with us!”
“Me? But I need to stay and monitor the ER.”
“Do you have a more critical patient than this one?”
“N-no.”
“Then come along. If something happens, having one more pair of hands, no matter how clumsy, is better than nothing.”

Dragging another person along, Kang-hyuk grabbed the gurney carrying the patient.

“You, just focus on pressing that wound!”
“Y-yes.”

Kang-hyuk preemptively stopped Anus from trying to help in any other way. He gave similar instructions to the resident.

“Just monitor the ventilation! Keep squeezing that bag!”
“Y-yes, sir!”
“I’ll handle the vitals. Just keep ventilating like you’re doing now.”
“Understood.”

As Kang-hyuk promised, he kept his eyes glued to the monitor displaying the patient’s vitals as they moved toward the operating room.

Last year, Hanguk University Hospital had received funding from the Ministry of Health and Welfare to remodel the ER, adding a dedicated operating room right next to it.

Though the room was rarely used and had been criticized as a waste of taxpayer money, it was now proving its worth.

“Ah, that new building smell.”

Kang-hyuk wrinkled his nose as he entered the operating room, which smelled like stale air mixed with the unpleasant odor of new construction.

To Anus and the resident, it was simply uncomfortable. But to Kang-hyuk, it was infuriating.

“Are you kidding me? Who’s in charge of this room?”

The nurse who had been quietly doing her job finally spoke up.

“We rotate shifts here.”

Kang-hyuk found her far more reliable than Anus, so his tone softened slightly.

“Did you set up positive pressure ventilation? How can you let the air circulation be this bad?”
“I’m sorry. There were no specific instructions….”
“Who’s the trauma team leader right now?”
“The hospital director, temporarily….”
“Of course. Turn it on immediately.”

That the overburdened hospital director was also acting as the trauma team leader spoke volumes about how little they cared about running the team properly.

‘Whirrr.’

Thankfully, the positive pressure ventilation system worked flawlessly, quickly clearing the stale air.

“Alright, move the patient onto the table.”

“One, two, three!”

As the medical staff, including Anus, moved the patient onto the operating table, the operating room door slid open with a mechanical sound.

A man with bloodshot eyes and slumped shoulders walked in—Hwang Sun-woo, the anesthesiology on-call doctor.

He was notorious even among the notoriously prickly anesthesiologists.

“Finally here? You’re from anesthesiology, right?”
“Y-yes. You’re the one who called earlier….”
“That’s right. Normally, you’d be in big trouble for being late, but the patient is here, so let’s start. It’s an open thoracotomy, so prep for that.”
“Uh… sure…”

Sun-woo’s face twisted into a grimace.

It was understandable. Surgeons usually had to “ask” anesthesiologists for cooperation, not bark orders at them like this. And to make matters worse, the person in front of him was someone he’d never seen before.

‘Is this the guy they scouted?’

Rumor had it that they’d brought someone in from some volunteer organization. Clearly, that was wrong.

No one from an organization like that would have such a terrible personality.

“What are you hesitating for? Don’t tell me you’ve never done anesthesia for an open thoracotomy before.”
“I’ve done it.”
“When?”
“During residency…”
“So, never solo, huh?”
“Does it make a difference?”

Kang-hyuk’s face contorted in frustration.

Saying that there was no difference in administering anesthesia for an open-heart surgery was nothing short of madness.

“Try stepping out of line. If you don’t follow my instructions exactly, you know what’ll happen, right?”
“Got it. I’ll proceed.”

Sun-woo, the anesthesiologist, answered half-heartedly without even looking at Kang-hyuk. He then checked the tube in the patient’s mouth and connected the anesthesia machine.

“Alright, let’s start with this…”
“Are you out of your mind?”

Kang-hyuk slapped the vial of propofol out of Sun-woo’s hand, sending it crashing to the floor.

Even the resident and Anus, who were annoyed with Sun-woo, thought this was excessive. Naturally, Sun-woo looked at Kang-hyuk with disbelief, though he quickly averted his eyes.

“What the hell are you doing?”
“Who uses propofol for heart surgery, especially on a patient with unstable blood pressure? Do you want to kill them with hypotension? Will you take responsibility for that?” (T/N: Hypotension is [low blood pressure], where the force of blood against the artery walls is too weak. This can reduce blood flow to vital organs, causing symptoms like dizziness, fainting, or even shock in severe cases.)
“Ah…”
“Where were you originally assigned?”
“Otolaryngology…”
“Figures.”

Otolaryngology (ENT) surgeries were usually short and uncomplicated. While head and neck cancer surgeries could be grueling, most patients in that department were in stable condition.

That might explain Sun-woo’s behavior, but even so, Kang-hyuk couldn’t believe his lack of competence.

‘How can someone be this clueless? Did he not study at all?’

Kang-hyuk wanted to walk out then and there. In less than an hour, he had seen just how poorly the trauma team was being run. But the patient was already on the operating table. Kang-hyuk wasn’t the type to abandon a patient under his care.

“Use etomidate. It’s the best option for now. We’re not just operating on the heart—we need to check the abdomen first.” (T/N: Etomidate is a [short-acting anesthetic] commonly used to induce general anesthesia or sedation, particularly in critically ill patients. It is preferred in cases where maintaining stable [blood pressure] and [cardiac function] is crucial, as it has minimal effects on the heart and circulation.)
“Ah… Fine. I’ll do that.”

Sun-woo reluctantly prepared the etomidate and administered it through the patient’s IV line. The patient, already unconscious, fell into a deeper state of sedation.

“Good. Now, head back to the ER and keep an eye on things. Anus, clean the patient’s abdomen and chest thoroughly. For the draping, expose both areas together.”
“Yes, doctor.”

Anus responded with a firm nod, completely different from when he first met Kang-hyuk. Everything Kang-hyuk had done or said so far had been correct. He had even instructed the anesthesiologist on the proper drug to use.

‘His personality is rough… but his skills are real.’

While Anus disinfected the patient’s chest and abdomen with brown Betadine, Kang-hyuk stepped outside the operating room to the scrubbing station.

‘Screech.’

He meticulously scrubbed his hands and arms with Betadine soap from his fingertips to his elbows, ensuring everything was spotless.

‘Whoosh.’

Kang-hyuk pressed a knee button, releasing a stream of cold water. He rinsed off the soapy residue, letting his thoughts wander.

‘I came here because they offered funding and a trauma team, but…’

The reality was exactly as he had feared. Korea still didn’t treat trauma patients as proper patients. They were seen as nuisances—something hospitals hoped wouldn’t show up, or, if they did, could be handled with minimal effort and sent away.

‘I need to start by finding reliable people. Rotating shifts like this is no way to run a team.’

Trauma care and surgery required extreme expertise. Having dozens of doctors take turns for a single day at a time was a recipe for disaster, as no one could build proper experience.

‘Anus… That guy might actually be useful.’

With that thought, Kang-hyuk re-entered the operating room. Water dripped from his forearms onto the floor as he prepared for what came next.