A Brave Little Heart
Today was the day they would finally visit the completed Namgoong Animal Medical Center.
Lee Jun looked up at the ten-story building standing before him. Enormous letters gleamed brilliantly across the wall.
"Phew. So that whole thing is an animal hospital?"
"Whoa! Now ain't that somethin'? You're tellin' me from the first floor all the way up to the very top, the whole buildin's an animal hospital?"
Go Gi-jin stood beside Lee Jun, his eyes sparkling with awe. The building was not merely tall — it was vast, and every last floor of it was an animal hospital.
"It's something, isn't it?"
"It's really somethin', I tell ya. Completely different from when we saw it under construction."
"Seems that way."
As Go Gi-jin had said, they had already visited three times during construction — but the finished building was magnificent. Lee Jun let his gaze travel slowly downward, taking in the medical center from the rooftop all the way to the first floor, committing every detail to memory.
And may they spend their stay in comfort.
Lee Jun murmured the wish with both hands clenched tight, gazing up at the building. Beside him, Go Gi-jin squeezed his eyes shut and muttered a prayer of his own.
Meaning: get healthy, and go home.
Watching Go Gi-jin wish so earnestly for the animals' happiness, Lee Jun smiled.
"Well then — shall we go in?"
"Yup. Let's go in."
The moment Lee Jun and Go Gi-jin stepped through the entrance, Namgoong Hyun and Han Na-hyeok — who had been chatting with visitors — spotted them and came forward in welcome.
"Welcome, both of you."
"Hey. You made it."
"Congratulations on the opening."
"Congratulations to ya."
"It's so bright, and yet so cozy — the patients who come here are going to feel at ease."
"It's real nice."
"Thank you. It's all thanks to you both for being so generous with your advice."
Beside him, Han Na-hyeok nodded in agreement and added,
"Thanks to that, our medical center's patient flow turned out exceptionally well."
"Oh, now that's genuinely good news."
"It sure is. Ah — there's still time before the opening ceremony. Want to look around?"
"I'd love to."
"I'll start you off at the emergency treatment room."
Han Na-hyeok volunteered as their guide and was about to set off when Lee Jun stopped him.
"Sunbae, you should be greeting the guests. We'll look around ourselves and come back."
"We'll go have a look and come back."
"Hold on a second."
Han Na-hyeok asked a staff member standing nearby to show the two of them around. Lee Jun and Go Gi-jin followed the employee through the lobby and set off on their tour of the medical center.
The first floor of Namgoong Animal Medical Center held a spacious lobby, a cashier's desk, three canine exam rooms, one feline exam room, and an emergency treatment room paired with an emergency operating theater. The first-floor exam rooms were consultation rooms for speaking with guardians; each specialty's exam rooms were located on other floors.
The first place they went was the first-floor emergency treatment room Han Na-hyeok had mentioned. It was, as the name suggested, a space for treating animals who arrived in emergency condition — equipped for everything from simple procedures to an emergency operating theater for patients whose lives hung by a thread.
Stepping into the broad, well-appointed facility, where everything from a basic blood test onward could be handled in a single place, both men let out a breath of wonder.
"Wow."
"My word. This is nice..."
Seeing their eyes light up, the staff member launched into an enthusiastic explanation.
"This is the pride of our medical center. Patients can be examined and treated in a single one-stop process. And with the operating theater right next door, we can take a case straight into surgery when time is critical."
"Is that so?"
"Yes. The operating theater is equipped with an endoscope and a C-arm, so even emergencies like foreign-body ingestion can be treated on the spot."
Foreign-body ingestion happened far more often than most people imagined. Among those cases were more than a few in which every second counted, and Lee Jun — who had lived through a great many of them — was genuinely delighted.
"This is really something."
"It sure is. Real nice, I tell ya."
As Go Gi-jin gazed around the interior with shining eyes, Lee Jun said with a smile,
"Want me to tell Han-sunbae you'd like to work here?"
