Trauma Center : Golden Hour - Chapter 5

“Anus, stand on the opposite side of me. You’ve done this during residency, right?”

Kang-hyuk was already holding a scalpel, standing on the patient’s right side. Anus took his place on the left, opposite Kang-hyuk.

“Yes, I’ve done it.”
“Splenectomy too?”
“As an assistant…”
“Ah, right. You’re Anus. Makes sense. So, the weapon was a sashimi knife, 5 cm in length, and over 10 cm deep.”
“Can you tell the depth just by looking?”
“Roughly, based on the bleeding earlier. It’s something you learn through experience. You won’t just know it.”
“Ah, I see…”

Anus glanced at Kang-hyuk. No matter how he looked at him, Kang-hyuk didn’t seem much older than himself. In fact, when Kang-hyuk was wearing his suit earlier, he’d looked like someone his age.

“Anyway… Time to make the incision. Pull it open.”
“Yes.”

Following Kang-hyuk’s instructions, Anus spread open the long wound. While the pressure they’d applied earlier had reduced the bleeding, pulling the wound apart caused the blood to start flowing again.

But this wasn’t the time to keep stalling by holding pressure; they needed to open the wound and find the source of the bleeding.

‘Zzzzt.’

Kang-hyuk extended the wound by making additional 2 cm incisions at the top and bottom.

“Give me the electrocautery.”
“Here you go.”

The nurse handed him the device. After checking it, Kang-hyuk inserted it into the extended incision.

‘Crackle-crackle.’

As Kang-hyuk worked with the electrocautery, white smoke rose as the tissue was cauterized.

‘Hsss.’

Anus immediately suctioned the smoke before it could reach Kang-hyuk’s nose, a move that showed he was a fairly competent resident.

“Anus.”
“Yes?”
“Do this well enough, and maybe I’ll start calling you by your real name.”
“Ah, thank you…”

Anus didn’t know how to respond to Kang-hyuk’s sarcastic acknowledgment.

‘Shouldn’t he apologize for calling me Anus in the first place…?’

But before he could dwell on the thought, Kang-hyuk’s hands began moving faster, making it increasingly difficult for Anus to keep up.

“Anus, hook the peritoneum and pull.” (T/N: Peritoneum – A thin membrane that lines the abdominal cavity and covers most abdominal organs. )
“Yes.”
“No, no! Not upward—lower!”
“Ah, sorry.”
“Not like that… Can’t you see where the bleeding is coming from?”

Kang-hyuk gestured inside the wound.

From Anus’s perspective, all he saw was a mass of dark red blood clots. But Kang-hyuk clearly seemed to see something else, judging by his growing irritation.

“Forget it. If you can’t see, don’t bother. Just hook here and pull to the sides.”
“Got it.”
“Good. That’s enough. If you pull too much, the vessels might get distorted and hide.”

Taking the suction device from the tray, Kang-hyuk began clearing out the pooled blood. With the other hand, he used forceps to gently dab away at the wound. Bit by bit, he worked deeper.

‘What is he even seeing in there…?’

Anus stared at the tip of Kang-hyuk’s instruments, trying to figure it out. But all it did was strain his eyes without yielding any answers.

“Got it.”

Kang-hyuk finally pinched something with his forceps from within the mass of blood. Instantly, the bleeding, which had been pouring out, reduced dramatically. It felt like 70–80% of the blood loss had stopped.

“Uh?”
“What do you mean, ‘uh’? Haven’t you controlled bleeding before?”
“I… have.”

Every surgeon had dealt with internal bleeding during their training, especially in a place like Hanguk University Hospital. Being questioned about something so basic made Anus frown slightly.

“Then how could you not see this?”
“What do you mean ‘this’?”

“Hmph.”

Kang-hyuk stared at the pinched vessel in his forceps. The crushed edge of the severed splenic artery branch was now visible.

‘Guess normal eyes can’t see something like this.’

Setting down the suction device, Kang-hyuk extended his hand.

“Give me a Kelly.”
“Here, doctor.”

The nurse handed him the Kelly clamp. Using it, Kang-hyuk clamped the severed vessel and gently tugged on it. The hidden end of the artery emerged, exposing the source of the bleeding.

“Of course, it’s a branch of the splenic artery. No wonder the bleeding was so bad.”
“Ah…”
“Anus, why are you sitting there in awe? Aren’t you going to tie it off? Or should I just hold this all day?”
“R-right! Suture, please!”

Anus quickly acknowledged his mistake and extended his hand toward the nurse. Luckily, she had already prepared silk suture material, anticipating the request.

“Here you go.”
“Yes, professor. I’ll tie it now.”
“Go ahead.”

With a focused expression, Anus tied off the artery Kang-hyuk had clamped. His movements were fast, precise, and firm.

‘Tug, tug, tug.’

Kang-hyuk nodded in satisfaction.

“Not bad, Anus. You’re pretty good at this.”
“Th-thank you.”
“You’ve been tying all your life, haven’t you? Are you on the spectrum or something?”
“What? No, of course not!”
“You know, there are always those guys in med school who obsessively tie anything they can get their hands on.”

