The Heart Beats Again
The aortic conversion got underway, and the pulmonary artery followed close behind. One after another, the circuits came online. The complication they had feared never came.
"Whew. That's one hurdle down."
"Thank goodness."
"Hah..."
Sighs of relief rose from every corner of the operating room. Listening to them, Lee Jun spoke inwardly.
Thank you, Bokshil.
While he silently thanked her for holding on, blood raced through the connected tubing, took on oxygen from the machine, and flowed back into her body.
Whirrr. The sound of the cardiopulmonary bypass running smoothly was a beautiful thing to hear. It meant the connection had succeeded.
"Hah..."
Lee Jun let out a delayed breath, the look of a man who had set down a weight. But the composure lasted only a moment before the cool, precise expression returned. With bright-red blood cycling through the bypass, there was not a second to waste.
Listening to the machine's steady whir, he gave the order.
"Cooling down!"
Drop her body temperature.
"Yes!"
A short while later, Yoo Mu-hwan spoke up.
"Temperature is 34 degrees."
The 38.2 that had been her baseline was falling.
"Temperature is 32 degrees."
Lower still. Lee Jun asked,
"Has the heart stopped?"
"Not yet..."
Tension thickened in the room.
Then the loosened mitral valve came into view.
"What's the temperature?"
"30.1 degrees."
As body temperature dropped, so did the tissues' demand for oxygen, which meant less damage. At Yoo Mu-hwan's report, Lee Jun said,
"A little lower, then stop."
"Yes."
A moment later, the heart that had been moving sluggishly went still.
From here on, the machine linked to her vessels would stand in for Bokshil's heart and lungs.
A taut, stretched silence filled the operating room.
Valve surgery demanded that the surgeon's fingertips be both fast and exact. Speed raised the odds of survival; precision meant the patient recovered without complications. In other words, it was a race. Accurate, and fast. A single mistake, and this heart might never beat again.
The responsibility riding on Lee Jun as the operating surgeon was beyond anything words could hold. Bokshil's life, lying there on the table, sat at the ends of his fingers.
In that taut silence, Lee Jun looked down at her stopped heart.
Just as I thought.
His eyes sharpened. Then his hands went straight to the mitral valve.
Over a heart that did not move, Lee Jun's hands never stopped.
The procedure he was performing — mitral valvuloplasty — had one aim: to keep the blood from flowing backward. In people, a ruined valve could be replaced with a mechanical one of metal or a tissue valve fashioned from animal material. But in a dog as small as Bokshil, artificial valves were nearly impossible to place. So he was narrowing the loosened valve annulus back to its original size with his own hands.
In a matter of moments, the annulus was drawing tight.
Watching from right beside him, Choi Woo-jin's eyes went wide.
He's gotten even faster.
Han Na-hyeok was no less stunned.
How does this kid keep getting better?
It had been a while since Lee Jun's last surgery of this kind, and any flicker of worry that rust might have set in now looked ridiculous. His hands were fast. And they were precise.
While they were still marveling, Choi Woo-jin held out a suture.
The annulus had been cinched. Now it was time to rebuild the chordae tendineae.
The chordae were the ligaments that held the valve — the same job as the cords of a parachute, pulling taut when the canopy opened. They ran from the valve down into the muscle of the ventricle, and in degenerative valve disease they ruptured right along with everything else.
Bokshil was no exception. Of the chordae in front of them, several had already snapped. Others hung so slack they looked ready to go at any second.
Choi Woo-jin held the tissue so Lee Jun could work, and Lee Jun began building new chordae out of artificial suture. Beside him, Han Na-hyeok put his hands in too. The cords the two of them were making would take the place of the ones that had worn away.
Han Na-hyeok's hands were fast as well. Choi Woo-jin assisted them both.
Why is he this fast?
Han Na-hyeok, working right there with him, kept swallowing exclamations before they could leave his throat. Even so, Lee Jun's speed left him reeling. It was absurd. Accuracy was a given — but even watching from an arm's length away, his eyes could barely keep up.
He could not afford to stand there admiring it. He would not be the reason this surgery ran long.
Han Na-hyeok's hands sped up.
As the two of them accelerated, Choi Woo-jin's hands did too.
I can barely keep up with this bastard Lee Jun as it is — now sunbae's going off too?
Their unhesitating hands pulled his along. But a single slip, and the heart in front of them would stay stopped forever. There could not be a hair's breadth of error in a single motion.