"Aw, what're you sayin'? No matter how nice this place is, it can't beat our hospital."
Go Gi-jin looked at him as if he couldn't believe he'd even suggested it.
"That so?"
"Course it is. Come on, let's see the rest."
"Right this way, please."
The staff member led them from the first basement level all the way to the tenth floor.
Namgoong Animal Medical Center occupied eleven floors in total, from B1 to the tenth. The first floor housed the emergency treatment room and the outpatient exam rooms. From the second floor up were seven internal-medicine specialty rooms — ophthalmology, cardiology, and the rest — along with laboratories, a surgical outpatient clinic, and a surgical rehabilitation room. There were inpatient wards with walking paths attached to those floors, a surgery center, and a clinical pathology center, all on a grand scale. A research center and seminar rooms occupied an entire floor of their own. The diagnostic imaging center likewise claimed a full floor, and feline examination and inpatient care had been given a floor to themselves, built out as an independent space.
After they had swept through every floor, the two of them headed for the surgery center on the third — they had deliberately saved the operating theaters for last. There were seven operating rooms on the third floor.
"My oh my, this is outstandin'. They said all seven of these ORs were built with negative-pressure design, right?"
"That's correct. The negative pressure can be regulated with complete precision, and the airflow was designed to travel in one direction only."
"Ain't that somethin' else?"
"I'm envious. This surgery center... I really am envious."
Having said it twice in a row, Lee Jun let out a short laugh.
"Why's that?"
"No, I was just thinking that people really are creatures of forgetfulness."
"Huh? What's that supposed to mean?"
"Well, think about it. It was only a few months ago I was wishing we could just have two operating rooms. The moment that came true, here I am already wanting something better."
Mongmong Animal Hospital had two operating rooms, and the diagnostic and surgical equipment Lee Jun had hoped for had improved by leaps and bounds compared to before.
"That may be, but a good thing's a good thing. Hyung-nim, you oughta go and build a hospital like this too."
"Should I?"
Lee Jun answered with a faint smile. The truth was, he was thoroughly fond of his own hospital as it stood. And yet, after walking through facilities like these, a hunger had taken root. His desire to focus on primary care — on catching illness early — remained unchanged. Separate from that, though, he found himself wanting to examine and operate on animals in a better environment.
"And later we'll build a Meong Meong Animal Medical Center Hongseong branch too?"
"Heh heh heh, that'd be real nice. I'd be the center director, right?"
"Depends on how you do."
"Heh heh heh. I'm feelin' confident, I am."
"Hahaha. Time's up — let's head down to the first floor."
Trading jokes, the two of them went back downstairs.
They had met a fair number of staff members during the tour, and the gazes those people turned on Lee Jun ran in several directions. There were looks of respect, greeting him warmly. Looks of curiosity — so that's the man from the rumors. Looks of complete blankness, thinking nothing at all. And last of all, looks of suspicion, wondering whether this veterinarian named Lee Jun was truly as skilled as everyone said, or whether the talk had simply grown louder than the truth.
Kang In-hyeok, of the Namgoong Animal Medical Center surgical team, was one of those who wore that last expression.
Hmph. So that's the veterinarian from all the rumors.
Among his peers, Kang In-hyeok was considered outstanding, and the look he turned on Lee Jun was not a kind one.
The chance to show veterinarians who thought like Kang In-hyeok exactly what Lee Jun could do arrived sooner than expected.
Three days after they had attended the opening ceremony, a call came in from Han Na-hyeok.
"Oh, Han-sunbae. You've only been open a few days and you're already calling. Shouldn't you not even have time to eat? You're going to get yourself in trouble."
"Hahaha, you're telling me. At this rate I might get fired."
"Haha. If you get fired, come to our hospital. I'll give you the best possible terms."
"My, my. Lee Jun's grown a lot. Already thinking of putting me to work."
