Chapter 44: Emergency Cesarean Section

“Scalpel!”

Time was more urgent than ever.

Kim Cheolsu grasped the scalpel and made an incision on the patient’s lower abdomen.

–zzzzzt…!

Making a vertical cut from the pubic symphysis down toward below the navel, he entered the abdominal cavity.

With the naked eye, the patient’s uterus was immediately visible. Now, he had to cut into this uterus and deliver the fetus…!!

At that moment, Shin Seyoung asked,

“Major, which uterine incision method will you use?”

Kim Cheolsu’s expression turned serious.

There are three types of uterine incisions.

They are [Low Transverse Incision], [Classical Incision], and [Low Vertical Incision].

The first, [Low Transverse Incision], involves a semicircular horizontal cut along the lower part of the uterus.

It is used when the lower part of the uterus is large enough for the fetus’s head to pass through.

If a cesarean is performed this way, the patient can attempt natural delivery in the next pregnancy.

“The [Low Transverse Incision] seems difficult. The patient’s lower uterus is narrow. Even if I cut as widely as possible, the fetus’s head won’t be able to come out.”

“I see. But with the [Low Transverse Incision], the patient could try natural delivery next time… I’m sorry. I shouldn’t have said that.”

Lieutenant Shin Seyoung’s face darkened.

She had realized that such an advantage no longer existed now.

The patient’s heart was rapidly approaching cardiac arrest. Checking the ECG monitor, her expression darkened further.

“You’ll have to cut faster, Major. The patient will die soon.”

“I’m aware. I was just debating whether to perform a classical incision or a [Low Vertical Incision].”

“What’s the difference?”

Though a nursing officer, Shin Seyoung was always curious.

Despite the urgency, Kim Cheolsu didn’t reprimand her.

He himself hadn’t decided which method to choose yet.

“If we do a classical incision, the patient must have cesarean delivery in the future. Attempting natural delivery risks uterine rupture. This method is used especially for premature infants with placenta previa (abnormally positioned placenta) or placenta accreta (placenta strongly attached to the uterus).”

Fortunately, the X-ray of the eye suggested no major placenta problems.

The baby was only 25 weeks, but appeared healthy.

“In any case, there’s no reason to use the [Low Vertical Incision]. While it also allows natural delivery next time, sadly, the patient will never have another childbirth.”

The atmosphere in the operating room grew heavy.

With every passing second, the patient’s chance of revival vanished. The hemorrhage was too severe; she was on the verge of cardiac arrest.

The priority now was saving the fetus.

The three incision sites just explained differ as follows:

The [Classical Incision] cuts the upper uterus (from below the chest to above the navel), the [Low Vertical Incision] cuts below the navel, and the [Low Transverse Incision] cuts the lowest part of the uterus, as the name suggests.

Kim Cheolsu spoke in a grave tone.

“Since the fetus is lying transversely, I will use the classical incision.”

He tried to lift the uterine serosa (uterus outer layer) to create a bladder flap but stopped.

There was no time now to make the bladder flap to prevent bladder injury.

Suddenly, the heart monitor beeped sharply, and Lieutenant Shin Seyoung shouted.

–Beep…! Beep…!

“The patient’s heart has stopped! Cardiac arrest! Major!! The ECG line has completely flatlined!”

–murmur murmur

“What do we do? The patient is basically dead!”

“There’s no time! If we don’t get the fetus out fast, this surgery is pointless!”

“This is terrible! The fetus can’t be saved at this rate!”

Though the staff voices panicked, Kim Cheolsu held the scalpel steady, focusing.

Four-minute rule!

If the mother dies, cesarean must start within 4 minutes, and the fetus must be delivered within 5 minutes, or the fetus dies too.

Since cesarean had already begun, time was tight but sufficient.

No, though urgent, Kim Cheolsu steeled his mind, convincing himself there was still enough time.

Shin Seyoung silently wiped the sweat dripping from his chin.

“Stay strong, Major.”

Encouraged by her words, Kim Cheolsu cut the serosa with Metzenbaum scissors and dissected it aside.

With the uterine outer layer peeled back, it was time to cut into the uterus itself.

Using a Yankauer suction to clear blood, he incised about an inch deep with the scalpel.

Carefully opening the uterus, he saw the fetal membranes inside.

