Please, Beat Again

"Go. Go tell Yoo to come here."

Lee Jun spoke to Go Gi-jin, who had been pacing outside the director's office.

"Yessir, I'll do that."

Just as Go Gi-jin started to move, Lee Jun called him back.

"Ah—wait. No. I should go myself. I need to get the surgery prepped anyway. You stay here and get the consent form from Kim Dong—I mean, from Song-i's guardian."

"Yessir, I'll do that."

Lee Jun hurried out of the director's office. On his way past, he spoke to Kim Dong-wook.

"I'll come back in a bit and explain the surgery Song-i's going to have."

"Y-yeah."

Hearing Kim Dong-wook's reply, Lee Jun pulled the phone from the drawer, already dialing as he strode out.

The tone rang twice. Then a voice came through.

Lee Jun was already in the treatment room by the time he hung up. The moment the call ended, Yoo Mu-hwan asked him a question.

"You're going to extract it directly?"

"Yeah. The way she is now, I don't think she'll last long enough for it to dissolve."

"I was thinking the same thing. The person you were just on the phone with…?"

"Choi Woo-jin. I asked him to come help."

The instant the name left Lee Jun's mouth, Yoo Mu-hwan's face lit up.

The blood vessels of a dog weighing barely three kilograms are extraordinarily thin. Opening one of those vessels was already a surgery of hair-fine precision—and that alone would have been difficult enough. Song-i's condition made it worse. She was in arrhythmia, with pulmonary edema on top of it. A surgery where table death was a real possibility if anything went even slightly wrong. And now a seasoned surgical veterinarian was coming to put his hands on it.

"Ah—if Senior Choi is coming, I can breathe a little easier."

Yoo Mu-hwan went on, the relief plain in his voice.

"I was worried whether I'd be able to assist properly on a surgery this big."

"Of course you could, Yoo. But this time I need you on anesthesia. You know as well as I do—getting Song-i's anesthesia right is the most important thing right now."

Anesthesia mattered. What mattered even more was the work of drawing a clot out of a vessel as thin as thread. Yoo Mu-hwan swallowed hard at the thought.

"I'll start prepping for surgery right away."

"Please do."

While the preparations got underway, Lee Jun returned to the exam room where Kim Dong-wook was waiting. The moment he stepped through the door, Kim Dong-wook—his face the color of dirt—shot to his feet.

"J-Jun, that… I mean, is a surgery like that even possible?"

Go Gi-jin had already explained to him what they were about to do to Song-i.

"Ah. You mean the vascular incision."

"Yeah. A vessel as thin as thread—how do you even…"

"How do we cut it, you mean?"

Kim Dong-wook's head bobbed in a frantic nod. And then the door banged open, and Choi Woo-jin walked in.

"Huh? You… Kim Dong-wook?"

"Choi… Woo-jin?"

For a moment the exam room went taut as a wire.

"Kim Dong-wook, what are you doing here…"

The blade-sharp voice stopped. Choi Woo-jin looked him up and down. Then he turned to Lee ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠Jun.

"This guy's dog?"

"Yeah."

Kim Dong-wook spoke, his voice drained of strength.

"I… I'm sorry."

"We'll talk about that later. That's not what matters right now."

"R-right."

Choi Woo-jin shifted his gaze back to Lee Jun, his tone easing a fraction.

"You've got a scrub set for me?"

"It should already be ready."

"Thanks."

"I should be thanking you."

"Then let's go get ready."

Choi Woo-jin started for the door, then spoke over his shoulder to Kim Dong-wook.

"We've spent our days and nights learning to cut and suture vessels as thin as the thread you just mentioned."

Meaning: don't worry about the surgery.

"R-right."

Kim Dong-wook could only keep dipping his head.