"Of course. I've grown a ton. Anyway — what's going on?"
Lee Jun dropped the jokes and asked why he had called. He had reason to: the day before, Namgoong Hyun had stopped by Mongmong Animal Hospital and mentioned that Han Na-hyeok was extraordinarily busy.
"Ah, it's nothing else — I think you need to do a PDA procedure."
PDA — Patent Ductus Arteriosus — was a vascular malformation that occurred when a blood vessel used for circulation in the mother's womb, which ought to close at birth, failed to seal. If that vessel remained open, blood leaving the heart could not travel through the body as it should, and instead escaped into the pulmonary artery. The result was a burden on the heart, a decline in cardiac function, and a deformation of the heart's very shape.
Han Na-hyeok was asking Lee Jun to perform the procedure that would correct it.
"Not surgery — a procedure?"
"Yeah. A referral came in, and looking over the records they sent, it seems like a candidate for a procedure. You're better at procedures than I am."
"Come on, what are you talking about. You're much better, sunbae."
"Hahaha. I wish that were true. This one's vessel type is a bit ambiguous. Looking at the vessel, it seems like it needs surgery — but I think you could finish it with a procedure. So I wanted you to take a look first and make the call."
As Han Na-hyeok said, Lee Jun was better than he was at both PDA corrective surgery and the interventional procedure. Even so, Han Na-hyeok was a man of considerable skill in this operation himself. For someone like that to speak this way meant the case was one of considerable difficulty.
"Understood. I'll look tomorrow and decide."
"Okay. So I'll have them come in at two tomorrow?"
"Ah — that's why you called. Yes, two o'clock. How old is the little one? Around two?"
"Not two — three."
"Three? Hmm. I'm not sure the vessels will hold."
A little of the strength went out of Lee Jun's voice. This operation was recommended at a young age, because as the animal grew, the vessels weakened. When that happened, they ruptured easily during surgery or a procedure. That was why the force had drained from his voice.
"That's why they referred, I suppose."
"Probably."
"You're going to try?"
"Yes. We have to try everything we can."
"Okay. See you tomorrow."
"Yes. I'll see you tomorrow."
Lee Jun hung up and let out a faint sigh.
"That little one... if they'd only operated a little sooner..."
"Huh? Did somebody get hurt?"
Go Gi-jin, coming into the director's office through the open door, heard Lee Jun talking to himself and his eyes went wide.
"No, it's not that. There's a three-year-old with PDA, so..."
"Aigoo, that poor little thing must've had it real rough. How'd they not know till now?"
Patent ductus arteriosus was most often discovered in puppyhood, when a young animal was brought in for vaccinations.
"The heart murmur probably wasn't very loud. Or there was some other reason. We'll know when we go tomorrow."
"That's just pitiful."
"It is."
"Anyway, I hope the rest of that little one is healthy enough to get through the surgery or the procedure just fine."
"Let's hope so."
Lee Jun hoped, as Go Gi-jin had said, that the little one's other organs were sound.
The next day, Lee Jun saw patients at Mongmong Animal Hospital until noon, then headed over to Namgoong Animal Medical Center. The moment he arrived, he went through the records of the dog with PDA. He wanted to know the basics before he met her.
3-year-old female Pomeranian, 2.3 kg.
Recently developed a severe cough and loss of appetite. Presented to a neighborhood animal hospital...
Judging by a little girl named Himchan-i — "the vigorous one" — she had probably been frail and quiet as a puppy. They must have named her in the hope that she would live with strength. In truth, though, Himchan-i would have gone on being quiet. Had she been an active child, the strain of running and playing would have overloaded her heart. She might have panted violently, or even fainted — and if she had, the illness would have been found far sooner than this.
Lee Jun set the regret aside and played the ultrasound recording. After reviewing the footage, he let out a breath of relief.
"Thankfully, it's an L-to-R shunt."