Kang-hyuk recalled a colleague who had tied every button and knot in sight, only to be diagnosed with Asperger syndrome just before graduating.

“Are you one of those types too?”
“N-no, I just happen to be good at tying sutures.”
“Really? Hmm… So you’re more of a hands-on type than a thinker, huh?”
“No, I told you—I was top of my class.”
“Anyway, who talks this much during surgery?”
“Huh?”

Anus looked at Kang-hyuk with a face that clearly asked, ‘Who started this conversation in the first place?’ But Kang-hyuk was already back to focusing on the patient’s wound, completely ignoring Anus.

“There’s more blood seeping out now. Anesthesia!”
“Y-yes?”
“What’s the blood pressure?”
“Uh… 90—no, 95.”

Sun-woo, who had been hiding in the back and casually chatting on KakaoTalk, quickly replied.

“95? This patient’s still in hypovolemic shock, and the bleeding isn’t fully controlled yet. Did you use a vasopressor?”

Kang-hyuk turned to glare at Sun-woo with eyes that seemed to shoot flames. Sun-woo, caught off guard, instinctively lowered his head.

“The blood pressure was low earlier…”
“How low?”
“Sixty…”
“And you used a vasopressor for a patient who had pericardial tamponade and underwent a needle aspiration?!”
“I…”

Sun-woo fumbled for a response, fully aware that he had messed up.

‘Great, I just wanted to make things easier and used the vasopressor, but of course this lunatic caught me.’ (T/N: I still remember this douche’s face in the Kdrama. Someone I love to punch the face.)

Figuring out blood pressure changes from the bleeding volume—Sun-woo couldn’t help but think Kang-hyuk was insane.

And that insane person was now furiously angry.

“What’s your name?”
“Uh…”
“Forget it. Doesn’t matter. Everyone here knows who you are anyway. Call another anesthesiologist right now. When they arrive, you’re out.”
“But that’s a bit…”
“Shut up. I don’t consider anyone who prioritizes their own comfort over a patient’s well-being to be a doctor. Do you think I’m going to let a non-doctor stay in this operating room? Call someone else now.”

Kang-hyuk then turned his piercing gaze to Anus, who flinched despite having done nothing wrong.

“Y-yes.”
“Because of that idiot’s mistake, we’ve lost time. We’re speeding things up now. Stay sharp and keep up.”
“Y-yes, sir.”

“Give me a suture kit. Use a No. 2 needle. We’re sealing the bleeding with sutures instead of a partial splenectomy.”
“Oh, uh, yes.”

The nurse, visibly startled, handed Kang-hyuk the suture kit. The No. 2 needle, usually reserved for stitching abdominal skin, was large and thick. It was rarely used inside the abdominal cavity because it was difficult to maneuver in tight spaces.

‘Thunk.’

But Kang-hyuk, as if to prove the skeptics wrong, moved the needle with confident, precise hands.

‘Thunk.’

The needle pierced through the bleeding spleen with flawless accuracy, each movement deliberate and smooth.

‘Is this even going to work…?’

At first, it looked like nothing more than random stabbing, even counterproductive. Every time the needle went through, blood seemed to gush out even more.

‘Thunk.’

By the third stitch, Anus began to understand what Kang-hyuk was doing.

‘He’s compressing the spleen’s shape to stop the bleeding. If you press down on it, the bleeding stops…’

The spleen was a tricky organ. While it wasn’t essential for survival, its removal made the body more vulnerable to certain infections. It was also notoriously difficult to suture due to its high blood content and role in breaking down old blood cells.

That’s why most surgeons gave up on saving it, opting for removal instead.

For Anus, this was the first time he’d ever seen someone attempt to preserve a spleen this way.

“What are you staring at? Aren’t you going to cut the suture?”
“Ah, yes. Cutting.”

“Good. The bleeding’s controlled. You can close the skin, right?”
“Of course.”
“Then handle that. I’m moving to the chest to open it up.”
“A-alone?”
“Do you do incisions in pairs?”
“N-no, but…”

Opening the chest without an assistant sounded reckless—bordering on insanity. Anus, determined to finish his task quickly, moved his hands as fast as he could to close the abdomen.

Kang-hyuk left Anus behind and moved up to the patient’s chest. Turning his head, he saw Sun-woo, looking like he’d swallowed a bitter pill, explaining the case to his replacement.

“So, there was pericardial tamponade and hypovolemic shock from the abdominal stab wound, right?”
“Yeah, how many times do I have to repeat myself? Anyway, there’s that, and a vasopressor was used once.”
“What? A vasopressor? With pericardial tamponade?”
“Of course I used it. Don’t overstep your bounds, you’re just a resident.”
“S-sorry.”

The new anesthesiologist looked older than Sun-woo but clearly held a lower rank. It was evident from how he was being scolded for no reason.

Kang-hyuk, irritated by the pointless power dynamics, decided to ignore it. He had more pressing matters to handle.

“Scalpel. We’re opening the chest.”