-Bepo bepo …!
The transfer vehicle from the Capital Hospital arrived at the emergency room.
Kim Cheolsu looked at Shin Segyeong and Oh Hajin behind him, both tense, then turned his gaze forward again.
-Clack.
The back door of the transfer vehicle opened, and a doctor stepped out. He offered a sharp smile and extended his hand toward Kim Cheolsu.
“I’m Captain Bae Jihan of Neurosurgery. Pleasure to meet you. I’ve heard a lot about Major Kim Cheolsu. It seems our neurosurgery department owes you a great debt this time. Please take good care of today’s surgery.”
A mere captain acting quite cocky. Yet, Kim Cheolsu understood his position. After all, coming all the way down to distant Hampyeong out of the blue must have rattled him.
Kim Cheolsu shook his hand without changing expression.
“Pleased to meet you, Captain Bae.”
“…….”
Bae Jihan looked visibly flustered. Even among junior officers, it was customary for military doctors to use honorifics with each other. Everyone here had medical licenses, so the atmosphere was different.
And the Capital Hospital was generally held in higher regard than other military hospitals. But Kim Cheolsu seemed to dismiss that entirely, pressing down with rank alone.
“As I heard in rumors, the genius doctor is truly exceptional. Let’s first transfer the patient.”
Kim Cheolsu ignored the sarcastic tone and locked eyes with the general lying on the transfer stretcher.
“Yes, sir. Major Kim Cheolsu reporting.”
“Heh-heh — I value talent. So I don’t hold grudges about past matters. Looking forward to the surgery today.”
Military Police Chief Yong Daegil smiled as he was wheeled into the hospital on the stretcher.
There was a clear trace of fear that Kim Cheolsu might deliberately botch the surgery.
Of course, that was out of the question. Now that surgery was underway, he planned to give his absolute best.
He flicked his fingers, calling Captain Bae from Neurosurgery.
“You come with me to the radiology room. We need to review the scans you brought.”
“…. Yes. Understood.”
Captain Bae honestly wanted to return to the Capital Hospital immediately. He had no desire to take part in a major surgery in this rural backwater… and above all, he didn’t want to be dragged around by the arrogant Kim Cheolsu.
No matter the superior rank, he didn’t want to admit respect for a country doctor like this.
But Kim Cheolsu’s presence was overwhelming. He gave no chance to talk back and issued orders.
Bae grumbled internally as he followed him to the radiology room.
He displayed the MRI images saved on a CD and began explaining.
“This is the MRI of patient Yong Daegil, who is already showing severe neurological deficits such as headache, vomiting, paralysis, and seizures. The MRI was taken using gadolinium contrast… If you look closely, you can see the dura tail sign around the meningioma.”
“Right. The dura tail sign occurs when the dura mater—the thick outermost membrane among the meninges—responds to the contrast agent. Seeing the dura tail sign on the MRI made it easier for the Capital Hospital to diagnose the meningioma. And… I think this is even more important: you can see the arachnoid plane around the meningioma—the boundary between the tumor’s capsule and the arachnoid membrane. On the MRI, seeing this arachnoid plane means the tumor is separated from surrounding brain tissue. In simple terms, it means there’s surgical space beside the meningioma. Lucky! If all goes well, we can remove the tumor without damaging other brain tissue. This should reduce postoperative complications for the patient.”
“….!! How do you know that? Only neurosurgeons would know this…”
Bae’s mouth dropped open in surprise. Honestly, he had mocked the idea of a general surgeon handling a case that the Capital Hospital’s neurosurgery department refused.
It made no sense.
But Kim Cheolsu knew such detailed information about brain meningioma that Bae was shocked.
“Stop the useless talk and continue with the presentation. So, how large is the tumor?”
“…. 3 centimeters. Why do you ask?”
Thinking, Could he possibly know this too? Bae asked, doubting that Kim Cheolsu would know the exact surgical techniques.
Even if a genius doctor, that would be impossible.
This was a complicated surgical method that even many neurosurgeons did not know well.
But Kim Cheolsu replied coldly.
“Why ask? Because if the tumor is larger than 3cm, we must use the subpial dissection technique. The meninges are made of three layers from the outside in: dura mater, arachnoid, and pia mater. Fortunately, we only need to go as far as the arachnoid.”
“…. Still, it’s a difficult surgery. Are you really planning to do this? The rumors about Major Kim Cheolsu being a genius are already widespread in the Capital Hospital. Patients think all their diseases can be cured by you. But I don’t believe it. No such doctor exists!”
Rumor had it that Kim Cheolsu performed surgeries in orthopedics, general surgery, and trauma surgery.
But seeing him now attempt neurosurgical brain tumor surgery made Bae angry.
The Capital Hospital’s neurosurgery department had sent the patient down to Hampyeong because they couldn’t operate, yet this country doctor was fully prepared.
Yet Kim Cheolsu glared without anger and said to Bae.
“I’m not a perfect doctor. I just do my best until the end to save the patient.”
“That…! If the general dies, how will you take responsibility? You won’t be able to handle the huge aftermath. The Military Police Chief is a graduate of the Military Academy and wields strong influence in the army. That’s why even the head of neurosurgery feels pressured…”
“You don’t avoid surgery because of pressure?”
Kim Cheolsu asked sharply, and Bae stammered a weak excuse.
“Well… it’s not nothing. What happens to the doctor if the general dies during such a difficult surgery?”
“General? You’re making a grave mistake. In front of a doctor, everyone is just a patient. The patient’s rank or position doesn’t matter. Stop talking nonsense. Now pull yourself together and come into the operating room. Surgery starts in ten minutes.”