As the uterus opened, the fetal membranes bulged outward. Since he used the classical incision, the opening was extended downward.

He gripped the protruding membranes with Allis forceps and tore them open.

“Phew.”

Finally, the fetus inside the membranes became visible.

Kim Cheolsu calmly said,

“I will deliver the fetus now.”

The fetus, lying horizontally, revealed its head first.

He inserted his hand into the incision, supporting the fetus’s head.

Then, lifting the head, he pulled it close to the incision’s edge.

But there was a visible problem with the fetus’s head.

“The umbilical cord… is wrapped around the fetus’s neck. The baby may not breathe, so I’ll carefully untangle the cord while delivering.”

Kim Cheolsu’s voice echoed through the OR.

Everyone was tense.

The mother was already dead; whether the fetus lived or died depended on this moment.

–slip…

Fortunately, having safely pulled the head to the incision’s edge, only the full extraction remained.

“Lieutenant Shin, please apply pressure to the uterine fundus.”

“Yes, Major!”

Shin Seyoung pressed on the uterine fundus with her hand to assist.

Meanwhile, Kim Cheolsu fully delivered the fetus’s body.

The surgical staff’s faces brightened.

–Wow…! The fetus is out!!

–Amazing. Such speed and skill. Do all military doctors operate this well?

They were almost at the finish line.

But Kim Cheolsu remained tense to the end.

“Pass me the Pean forceps. I’ll ligate and cut the umbilical cord.”

Using two forceps, he clamped the cord four inches from the fetus’s navel and cut it.

Mother and fetus were completely separated.

A slight tap on the baby’s buttocks made it start crying.

–Waaah! Waaah!!

–It lived! The baby lived!!

–Wow!!! Incredible! How did you save the baby?! That’s insane!!!! Amazing!

–Unbelievable. There’s still plenty of time before 4 minutes! Already?

“Quiet! Move the fetus to the incubator. We will finish the surgery.”

But it wasn’t over yet.

Kim Cheolsu massaged the patient’s uterine fundus while fully removing the placenta.

Using ring forceps, he extracted remaining fetal membranes inside the uterus.

He inserted his hand behind the uterine fundus, fully exposing the uterus outside the incision.

Removing all remaining membranes, he wiped the endometrium clean with medical sponges.

Though the mother was dead, he cleaned the interior thoroughly until the very end. It was a matter of respect for the deceased.

If the patient had lived, this procedure would have helped prevent postpartum hemorrhage or infection.

“… Now, I will close the uterus.”

Though the fetus survived, Kim Cheolsu’s expression remained somber.

He clamped the uterine incision with ring forceps to stop bleeding, then closed the incision in two layers with sutures.

It was a technique called running locked stitch.

After confirming the closure was secure, he returned the uterus back into the abdomen.

He removed amniotic fluid from the pelvis using medical sponges, then completely sutured the patient’s abdomen closed.

“…..”

Kim Cheolsu’s hands moved astonishingly fast, so it took little time after sending the fetus to the incubator.

Yet, the OR’s atmosphere was very heavy.

Even though it was unavoidable, the feeling of failing to save the mother was widespread.

Looking at his watch, Kim Cheolsu murmured slowly,

“… July 15, 2001, 7:25 p.m., the patient has passed away.”

Shin Seyoung spoke beside him.

“You did well, Major. It was a difficult surgery. I’m glad the fetus was saved.”

“Yes… that’s true. Please finish cleaning up the OR.”

As Kim Cheolsu left the room looking drained, the staff finally began to talk noisily.

–Truly amazing. I barely saw the military doctor’s hands move. It’s surprising to have such a surgeon in a military hospital.

–Exactly. He seems better than our hospital’s doctors. Incredible.

–I’ve never seen a surgery that great in my life… so fast and precise, almost like art.

Except for Oh Hajin and Shin Seyoung, all were hospital staff, so their astonishment was even greater.

Seeing this, Shin Seyoung and Oh Hajin felt joy but did not show it.

No matter how proud the surgeon’s moment was, they couldn’t laugh now.

It was the first time since his commissioning that a patient died in the OR.

Shin Seyoung worried and said softly,

“… I hope Major is okay. I hope he doesn’t take this too hard.”

–bustle bustle…

The emergency room was filled with lively energy.

When Kim Cheolsu returned, the ER was packed with minor patients.

The military police’s control of the Express Terminal Station entrance had worked.

