Wake Up, Dangdang-i

That night, at eleven o'clock, Lee Jun stared through the monitor until a low sound escaped him.

"Mmm..."

Cha Da-jeong, wearing the same expression as she studied the screen beside him, glanced over.

"Director, is his condition all right?"

"Well, he looked fine on the outside. But look at all these heartworms. How many are there, exactly?"

"I counted twelve just from what I could confirm. There are bound to be more."

"Whew. That's a lot."

"I don't think Dangdang-i is a year old, either. We had a similar case back in school."

"Yeah, he doesn't look it. How old was that one?"

"Four. A French Bulldog. He'd been on drug treatment, then got transferred to us as an emergency. We pulled twenty worms out of him."

"Aigoo, so they didn't realize he had that many adults. How is he now?"

Heartworm disease can be treated with medication or with surgery. In a light infection, an injectable adulticide called Immiticide is enough. When the adult worm burden is heavy, though, the worms have to be taken out by hand.

Immiticide will kill the adults, yes. So why go to the trouble of fishing them out surgically? Because of what comes after.

An adult heartworm runs anywhere from twelve to twenty-five centimeters. Sometimes a surgeon pulls out a specimen closer to thirty. Imagine a creature of that size thrashing through a blood vessel when it is fed a lethal poison. It will not die quietly. And even a quiet death is a problem, because a dead worm is a plug. These bulky parasites pack themselves into the great vessels — the pulmonary arteries, the right atrium — in dense, writhing clusters. If they convulse on the toxin, the damage to the heart and the pulmonary arteries is a given. Worse still, dying worms release toxins of their own.

The French Bulldog Cha Da-jeong had mentioned had been injected with adulticide while still crawling with worms. The prognosis in a case like that can turn grave in a hurry. That was the weight behind Lee Jun's question.

"Fortunately the surgery went well, and his treatment wrapped up cleanly."

"That's a relief."

"Yes, so... Dangdang-i should be all right too, shouldn't he? His liver values are high, but there's no ascites and no blood in the urine."

"He'd better be."

Lee Jun's face had gone somber. The surgery worried him, but it was the remark about Dangdang-i's age that had truly settled over him. Dangdang-i. How did you spend all that time? Year after year of waking up to the possibility of dying before the day was out.

That was the face, then. Lee Jun found himself remembering Dangdang-i as he had first seen him the day before — that small Boston Terrier stepping forward with a look of grim resolve, putting his friends behind him. Perhaps Dangdang-i had been grateful to those much larger companions who had shielded him and hidden him. And perhaps it had been unbearable, and shameful, to watch those same friends suffer right in front of his eyes. Gratitude and guilt. That was what made him decide. He might have made that same decision yesterday, and today, and tomorrow. And every time, his friends had stopped him.

Lee Jun ached for all of them — for Dangdang-i, and for those big dogs who had thrown themselves in front of a body so much smaller than their own. The sound he let out then was longer and darker than the one he had given the monitor.

He was still adrift in the thought of Dangdang-i when Cha Da-jeong spoke.

"But Dangdang-i... how did he even end up there?"

It clearly struck her as strange: a little dog among all those giants.

"Someone might have brought in a lost dog. Or maybe whoever... ah, never mind. Whatever it was, it couldn't have been anything good."

The farm owner collecting a stray, or a guardian walking away and leaving him there. Any number of reasons, none of which Lee Jun wanted to picture. He let the sentence trail off.

"I suppose so."

Cha Da-jeong said it and sighed. Lee Jun answered her — though in truth he was speaking to himself.

"Still, at least Caval Syndrome never set in. We can be grateful for that."

He would think of it that way. Better to spend the time figuring out how to help Dangdang-i live happily than to sit with the image of all the days he had already suffered.

"You're right. That really is a blessing."

Cha Da-jeong was still watching something writhe on the monitor as she answered.

"Yeah. It is."

On the morning of the third day since the big dogs had begun living in the basement of Mongmong Animal Hospital, Cha Da-jeong went downstairs with Lee Jun and came back up with Dangdang-i in her arms.

The little warmth of him against her, the dazed look on his face — her thoughts were a tangle. He's stiff as a board. Being held by a person was so foreign to him that his whole body had gone rigid. She was half afraid he would slip right through her arms.

If that had been all, she would have thought, Ah, he's just not used to human hands. But his head had settled onto her shoulder, and from his throat came a strange little sound.

Grrluu... grrl, grrung.

That's a happy sound, isn't it? A dog who wanted a person's touch and feared it in the same breath. Cha Da-jeong's heart went out to him.

