"Yes, we're going with ketamine-centered MAC. Short incision; hemostasis first."
MAC (Monitored Anesthesia Care) was a method of lowering consciousness with sedatives while controlling pain through local nerve block.
Nurse Go Hayeong couldn't believe it.
'He can do this? This young doctor?'
But she had already witnessed Taeho's skills.
In an emergency like this, she had no choice but to trust him.
Go Hayeong moved her hands like lightning. Her skilled fingertips attached the monitor leads to the patient's body with precision.
"Monitor connection complete. ECG, blood pressure every two minutes, oxygen saturation, and nasal cannula ETCO₂ are all set."
Before Go Hayeong even finished her report, public health physician Lee Junho cut in.
"I've secured two 16-gauge IV lines. The fluids are warming."
Beads of thick sweat formed on Lee Junho's forehead. He had only ever read about MAC in textbooks; this was his first time performing it in reality.
'Is this really possible?'
Lee Junho focused on his trembling hands to secure the lines.
Taeho glanced at the monitor. His concern turned to conviction.
"Blood pressure 65 over 40, pulse 134. Stage 3 shock."
"Emergency release of four units of packed red blood cells. Administering one gram of tranexamic acid."
Taeho nodded briefly. Time was gold.
"Ketamine 30 mg first. Add 10 mg as needed. Have 0.5 mg midazolam on standby."
While Go Hayeong's hands prepared the drugs, Taeho observed the patient's face. As the ketamine gradually circulated through his veins, the patient's rigid expression slowly relaxed. His eyes were half-closed, but his breathing remained steady.
"Doctor…… will I be awake during the surgery?"
The patient's voice trembled thinly.
Taeho bent down to meet the patient's gaze.
"Yes. You won't fall asleep, but the pain will be minimized. I'll keep talking to you throughout. Tell me right away if you feel uncomfortable."
A warm voice meant to reassure the patient.
Go Hayeong lifted the vial and read the label aloud to verify.
"Lidocaine one percent with epinephrine, thirty milliliters total, ready."
The liquid inside the transparent syringe gleamed under the fluorescent light.
"I'm going in layer by layer along the rectus sheath. It might sting."
The moment the slender needle pierced the skin, the patient let out a long breath.
Taeho nodded.
"Time out."
The operating room fell into momentary silence.
"Patient Hong Jeonggi, emergency laparotomy, estimated source of bleeding: splenic injury, sedation under MAC. Does the team agree?"
"We agree."
Hayeong and Junho's voices rang out almost simultaneously.
"Scalpel."
Cold metal touched Taeho's hand. As the sharp incision began and the abdominal wall opened, dark red blood poured out. Far more than expected.
"Ha!"
Lee Junho's face turned pale as he looked at Taeho.
But not a flicker of emotion crossed Taeho's face.
"Suction!"
Go Hayeong's reaction was like lightning.
As suction began, red liquid flowed through the transparent tube with a slurping sound.
Taeho's eyes gleamed sharply.
Through Bio Vision, a deep laceration approximately 4 cm in length at the lower end of the spleen was revealed as vividly as a 3D hologram.
Grade III injury. Active bleeding from a branch of the splenic artery.
"Estimated bleeding from the splenic artery is approximately 150 milliliters per minute."
"Yes, Doctor!"
Taeho's hand compressed the bleeding site precisely. Through Bio Vision, he could see the optimal pressure point and angle.
'Fortunately, the splenic hilum is intact. We can preserve it.'
In his vision, the entire spleen's blood flow pattern was displayed in colors. Red indicated normal blood flow, orange indicated reduced flow, and black indicated areas at risk of necrosis. Thankfully, most of it was red.
"Please prepare 4-0 Prolene and a hemostatic agent."
"Yes!"
Taeho moved along the surgical path indicated by Bio Vision. Just as a GPS guided the optimal route, the sequence and angles for suturing were displayed step by step in his field of view.
Go Hayeong leaned close to the patient's ear and spoke softly.
"Patient, you may feel a pulling sensation. Breathe slowly."
"Y-yes……"
The patient's hand trembled.
