Trauma Center : Golden Hour - Chapter 105

“Okay, like this. No, like this…”

Kang-hyuk carefully brought the harvested muscle to the damaged part of the heart.

He had already cut away all the areas of the defect that couldn’t be salvaged, trimming the edges so precisely that the hole was nearly a perfect circle.

“Professor, what are you doing right now?”

Jaewon looked at Kang-hyuk with clear confusion.

Jang-mi was the same. She’d already prepared all the sutures and instruments, but now found herself with nothing to do, her expression bored.

“Hmm.”

Even Gyeongwon, usually focused on the anesthesia monitor or calculating medication, was idle—standing slightly to the side by the patient’s head, glancing between Kang-hyuk’s hands and face.

“Ah, here… like this…”

Kang-hyuk continued pressing the muscle graft onto the defect in the [right ventricle], adjusting its placement.

Anyone else would have already just set it down and begun suturing. But over five minutes had passed like this.

Such a delay was unheard of.

“Professor, what are you doing?”

Jaewon asked again, this time more loudly.

At last, Kang-hyuk seemed to register Jaewon’s presence, though his eyes remained glued to the surgical field.

“I’m matching the [muscle fibers].”

“The muscle fibers…?”

“Yeah. [Cardiac muscle] and [quadriceps muscle] are different, so I can’t make them fit perfectly. The [muscle fiber] thickness isn’t the same, either. But if I make them at least roughly line up… the sync will be better.”

“Sync… So you’re not going to use a [pacemaker]?”

(T/N: [Pacemaker] is a medical device implanted in the chest to help control abnormal heart rhythms by sending electrical impulses to stimulate the heart to beat at a normal rate.)

A heart is basically a pump.

It has to contract in the right place at the right time to push blood throughout the body.

That’s what ‘sync’ meant here—when it’s off, the result is [arrhythmia].

(T/N: [Arrhythmia] is a condition in which the heart beats with an irregular or abnormal rhythm, which can be too fast, too slow, or erratic.)

Th𝚤𝑠 𝗰h𝙖p†ꬲr ɪ𝐬 p𝗼𝐬𝘵𝗲ⅾ b𝗒 Ƙ𝙞𝐭ℯ𝐧𝟬𝘷𝖾𝙡

A [pacemaker] is a device that regulates arrhythmia.

“Pacemaker?”

Kang-hyuk looked like he’d never heard the term before.

“Yes. Pacemaker. The [right ventricle] is so badly damaged…”

“Well, not a bad idea. A pacemaker.”

“Uh… thank you.”

Jaewon wasn’t sure if that was praise, but he said thanks anyway—Kang-hyuk rarely gave compliments.

“Thank you… what for…”

Kang-hyuk shook his head and continued.

“But if you put in a pacemaker, there are too many restrictions.”

“That’s… true.”

“And you’d need another surgery to remove it.”

“That too… yeah.”

There’s no such thing as a perfect treatment.

Every option has downsides, especially life-saving measures like pacemakers.

“So, isn’t it better not to use one?”

“If you don’t use one… won’t the patient die?”

Jaewon looked at the piece of thigh muscle, thinking there was no way it would beat in sync with the heart.

But Kang-hyuk saw it differently.

“Why would they die?”

“I mean… obviously… How can muscle from another part of the body function like that?”

“I did all those experiments to make it work.”

“Experiments? Ah… that…”

Jaewon remembered the “experiment” that had looked like a joke earlier.

“What’s with that face?”

Kang-hyuk kicked Jaewon’s shin lightly, then held out his palm.

“Ow, hey.”

“Don’t whine. If you get kicked with a Crocs, it doesn’t hurt.”

“It hurts my feelings. Who even hits people in the OR these days…”

“If you mouth off to your professor, you’d get slapped. Haven’t you seen ortho? That first-year’s eardrum burst.”

“Ah…”

Jaewon recalled the much-discussed incident when an orthopedics first-year came to the ER with blood coming from his ear.

It had been 2 a.m.—of course, both Kang-hyuk and Jaewon were still awake.

‘He said he fell, didn’t he?’

The slap mark was obvious, but he insisted he’d just fallen.

But every department had its secrets, so they just checked inside his ear.

He had a ruptured eardrum—so they prescribed antibiotics to prevent infection.

Trauma-induced [tympanic membrane perforation] usually heals quickly.

(T/N: [Tympanic membrane perforation] refers to a hole or tear in the eardrum, which can result from trauma, infection, or sudden pressure changes.)

‘Wonder how that kid’s doing now.’

Jaewon briefly reminisced about the poor first-year.

Kang-hyuk, meanwhile, looked exasperated.

“Look at this. Daydreaming in front of your professor.”

“Ah, sorry.”

“Sorry? Idiot, you should thank your luck it’s during surgery. If I had both hands free…”

Kang-hyuk flexed his imposing forearms.

Jaewon instinctively stepped back.

“Hey, we’re trying to save someone here. Why are you talking about killing people in the OR…”

“Ugh.”

Kang-hyuk shook his head and looked down at the heart.

