The mother lies on her back on the operating room table. She’s covered almost entirely by green surgical drapes, except for the lower section of her pregnant abdomen, which has been cleaned and prepped for C-section. The tray full of surgical instruments is ready, tidy rows of scalpels, forceps, scissors and retractors all laid out, and a theatre nurse stands beside them, silent and faceless in gown, cap and mask. All around the OR are more theatre staff, crowding the table and seeming to loom over Jongdae like disapproving statues. He feels small and uncertain among them. The EKG monitor scrawls readout lines across the table, spiking up with each beat of the mother’s heart.

Hurry! The urge seems to come from all around him, bringing with it a shiver of dread that starts in the centre of his chest and makes its way down his arms and legs to tingle in his fingers and the soles of his feet. Hurry, or it will be too late!

Jongdae knows the baby is in distress. He knows the mother is under general anesthesia rather than epidural, though the reason why escapes him right now. There must be a good reason, but all he knows right now is that the urgent call is right - he must hurry. He reaches out a hand and a scalpel is put into it. He makes his first cut, a low transverse incision below the mother’s navel - the baby must be in vertex position, head down, or he would have planned a different incision. The layer of yellow fat becomes visible, and gloved hands appear from beside him and across the table, helping him part the fat until they reach the muscle.

Hurry! Jongdae glances up at the wall clock and finds that ten minutes have elapsed. Confusion mixed with panic s its way into him. How can ten minutes have passed already? This stage should take less than a minute. Jongdae has a reputation for performing the swiftest and most accurate C-sections in the hospital, how can it possibly have taken him ten minutes just to make his first incision?

He looks back down at the surgical wound. The red muscle is visible below the fat. He sections the central conjunctive tissue with scissors, the hands of his assistants strong and sure as they apply traction with forceps. Someone places a Doyen’s retractor to prepare a perfect surgical field, and now Jongdae is looking at the surface of the uterus, pink and patterned with blood vessels. He glances at the wall clock again and sees that twenty minutes have passed now. His panic increases. He doesn’t understand why it’s taking him so long, and he doesn’t have time for this, he can't mes around like an amateur when the baby is in distress and the mother is under general anaesthesia.

What are you waiting for? Hurry up! He’s not sure which of the statue-like assistants has spoken, but whoever they are, they’re right. He needs to hurry. But the sight of the uterus has him locked frozen, scalpel hovering just above the surface, and he’s sick with dread, because this is where it happens. This is where the blood comes.

You have to do it! Pulsing urgency is everywhere, in him, in the walls, in the assistants, in the patient, in the unborn baby. He cannot wait. Blood or no blood, this baby is in distress, and he must save it. He places the scalpel to the uterus and sections it.

Blood flows out over his hands like a river, far more than there should be, far more than is surely possible, and yet the blood just keeps on coming. It’s all over his gown, it’s on the assistants, pooling over the table and pouring to the floor like a waterfall, splattering him, drenching him. Jongdae shakes his head desperately and reaches into the uterus for the baby’s head. It’s a full-term baby and should be right there, impossible to miss as it fills the entire womb, but somehow he can’t find it, and his hand s wildly in a pool of hot blood. There are cries from the assistants, from the anaesthesiologists, and though he can’t really take in their exact words he knows their meaning; she’s crashing! She’s bleeding out! Get that baby out now or they’re both going to die!

Jongdae is gasping as he looks for the fetus. He can’t see, can’t see for blood. He needs suction but he can’t get the words out. What are the assistants doing? Why aren’t they helping him? He looks up frantically and the walls of the OR are dripping, painted in blood, and one of the assistants grabs his shoulder and starts to shake him, calling his name. “Jongdae, you’re dreaming, you’re dreaming, wake up -”

Jongdae’s eyes fly open. He sees darkness, feels softness around him, there’s a hand on his shoulder and he sits up, panting, throat feeling like it’s sticking together, lungs seizing. Ahreum is sitting up too, half-turned in the bed to face him, her hand on his shoulder. She’d been leaning over him to wake him.