She tipped her head to the right until it met his. Shoulder and temple, both full of Dangdang-i's warmth, she made a quiet wish.

"Dangdang-i, let's get through this surgery together."

Hehe. Okay.

She could have sworn she heard him answer, and the corner of her mouth curled up.

"Dr. Cha, you really like Dangdang-i, don't you?"

Lee Jun had been watching her.

"I do. He's cute, and kind, and so gallant."

How could anyone not adore him?

"Ah — did I tell you? Dangdang-i here stepped out in front and left his friends behind him."

"What?"

"It's a whole story. Anyway. Dangdang-i. Once you catch a little nap, your body will feel like new."

Woof!

Dangdang-i answered him at full volume.

Heartworm extraction is not an easy surgery.

The jugular — the great vessel running through the neck — is brought to the surface. Then an instrument like a wire is fed into the vein, and the worms are fished out one by one. Writhing worms. Threading a tool into a vessel that narrow is dangerous enough; using it to hook a parasite is the kind of operation that draws a sigh just to describe.

And that operation was about to be performed in the surgical suite at Mongmong Animal Hospital. A heartworm extraction. The lead surgeon was, of course, Lee Jun. Beside him, Kim Jaeyeon would assist. He spoke up as Lee Jun laid out the instruments.

"I heard they used to use Ishihara Forceps for this?"

"Yeah. That's what we used before this came out."

Lee Jun said it, then added, as if the thought had just surfaced,

"Sometimes we even fished them out with wire."

"Wire?"

Kim Jaeyeon startled.

"Yeah. You tie a thread to a wire and fish them out."

"Does that actually work? I've heard of people doing it, but..."

"You end up doing it, when you're somewhere that doesn't have much."

Yoo Mu-hwan, who had been checking the anesthesia machine, picked up the thread.

"Director, I heard that method actually pulls them out pretty well?"

"You've done it?"

Kim Jaeyeon's eyes had gone wide.

"Yeah, in India. Things are rough there. I did a fair number of heartworm extractions."

"Prevention probably isn't great, so there must be a lot of infected dogs. And it's so hot..."

"Well, it's not like they're short on mosquitoes. Once the temperature hits fourteen degrees Celsius, infection's always lurking."

"A place like that is dangerous year-round."

"Then I suppose I ought to learn it too. Not the endoscopic extraction — the wire. That sort of thing."

"Ah, that's right. You said you wanted to come along."

"Yes. I'd like to do volunteer work in India or Thailand. In graduate school the only outreach I did was two trips to Laos with the surgery department."

"That's perfect. Dr. Go said he wants to volunteer at an elephant sanctuary. You two could go together."

"Oh — elephants and Senior Go actually seem like they'd suit each other."

"Right? I think so too. And Dr. Kim, you take the Ishihara. Wire is trickier than it looks. A little too much force and the vessel tears."

"Ah, maybe I should. But the Ishihara's out of production, isn't it?"

"I've got a few. You can take those... ah, I've also done it with a feeding tube. That works pretty well."

The conversation had been about pulling heartworms out of a blood vessel, and then a feeding tube appeared in the middle of it. Kim Jaeyeon and Yoo Mu-hwan both blinked. A feeding tube was a soft line passed down the esophagus to deliver nutrition to patients who could not eat on their own. Soft, by definition.

"A feeding tube?"

"Yeah. Five-French or six-French seemed about right."

Kim Jaeyeon was still trying to picture how anyone fished a heartworm with one of those when Lee Jun, as if it were nothing at all, went ahead and specified the size. ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠The French gauge is tied to circumference; divide by three and you have the diameter in millimeters. Six-French is roughly two millimeters.

Everyone in the operating room looked faintly ill. Sure. The Director could do it. As for the rest of us...

While that conversation was still hanging in the air, the surgical suite door opened and Cha Da-jeong came in with Dangdang-i in her arms.

"Dangdang-i's here."

"Oh! Dangdang-i's here?"

"Dangdang-i!"

Every voice in the room gathered around his name, gentle and warm. Dangdang-i, a little more at ease in Cha Da-jeong's arms than he had been that morning, answered with a bright woof.

Lee Jun spoke to him.

"Our Dangdang-i's so brave. He said he'd go first so his friends wouldn't be scared."

Dangdang-i beamed.

He had come to Lee Jun himself and declared — proudly, true to his name — that he would take the procedure first so the others would not be afraid. That was how he had earned the first place on the table. If this surgery succeeded, his friends would be able to face theirs without terror. Lee Jun fully intended to have Dangdang-i standing proud before those friends by evening.

Yoo Mu-hwan spoke.