Thrombosis is what happens when the blood inside a vessel hardens into a clot—when viscosity rises, when circulation stagnates, when the clotting cascade runs too hot. The clot blocks the vessel, and the blood stops moving. Strength fails, of course. The limbs go numb. Convulsions set in. Sometimes the animal simply collapses. With no circulation there is no oxygen, and the carbon dioxide in the blood cannot be cleared either. Every organ in the body begins to fail. And because a catastrophe of that scale is unfolding inside the body, the pain that comes with it is inevitable. That Song-i had been ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠screaming as if she were being torn apart, thrashing against it, was only natural.

Which was why Yoo Mu-hwan, who knew they had to operate on her without losing a single minute, was rushing through the surgical prep. His hands moved fast. His head, though, was full of Lee Jun.

Our director is incredible. Diagnosing thrombosis on the spot—aortic thrombosis, no less.

Thrombosis was notoriously hard to catch. In a case like this, it would have been easy to misread it as a disc problem, the way the hospitals Song-i had already been through had done. And Lee Jun had not only named it at once—he had committed to surgery.

It's the best choice in this situation. Surgery is the only answer, honestly.

The problem was Song-i's condition.

Please. Hold on.

And please, Yoo Mu-hwan prayed, hands gathered without quite meaning to, let Director Lee Jun's hands be fast.

The prayer finished, he worked faster. There was more to prepare than usual. He had to set up gas anesthesia for a patient who might stop breathing at any second. He had to be ready for the emergencies that could hit the instant circulation returned to a body that had been stalled by the clot—cardiac shock, sudden death. And the thrombolytic therapy had to run at the same time as the surgery, which was one more thing driving him. Even so, with his native meticulousness and precision, and with the speed he had learned at Mongmong Animal Hospital, the preparations flowed as smoothly as water.

In what felt like a blink, everything was ready. Outside the operating room, a light came on.

Lee Jun took the surgeon's place. Choi Woo-jin stood as first assistant, Yeo Un-hyeok as second. Go Gi-jin took third, and the four of them waited only for the start.

A difficult surgery lay ahead for Lee Jun, and for Song-i. He spoke to the little dog lying on the table.

It was what he always said to the animals on his table. This time he put more conviction behind it than usual. He met the eyes of everyone in the room, one by one, and last of all looked at Yoo Mu-hwan and nodded.

Yoo Mu-hwan opened his mouth.

"Beginning anesthesia."

A moment later he signaled that Song-i was under, and Lee Jun spoke.

"We're beginning the surgery."

The words were barely out before his hands moved—bold, decisive, opening the skin in a single stroke. The midline of the abdomen parted in a clean incision.

That's Jun for you. Clean as ever.

Lee Jun's hands were living up to every bit of their reputation. Choi Woo-jin's eyes sharpened as he followed them. Equipment these days was good enough that an incision could cauterize as it went, but you still wanted to stay off the vessels if you could help it. Nerves, too. Fascia, cut as cleanly as possible. All of that usually took time. Lee Jun's hands did not hesitate. The skin incision, the subcutaneous cut, the separation of muscle—it happened in a breath. Fast. Not a single wasted motion. And precise on top of it. Choi Woo-jin, Yeo Un-hyeok, Go Gi-jin: all of them, with one mind, were quietly stunned.

This is almost too much.

Too fast, and too accurate—and they meant it as praise. While they were still catching up, the abdomen was open, and in the next instant the aorta in the lower belly lay exposed.

"Hah!"

"Eutta!"

"Whoa."

The sounds broke from Choi Woo-jin, Go Gi-jin, and Yeo Un-hyeok at the same time. Lee Jun spoke.

"I'm going to open the vessel. Stay with me, Woo-jin."

"Okay."

"Let's place the stay sutures first, then go in."

Before you cut a vessel, you tie it off at either end of the incision. That way blood does not leak from the opening—and, just as important, a fragment of clot cannot break free and ride the bloodstream somewhere else.

"Okay. I'll take that."