"Thank you," he gasps, desperately relieved to have been saved from the nightmare. His skin feels slick, and he has a sudden, flash-pan fear that it’s blood, but when he stares down at his arms and hands, there’s nothing but the sheen of sweat covering his skin.

Ahreum leans over to the side of the bed to turn on the lamp, illuminating the bedroom in a soft glow. A cup of water from the bedside table is placed in his shaking hand and he gulps it down.

“Was it the same one?” Ahreum asks. Her hand is back on his shoulder, uncaring about how sweaty he is.

Jongdae lets out a long, shuddering breath. “Yeah. I’m so sorry,” he says. “I woke you up again.”

“You can’t help it,” Ahreum says softly. “Do you want to talk about it?”

Jongdae shakes his head. Sweat rolls down from his hairline and he scrubs his damp face in his hands. He feels disgusting, whole body slippery with sweat, and his t-shirt is soaked. He pushes the blanket aside. “I need to shower,” he says, glancing at the digital clock on the side-table. “It’s nearly five - I would have been up in half an hour anyway. Go back to sleep, love.”

He turns on all the lights in the bathroom, the one above the mirror as well as the overhead, chasing the echoes of his nightmare away with the bright, clean walls of reality. He showers with the water on full blast, prickling his skin. The OR of his nightmare is unrealistic, belonging more to a horror movie than a clinically accurate situation, but the panic of it still clings to him. It’s not the specifics of the nightmare that are so bad, though they’re horrific enough in their graphic imagery; it’s the feelings that come with it. The fear that he’s going to lose the mother, or the baby, or both. The fear that he’s not fast enough, not skilled enough, and that it’s all his fault. They’re fears that belong to the waking world as well as in his dreams.

When he goes back into the bedroom to get dressed, he finds the covers pushed back and the bed empty. He hears the sound of the coffee grinder coming from the kitchen and sighs a little as he pulls on a pair of dark jeans and a soft button-down shirt. He feels bad that he’s disturbing Ahreum’s sleep as well as his own, but she wouldn’t hear of it when he’d suggested he sleep on the couch until the nightmares became less frequent.

There’s steaming coffee waiting for him on the kitchen table when he walks in, buttoning the cuffs of his shirt. Ahreum is already sitting down, hands wrapped around her own mug, and Jongdae sits opposite her wearily.

“I’m on call today,” he says in response to her querying look. “That’s probably why I had it.” Although he performs C-sections much more frequently as a planned procedure rather than an emergency one, it’s the emergencies that scare him. Planned C-sections are so much more under control, and the mother is usually only under epidural, avoiding the greater risks of general anaesthesia. He picks up his mug and takes a careful sip of coffee. Ahreum watches him, her gentle eyes full of concern.

Thanks to Soomin’s prompting, he told Ahreum four weeks ago about the subject matter of his nightmares. Not in specifics, there’s no need to horrify her; she just knows that he dreams of losing pregnant patients in the OR, and that he’s probably getting them because of the recent table deaths. When Ahreum had just hugged him and thanked him for telling her, and appeared completely unaffected by it, he’d worked up his courage and told her a few days later about the severe stress response he’s been getting when he hears his pager go off.

Now Ahreum gets out her phone from the pocket of her dressing gown and lays it on the table. “Would it be a good idea to practice, if you’ll be hearing your pager a lot today?”

This is a benefit of telling Ahreum about his struggles that Jongdae had never thought of; she’s been able to think of specific things that might help him. The day after he’d told her about the pager issue, Ahreum had suggested they practice listening to the beeping noise in a safe situation where Jongdae can calm himself. She’d downloaded an audio clip of a pager to her phone, and they’d sat on the couch while she played it over and over and Jongdae had gone through the breathing and relaxation exercises Soomin had shown him, consciously relaxing the muscles that tensed up when the pager noise went. They’ve been doing it regularly, and it’s been amazingly helpful. Jongdae is almost at the point where the pager going only gives him a quick flash of panic, and he’s starting to dread it less, too.