Compared to the original situation, Seoul citizens’ casualties had clearly decreased.

–Ah! It hurts! Can you be a little gentler? Aaah! It hurts!

–Why is the service at this hospital so bad? My leg is swollen; when will I get treated? Seriously!!

But Kim Cheolsu couldn’t smile watching this.

The disaster had been averted, but people still died.

His nose tingled as he slowly walked through the ER to the vending machine for coffee.

–slurp

The sweet coffee warmed his body a bit.

He sat alone for about ten minutes, drinking quietly.

He believed life and death depended on the doctor.

So he always tried to save every patient…but today, he wanted alcohol, not coffee.

“……”

Without a word, Kim Cheolsu tossed his empty paper cup hard into the trash.

It didn’t make much noise. It was just a paper cup, after all.

But inside Kim Cheolsu, a loud sound was echoing.

–tap tap

–tap tap

–tap tap…

Kim Cheolsu walked to the glass window showing the incubators, followed silently by Shin Seyoung.

Inside the incubator lay a tiny living baby.

If the accident hadn’t happened, that baby would still be growing inside its mother…

Kim Cheolsu felt a sudden wave of deep sorrow rise up.

“Hoo…”

He took a deep breath.

“Major…”

Without realizing it, she wiped the tears streaming down his cheek with a handkerchief.

She cried with him, offering comfort.

“You did your best, military doctor… sob… we all worked hard. So don’t… don’t cry… Major. I want to cry too…”

“I wanted to save her. I wanted to save the mother… but I couldn’t. I’m sorry. I’m truly sorry…”

Staring at the tiny, precious baby, Kim Cheolsu knelt down right there.

He broke down with guilt for not saving the mother.

Knowing that baby’s mother was no longer alive crushed his heart.

Tears flowed endlessly down his cheeks.

Shin Seyoung patted his shoulder, crying alongside him.

“You did nothing wrong, Major. Please get up. Come on…!”

*****

Thankfully, no more severe patients appeared that night.

That thought comforted Kim Cheolsu’s heart.

The stormy night of wind and rain ended, and morning came on the 16th.

Kim Cheolsu and Shin Seyoung walked out of the ER, bathed in the morning sun.

–click!! click!!!

Suddenly, reporters swarmed them.

They had found the person they were looking for and rushed over, snapping photos.

“Doctor Kim Cheolsu, is that you? We heard rumors you performed surgery on a patient from yesterday’s Express Terminal Station flooding accident. Is that true?”

“I’m from MBS! There are talks that the surgeon who performed that incredibly difficult surgery is actually a military doctor… The public is cheering for the hero doctor who appeared in the tragic flood accident. Please spare a moment for an interview…”

The dozens of reporters holding up cameras exhausted Kim Cheolsu.

He honestly didn’t even have the energy to get annoyed.

With his tall frame, he pushed through the crowd, took a taxi, and left the hospital.

–vroom

“Oh wow!! Major Kim Cheolsu has basically become a national star, hasn’t he? So many reporters showed up. What’s the story behind this?”

Riding in the taxi, Oh Hajin was surprised and said.

Shin Seyoung, seeing this spectacle for the first time, gazed out the window in awe.

“The news that he saved a fetus by cesarean yesterday has spread outside.”

Kim Cheolsu replied gruffly,

“But the mother died. It’s nothing to celebrate.”

Seeing his stubbornness, Shin Seyoung said,

“But you saved the baby. I’m really proud of you, Major! You’re amazing!”

“……”

The mood in the car instantly warmed.

Oh Hajin smiled, thinking their atmosphere was romantic.

Kim Cheolsu didn’t mind and looked out the window.

Thank goodness. No more patients were injured… Now he could finally breathe easier.

He was relieved no hundreds of casualties occurred as might have happened originally.

Only now did he truly relax.

“Huh? Major, you’re sleeping?”

Oh Hajin in the passenger seat saw Kim Cheolsu in the rearview mirror.

Shin Seyoung raised her finger, signaling to be quiet.

“Shh, let’s stay quiet until the hotel. You haven’t slept all night.”

“Oh! Right. Understood, Lieutenant Shin.”

Shin Seyoung gently spoke to Kim Cheolsu, resting his head on her shoulder.

“Major, please rest comfortably even if just for a moment—you worked so hard today.”