Gwak Byeongdae's face twisted grotesquely. His face paled, and cold sweat beaded on his forehead.
Taeho immediately went to Gwak Byeongdae's side, took his wrist, and checked his pulse.
"When did it start hurting? Did it come on suddenly?"
"Just now... It suddenly... ugh..."
Taeho palpated Gwak Byeongdae's abdomen. His abdomen was rigid and hard like a wooden board. The moment Taeho lifted his pressing hand, Gwak Byeongdae let out a scream-like sound.
"Uuugh!"
Rebound tenderness was distinct.
Could it be a perforation?
Sure enough, Rema reacted.
—Acute peritonitis or duodenal perforation (Perforated Ulcer) probability 72%.
—Heart rate 110, blood pressure 90/60.
Taeho's face hardened in an instant. He opened the office door and shouted.
"Is anyone there! Please call 119 here. We need to get to the emergency room."
Staff members ran in from outside.
One male employee called 119 on his cell phone.
Another employee came holding a cup of cold water with both hands.
"Section Chief, are you alright? Shall I get you some water?"
"Absolutely not. He must not ingest anything!"
Taeho said decisively and pushed the cup away.
If peritonitis had developed, even a sip of water was dangerous. It was a critical situation that could lead to death if not treated quickly.
The employees were at a loss, flustered and in disarray.
Taeho gave them instructions.
"If you have a pillow or cushion, bring it and place it under his legs. We need to have him bend his knees."
"Like this?"
"Yes. That's right. Section Chief, please don't move as much as possible and breathe slowly."
Taeho placed his hand on the forehead of Gwak Byeongdae, who was lying on the floor, to calm him.
The employee who had been on the phone shouted.
"They said 119 will arrive in 10 minutes!"
"Understood. Please maintain this position until then."
Taeho continuously checked Gwak Byeongdae's pulse and breathing as he spoke.
"Have you had any stomach problems before? Like a gastric ulcer or gastritis?"
"My stomach hasn't been good since a few years ago..."
"When was the last time you ate something?"
"I was busy today, so I haven't eaten anything... ugh..."
That was a small relief.
The ambulance siren grew closer.
"119 is here!"
Paramedics burst into the section chief's office carrying a stretcher and equipment.
"What is the patient's condition?"
"Suspected perforation with acute abdominal pain. He's NPO, and no medication has been administered."
"Understood. We'll transport him immediately."
The paramedic carefully examined Gwak Byeongdae's abdomen and moved him onto the stretcher.
"Which hospital will you go to?"
"Samcheok Medical Center is the closest from here."
The paramedic looked around and asked.
"Who will accompany him as a guardian?"
While the employees hesitated, Gwak Byeongdae grabbed Taeho's hand.
Taeho met Gwak Byeongdae's desperate gaze and nodded.
"I'll go with him. I'm a doctor."
The ambulance departed with its siren wailing.
Gwak Byeongdae lay on the stretcher, and Taeho sat beside him.
"Doctor, the patient's blood pressure has dropped further to 85/50."
One paramedic reported urgently without taking his eyes off the monitor.
"Pulse is 120, and his breathing is irregular..."
If this was peritonitis caused by perforation, shock could be progressing. Moreover, if the perforated area grew larger and caused intra-abdominal bleeding or severe acute peritonitis, the chances of it becoming life-threatening increased.
"What's his temperature?" "38.7 degrees, and it's still rising!"
The paramedic's face hardened as he looked at the thermometer reading.
Rema displayed Gwak Byeongdae's vital signs as a digital graph in real-time.
—Hypotensive shock in progress. Peritonitis probability 80% or higher.
—Blood lactate levels are also rising.
At this rate, it was dangerous.
Taeho immediately gave instructions.
"Switch to rapid infusion of Ringer's solution. 500mL per hour. If you have colloid solutions or albumin preparations, please prepare them as well."
Gwak Byeongdae closed his eyes and scrunched up his face severely.
A pain that felt like his organs were being scraped with a fiery knife washed over him.
He'd rather be dead...
Then the faces of his eldest, who had grown much quieter since becoming a senior in high school, and his second son, who had begun to grow a dark beard, came to mind.
If I died like this, those kids' futures would be ruined.
His wife's face came to mind too, laughing as she said they should travel comfortably together once the kids got into college.
He couldn't die like this. He couldn't go like this after working himself to death.
As his desire to live grew stronger, the young doctor sitting before his eyes looked like a god.
He was the god he could cling to and rely on in this moment.