"Hemostat."
A cold metallic sound. Taeho's hand clamped the vessel precisely.
"Add 10 mg ketamine."
Go Hayeong murmured quietly and administered the drug.
The numbers on the monitor gradually began to stabilize.
Lee Junho's voice had calmed considerably compared to before.
"Blood pressure 78 over 50, pulse 120. First unit of transfusion is halfway in."
"Lower pole laceration, 4 cm. Proceeding with suture preservation. 3-0 Vicryl."
With the small sound of a package being torn open, Go Hayeong handed over the needle holder.
Taeho's hands moved as if dancing. After short, rapid movements, the bleeding tapered off. As an oxidized cellulose patch was carefully placed over the wound, the blood flow gradually ceased.
"Hemorrhage flow eliminated. Maintain packing; recheck surroundings."
Taeho examined the surgical site once more, then raised his head.
"No abnormalities. Mr. Hong Jeonggi, you've passed the critical point. The bleeding has stopped; we're starting the sutures now."
"Yes. I can hear you."
The patient answered in a much more relieved voice.
The stapler closed the wound with a steady rhythm, clicking away.
"Gauze, needle count matches. Dressing complete."
Lee Junho finished the final check.
"Estimated blood loss 1,500 cc; two units of transfusion in progress. Vitals are stable."
When Go Hayeong finished her report, Taeho approached the patient again.
"You endured well. You maintained consciousness throughout, and the pain was minimized. We're headed to the recovery room now."
The patient smiled with effort.
"You kept talking to me during the surgery…… It was less scary."
As Taeho adjusted his surgical gown, he said one last thing.
"Everyone worked hard. Let's get his blood pressure up in recovery, then re-evaluate with imaging and determine when to remove the packing."
The patient on the transport bed breathed evenly as he headed to the recovery room.
Park Hyeonu, the chief of internal medicine, who had been waiting outside, approached.
An expression of disbelief.
"You really performed a laparotomy under conscious sedation?"
"Yes. There was no time to wait for general anesthesia."
Taeho answered calmly.
"The patient even answered questions intermittently."
Lee Junho added excitedly, his face brightening. He was certain that being able to participate in and witness such a surgery firsthand was a tremendous stroke of luck.
Go Hayeong smiled and shook her head as if she still couldn't believe it.
"I've been a nurse for twenty years, but this is my first awake laparotomy."
"Unbelievable."
Park Hyeonu stared blankly at Taeho's retreating figure as if he had seen a monster.
Five consecutive emergency surgeries were performed.
The last patient was brought into the operating room. The patient was in critical condition with multiple traumas to the abdomen, chest, and pelvis. Taeho and Yu Sihyeok looked at each other and nodded.
"Director Gang, I'll proceed with the orthopedic surgery, so please take the abdomen."
"Understood, Chief Yu!"
Through their collaboration, a major surgery spanning two hours began.
Two hours later. When the final skin suture was done, Taeho exhaled deeply above his mask. The operating room door opened, and the two emerged with faces etched in exhaustion.
"All surgeries have been completed successfully."
Director Kim Byeongjo stepped forward first and grasped both their hands tightly.
"Director Gang, Chief Yu. Thank you so much. You've worked hard."
"Not at all. It's thanks to everyone's hard work together. It's thanks to your leadership, Director."
Taeho smiled brightly.
Yu Sihyeok smiled and nodded in agreement.
Cheers and applause burst out among the medical staff.
"Wow!"
"Great work!"
"You've worked hard!"
Director Kim Byeongjo spoke loudly to the medical staff.
"Everyone, don't forget what we accomplished today. All five emergency surgery patients—successful! All eight patients transferred to higher-level hospitals were also transferred in stable condition!"
As his voice trembled, Director Kim Byeongjo paused briefly to catch his breath. Then he continued in a voice full of emotion.
"In the end, excluding the two who were already dead at the scene, 43 out of 45 total survived. This is a miracle!"
The corners of Director Kim Byeongjo's eyes reddened.
"I've been at this hospital for twenty years, but I've never felt a sense of fulfillment like today. No, this is the proudest day of my thirty years as a doctor."