All three of them, heavy with the weight of it, built new chordae onto that small valve.
And they were not the only ones who felt it.
Eom Jin-han, on the heart-lung machine, was staring so hard it looked as if light might shoot from his eyes. Over the narrow operative field, six hands moved without a wasted gesture. Teamwork locking into place, click by click.
While the three of them worked at speed, Eom Jin-han's gaze, in his role as perfusionist, flicked just as fast. So did Yoo Mu-hwan's. Monitoring temperature, blood pressure, oxygen saturation without a pause, Yoo Mu-hwan spoke.
"Sunbae Eom, could I ask you to check the oxygen mix?"
"Got it."
Six hands never stopped. Around them, their colleagues held Bokshil's condition steady so the three at the table could operate without a second thought.
Any surgery that used cardiopulmonary bypass was better the shorter it ran. The longer the machine stayed on, the greater the risk of complications afterward — to the brain, the liver, the kidneys.
The two men matching Lee Jun's pace had faces flushed with heat.
This is actually working.
This is going to work.
Both of them could feel the surgery tipping toward success. And a short while later, success was right in front of them.
The procedure was coming to a close. Han Na-hyeok let out a shallow breath.
"Now we just have to come off bypass..."
Ahead of them sat the pressure problem they had worried about from the moment the machine first spun up. They would have to drop the perfusion flow to ease the pressure building in the aorta. That was Eom Jin-han's job.
The three pairs of hands kept moving. Every time Lee Jun put out a hand, the instrument he wanted was already in it. Choi Woo-jin had been waiting with it.
A moment later, Lee Jun spoke.
"I think we can start weaning, don't you?"
Ease the machine down, bit by bit. As the bypass slowed, the heart and lungs would take their work back.
Eom Jin-han exchanged a look with Yoo Mu-hwan, then said,
"Starting the wean."
Everyone held their breath and watched as the machine wound down.
Wmmmm. As the hum of the bypass faded, Lee Jun's, Choi Woo-jin's, and Han Na-hyeok's hands grew busier still. Kim Jaeyeon had joined them, and his hands were moving just as fast.
The clamps that had been holding the vessels shut came off. The cannulas were drawn out one by one. In that same moment, Cha Da-jeong stepped in and set an ultrasound probe against the heart — to see that it was beating, and to see that the repair had held.
"It's back."
At Cha Da-jeong's word that the heart was beating normally, a smile touched the corner of Lee Jun's mouth. Hidden, of course, behind the surgical mask.
"We did it!"
"Whew. We really made it over the hump."
"Now we just have to wake her up."
Hearing those hopeful voices, Lee Jun's hands moved even faster. They could close with confidence now. There was no reason to linger.
Choi Woo-jin placed a chest tube, and Lee Jun sutured it so it would not slip. In the hours ahead, the fluid pooling in the pericardium would drain through that tube.
Lee Jun closed the split sternum. The muscle that had been divided at the start of the surgery came back together. The subcutaneous layer followed.
At last Choi Woo-jin closed the skin, and Lee Jun reached for the bandage. Seeing it, Han Na-hyeok caught the roll still in Lee Jun's hand.
"What do you think you're going to do with those hands?"
"What do I— wait. What's wrong with my hands?"
Lee Jun looked down and his face went startled. His hands were shaking hard.
"I'll do the bandage. Go rest. You're going to drop if you keep this up."
"Come on, sunbae, you're not in much better shape. If you bandage her, it'll come loose in no time. I'll do it — you go rest too. Bandaging's my job anyway, isn't it?"
At Choi Woo-jin's words, Han Na-hyeok let out a short laugh.
"Take a look at yourself before you talk. You don't look any different from the rest of us."
He was right. Choi Woo-jin's fingertips were trembling too — the aftershock of more than five hours gripping instruments, every one of those hours spent wound tight as a wire.
"Huh...? Wow. Guess I'm past it. Past it. Getting wrecked after a five-hour run. Used to be I could go five hours and jump straight into another one."
Choi Woo-jin said it with a wry look and passed the bandage to Kim Jaeyeon, who had come up beside them. Han Na-hyeok spoke to his back.
"The minute that kind of talk comes out of your mouth, you're already an old man in the back room. Come on, us back-room geezers should make our exit. We'll only get in the way if we stay."
