Chapter 53

“Hm.”

Kang-hyuk stepped past Lee Ki-young, who was staring intently at him, and moved up toward his head.

Jaewon hurried to follow behind, with Jang-mi trailing close as well.

“What’s the current ventilator mode?”

Kang-hyuk pointed at the machine pumping air into Lee Ki-young with a rhythmic “shhh-shhh” sound and asked Jaewon.

Of course, it wasn’t because Kang-hyuk didn’t know.

He could tell just by the pattern of the patient’s breathing.

This was simply a check to see whether Jaewon knew too.

“Uh…”

Jang-mi vividly recalled how badly Jaewon had been grilled the last time he was asked this question.

It hadn’t just been about the mode—they’d questioned him on the pressure levels and breathing rate as well.

Normally, once the ventilator mode was set, the rest would be adjusted by the ICU care team.

In fact, in the main building’s ICU, weaning was often done automatically once the attending physician placed an order.

“It’s—”

Jang-mi tried to jump in and give the answer before Jaewon got hit again, but he stopped her.

Then, looking directly at the machine, he answered with confidence.

“SIMV (Synchronized Intermittent Mandatory Ventilation).”
(T/N: SIMV provides mechanical breaths only when the patient doesn’t breathe spontaneously.)

Kang-hyuk gave him a look that said, “That much is obvious,” and continued questioning.

“Alright. Then what’s the spontaneous breathing rate?”

“Spontaneous breathing rate… hmm.”

This wasn’t something one could immediately answer like before.

It wasn’t written in textbooks—it was field knowledge.

Even Jaewon, who’d ranked first in the specialist exam, needed a few seconds to think.

But unlike others, his thinking time was very short.

Time spent with Kang-hyuk was intense and highly concentrated.

“Over 90%.”

“Then we need to change the mode. What do we switch to?”

“CPAP (Continuous Positive Airway Pressure).”
(T/N: CPAP maintains a constant positive pressure to keep the airway open while allowing spontaneous breathing.)

“Then go ahead.”

Kang-hyuk stepped aside and gestured to the machine.

Jaewon walked over without hesitation or nervousness and adjusted the settings.

Soon, the ventilator’s mode changed, the breathing sounds shifted, and a subtle difference emerged.

Simultaneously, Kang-hyuk, Jaewon, and Jang-mi all turned their heads toward the patient monitoring system.

Their focus was especially on the oxygen saturation.

When weaning a patient off mechanical ventilation, that value was always the most critical.

“Hm.”

But Kang-hyuk didn’t only check the oxygen level.

He also observed Lee Ki-young’s condition closely.

Even if saturation remained stable, they’d have to stop the weaning process if the patient struggled too much.

‘No facial changes… no visible pulling between the ribs. Good.’

When people are short of breath, the intercostal muscles between the ribs tend to move excessively.

This is an instinctive effort to adjust thoracic volume.

It’s also a key indicator when judging whether breathing is stable or not.

“Good. We can proceed to the next step.”

After monitoring for another five minutes, Kang-hyuk gave the go-ahead.

Jaewon moved up to Lee Ki-young’s head and gently tapped his shoulder.

“Mr. Lee Ki-young.”

Startled by the sudden voice, the patient looked up with effort.

Despite having undergone a major surgery, he didn’t appear to be in severe distress.

Jaewon smiled and pointed to the tube.

The tube inserted deep into Lee Ki-young’s mouth.

The source of his current discomfort.

“We’re going to take this out now. If you understand, blink once.”

What a welcome message that must have been.

Lee Ki-young blinked rapidly.

He even nodded—but that wasn’t recommended.

The tube in his throat could cause immense irritation from such movement.

Jaewon soothed the now wince-stricken Lee Ki-young and gave him a moment.

Click.

Meanwhile, Kang-hyuk turned off the analgesic being administered to the patient.

It was a drug called [Remifentanil], known for its very short half-life and quick loss of effect after discontinuation.
(T/N: Remifentanil is a powerful painkiller with minimal sedation and rapid clearance, making it ideal for postoperative recovery.)

Moreover, it offered more analgesia than sedation, helping maintain or recover patient consciousness.

Numerous papers had confirmed that patients treated with this drug experienced fewer side effects like delirium and recovered faster post-surgery compared to other options.

‘But I heard this drug is one of the main reasons our department runs a deficit.’

If it’s safer and promotes faster recovery, it sounds like an excellent medication.

But it could be replaced with much cheaper alternatives.

From the patient’s perspective, Remifentanil was clearly better.

But from a national healthcare standpoint, encouraging the use of more affordable drugs helped more patients overall.

It made sense—but didn’t feel good.

“Alright, I’m going to remove it now. You’ll need to hold your breath. Otherwise, it’ll be very uncomfortable.”

At Jaewon’s words, the patient blinked with all his might.

Taking that as a signal, Jaewon deflated the balloon anchoring the tube inside the airway.