"Please... save me..."
Gwak Byeongdae gasped for breath, barely managing to speak.
"Section Chief, I'll palpate your stomach a little. Please bear with me for a moment even if it's difficult."
Taeho slowly pressed on his abdomen.
It was not good. At this level, the perforation might have grown quite large.
Taeho asked calmly.
"Did you contact Samcheok Medical Center to have them prepare for emergency surgery?"
"Yes, we notified them we'd arrive within 5 minutes. The emergency surgery team is on standby."
The paramedic chief answered while communicating over the radio.
"Uuugh..."
Gwak Byeongdae writhed, perhaps because the pain was too severe, and gripped Taeho's hand.
"Slowly administer 50mg of Tramadol. Inject it slowly while being careful not to let his BP drop, and maintain oxygen at 5 liters."
Gwak Byeongdae gasped, and as the pain seemed to lessen slightly, his furrowed brow relaxed a bit.
"Section Chief, please hold on a little longer. Once we arrive at the hospital and take a CT scan, you'll go straight into surgery."
When Taeho soothed him with a gentle voice, Gwak Byeongdae met his eyes and expressed his gratitude.
Taeho nodded and checked the vital signs again.
"His temperature is rising again. Please attach the ECG patches."
Although a gastric perforation was suspected, the heart could also be under immense stress.
Taeho watched the ECG graph carefully and spoke.
"No arrhythmia, just severe tachycardia. It will improve if we supply more fluids and electrolytes."
"We'll arrive at the hospital soon, sir!"
The emergency room sign lights began to appear through the car window.
Finally, Taeho gently squeezed Gwak Byeongdae's hand.
"Section Chief Gwak, you're still okay. Don't lose consciousness. Breathe in slowly and breathe out."
Gwak Byeongdae nodded slightly with tear-filled eyes. Since the doctor said he was okay, he felt like everything would really be okay. He couldn't express his gratitude toward this young doctor in words.
The ambulance stopped, and the doors swung wide open.
An ER nurse and an intern were waiting.
Medical staff busily rushed over and moved Gwak Byeongdae to an ER bed.
Taeho jumped out with them and shouted.
"Suspected gastric perforation. There is abdominal rigidity and rebound tenderness. Vitals are BP 90/60, pulse 110, Shock Index is high. IV fluids and Tramadol are being administered."
The medical staff nodded and pushed the bed, rushing into the emergency room.
The moment they passed the Samcheok Medical Center ambulance bay, a nurse who had been waiting inside rushed over urgently.
"Sir! All the on-call surgeons are currently in other emergency surgeries today. We requested support from other hospitals, but it's expected to take at least 2 hours."
In that instant, Taeho's mind froze.
A large traffic accident had occurred downtown shortly before, and all the emergency medicine specialists and surgeons were tied up.
Only a second-year intern was present.
Then, Rema projected augmented reality before Taeho's eyes.
The surgical procedure was reproduced in delicate detail.
'Can I really direct this myself?'
But if he didn't act now, it was the golden hour where Section Chief Gwak Byeongdae's life was in danger.
Taeho calmly assessed the situation.
"If we don't repair it via laparoscopy immediately, his life will be in danger."
"We learned to perform a laparotomy in this kind of case?"
Intern Kim Dohyeon shouted, his face pale.
"The perforation is located deep in the posterior wall of the duodenum, making visual confirmation difficult via laparotomy. We must approach precisely via laparoscopy to perform a safe suture."
"But the professors are currently..."
Kim Dohyeon nodded blankly at Taeho's words.
Having to take responsibility for everything, his mind went blank and no thoughts came to him.
"I'll do it."
"You're saying you'll do this yourself, sir? You don't have surgical privileges at this hospital."
Taeho looked at Dohyeon with unwavering eyes.
"I've directed laparoscopic surgery at Seyoung Seoul Hospital. Please approve this as an emergency exception."
Even though Taeho shouted urgently, Kim Dohyeon couldn't decide what to do.
"I... that's, uh..."
Kim Dohyeon stammered like a broken computer.
Finally, Taeho grabbed Kim Dohyeon by the collar.
"Get a hold of yourself! If you don't decide right now, the patient will die!"
"Ah... Yes? Yes! Just a moment."
Kim Dohyeon ran off to request approval for the emergency exception.
Shortly after, the head nurse's message was relayed.
'Emergency exception approved.'
Taeho spoke to the OR nurse.
"Prepare the equipment immediately. The patient won't last more than 90 minutes."