One by one, the medical staff and employees approached Taeho, expressing genuine trust and respect.
Even Nurse Kim Sujin, who had been about to leave for Seoul, changed her mind.
"I'll stay here. I want to grow more here. I don't think I could gain such valuable experience anywhere else."
Her face was sweaty and flushed from running around all day. But only her eyes were shining.
"That was a wise decision."
Taeho nodded with a smile.
His entire body was drenched in sweat, utterly exhausted. But what mattered was that he had been able to save many people in such a major accident.
Above all, this incident had completely erased the doubts the staff had harbored about the young director.
Samcheok Medical Center was more vibrant than ever.
***
"It's the Vice Director's first outpatient clinic. Fighting!"
At Nurse Park Geumja's encouraging words, Park Suhyeok smiled awkwardly.
The name tag reading "Vice Director, Geumsan Clinic" on his white coat felt unfamiliar. Having trained at a university hospital for twenty years and lived as a professor, a local clinic felt like a completely different world.
The clinic door opened, and a grandmother in her seventies entered with a cane. It was Grandmother Kim Sundeok, a regular patient who had been receiving diabetes management from Taeho for two years.
"Welcome, Grandmother."
Park Suhyeok greeted her politely. But Grandmother Kim Sundeok's expression seemed somehow uneasy and awkward.
"Where'd the doctor here go?"
"Director Gang is busy today, so I'll be treating you."
Park Suhyeok opened the chart and placed the manual beside him. It was the "Regional Patient Response Guide" that Taeho had personally compiled.
"Your blood sugar levels…… hm, they continue to exceed the target range on a fasting basis."
"What's all that nonsense?"
"In other words…… your average pre- and post-meal glucose levels both show patterns exceeding the upper limit, so it is determined that the overall glycemic control strategy needs to be reset."
The grandmother stared blankly at Park Suhyeok.
"What's that?"
Park Suhyeok was taken aback, realizing he had spoken as if lecturing residents at a university hospital.
"Ah, I'm sorry. Your blood sugar is a bit high, so we need to adjust your medication."
"……"
"No matter how much medication you take, you also need to exercise appropriately and control your diet. Regular monitoring is important."
"What's a monitor? I don't know what you're talkin' about……"
The second patient, Grandmother Lee Hyosun, entered. She was a patient who visited regularly due to knee arthritis.
"Grandmother, how is your knee?"
"It's been sore these past few days, hurts even more. Can't even walk around without it hurtin'……"
Park Suhyeok nodded as he looked at the chart.
"Hm, degenerative changes are progressing……"
Realizing his mistake, he quickly changed his wording.
"Ah, it seems degenerative changes are progressing. While continuing conservative treatment, we need to focus on pain control—no, on pain management."
"Huh?"
Grandmother Lee Hyosun's expression became exactly like Grandmother Kim Sundeok's.
Park Suhyeok tried to explain in simpler terms.
"Grandmother, as the degenerative changes in your knee cartilage progress, an inflammatory reaction occurs inside the joint cavity, and this causes thickening of the synovial membrane, which……"
"What's all that? So what're you tellin' me to do?"
"Ah…… so, your joints are worn down and hurting. We'll continue drug treatment while trying to manage the pain."
"Then why didn'tcha just say so simply from the start? Why d'ya gotta make it so complicated! Sheesh……"
At the grandmother's grumbling, Park Suhyeok broke out in a cold sweat.
That wasn't all. The real problem was that Park Suhyeok's cautious personality meant each patient took more than twice as long as with Taeho.
"Hey there! How long we gotta wait?"
A voice of complaint burst from the waiting room. It was past 2 p.m., yet they hadn't even finished the morning scheduled patients.
"We're sorry. Please wait just a little longer."
Nurse Park Geumja apologized, but the grandmothers' complaints continued.
"Director Gang sees us in a flash, but why does this new doctor take so long?"
"Lordy, I can't make heads or tails of this nonsense……"
Just then, Taeho entered the Geumsan Clinic.
He was on his way back from Samcheok Medical Center.