Choi Woo-jin tied the vessel off in a few quick motions, and Lee Jun followed at once, opening the thread-thin vessel where the thrombus had packed it solid. Fast, and delicate. Song-i's vessels had been damaged for a long time; compared to a healthy dog's, they were terribly fragile. The slightest wrong touch could burst them. The unhesitating hands of a moment ago became something else entirely. Lee Jun separated the vessel with extreme care. Even with Choi Woo-jin's stay sutures in place, if the wall tore, or if he nicked a vessel beside it, death would follow immediately.

Then the mass that had been blocking the vessel came into view.

"The thrombus covers a pretty wide area."

"Whew… with a clot like this, dissolving it never would have been easy."

Choi Woo-jin clicked his tongue. A thrombus of this size would have killed her before any lytic agent could eat through it.

"Good call, going to surgery. I think I still would have tried thrombolysis."

It was praise, and it was also an admission: choosing a surgery this hard, even when it was the right call, was not an easy thing to do. Lee Jun gave a short nod.

"If the range ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠were narrower, or if Song-i didn't have the arrhythmia, I would have put in the thrombolytic and waited too."

He was already moving as he answered, rapidly clearing the clot that packed the aorta and the branch arteries running all the way down toward the hind limbs.

"Now we close the vessel. The thing we have to watch for most here is air embolism."

Air embolism: ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠air bubbles entering the bloodstream and blocking flow, starving an organ of function. Song-i's vessel was open. Close it with air still inside, and bubbles would be left in the lumen, waiting to cause trouble.

"If the bubbles travel the veins and get filtered by the lungs, it's not a problem. But if they go through an artery into the heart or the brain, it's an emergency. And the vessel sitting in front of us right now is the aorta."

He drew a short breath and called to Choi Woo-jin.

"Woo-jin. Let's go."

"Okay."

Four hands moved without rest. To everyone watching, the vessel was restored in an instant. For Lee Jun it was stitch by painstaking stitch, everything he had poured into each one. Sweat beaded on his forehead. A dangerous surgery, and one that demanded a concentration that left no room for anything else.

"Now we have to take down the stay sutures… Yoo. How is she?"

"She's been stable so far."

"Okay. Taking them off now."

Lee Jun released the clips that had been holding the vessel, carefully, one by one. In a breath, everything returned to the way it had been. Then, in reverse of the opening—muscle, subcutis, skin. Lee Jun closed the subcutis; Choi Woo-jin followed on the skin.

It was done. A shallow breath escaped both of them.

And then—

The warning flooded the operating room. Every gaze in the room snapped to Song-i, still lying on the table as if she were only asleep.

Her heart had stopped.

"She's in arrest! CPR!"

Lee Jun shouted it as he set his instruments aside as if flinging them, his hands already reaching for Song-i's heart.

Thump. Thump. Thump.

"One, two, three, four, five…"

Both of his hands drove into her chest without hesitation. CPR, begun. His compressions were regular, a measured cadence, unvarying. He paused the chest work for a beat and locked his eyes on the monitor.

"Please. Please…"

He muttered it, willing Song-i's heart to move again, and called out to the room. Nothing moved.

"Defibrillator!"

The emergency device for a patient in arrest. At Lee Jun's shout, Yeo Un-hyeok answered.

"On it."

Yeo Un-hyeok fired up the unit they had already staged. Lee Jun took the paddles; Choi Woo-jin was already pouring gel across them.

"Charging!"

Lee Jun called it, and Choi Woo-jin followed.

"Clear!"

Lee Jun set the paddles in the exact positions and called it out.

"Ready… shock!"

The charge fired. Electrical current slammed into Song-i's chest. Her body jerked, a small convulsion of impact. The moment Lee Jun lifted his hands, Choi Woo-jin took over the compressions.

The seconds stretched, tight and merciless. They ran the same sequence again. From every mouth in the room the same sound kept coming, like an incantation: Please. Please.

A short span of time that felt like an eternity passed. And then—

The sound of hope filled the operating room, clear and luminous.

In that instant—

"Yeahhh!"

"Sh-she's alive."

"She's alive!"

They cried it out with one voice.