Once deflated, the tube loosened, making it easier to remove.

“Okay, here it comes. Keep holding your breath.”

With those words, Jaewon slowly pulled the tube out.

The thick phlegm coating the tube bore witness to how much Lee Ki-young had endured while intubated.

Cough cough.

Lee Ki-young let out a weak cough.

Kang-hyuk recalled that this morning’s X-ray had shown no signs of pneumonia or other infections.

‘So there’s no need to worry.’

The color and odor of the sputum flying out with the cough also suggested there was no infection.

Others might struggle to tell just from that.

Kang-hyuk was a man who got things done.

So he stood in front of Lee Ki-young with a satisfied smile.

Soon, Lee Ki-young’s coughing subsided as if it had never happened, and Kang-hyuk greeted him.

Though they’d known each other for quite a while now, this was actually the first time they were speaking face-to-face.

That was typical of the doctor-patient relationship in trauma surgery, and Kang-hyuk felt no awkwardness about it.

“Mr. Lee Ki-young. I’m Baek Kang-hyuk, the one who operated on you.”

“Ah… the surgery… Then this place is…?”

Patients in the ICU usually had a hard time understanding the passage of time or grasping their surroundings clearly.

The ICU ran with the lights on 24/7, and various medications made patients groggy.

Though Lee Ki-young hadn’t been unconscious for a particularly long time, his memories couldn’t be expected to be clear.

“This is Hanguk University Hospital. It’s where your father was hospitalized.”

“Ah, right… Yeah, that’s right. My father…”

Lee Ki-young looked as if he were recalling a memory buried long ago.

He muttered to himself for a while, then turned to Kang-hyuk and asked,

“What happened to my father?”

“He passed away.”

“I… I see…”

Fortunately, he didn’t seem too shocked.

That was about what Kang-hyuk had expected.

He already knew the medical history of Lee Ki-young’s father through the charts.

His condition had been too hopeless, and he had been ill for too long for it to hit all at once.

‘But how will he react to what comes next?’

Kang-hyuk expected the next part to land differently as he opened his mouth.

Unlike most doctors who hesitate when delivering bad news, Kang-hyuk didn’t flinch.

If it was something the patient was going to find out anyway—something they needed to know—then the sooner the better. That was his belief.

“Do you remember the day your father fell into brain death?”

“Ah…”

Lee Ki-young slightly parted his lips at Kang-hyuk’s question.

His face showed signs of remembering something.

But it wasn’t a clear memory.

Of course it wouldn’t be—he’d suffered massive blood loss.

There was no way his brain had received a proper blood supply during all that.

If he could remember that perfectly, he wouldn’t be human.

“You were on your way to Hanguk University Hospital with your family when the accident happened. You were crossing Yeongdong Bridge. A speeding truck lost control on the snowy road and rear-ended your vehicle.”

“Ah… right… that…”

“From the collision, you sustained severe abdominal injuries and were transported to our emergency room.”

“My stomach… Ah, I see.”

Due to fragmented memories, Lee Ki-young couldn’t recall who else had been with him in the car.

He was simply using Kang-hyuk’s words to piece together the events.

So the only thing he could remember was the massive impact to his abdomen.

He had no recollection of his younger sister being thrown out the front windshield…

Or his wife and brother-in-law, crushed in the back seat by the truck.

Kang-hyuk continued, watching Lee Ki-young stare at his abdomen with a troubled expression.

“In the ER, we found severe internal bleeding and hypovolemic shock, so we proceeded to emergency surgery immediately.”

“Right… I see…”

It wasn’t something a layperson could easily understand.

Lee Ki-young just stared at his belly and nodded.

“When I opened you up, I found ruptured blood vessels and reconstructed them. But there was also bleeding from areas that couldn’t be repaired. From your liver.”

“My liver…?”

Only then did Lee Ki-young’s gaze shift to Kang-hyuk.

“Yes. Your liver. It was so damaged that we had to remove nearly the entire organ.”

“Then how… how did I…?”

“If left untreated, you would’ve died without a doubt.”

There was not a single lie in Kang-hyuk’s words.

Lee Ki-young had been beyond saving otherwise.

“How… am I alive, then? That means…”

“The liver inside your abdomen—it’s your father’s. I performed a transplant.”

“A transplant…? On me?”

“Yes. There was no other way.”

“My father’s liver… is inside me…”

Lee Ki-young touched his abdomen again, his expression even more complicated than before.

He had been on his way to see his father after learning of his brain death—then got into an accident and nearly died.

And yet, thanks to his father’s brain death, he received an organ transplant and survived.

Calling it a coincidence didn’t feel strong enough—it was a cruel, twisted irony.

He stayed silent for a moment, then looked up again.

His eyes were clearer now as he asked Kang-hyuk the one question he had hoped would never come.

“I wasn’t the only one in that car. What about the others… what happened to them?”