“Sure,” he says now, and Ahreum plays the audio clip. The harsh, intrusive beeping fills the kitchen, and Jongdae closes his eyes and breathes slowly. The kitchen is warm and smells like coffee and cooked rice from the overnight rice cooker, and Ahreum’s hand is laid on top of his, soft as she the back of his wrist with her fingertips. Jongdae opens his eyes and finds she’s smiling at him.

“You’re doing really well,” she says, and Jongdae interlaces their fingers across the table, smiling back as his heart warms.

“You’re so good at this kind of thing,” he says when the audio clip finishes.

“I’m just happy you let me in enough to help you,” Ahreum says. “That counsellor knows what she’s talking about.”

“She does,” Jongdae agrees. “I might go talk to her again, actually, if I get a quiet moment today.”

“What about?”

“See if she’s got any ideas about dealing with the nightmares,” Jongdae says. “I can’t keep on waking you up like this, it’s not fair to you.”

“It’s not fair to you either,” Ahreum says. “You don’t get enough sleep anyway, what with Chief Heo loading you up so much these days, and I hate seeing you suffering like that.”

“It’s just a nightmare,” Jongdae says reassuringly, avoiding the issue of Chief Heo and her renewed vendetta towards him. He knows he just has to keep his head down and accept all the extra work until he’s proven that he won’t challenge her authority again. “It’s not real.”

“The feelings are real,” Ahreum says. “You’re terrified when you’re in that nightmare. I’m sure it’s not good for you to go through it so often.”

“I’ll talk to Soomin,” Jongdae promises. He has her card in his wallet, which lists the hours she’s in the clinic over on B block. He can’t count on being available when she makes her hospital rounds.

He’s in his office mid-way through the morning when the ED pages him. He swallows the flash of panic and takes a deep breath as he turns the noise off. Nothing to be afraid of, not until he’s seen the patient. The reassurance is coming more easily with practice, becoming more instinctive. He heads down to the ED, where he’s directed to a room in which a 23-year-old woman has presented at 28.5 weeks gestation with shortness of breath, dizziness, and edema in her feet and ankles. When he gets there, he finds Kim Minseok and Kim Joonmyun already in the room, and concern rises up in him. The presence of the chief of the emergency department and a cardiothoracic surgeon tells him that this case is likely to be serious. He glances at the EKG, which is showing a rapid pulse of 115 beats per minute. Joonmyun has his stethoscope on her chest, face intent as he listens to her heart. Jongdae walks over to the bed, introducing himself to the patient and her partner as Joonmyun straightens up.

“There is a blowing holosystolic murmur,” Joonmyun says, more to Minseok than Jongdae. “I’ll need an echocardiogram.” He steps back to call the technician, and Jongdae starts an obstetric abdominal exam, pressing his lips together at the news of the murmur. Managing heart disease in pregnancy comes with a whole extra set of risks and challenges, and his examination tells him her heart is not the only issue.

“Incarcerated gravid uterus,” he tells the other two doctors. It’s a rare condition where the uterus is trapped between the sacral promontory and pubic symphysis, and as the baby grows it’s going to put even more pressure on the already struggling heart, potentially compressing the vena cava and reducing cardiac output. Minseok looks between them both, then beckons them across the room to discuss the case. Jongdae is intensely grateful for the other two doctors being here. Not only does he know them both personally, which is always reassuring, they’re a couple of years older and more experienced than him, and he’s never forgotten how nice Joonmyun was about checking patients Jongdae should know better than to call consults for. This particular patient, however, definitely needs the cardiothoracic surgeon’s input.

“So, we have symptomatic severe mitral stenosis in a pregnant patient,” Minseok says. “Thoughts?”

“The MS needs treating urgently,” Joonmyun says. “She needs a valve replacement, but a CPB in pregnancy has significant fetal and maternal risks.” He looks at Jongdae. “What are the chances of a successful C-section at this stage?”