The entire emergency room began to move busily. A suffocating tension permeated the area.
Taeho put on surgical scrubs and gloves.
His mind cleared and his heart pounded.
He had forgotten.
The feeling of operating on an emergency patient.
Adrenaline and cortisol surged forth.
The sensation of every nerve cell sharpening and coming alive.
Rema was accurately guiding the surgical procedure through augmented reality.
—Laparoscopy preparation complete. Intubation status good. Surgery can begin.
Taeho approached the patient's side.
"Please check the general anesthesia status."
"He's stable. BP 95/60, pulse 115, oxygen saturation 97%."
The anesthesiology resident reported.
Then a nurse spoke.
"All laparoscopy equipment is set up."
Taeho looked at Kim Dohyeon and spoke.
"Dr. Kim Dohyeon. I'll ask you to be my first assistant. Please handle the suction and grasper."
"Yes. Understood."
Without even the slightest tremor in his hands, Taeho skillfully made a small incision in the abdomen and inserted the instrument.
When the state of the internal organs appeared on the screen, everyone in the emergency room held their breath.
"I've located the perforation. No bleeding, and the perforated site is clearly visible."
Taeho spoke in a calm voice.
Fluid leaking from inside the abdomen was visible on the screen.
"I'll keep the field clear with suction."
Kim Dohyeon's hands moved urgently yet accurately. Once the intraperitoneal fluid was removed, the damaged area was clearly revealed.
"It's here."
Taeho skillfully picked up the suturing instrument.
Rema was displaying the suture points and sequence in real-time via augmented reality.
Taeho calmly moved the instrument and began delicately suturing around the hole.
"The patient's blood pressure is dropping! 85/55!"
The anesthesiologist's urgent voice rang out.
Taeho furrowed his brow and quickly gave instructions.
"Increase the IV fluid rate and prepare dopamine."
"Yes, understood!"
The anesthesiologist immediately carried out the instructions.
Taeho's hands moved as precisely as a machine.
"First suture complete. Beginning the second suture."
The endoscopic image on the screen clearly illuminated the suture site.
It felt as if the flow of time had stopped.
The tension in the emergency room was reaching its peak.
But Taeho actually grew calmer and calmer.
Kim Dohyeon also perfectly matched his movements to Taeho's instructions.
"Second suture complete. Please check the status."
"BP 90/60, pulse 105. He's stabilized a bit."
Relief was evident in the anesthesiologist's voice.
Taeho exhaled shortly.
"Going into the final suture. Let's focus a little longer."
Everyone's gaze was focused on Taeho's fingertips on the screen. The final needle passed precisely through the perforated site.
"Final suture complete. Let's check for leakage."
Kim Dohyeon quickly examined it.
"No further leakage. It's clean!"
After suturing the surgical site, Taeho relaxed and stepped back.
All the medical staff in the emergency room finally let out sighs of relief.
Taeho spoke.
"Section Chief Gwak Byeongdae, can you hear me?"
Gwak Byeongdae's eyelids trembled, then opened with difficulty.
"Do you remember riding the ambulance from the city hall and being brought to the hospital? If you remember, please blink once."
Gwak Byeongdae's eyelids slowly closed and opened.
"Good. The surgery went well, and you'll be going to the ICU now. I'll see you later."
After Taeho confirmed the patient had regained consciousness, the anesthesiologist increased the anesthetic depth.
As Gwak Byeongdae's eyelids closed, tears streamed down his temples.
"To finish the sutures so quickly, this is a miracle."
Kim Dohyeon shook his head as if he couldn't believe what he had witnessed.
The anesthesiologist and nurses were in a similar state.
"You worked hard."
"You really worked hard, Dr. Kang."
Taeho nodded, his face soaked with sweat.
"Not at all. This was possible because everyone worked together. Please take care of the remaining procedures."
Taeho walked out of the emergency room.
The ecstasy of having saved a life spread throughout his entire body.
Rema's voice was heard.
—Emergency laparoscopic surgery +80 coins.
—Current total: 233 coins.
After the surgery, the patient was transferred to the recovery room.
While Kim Dohyeon and the nurses were organizing the equipment, the operating room door burst open.
"Kim Dohyeon! What the hell!"
The Chief of Surgery, Yu Sihyeok, entered gasping for breath. He had rushed over immediately after finishing emergency surgery on a traffic accident victim.
"Chief, I'll explain."
"Explain? I heard you let an external doctor perform a laparoscopy! If the patient dies, are you going to take responsibility?"