After Kim Cheolsu left, Bae punched the emergency room wall hard.
-Thud!
A feeling of helplessness and despair washed over him. Why was he so different even though they were both doctors?
Thinking about the possibility of surgical failure, he felt like a self-serving scoundrel.
“Damn. I wanted to operate too. But how can I when I’m scared? This is the army. The army! It’s on a different level from civilian hospitals.”
Bae stormed off toward the changing room to put on his surgical gown.
Today, he only planned to do what he was told. He would shift all responsibility for the surgery onto Kim Cheolsu.
Of course, he couldn’t help but feel like trash himself. Deep inside, the spirit of Hippocrates that was once pure still lived within him.
Clenching his fists until his knuckles bled, he muttered with burning eyes.
“I’ll see about that. I’ll prove how great this ‘mad dog of Hampyeong’ really is, whether the world’s talk is true or not. Saving a patient the Capital Hospital’s neurosurgery gave up on? Ha! I just don’t believe it.”
*****
Before entering the operating room, Kim Cheolsu went to neurosurgery to read about surgical techniques for brain sulcus meningioma.
After about 30 minutes of reading, he muttered to himself.
“I roughly understand the surgical method. But since it’s my first time using it, whether I can perfectly apply it during the operation… we’ll see.”
*****
“Major, anesthesia is complete.”
Shin Segyeong said as she observed the general lying on the transfer stretcher in the operating room.
At that moment, the functional imaging device, patient monitor, and neuronavigation system lit up.
The patient monitor checks the heart’s activity, blood pressure, blood oxygen saturation, and body temperature in real-time, allowing the team to know if the patient’s condition worsens.
The functional imaging device detects neurological abnormalities during surgery.
Simply put, it measures whether the brain’s electrical signals are normal. If a critical brain area is accidentally resected, electrical signals will show abnormalities.
Then the patient will suffer serious complications, such as paralysis and memory loss…
The neuronavigation system is like a car’s GPS. It shows the surgeon in real-time how far they’ve resected.
Frankly, brain surgery is like walking through a maze without knowing where anything is.
Compared to hilar bile duct cancer surgery, where liver and gallbladder are clearly distinguished because of their shape, the brain’s regions are much harder to differentiate.
To tell apart similarly shaped brain areas, devices like these are essential.
Facing the anesthetized general, Kim Cheolsu calmly explained to Bae Jihan, Oh Hajin, Shin Segyeong, and the surgical staff.
“From now on, we will attempt complete resection of the brain sulcus meningioma. Removing tumors attached to the outer brain is easier than in other locations, but if we mistakenly resect important brain areas, postoperative neurological deficits may worsen, so caution is needed.”
Shin Segyeong asked.
“Then this surgery will not only remove the tumor but also treat paralysis and seizures. Did I say that correctly?”
“Correct. Patient Yong Daegil already suffers intermittent paralysis and seizures severe enough to make daily life difficult. These are caused by the brain tumor. So today, we will completely remove the brain sulcus meningioma, a type of brain tumor. This surgery is as difficult as the recent hilar bile duct cancer surgery, so everyone stay alert.”
“Yes, understood!”
The surgical team was confident but clearly tense. This was no ordinary patient—it was a general.
If the surgery failed, who would bear the responsibility?
When people get nervous, their responses slow and their hands stiffen.
Seeing the anxious looks among the staff, Kim Cheolsu declared firmly.
“I take full responsibility for this surgery. Even if something goes wrong, I promise no harm will come to you all. Now, let’s begin.”
First, Kim Cheolsu shaved the patient’s hair completely. Then, he positioned the patient so the left side of the head, where the tumor was located, faced upward.
He fixed the head to the table with three pins to prevent movement during surgery.
The brain is extremely sensitive; any accidental movement or pulling could cause serious injury.
If that happened, the patient would suffer lifelong complications.
He disinfected the surgical area with Betadine solution.
Then, excluding the surgical site, he covered the entire head with sterile drapes.
During this, he used a sterile pen to mark important anatomical landmarks on the drape.
This was to easily identify crucial bone sutures like the coronal and sagittal sutures.
“Haah… now, I will incise the skin flap of the left frontal lobe.”
To reach the meningioma inside the left frontal lobe, he first needed to open the scalp skin flap.
Using X-rays, Kim Cheolsu confirmed the tumor’s location.
The disgusting thing was in sight. He had to cut it out, so it wouldn’t harm the brain!
The following surgical steps involved sequentially opening multiple layers of the skull to access the tumor attached to the brain.
The first step was opening the skin flap.
Using a scalpel, Kim Cheolsu made an S-shaped incision in the scalp and carefully began creating the skin flap.
After incising the skin over the dura mater, he clipped the veins and superficial temporal arteries to reduce bleeding.
Next, using hooks, he peeled the scalp away from the skull’s periosteum (the membrane covering the bone).
Finally, he carefully peeled off the periosteum with the scalpel, then wrapped it in moist gauze and folded it to the side.
Now, the skull bone was fully exposed.
Like creating the skin flap earlier, he was entering the crucial step of creating the bone flap.
With tense eyes, Kim Cheolsu spoke.
“Haah… now, Lieutenant Shin Segyeong, please hand me the drill. I will open the patient’s skull, avoiding damage to the venous sinuses.”
“Here it is, Major.”
The drill in his hand whirred to life.
-Vvvvvrrr …!!!
Cold sweat formed on Kim Cheolsu’s forehead as he placed the drill against the patient’s skull.