“28.5 weeks is early preterm, but it’s doable,” Jongdae says. He glances at the patient. She’s watching them over her oxygen mask, probably trying to get some clue as to what they’re talking about. Their eyes meet and he sends her a quick reassuring smile before looking back at the others. “The fetal survival rate is 80 to 90 percent. There’s certainly a much higher risk of mortality in the setting of cardiopulmonary bypass. Of course, there are the developmental concerns for the preterm baby to consider, but we’d be better talking to a neonatologist for that.”

“Might be a good idea,” Joonmyun agrees. “It’ll depend on the echo results, but I doubt we have time to wait until the baby is full term.”

“I’ll get the on-call neonatologist down here,” Minseok says, and steps aside from the door as the technician appears, pushing the portable echocardiogram on its wheeled trolley.

“Are you happy to do an emergency C-section if it comes to that?” Joonmyun asks Jongdae. They’re still standing close together while Minseok talks on his phone to the neonatologist, but Joonmyun’s eyes are on the technician as she talks to the patient, explains the procedure, and begins the echo.

“Happy might not be the right word for it,” Jongdae says wryly, “but if she needs an urgent valve replacement, we don’t have much choice. I wouldn’t want her carrying to term with an incarcerated gravid uterus anyway, that’s only going to make matters worse for her heart.” He tries to ignore the sinking feeling in his stomach. Emergency C-section on a patient at risk of cardiac arrest - it’s his nightmare all over again, but he forces the image of the blood-painted OR walls out of his mind. It’s not going to happen. The situation is going to be under control. He will not let his fears rule him.

The neonatologist turns up while Joonmyun is reading the echo results. Jongdae knows her quite well as their specialities overlap so often; tall and athletic with a thick rope of hair plaited down her back and wide dark eyes, Dr. Choi Minjung smiles and greets them as she enters the exam room. With four specialists and a technician now present, as well as the patient on the bed and her partner sitting beside her, the room is getting crowded, and they’re forced to huddle close as the technician starts to maneuver the bulky echo trolley out of the room again.

Joonmyun is looking tense now that he’s seen the echocardiogram results; the murmur is bad enough that he wants to replace the valve urgently. The fetus could already be suffering from the loss of blood flow, and Dr. Choi confirms that the risks to the baby's development on early C-section are worth it. They can’t risk the mother going into cardiogenic shock because they waited a couple of weeks for the fetus to be that bit stronger.

They discuss several options and eventually come to an agreement on the best way to proceed. With the mother under epidural, Jongdae will perform a C-section while Joonmyun and his cardiothoracic team stand by in the OR, ready to take over in case of a cardiac emergency. Assuming the C-section goes to plan, Joonmyun will do the valve replacement within 24 hours of the C-section birth to reduce the risk of bleeding due to the normal postpartum fluid shifts. They’ll also have anaesthesiology on standby and have venous and arterial access already established, so that if the mother becomes unstable during the C-section Joonmyun and his team will be able to go straight into emergency heart surgery, but they all hope it won’t come to that.

As the main condition is mitral stenosis, Joonmyun agrees to admit her to cardiology. He waits to explain the plan to the patient, and Jongdae heads up to the OR to get ready for the emergency C-section. The largest OR is prepared due to needing two medical teams present, plus Dr. Choi who will take the infant directly to the NICU. When they’re all inside and the patient is ready, Jongdae is suddenly reminded again of his dream. There are so many people in the room, strangely identical in their gowns and masks, and unless Joonmyun needs to take over in the event of cardiac instability, Jongdae is the lead surgeon. All their attention is on him. He takes a steadying breath and glances over at Joonmyun where he waits against the wall. The cardiothoracic surgeon smiles at him behind his mask and gives him a cheerful double thumbs-up. Jongdae smiles back despite the anxious tension in his stomach and turns back to the patient to start the procedure.