"Anesthesia going in."

"Okay."

Lee Jun answered him and looked down at Dangdang-i, already recumbent on the table. Those big eyes, which had been watching him so steadily, without a tremor, were ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠growing smaller by degrees. Lee Jun smiled.

"Catch a little nap, Dangdang-i. I'll see you when you wake."

Blink. Blink. Dangdang-i was too sleepy to answer out loud. His face did it for him — the corners of his mouth curled up, just slightly.

Lee Jun looked down at that peaceful expression and announced the start of the operation.

A surgery that opened the jugular and fed a retrieval instrument into the vein. Keep the incision as small as possible. The jugular is a sizable vessel; if it tears, the blood comes in a flood.

Lee Jun's hands were fast. In a matter of moments the jugular lay exposed at the neck. He passed a suture around it, tied it loosely, and slid the endoscopic instrument into the gap.

Try to pull them all at once and everything goes wrong. A few at a time, with care. Calm hands, and quick ones. In another instant he drew the instrument back out — and the first worm came with it. A heartworm that looked well over twenty-two centimeters, caught on the device, writhing as it left the vessel.

"Oh—!"

"Ugh!"

Everyone had their own version of a flinch, and that was the first and last of it. After that they were too busy — dropping the rapidly arriving worms into a formalin jar, ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠watching Dangdang-i's plane of anesthesia, assisting Lee Jun — to do anything but work.

Well into the hunt, Lee Jun spoke.

"I don't think I'm seeing any more. How many was that?"

"Fifteen."

"Hoo. That's a lot. Dr. Cha, do you see anything?"

He was checking the C-arm fluoroscope for stragglers as he asked.

"No, I don't think there's any more. This many, in a body that small. Caval Syndrome could have taken him. We're so lucky it didn't."

Fifteen adults was a burden heavy enough to have triggered vena cava syndrome — pneumonia, respiratory distress, syncope, ascites, hemoglobinuria, even sudden death.

"Right. This way it stings a little less."

"Exactly. To finally be happy, and then not even get to have that happiness — that would have been too cruel."

Yes. Everyone at the table agreed with her.

"All right. Now we just wait for him to open his eyes. You all know — we stay on him until he's out of anesthesia."

"Yes. I'll stay right beside him."

"No, I'll sit with him. Senior Yoo, you have more anesthesia to run in a bit."

Lee Jun and Kim Jaeyeon's surgeries would keep coming. Yoo Mu-hwan and Yeo Un-hyeok would be covering anesthesia. Go Gi-jin would be buried in appointments in the exam rooms. The only person with any room to spare was Cha Da-jeong.

"You will?"

"Yes."

That day, the lights stayed on in both of Mongmong Animal Hospital's operating rooms. Besides Dangdang-i's case, there were five more heartworm extractions — every one of them for the big new members of the hospital family.

That evening, in the large-breed inpatient ward, five pairs of eyes were rolling groggily about. Dangdang-i was not among them. Not because he was too small for that ward. He simply had not opened his eyes yet.

Dangdang-i lay in the ICU with his eyes closed, Yoo Mu-hwan watching over him. Beside Yoo Mu-hwan, Cha Da-jeong's lips were raw. She had a habit of chewing them when she was tense, and she ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠was tense now. Bite, bite — and then she asked,

"Senior, why won't Dangdang-i open his eyes?"

"His vitals are fine, so we wait. He'll open them."

"He will, right?"

You have to. Dangdang-i. Open your eyes.

Cha Da-jeong clenched her fists and said it under her breath.

That was when a great noise rose from outside.

Mraaaoowk!

Nyaaok-nyaoooowl!

Aroo-ruff-ruuuff!

Hoesaegi, Kkamnyangi, and Sapsaree were pouring their strength into him.

A moment later the three of them came into the ICU with Lee Jun, wrapped in the same non-woven gowns they had worn the day they visited Bokshil. Even inside the unit they kept calling Dangdang-i's name. The three voices went on and on — and then, just barely, Dangdang-i's ear twitched.

Hoesaegi noticed first.

The cats were still calling him when Sapsaree burst out of the ICU at a run.

Sapsaree's ringing cry had barely ended when a howl went up that shook the whole of Mongmong Animal Hospital.

This time it was not short. The howl held for a full minute.

Dangdang-i's ears began to twitch faster. And then his eyelids lifted.

And then—

A sound spilled from Dangdang-i's mouth. His gaze wandered through the air, searching, until it found Lee Jun's eyes.

"Sleep well, Dangdang-i?"

In that instant the corner of Dangdang-i's mouth slid up into a grin.