PDA could be divided, according to the direction of blood flow, into a left-to-right shunt and a right-to-left shunt. Blood flowing from the aorta into the pulmonary artery was a left-to-right shunt; the reverse — blood flowing from the pulmonary artery into the aorta — was a right-to-left shunt. When right-to-left flow increased until most of the blood was traveling from the pulmonary artery into the aorta, the condition was called Reverse PDA, and the prognosis was poor. Pulmonary arterial blood carried almost no oxygen; when that blood entered the aorta and spread through the body, the result was oxygen starvation, cyanosis, respiratory distress, and the failure of organ after organ.
A left-to-right shunt could be cured by surgery. A right-to-left shunt was a surgical contraindication — operating on it meant immediate death. That was why Lee Jun had been so relieved to confirm a left-to-right shunt.
He finished reviewing the remaining records, then went to meet Himchan-i.
She was, just as he had expected, an exceedingly quiet Pomeranian. Frightened of the unfamiliar space, she had buried her head in her guardian's arms.
A timid little thing...
How terrified must she be? Lee Jun's gaze settled on her.
"Hm?"
His eyes widened slightly. From the mouth of the dog he had assumed was hanging her head in fear came words he had never expected.
Himchan-i gave a small woof and wrapped both tiny front paws around her guardian's arm. The guardian who had come into the exam room wore an expression of unmistakable tension — and Himchan-i was the one comforting her.
Haha. Honestly. I've never met a little one like this.
With a temperament that bold, she would surely pull through. A little easier in his heart, Lee Jun explained what examinations he would be running.
Himchan-i answered without a hint of hesitation, and the guardian beside her, who had heard the explanation along with her, thanked Lee Jun.
"Thank you, Doctor. Hearing what kind of tests Himchan-i will have, and how they'll be done — I feel a little more at ease."
"I'm glad. Then I'll take Himchan-i for her exams and be right back."
Lee Jun gathered Himchan-i into his arms and carried her to the examination room.
"Himchan-ah. If it gets hard to breathe during the exam, or if you feel dizzy, raise your front paw like this, okay?"
Once again, Himchan-i answered without the slightest fuss. And just as her answer had promised, the examinations went smoothly.
The results, however, did not.
"One-point-four... The pulmonary hypertension is far too severe."
Lee Jun read off the ratio of pulmonary to systemic blood flow and let out a sigh. In a typical left-to-right shunt PDA patient the figure came in at 1 or below; at 1.5 or above, the case was judged to be Reverse PDA, and surgery was contraindicated. If a Reverse PDA was closed surgically, the vessel that had been dispersing the enormously high pulmonary arterial pressure would be gone — and the heart, unable to withstand the sudden spike, would fail at once.
Han Na-hyeok, reading the results beside him, sighed as well.
"It is. She's right on the verge of tipping into Reverse PDA. That's why the heart murmur was so faint."
"So that's what it was."
"Can we even operate on this?"
"Honestly, it would be difficult. This case can practically be considered reverse already."
"True."
"The likelihood of an event after vessel occlusion is far too high."
Meaning: death on the table. Lee Jun delivered the assessment without softening it.
"It is high."
"If she simply takes her medication and is managed well, she might live another year or two — maybe even three. But if we rush the anesthesia and she dies on the table..."
Lee Jun let the sentence hang, and Han Na-hyeok exhaled.
"When they said they were sending a referral, I thought she was a surgical candidate. I didn't realize it was this severe."
Lee Jun nodded slowly. Among every PDA case he had ever handled, this one ranked in the top five for severity.
"What do we do? Can you even do it? Even if we try, it's a problem."
At Han Na-hyeok's question — half lament — Lee Jun thought of Himchan-i, blinking those clear eyes, speaking her mind without a hint of hesitation.
If she had a normal heart... how much bolder, how much more cheerful a little dog would that Himchan-i become?
Lee Jun wanted to see that Himchan-i.