It’s not really like his dream, not even at this stage. The mother is awake, the epidural numbing her only from the belly down. The nurses by her head are talking to her, reassuring her as Jongdae works. He’s using a low vertical incision instead of a low transverse, as the fetus is still in breech and hasn’t turned head-down yet. There’s no unexpected river of blood as he enters the uterus.

“Baby’s coming out,” Jongdae announces loud enough for the mother to hear, a smile in his voice as he deftly unhooks the umbilical cord from around the fetus and eases it into the world.

“Already?” the mother sounds startled.

“Dr. Kim is one of our swiftest surgeons,” one of the nurses tells her. Jongdae glances up at the wall clock as his assistants cut the cord; time from incision to birth has been less than four minutes. He passes the tiny baby into Minjung’s waiting hands. “A beautiful baby girl,” Minjung takes time to tell the mother as she quickly wipes the baby down and prepares to whisk her away to the NICU, where she’ll live in an incubator until she’s big enough to brave the outside world. Jongdae doesn’t turn away from the incision in the mother’s abdomen. He takes the suturing tools the nurse passes him and begins the process of removing the placenta and closing the surgical wound.

After they’re done and the mother is taken to recovery, Jongdae scrubs out along with the rest of his team. The relief coursing through him is making him feel slightly shaky. He leans against the trough sink and takes several deep breaths to calm himself. He hadn’t realised just how much stress he’d been holding inside himself until the C-section was successfully over.

Joonmyun is waiting for him in the corridor, arms folded as he leans against the wall. He’d scrubbed out a little before Jongdae once they were sure the mother was stable during the birth. He smiles at Jongdae as he comes out of the scrubbing area and pushes away from the wall to fall into step with him.

“Fantastic job,” he says.

Jongdae shakes his hands out, trying to get the adrenaline out of them. “I’m just relieved she stayed stable throughout the procedure."

“The fact that she did is probably thanks to your swift work,” Joonmyun tells him. Jongdae laughs a little, shrugging the praise off. “No, I’m serious,” Joonmyun says. “The anaesthesiologist mentioned it too. You kept both mother and child under as little stress as was feasibly possible.”

Jongdae’s pretty sure Joonmyun is only saying that because he knows Jongdae’s been struggling a little lately, but he appreciates the thought, so he smiles at the older surgeon and changes the subject, asking if he has time to join him for a quick coffee break, to which Joonmyun cheerfully agrees that he does.

“How are Yejin and Yejoon doing?” Jongdae asks when they’ve grabbed takeaway coffee-mix from one of the hallway machines and headed up to the rooftop for a breath of fresh air. Spring has fully arrived, and the ornamental potted trees on the rooftop are in bloom, white and pink cherry blossoms dancing in the cool breeze overhead as they sit on one of the green-painted benches. Joonmyun lights up as he starts to talk of his baby son, and shows Jongdae at least twenty pictures on his phone. Yejoon is at the stage of lying on his front and holding his head up on his own.

“They grow so quickly.” Jongdae shakes his head as he watches a video clip of Yejoon flapping his arms and legs as he rocks on his stomach, burbling and squealing with the sheer joy of moving. “It seems like only yesterday I was delivering him.”

“They do,” Joonmyun agrees, and sighs. “Sometimes it feels terrifying. These precious times are flying by so fast, and if I blink I’ll miss them. Did you ever feel like that with yours?”

“Oh, yes,” Jongdae nods. “Children change so quickly, it’s almost inevitable that we feel like that. I remember Chorong being small enough to lie in the crook of my arm, and now she’s just turned seven and up to my elbow already.”

“Honestly, I worry I’m missing out, by the nature of my work,” Joonmyun admits. Jongdae glances at him, hearing the more serious note in his voice. “I still can’t believe I’m a dad sometimes. When I have to focus during emergencies or long surgeries, I don’t think of him for hours and hours, and then I’ll come home and it’s like he’s grown overnight. One day I’m going to come home and he’ll be sixteen and I won’t even recognize him.” He laughs. “Stupid, right?”

Jongdae shakes his head.