"Aigoo. I suppose we should."
Choi Woo-jin followed Han Na-hyeok out. When the two of them looked at Lee Jun, he nodded and said to the rest of the operating team,
"We're heading out."
No reminder to watch Bokshil well. No request that they take care of her. Just that. Which meant he trusted them that much. The juniors, who could hardly miss what sat behind the words, answered with steady faces.
"Please don't worry."
Hearing that solid reply, the three of them shuffled out of the operating room, looking thoroughly, deeply relieved.
As they walked, the team called after them with one voice.
"Thank you for your hard work!"
Lee Jun turned back. He put up a thumb.
We all had to be here for this surgery to end the way it did. That was what the words carried. Smiles broke across every face.
Now they only had to open the door, and they would be outside the operating room. Out there, Bokshil's guardian, Na Haram, would be craning her neck, waiting.
"Hrm."
Lee Jun drew a breath, then opened the door and stepped out.
Just as he had expected, Na Haram came into view.
"The surgery..."
She could not finish the sentence. Lee Jun answered her.
"The surgery finished safely. It went well."
"Ah..."
"All that's left is for her to wake up."
For an instant Na Haram's eyes wavered. The possible aftereffects Lee Jun had explained to her before the operation rose in her mind, a crowd of complications drifting through her head. But they faded just as quickly. Bokshil was breathing. That alone was enough to make her glad.
Through those long, long hours, Na Haram had stared at a single thing and wished for nothing else.
Then Na Haram bent at the waist.
"Thank you. Thank you so much. Doctors, thank you so much."
"Not at all. Bokshil is the one who found the strength. If you wait just a little, she'll be moved to the intensive care unit. You can go see her then."
Lee Jun offered a greeting and started down the corridor with the other two. Watching the three of them shuffle away, Na Haram bowed once more. She could feel how hard they had worked for Bokshil.
"Thank you, Director Lee Jun. And all of you."
"...Ah... Shil."
From somewhere impossibly far away, her name was being called. By the mommy she loved so, so much.
Bokshil answered at once — Yip! — but no voice came out.
I'm here! Mommy!
Afraid Mommy might not find her, she called a little louder. Woof! But all that came was a thin wheeze, like air leaking from a balloon.
Why is it like this? Mommy can't go somewhere else.
She was worried Mommy would fail to find her and leave. If that happened, she would be separated from the mommy she loved so, so much.
No!
She hated that. When she had wandered alone with nowhere to go, it had been so scary and so lonely. And she had been hungry. She hated the thought of that happening again. Just imagining it made sweat bead on her paw pads, and the place above her belly pounded, pound-pound-pound.
Maybe that was why it hurt so, so much.
A whine rose on its own — keening, keening, keening — but even the sound of her own pain came out strange.
Ee—ee—ee—
Like that.
Sick with frustration, she kept crying ee—ee—ee.
Then, all at once, a warm hand settled on her.
It was the hand of the mommy she loved so, so much.
In that instant the corners of Bokshil's mouth lifted by themselves.
She was smiling — heh, heh, heh — when Mommy's voice reached her.
"...il. You did so well... thank... you."
She did not know what the words meant, but it was good anyway. She could feel Mommy's hand. She could hear Mommy's voice.
So Bokshil giggled. And then she thought of nothing at all.
"B-Bokshil smiled."
"She must have felt your hand. She has to be in a great deal of pain, but seeing her smile like that, her condition looks good."
"Does it?"
"Yes. The incision will hurt, of course, but her throat — where the tube was — is going to be very uncomfortable. Even drinking water will hurt for a while. But looking at that smile, she seems all right."
"It just breaks my heart. If she were a person, she'd at least know why she was hurting. Bokshil doesn't even know why. She just hurts."
I already explained it to her. And I'll explain it again when she wakes.
It would hurt. But Bokshil would hurt knowing the reason. Her throat would be back to normal in a few days; the incision would ache for some time yet. Even so.
Give her a month, and she'll be tearing around the place, thrilled with herself.
The surgical pain would ease by degrees. That did not worry him. The aftereffects, a little.
Oxygen was getting through the whole time. She'll be all right. And the surgery wasn't long.
Close to five hours. Long, if you wanted to call it long — but not long compared with other cases of this kind.
Half a day had passed since they had moved her from the operating room to intensive care, and everything was proceeding without a hitch. All Bokshil had to do now was wake.