The round muscle graft sat inside the defect.

It might look randomly placed, but it wasn’t.

‘The conduction direction should continue this way…’

Jaewon remembered only seeing the muscle contract when Kang-hyuk used the [Bovie] to stimulate it.

But Kang-hyuk could tell much more just by the color of the blood—he could even gauge the patient’s oxygen saturation.

He could distinguish not only [muscle fiber] direction, but even the bundles.

He knew where and how electricity would flow, and what it would ultimately stimulate.

‘So just suture it like this.’

And so the muscle graft was positioned exactly based on all that information.

“Gangster, time to suture. Hand it over.”

“Yes.”

Jang-mi, looking a bit impatient, handed over the suture instrument.

The needle was loaded with 7-0 thread.

It’s normally used for [microsurgery], and isn’t really ideal for muscle—smaller needle, thinner thread means weaker suture strength.

(T/N: [Microsurgery] is a procedure performed under a microscope to join very small structures like nerves and blood vessels.)

If you’re not careful, it can easily tear through.

“Good.”

But Kang-hyuk looked pleased as he started suturing.

You can achieve suture strength with any thread if you suture well.

What mattered most now was not breaking the [electrical conduction]—he needed to avoid damaging the tissues further, or minimize it as much as possible.

For that, the thin 7-0 thread was ideal.

“Cut.”

“Yes.”

Kang-hyuk tied a knot the moment he picked up the instrument.

He was so fast, Jaewon almost wondered if it was just a temporary stitch.

But it was a proper knot.

He wasn’t just fixing the graft in place.

‘Wasting time would be an insult to Professor Baek…’

Why waste time, when you could suture this fast?

Thud.

Without delay, Kang-hyuk continued suturing.

In an instant, the harvested thigh muscle was attached to the heart.

Except for the color and texture, it looked as if it had always belonged there.

“Wow…”

“Don’t just stand there—this has to be connected, too.”

Kang-hyuk showed Jaewon the bundle of blood vessels coming from the thigh graft.

It was a pair—artery and vein.

“Oh, right. That’s essential.”

If those weren’t connected, the new muscle graft would rot and cause severe complications within days—another rupture, or death from infection.

“But where do you connect them?”

“Do you really not know?”

“It’s just… there aren’t any appropriate arteries or veins near the heart…”

Jaewon, looking flustered, pointed at one crossing the heart.

The famous [coronary artery].

If you messed that up, the patient could die of [myocardial infarction].

(T/N: [Myocardial infarction] is the medical term for a heart attack, which occurs when blood flow to a part of the heart is blocked, causing damage to the heart muscle.)

Kang-hyuk wouldn’t risk it.

No matter how wild he seemed, he was the most rational person here.

“Where do the [coronary arteries] branch from?”

“Coronary arteries…?”

Jaewon was a general surgeon.

It was normal to forget other specialties’ material—there was just too much to remember.

Not from lack of effort, but sheer workload.

“Sheesh.”

Kang-hyuk had no patience for such things.

“They branch off the [aorta]. That’s how important they are.”

“Ah, right…”

“So, where do you connect this?”

“Ah… the aorta…”

“Exactly. The aorta’s clamped, so there’s no blood flow—this is easy.”

“R-right. Yeah… really…”

Jaewon looked at the clamped aorta just below where the [coronary arteries] came off.

So the [myocardium] was still getting blood, even if the heart was stopped.
(T/N: [Myocardium] is the muscular tissue of the heart.)

“Scissors.”

“Yes.”

Kang-hyuk took the micro-scissors and made a tiny hole in the [aorta].

He didn’t even pause to line it up; it just matched the end of the blood vessel bundle.

“Suture again. Slave, pay attention. There are a lot of places where you really don’t want to cut.”

“Yes, Professor.”

Jaewon was now handling the suture threads with maximum care.

The heart, the aorta, the coronary arteries, the vessels being joined—if he damaged any, the patient could die.

The patient might survive, though.

Because Kang-hyuk was here.

But Jaewon would not.

Because Kang-hyuk was here.

Snip.

So Jaewon cut the thread as carefully as possible.

The only saving grace was that Kang-hyuk was so fast.

“Okay, artery’s connected. The vein… let’s attach it here.”

Kang-hyuk chose to connect the vein to the [pulmonary artery].

It’s called an artery, but actually carries deoxygenated blood.

It collects blood that’s about to go to the lungs to get oxygen.

“That’s it. How does it look?”

Kang-hyuk looked at Jaewon after connecting both vessels.

Jaewon still looked stunned.

Was it really done?

Kang-hyuk was a great doctor, but even he didn’t save every patient.

‘Even Professor Baek is human…’

There were limits.

Jaewon felt they’d hit that wall today, too.

The heart had ruptured in the helicopter; he’d kept it together with a gloved hand.

But Kang-hyuk said something totally different from what Jaewon expected.

“Let’s pause the [cardiopulmonary bypass machine] for a moment. Anesthesia, give max oxygen. Let’s restart the heart and see how it looks.”